Table 1. Summary of reviewed articles.
| Primary author [year] | Objective(s) | Sample description | Methods | Results re. health literacy level | Health literacy integration into design | HLO 2016 strategies (2010 strategy*) |
|---|---|---|---|---|---|---|
| Abujarad [2018] | To describe how an mHealth tool was designed, developed, and evaluated for advancing the informed consent process | Connecticut, USA N=14 Patients and researchers from an asthma clinic and a university institutional review board member Age: 21–74 years 55.7% female 66.7% white 77.8% Bachelor+ |
Development and evaluation of app User-centered design methodology Focus groups, pilot of app General literacy Literacy tool: not used |
Not reported | Desired reading level was at 8th grade level | 2.6: Write in plain language |
| Text-to speech translation is a key feature of VIC and is achieved by online and automated text-to-speech translation | 3.11: Make your site accessible to people with disabilities | |||||
| Text-to-speech interfaces addresses literacy issues and makes the IC process an option for inexperienced computer users | 5.1: Share information through multimedia | |||||
| Bahadori [2020] | To assess the readability of the information provided within total hip replacement and total knee replacement apps to understand more about the impact this could have on patients | Location: UK N=15 apps |
Systematic review of apps General literacy GFI, FKGL, FRES |
Only one app reached “easy to read” criteria across all three indices | Consider specific needs of target population | 1.2*: Understand their motivations |
| Target a GFI and FKGL of 6 and FRES of 70 | 2.6: Write in plain language | |||||
| Decrease number/length of sentences | 3.1: Limit paragraph size. Use bullets & short lists | |||||
| Involve patients in app development and user acceptance testing | 6.1: Recruit users w. limited literacy/health literacy skills | |||||
| Monitor patient experience to see if readability needs to be improved | 6.4: Test whether your content is understandable and actionable | |||||
| Ben-Zeev [2013] | To describe the development of a smartphone illness self-management system for people with schizophrenia. | Illinois, USA N=8 Practitioners from a psychiatric rehabilitation agency Age: not reported Sex: not reported Race/ethnicity: not reported Education: not reported |
Development of app Survey, focus group General literacy Literacy tool: not used |
Not reported | Apps and technological systems must be usable by people with low literacy levels and cognitive impairments | 1.1: Reading & cognitive processing challenges |
| Deploying existing mHealth resources intended for the general population may prove problematic | 1.4: Mobile considerations 6.1: Recruit users w. limited literacy/health literacy skills 6.4: Test whether your content is understandable & actionable |
|||||
| Bender [2016] | To describe promoters’ and health care providers’ current practices and experiences disseminating health education and perceptions regarding visuals promoting physical activity and limiting sedentary behavior for a visually enhanced low-text mHealth app | Location: California, USA N=21 Eligibility: bilingual healthcare providers in low-income Latino communities Age: mean 41.2 years 86% female Race/ethnicity: not reported Education: not reported |
Evaluation of app Focus groups, qualitative interviews Health literacy Literacy tool: not used |
Not formally assessed in clinics, but difficulty frequently observed in ad-hoc assessments Limited health educational materials with visual aids exist |
Use visuals with simple text and culturally tailored themes and imaging | 3.8: Use images that help people learn |
| Make sure the meaning of your image s clear to all users | ||||||
| Formalize health literacy measurements | NA | |||||
| Boyd [2015] | To describe the design, methodology, limitations, and results of the MyIDEA tablet app | Illinois, USA N=5 Advisers of drug-eluting stent patients Age: not reported Sex: not reported Race/ethnicity: not reported Education: not reported |
Development of app App development Health literacy Literacy tool: not used |
Identified by 5 patient advisors as a key attribute of the patient population | Write text at a sixth-grade reading level and provide narration as an additional method for individuals with low literacy to understand text-based information | 2.6: Write in plain language |
| Include audio and images as supplemental information for people below a sixth-grade reading level | 3.8: Use images that help people learn | |||||
| Casey [2014] | To explore patients’ views and experiences of using smartphones to promote physical activity in primary care | UK N=12 Smartphone owners Age: 17–62 (mean 42) years 75% female Race/ethnicity: not reported Education: not reported |
Evaluation of app Interviews Smartphone literacy Literacy tool: not used |
83% had emailed on phone, 33% had downloaded apps previously | Reduction, or simplifying a task to influence behavior, was evident by the reports that the app was easy to use, required basic numerical literacy, and was highly visible on the home screen | 4.1: Create a simple & engaging homepage 4.2: Label & organize content with your users in mind 4.3: Create linear information paths 4.7: Provide easy access to home & menu pages |
