JMIR Publications

ABSTRACT

Background:

The use of eHealth services has grown widely popular and, thus, it is important that they are usable by and accessible to all potential users with the widest range of needs, characteristics, and capabilities. eHealth services may be cognitively demanding for people who are ill, exhausted, and suffering. In addition, there are many vulnerable groups, such as older adults, may have cognitive restrictions on perception, attention, memory, and comprehension of language. Many studies do not consider the preferences or needs of user groups who are likely to face challenges related to these cognitive aspects.

Objective:

The main objective of our study was to understand better what cognitive accessibility is in practice in the context of eHealth services. Furthermore, we wanted to discover what kind of problems vulnerable groups face when using eHealth services and what to consider when testing eHealth services with vulnerable groups.

Methods:

We tested two Finnish publicly available online symptom checkers with a qualitative usability testing approach. Thirteen participants from three different groups took part in the study: older adults, mildly intellectually disabled individuals, and non-native Finnish speakers. The main research methods were the thinking aloud method, questionnaires, and semi-structured interviews.

Results:

We discovered that vulnerable groups had many problems with the tested services. The problems were largely similar across all three groups. The clarity and terminology used in the services caused particular difficulties. The services presented too much information and choices for the users at once, and the terminology included too many medical terms that were difficult to understand. When testing with vulnerable groups, it is important to plan the sessions carefully so that they are not too long, as these users often need more time to complete the tasks. Furthermore, testing with vulnerable groups was quite efficient, as the results likely benefit also a wider audience.

Conclusions:

According to the results of this study, a large group of people faces cognitive challenges with eHealth services that hinder or slow the use of such services and make using the services more difficult. At the worst these problems cause errors in using the services. We would recommend involving vulnerable groups in testing eHealth services, testing a broader range of services, and to including users with diverse capabilities, who are likely to face challenges in cognitive accessibility.