ABSTRACT: INTRODUCTION:Despite the investment in public reporting for a number of healthcare settings, evidence indicates that consumers do not routinely use available data to select providers. This suggests that existing reports do not adequately incorporate recommendations for consumer-facing reports or web applications. METHODS:Healthcentric Advisors and Brown University undertook a multi-phased approach to create a consumer-facing home health web application in Rhode Island. This included reviewing the evidence base review to identify design recommendations and then creating a paper prototype and wireframe. We performed qualitative research to iteratively test our proposed user interface with two user groups, home health consumers and hospital case managers, refining our design to create the final web application. RESULTS:To test our prototype, we conducted two focus groups, with a total of 13 consumers, and 28 case manager interviews. Both user groups responded favorably to the prototype, with the majority commenting that they felt this type of tool would be useful. Case managers suggested revisions to ensure the application conformed to laws requiring Medicare patients to have the freedom to choose among providers and could be incorporated into hospital workflow. After incorporating changes and creating the wireframe, we conducted usability testing interviews with 14 home health consumers and six hospital case managers. We found that consumers needed prompting to navigate through the wireframe; they demonstrated confusion through both their words and body language. As a result, we modified the web application's sequence, navigation, and function to provide additional instructions and prompts. DISCUSSION:Although we designed our web application for low literacy and low health literacy, using recommendations from the evidence base, we overestimated the extent to which older adults were familiar with using computers. Some of our key learnings and recommendations run counter to general web design principles, leading us to believe that such guidelines need to be adapted for this user group. As web applications proliferate, it is important to ensure those who are most vulnerable-who have the least knowledge and the lowest literacy, health literacy, and computer proficiency-can access, understand, and use them. CONCLUSIONS:In order for the investment in public reporting to produce value, consumer-facing web applications need to be designed to address end users' unique strengths and limitations. Our findings may help others to build consumer-facing tools or technology targeted to a predominantly older population. We encourage others designing consumer-facing web technologies to critically evaluate their assumptions about user interface design, particularly if they are designing tools for older adults, and to test products with their end users.