| Ceasar [2019] | To utilize focus groups for gathering qualitative data to inform the development of an app that promotes physical activity among African American women in Washington, DC | Washington DC and Maryland, USA N=16 African American women in low-income areas of Washington DC Age: 51–74 (mean 62.1) years Bachelor+: 63% |
Development of app Focus group Technology literacy Literacy tool: not used |
Technology literacy identified as a perceived barrier towards using apps to promote physical activity | Use focus groups as a collaborative tool to inform app development | 2.1: Identify user motivations and goals. 6.1: Recruit users with limited literacy skills 6.4: Test whether your content is understandable and actionable |
| Increase relatability with local information | 5.3: Provide tailored information | |||||
| Check-ins or IT support to address technical difficulties | 6.4: Test whether your content is understandable and actionable 6.8: Test on mobile |
|||||
| Chaudry [2013] | To (1) determine whether the interface design can help a low literacy population accurately estimate portion sizes of various liquids; and (2) to confirm the successful results of our previous study when the interface is high fidelity |
Indiana, USA African American patients with chronic kidney disease Study 1 (n=10): mean age 58 years, 40% female Study 2 (n=18): mean age 53 years, 72% female Education: not reported |
Development and evaluation of app Health literacy REALM |
Literacy only assessed in study 1 because participants were embarrassed to complete the test in front of peers 6/10 patients read below a 9th grade level People with varying literacy skills were able to comprehend and navigate the design of the interface to search and select specific portion sizes |
Recommend using literacy tests other than REALM to reduce discomfort when speaking aloud | 1.1: Reading and cognitive processing challenges 6.2: Identify and eliminate logistical barriers to participation |
| Connelly [2016] | To provide a case study of design of an ecological momentary assessment mobile app for a low-literacy population. | New York, USA N=41 Farming population of Mexican American women, primarily Spanish speaker, none completed college Ages: 18–45 years for Phases 1–3, mean age 28.8 years for Phase 3 |
Development and evaluation of app Focus groups Health literacy SAHL-S&E, NVS |
Phase 1: Mean SAHL 16.1, 3/8 women scored as low literacy, all women struggled to complete tasks Phase 2: Literacy not assessed Phase 3: Mean SAHL 14.2, 4/11 women scored as low literacy. Mean NVS score of 1 Phase 4: 5 of 7 participants had low literacy skills |
Differences in health literacy better identified with NVS than SAHL with usability best tested in situ | 1.1: Reading and cognitive processing challenges 6.3: Create plain language testing materials |
| Interface has larger pictures with short labels and could be read aloud | 3.8: Use images that help people learn | |||||
| Mobile app focus groups to explore app design | 6.1: Recruit users with limited literacy skills | |||||
| Provide a case study of design of an ecological momentary assessment mobile app for a low-literacy population | 6.4: Test whether your content is understandable and actionable | |||||
| Iterative, user-centered design process with focus groups was essential for designing the app rather than merely replacing words with icons and/or audio | 6.4: Test whether your content is understandable and actionable | |||||
| Coughlin [2017] | To develop an app to provide women with information about how they can reduce their risk of breast cancer through healthy behaviors. | Washington and Georgia, USA N=5 Women interested in breast cancer risk reduction Age: not reported Race/ethnicity: not reported Education: not reported |
Development of app eHealth literacy Literacy tool: not used |
Not reported | Varying levels of eHealth literacy will be addressed by using simple navigation features and providing straightforward instructions about how to use the app and connect it to commercially available products | 1.2: Understanding navigation 2.5: Provide specific action steps |
| It will be possible for women to use the app without interfacing with commercial Internet sites | NA | |||||
| Dev [2019] | To present feedback on a family planning app. | Kenya N=42 Postpartum women (n=25) and family planning providers (n=17) from maternal and child health clinic Age: 14–21 years for patients (n=15) and 18–58 years for providers Education: not reported |
Development and evaluation of app Interviews General literacy and technology literacy Literacy tool: not used |
General and technological literacy were seen as potential barriers | Increasing graphics, audio, and video were recommended to overcome literacy barriers | 5.1: Share information through multimedia. 5.2: Design intuitive interactive graphics and tools |
| Dunn-Lopez [2020] | To determine: readability, types of functions, and linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure available in the Apple and Google Play Stores | N=10 apps Inclusion: mHealth apps targeting patients with heart failure in the Apple and Google Play app stores |
