ANALYSIS AND DEVELOPMENT OF CONSUMER HEALTHCARE INFORMATION WEBSITES COURTNEY JOHNSON, B.E. A THESIS TECHNICAL COMMUNICATION

Transcription

1 ANALYSIS AND DEVELOPMENT OF NSUMER HEALTHCARE INFORMATION WEBSITES by URTNEY JOHNSON, B.E. A THESIS IN TECHNICAL MMUNICATION Submitted t the Graduate Faulty f Texas Teh University in Partial Fulfillment f the Requirements fr the Degree f MASTER OF ARTS Apprved Deember, 1997

2 / ^ ^ ^ Cpyright 1997, Curtney Jhnsn

3 ACKNOWLEDGMENTS I have t thank my family fr their lve and supprt thrughut this prjet. Many times, their enuragement was the mtivatin I needed t mplete the next step. I als have t thank my mmittee members, Dr. Carlyn Rude and Dr. Stuart Selber fr their guidane and supprt. Their perspetive thruhgut the prjet allwed me t step bak and take anther lk at my wrk. Als, I wuld like t thank Dr. Betsy Gebel Jnes and Dr. Rn Warner f the Department f Family Mediine at TTUHSC. Their ntributin was vital, and 1 appreiate the supprt that they prvided thrughut the prjet. n

4 TABLE OF NTENTS ACKNOWLEDGMENTS LIST OF TABLES LIST OF FIGURES ii vi vii CHAPTER I. INTRODUCTION 1 Site Histry 1 Audiene fr the Site 3 n. REVIEW OF HEALTH MMUNICATION LITERATURE 4 Intrdutin 4 Fus n Cnsumer Healthare Infrmatin 5 Mving Mediine t the Wrld Wide Web 5 Why Health Cnsumers G t the Web 6 Need fr Cntrl 6 Dismfrt with Self-Dislsure 8 Impliatins fr Site Prviders 9 Auray f Health Messages 9 Presentatin and Organizatin f Infrmatin 11 Review f Website Design Literature 11 Develping a Shema 13 Differenes in Page versus Sreen 14 Use f Clr 15 Navigatin 15 ni

5 III. NSUMER HEALTHCARE WEBSITE AT TTUHSC:DESIGN AND APPLICATION 17 Intrdutin 17 Site Desriptin 17 Cntent Issues 18 Cntent Struture f Site 18 Children's Health 19 Znti Diseases 20 Challenges ~ Audiene Cnsideratin 21 Website Design Issues 22 Frames 23 Banner Frame 23 Menu Frame 24 Main Frame 24 Navigatin 24 Clr 25 Cnlusin 25 IV. USABILITY TEST 27 Intrdutin 27 Methdlgy 28 Results 30 IV

6 Cntent 30 Navigatin 30 Disussin 31 Cntent 31 Navigatin 32 V. NCLUSIONS 33 Funtinal Website 33 Definitin f Design 33 APPENDIX LITERATURE CITED 34 A. WEB SITE PAGES 36 B. USABILITY TEST 46

7 LIST OF TABLES B.l. Pre-Test Questinnaire Results 52 B.2. Senari #1 Perfrmane Results 53 B.3. Senari #2 Perfrmane Resuhs 54 B.4. Pst-Test Questinnaire Resuhs 55 B.4.. Pst-Test Questinnaire Resuhs 56 VI

8 LIST OF FIGURES A. 1 Cnsumer Health Hme Page 36 A.2 Children's Health Main Web Page 36 A.3 Cli Web Page 37 A.4 The Cmmn Cld Web Page 3 7 A. 5 Diarrhea Web Page 3 8 A.6 Fever Web Page 38 A. 7 Immunizatin Web Page 39 A. 8 Pisning Web Page 39 A.9 Child Safety Web Page 40 A. 10 Sleep Prblems Web Page 40 A. 11 Teething Web Page 41 A. 12 Vmiting Web Page 41 A. 13 Children's Health TTUHSC Resures Web Page 42 A. 14 Childem's Health Additinal Resures 42 A. 15 Znti Diseases Main Page 43 A. 16 List f Diseases Web Page 43 A. 17 Znti Diseases TTUHSC Resures Web Page 44 A. 18 Znti Diseases Additinal Resures Web Page 44 vu

9 CHAPTER I INTRODUCTION The Texas Teh University Health Sienes Center (TTUHSC) in Lubbk, Amarill, Odessa, and El Pas supprt residents in 108 unties in west Texas and fur unties in eastern New Mexi. With this brad regin mes the daunting task f trying t meet the needs f all the residents in this area. TTUHSC sees as part f its missin t supprt these mmunities that d nt have ready aess t ne f the fur main ampuses. In rder t serve these needs, TTUHSC has regnized the need t establish a rural mediine system. In partiular, the Department f Family Mediine at TTUHSC in Lubbk is in the early stages f reating a supprt system fr the mmunities f the regin. Site Histry Dr. Betsy Gebel Jnes is the website designer and manager fr the Department f Family Mediine at TTUHSC. She established a departmental site that serves as bth an infrmatinal and prmtinal site. The main fus is t infrm site visitrs abut the failities and researh interests in the department. In additin, the site prmtes the resideny prgram in an effrt t reruit ptential residents t TTUHSC. Family Mediine regnized that they needed t supprt anther aspet f their department ~ rural heakhare. The department reeived a grant t strengthen their supprt f the 108 unties served by TTUHSC failities. One f the prjets

10 supprted by this grant was the develpment f a rural health website that was an extensin f the department hme page. There wuld be tw audienes fr the site: nsumers and healthare prfessinals. Different apprahes and ntent had t be prvided fr eah audiene. An infrmatinal site fr nsumers wh were nt readily able t aess healthare at ne f the TTUHSC failities was started. One mediiun that they have deided t use in rder t reah these peple is the Wrld Wide Web. By using this medium, TTUHSC an reah several f its nsumers in the area. TTUHSC des nt want t substitute a nsumer's visit t a healthare prfessinal, but wants t augment the infrmatin that a healthare prfessinal wuld give. Many f these nsumers annt readily aess healthare and need a resure t use until they are able t visit a healthare prfessinal. What TTUHSC wants t d is reate a presene in the regin as being a mmunity wide healthare faility. T start the prjet, a website fr nsumers needed t be reated. Althugh there are several needs f all the nsumers in the regin, a website needed t be established that uld meet the dynami demands f the nsumers. What was needed was a prttype f a site that uld serve as a template and uld grw, expand and hange arding t the demands and needs f the nsumers. Several issues had t be nsidered in the reatin f this site. This versin was nt the establishment f the entire site, but f a prttype f the site. This prttype wuld serve as the fundatin r basis f the website as it evlved. The gal was nt t reate the entire site, but rather t start with a prttype that wuld evlve and expand.

