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					                                    Aging by Design 2005

 The NIA/NLM Guidelines for
 Elder Online Accessibility and
 the Importance of Usability Testing

 Roger W. Morrell, Ph.D.
 Director of Usability Assurance
 Practical Memory Institute LTD
 Spencerville, MD, USA

Practical Memory Institute® ____________________
  Stephanie R. Dailey, MA        Kathleen Cravedi, MA
  Education Specialist           Eve-Marie Lacroix, MA
  Claudia Feldman                Joyce Backus, MSLS
  Former Deputy Director         The National Library of Medicine
  Jane Shure                     Donald A.B. Lindberg, MD
  Former Director                Director
  Office of Communications and   The National Library of Medicine
  Public Liaison, NIA
  Richard J. Hodes, MD
  National Institute on Aging

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   The NIH Senior Health Project

   The Guidelines

   Projects that have tested or incorporated
    the Guidelines
   The importance of usability testing with
    older adults

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  Older adults and information
   In the beginning, electronic products were
  designed by young people to be used by young
   Video games were designed.

   Computers were introduced into schools.

   Training opportunities were geared toward
  younger people.

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   Older adults are very interested in learning
  how to use information technology.
   Older adults are not more anxious and do
  not have poorer attitudes toward the use of
  information technology relative to younger
   Older adults can learn how to use these
  technologies and retain these skills over time.

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   Other electronic products, such as
  e-Learning and training programs on CD ROMs
  are also well received by older adults.
   Underserved populations are also very
  interested in using interactive technology.
   Older adults are now the fastest growing
  segment of new Internet users.

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  The NIH Senior Health Project

  Sponsored by The National Institute on Aging
  and The National Library of Medicine

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 Goals of the project
  Isolate the basic and systematic research in
 cognitive aging, human factors and aging, and
 consumer informatics.
  Develop a set of Guidelines on how to design
 online materials that are elder-accessible that
 take into consideration age-related changes in
 vision, cognition, and motor skills.
  Use the Guidelines to construct an accessible
 web site that presents health information to older

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                        The Guidelines

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    Typeface                         Justification
     Use   a sans serif typeface.    Use   left justified text.
    Type Size                        Color
     Use   12- or 14-point.          Avoid yellow and blue and
    Type Weight                      green in close proximity.
     Use   medium or bold face.     Backgrounds
    Capitals and Lowercase            Use  dark type or graphics
     Avoid   all caps in text.      on a light background.
    Physical Spacing
     Double   space all text.

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     Style                         Organization
      Present   the information    Use  short segments that fit
     clearly.                      on one page.
     Phrasing                       Standardized the presentation
      Use   the active voice.     of the text.
     Simplicity                    Online Glossary
      Write  the text in simple    Provide   an online glossary
     language.                     of technical or medical terms
      A sixth-grade reading       that is linked to the text.
     level is recommended.

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    Navigation                        Menus and Scrolling
     Simple  and straightforward.     Avoid pull down menus and
     Use explicit step-by-step       automatically scrolling text.
    procedures.                        Reduce the amount of scrolling
     Carefully label links so that   required to read a page.
    their destination is clear.        Incorporate scrolling icons
    Consistent Layouts                such as “top of page” if pages
     Use  a standard page design     are longer than one screen.
    and the same symbols and
    icons throughout.

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    Backward and Forward           Site Maps
    Navigation                      Provide    a site map.
     Incorporate  buttons such    Help and Information
    as “previous page” and          Providea telephone number
    “next page” to allow the       and an email contact.
    reader to re-read the text.
     Use  large buttons that do
    not require precise
    manipulations of the cursor.

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    Illustrations and              Text Alternatives
    Photographs                     Provide   text alternatives
     Use   text-relevant images   such as open- or closed-
    only.                          captioning or a static version
    Animation and Video            of the text.
     Use  short segments to        Provide the ability to print out
    reduce download time           a transcript if information is
    and retain viewer interest.    presented in animation, video,
     Provide amounts of           and audio.
    downloading and viewing
    time required.