Review of apps General literacy FKGL |
Average reading grade level 9.35 Only 1 app had a reading grade level of <6th grade |
Essential elements in providing health literate content at a 6th grade reading level include plain language, short sentences, brief paragraphs, bulleted or numbered lists, and actionable content | 2.5: Provide specific action steps 2.6: Write in plain language 3.1: Limit paragraph size. Use bullets and short lists |
| Fontil [2016] | To (I) adapt the literacy level and cultural relevance of online program content for low-income, underserved populations; and (II) test the feasibility and acceptability of the modified program | California, USA Sample size not reported Low-income prediabetes patients at a large safety net clinic Age: not reported Sex: not reported Race/ethnicity: not reported Education: not reported |
Development and evaluation of app Focus groups Technology literacy Literacy tool: not used |
Not reported | In addition to simplifying overall language, we simplified explanations of scientific concepts, preserving core concepts while improving understandability | 2.3: Describe the health behavior – just the basics |
| To address concerns about the complexity of the curriculum, we adapted the readability level of each lesson (originally 9th grade or higher) to mostly a 5th-grade level or below | 2.6: Write in plain language | |||||
| Creating technical assistance tools for various stages of the program to address lower technology literacy | 6.5: Use moderators who have experience with users with limited literacy skills | |||||
| Gibbons [2014] | To explain health information technology (HIT) universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems | Review study | Reviews of app studies Health literacy, IT literacy Literacy tool: not used |
Not reported | Use disparities-oriented use cases when designing an app | NA |
| Use symbols that have been found to be common across culture | 3.8: Use images that help people learn | |||||
| Include a target population with low health literacy during usability evaluation | 6.1: Recruit users with limited literacy skills—and limited health literacy skills | |||||
| Giunti [2018] | To examine how mHealth can facilitate physical activity among those with multiple sclerosis (MS) and understand the motivational aspects behind adoption of mHealth solutions for MS. | Switzerland Patients with MS and healthcare professionals N=12 patients, 12 professionals Age: 35–62 years for patients, 26–64 years for professionals 50% female Race/ethnicity not reported Bachelors+: 33% |
Evaluation of app Mixed methods: focus group, interview, survey eHealth literacy eHEALS |
Patient eHealth literacy median score 17.75 (IQR 11–28.5) | Personas were created to represent persons with MS at different eHealth and health literacy levels | 3.8: Use images that help people learn |
| Huang [2015] | To enhance foreign visitors’ capabilities in communication during exchange information with local foreign doctors by developing an effective patient-physician communication mobile system | Austria and Taiwan Sample size not reported Foreign students seeking medical care and physicians Age: not reported Sex: not reported Race/ethnicity: not reported Education: not reported |
Evaluation of app Case studies and interviews Health literacy Literacy tool: used but the name of the tool not reported |
Foreign patients scored significantly higher after exposure to eHealth system compared to before the exposure | The voice-to-text bilingual function will be used to assist the patients with low health literacy | 5.1: Share information through multimedia |
| Lord [2016] | To explore provider and staff perceptions of implementation of the A-CHESS mobile recovery support app with clients in 4 addiction service settings | United States N=12 Clinicians and administrators from 4 agencies that serve people with substance use disorders Age: 25–53 years 50% female 91% white Education: not reported |
Evaluation of app Qualitative interviews, deductive analysis guided by CFIR model General literacy and technology literacy Literacy tool: not used |
Not reported | Use speech-to-text functionality to help individuals with low literacy | 5.1: Share information through multimedia |
| Mackert [2017] | To explore the perceived role of men in prenatal health, use of an e-health application, and participant suggested ways of improving the application | Texas, USA N=23 General population of adult males Age: mean 26.0 years 52% white 100% some postsecondary ed |
Evaluation of app Semi-structured interview Health literacy NVS |
Average NVS score 5.3, suggesting the sample had adequate levels of health literacy Can balance between being broad applicability and individualization, regardless of level of health literacy users have |
Need app design to be engaging and interactive, from adding videos and games inside the application, to personalizing the experience, to changing font size and color | 5.1: Share information through multimedia 5.2: Design intuitive interactive graphics and tools |
| Encouraged dynamic personalization allowing users to input personal data | 5.3: Provide tailored information | |||||
