"Senior Surfing: eHealth and Older Adults" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Sabrina Kurtz-Rossi, MEd, Principal, Kurtz-Rossi & Associates. Description: This session will provide participants with information about eHealth literacy and techniques for helping older adults use the Internet to find health information for informed decision making and self-management of chronic disease.

1. Sabrina Kurtz-Rossi, M.Ed.
Kurtz-
Health Literacy Consultant
Kurtz-
Kurtz-Rossi & Associates
Sabrina_kurtz-
Sabrina_kurtz-rossi@comcast.net
Member Clear Language Group
www.clearlanguagegroup.com
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2. Case Example
Eighty-three year old Virgil Heidbrink has found
what he thinks is the perfect place to retire. He’s met
interesting people there. They share their life stories
and favorite jokes. And he’s convinced that the new
social connections are keeping him young in spirit.
Bob Moos, The Dallas Morning News
Oct 12, 2009
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3. Case Example
Mr. Heidbrink spends 3 – 4 hours a
day on the Internet where he writes his
blog and answers email. A computer
coach helped the resident at the
Edgemere retirement community in
Dallas build and maintain his website.
www.virgilsviews.com
Bob Moos, The Dallas Morning News
Oct 12, 2009
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4. Objectives – Workshop
 Discuss the opportunities and challenges of the
Internet for older adults
 Apply strategies to improve the health information
literacy skills of seniors and their caregivers
 Review teaching resources to support seniors and
caregivers use the Internet to find health information
 Identify features that improve the usability of health
information websites for seniors
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5. What are the Challenges?
 Health literacy among older adults
 Readability of health information
 Access to computers and the Internet
 Accuracy and reliability of information
 Health information literacy skills
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6. Health Literacy in the U.S.
 Over 75 million adults
have Basic and Below
Basic health literacy
 Seniors have the lowest
health literacy
 Only 12% total (3%
seniors) have proficient Number & Percent of Adults in Each
Health Literacy Level
health literacy
Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics,
The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy.
http://nces.ed.gov/naal/health_results.asp
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7. Readability of Health Information
 Numerous studies show the mismatch between
patient skills and the readability of health
materials (Meade 1989, Davis 1990, Dollahite 1995,
Stevens 2007, Vallance 2008, Bergman 2010 )
 More recent studies look at the readability and
usability of health information on the Internet
(Berland 2001, D’Allesandro 2001, Fogel 2003,
Birru 2004, Leroy 2008, McInnes 2011)
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8. Medicare Website
www.medicare.gov
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9. Activity
 Use www.Medicare.gov to find the following:
 Tips for how to prevent fraud
 Medicare & You Handbook in Spanish
 Eligibility criteria for home health care services
 List of Medicare Health Plans with drug
coverage in your area
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10. Medicare Website Usability Study
 69% could not determine eligibility for
home health care services
 80% could not find their local agency
 57% could not make decision about
Medicare Part D
 72% could not follow the steps
needed to select a plan
Source: Czaja, S. et al. (2008) Usability of Medicare Health Web Site. JAMA. 300(7):790-792. Available at:
http://jama.ama-assn.org/cgi/content/full/300/7/790-a 10

11. The Fastest Growing
Online Population – Seniors!
Internet Use by Seniors Age 65 and Older Over Time
Percent
45%
40%
35%
30%
25%
42%
20% 34%
29%
15%
22%
10%
5%
0%
2004 2005 2006 2011
Year
Source: Fox, S. (2004). Older Americans and the Internet; Fox, S. (2006). Online Health Searches; Usage Over
Time. Pew Internet and American Life Project. Available at: http://www.pewinternet.org 11

12. Seniors Online
 42% of adults age 65 and
older are online
 Seniors with higher
incomes more likely to
be online
 Seniors with higher
education more likely to
be online
Source: Kaiser Family Foundation (2005). E-Health and the Elderly: How Seniors Use the Internet For Health
Information. Available at: www.kff.org 12

13. Seniors Off-line
 Majority of non-users are age 65 and older
 “Truly Unconnected” tend to be even older
 Concerned about content and safety
 Too expensive, don’t have the time
 Don’t need it, and don’t want it
 Too complicated and hard to use
 Don’t have a computer or Internet access
Source: Lenhart, A. (2003). The Ever-Shifting Internet Population. Pew Internet and American Life Project.
Washington, DC. Available at: www.pewinternet.org/pdfs/PIP_Shifting_Net_Pop_Report.pdf 13