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  An ongoing project

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   The web site was launched in October, 2003
  on Capitol hill with Senator Tom Harkin
  conducting the first “official” search.
   This is an ongoing project. Since the launch
  other NIH Institutes have posted health
  information on the web site.
   continues to serve
  as a model for online elder accessibility.

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 This is the “Talking Web”.
 Type size can be immediately enlarged.
 Page contrast can be changed.
 Example of a page using the Contrast Feature.
 The navigation system is readily apparent
and consistent.
 The typeface and type size used are easy to read.
 Large buttons are easy to click on.
 The videos feature open captioning and transcript
print out availability.
 The videos are easy to use.
 Animations are used to illustrate textual concepts.
  The web site has won several
   2004 International Council on Active Aging
  Award for one of North America’s six most
  innovative active aging programs
   Outstanding 2004 Plain Language Award
  from the National Institutes of Health
   2005 Honorable Mention Award from Medicine
  on the Net

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  Projects that have incorporated
  the Guidelines

  Research projects
  A new project
  A project to be expanded

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  Research Projects
  Annie Becker, Ph.D.
  Research grant funded by The National Science Foundation

  Roger W. Morrell, Ph.D.
  SBIR grant funded by The National Institute on Aging

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 Assessments of Existing Web Sites
  Becker (in press) conducted heuristic
 usability studies on 125 government, commercial,
 and nonprofit web sites designed to provide
 health resources.
  The NIA/NLM Guidelines and other factors
 were used as gauges to test the elder-
 accessibility of the web sites.
  The results showed that none of the categories
 of accessibility tested attained high ratings of
 overall usability.

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  Approximately 93% of the web sites used
 small fonts and 24% of the web sites required
 manipulations requiring intricate mouse skills.
  Approximately 30% of the web sites required
 higher than a high school education to
 comprehend the health information sampled.
  The study concluded that many current health
 information web sites are not accessible at some
 level to older adults.

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 Redesign of Existing Web Sites
  Morrell (2005) conducted individual usability
 testing on sections of a nonprofit and a
 for-profit web site with older adults as
 participants (average age = 73.2 years of age).
  Usability testing was then conducted on the
 same sections of the web sites with another
 matched group of older adults after they had
 been revised according to the NIA/NLM

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  Results demonstrated dramatic differences
 in performance of the usability tasks with
 successful task performance improving from 0%
 to 100% in some instances.

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  The Sharper Memory® Project
  a new project

  Practical Memory Institute LTD
  SBIR grant funded by The National Institute on Aging
  Awarded to Robert Rager, President, Practical Memory Institute LTD
  and Preston Harley, Ph.D., Principal Investigator

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  The Sharper Memory® Project will
   The development of a new “Sharper Memory”
  cognitive fitness educational web site designed
  to improve cognitive health literacy.

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  Features of the web site
   Access to resources on memory improvement
  for individuals of all ages.
   A “Sharper Memory Monitor ®” feature that will
  allow users to select and plan interventions to
  improve memory and to record changes in
  memory over time.
   Memory enhancement techniques.

   Information for caregivers and resources for

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 A monthly e-Newsmagazine on memory
 A parent web site is available for additional
information and the purchase of products.
  Initial research findings
   Initial focus group assessments indicate that
  the older adults want their own “private,
  individualized” web site.
   The older adults do not want to admit to others
  that they are having “memory problems”.

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  The BusinessThinkingTM Project
  a project to be expanded

  SeniorThinking, LLC
  SBIR grant funded by The National Institute on Aging
  Awarded to Marian Stoltz-Loike, Ph.D., CEO, SeniorThinking, LLC

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   All products are designed in CD-ROM
  format and can be engineered to be
  accessed through corporate/government
  intranets, the web site,
  as well as the Internet in general.
   The products are designed to be used to
  alleviate the high costs of personnel training
  in traditional formats.