| Miller [2017] | To determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid | North Carolina, USA Patients due for colorectal cancer screening N=450 Age: 50–74 years 53.8% female 37.6% African American Education: not reported |
Evaluation of app Secondary usability analysis Health literacy Literacy tool: validated item, “How confident are you filling out medical forms by yourself?” |
36.9% with limited health literacy | Design apps for those with low health literacy and low computer literacy: use a simple interface displaying only one question per screen with large response buttons, similar to what would be found at an automated teller machine or self-checkout kiosk | 1.4: Mobile considerations 5.4: Create user-friendly forms and quizzes |
| Use simple language and include audio narration to assist those with literacy barriers | 2.6: Write in plain language 5.1: Share info through multimedia |
|||||
| Monkman [2013] | To (I) adapt a set of existing guidelines for the design of consumer health Web sites into evidence-based heuristics; and (II) apply the heuristics to evaluate a mobile app | NA | Evaluation of app using heuristics Health literacy Literacy tool: not used |
As the heuristic evaluation yielded valuable recommendations for improving the app, this approach (based on modifying evidence-based design guidelines) to developing heuristics for investigating usability and health literacy appeared to be successful | Although the majority of the recommendations from the HLO guide for Web sites were applicable for assessing mobile usability, the heuristics generated in this study may benefit from being complemented with other evidence-based heuristics specific to mobile devices | 1.4: Mobile considerations 2.2: Put the most important information first 2.4: Stay positive. Include the benefits of taking action. 2.5: Provide specific action steps 2.6: Write in plain language 2.7: Check content for accuracy Category 3: display: 3.1–3.11 Category 4: organize: 4.1–4.10 5.1: Share information through multimedia 5.3: Provide tailed information 5.5: Consider social media sharing options |
| Mueller [2020] | To develop, pilot, and assess a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages | Nepal N=71 Age: mean 40 years Education: informal to bachelor’s degree |
Development and evaluation of app Observation and focus groups Development and field evaluation of a game designed for individuals with low literacy General literacy Literacy tool: not used |
Not reported | Co-design of images with intended population | 1.1*: ID your users. Who are they? |
| Pictogram sets can be switched out for newly designed pictograms that are contextualized and localized to other study areas, countries, or topics | 3.8: Use images that help people learn (choose realistic images) | |||||
| Muscat [2020] | To develop an intervention that addressed health literacy for Australian adults with kidney failure requiring dialysis to promote active patient participation in CKD management and decision-making | Location: Australia No participants other than the research team |
Development of app Health literacy Literacy tool: not used |
Not reported | Calculate readability statistics | 5.4: Create user-friendly forms & quizzes 6.4: Test whether your content is understandable & actionable |
| Apply the Patient Education Materials Assessment Tool | 6.4: Test whether your content is understandable & actionable | |||||
| Supplement written content with audiovisual formats | 5.1: Share information through multimedia | |||||
| Incorporate micro-learning and interactive quizzes | 5.4: Create user-friendly forms & quizzes | |||||
| Improve literacy skills with question prompt lists, volitional help sheets, and skills training | NA | |||||
| Ownby [2012] | To evaluate the extent to which an electronic intervention targeting health literacy and organized by the elements of the Information-Motivation-Behavioral Skills model could improve patients’ health literacy and medication adherence. | Location: Florida, USA N=124 Persons with HIV Age: 20–67 (mean 47.1) years 29% female 63.4% African American, 36.6% white 10.5% college graduates |
Evaluation of app Health literacy TOHFLA |
Mean TOFHLA: numeracy 46.02, reading 42.46, total: 88.48 6 participants with inadequate health literacy, 10 marginal, 108 adequate Intervention led to greater increases in adherence among those with lower numeracy and lower baseline adherence |
Present numeric dosing data in a graphic calendar format | 5.2: Design intuitive interactive graphics and tools |
| Poduval [2018] | To determine whether there was evidence of a digital divide when a Web-based self-management program for type II diabetes mellitus was integrated into routine care | London, UK N=330 Adults with type 2 diabetes Age: mean 58.4 years 44.5% female 45.5% white 48.8% bachelors or more |
Evaluation of app Retrospective analysis General and digital health literacy Literacy tool: not used |
Not reported | Consideration of literacy levels and audio/visual media for usability | 2.6: Write in plain language 5.1: Share information through multimedia |
