Print: Appendix B

Appendix B

How This Guide Was Developed

The 1st 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. The guide was built 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 (GSA).

Although many of the original recommendations in the guide hold true today, much of the technology and related best practices have evolved. That’s why we decided to release a 2nd edition of Health Literacy Online.

The Latest Edition of Health Literacy Online

To update the guide, we reviewed the growing body of literature related to literacy, health literacy, user-centered design, and usability. Using information in articles and resources published after 2008, we’ve updated the recommendations to reflect emerging technologies, a deeper understanding of the cognitive processing of adults with limited literacy skills, and more (see section 1).

Specifically, we’ve included new information about:

  • Mobile usability, navigation, search, and responsive design
  • Limited-literacy users’ behaviors online
  • How to conduct research with users with limited literacy skills

We’ve also incorporated new findings from ODPHP usability testing with more than 70 users with limited literacy skills. Research that informed the 2nd edition of Health Literacy Online includes:

  • A tree-testing study of to evaluate information architecture
  • A baseline mobile usability test of’s responsive template
  • Additional usability tests to evaluate and iterate small design changes and new tools on

Finally, we’ve engaged a team of experts (see appendix A) to contribute additional insights on best practices in the field. Reviewers were selected based on their expertise in literacy and health literacy, health communication, plain language, usability, and conducting user research with users with limited literacy skills. Each reviewer provided feedback on content, organization, and examples throughout the guide.

Read more about ODPHP’s original user research in appendix C.