Most of us eat and sleep with our smart phones. But there are still many people who find technology stressful and overwhelming. People with limited literacy skills are often included among this latter group. By following a thoughtful, user-centered design process, you can overcome the common barriers to reaching and engaging people with limited literacy skills, such as: • Complex information and navigation • Unfamiliar tools • New technology Reaching out to and receiving meaningful feedback from audiences with limited literacy skills can be challenging and requires special considerations. This presentation will offer tips for conducting user testing with limited literacy audiences. From our experience conducting usability research with hundreds of participants with limited literacy skills, we’ll share lessons learned and practical tips for a user-centered design process that leads to easy-to-use, accessible content and tools. This presentation will detail proven strategies for: • Recruiting participants • Developing questions and prompts in plain language • Moderating testing sessions We’ll discuss user-centered design methods that are particularly effective in gaining insights from participants with limited literacy skills, including collaging, card sorting, and in-person usability testing. We’ll also talk about how to choose the right software and testing environment to meet this audience’s needs. Lastly, we will explore — through case studies — the behaviors, habits, and preferences of limited literacy users.

1. UX Research with Limited Literacy
Audiences
Tips and case studies
Mary Ann Petti, MPH, CHES
+ @MaryAnnPetti
+ @CommunicateHlth

3. Presentation overview
① Why care about literacy and health literacy?
② What we know about limited literacy users
③ Sample UX research methods and case studies
④ 10 tips for involving participants with limited
literacy skills in UX research

4. a question?

5. Which of the following is the strongest
predictor of a person’s health status?
 Income
 Employment
 Education level
 Racial or ethnic group
 Literacy skills

6. Literacy
An individual’s ability to read and write.

7. Health Literacy
An individual’s ability to obtain,
process, and understand basic
health information and services
needed to make appropriate health
decisions.

8. Literacy vs. health literacy

9. Health literacy level by task

10. Why care?

11. Why care?
Household decision
makers

12. What we know about users with
limited literacy skills

13. Prone to skipping
information and focus on
the center of the screen
1

14. Prone to skipping & focus on the center of the screen
Gaze path of a participant
with limited literacy skills
who reads only the text that
looks easy to read.
Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.),
Eye Tracking in User Experience Design (p. 339). Waltham, MA: Elesvier.

15. Easily overwhelmed and
tend to have a limited
short-term memory
2

16. Easily overwhelmed & limited short-term memory
Gaze path of a participant
who does not have limited
literacy skills.
Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.),
Eye Tracking in User Experience Design (p. 335). Waltham, MA: Elesvier.

17. Easily overwhelmed & limited short-term memory
Gaze path of a participant
with limited literacy skills
attempting to read every
word.
Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.),
Eye Tracking in User Experience Design (p. 336). Waltham, MA: Elesvier.

18. Usually navigate in a linear
fashion and back-track
frequently
3

21. Are likely to access web
content from a mobile
device
4

22. Likely to access web from a mobile device
2 out of 3 adults
in the U.S. own a
smartphone.
1 in 5 adults in the
U.S. rely on their
phones for
Internet access.

23. What we know
Users with limited literacy skills are…
• Willing to use the web to access health information
• Able to accomplish tasks when websites are
designed well

24. ALL users benefit from improved readability and usability
Success Rate Original Site Rewritten Site
Lower literacy 46% 82%
High literacy 68% 93%
A health website
compared to a revised
prototype (designed to
support users with limited
literacy skills)
High literacy users: 3x as
fast with the revised site
Source: Summers, K., & Summers, M. (2005). Reading and navigational strategies of Web users with lower literacy
skills.
Total Task Time Original Site Rewritten Site
Lower literacy 22.3 min 9.5 min
High literacy 14.3 min 5.1 min
Satisfaction
(1-5 scale, 5=best)
Original Site Rewritten Site
Lower literacy 3.5 4.4
High literacy 3.7 4.8

25. Research methods:
Considerations when working
with limited literacy audiences

26. Understand. Organize. Evaluate.

27. Case Study 1: Collaging

28. Collaging for positive patient-provider interaction
Goal: Find out what matters most to patients when
talking to a doctor about cardiovascular health
Methods: Participants create a collage that represents
the characteristics they would like to see in something,
and the characteristics they would not like to see in
something (in-person, n=8)

29. Sample Method: Collaging
SUCCESSFUL
METHOD!

30. “This is how I feel — free and full of energy. I want my
doctor to understand that this is how I want to feel with his
or her help.”

31. Case Study 2: Tree Testing

32. Remote tree testing for content organization
Goal: Evaluate how easy it is for limited literacy users to
locate information on healthfinder.gov
Methods: Users are given a task to complete using the
sitemap — researchers are on-site for technical
assistance (in-person with web-based tool, n=40)

33. Practice!
 Go to my Twitter page: @MaryAnnPetti
 Click the link in the pinned tweet
 Take the 3-task test
 https://communicate-
health.optimalworkshop.com/treejack/uxpabos15

34. Tree testing with professionals
Task: Where would you go
to learn what Wisconsin is
doing to support Healthy
People 2020?
 This chart represents an
unsuccessful task on a website
targeting low lit consumers

35. UNSUCCESSFUL
METHOD

36. Tree testing with limited literacy users
Task: Where would you find
healthy snack ideas for kids?
 This chart represents an unsuccessful
task on a website targeting low lit
consumers

37. Case Study 3: Mobile Usability
Testing

38. Mobile usability testing
Goal: Evaluate mobile user experience of healthfinder.gov
Methods:
 In-person mobile testing with 8 users
 Mr. Tappy & iPEVO camera
 Limit think aloud — allow more room for free
exploration

39. SUCCESSFUL
METHOD!

41. Mobile usability testing

42. Health Benefits
Health
Benefits
Mobile usability testing

43. 10 tips for involving participants
with limited literacy skills

44. Top 10 tips
① Partner with community organizations to recruit
special populations
② Screen for participants with limited health
literacy using proxy measures
③ Ask participants to bring their mobile phones if
testing on mobile — and be sure to have WiFI
access

45. Top 10 tips
④ Develop screeners, consent forms, and
moderator’s guides in plain language
⑤ Use cash incentives when possible
⑥ Limit the number of tasks
⑦ Be cautious using remote and online testing

46. Top 10 tips
⑧ Pre-test your protocol with at least one
participant with limited literacy skills
⑨ Choose a moderator with experience
conducting research with limited literacy
participants
⑩ Conduct testing sessions in a setting that is
familiar and accessible to participants

47. Why should I do user testing?

48. A dollop of toothpaste
on a toothbrush.

49. “It’s a swan. On a boat.
Floating down a river.”

50. Helpful resources

51. Thank you!
Mary Ann Petti
maryann@communicatehealth.com
communicatehealth.com