| Text written for people with a reading age of 12, all essential information was provided in video as well as text format | 2.6: Write in plain language 5.1: Share information through multimedia |
|||||
| Personal stories included | 5.3: Provide tailored information | |||||
| Povey [2020] | To use a participatory design research approach to understand adaptations which might improve the engagement, reach and acceptability of this resource from the perspective of Aboriginal and Torres Strait Islander youth | Torres Strait N=120 Co-design group: Islander youth (n=45) aged 10– 18 years, 47% female, 93% in secondary school Survey: Islander people (n=75), 51% under 18, 60% female |
Evaluation of app Mixed methods, participatory design General literacy and mental health literacy Literacy tool: not used |
Not reported | Engagement via humor, music, vibrant colors, relatable images, and stories about positive change | 2.4: Stay positive. Include benefits of taking action 5.1: Share info through multimedia |
| Audio and intuitive visuals encouraged for lower literacy | 3.8: Use images that help people learn (choose realistic images – photos of “real” people) 5.1: Share information through multimedia |
|||||
| Sustain use with customization, interactive activities, and challenges/records of progress over time and options for sharing | 5.3: Provide tailored information | |||||
| Povey [2016] | To explore Aboriginal and Torres Strait Islander community members’ experiences of using two culturally responsive e-mental health apps and identify factors which influence the acceptability of these approaches | Torres Strait N=9 People identifying as Aboriginal/Torres Strait Islanders who spoke English and did not have a severe level of mental illness. Age: 18–60 years 66.7% female Education: not reported |
Development and evaluation of app Qualitative focus group General literacy Literacy tool: not used |
Not reported | Graphics and animation perceived as supporting motivation | 2.4: Stay positive. include benefits of taking action (give users motivation to make a change) |
| Culturally relevant graphics, voices, animation, and optional short video clips may assist in engagement with content and overcome literacy issues. | 3.8: Use images that help people learn (choose realistic images) | |||||
| Schnall [2015] | To understand the perceived ease of use, usefulness, risk and trust that contribute to behavioral intention to use a mobile app for meeting the healthcare needs of persons living with HIV (PLWH) | Location: New York, USA N=80 PLWH and clinicians/case managers PLWH (n=50): ages 18–59 years, 26% female, 52% Black, 50% Hispanic Clinicians/case managers (n=30): ages 23–62 years, 83.3% female, 56.7% white, 20% Hispanic Education: not reported |
Evaluation of app Qualitative participatory design via focus groups, app evaluation General and technology literacy Literacy tool: not used |
Not measured | App should not rely on internet connectivity | NA |
| Present information with simplicity | 2.2: Put the most important information first 2.3: Describe the health behavior – just the basics 2.6: Write in plain language |
|||||
| Siedner [2015] | To identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and; evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility | Location: SW Uganda N=385 PLWH undergoing CD4 testing and can access a mobile phone Age: median 32 years 65.2% female 10.6% post-secondary |
Evaluation of app Secondary data analysis from randomized clinical trial General literacy Ability to read a complete sentence |
Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda | Coded messages, which obviate the need for literacy, were as effective as direct messages and might augment privacy | 1.1: Reading & cognitive processing challenges |
| In person confirmation of mobile phone competency was highly predictive and should be considered for future similar interventions where possible End-user characteristics, particularly literacy and technology experience are important predictors of an mHealth intervention for PLWH in rural Uganda |
1.1*: ID your users. Who are they? | |||||
| Thorough assessments of end-user written literacy and technology experience should be made before and during implementation design | 6.1: Recruit users with limited literacy skills – and limited health literacy skills | |||||
| Coded messages can have similar efficacy as text messages, while maintaining confidentiality | 6.4: Test whether your content is understandable and actionable | |||||
| Sox [2010] | To create an interface for parents of children with ADHD to enter disease-specific information to facilitate data entry with minimal task burden | Massachusetts, USA N=17 English or Spanish speaking parents who are primary caretakers of a school-aged child with ADHD Age: not reported Sex: not reported Race/ethnicity: not reported Education: not reported |
Development and evaluation of app Needs analysis, usability testing, and performance testing Health literacy TOFHLA |
2/10 participants with lower health literacy (<81) | Alternative text explanations and audio files to support lower health literacy | 5.1: Share information through multimedia |
| Acknowledge tension between expectations of a highly-educated parent and a parent with limited health knowledge | NA | |||||
