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      Age-Sensitive Design of Online Health Information: Comparative Usability Study

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          Abstract

          Background

          Older adults’ health maintenance may be enhanced by having access to online health information. However, usability issues may prevent older adults from easily accessing such information. Prior research has shown that aging is associated with a unique pattern of cognitive changes, and knowledge of these changes may be used in the design of health websites for older adults.

          Objective

          The goal of the current study was to examine whether older adults use of a health information website was affected by an alternative information architecture and access interface (hierarchical versus tag-based).

          Methods

          Fifty younger adults (aged 18-23) and 50 older adults (aged 60-80) navigated a health information website, which was organized hierarchically or used tags/keywords, to find answers to health-related questions while their performance was tracked. We hypothesized that older adults would perform better in the tag-based health information website because it placed greater demands on abilities that remain intact with aging (verbal ability and vocabulary).

          Results

          The pattern of age-related differences in computer use was consistent with prior research with older adults. We found that older adults had been using computers for less time ( F 1,98= 10.6, P= .002) and used them less often ( F 1,98= 11.3, P= .001) than younger adults. Also consistent with the cognitive aging literature, younger adults had greater spatial visualization and orientation abilities ( F 1,98= 34.6, P< .001 and F 1,98= 6.8, P= .01) and a larger memory span ( F 1,98= 5.7, P= .02) than older adults, but older adults had greater vocabulary ( F 1,98= 11.4, P= .001). Older adults also took significantly more medications than younger adults ( F 1,98= 57.7, P< .001). In the information search task, older adults performed worse than younger adults ( F 1,96= 18.0, P< .001). However, there was a significant age × condition interaction indicating that while younger adults outperformed older adults in the hierarchical condition ( F 1,96= 25.2, P< .001), there were no significant age-related differences in the tag-based condition, indicating that older adults performed as well as younger adults in this condition.

          Conclusions

          Access to online health information is increasing in popularity and can lead to a more informed health consumer. However, usability barriers may differentially affect older adults. The results of the current study suggest that the design of health information websites that take into account age-related changes in cognition can enhance older adults’ access to such information.

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          Most cited references28

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          Development of a brief test to measure functional health literacy.

          We describe the development of an abbreviated version of the Test of Functional Health Literacy in Adults (TOFHLA) to measure patients' ability to read and understand health-related materials. The TOFHLA was reduced from 17 Numeracy items and 3 prose passages to 4 Numeracy items and 2 prose passages (S-TOFHLA). The maximum time for administration was reduced from 22 minutes to 12. In a group of 211 patients given the S-TOFHLA, Cronbach's alpha was 0.68 for the 4 Numeracy items and 0.97 for the 36 items in the 2 prose passages. The correlation (Spearman) between the S-TOFHLA and the Rapid Estimate of Adult Literacy in Medicine (REALM) was 0.80, although there were important disagreements between the two tests. The S-TOFHLA is a practical measure of functional health literacy with good reliability and validity that can be used by health educators to identify individuals who require special assistance to achieve learning goals.
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            Users of Internet Health Information: Differences by Health Status

            Background Millions of consumers have accessed health information online. However, little is known about their health status. Objective To explore use of Internet health information among those who were sicker (fair/poor general health status) compared with those reported being healthier. Methods A national, random-digit telephone survey by the Pew Internet & American Life Project identified 521 Internet users who go online for health care information. Our primary independent variable was general health status rated as excellent, good, fair, or poor. Patterns of Internet use, and types of information searched were assessed. Results Among the 521 users, 64% were female, most (87%) were white, and median age was 42 years. Most individuals indicated that they learned something new online (81%) and indicated that they believe most information on the Internet (52%). Compared with those with excellent/good health, those with fair/poor health (N = 59) were relative newcomers to the Internet but tended to use the Internet more frequently, were more likely to use online chats, were less likely to search for someone other than themselves, and were more likely to talk about the new information with their physician (odds ratio 3.3 [95% confidence interval 1.8-6.3]), after adjustment for age, education and income. Conclusions Health care professionals should be aware that their sicker patients are more likely to ask them about information they found online. Physicians, public health professionals, and eHealth developers should work together to educate patients about searching for health information online and to provide tools for them to navigate to the highest quality information.
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              Possible implications of aging for interface designers

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (Centre for Global eHealth Innovation, Toronto, Canada )
                1438-8871
                Oct-Dec 2009
                16 November 2009
                : 11
                : 4
                : e45
                Affiliations
                [2] 2simpleDepartment of Management simpleClemson University ClemsonSCUSA
                [1] 1simpleDepartment of Psychology simpleClemson University ClemsonSCUSA
                Article
                v11i4e45
                10.2196/jmir.1220
                2802567
                19917549
                2bee8888-8bd4-4ac4-b645-8ef685d87edd
                © Richard Pak, Margaux M Price, Jason Thatcher. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.11.2009.  

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 18 February 2009
                : 19 March 2009
                : 12 August 2009
                : 03 September 2009
                Categories
                Original Paper

                Medicine
                internet,information organization,aging,health-related websites
                Medicine
                internet, information organization, aging, health-related websites

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