Form 1 NLM MedlinePlus Usability Testing ICR Instrument

OMB Control Number: 0925-0648

Expiration Date: March 31, 2018

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

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Section 1 – Introduction and preliminary discussion

Thank you for participating in this study of a health information website. We are very interested in learning how to make this website as easy to use as possible. We have a list of activities to try out on this web site. We will watch you go through the website today and try out different features in order to figure out what parts of the website are easy to use, and what parts of the website need to be improved.

Some key things to remember as we go along today:

• There are no right or wrong answers. I am not testing you or your knowledge.

• What I am concerned about is how to make this website easier to use, so that users like you can get the information you need.

• I am interested in your thoughts and opinions as we proceed. So please “think aloud.”

• I did not create the site, so please feel free to be as positive or as negative as you want.

1. Section 2 – Task Completion

Task 1: Impression of search results

Before we go into the website, let’s talk first about how you might search on Google for health information. Imagine that you found out that a friend has high blood pressure and you want to find out more about what high blood pressure is and what your friend can do about it.

[Present simulated Google Search Page Image.]

So you did a search for “high blood pressure” and you saw these results. Take a look at the results and tell me which result you might click on first, and why.

If that didn’t have what you wanted, which result might you click on second?

Now, I’m going to show you what each of these two links goes to. Take a look at both pages and then tell me which of the two pages you prefer and why.

Open two separate tabs going to and vary which page is shown first.

Health Topic Page: https://www.nlm.nih.gov/medlineplus/highbloodpressure.html

and

Encyclopedia page: https://www.nlm.nih.gov/medlineplus/ency/article/000468.htm

How is the purpose of these two pages the same? How is it different? Which page do you prefer, and why?

Logging notes:

• Which Google result(s) are users most likely to click on and why?

• On first look, are Health Topic Pages or Encyclopedia pages preferred more and why?

Rotate Tasks 2, 3 and 4 to compare comprehension of these different sources w/o ordering bias.

Task 2A: Comprehension of Health Topics Page Navigation

Take a look specifically at this page – show screen shot of “on this page” section only from:
https://www.nlm.nih.gov/medlineplus/highbloodpressure.html

Let’s look at these links but don’t click on anything just yet. My question for you now is, what would you expect to see if you would click on certain section titles:

Alternate which list of five is used by participant:

List 1

• Start Here

• Specific Conditions

• Genetics

• Reference Desk

• Patient Handouts

List 2

• Summary

• Prevention and Risks Factors

• Living With

• Related Issues

• Find an Expert

Take them to the actual page now.

Go ahead and scroll down this page – as you look at the different sections on this page, tell me which sections would be most helpful in giving you more information about high blood pressure. Why do you think those sections would be helpful?

Test administrator to probe as necessary to verify comprehension.

Do all of the links on this page go to other pages that you need to read, or are there links that go to information about high blood pressure that you can get in other ways?

Alternative question (ask instead if needed): Let's look at all of the links on this page. What do you think you would see, in general, if you clicked on these links? Would you see pages full of information to read? Pictures? Checklists?

If still not clear, probe further: What do you think these little blue icons represent?

Logger notes:

• Which sections stand out to them the most?

• Do they notice the medical encyclopedia links?

• Do they notice the related health topics links?

• Do they realize that most links on the body of the page go to external websites while links in the right hand column Encyclopedia and Related Health Topics stay in this site? Do they care?

• Are they attracted to easy to read links?

• Do they notice videos?

Disclaimer notes are out of scope on Health Topic pages, as are Languages and NIH MedlinePlus Magazine (on pages where these exist.)

Task 2B: Comprehension of a Health Topics Page Content

Now let’s take a look specifically at this summary – show screen shot of “Summary” section only from:
https://www.nlm.nih.gov/medlineplus/highbloodpressure.html

Take a look at this summary section. Please read it and then I’ll ask you some questions.

How can a doctor tell if you have high blood pressure? Answer: Get a reading of 140/90 or higher.