14. Health Information and the Internet
 80% of Internet users search
for health information
 86% do not seek advice about
which websites to use
 72% express trust in most or
all information found online 42% of adults age 65 and
older are online
 75% rarely or never check for
source and date
Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American
Life Project. Available at: http://www.pewinternet.org/PPF/c/5/topics.asp 14

15. Caregivers Online
 Half of health searches are for someone else
 Among e-caregivers (those who help others)
 36% found health care advice
 34% found health care services
 26% found information to compare options
 58% said the Internet was their most important resource
Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC.
Available at: www.pewinternet.org 15

16. Affects on Health
 58% said the Internet affected a
decision they made about treatment
 55% changed their approach to
maintaining their health
 44% changed the way they think
about diet, exercise, or stress
 39% changed how they cope with
chronic disease or chronic pain
Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC.
Available at: http://www.pewinternet.org 16

17. A real drug. A real disorder. A spoof
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18. Focused Outreach
Health Information Literacy
 National Network of Libraries of Medicine –
New England Region (NN/LM NER)
http://nnlm.gov/ner/
 Program Goals
 Increase access health information for communities
experiencing health disparities
 Collect formative and summative evaluation
data for program improvement
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19. Three Phases, Two Communities
1. Community Assessment
1. Western
 Key informant interviews Maine (rural) **
*
2. Focused Outreach Implementation
 Tailored efforts based on assessment findings
 Community-based partnerships
*
3. Evaluation
2. Providence, RI
 Outcome measures: pre-post training evaluations, (Latino)
follow-up assessment
 Process measures: story-based evaluation,
community partner exit interviews
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20. Community Assessment
Western Maine, Rural Seniors
 Findings (n=9)
 Rural with growing senior population
 Growing African immigrant community
 Healthy communities coalitions as partners
 Strong school health program
 Broadband is limited
 Libraries offer public access
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21. Focused Outreach Implementation
Western Maine, Rural Seniors
 Tailored Approach
 Core outreach activities (professional trainings,
consumer education, and materials) targeted to the
needs of seniors
 Established partnerships with healthy communities
coalitions and provided stipends for outreach activities
 Promoted NLM resources (MedlinePlus,
NIHSeniorHealth) via trainings, exhibits, libraries,
senior services, etc.
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22. Evaluation Results
Western Maine – Rural Seniors
 Outputs
 Consumers reached (n=154)
 Consumer pre-/post-training evaluations (n=85)
 Consumer follow-up (n=13 )
 Service providers trained (n=98)
 Service provider pre-/post-training evaluations (n=82)
 Service provider follow-up (n=28 )
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23. Evaluation Results
Western Maine – Rural Seniors
 Consumer Pre-training: Age of Respondents
0.0%
3.7% N=82
7.3%
18 - 24 years old
25 - 34 years old
35 - 49 years old
50 - 64 years old
57.3% Over 64 year old
31.7%
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 23

24. Evaluation Results
Western Maine – Rural Seniors
 Consumer Pre-training: Use of the Internet
Never 34.9% N=83
Every day 36.1%
Never
Sometimes
Every day
Sometimes
27.7%
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 24

25. Evaluation Results
Western Maine – Rural Seniors
 Consumer Pre-training: Where Respondents
Access the Internet
60.0%
N=71
52.1%
50.0%
40.0% 36.6%
30.0%
20.0%
14.1%
10.0% 5.6%
0.0%
0.0%
Home School Work Library I don't use the
Internet
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 25

26. Evaluation Results
Western Maine – Rural Seniors
 Consumer Pre/Post-training: Ever Used
NLM Resources
45%
Pre N=82
40% 39%
Post N=62
35%
30% 29%
25% Pre-Training
20%
Post-Training
15%
10%
5% 2%
1%
0%
MedlinePlus NIHSeniorHealth
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 26

27. Evaluation Results
Western Maine – Rural Seniors
 Consumer Pre/Post-training: Confidence in Ability
to Find Health Information Using the Internet
90%
79%
80% Pre N=81
70% Post N=65
60%
51%
50% 46%
Pre-training
40%
33%
Post-training
30%
20% 16% 17%
10%
0%
Confident Not Sure Not Confident
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 27

28. Evaluation Results
Western Maine – Rural Seniors
 Consumer Post-training: Likely to Use
MedlinePlus in the Future
Not likely 16.2% N=62
Likely
Not sure 16.1% Not sure
Not likely
Likely 67.7%
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 28

