The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website

Background Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal’s strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites.


Accessibility
We included the potential for CSS styles to accommodate higher contrast versions of the site for users with low vision. For older users who may have challenges using a mouse, we included more separation between hyperlinks, and button sizes were enlarged. Click zones or tap zones for touch interfaces were also generous in size to accommodate users with less dexterity. Quality assurance testing was done to ensure compatibility with a wide range of operating systems and browser versions.

Content for Professionals
The research evidence on the Portal intended for professionals comes from three best-in-class resources. McMaster Premium LiteratUre Service (McMasterPLUS™) [1,2] is an information service that provides the best research evidence for clinicians and includes articles that are continuously selected from more than 120 journals, through a critical appraisal process that identifies studies and systematic reviews that are scientifically strong. Articles that meet specific scientific criteria are then rated by frontline clinicians on two 7-point scales, one for clinical relevance and one for newsworthiness or novelty. The Health Evidence™ database, [3] developed for public health professionals, includes quality-rated systematic reviews about the effectiveness of public health interventions, such as immunization campaigns. The Health Systems Evidence database [4,5] was developed for managers and policymakers, and includes many types of research evidence about methods to address problems in the health system. The content from each of the three databases is filtered for relevance to healthy aging and health care for seniors (i.e., studies with older adults, research on health promotion or disease prevention or optimal management of health problems) before being included on the Portal.

Clinician Articles
The clinician articles, coming from McMasterPLUS™, contain the following: • Title of the original article, authors, journal citation, and link to the abstract in PubMed • Clinical peer ratings: ratings by three to four physicians from each pertinent discipline (33 possible clinical disciplines in total, e.g., internal medicine, cardiology, psychiatry) on relevance and on newsworthiness • Scientific abstract • Clinical comments provided by raters from each relevant discipline.

Public Health Professional Articles
The publichHealth articles, coming from Health Evidence™, include the following: • Title of the original article • Quality rating: Strong (8 to 10 / 10), moderate (5 to 7 / 10), or weak (1 to 4 / 10), assigned by two independent reviewers using the Health Evidence Quality Assessment Tool

Policymaker Articles
The Policymaker articles, coming from Health Systems Evidence, are organized as follows for each document:

Content for Citizens
The rigorous process used for inclusion of the professional resources in the Portal was also utilized to develop content for citizens, specifically Evidence Summaries and Blog Posts.

Evidence Summaries
The Evidence Summaries contain the following sections: • The Blog Posts chosen by our participants to review included: • Sleep and aging: How many zzz's are optimal to stay healthy?
• Loneliness hurts. How to recognize loneliness as a health concern.
• How fast should I walk to cross the road safely? Fast facts about walking speed • Want to become more physically active? Start by joining a walking group!

Mac_Aging News (Twitter feed)
The tweets are based on a 9 a.m. daily search of the previous day's media coverage. Each day, the Portal staff search for health and lifestyle news articles using Factiva in all Canadian newspapers and the Canadian Press, Canadian Press Broadcast and Postmedia newswires, and using Google News Alert. The search is based on the following key words: Aging, seniors, baby boomer, baby-boomer, Alzheimer, dementia, frail, frailty, ageing, elderly, homecare, home care, community care, and community-based care. One a list of potentially relevant articles is compiled, the Portal databases are searched for relevant evidence. We then tweet out the NEWS article paired with the related EVIDENCE tweets.

Other Content
There is also access to information about aging-related events such as expert-given public talks, live webcasts, as well as video recordings of these events.

Navigation and Content Retrieval
The Portal's overall organization, page design, font, icons and links have been designed and constructed to afford the user ease of navigation to its many features. The search engine powers the retrieval of Portal content, with features that both categorize and prioritize its search results.
The results that best match the users' role are displayed most prominently in the central portion of the webpage while links to the Portal's other content are easily accessible in a sidebar menu. The Portal also offers the user a browsing option to find citizen content by way of selecting among 66 unique citizen topics organized into three categories which include: health conditions (e.g., back pain, cancer, stroke), healthy aging practice (e.g., exercise, nutrition) and healthcare delivery (e.g., community care). The browse feature allows the citizen to select a topic area of interest and retrieve all content indexed to the topic and listed in order of its quality of evidence. Citizen content tagged with a given category is connected to other similar content by following the topic link in the item's record, facilitating access to Evidence Summaries, Web Resource Ratings and Blog Posts on the topic. The citizen topic tags appear in all citizen content records and can be followed from a record also retrieved from a search.