11 Audiene fr the Site The TTUHSC system serves the residents in the 108 unties in west Texas (frm Amarill t El Pas) and fur unties in eastern New Mexi. This regin is anhred by the fur main TTUHSC ampuses in Amarill, Lubbk, Odessa, and El Pas. These are the largest ities in the regin and they supprt untless smaller mmunities. Beause the area is s heavily ppulated and beause the ppulatin is s spread ut, these fur ampuses annt meet the needs f all the residents f the regin. Many f the peple in the utlying unties nly me t ne f the main ampuses fr yearly hek-ups and/r fr emergenies. Therefre, nt all the residents have quik and easy aess t healthare. Thus, the audiene fr this site are thse peple wh uld aess the Wrld Wide Web fr healthare infrmatin. As a result these residents wuld aess the TTUHSC site sine they are familiar with it being a majr healthare prvider and researh faility in this area. Several issues had t be nsidered in the develpment f the site prttype. The issues are entered in health mmuniatin thery and website design. The site nt nly had t meet the medial needs f the nsumers but it als had t be usable fr the nsumers as well as fr the site prviders at TTUHSC. What is utlined in this thesis is the researh nduted n the theries invlved in the reatin f this site, the desriptin f the site, a usability test f the site, and nlusins abut the thesis and the site.

12 CHAPTER n REVIEW OF HEALTH MMUNICATION LITERATURE Intrdutin Mst peple have aess t healthare and have partiipated in a health mmuniatin relatinship. As patients, we seek infrmatin that will hange r slve a medial situatin. There are many variables that affet hw we reeive this infrmatin and hw we use this infrmatin. In the traditinal sense, we aess this infrmatin when we visit a healthare prfessinal at a heahhare faility. Nt nly d we gather infrmatin in ur fae-t-fae visit with ur healthare prfessinal, but we als gather infrmatin in the frm f print media. We llet brhures at medial ffies that we use fr further infrmatin abut medial nditins. With the advent f the Internet, mre and mre healthare nsumers are lgging n t aess muh f this same infrmatin. The questin is: Hw des this new mmuniatin tehnlgy affet hw the patient reeives and interats with the healthare infrmatin? Are the same fatrs present in the traditinal healthare setting as there are in the Internet setting? What are the new fatrs that are intrdued when nsumers turn t the Internet as their sure fr healthare infrmatin? What effet des this new mmuniatin tehnlgy have n heahh mmuniatin verall? Is this a variatin n traditinal health mmuniatin r is this a mpletely different frm f mmuniatin altgether? Patients and lay peple (nsumers) aess infrmatin n the Web t find health related infrmatin. Usually nsumers d nt lk fr healthare infrmatin as a leisure ativity. This researh is a result f medial news. Many times this

13 medial news requires a hange in lifestyle. Beause f this deliate situatin, the infrmatin must be presented in a manner suitable fr the patient at that time. Fus n Cnsumer Healthare Infrmatin The advent f the Wrld Wide Web has allwed fr hanges and advanes in many areas f mediine. The Web allws fr inreased llabratin amng healthare prfessinals. In additin, it uld be used t imprve the area f telemediine. Hwever, in this study, nly nsumer healthare infrmatin will be analyzed. The reasn fr this narrw fus is beause f the numerus impats that the Internet has had n nsumers and health infrmatin. It has empwered thse with the tehnlgy and the knwledge t ntrl their health situatin and/r behavir. Cnsequently, it has als exluded thse nsumers wh d nt have the tehnlgy and/r knwledge t aess this infrmatin. The tehnlgial advanes have a greater impat than just plaing hardpy infrmatin n-line. Mving Mediine t the Wrld Wide Web The mve t plae healthare infrmatin n-line has its wn agenda. The new mmuniatin tls are a result f the new trends in healthare. Researhers see that new medial develpments must nt just be engineering feats, but must result frm lifestyle hanges (Krger, 1994). Krger sees the mve f nsumers aessing mre healthare infrmatin but warns f mediine's ntributin t the infrmatin pl: "We must imprve the quality f what we d, nt simply add t the lutter, and we must apply the best f sientififindingst what we say and hw we say it" (1994, p. 219). Chamberiain states the gal f nline healthare infrmatin best when he says, "The gal is still the same: t get therightmessage t therightpeple, in the right (mst effetive and effiient) manner, subjet als, almst ertainly, t budgeting nstraints" (1994, p. 281). In the push frward t present infrmatin t the users,

14 the site prviders must be nerned that the new medium des nt affet the message. Sine nsumers are relying n the infrmatin, it must be presented in a way that is benefiial t the nsumer. Cnsumers turn t the Web fr infrmatin aess fr several reasns, tw f whih are the need fr ntrl and dismfrt with self-dislsure. Whv Health Cnsumers G t the Web Need fr Cntrl In their bk. Health Cmmuniatin: A Handbk fr Health Prfessinals, Peter and Laura Nrthuse see ntrl as an imprtant variable in health mmuniatin. They state that persnal ntrl is imprtant t smene dealing with a health issue: "Cntrl des nt need t be exerised, r even be real, t have an effet n the individual; it nly needs t be pereived" (1985, p. 37). With just the feeling that they have ntrl ver the infrmatin, the patient and the families might feel as if they have sme ntrl ver the situatin. If peple have a sense f ntrl ver their situatin then they are mre likely t make hanges in their life: "Persnal ntrl nsists f peple's beliefs abut hw well they an bring abut desirable events and avid undesirable nes. Peple wh feel a strng sense f persnal ntrl regarding health are mre likely t have a healthy lifestyle, seek and fllw medial advie when ill" (Lieberman, 1992). When nsumers have persnal ntrl ver the infrmatin, they are mre mtivated t learn and t take ntrl f their urrent situatin. They are als mre mtivated t seek mre knwledge n the partiular tpi (Lieberman, 1992). In the traditinal sense f health mmuniatin, ntrl is a majr element. As Nrthuse and Nrthuse explain, "[L]ss f ntrl results in depersnalizatin in patients and that patients typially respnd t depersnalizatin by ating helpless...r

