36685 Mhealth Usability Strategies for Limited Literacy Users from Healthfinder.Gov

Mary Ann Petti, MPH, CHES1, Kat Good-Schiff, MFA1, Huijuan Wu, PhD1, Sandra Hilfiker, MA1 and Ellen Langhans, MA2, 1CommunicateHealth, Inc., Northampton, MA, 2Office of Disease Prevention and Health Promotion, Dept of Health and Human Services, Rockville, MD

Theoretical Background and research questions/hypothesis:  43% of Americans only read at a basic or below basic level, but how many of us develop, design, and test mobile technologies with this in mind? Mobile content is twice as difficult for all users to digest. When reading on a small screen, comprehension scores for complex web content (like health information) were as low as 48% that of the same website on a desktop computer.1 Many of us eat and sleep with our smart phones. But for people with limited literacy skills, technology can be stressful and overwhelming. Over 90% of adults own a mobile phone and nearly 65% own a smartphone. 15% of Americans rely solely on their smartphones for Internet access — and they are much more likely to have limited literacy skills.2 How can we make sure mobile technologies are understandable and accessible to all users, especially those who need it the most?

Methods and Results (informing the conceptual analysis):  Healthfinder.gov provides consumers with evidence-based, original content on prevention and wellness topics. The site’s design and content has been tested extensively — both from the beginning and throughout its existence — with limited literacy users. With mobile adoption and smartphone dependent rates rising increasing, the team sought to evaluate healthfinder.gov’s mobile experience (healthfinder.gov is a responsive website).   To begin our study, we conducted a literature review on mobile and responsive design usability guidelines. We then conducted baseline mobile usability tests with 8 limited literacy users3 to assess the navigation, usability, and overall user experience of healthfinder.gov on a mobile device. We hypothesized that, since limited literacy users are more likely to be smartphone dependent for Internet access, they would be slightly more successful accessing healthfinder.gov from their smart phones than they are in a usability lab on a desktop computer. Results from usability testing:

  • Participants were more successful navigating through the linear health topic categories than they were on desktop.
  • Most participants did not use the mobile menu to find information.
  • Participants struggled to find and use health topic pagination — often skipping it entirely.


Overall, limited literacy users were more successful navigating healthfinder.gov on mobile devices than they were on a desktop computer. We attribute the success to the familiarity users have with their own device, as well as the minimization of visual distraction on a small screen. 

Implications for research and/or practice:  We know that limited literacy users are willing and able to use the web and accomplish tasks on mobile devices when websites are designed well, and with mobile design in mind. Results from the literature review and the healthfinder.gov mobile usability study will be used to update the forthcoming revised edition of Health Literacy Online, a publication of the Office of Disease Prevention and Health Promotion (ODPHP) that has provided seminal guidance to health communicators and web developers since its publication in 2010. These new guidelines will provide research-based strategies to public and private health communication teams working to create excellent mHealth experiences.

1. http://www.nngroup.com/articles/mobile-content-is-twice-as-difficult/
2. http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/
3. http://www.nngroup.com/articles/why-you-only-need-to-test-with-5-users/