“Using Cognitive Aging and Vision Research to Develop Senior-friendly Online Resources” *************** Stephanie Dailey

1. “Using Cognitive Aging and Vision Research to Develop Senior-friendly Online Resources” *************** Stephanie Dailey Educational Research Specialist National Institute on Aging

2. NIH Senior Health. gov: A Research-based Design

3. Overview • This presentation describes the research on which the design of the NIH Senior Health web site is based. • Also shown are the web site’s senior-friendly features and the ways in which they address the cognitive and visual changes that typically occur with aging.

4. What is NIHSeniorHealth? • A web site that presents aging-related health information in a senior-friendly format. • A joint project of the National Institute on Aging (NIA) and the National Library of Medicine (NLM), both part of the National Institutes of Health (NIH). • Based on NIA’s cognitive aging research. The web site has also been tested with groups of older adults to ensure that they can easily use it.

5. NIHSeniorHealth represents an NIH partnership involving: The National Institute on Aging (NIA) Providing research on cognitive aging and subject expertise on aging-related diseases and conditions. The National Library of Medicine (NLM) Providing expertise in effective information delivery and “best fit” technology. Other NIH Institutes Providing subject expertise on aging-related diseases and conditions.

6. What makes a web site senior friendly? • A senior-friendly web site is one where people 60 and older can easily see, comprehend, remember, and navigate the information.

7. Why do older people need a senior-friendly web site? • Research funded by the National Institute on Aging has shown that visual and cognitive changes among older adults can affect how well they perform in an online environment. 1 1 Craik and Salthouse, 2000; Morrell, 1997

8. How does NIHSeniorHealthaddress these needs? • It includes senior-friendly features that are designed to address the types of cognitive and visual changes in older adults that can prevent them from having a positive online experience.

9. What are the cognitive changes that the web site addresses? • The cognitive changes addressed by the web site design include changes in: • working memory • perceptual speed • text comprehension

10. What is working memory? • Working memory is the ability to simultaneously store and process information. Research shows that working memory declines with aging.2 On the web site, repetition is one of the techniques used to address working memory. 2 Craik and Salthouse, 2000

11. Using repetition helps working memory: Text conveys initial information.

12. Using repetition helps working memory: Video reinforces Text.

13. Using repetition helps working memory: Open-captioning on videos reinforces audio information.

14. Using repetition helps working memory: Quizzes reinforce points made in text.

15. Using repetition helps working memory: Quiz answer repeats original wording from text.

16. Using repetition helps working memory: Content is repeated in question-answer format (FAQ).

17. Re-reading of content also aids working memory: Forward-backward navigation facilitates re-reading.

18. What is spatial working memory? • Spatial working memory is the ability to visualize and recall where objects are located. Research shows that a person’s spatial working memory declines with aging.3 Locating the navigational controls in the same place on each page is one way the web site accommodates declines in spatial working memory. 3 Craik and Salthouse, 2000

19. How the web site addresses changes in spatial working memory: Consistent location of main menu button. Consistent placement of chapter and subchapter buttons. Consistent location of “next page” and “previous page” buttons.

20. What is perceptual speed? • Perceptual speed is the speed at which a person processes information. Research shows that a person’s perceptual speed slows down with aging.4 On the web site, there is no scrolling text, and navigation is always under the control of the user. 4 Salthouse,1993.

21. How the web site addresses changes in perceptual speed: Forward-backward navigation allows user to self pace.

22. What is text comprehension? • Text Comprehension is the ability to understand written text. Research shows that a person’s ability to understand certain aspects of written text -- such as inferences -- declines with aging.5 Plain language, “chunking” of information, and the use of text-relevant images are some ways the web sites addresses changes in text comprehension. 5 Park, 1992

23. How the web site addresses changes in text comprehension: Content written in plain language. Minimal use of passive voice. No inferences. Ample white space directs the focus to the content.