15 by ating angry... may reat t the lss f ntrl thrugh heightened sensitivity t their physilgial respnse t illness r by seeking infrmatin frm numerus peple in an indisriminate manner (1985, p. 41). This may be the pint where patients turn t the Internet fr infrmatin. They need t feel sme srt f ntrl ver their situatin and they have t resrt t ther infrmatin hannels when they feel like their relatinship with healthare prfessinals has been insuffiient r untrustwrthy. One f the benefits f nline heahhare infrmatin is that users have ntrl ver the infrmatin that they aess. With the ntrl ver the infrmatin, the lients and family feel like they have sme srt f ntrl ver their situatin. Aessing infrmatin via the Wrld Wide Web allws users t ntrl the infrmatin and the path that they take t arrive at the infrmatin. The user perfrms searhes and deides what infrmatin t dwnlad. One f the bstales that a nsumer has t manage when aessing medial (r any) infrmatin n the Internet is navigatin. Cnsumers need t be able t btain the infrmatin that they need. Navigatinal hies give the users ntrl in seleting the infrmatin they want. One f the nuanes with the Web is the inreased ntrl that users have. They an be muh mre seletive abut the infrmatin that they hse and the path that they hse t arrive there. Nt nly d users ntrl whih infrmatin they aess, but they als ntrl hw they arrive at the infrmatin. Hwever, the navigatin annt interfere with the message, and the site prvider an wrk t ensure that. Anther issue f ntrl n the Internet mesfrmthe perspetive f the site prviders. The senders r infrmatin prviders d nt have ntrl ver hw the users ntrl this infrmatin. Chamberiain disusses this viewfrmthe site prvider: "We have already entered a new era f demassifiatin where the nsumer is empwered by newer tehnlgies t make individual hies frm a huge seletin f

16 media" (1994, p. 273). He ges n t explain, "The demassifiatin has dramatially inreased the target nsumer's ability t zap, t disard, t refuse t wath, read, r listen t any messages sent" (1994, p. 281). With all f these elements f ntrl, a nsumer heahhare infrmatin website must take all f these int nsideratin. The prviders must establish a site that prvides aurate infrmatin that the users an ntrl and design navigatin that mplements the infrmatin and allws the user t interat with the infrmatin. Dismfrt with Self-Dislsure An element f health mmuniatin that relates t ntrl is self-dislsure. Clients many times d nt feel mfrtable in dislsing persnal nerns r fears t their heakhare prfessinals. The nsumers might als feel embarrassed r intimidated by asking infrmatinfrmthe health prfessinal in a ntrlled healthare setting. The mputer interatin affrds the users the pprtunity t aess the infrmatinfrmthe mfrt f their wn hmes. Lieberman states, "The mputer is thefirstmmuniatin medium ever t prvide interative, individualized respnses withut the presene f anther persn. When the tpi is sensitive, as heakh tpis are, the annymity permitted in a mputer envirnment an be less intimidating than interatin with a health prfessinal" (1994, pp ). Medial issues are a very persnal and private matter fr mst peple, and they d nt feel mfrtable revealing suh persnal infrmatin. When they d dislse suh infrmatin, they experiene "feelings f vulnerability and unertainty" (Nrthuse and Nrthuse, p. 57). This fear f dislsing suh persnal infrmatin relates t the fear f being evaluated r judged beause f this infrmatin: "They wrry that if they dislse their feelings abut their illness, thers will evaluate them andfindthem t be respnding in weak, exessive, r strange ways" (Nrthuse and 8

17 Nrthuse, p. 57). This feeling f self-dislsure uld be a reasn why s many peple turn t the Internet fr medial infrmatin. As Krger suggests, "Sme peple may learn mre effetively thrugh impersnal hannels beause f learning style preferenes" (1994, p. 219). Sine medial ndkins are s persnal, many peple may prefer t sk in the privay f their hme t searh fr infrmatin. In the February 1997 issue f Cnsumer Reprts, a new Internet surfer disussed her entrane nt the Internet t find infrmatin n her hrni disease. She stated, '"Peple are embarrassed t talk...with their dtrs, families, and friends...'"(1997, p. 27). Nw that she is n the Internet, she has fund a "virtual mmunity" where she feels mfrtable mmuniating abut her ndkin with ther fellw patients (1997, p. 27). Cnsumers need an envirnment where they feel mfrtable researhing senskive infrmatin. One f the benefits f the Wrld Wide Web is that k prvides nsumers with a hane fr interatin with a faeless sure. Als the mmuniatin is mstly ne way; the nsumers never have t reveal their identity r input any persnal infrmatin if they hse nt t. Instead, they may mve freely thrugh the Web. Sine this idea f self-dislsure is ritial t the suess f health infrmatin n the Wrld Wide Web, web designers must maintain this sense f privay. Users shuld feel at ease interating with a site. They shuld nt have t dislse infrmatin r feel as if they are being wathed. Impliatins fr Ske Prviders Auray f Health Messages One f the mst dangerus aspets f searhing fr health infrmatin n the Wrid Wide Web is trusting the auray f the infrmatin. Trust is an essential part f a tradkinal heakhare relatinship. Cnsumers generally trust what the

