Progressing from discretionary to obligatory evaluation practice to improve access and use of health information interfaces for all

Author: Amanda Adams

Adams, Amanda, 2022 Progressing from discretionary to obligatory evaluation practice to improve access and use of health information interfaces for all, Flinders University, College of Nursing and Health Sciences

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Access and use of digital health interventions have become a critical factor in the transition to patient-centred models of care. Characteristics shaping an individual’s online interactions are also those influencing barriers to using and understanding health information. Evaluations of usability and accessibility are considered crucial developer activities. Considered intrinsically burdensome, complex, and costly, evaluations have become discretionary to the process. Consequently, assumptions of universal Internet access and technical competency levels drive interface design leading to increased digital, social and health exclusion. My significant original contribution to knowledge within this thesis was improving scholarship and awareness of real-world evaluation practice during health information resource development. Contextualised to palliative care, the studies reflect those evaluations could improve interface design to ensure that carers and patients understand information to assist decision-making when facing a non-curable life-limiting condition.

Primary study question:

Does comprehensive and structured evaluation of usability and accessibility when undertaken during development identify interface areas that could improve user experience?

What is known already:

Consumers are driving the need to personalise their health management. Online health information lies crucially on the intersection between consumers need for information, abilities to understand information and potential improvements in health outcomes. Socio-cultural characteristics interplay across all factors influencing digital equity, competency, and technological acceptance. These characteristics affect literacy and health literacy levels, directly impacting on abilities to make informed health decisions. Improving digital readiness levels can increase confidence and the ability to assess information trustworthiness. Usability and accessibility evaluations are critical to user-centred design (UCD) but are not readily employed nor reported within health resource development. Team structures, usability experience, funding levels, participants and process management are all likely factors influencing the likelihood of evaluations being undertaken. Delegation of responsibility for evaluations is unresolved between development teams and commissioning funders.

Main findings:

Evaluation outcomes are not readily reported within peer-reviewed literature and cannot be used as an evidentiary source supporting novice developers’ evaluation practice. Developer uncertainty and their unawareness of the implications of usability errors on interface accessibility across reiterations limit their ability to design usable experiences for all end-users. Inherent barriers to evaluations include previous usability and development experience and capacity to access participants. Attempts to diversify usability samples to include individuals from hard-to-reach groups facing barriers to online health information is problematic and may require in-person strategies rather than reliance on electronic messaging. Experiential digital capabilities appear to be reflective within measures of digital health literacy (DHL) in those choosing to interact remotely with usability evaluation methods, whereas socio-cultural/economic factors influence DHL in reluctant individuals engaging online. DHL stratification produced performance and behaviour variations, complicating participant selection. Responsibility for ensuring evaluations are employed needs to be considered by commissioning funders to ensure resource interfaces provide meaningful experiences for all users.


Through identifying deficiencies and barriers within the development of health information resources, strategies can improve the normalisation of evaluation practice within processes by clearly articulating the roles, expectations and responsibilities of participants, developers, evaluators, and commissioning funders. Structured evaluation practice improved interface designs for end-users of palliative care resources to create a meaningful information experience.

Keywords: Usability Evaluation, Accessibility, Interface Design, Universal Design, Inclusive Design, Interdisciplinary Teams, Online Health Information, Digital Inclusion, Digital Health Literacy

Subject: Health Service Management thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Professor Jennifer Tieman