43% of Americans only read at a basic or below basic level, but how many of us develop, design, and test our interactive tools and websites with this in mind? In this session, we’ll examine how we can adapt user-centered design principles to engage a wider audience, while bringing clarity and ease to existing users. Focusing on users with limited literacy skills, we’ll explore how to: Co-create interactive tools and websites Develop effective and engaging content Optimize visual design for clarity and accessibility Throughout our hands-on session, we’ll work with case studies and examples from our years of work in health communication. You’ll learn specific strategies to integrate best practices for limited literacy challenges into your existing workflow.

1. How to Make the Web Easier
for Users with Limited Literacy
Skills
Sandy Williams Hilfiker
Stacy Robison
@CommunicateHlth

2. Presentation Overview
① Why do we need to care about literacy?
② What we know about limited literacy users
③ UX research with limited literacy participants
④ Implications for content and design

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

4. Literacy vs. Health Literacy

5. What’s unique about health
information?
 Complexity of health care and public
health systems
 Stress and anxiety related to your own
health or the health of loved ones

6. What we know
about web users
with limited literacy
skills

7. What We Know
Users with limited literacy skills are…
 Willing to use the web to access information that is
important to them
 Able to accomplish tasks when websites are designed
well
 More likely to use a mobile phone to access the web
than a desktop

8. 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.

9. Easily Overwhelmed & Limited Working 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.

10. Easily Overwhelmed & Limited Working 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.

11. ALL users benefit from improved readability and usability
Comparing time-on-task on the original site with a
prototype (designed to support users with limited
literacy skills):
Time on Task
(Mean)
Original Site Prototype Improvement
High literacy 14:19 5:05 +182%
Lower literacy 22:16 9:30 +134%
All users 17:50 6:45 +164%
High Literacy
Users:
3x as fast with the
revised site
93% success rate
on revised site
(compared to 68%
with original)
Source: Summers, K., & Summers, M. (2005). Reading and navigational strategies of
Web users with lower literacy skills.

12. UX research with limited
literacy participants

13. Curse of knowledge

14. Use this tool to get recommendations based on
your age and sex

15. Methods

16. Sample Method: Collaging
 Participants create a
collage that represents the
characteristics they would
like to see in a new website
 Result: Provides insights
into users’ needs normally
not revealed in interviews
and focus groups

17. “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.”

18. Try It

19. 1 2 3
4 5 6
7 8 9

20. + Choose 2 images that represents qualities of your ideal
work environment.
+ Choose 1 image the represents the qualities you would
NOT want in your work environment.
+ Write a brief description why you chose each image.

21. Sample Method: Tree Testing
 A technique for evaluating how
easy it is for people to locate
information within a material or
website structure
 Participants are given a topic to
find within a text version of a
site map or table of contents

22. 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

23. 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

24. 10 tips for involving
participants with limited
literacy skills

25. Top 10 Tips
① Partner with community organizations to recruit special
populations
② Screen for participants with limited literacy and limited
technology use
③ Develop screeners, consent forms, and moderator’s
guides in plain language
④ Use cash incentives when possible
⑤ Limit the number of tasks

26. Top 10 Tips
⑥ Be cautious using remote and online testing
⑦ Pre-test your protocol with at least one participant with
limited literacy skills
⑧ Choose a moderator with experience conducting
research with limited literacy participants
⑨ Conduct testing sessions in a setting that is familiar
and accessible to participants
⑩ Test on mobile using the participant’s device; ensure
Wi-Fi is available

27. Implications for Content
and Design

28. Limit your messages+

29. What do you want your
readers to know or do?
(Organize your content accordingly)

30. Identify your main message(s).
 Ideally no more than 3
 Decide what is a main message and what
is supporting content
 Put your main messages first

31. Prioritize the Behavior
Asthma makes breathing difficult for more than 34 million Americans.
Asthma in children is on the rise, but with proper treatment for
symptoms of asthma, kids and adults can live well.
If someone in your family has asthma, start by getting rid of these
common causes of attacks:
Mold or dampness
Cockroaches
Secondhand smoke
✗
✗
✓

32. Write clearly+

33. Write in Plain Language
 Use short, simple sentences.
 Use familiar language.
 Make it actionable.
 Use the active voice.

34. Example:
Your primary doctor may refer you to a
neurologist. A neurologist is a doctor who treats
problems related to the brain and nervous
system.
Tip:
Think about whether it benefits the user to learn a jargon
term — or if it makes sense to work around it. Do they
need to know the new term?

35. Use short, simple sentences.

36. Limit paragraph size+

37. No walls of text
Write for users’ limited working
memory.
Use clear, stand-alone sections or
chunks with headings.

38. What is a chunk?
Here is your header
 Point 1
 Point 2
 Point 3
 Point 4
Here is your header
No more than three lines of text. No more than three
lines of text. No more than three lines of text. No more
than three lines of text.

39. Use white space wisely.
 Break up sections of text to avoid “walls”
 Include generous padding around images
Remember: Leave more white space above
a header than below

40. Use meaningful headings
Which page title would be most helpful if your child
had asthma?
① “About asthma”
② “Asthma symptoms”
③ “Prevent asthma attacks at home”

41. Use good visual
design+

42. Design is more than aesthetics
It can help people:
 Find what they need
 Understand what they find
 Remember what they read

43. It’s all about cognitive processing
The more pre-cognitive cues in a
picture, the quicker we can process
it, saving “high level” mental capacity
for deeper analytic processing.
(like reading and interpreting)

44. You read this first.
And now you’re reading this.
Since you probably skipped this, I’m guessing your eyes jumped here third.

45. Using Grouping
Who should get the flu shot?
Everyone age 6 months or older.
When should I get the flu shot?
As soon as possible, typically in the fall.
Are there side effects?
Soreness or redness where the shot was given.

46. Using Grouping
Who should get the flu shot?
Everyone age 6 months or older.
When should I get the flu shot?
As soon as possible, typically in the fall.
Are there side effects?
Soreness or redness where the shot was given.

47. Combine Grouping AND Contrast
Who should get the flu shot?
Everyone age 6 months or older.
When should I get the flu shot?
As soon as possible, typically in the fall.
Are there side effects?
Soreness or redness where the shot was given.

48. Choose readable fonts+

49. Font Size (web)
16-20 px
12px✗
✓

50. Letter Width
Avoid overly wide or condensed fonts

51. Counter
Look for fonts with adequate counter
space

52. The best font choices are ones
where readers do not notice the
font, but the message.
Source: urbanfonts.com

53. The Last Word

55. Thank you!
@ CommunicateHlth

56. communicatehealth.com/blog