18 prfessinal tells them. Likewise, nsumers trust what they wuld be presented with n the Web. Althugh there are numerus sites available t healthare nsumers, Chamberiain believes that nt all f the infrmatin an be trusted t be aurate. "At the utset, it is wrth remembering that the message itself remams paramunt; n amunt f tehnlgy is ging t mpensate fr an ill-neived r ill-designed message" (1994, p. 272). In the February 1997 issue f Cnsumer Reprts, the edkrs warn the readers abut dubius infrmatin. They state that there is bth aurate and inaurate infrmatin (1997, p. 27). In the intrdutin t their bk. Tehniques fr Tehnial Cmmuniatrs, Bamum and Carliner define the rle f the tehnial mmuniatr as fllws: "Tehnial mmuniatrs lighten the infrmatin lad n thers by preparing infrmatin fr effetive, effiient use" (1993, p. 1). The authrs ntinue by stating, "Tehnial mmuniatin is the press f translating what an expert knws fr an audiene with a need t knw" (1993, p. 3). Anther variable that uld be a tremendus barrier in this relatinship is the prblem f unshared meanings. Prfessinals invlved in presenting infrmatin nline have t realize that they d nt share the same meanings r ntext with the nsumers. Cnsumers d nt understand the infrmatin n the same level that the prfessinal des. The infrmatin has t be presented t the nsumer and nt t the prfessinals. In the ase f healthare, web designers shuld be mre areful as t what they pst. Muh f the available infrmatin is direted mre tward healthare prfessinals. Sine the Internet allws free aess t users, k is diffiult t ntrl what the users btain. Patients and lay peple have truble with the tpis vered. In the ase f healthare, web designers shuld be mre areful as t what they pst. Muh f the available infrmatin is direted mre tward heakh are prfessinals. Sine the Web allws free aess t users, k is diflfiuk t ntrl what 10

19 the users btain. Cnsumers uld have truble with the tpis vered. The key then is that tehnial mmuniatrs remember wh the audiene is. They d nt have the same bakgrund r terminlgy that the experts have. Tehnial mmuniatrs must prvide aurate infrmatin that is sukable fr their intended audiene. Presentatin and Organizatin f Infrmatin Anther fatr is the language and type f infrmatin presented t the audiene. Sine the users are in ntrl f their surfing f the web, they must feel mfrtable in the new envirnment. Cnsumers d nt have muh time and d nt want t spend the time they d have wading thrugh layers f infrmatin n the Web. Nt nly must the infrmatin be aurate, but k must als be rganized in suh a manner that makes aess easier. The infrmatin must be presented in a lgial manner t assist mprehensin. Sine this is relatively new material fr the user, the infrmatin must be rganized in an effiient manner t ensure user's ntrl ver the infrmatin as well. Mre speifially, Janie C. Redish pints ut that peple want t "get in, get the infrmatin, and get ut f the dument" (1993, p. 19). Therefre, the mre rganized and nise the infrmatin is the easier k is fr the reader. In her artile, "The Cmputer's Ptential Rle in Heakh Eduatin," Debra Lieberman states: "Ideally learners shuld be free t preedfrmtpi t tpi in the rder they prefer, whih enhanes their persistene at seeking infrmatin" (Lieberman, 1992). Review f Website Design Lkerature Tehnial mmuniatin is nerned with prviding audienes with a message. The primary task fr a tehnial mmuniatr is tfigureut hw best t suk the needs f the audiene with the medium that is being utilized t transfer the message. As Martin states, "Quality is measured by hw well ur user's needs have 11

20 been antiipated and met. The message reeived bemes the message sent" (1995, p. 96). The Wrld Wide Web is a brand new medium fr tehnial mmuniatrs t nquer. Sine tehnial mmuniatrs still have the audiene as their main nern, they must deal with hw the audiene perfrms with and in this new medium. Many f these issues are reslved with the design elements that have been established. What is the best way t present the infrmatin m this new medium in rder t best ammdate the end user? Beause tehnial mmuniatrs are s nerned with develping Wrld Wide Web appliatins t be mre userfiiendly,a set f rules, standards, r guidelines has been established. These guidelines were established s that Webske develpers uld reate effetive and effiient hme pages that wuld best suk the audiene. These deisins fr the design issues riginatefrmthe guidelines fr print dumentatin that have been adapted fr Internet appliatins. Tehnial mmuniatrs are making the paradigm shiftfrmpaper t mputer. Mre imprtantly, the audiene is als making this shift. An added respnsibility f the tehnial mmuniatr is t help the audiene make that transitin; they have t bring the audiene int the tehnial mmuniatin disurse mmunity beause new users wh have n prir knwledge f this medium are rapidly jining and, arding t Hunt, "the values f this mmunky have been erded" (1996, p. 381). Tehnial mmuniatrs bring the audiene int the mmunity by reating a shema fr the audiene t relate t. The mst mmn shema that has been develped is t make the Web skes lsely resemble paper duments. Several areas f dument design have been researhed t try andfindthe mst effiient methds fr delivering the message. The main area I am nerned with is hw tehnial mmuniatrs are making the mvefrmprint duments t nline dumentatin. The elements f dument design that I am interested in are develping a shema, differenes m page versus sreen, use f lr, and navigatin. 12

21 Hw d researhers suggest making the transkinfrmpaper t nlme in these elements? Many f the elements are deided upn based n what riginally wrked in the print medium. Are there ther riteria that tehnial mmuniatrs shuld use t determine hw t best ammdate the user in this new medium? Develping a Shema One f the basi priniples in dument design is prviding the user with a shema fr learning new infrmatin. Researhers have suggested that tehnial mmuniatrs d the same fr themselves in making the transitin t nline dumentatin. Dnald S. Humphreys suggests that tehnial mmuniatrs apply the familiar t the unfamiliar in making the transkin (1994). Grie and Ridgway als disuss the shift that tehnial mmuniatrs must fae when heading int hypermedia. They suggest that k is "a fundamental shift in the way we lk at infrmatin" (1995, p. 35). They als state that different media all fr different gnitive presses. Therefre hypermedia users must shift gears (1995, p. 37). Mariana Ce reinfres these ideas abut making the transkin by stating, "There are tremendus psyhlgial adjustments that tehnial mmuniatrs have t make t reate nline infrmatin suessfully and that users have t make t use it suessfully" (1996, p. 216). There are several different ways t develp shema. Webskes an mdel a nsumer's pre-existing shema r they an establish a new ne within the ske. Whihever way is used, nsumers need a nsistent pattern that they an use and build n thrughut the ske. Fr heakhare ske, nsumers apprah the site with questins that they want answered. Therefre a healthare webske uld use a frmat f questin and answer t present the infrmatin. 13

