Print: Appendix E

Appendix E

Annotated Bibliography

Colter, A., & Summers, K. (2014). Eye Tracking with Unique Populations: Low Literacy Users. In J. Romano Bergstrom & A. J. Schall (Eds.), Eye Tracking in User Experience Design (pp. 331–346). Waltham, MA: Morgan Kaufmann Publishers/Elsevier.
This chapter explores eye tracking and its application to users with limited literacy skills in the field of user experience. It describes the typical online behaviors of users with limited literacy skills using the eye tracking method.

Dailey, S. (2005). Empowering older adults with health information. Journal on Active Aging, 4(2), 61–62. Retrieved from [PDF – 403 KB]
This background piece heralds the award-winning work of the National Institute on Aging and the National Library of Medicine on NIH SeniorHealth. The article describes the purpose of the website and provides an overview of some of the lessons learned.

Echt, K. V. (2002). Designing Web-based health information for older adults: Visual considerations and design directives. In R. W. Morrell (Ed.), Older adults, health information, and the World Wide Web (pp. 61–88). Mahwah, NJ: Lawrence Erlbaum Associates.
Echt summarizes the research behind web-based interface design and explains the special considerations necessary to design web-based health information for older adults. This chapter includes clear guidelines for layout, organization, navigation, and graphics.

Freimuth, V. S., & Mettger, W. (1990). Is there a hard-to-reach audience? Public Health Reports, 105(3), 232–238.
This article deconstructs assumptions about “hard-to-reach” audiences. It offers alternative perspectives to highlight the strengths of different audience segments, encouraging innovative approaches to communication.

Kaphingst, K. A., Zanfini, C. J., & Emmons, K. M. (2006). Accessibility of Web sites containing colorectal cancer information to adults with limited literacy (United States). Cancer Causes and Control, 17(2), 147–151.
Kaphingst and colleagues found that many colorectal cancer websites were too difficult for the average American adult—and much too difficult for adults with limited literacy—to use. Common problems with the sites included insufficient use of illustrations for key messages, crowded layout and long line lengths, and lack of cues to highlight key content.

Kodagoda, N., & Wong, W. (n.d.). Why design for people with reading difficulty and low literacy. Retrieved from [PDF File – 121 KB]
This document summarizes previous research conducted by the authors on users with low literacy and the web. The authors explain the benefits of semantic web technology and offer design guidelines for users with low literacy.

Lefebvre, R. C., Tada, Y., Hilfiker, S., & Baur, C. (2010). The assessment of user engagement with eHealth content: The eHealth Engagement Scale. Journal of Computer-Mediated Communication, 15(4), 666-681. Retrieved from
This article describes the psychometric testing and evaluation of the eHealth Engagement Scale, which was adapted from commercial advertising research. The eHealth Engagement Scale may prove to be an important mediator of user retention of information, intentions to change, and ultimately efforts to undertake and achieve behavior change.

Morrell, R. W., Dailey, S. R., & Rousseau, G. K. (2003). Commentary: Applying research: The NIH Senior Health Project. In N. Charness & K. W. Schaie (Eds.), Impact of technology on successful aging (pp. 134–161). New York, NY: Springer Publishing.
This chapter offers a detailed outline of the special considerations, design principles, and methodology implemented in the NIH Senior Health Project. The authors explain the unique needs of aging populations—including their usability testing procedures and results—and clearly lay out detailed guidelines for web content development for aging populations.

Neuhauser, L. (2001). Participatory design for better interactive health communication: A statewide model in the U.S.A. Electronic Journal of Communication/La Revue Electronique de Communication, 11(3,4). Retrieved from
This article provides an example of how participatory design was used by hundreds of parents and people with disabilities to create a health website for 38 million residents of the State of California.

Nielsen, J. (2005). Low literacy users. Jakob Nielsen’s Alertbox. Retrieved from
This website provides an overview of the user population with lower literacy as well as practical tips for improving the usability of websites.

Redish, J. (2012). Letting Go of the Words: Writing Web Content that Works (2nd ed.). Waltham, MA: Morgan Kaufmann Publishers/Elsevier.
Janice (Ginny) Redish provides a comprehensive and accessible overview of writing web content, with screenshots and examples included throughout.

Summers, K., & Summers, M. (2004). Making the Web friendlier for lower-literacy users. Intercom, 51(6), 19–21.
The authors describe some of the online behaviors of limited literacy users. These behaviors, such as avoiding search functions or reading every word, often contradict developers’ most basic assumptions. This resource helps address these issues while developing online prevention content.

Summers, K., & Summers, M. (2005). Reading and navigational strategies of Web users with lower literacy skills. Proc. Am. Soc. Info. Sci. Tech., 42(1). Retrieved from
This research article summarizes results from a study that sought to understand the differences between the reading and navigational strategies of users with low literacy skills and those with medium to high literacy skills. The authors offer strategies and design principles to make web-based health content usable and accessible for lower literacy adults.

Zarcadoolas, C., Blanco, M., Boyer, J. F., & Pleasant, A. (2002). Unweaving the Web: An exploratory study of low-literate adults’ navigation skills on the World Wide Web. Journal of Health Communication, 7(4), 309–324.
Based on an ethnographic study of a group of low-literate adults, the authors identify specific navigational and content issues that present barriers for this population. They discuss preliminary assumptions that can be used to inform the development of web tools for low-literate adults and directions for future applied research.

Zarcadoolas, C., Pleasant, A. F., & Greer, D. S. (2006). Health literacy and the Internet. In Advancing health literacy (pp. 117–140). San Francisco: Jossey-Bass.
In this book chapter, the authors explain the strengths and weaknesses of using the internet to communicate health information. In addition to reviewing key research findings, they outline specific challenges, opportunities, and ethical issues. This chapter contains applied exercises and an abbreviated glossary of commonly used internet jargon.