| Srinivas [2019] | To report a case study involving the design and evaluation of a mobile ecological momentary assessment (EMA) tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior | Midwest, USA N=59 Obese women a referred to HealthyMe program Age: 35–64 years 83% Black, 17% White 61% college |
Development and evaluation of app Focus groups, semi-structured interviews, prototype testing, 2 field trials Health literacy NVS |
59.3% low health literacy | Specific to reducing burden while capturing a user response, we suggest designing a system that uses simple-worded, direct questions with fewer words that are easier to read and quicker for the participant to understand and has simple response options that are easier to read, quicker for the participant to understand and select from | 3.1: Limit paragraph size. Use bullets & short lists 5.2: Design intuitive interactive graphics & tools 5.4: Create user-friendly forms & quizzes |
| Wildenbos [2018] | To synthesize literature on aging barriers to digital (health) computer use, and explain, map and visualize these barriers in relation to the usability of mHealth by means of a framework | NA | Review of app studies Scoping review Computer literacy Literacy tool: not used |
Cognitive barriers impact satisfaction via diminishing age dependent abilities (numeracy & representational fluency) Motivational barriers impact learnability via diminishing age-dependent computer literacy |
Encourage designers, programmers and developers should be to create mHealth interventions with inclusive design, or flexible enough to be usable by people with no limitations as well as by people with functional limitations related to disabilities or old age | 3.11: Make your site accessible to people with disabilities |
| The MOLD-US framework can aid mHealth designers in inclusive design efforts. The visual overview of MOLD-US enables a quick assessment of aging barriers and medical conditions that involve deteriorating capacity | 3.11: Make your site accessible to people with disabilities | |||||
| Wildenbos [2019] | To assess usability problems older patients, encounter in two mHealth apps, aiming show the value of MOLD-US, a recent aging barriers framework, as a classification tool to identify the intrinsic cause of these problems. | Netherlands N=23 Age >50 years, can read Dutch Sex: not reported Education: not reported |
Evaluation of app Case-study Computer literacy Think Aloud method |
28 high severe usability issues of the mHealth apps were identified Core natures were related to motivational and cognitive barriers of older adults Participants had difficulties understanding app navigation structure, missing important text, buttons and icon elements |
Cognitive load should be minimized, i.e., by a clear navigational structure and aligning an interface with expectations of older adults mind | 4.2: Label and organize content with your users in mind |
| Advise to put more emphasis on addressing motivational barriers of older adults within user interface design and guidelines | 1.2*: Understanding their motivations. Why are they here? 2.1: Identify user motivations & goals. Why are they here? |
|||||
| User-interface design elements such as font size and buttons should be adjusted to the older adult user population. | 3.3: Use a readable font that’s at least 16 pixels | |||||
| Advise to involve older populations as co-creators in the requirements analysis and design phases when developing mHealth | 6.1: Recruit users with limited literacy skills – and limited health literacy skills | |||||
| Usability evaluation approaches may need adjustments to prevent reporter bias and become better suited for testing mHealth services with the older adult and chronically ill patient populations | 6.2: ID & eliminate logistical barriers to participation | |||||
| Colored information visuals explaining navigation and consequences of decision could be used as a decision aid tool since these types of visuals have a positive effect on the accuracy of the decisions made by older adults in eHealth tools | NA | |||||
| Using feedback messages in interfaces should not only inform users on (the result of) their actions but should also offer the user options to recover from wrong actions and return to previously retrieved information or actions | 1.2: Understanding Navigation | |||||
| A clear (video) instruction on how to use an app should be given when older users register for an app, including an aid to return to this instruction during any point in an app’s usage” | NA |
*, Recommendation from 2010 guidelines. CKD, chronic kidney disease; HIV, human immunodeficiency virus; ADHD, attention-deficit hyperactivity disorder; eHEALS, eHealth Literacy Scale; CFIR, Consolidated Framework for Implementation Research; VIC, Patient Centered Virtual Multimedia Interactive Informed Consent tool; IQR, Interquartile range; GFI, Gunning Fog Index; FKGL, Flesch-Kincaid Grade Level; FRES, Flesch Reading Ease Score; NVS, Newest Vital Sign; REALM, Rapid Estimate of Adult Literacy in Medicine; SAHL-S&E, Short Assessment of Health Literacy-Spanish and English; TOFHLA, Test of Functional Health Literacy in Adults; HLO, Health Literacy Online; NA, not applicable.