Health problem solving by older persons using a complex government web site: Analysis and implications for web design

A large number of health-related Web sites currently exist that offer consumers a wealth of information that can be used to enhance the quality of their lives. Much less attention has been given to Web sites that can support complex health-related problem solving, as opposed to more general information search activities, of user populations such as older adults. In this article, we expand on a prior usability study that examined the performance of 112 older adults who were asked to solve two problems using the U. S. government's Medicare.gov Web site. The indications from that study were that older adults had difficulty carrying out these problem-solving tasks. This article illustrates, in the context of a case study, the use of a structured methodology for obtaining insights into Web site design issues that could make it difficult for healthcare consumers such as older adults to solve health-related problems. Initially, a number of Web design guidelines that have been developed for older users are presented. The argument is made that such checklist-type guidelines, though essential, are difficult to apply to complex Web-based problem-solving activities. Following a review of research in the area of Web-based health information seeking and problem-solving by older adults, the description and implementation of a methodology for aiding designers in anticipating cognitive demands that older users might confront during their problem-solving activities is presented. Detailed analysis of task performance is then presented to demonstrate that very few of the study participants were able to successfully negotiate the solution to the problem. The use of the methodology for identifying a number user-Web site interaction issues and for proposing recommendations particularly relevant to older users, and ultimately for enhancing the accessibility of health Web sites, is highlighted. Finally, a detailed framework is presented that is intended for guiding designers in the application of this methodology. © 2011 ACM.