What should you do if you have high blood pressure? Answer: healthy lifestyle, exercise, DASH diet, medication

If you have high blood pressure, what health problems are you at risk for? Answer: stroke, heart failure, heart attack, kidney failure

Do you know what the DASH diet is? How could you find out? Answer: click on the “DASH diet” link in the summary

Logger notes:

• Assesses comprehension of this page’s summary paragraphs content.

Task 2C: Comprehension of Labels in “Start Here”

Now let’s take a look at the “Start Here” section. Tell me which of the following you would click on first and why.

Test administrator to probe as necessary to verify comprehension.

Is there anything you would want to change about how this section looks? Could this section be more helpful?

Logger notes:

• Which links are they most attracted to and why?

• Are they attracted to easy to read links?

• Do they notice the organizations (e.g., American Academy of Family Physicians)? Do they use the organization information to make decisions?

• Does there appear to be any confusion about which links will be most useful/helpful to them?

Task 3A: Comprehension of Encyclopedia Page

Now take a look specifically at this page:

https://www.nlm.nih.gov/medlineplus/ency/article/000468.htm

Go ahead and scroll down this page – as you look at the different sections on this page, tell me which sections would be most helpful in giving you more information about high blood pressure. Why do you think that section(s) would be helpful? Are there any sections that don’t seem useful to you? Why?

Test administrator to probe as necessary to verify comprehension.

Logger notes:

• Which sections stand out to them the most?

• Do they seem to understand what the sections are for?

Task 3B: Comprehension of Content on Encyclopedia Page

Now let’s take a look specifically at the [ITERATE THROUGH ONLY THE THREE BELOW]. Please read it and then tell me what it says in your own words. After they describe in their own words, ask them the following questions.

• Causes section

  • What is high blood pressure called if it is caused by something like pregnancy?
    Answer: Secondary hypertension

• Symptoms section

  • If you have high blood pressure, when are you also likely to have nausea or vomiting? Answer: This is likely if you have malignant hypertension.

• Treatment section

  • Why should you reduce your stress?
    Answer: It will help you control your blood pressure (or pre-hypertension) and reduce risk of complications.

Logger notes:

• Assess comprehension compared to health topic page and video

Let’s now go to the home page of this health information website. Go ahead and show me how you would do this.

Do they know that the logo or breadcrumb can be used to go home?

Task 4: Findability and Comprehension of Video

Now, let’s say you are on the home page, and you’d like to go ahead and find a video about blood pressure.

If they try to use search to find the video, ask them to just click through from the page instead.

Path: Videos & Tools > Health Videos > Blood Pressure

I’d like you to watch this video. When we are done, I’d like you to explain to me what the key points are of the video.

Tell me what you’ve learned from the video in your own words. What information felt most useful to you? Was there anything the video talked about that seemed confusing?

Note: Video should work on Chrome by the time of testing, but should be tested first.

Allow them to re-watch the video to answer questions but make sure not to spend too much time on rewatching to the exclusion of other tasks.

At what two points is blood pressure measured? Answer: When the heart contracts and when the heart relaxes?

What would a normal blood pressure be? Answer: 115/70

Why is it important to have a healthy blood pressure? Answer: To get blood to your tissues and organs (to your body).

Logger notes:

• Do they know to go to the videos and tools page?

• Do they understand that they need to then go into health videos?

• Do they go back to the video or do they look at the overview?

• Assess comprehension compared to health topic page and encyclopedia article

Task 5: Navigation

Knowing that there are three ways to learn about high blood pressure: a video, the first webpage we looked at on high blood pressure, or the second webpage we looked at on high blood pressure, which of the three did you prefer and why?

In real life would you prefer only to look at [preferred] or do you think that you would want to look at one or two of the other ways to learn about high blood pressure?

Open up the three types of pages as separate tabs (so they can’t go back) and ask:

For Encyclopedia article and video link ask:

From this page, how do you get back to the health topics article?

