Week 8 Learning Goals and Objectives ......................................................................................................... 1
Week 8 Introduction ..................................................................................................................................... 2
Week 8 Readings ........................................................................................................................................... 5
Week 8 Independent Learning Activities ...................................................................................................... 6
Week 8 Forum Discussion ............................................................................................................................. 7
 Describe the principles of user-centered design.
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What specific design principles are relevant to the development of consumer health information applications? Why?
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Formulate a process for the development of consumer health information applications through the Applied Informatics Project
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Discuss the roles and functions of various members of a design, development and usability team.
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Define ‘usability’. How is usability assessed?
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Explain the importance of usability in consumer health information applications.
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Define and describe ‘health literacy’ and ‘health information literacy’ and ‘numeracy’.
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Discuss informatics strategies to address health literacy and health information literacy, literacy (general reading) or numeracy issues.
 What economic factors in healthcare, society and/or in people’s lives impact on telemedicine and CHI?
The following mini-lecture is a summary of some basic principles of user-centered design to introduce you to the topics we will explore in this module. Although this week is about DESIGN, understanding design will help you be more effective at EVALUATING resources as well! The information that we are studying this week should be kept in-mind as you complete the consumer health applications critical analysis assignment:
ABOUT USER-CENTERED DESIGN
User-centered design is a philosophy and a process that focuses on interpersonal factors that influence message processing. These factors may be cognitive, such as learning style and problem-solving ability; affective, such as anxiety level; or cultural.
Principles of user-centered design were derived from the discipline of engineering, particularly in software design, but these principles also apply to the design of healthcare products for consumers.
Two conditions for user-centered design are usefulness (Does the product meet the needs of users?) and usability.
Usability is the quality of a user’s experience when interacting with a product or system, such as a patient education pamphlet, computer-based education program, website, mobile app, video, etc. Usability includes such aspects as ease of use, efficiency, effectiveness and satisfaction.
Kristof and Satran 1 proposed a three-stage development process for designing interactive products to enhance usability: information design, interaction design, and presentation design.
The goals of the information design phase of creating a tool are to: define the product and intended audience; specify the goals and objectives of the product; and develop the content inventory.
Key questions to be answered in this phase are:
 What do you want to communicate?
 What should the product (program, website or education material) accomplish for the user?
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 Who is the audience? What physical, social, psychological characteristics must be considered?
 How will the product be used?
Keep these issues (above) in-mind as you do the critical analysis assignment!
A critical outcome of this phase is the construction of an information flowchart that includes content, media elements, and organization. Steps in constructing the information flowchart include:
1. Generate list of essential content categories
2. Group categories by topic
3. Arrange into structure with links to show relationships among topics (e.g., hierarchy, priority)
4. Identify media elements that facilitate communication of topic (e.g., diagram, video, animation)
The second phase of the design process is the interaction design. The overall goal of this phase of product design is to determine how the product should work. These aspects are rarely considered when designing traditional patient educational materials such as printed pamphlets.
However, determining how the user will access and control the flow of information is important for any health type of communication, particularly when the tool is online or via mobile app.
Designing an intuitive guidance system is crucial. Navigation pathways must be developed for every element of the information flowchart. Key questions of this phase are:
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How will the user obtain information? (such as a menu, icon, or hyperlink)
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How will user move from one topic to another?
Keep these questions (above) in-mind as you do the critical analysis assignment! They’ll help you better evaluate the tools you select.
It is important that users are able to predict what will happen within a consumer health program/tool/app. An orientation screen to explain navigational elements is valuable, as are
“back” buttons and help screens to assist users during program execution.
In the production process, the outcome of the interaction design phase is a detailed storyboard that specifies every screen element (picture, sound and action) for the program.
The presentation design is the final phase of product development. In this phase the interface style and layout are planned. One technical consideration for computer-based patient education programs is the capability of the user’s hardware (processor, screen resolution, memory, platform/operating system). The program must be developed to execute on computers with low-grade functionality.
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When designing mobile apps, important considerations would include what types of smart phones are required, associated app costs, battery usage, etc. One study found that the average person gets a new phone every six months, so this would be an important consideration in designing an interactive tool that shares information between a smart phone and a doctor, for example.
The constraints of the user’s system have implications for the use of media elements that require processing speed and memory, such as audio and video.
The user interface should also create a general theme or “feel.” The goal is to achieve a sense of unity and personality, through the systematic use of visual elements, such as color-coding or the use of icons. Identifying a metaphor (e.g., the file folder icon in Windows-based applications) can achieve unity while avoiding monotony.
Capitalize on intuitive factors when designing the layout of information. For example, present information from left to right or top to bottom; place control elements in convention positions
(such as a drop-down menu bar across the top of the screen).
