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U.S. Department of Health and Health Services
Office of Disease Prevention and Health Promotion
Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites
What We Know About Web Users With Limited Literacy Skills

Many adults with limited literacy skills have had little training and experience searching the Web. They struggle not only with reading the content on the page, but also with retaining and managing new information as they move through a Web site.4,5,12

Several key characteristics and common behaviors of users with limited literacy skills affect how they perform on a Web site. Many of the following characteristics are common to all Web users; however, the degree to which they occur is greater for users with limited literacy skills.

Willing and Able

Most importantly, we know that users with limited literacy skills are generally:

  • Willing to use the Web to access health information
  • Successful in accomplishing their tasks when Web sites are designed well4–6

More often than not, poorly designed Web sites—more than limited literacy skills—contribute to users' challenges online.

Simple navigation and clear content can help adults with limited literacy skills find, understand, and use health information on a Web site.

Skipping Instead of Scanning

Most Web users skim and scan a Web page before they read.7,13 They may read the first few words or sentences on a page and then scan the rest of the headings and bulleted lists on the page until they find what they're looking for.

Users with limited literacy skills have a hard time scanning headings and subheadings to grasp and manage the information on a Web page. Instead, these users have a tendency to do one of the following:

  • Read every word on the page.
  • Skip over entire chunks of dense text.
  • Start clicking on links instead of reading the content.4,5,14–17

Instead of jumping from one heading to the next, users with limited literacy skills may skip and land in the middle of a page, or even the middle of a paragraph.4

Web sites with short, stand-alone sections of text written in plain language can make it easier for adults with limited literacy skills to find information and absorb and retain what they read.4,12,14,15,18 In fact, one study found that users with limited literacy skills skip over a paragraph when it contains more than three lines of text.15

  • Use short chunks of text and bulleted lists.

Difficulty Searching

Users with limited literacy skills avoid searching. Instead, users prefer to browse topics using an alphabetical list (even if the list is long).4,16,19 When they do use the search function, they may have difficulty spelling the search term.4,5,16,19

  • When designing your site, include both a search function and another way to browse the content, such as an "A to Z" list. Be sure to compensate for misspellings in the search box and to limit the number of results on a page.

Focusing on the Center of the Screen

Research with users with limited literacy skills indicates that they tend to have a narrow field of view.4,5,12,15,18,20 As these users read through a page, they are less likely to notice content above, below, or to the sides of their focus of attention. Links and content in the right margin are often mistaken for advertisements or ignored.12,20

Moreover, many users with limited literacy skills don't scroll.4,5,18,20 This means they are only seeing the content in the center of their screen.

  • It's important to keep key text above the fold when possible. "Above the fold" means that the text fits on the screen and can be read without scrolling.
  • Use only left and center navigation elements.

Easily Overwhelmed

Dense text, small font size, content in the margins, complex sentences, and too many links can overwhelm users with limited literacy skills. As a result, users may skip over key content or give up their search prematurely, often settling for incomplete or vague information.4,7,12

Even content written in plain language can be overwhelming if too much text is together in one paragraph or there is not enough white space on the page.

  • Display content clearly on the page and avoid clutter.

Limited Working Memory

Users with limited literacy skills, including many older adults, reach "information overload" more quickly than users with stronger literacy skills. Those with limited literacy skills are less likely to remember content from previous pages, and they rarely look ahead or back on a page.4,15,16,18 As a result, you can't rely on context to orient users or to add meaning to the text on the screen.

In one study, users with limited literacy skills were prompted to enter their age and sex into a Web-based tool. When they viewed the results, many users had difficulty making the connection between the results page and the data they entered on the previous screen.15

  • To compensate for users' limited working memory, use clear, stand-alone headings and sections that function independently. Include plenty of visual cues to orient users on the site.

Simple Navigation

Users with limited literacy skills are often less experienced using the Web. They may be unfamiliar with—and often may ignore—common navigational elements such as drop-down menus, clicking buttons and links, or breadcrumbs.5,12,15,18,20,21

Breadcrumbs are found near the top of the page and look like this:

Home > Quick Guide to Healthy Living > Nutrition and Fitness

In one study, even after being shown how to return to a home page, users with limited literacy skills had difficulty repeating the task from a different page on the site.18–20

Studies with users with limited literacy skills found that they had success with simple tabbed navigation with linear (numbered) pages.16,17

  • Use obvious step-by-step navigation, such as numbered pages and "previous" and "next" buttons, whenever possible.

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