For Health Topics page ask:

From this page, how do you get to the video?
Then take them back: And now how do you get to the encyclopedia article?

Then, take them back (if not discussed previously) and ask:

What do you think the Related Health Topics in the right column are for? Did you notice them at first?

What does “Medical Encyclopedia” here mean to you?

Logger notes:

• Do they understand how to navigate between pages? Any method of click-through they use is acceptable, except search. (back button will be effectively disabled by starting a clean window/tab)

Task 6A: Main Navigation: Drugs and Supplements

Where would you go to learn more about the medicine called Advil?

Drugs and Supplements is the correct answer. No need to navigate further as we are only testing the main navigational label here and will avoid bias with task 6B.

If they start using search instead, let them use search and skip to Task 6B before returning back to this task. Then take them back to the main MedlinePlus page and ask them to now find out about Advil without using search.

Logger notes:

• Do they understand main navigation headers?

• They pass when they recognize that the Drugs & Supplements link in the header will get them there. If they go home and use the left topics that mirrors the top navigation to get to the right place, that is considered a pass.

Task 6B: Internal Search for Brand Name Drugs

If 6B was not completed during 6A, take them to the MedlinePlus home page and then ask:

Advil is a pain reliever you can buy in drugstores. Let’s say you read a page on Advil you found through that Drugs & Supplements page but felt that it didn’t answer what you wanted to find out about Advil. How could you search this website to see if this website has more information related to Advil that wasn’t on that page?

If they acknowledge internal search, prompt them to go ahead and search. If they do not notice internal search that is a failure, however they should still be prompted to use it in order to assess results.

Once they see a list of results: Take a look at the links and see which links you would want to click on although don’t actually click just yet. Which links would you want to click on? Why did you choose those links?

Logger notes:

• Do they recognize internal search?

• Do they understand the results that they see? Is there any confusion about the generic term “Ibuprofen” coming up so frequently in search results?

Task 6C: Main Navigation: Health Topics

Starting at this point, where would you go if you wanted to learn about fitness?

Health Topics > Fitness and Exercise

If they start using search, ask them to try to find information about fitness without using search.

Logger notes:

• Do they understand main navigation headers?

• They pass 6C when they recognize they need to go through Health Topics>Fitness & Exercise (under Health and Wellness column) or if they use the same approach from the left side of the home page.

Task 7A: Findability of sharing/updates options (DAY 1 & 2) (As time permits)

If you thought this web page would be helpful to your friend who has high blood pressure, how would you let him or her know about it?

If you wanted to email it to him or her, could you do that right from this page?

Assess whether they notice the social media icons and then ask: Without clicking – just by looking at them – what do you think that each of the icons here would be used for?

Logger notes:

• Do they notice/understand the email this page and social media icons at the top?

• Is using email to share this information likely? Would they print the page instead, or read it to the friend? Which of these tools would they be likely to use?

Task 7B: Findability of email updates (DAY 3 & 4) (As time permits)

Bring up a health topic page.

Let’s say you wanted to know every time new information is added to this web page. How might you do that?

How would you sign up to get an email alert anytime new information has been added?

Logger notes:

• Do they notice/understand the Get email updates at the bottom of the page?

• Would they be likely to use email to get updates? What is their preferred method of staying current?

Task 8A: Comprehension of a Topiclette (As time permits)

Start at: https://www.nlm.nih.gov/medlineplus/flushot.html

I’d like you to review the information in the summary section about flu shots and then I’m going to ask you some questions.

What would you do if you want to get a flu shot but are afraid of needles? Answer: Get the nasal spray.

How does the flu vaccine keep you from getting the flu? Answer: Causes antibodies to develop in your body.

How many times in your life should you get a flu shot? Answer: Every year

As time permits: For participants who expressed appreciation of any aspect of the high blood page, open up https://www.nlm.nih.gov/medlineplus/highbloodpressure.html again and probe about what they would do to find those same things about the flu shot.

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