Below are design principles to keep in mind as you are evaluating tools for the critical analysis assignment:
Visibility Users must form a mental model of the information environment, visibility of elements (hyperlinks, “buttons, etc.) help users form correct model; avoid hidden elements (“pop-ups”, roll-overs); do not use graphics as links
Memory load
Feedback
Legibility
Try to reduce or minimize the amount of information the user must keep in short-term memory for navigation; make user actions/requirements consistent (always move from screen to screen the same way)
When the user does something (clicks, provides input), something should happen.
Choose fonts for maximum readability san serif; Arial)
12 point font; do not mix several fonts; increase contrast but avoid intense color combinations
AVOID ALL UPPERCASE -- IT’S THE EQUIVALENT OF YELLING!
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Language Use verbs as much as possible; use lists and short phrases to reduce reading fatigue; reading level is always an issue (literacy); provide alternative formats (audio, video) when possible
References
1 Kristof R, Satran, A. Interactivity by Design. San Jose, CA: Adobe Press, 1995
The graph above is excerpted from: McDaniel, AM. (2004). Usability basics for clinical nurse specialists. Clinical Nurse Specialist, 18, 60-1
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Nielsen-Bohlman, Chapters 1 and 2
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Nelson & Ball, Chapters 3 and 6
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Lewis, Chapters 4, 5, and 6
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Usability and accessibility in consumer health informatics current trends and future challenges.
Goldberg L. Lide B. Lowry S. Massett HA. O'Connell T. Preece J. Quesenbery W. Shneiderman B.
American Journal of Preventive Medicine. 40(5 Suppl 2):S187-97, 2011 May.
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Commercial off-the-shelf consumer health informatics interventions: recommendations for their design, evaluation and redesign. Marquard JL. Zayas-Caban T. Journal of the American Medical
Informatics Association. 19(1):137-42, 2012 Jan-Feb.
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The future of the cancer prevention workforce: why health literacy, advocacy, and stakeholder collaborations matter. Sulik GA. Cameron C. Chamberlain RM. Journal of Cancer Education. 27 Suppl
2:S165-72, 2012 May.
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Jessica S. Ancker and David Kaufman, Rethinking Health Numeracy: A Multidisciplinary Literature
Review. Journal of the American Medical Informatics Association 2007;14(6): 713-21.
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Wilson M. Readability and patient education materials used for low-income populations. Clinical
Nurse Specialist. 23(1):33-40; quiz 41-2, 2009 Jan-Feb.
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A. Pick any consumer health resource of your choice (start with MEDLINEplus to help you find something specific: http://medlineplus.gov
Then use the Fry or Flesch readability tests (or any other standardized readability test) to determine the reading level of the source you selected: http://www.readabilityformulas.com/fry-graph-readability-formula.php
(Fry) http://www.readabilityformulas.com/flesch-reading-ease-readability-formula.php
(Flesch)
To calculate a grade level score:
1. Randomly select three separate 100 word passages. (Count every word including proper nouns, initializations, and numerals.)
2. Count the number of sentences in each 100 word sample (estimate to nearest tenth).
3. Count the number of syllables in each 100 word sample. (Each numeral is a syllable. For example, 2007 is 4 syllables and one word.)
4. Plot the average sentence length and the average number of syllables on the graph.
5. The area in which it falls is the approximate grade level.
At what reading level is the site you selected? How will this impact on its use by its primary
audience? Will the average consumer be able to read this information
What important factors might reading level NOT take into account?
B. Now find a volunteer -- anyone you know -- and administer the REALM (Rapid Estimate of
Adult Literacy in Medicine) test: http://chua2.fiu.edu/faculty/haskins/PHT5524/Course%20Materials/Patient%20Education/REA
LM.pdf
(full REALM with instructions) http://www.ahrq.gov/populations/realm.pdf
(REALM short version)
What were the results? What did you learn?
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This week’s framing questions are listed here. Also refer back to the mini-lecture.
Share the results of the REALM test that you and a volunteer did together.
Define and describe ‘health literacy’ and ‘health information literacy,’ or ‘numeracy’. Why do these matter to consumer health applications?
Why is readability important?
What factors does readability NOT take into consideration?
What factors other than readability may be relevant for designing excellent consumer health applications?
Discuss informatics strategies (like adjusting readability and cognitive levels required) to address health literacy and health information literacy.
What principles of user-centered design are relevant to the development of consumer health information applications? Discuss and describe.
What themes/trends do you see among CHI applications discussed in the literature (e.g.,
“collaborative healthware” as discussed in Nelson & Ball)?
Are the issues described in the literature (thoroughly developed applications that are systematically evaluated) the same as those developed by commercial or consumer health entities (health advocacy groups like the Alzheimer’s Association)?
Consider Table 2-1 in the Nielsen-Bohlman text: Based on what you see here, consider how likely is it that health consumers have most of the skills needed? Now what?
Why are oral communication skills of great importance to public health and health care outcomes?
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