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About Health Literacy Online: 2nd Edition

Health Literacy Online is about broadening access to user-friendly health information and services on the web. This research-based guide discusses why and how to design health websites and other digital health information tools for all users, including the millions of Americans who don’t have strong reading or health literacy skills—as well as those who don’t have a lot of time to find, process, and use complex health information.

It’s written for anyone involved in creating online health content, from start to finish—writers and editors, content managers, digital strategists, user experience strategists, web designers, developers, and others. The strategies and tips can also be applied widely across disciplines.

Why This Guide

Many web users struggle with even the most basic tasks—for example, using a search function, navigating from a drop-down menu, and scanning a webpage for relevant information. This may not matter too much in the context of an online news article or confusing eCommerce site. But the stakes are raised considerably when a person is trying to sign up for health insurance, learn about a new medical diagnosis, or look up how to correctly install a child safety seat. And today, these activities are more likely to occur online than off.

How easily users can accomplish health-related tasks online depends largely on the quality of the websites we create. This guide represents more than a collection of recommendations; it reflects an approach to responsible digital design and development that:

  • Prioritizes the information needs and preferences of consumers
  • Involves end users as co-creators of web products
  • Responds to small and large screens—and all sizes in between
  • Recognizes that designing for limited-literacy users is designing for all users

A Note on the Research

The first edition of Health Literacy Online (2010) synthesized lessons learned from ODPHP’s original research with more than 700 web users and the small but growing body of literature on the web experiences of users with limited literacy skills.

In this second edition, we’ve updated the recommendations to reflect findings from a more robust body of literature related to the cognitive processing and online behavior of adults with limited literacy skills (see section 1), as well as additional original ODPHP research conducted during the past 5 years. As with the first edition, we build on the principles of web usability described in the Research-Based Web Design and Usability Guidelines developed by HHS in partnership with the General Services Administration.

In addition, we’ve included new considerations for mobile devices. A growing subset of Americans only access the web via a phone or mobile device, and many of these users are likely to have limited literacy skills. Like the rest of the recommendations in the guide, the guidelines for mobile are based on best practices in the literature and original testing conducted by ODPHP. Fortunately, many of the strategies employed to improve the online experience for users with limited literacy skills—such as putting the most important information first and simplifying navigation—are the same best practices for mobile devices.

In section 6, we offer specific tips for involving web users with limited literacy skills in the design and testing of health websites. Throughout the guide, we incorporate quotes from web users with limited literacy skills who participated in our usability studies. These quotes speak to the valuable role web users play in writing and designing effective websites.

Health Literacy Online: Key points

  • As many as half of U.S. adults have limited literacy skills. Even more Americans—up to 9 in 10—have limited health literacy skills.
  • Literacy skills affect how people find, understand, and use information on the web. Users may get distracted easily, give up quickly, and struggle with dense text and complex navigation. This is true across devices.
  • The simple strategies described in this guide—like increasing font size and using bulleted lists—can break down literacy-related barriers and increase a user’s odds of success.
  • Designing with limited-literacy users in mind results in health websites that are easier to use for everyone.