22 Differenes in Page versus Sreen One f the biggest differenes between paper and nline dumentatin is that the display sreens are vastly different. One page in a print dument vers apprximately three t six sreens in an nline dument (Hrtn, 1994). The dimensins f the tw media are als vastly different. The print dument is lnger but nt as wide as the mputer sreen. A mputer sreen an hld 24 lines with 80 haraters n eah line (Nrd and Tanner, 1993). Beause f these differenes, researhers have develped rules f thumb fr presenting infrmatin nline. The mst imprtant rule is t remember that a sreen and a page are nt the same thing and therefre require different design tehniques (Hrtn, 1994; Ce, 1996). Online dumentatin requires 40-60% f white spae (Nrd and Tanner, 1993; Ce, 1996). Hrtn suggests the fllwing guidelines fr plaing infrmatin n a sreen: dn't pak infrmatin t tightly, simplify design, replae text with graphis, ndense text fr ntinuus reading, use blank spae atively (1994). These are all guidelines that an be emplyed in the site. Sine the nsumers are nerned with the text, they d nt need a design that lutters the ntent. In additin, nsumers need t be aided in the transitin frm page t sreen. Elements f a hardpy dument an be translated and adjusted fr the sreen. Site prviders f healthare sites shuld make this an easy transkin. They shuld make the sreen mdel a page in sme ways. One way is t limit the amunt f srlling t ne sreen. In this way the sreen mimis the page in that all r mst f the infrmatin is ntained in ne area. 14

23 Use f Clr The arrangement f the text is nt the nly visual tl in the nline dument. Clr als plays an imprtant part in making the transkinfrmpaper t nline. One f the main differenes in lr between the tw media is st. Clr in paper duments is expensive while k is basially free in nline duments. The prblem that this auses is that tehnial mmuniatrs tend t use several lrs in an nline dument. Researhers suggest that nly six lrs be used at ne time in a sreen (Ce, 1996). Web designers have agreed t sme guidelines n hw t use lr in hypermedia. They suggest that lrs be hsen with great are. Tehnial mmuniatrs shuld determine lr hies arding t the user's lr nventins (Hrtn, 1994). Ce relates the psyhlgial imprtane f ertain lrs. Clrs tend t have an emtinal impat as well as ultural and sial assiatins (1996). The lr shuld reflet bth the ntent and the site spnsr. A nnetin shuld be made in rder t help establish the shema. It shuld nt interfere with the message but enhane k. Navigatin Paper duments are a linearly navigable media. Hwever nline dumentatin is nt. This differene pses a majr prblem fr bth tehnial mmuniatrs as well as their audienes. Online duments are layered in suh a way that users use hyperlinks t "jump" t the next sreen. There are n page numbers Uke there are in paper duments. One f the majr dangers r hazards with nline is that users an get lst in the hyperlinks in a sreen (Ce, 1996). T alleviate this prblem, Humphreys suggests using print-based navigatinal tls, suh as page numbers 15

24 (1994). Ce disagrees with Humphreys when she states that bk shemata d nt neessarily apply t nline shemata. She ntends that navigatin tls, suh as page numbers, are nt transferable t nline beause the user annt turn a page n the sreen. (1996). This is ne f the biggest hallenges fr tehnial mmuniatrs beause they have t determine hw t balane the ntrl f the medium between them and the user (Grie and Ridgway, 1995). Finally Ce als addresses the user's frustratin threshld. She reprts that users have less stamina and patiene when reading nline infrmatin: "White spae, hunking, indexing, hyperlinking, and using a synnym file all failkate users' ease-f-use in nline infrmatin" (1996, p. 223). Many users expet t be led thrugh nline dumentatin and they d nt want t have t make t many deisins at eah junture in the dument (Hrtn, 1994). The tehnial mmuniatrs have t layer the infrmatin and prvide enugh links s that the user an navigatefreelyin the dument (Hrtn, 1994). Beause the main nern is fr nsumers t be able t easily aess the infrmatin presented in the ske, the navigatin shuld be intukive and shuld be usable by the nsumers. Navigatin shuld nt be a hindrane, but rather an aid t nsumers. Users must be prvided with the ske struture in a navigatin tl. Users must knw r have a sense f where they are in the site. They need a safety net sine this is a new medium. The navigatin must be nsistent and reliable espeially if the users are nt familiar with brwser searh tls. 16

25 CHAPTER III NSUMER HEALTHCARE WEBSITE AT TTUHSC: DESIGN AND APPLICATION Intrdutin T demnstrate my literature review f health mmuniatin and website design, I eleted t develp a nsumer healthare webske at the Texas Teh University Health Sienes Center. The Department f Family Mediine at TTUHSC is launhing a rural health are webske that ntains bth a nsumer healthare divisin and a healthare prfessinal divisin. Sine my researh interests fus n nsumer healthare infrmatin, I develped a ske fr that partiular audiene. My gal was t develp a usable webske design fr bth users and web managers. In additin, I intended t establish the ske with infrmatin geared tward residents in the 108 unty jurisditin f the Texas Teh University Health Sienes Center System. By reating this website, I was able t utilize the infrmatin that I gathered in my preliminary literature review. Site Desriptin The initial design f the ske had afiintinaldesign and ntained infrmatin fr the nsumers. At the beginning f the prjet, we hse five re ntent areas t start the ske. One the design was reated, the ntent uld fill in the design. Hwever, as the site develped the ntent affeted the site design and aused hanges in the inkial design. The ske fr purpses f this prjet was nt meant t be an exhaustive ske that listed all the pssible tpis that nsumers might have. Instead, a 17

26 usable web design and establishment f a few ntent areas were nsidered the main pririties t initiate the ske. Cntent Issues In preliminary meetings with Dr. Jnes, we determined re ntent areas that uld be used t establish the ske. The tw areas that were established and develped in the urse f the reatin f the webske were hildren's heakh and envirnmental health and znti diseases. Althugh there were ther areas that were suggested, these tw areas served as the prehminary fus f the prjet. We used the hildren's health setin as a general subjet area whih uld be used by many f the residents in the area. Initially, the ntent areas were t be hsen arding t sme speialty ffered by TTUHSC t prmte researh mterests at the faility. The znti diseases setin an be seen as a general tpi, but k als serves a dual purpse in this regin. Sine this is a large agriultural regin. Ranhers and farmers an use the infrmatin ntained here fr their Hvestk. Althugh there is infrmatin fr detetin f these diseases in humans, there is als infrmatin abut these disease in animals. These were the tw areas that we used t establish the site. TTUHSC regnizes that the ntent will expand and develp ver time. Cntent Struture f Site The struture f the tw setins f the site are sunilar in rder t maintain nsisteny fr the users. Eah setin has an verview r welme page. This page infrms the users as t the purpse, struture and ntent f the setin. Here the users are instruted that this infrmatin is prvided as a resure and is nt intended as a substitute fr a visk t a heakhare prfessinal. In additin, n the welme page the users are infrmed f the struture f the setin. The purpse and struture f eah setin are very similar but had t be dupuated n eah page beause k is 18

