The children's computerized physical activity reporter: children as partners in the design and usability evaluation of an application for self-reporting physical activity.

The objectives of this three-phased study were to design and evaluate the usability of a computerized questionnaire, The Children's Computerized Physical Activity Reporter, designed with and for middle school children's self-report of physical activity. Study design was qualitative, descriptive, and collaborative, framed in a usability engineering model, with 22 participating children (grades 6-8; mean age, 12.5 years; range, 11-15 years) of three ethnic backgrounds. In Phase 1, children's understanding of physical activity and needs for reporting were determined, which were then translated in Phase 2 to the design features and content of the questionnaire; content validity, readability, and algorithm reliability were completed. Phase 3 involved children's evaluation of the questionnaire's usability (ease of use, efficiency, and aesthetics). The children all liked the questionnaire but identified several usability issues within instructions and reports. Working collaboratively with children was highly effective in ascertaining their understanding of physical activity and their self-reporting needs. Thus, the questionnaire's design was created from children's understanding of physical activity and their needs for recalling activities. The development of the questionnaire and its usability evaluation contribute to understanding children's physical activity and to the importance of designing for usability. Additional research is needed to ascertain reliability and validity of data derived from its use and to explore its usefulness in clinical or research venues.

A comparison of Web and print media for physical activity promotion among adolescent girls.

PURPOSE: To compare the effectiveness of a Web-based physical activity (PA) intervention with identical content delivered in a printed workbook among a sample of adolescent girls. METHODS: Participants consisted of 319 girls with home Internet access enrolled in four middle schools within one school district. A randomized trial design was used to compare changes in PA self-efficacy and intentions after two weeks of exposure to either a Web- or print-based intervention delivered to their home. Self-reported physical activity was assessed as a secondary outcome. Analysis of covariance was conducted to determine changes between the intervention groups while controlling for baseline levels of PA constructs. RESULTS: Both Web and print groups had significant changes in physical activity self-efficacy (Web: t[155] = 2.58, p = .01; print: t[156] = 3.11, p = .002) and intentions (Web: t[157] = 2.27, p = .02; print: t[159] = 6.32, p < or = .001). The print group demonstrated significantly greater increases in intentions compared with the Web group (F [1,315] = 13.53, p < or = .001). Self-reported physical activity increased significantly in the print group only (t[159] = 3.21, p = .002). CONCLUSIONS: It cannot be assumed that new media technologies are superior to traditional media such as print for health communication to adolescents. These results suggest that a printed workbook was more effective than an identical website for increasing physical activity intentions and behavior among a sample of middle school girls.

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites.

OBJECTIVE: To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN: Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS: Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Student's t tests. RESULTS: Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS: Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.

Development of a computer-based system for continence health promotion.

Computer-based systems (CBS) can provide information to help individuals analyze their health care needs and make decisions about management of health problems. This article discusses the development of a CBS that delivers an individualized educational intervention for continence health promotion. System development included cycles of prototype design, testing, analysis, and redesign. Knowledge acquisition, representation methods, and design decisions are discussed. Participants completed 4 rounds of usability testing and a pilot test, which resulted in enhancements to both the CBS and the expert system feature that produced individualized feedback. This iterative design process involved users throughout system development. User involvement resulted in a tutorial to explain navigation and other features of the CBS, graphics to enhance the written message, and clarification of continence-related content. The procedures resulted in an informative, usable product; they can be used to develop systems that provide information about symptom self-management for other health conditions.

Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized information collecting system. In this paper we describe the design, development, and function of a computer system that uses recent technology to overcome the limitations of previous computer-based data collection tools by adapting the human-computer interface to the native language, reading literacy, and computer skills of the user. Specifically, our system uses a numerical representation of question content, multimedia, and touch screen technology to adapt the computer interface to the native language, reading literacy, and computer literacy of the user. In addition, the system supports health literacy needs throughout the data collection session and provides contextually relevant disease-specific education to users based on their responses to the questions. The system has been successfully used in an academically affiliated family medicine clinic and in an indigent adult medicine clinic.

Public librarians as a resource for promoting health: results from the Health for Everyone in Libraries Project (HELP) librarian survey.

Public libraries are located in all communities, and two thirds of adults visit one each year. Libraries give the public access to computers and the Internet, and librarians offer technical assistance for accessing information. The interests and training needs of public librarians for assisting the public in accessing health information have not been addressed. One public library/librarian in each North Carolina county was randomly selected to complete a written questionnaire to assess health-related information services and librarians' skills for providing these services. 84% of librarians (83/99) completed the questionnaire. Results indicate that librarians answer more than 10 health-related questions per week, feel moderately comfortable answering these questions, and are very interested in receiving additional training for addressing health-related questions. Creating public library/public health partnerships holds much promise for enhancing the ability of community members to access desired health information.

An assessment of the quality and usability of smoking cessation information on the Internet.

Little is known about the quality and usability of on-line health information. This analysis evaluated smoking cessation Web sites' content quality and usability. Thirty sites were analyzed to determine their adherence to established tobacco cessation guidelines and their accessibility, usability, credibility, and currency. Most explained addiction (86.7%) and mentioned nicotine replacement therapy (NRT) (93.3%) and social support (93.3%). However, few explained potential side effects of NRT (33.3%) or which smokers should avoid using NRT (30.0%). Two sites advocated substituting smokeless tobacco or herbal cigarettes when quitting, and 16 (53.3%) provided information written at greater than an eighth-grade level. Few sites provided a search mechanism (40.0%) or offered text-only versions (30.0%), and most (83.3%) failed to indicate when content pages were last updated. Most sites adhered to established cessation guidelines. A small subset offered erroneous and potentially harmful information. Applying fundamental design principles would improve accessibility, usability, credibility, and currency.

Evaluation of a tool to categorize patients by reading literacy and computer skill to facilitate the computer-administered patient interview.

Past efforts to collect clinical information directly from patients using computers have had limited utility because these efforts required users to be literate and facile with the computerized information collecting system. In this paper we describe the creation and use of a computer-based tool designed to assess a user's reading literacy and computer skill for the purpose of adapting the human-computer interface to fit the identified skill levels of the user. The tool is constructed from a regression model based on 4 questions that we identified in a laboratory study to be highly predictive of reading literacy and 2 questions predictive of computer skill. When used in 2 diverse clinical practices the tool categorized low literacy users so that they received appropriate support to enter data through the computer, enabling them to perform as well as high literacy users. Confirmation of the performance of the tool with a validated reading assessment instrument showed a statistically significant difference (p=0.0025) between the two levels of reading literacy defined by the tool. Our assessment tool can be administered through a computer in less than two minutes without requiring any special training or expertise making it useful for rapidly determining users' aptitudes.