Table 1.
Lessons Learned for eHealth Tool Development for Diverse, Older Adults
| 1. Develop clear objectives and a conceptual framework |
| a. Identify gaps in scientific literature and eHealth landscape to create an innovative solution |
| b. Identify a conceptual framework to guide the content of the eHealth tool |
| c. Conduct ongoing review of current technology standards and regulations |
| 2. Co-create with key community advisors and the target population |
| a. Identify key community advisors from the target population |
| b. Co-create all materials with the target population and key community to tailor to the end user’s unique needs, culture, and language (i.e., transcreation) |
| c. Base tech/content decisions on target population needs, not only eHealth conventions |
| d. Conduct ongoing, iterative user testing cycles with users from the target population |
| 3. Optimize design and layout for accessibility and ease of use |
| To address limited literacy, limited health literacy, and/or cognitive impairment, use clear health communication best practices: |
| a. Target text to the 5th-grade reading level and avoid jargon |
| b. Use short sentences of no more than 8–10 words in the active voice |
| c. Ensure white space for ease of review of page content |
| d. Ensure key content is listed first and is most visible on each webpage |
| e. Use non-text multimedia (e.g. pictures, videos, icons, colors) chosen by the target population that help explain the text |
| To address visual impairments (also helpful for limited health literacy and/or cognitive impairment): |
| f. Ensure text is large and readable, e.g. equivalent to 14-pt printed font or larger |
| g. Use a high contrast text color scheme, e.g. black text on white background |
| h. Offer speak aloud narration for text |
| To address hearing impairments: |
| i. Offer closed captioning for video content |
| j. Offer text scripts of video content |
| 4. To address limited computer literacy, use a simple navigation design |
| a. Ensure core navigation elements stand out, such as large intuitive buttons, with clearly labeled actions, such as “next” or “click here” |
| b. Decrease scrolling if possible |
| c. Use limited, standardized formatting and navigation labels throughout the eHealth tool |
| d. Provide a linear option through the program for passive users, such as a step-by-step navigation process |
| e. Provide a non-linear option for active users to skip to desired content (e.g., menus) |
| f. Use progress indicators, such as progress bars |
| g. To prevent users getting lost, avoid links that skip to other parts of the program |
| h. Get users to the key content with as few barriers and clicks as possible, such as not requiring users to sign in |
| 5. Use actionable information to enhance behavior change |
| a. Consider adhering to behavior change theories and techniques to engage users |
| b. Consider “how to” content and videos that model the health behavior of interest |
| c. Consider offering users the ability to create an action plan to follow up on desired behaviors |
| d. Tailor information based on users interest and personal experiences |
| 6. Provide accompanying written materials that align with the eHealth tool |
| a. Follow clear health communication principles for text/layout (see Lesson 3) |
| b. Align formatting, layout, and multimedia with the eHealth tool |
| c. Decrease access barriers to materials, such as not requiring users to sign in |
| 7. Create tracking mechanisms for ongoing input and feedback |
| 8. Consider the sustainability of the eHealth tool |
| a. Consider funding sources, ownership/copyright, and marketing. |
| b. Consider design decisions that may affect complexity and cost (e.g., providing static education versus an interactive platform, etc.). |