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   The BusinessThinkingTM products are
  e-learning courses on the use of software:
  PowerPoint, Excel, Word, and use of the Internet
  for people over the age of 50.
   Other courses include Career Development,
  Job Finding, and Pre-Retirement Planning.
   Additional courses are in the development

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 An explanation is presented immediately on
how to use BusinessThinkingTM products.
 All products begin with an Index.
 All courses are carefully organized.
 Illustrations and animations are used.
 All procedures are presented in a step-by-step
 Design is consistent throughout all products.
  The Research Component of the
  BusinessThinkingTM Project
   Usability tests were conducted on all products
  with mature adults (ages 50 – 69), individuals
  representative of mature adults still in the
   Knowledge assessments were also conducted
  to determine if mature adults can learn from the

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   Application of the NIA guidelines has
  resulted in almost errorless performance of
  usability tasks.
   In some instances, certain subcategories of
  information were hard to find (this information
  was not crucial to navigation).

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   Improvement in knowledge acquisition
  improved 23% on information about career
  development when the CD-ROM was used alone.
   We tested taking the CD-ROM home and
  using it for one week, adding an instructor-led
  Web-based component (via Webex), and
  adding a peer2peer component.
   All methods resulted in 50%+ improvement in
  performance of tasks after only about 3-4 hours
  of instruction.

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  These results suggest that mature adults can
  learn from e-learning products whether they
  use them:
      by themselves,
      with two or more people in a small
       group, or
      via the Internet.

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                      The Importance of
                      Usability Testing
                      with Older Adults

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   According to Mandel, “Usability is the glue
  that holds together all of the pieces that
  (hopefully) fit together and make up any product”
                   (Mandel, 1997, p. 101).

   Usability testing can be of great value
  because no amount of careful and meticulous
  planning can predict all the problems that are
  going to be experienced when using information

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   Usability testing reveals whether potential
  users can actually use a product.
   Usability testing provides feedback to improve
  product design, to reduce and remove glitches,
  bugs and problems, to compare products and
  versions or prototypes, and to validate that
  products meet pre-determined usability goals and
   More formal usability testing occurs in a
  laboratory environment where representative
  users are brought in to use prototypes of the
  software or online product.

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   Test subjects are asked to use the prototype
  and perform a series of tasks that are deemed
  representative and necessary for use of the
   Participants are asked to think aloud and often
  the sessions are videotaped for later scoring and
  clarification of performances.
   Results from each iterative round of usability
  testing are employed to further refine and
  redesign the product to ensure its usability.
  (see Mandel, 1997; Nielsen & Mack, 1004; Rubin, 1994 or visit the
  Usability Professionals’ Association web site for
  in-depth discussions of usability testing in general).

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   Usability testing is crucial for online and other
  electronic products designed for use by older
   Only through successive usability testing with
  individual older adults can you determine if your
  products are designed to mediate age-related
  changes in vision, memory, comprehension, and
  motor skills.
   The good news is that usability testing with
  older adults is beginning to move to the forefront.

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   Most important, the NIA/NLM Guidelines
  outlined in this presentation may be used to
  form the basis of protocol development when
  conducting usability testing with older adults in
  order to facilitate this type of assessment.
   Morrell and Stoltz-Loike will be presenting
  an outline of how to conduct usability testing
  successfully with older adults in “Making the
  Internet Century Accessible to Older Adults”.

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   There is an existing set of Accessibility
  Guidelines that have been produced by the
  National Institute on Aging and the National
  Library of Medicine that have been shown to
  increase usability of online materials for older
   Accessible online materials can be produced
  for older adults.

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   Only through usability testing with individual
  older adults can we ensure that online and other
  electronic materials are truly elder-accessible.

Practical Memory Institute® ____________________
  Thank you.

  Practical Memory Institute LTD
  P.O. Box 212
  Spencerville, MD, USA
  Tel: 301.384.0012
  Fax: 301.384.5566

Practical Memory Institute® ____________________