27 assumed that users wuld nt navigate thrugh the ske linearly. In additin t the welme page, eah setin als ntains a TTUHSC resures page. This page lists the mfrmatin fr the TTUHSC linis. This page is mluded t rekerate that the ske infrmatin is nt a substkute fr a regular visit. Anther similarity between the sites is that bth ntain an Additinal Resures page. This page lists addkinal resures, speifi t the setin, n the Wrid Wide Web. The resures are links t thse sites, and eah link is ampanied by a shrt desriptin t infrm the readers abut the ske. This empwers the users t hse the skes mre effiiently beause they have infrmatin abut where they are ging. The main strutural differene between the setins f the site is the rganizatin f the tpis in eah setin. Beause the infrmatin in the envirnmental health and znti diseases setin uld be ategrized under ne heading, the tpis are gruped n ne mam page. This way the setin navigatinal menu uld be limited t fur levels. Any addkinal levels and the user wuld have a diflfiuk time mprehending and wrking with suh a lengthy list. In the hildren's health setin, the tpis are mluded as a subsetin f the hildren's health setin f the menu. One f the main reasns is beause the tpis in this setin are s diverse that they uld nt be gruped like the diseases in envirnmental health. T demnstrate t the users the differene m the menu, these tpis are inluded in an indented hst that is m a different lr than the ske menu items. Children's Health The infrmatin used t reate the hildren's heakh setin f the webske is geared tward parents and aretakers. The infrmatin is general and again is meant t serve as referential infrmatin fr thse individuals wh d nt have immediate aess t healthare servies. One f the residents in Family Mediine reated a 19

28 hardpy dument paket f infrmatin abut hildren's health. This was very general mfrmatin that was nt rganized in a speifi way. Dr. Jnes prvided the paket and gave me permissin t edit the infrmatin fr plaement n the website. While mst f the infrmatin was useful, k needed sme edking and needed t be rganized in a useful manner fr the nsumers. Nt all f the setins frm the hardpy dument were inluded in the ske. The main tpi areas fr hildren's health that were inluded were immunizatin, fever, teething, sleeping prblems, aident preventin, the mmn ld, and li. Sine there is n bvius imetin amng these tpi, ther than that they are all mmn hildren's ailments, they are rganized as a glssary. They are listed alphabetially n the site menu under the main heading f hildren's health. The infrmatin in eah tpi is gruped arding t subjet heading r t frequently asked questin. The questin and answer frmat was hsen beause the majrity f the nsumers aess this infrmatin if they have a questin and need an answer. This way the infrmatin may appear as mre friendly r nversatinal than just as ld, referential infrmatin. Als the infrmatin r answers are presented as atin-riented in rder t empwer the user. This again emphasizes that the user an d smething with this infrmatin and is tld t d k. Znti Diseases The znti diseases setin is meant t serve as a referene guide fr nsumers. This guide ntained infrmatin abut znti disease that are mmn news items and that are speifi t west Texas and eastern New Mexi. This infrmatin is nt prvided as treatment infrmatin but as preventive measures. Like the tpis in hildren's heakh, the tpis in znti disease are prvided as glssary material. 20

29 The infrmatin inluded in znti diseases was prepared by Dr. Rn Warner, an epidemilgist in Family Mediine. He prvided me with the mfrmatin and allwed me t rganize k and present k in the mst effetive and effiient manner. Sine there are s many diseases and sine they uld all be ategrized under znti diseases, I deided t grup them n ne page and design k muh like a glssary. The glssary shema als mplimented the mfrmatin ntained under eah disease sine k is mre referential than atin-riented. Only the harateristis f eah disease are nted. The harateristis inlude a brief desriptin f the disease, auses, symptms and treatments. Again, the use f the questin and answer frmat is utilized t grup the infrmatin in a manner that wuld math the pssible use f the site by the nsumers. Challenges ~ Audiene Cnsideratins The main hallenge f the ntent f the ske was making it usable by the intended audiene. There were several fatrs that had t be nsidered in presenting the ntent t the audiene. One f the main nerns was the mental and emtinal states f the audiene at the time that they aessed the infrmatin. Very few Wrld Wide Web surfers leisurely researh healthare infrmatin. Instead, peple aess this infrmatin when they need k. In the ase f the nsumer healthare ske at TTUHSC, the audiene is peple wh are aring fr hildren wh are sik r peple wh are nerned abut animal-brne diseases. Bth audienes are nerned abut the health and welfare f smene, even themselves. As the literature suggests, the emtinal state f an individual lking fr infrmatin plays a bigger rle than the atual physial ndkin r ailment. Therefre, the infrmatin has t be presented in a manner that is effetive and effiient fr the user. The audiene des nt want t 21

