Hans C. Ossebaard*, University of Twente, RIVM (National Institute for Public Health and the Environment), Enschede/Bilthoven, Netherlands Track: Research Presentation Topic: Usability and human factors on the web Presentation Type: Oral presentation Submission Type: Panel Presentation Building: MECC Room: Auditorium 2 Date: 2010-11-30 02:00 PM – 02:30 PM Last modified: 2010-09-21

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Background
The Dutch national health and care portal is a government funded provision to enable and encourage people to make informed decisions in health, health care and health insurance. To enhance its usability for chronic patients, presumably a growing part of the portals’ audience, we conducted a detailed study among chronic patients and their fellows or informal carers.

Objective
The aim of this small sample size usability study was to observe people using the site in as realistic a situation as possible to discover how well it is used for its purpose. Research questions concern the participants’ evaluation of usability in terms of e.g. acceptability, accessibility, empowerment, satisfaction etc. and their evaluation of content in terms of understanding, usefulness et cetera.

Methods
For three high-prevalent chronic diseases - arthritis, asthma and diabetes - participants were recruited. Five patients and two of fellows per disease were randomly selected. All of them having frequent Internet experience while their knowledge of the portal was neglectable. Subjects were interviewed and tested; their background variables were recorded and their eHealth literacy was measured. The experiment further involved a 45-minutes scenario wherein subjects perform a number of navigational or search & find tasks using the portal while thinking aloud as observers watch, listen, interact, record and take notes. Scenarios provide insight into obstacles subjects may experience even if they cannot find the proper wording. The execution of the scenarios was audiovisually recorded using screencapture software (FastStone Capture 6.3) to enable analysis. Each task was followed by evaluative questions on navigation and information. The last part involved a semi-structured interview based on the Website Evaluation Questionnaire to find out the subjects experience of the portal’s usability. The outcomes were subjected to a focus group of participants in order to construct recommendations for improvement.

Results
Participants do not plainly and successfully complete a scenario. This varies over different information categories e.g. medical information, health insurances, or medicines. Most respondents have the skills and interest to deal with health information and the Internet. Only 40% however, believe the information is reliable enough to use for personal health decisions. Two basic search strategies and their combination have been studied. ‘Orienteering’ is the basic search strategy most subjects used: 65% of participants use only e.g. menu functionalities to complete a scenario in stead of e.g. the free search option. 22% use ‘teleporting’ only while in the rest of cases combinations were applied. Both strategies lead to equally successful results though the amount of actions in orienteering is much higher. This less efficient method is probably induced by the semi-structured browsing tasks and the design of the site where the free search function is less conspicuous. The analysis of verbal expressions from the protocols and the interviews were analysed as well as results form the focus group sessions.

Conclusion
Based on the study outcomes we are able to construct and present practical guidelines for usability of on line health information for chronic patients.