24. How the web site addresses changes in text comprehension: Content presented in short, “chunked” segments. Text-relevant photos aid comprehension.

25. What vision changes are addressed by the web site design? • Vision changes that occur with aging include reductions in the amount of light that reaches the retina, loss of contrast sensitivity and loss of the ability to detect fine details.6 The web site accommodates these visual changes in older adults by using: • A “talking web” that reads the text aloud • Large, sans serif type • Buttons that enlarge text and show high contrast • Dark type against a light background and lots of white space • Large icons 6 Echt, 2002

26. How the web site addresses vision changes: Dark type against a light background provides high color contrast. Talking Web. Higher contrast. Larger type. Large, sans serif type.

27. Testing • The NIH Senior Health web site has been tested a number of times with groups of older people. The ages of the people tested ranged from 60 to 88.7 • Both usability testing and online and in-person focus group testing were used. 7 Morrell, Dailey, and Rousseau,2003

28. Testing • The site was tested to determine how easy it was for older adults to navigate, understand, and read the information presented. • The site was also tested for its visual appeal.

29. Testing • Throughout the many rounds of testing, the writing style and the page layout were consistently rated highly by older users. • Test results pointed to navigation as the area most in need of adjustment.

30. Testing The following screen captures show findings and recommendations from early usability testing.

31. Positive aspects of the design as determined by usability testing on an early version of the site. The information is divided into short concise blocks which doesn’t overwhelm the reader. Top Menus Side Menus Main Text Bottom Menus

32. Positive aspects of the design as determined by usability testing on an early version of the site. The text is large enough for the older adults to read.

33. These recommendations from usability testing on an early version of the web site were incorporated into the design. 1 2 4 3 • The site requires the user take too many steps to access the lower levels of information. • Consider placing the important information higher up in the structure. Consider getting rid of the “Welcome to AgePage” page. Replace the information with the information listed on the “Topics” page.

34. These recommendations from usability testing on an early version of the web site were incorporated into the design. The structure of the site is too deep. In order to get to a list of topics pertaining to the overview of what Alzheimer’s disease is, the site requires 4 clicks from the user. At this point, the user sees another list of topics. Recommendation: Consider reducing the number of steps required of the user to access important information. For example, the middle page between the Home Page and the list of topics is an unnecessary step. There are too many preliminary steps. Put meaningful choices of content higher in the tree structure.

35. Most Popular Topics: 1. Exercise for Older Adults 2. Alzheimer’s Disease 3. Balance Problems 4. Prostate Cancer 5. Lung Cancer

36. Web Site TrafficOct 1 – June 30 • Page Views =  2,375,110 • Unique visitors = 266,260

37. References Craik, F.I.M., and Salthouse, T.A. The Handbook of Aging and Cognition. Mahwah, NJ: Lawrence Erlbaum Associates, 2000. Echt, K.V. Designing web-based health information for older adults: Visual considerations and design directives. In R.W. Morrell, ed. Older Adults, Health Information and the World Wide Web, 61-88. Mahwah, NJ: Lawrence Erlbaum Associates, 2002. Morrell, R.W. The application of cognitive theory in aging research. Cognitive Technology, 2 (1997): 44-47.

38. References (contd.) Morrell, R. W., Dailey, S. R., & Rousseau, G. K. (2003). Commentary: Applying Research: the NIH Senior Health Project. In N. Charness & K. W. Schaie, (eds), Impact of Technology on Successful Aging (pp. 134 - 161). New York: Springer Publishing. Park, D.C. (1992). Applied cognitive aging research. In F.I.M. Craik & T.A. Salthouse, (Eds.). Handbook of Cognition and Aging. (pp. 449-493). Mahwah, NJ: Lawrence Erlbaum Associates. Salthouse, T.A. (1993) Speed Mediation of Adult Age Differences in Cognition. Developmental Psychology, 29, 722-738.

39. Visit NIHSeniorHealth at www.nihseniorhealth.gov