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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
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Acknowledgements Stephanie R. Dailey,
MA Education Specialist Claudia Feldman Former
Deputy Director Jane Shure Former
Director Office of Communications and Public
Liaison, NIA Richard J. Hodes, MD Director Nationa
l Institute on Aging
Kathleen Cravedi, MA Eve-Marie Lacroix, MA Joyce
Backus, MSLS The National Library of
Medicine Donald A.B. Lindberg, MD Director The
National Library of Medicine
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• Overview
• ? 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 technology
• ? In the beginning, electronic products were
  designed by young people to be used by young
  people.
• ? 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
  adults.
• ? 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 adults.

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The Guidelines
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Justification ? Use left justified text. Color ?
Avoid yellow and blue and green in close
proximity. Backgrounds ? Use dark type or
graphics on a light background.
Typeface ? Use a sans serif typeface. Type Size ?
Use 12- or 14-point. Type Weight ? Use medium or
bold face. Capitals and Lowercase ? Avoid all
caps in text. Physical Spacing ? Double space all
text.
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Organization ? Use short segments that fit on one
page. ? Standardized the presentation of the
text. Online Glossary ? Provide an online
glossary of technical or medical terms that is
linked to the text.
Style ? Present the information
clearly. Phrasing ? Use the active
voice. Simplicity ? Write the text in simple
language. ? A sixth-grade reading level is
recommended.
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Menus and Scrolling ? Avoid pull down menus
and automatically scrolling text. ? Reduce the
amount of scrolling required to read a page. ?
Incorporate scrolling icons such as top of page
if pages are longer than one screen.
Navigation ? Simple and straightforward. ? Use
explicit step-by-step procedures. ? Carefully
label links so that their destination is
clear. Consistent Layouts ? Use a standard page
design and the same symbols and icons throughout.
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continued.
Site Maps ? Provide a site map. Help and
Information ? Provide a telephone number and an
email contact.
Backward and Forward Navigation ? Incorporate
buttons such as previous page and next page
to allow the reader to re-read the text. Icons ?
Use large buttons that do not require precise
manipulations of the cursor.
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Illustrations and Photographs ? Use
text-relevant images only. Animation and Video ?
Use short segments to reduce download time and
retain viewer interest. ? Provide amounts of
downloading and viewing time required.
Text Alternatives ? Provide text alternatives
such as open- or closed- captioning or a static
version of the text. ? Provide the ability to
print out a transcript if information is
presented in animation, video, and audio.
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www.nihseniorhealth.gov 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.
• ? www.nihseniorhealth.gov continues to serve
• as a model for online elder accessibility.

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? This is the Talking Web.
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? Type size can be immediately enlarged.
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? Page contrast can be changed.
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? Example of a page using the Contrast
Feature.
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? The navigation system is readily apparent
and consistent.
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? The typeface and type size used are easy to
read.
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? Large buttons are easy to click on.
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? The videos feature open captioning and
transcript print out availability.
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? The videos are easy to use.
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? Animations are used to illustrate textual
concepts.
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• The web site has won several
• Awards
• ? 2004 International Council on Active Aging
  Award for one of North Americas 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 Guidelines.
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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 include ? 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
  clinicians.

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? A monthly e-Newsmagazine on memory improvement

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? A parent web site is available for additional
information and the purchase of products.

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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 SeniorThinking.com 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
  stage.

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? An explanation is presented immediately on how
to use BusinessThinkingTM products.

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? All products begin with an Index.

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? All courses are carefully organized.

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? Illustrations and animations are used.

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? All procedures are presented in a step-by-step
manner.

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? Design is consistent throughout all products.

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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 workforce. ? Knowledge assessments were
also conducted to determine if mature adults can
learn from the products.
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Findings ? 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
  technology.

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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
  objectives.
• ? 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
  product.
• ? 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 adults.
• ? 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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Summary ? 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 adults. ? 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.

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Thank you. Practical Memory Institute LTD P.O.
Box 212 Spencerville, MD, USA Tel
301.384.0012 Fax [phone] Roger_at_memoryzine.co
m www.MemoryZine.com
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