Better site design can help low-literate adults make decisions about their health care.
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| Christina Zarcadoolas |
The Internet has proven to be a revolutionary channel for communication and education about health issues. It’s a quick and efficient way to help people understand how their bodies work and how they can take better care of themselves.
Unfortunately, much of the current Web content requires a relatively high level of reading comprehension skills. In a nation where an estimated 90 million American adults read no higher than a fifth-grade level and most Web information is written at the 10th-grade level or higher, there remains a very real “digital divide.”
Study of Low-Literate Web Users
There is a small but rapidly growing body of work examining the accessibility of Web-based information to low-literate populations. We designed and conducted an ethnographically based survey of 24 low-literate adults (English- and Spanish-speaking) as they moved through a predetermined set of Web sites (“Unweaving the Web: An Exploratory Study of Low-literate Adults’ Navigation Skills on the World Wide Web,” Journal of Health Communication, vol. 7, 309-324, 2002).
The primary focus of the study was navigation skills. We reviewed the content and design of numerous sites and selected those that either presented information directly relating to health (such as medical information) or employed navigation tools that were potential barriers to successful communication. For Spanish-speaking participants, Spanish mirror sites were used when available.
We found that there were indeed significant barriers for our new Web users:
- Web pages packed with graphics or text, while possibly an attempt to help low-literate readers, actually presented obstacles. In general, we found that basic links, such as highlighted words in a block of text, were easier, while graphic links, such as a logo or a photo, were more difficult.
- Active graphics--moving logos or pictures--and pull-down menus challenged our participants’ initial skill levels.
- Many of our Web surfers struggled with typing a URL address into a window.
These are all skills that are critical for anyone to effectively access and understand the health information available on the Web.
We discovered, however, that all of our participants quickly learned Web skills such as clicking on links, typing search words into windows, using pull-down menus and scrolling. Interestingly, when we documented any assistance given to participants, it was most consistently offered for scrolling and spelling.
Making the Web More Accessible
We believe that these barriers can be overcome by changes in design and language. For example, fewer graphics, more labels for graphics when they are used, and fewer pop-up windows will enhance the usability of Web sites for this underserved population. These types of improvements to Web access and navigation can substantially empower these individuals to obtain the information they need to manage their daily affairs and improve their health and well-being.
The Internet offers an extraordinary opportunity for us to have a positive impact on the health knowledge and health of millions of people who have previously been marginalized by their lack of reading skills. If we take seriously the special needs of our low-literate citizens when communicating information over the Web, we can help fulfill the promise of this new channel by extending its benefits to all.
Christina Zarcadoolas, Ph.D., is associate clinical professor at the Mt. Sinai School of Medicine in New York. Her new book is Advancing Health Literacy: A Framework for Understanding and Action, written with A. Pleasant & David S. Greer and published by Jossey-Bass.
The Institute for Healthcare Advancement’s 2007 Health Literacy Conference will be held May 3 - 4 at the Hyatt Regency in Anaheim, Calif. For more information, go to www.iha4health.org.
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This article 1st appeared on June 27, 2006 in HHN Magazine online site.
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