30 spend a great deal f time lking fr the infrmatin r deiphering k. As a resuk, I had t present the infrmatin in an rganized and lgial manner. Anther fatr that had t be taken in t aunt was the diverse eduatinal bakgrunds, knwledge bases and vabularies f the audiene. Sine there was a suh a wide range f nsumers in the regin, the infrmatin needed t be useful and usable by all members f the audiene. I had t make sure that the vabulary is nt laden with medial terminlgy that sme audiene members wuld nt be familiar with. Hwever I did nt want t dilute the mfrmatin suh that nsumers wuld be insulted by the elementary presentatin f the infrmatin. Fr thse users wh needed and wanted addkinal infrmatin, I inlude additinal website resures that they uld explre. In this way I tried t meet the needs f many f the members f the audiene. In deiding whih sites t inlude as additinal resure sites, I lked fr reputable heakhare spnsrs and tried t avid skes whse primary purpse was t prmte the faility r spnsr. The list f skes are anntated s that the users uld determine whih skes t investigate. Website Design Issues While the ntent was f great nern, the ske uld nt be fully funtinal withut a gd design t supprt it. In the ase f this ske, there were several issues t nsider. The primary nern was that the design had t be easily usable fr the nsumers as well as the website manager. Beause the users d nt want t spend muh f theu" time searhing fr infrmatin in the ske, the design needed t supprt easy aess t the infrmatin. Als the design needed t maintain sme srt f nsisteny s that the user uld quikly develp a shema that they uld use thrughut the site. Inluded in this design shema was a nstant reminder that the user was searhing a site maintained by TTUHSC. Sine the infrmatin is the 22

31 primary fus f the ske, the design needed t be simple and uld nt interfere with the message f the text. Nt nly did the design need t be benefiial fr the user, but k als needed t be useful t the ske manager. Sine the ske wuld be updated ften, then the manger did nt need t wrry with adjusting the design everytime text was added. Instead the manager needs t be nerned with develping the text fr the nsumers. Beause f the needs f bth the audiene and the site prvider a usable, easily updateable design was reated fr the webske. Frames In rder t meet the needs f bth the audiene and the website manager, I hse t reate a threeframedesign. Eahframehas a speifi purpse in meeting the needs f the audiene and the ske manager. Beause the site manager's mnitr will nt be the same size as the nsumers' mnitrs, theframeswere designed as sizable frames. This way the users uld resize any f theframesas they needed t. Eah f the threeframes'purpses are desribed belw. Banner Frame Cnsistent in the site is the baimer lated in the tp hrizntal frame. Inluded in thisframeis the TTUHSC lg. This lg prvides a nsistent reminder t the user abut the ske's spnsr. In additin, the setin f the ske where the user is lated is indiated by the main title in the banner frame. Althugh the user has the navigatinal tlbar nsistent n the left-hand side f the sreen, the main titles arss the tp prvide a quik sense as t where the users are at any ne time. 23

32 Menu Frame This frame ntains the site menu. Althugh this frame uld be pereived as stati, it is atually dynami as the nsumers navigate t different setins f the ske. The main tpis expand int the subtpis ntained in eah setin. The left frame prvides the users with a nsistent ske menu s that they wuld always knw hw the ske is strutured. This als helps beause the users are nt having t peridially return t a hme page befre jumping t anther setin f the ske. Thus, the nsumers an aess any setin f the ske at anytime. Main Frame The main frame f the ske is a dynami frame that updates as the user navigates thrughut the ske. One nern was the size f the mainfi-amen small mnitrs. In rder t try and ammdate all sizes f mnitrs, the frames ntained in the ske are all sizable. This means that fr users wh want t adjust the size f any f the frames, they uld in rder t read the infrmatin mre easily. Navigatin The verall struture f the site is displayed in the navigatinal tlbar psitined in the left frame. The main tpis f the ske as well as links t the TTUHSC page and t the Department f Family Mediine remain nstant as the users navigate thrugh the site. Hwever, as the nsumers enter ne f the tw main ntent setins f the ske, the menu expands t display the subtpis speifi t the site. In this sense, the users are always able t have a sense f where they are in the site at all times. Als, the menu serves as a nstant reminder t the nsumers as t the struture f the ske. Cnsumers will be aessing the tpis at randm and will nt be reading thrugh the site linearly as they wuld a bk r pamphlet. Sine I uld nt predit 24

33 whih path any ne nsumer wuld take thrugh the ske, I needed t allw the nsumers full and easy aess t all setins f the site. The ske menu allws fr this aess. As the user prgresses thrugh the ske, he r she an navigate thrugh the site hwever he r she hses. Clr Sine the infrmatin in the site was the primary fus, the lrs f the site were kept t a minimum s that they wuld nt be a distratinfrmthe message. The lrs are nsistent with lrs used n Texas Teh and TTUHSC webskes, in partiular, the department f Family Mediine's page. This was ne way t make a nnetin fr the users between the institutins, the department and the nsumer healthare page. The lkerature suggested that lrs n a web page be kept t six r less. I hse three beause there was n reasn t justify usmg mre than that. The ske needed t be unluttered and needed t fus n the text f the ske. The bakgrund was kept white like the bakgrund n the department hme page. Beause nsumers wuld be ding a great deal f reading at this site, the text needed t be highly visible and easy t read nline. Therefre blak was hsen fr the reading text. This is the best lr mbmatin fr reading nline and is a mbinatin that nsumers wuld be used t. Red was hsen fr different reasns. One reasn was t emphasize the affiliatin between this page and TTUHSC and TTU sme the shl lrs are blak and red. It als served as a ntrast t shw a differene in the menu and the text and the setin tkle and the text. In this sense k demnstrated a hierarhial differene. Als red displayed well n a white bakgrund nline. 25

34 Cnlusin In develping this webske, I utilized muh f the researh I had nduted in the areas f heakh mmuniatin and webske design. I als realized hw dependent eah f these issues is n the ther. The ntent f the ske needed t be supprted by the site. Cnsequently the design f the ske was determined by the infrmatin m the site. All in all, a funtinal design was reated and the nsumer healthare website was established fr TTUHSC. 26

35 CHAPTER IV USABILITY TEST Intrdutin The main purpse f this usability test is t determine hw users interat with the TTUHSC Family Mediine Cnsumer Healthare webske prttype. The infrmatin btained will be used t make hanges t the website t unprve usability. This test will be used t llet mfrmatin n hw the users interat with websites. Sme this is a prttype f the ske, the test nly vers issues relevant t the prttype. I am nerned with hw well the users interat and an use the ske menu. Are the users able t find the infrmatin and is the prttype intukive? Sme the prttype an nt inlude tpis f mterest t all nsumers, I will nt test the relevany f the ntent. Instead, I will test whether the users were able t aess the infrmatin and if they uld understand the mfrmatin that is there. One f the hallenges f testing a site like this is trying t mdel the situatin as best pssible. It wuld have been diffiult t find nsumers mterested nly in the infrmatin that was available in the prttype ske. Sine this was nt f nern, I did nt try t find nsumers wh wuld speifially use this mfrmatin. Als, the ideal envirnment uld als nt be dupliated. As the researh suggests, ne f the benefits f the Wrld Wide Web is that nsumers feel a sense f privay in aessing infrmatin. Als, mst nsumers aess this infrmatinfrmtheir wn hme. It was nt pssible t dupliate this situatin. In addkin, the nsumers' privay was handiapped beause an bserver sat lse by wathing and rerding ntes. Obviusly the testing ndkins were nt ideal representatins f the typial health infrmatin aess senari. 27

