Page 91 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

HeALtH LiteRACY, eHeALtH, AnD CoMMUniCAtion

and then revise the prototype based on the results of that review. After
that, the revised design should be tested with a target audience that is
culturally diverse and that includes limited-literacy members. During the
test the audience should be observed using the technology, they should
be asked about their experiences, and their comprehension should be
assessed. Based on this test, the technology should be revised again and,
if the technology will be in multiple languages, it should be tested in all
those languages as well.
Some considerations are specific to HIT. For example, design needs to
be usable with both old and new hardware and software. Some users may
have black and white monitors, some may have slow Internet connections
that would take a very long time to load fancy images, and some may not
have the plug-ins needed to access complicated graphics. The home page
of the website must be simple, and information should be prioritized with
a minimal amount of text per screen. Furthermore, it is important that
navigation is simple and consistent, with minimal need for scrolling. Lim-
ited-literacy individuals often have great difficulty with the concept that
they have to scroll down to obtain more information. AHRQ frequently
uses the three-click rule, that is, one must get users to the information in
three clicks or face the possibility of losing them.
Searching must be simplified, as it is one of the more difficult opera-
tions for individuals with limited literacy. They frequently misspell words,
and they may find it difficult to understand the search engines. The site
should have clearly defined hyperlinks and a printer-friendly option.
Audio transcription is an option to consider, especially for people who
have difficulty reading or seeing, as well as for those who have a hard
time finding information, particularly such things as instructions for using
home health equipment. It is also a good idea to give users information
about how to call for assistance.
Certain lessons have been learned about the use of computer kiosks.
For example, it is important to have a practice session to familiarize users
with the eLearning method. There should be one idea or question per
screen and information should be limited to what is needed to manage
the health problem. There should also be an option that allows the user
to repeat a message and there should be some kind of teach-back built in
so that learning can be reinforced. Again, audio transcription should be
considered.
The guide also discusses personal wireless devices. When developing
programs for these devices for use by adults with limited literacy, reliance
on text should be minimized, and text messaging should be simplified.
There are a number of ways to make home monitoring devices such
as glucometers and blood pressure cuffs easier to use including limiting
the number of steps needed to use the device, using large keys with clear

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