The Internet provides an extraordinary opportunity for adults 60 years or older to access online health information. It has become an important resource for those suffering from chronic illness who have difficulty accessing health information through traditional channels-whether it be because they are homebound or live in rural or remote areas. Providing online health resources, however, does not guarantee that older adults will be successful at understanding the information they access. Web sites that do not meet the online needs of targeted users may pose virtual barriers that prevent these information seekers from attaining their goals.
Web-design factors, such as font sizes and styles, foreground and background colors, patterned backgrounds, complex navigational schemas, and nonstandard search mechanisms, may prevent older adults from taking advantage of online health resources. Figure 1 illustrates these types of design issues as found on the Hawaii state government site (www.state.hi.us/dhs, accessed July 6, 2004).
Information content may pose reading-comprehension barriers by not accounting for visual acuity, cognitive abilities, and education levels of the older-adult population. In addition, ethnic elderly with low English proficiency might find it difficult or impossible to comprehend non-translated content. Web-site performance may also play a role in obtaining health resources, as those older adults relying on slower network-access speeds may become frustrated with lengthy page download times.
This study assessed 125 state-government, commercial, and nonprofit Web sites for potential usability barriers facing older adult users. Senior-friendly Web-design guidelines, put forth by the U.S. National Institute on Aging (http://www.nlm.nih.gov/pubs/checklist.pdf), were used to assess Web designs. These guidelines do not specify acceptable download times nor appropriate reading-grade levels for written content. As such, Web usability and health-literacy guidelines were also used to support these components of the assessment process. The home page was the basis for this study, as it is the portal to all resources made available on the site.
The results of the study demonstrate that there are significant barriers facing older-adult users in search of online health information. Approximately 93 percent of the sampled sites used font sizes smaller than 12 points for Web content, negatively affecting the readability of the site. Approximately 38 percent of the state-government sites studied required the use of mouse technology for navigational purposes, posing a barrier for those with unsteady hands or lost finger and hand dexterity. The median download time for all sites was over twice the recommended ten-second guideline , thus requiring lengthy wait times. Only 12 percent of the sites offered a Spanish version, many of which contained English text. Approximately 33 percent of sampled sites required a college education to comprehend extracted health information, which is far beyond health organization's recommended sixth-grade reading level.
Dr. Shirley Ann Becker (firstname.lastname@example.org) is Professor of MIS and Director of the National Center for Small Business Information at Florida Institute of Technology's School of Management.
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