36 Frm the researh lleted during this test, the website will be updated t imprve ks usability. Methdlgy The test was nduted ver tw days and tk plae in different latins. Eight partiipants mpleted the test. Fur partiipated in the test m English 208, a PC lab. The ther fur were tested m the Engineering Center. The fur tested in the Engineering Center als partiipated m a simukaneus study n usability testing. The test nsisted f three main parts: a pre-test questinnaire, the perfrmane test, and a pst-test questinnaire and debriefing. The pre-test questinnaire inquired abut the partiipants' mputer experiene, speifially abut their use f the Wrid Wide Web. In addkin, the pre-test questinnaire ntained questins abut the users' experiene f researhing health infrmatin n the Wrid Wide Web. The perfrmane task nsisted f the fllwing tw senaris: Senari #1 Yu are taking are f yur usin's infant baby girl wh is suffering frm a ld. Yu have a few questins abut hw t take are f her until yu an get in t see the dtr. Starting at the hme page, find mfrmatin abut the mmn ld imder the hildren's health setin. One yu have read the infrmatin, then return t the hme page f the site using a navigatinal tl f yur hie. Senari #2 Yu have heard abut an utbreak f a disease in Lubbk and yu want t knw mre abut it. Using the site menu, find the disease in the znti diseases setin. Read abut the disease, and then return t the ske hme page using the ske menu. 28

37 The gal f senari #1 was t test if the partiipants uld nt nly find mfrmatin abut the mmn ld in the hildren's health setin, but if they uld find speifi infrmatin abut infants and lds. In additin, the site menu was tested. The users had t use the ske tfindthe infrmatin, but then they uld use a navigatinal tl f their wn t return t the ske menu. This ptin was used t see whih tl the partiipants preferred. The gal f senari #2 was similar t the first in that the aessibility f the infrmatin was tested. Hw easily the partiipants fund infrmatin abut a disease was f the greatest nern. Als imprtant was hw the users seleted a disease t read. In additin, the users' return t the hme page was mre ntrlled; wuld they use the ske menu as instruted r wuld they revert t anther type f navigatinal tl? During the perfrmane test, I rerded ntes n the partiipants' atins, behavirs and times mpleting eah task. I did nt interfere with the test and did nt rret the partiipants if they made a mistake. One the partiipants indiated that they werefinishedwith senari #1,1 prvided them with senari #2. One they had mpleted the send senari, I began the third phase f the test. The third phase was the pst-test questinnaire and the debriefing sessin. While the partiipants mpleted the questinnaire, I made ntes abut the test and highlighted any questins that I had fr the debriefing sessin. One the partiipants had mpleted the questinnaire, the debriefing sessin began. The partiipants had thefirstpprtunity t express pinins and ask questins. Frm there, I reviewed bth questinnaires and asked them speifi questins abut the test's main issues. I als queried the users abut any respnses n the questinnaire that I wanted t 29

38 pursue. One I felt hke I had gathered and larified all the infrmatin, the partiipant was allwed t leave. Resuhs Cntent All eight partiipants fund the requested infrmatin in senari #1. Hwever, ne partiipant did ntfindthe infrmatin in senari #2. He aessed the znti disease setin, yet he never aessed the list f diseases. He did read the infrmatin n the znti diseases main page as if lking fr a lue as t where the mfrmatin was. One he finished with this page, he returned t the ske page, never aessing the disease list. Of the seven wh did suessfullyfindthe infrmatin, nly three seleted just ne disease t read as the senari had instruted. The ther fur read mre than ne. All eight partiipants understd the infrmatin presented t them. One fek that sme f the infrmatin uld be augmented with supplemental infrmatin. Navigatin Navigatin prved t be interesting in the resuks. Three f the partiipants never returned t the ske hme page at the end f bth senaris. These three all used the brwser navigatinal tls in trying t navigate bak t the hme page. Of the five wh did return t the hme page, tw had diffiulty infindingthe link m the menu Ust. Thus, nly three ttal partiipants suessfully ended bth senaris by returning t the hme page and by using the site menu. Anther issue that I tested ame as a preferene f tpi navigatin. One f the pst-test questins queried the partiipants as t whih setin they preferred: hildren's health r znti diseases. In the hildren's health setin, the ske menu 30

39 expanded and revealed the tpis under the setin heading. In the znti diseases setin, the diseases were listed n ne page. The site menu listed this page as "List f Diseases." The diseases page had all f the diseases listed as anhrs t the diseases listed n the page. Five f the eight (62.5%) users prefen-ed the hildren's heakh rganizatin f tpis. During their debriefing sessins, tw f the partiipants mentined that they liked having the list stati s that they uld "jump" t the mfrmatin. One f these tw partiipants went n t explain that bth navigatinal tls were useful sine bth aided her in btaining the infrmatin she needed. Cinidentally, during the perfrmane f senari #2, fur f the partiipants preferred srlling thrugh all f the infrmatin rather than using the list f anhrs. Tw f the partiipants realized during their srlling that the list at the tp wuld take them t the pint that they needed. Disussin Cntent All f the partiipants, exept ne, fund the infrmatin that they needed. During the pst-test, all were able t rerd sme f the infrmatin they aessed. All f the partiipants als understd the terminlgy. Sme suggested tpis that they wuld Hke t see n the ske. This infrmatin will be passed n t the ske prviders as ptential future ntent tpis. Fr the purpses f the test, the researh questins were suessfully answered. Fr the infrmatin that was present, all f the partiipants were able t understand the infrmatin. Even thugh ne partiipant never btained the infrmatin in senari #2, he did enter int the rtet setin. Beause f the resuks, the ntent will nt have t be adjusted. 31