29. Evaluation Results
Western Maine – Rural Seniors
 Consumer Post-training: Likely to Use
NIHSeniorHealth in the Future
N=65
Not likely 18.4%
Likely
Not sure
Not likely
Not sure 15.4%
Likely 66.1%
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 29

30. Evaluation Results
Western Maine – Rural Seniors
 Consumer Follow-up: Used NLM Resources
50%
46%
45%
40%
35%
30%
25% 23%
20%
15%
N=15 N=13
10%
5%
0%
MedlinePlus NIHSeniorHealth
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 30

31. Evaluation Results
Western Maine – Rural Seniors
 Service Provider Post-training: Likely to Use
NIHSeniorHealth in their Work
Not Likely 3%
N=87
Not Sure 14%
Likely
Not Sure
Not Likely
Likely 83%
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 31

32. Evaluation Results
Western Maine – Rural Seniors
 Service Provider Follow-up: Used NLM Resources
90%
82%
80%
70% N=27
60%
50%
41%
40%
30%
20%
10%
0%
MedlinePlus NIHSeniorHealth
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 32

33. Evaluation Results
Western Maine – Rural Seniors
 Service Provider Follow-up: Shared NLM
Resources with Others
80%
69% N=27
70%
60% 56%
50%
40%
30%
20%
10%
0%
Co-worker / other service Client / other community
provider member
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health
and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School 33

34. Teaching Observations
 Seniors are hungry for
health information
 Seniors are eager to learn
 Learning a new technology
is very stressful to some
 Very few seniors are “truly Auburn Public Library
Computer Training Class
unconnected”
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35. Teaching Resources
 NIHSeniorHealth: Helping Older Adults Search for
Health Information Online: A Toolkit for Trainers
http://nihseniorhealth.gov/toolkit/toolkit.html
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36. Health Information Literacy
 Health information literacy is the ability to:
 Recognize a health information need
 Identify sources and use them to find health information
 Assess the quality of the information and its usefulness
 Understand and use the information to make informed
health care decisions
Definition of Health Information Literacy Medical
Library Association (MLA) Task Force, 2003
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37. Core Content
 How do you know if the information you find
on the Internet is accurate (correct) and
reliable (trustworthy)?
 Who developed the website? Do you trust them?
 When was it last updated? Is it current?
 What is the purpose? Is it biased in anyway?
Source: Kurtz-Rossi S, Duguay P. (2010). Health Information Literacy Outreach: Improving Health Literacy and Access to
Reliable Health Information in Rural Oxford County Maine. Journal of Consumer Health on the Internet. 14:4, 325-340.
http://www.pewinternet.org
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38. Teaching Tips
 Provide hands-on practice
 Repetition, go slow
 Use health topics of interest
 Provide access to computers
 Teach small groups
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39. Usability Issues
 Vision: non-text, color, small print, PDF files
 Hearing: audio files, video, tutorials
 Motor: key board, small links
 Cognition: complex content or navigation
 Literacy: technical language, too much
information
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40. Universal Design
 Section 508 Standards
 Federal requirements for technology
accessibility
 Online tools to test 508 accessibility
 http://www.cynthiasays.com/
 http://wave.webaim.org
Source: Eichner, J. Accessible Health Information Technology (IT) for Populations with Limited Literacy. AHRQ, US
DHHS. (2007). Available at: http://www.heatlhlit.ahrq.gov
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41. Plain Language 2.0
 Text
 Use “living room” language
 Speak in active voice
 Provide glossary
 Use headers
 Chunk information
 Avoid acronyms
Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health
literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at:
http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
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42. Plain Language 2.0
 Design
 Use larger (12 or 14 point) sans serif font
 Limit use of bold, italics and other font features
 Leave plenty of white space
 Use upper and lower case letters
 Be careful with colors
 Include text with icons
Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health
literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at:
http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
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43. Plain Language 2.0
 Navigation
 Minimize scrolling
 Step by step navigation, show “breadcrumbs”
 Consistent layout
 Include non web-based contact information
 Make buttons large and easy to use
 Provide search function
Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health
literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at:
http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
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44. Plain Language 2.0
 Multi-Media
 Use short segment to reduce
download time
 Provide text alternative (e.g. open
caption or print version) for all
animation, video, audio
Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health
literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at:
http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
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45. NIHSeniorHealth.gov
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46. NIHSeniorHealth.gov
46

47. NIHSeniorHealth Videos
NIHSeniorHealth.gov
47

48. MedlinePlus.gov
48

49. MedlinePlus.gov
49

50. Healthfinder.gov
50

51. Healthfinder.gov
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52. Recommend Websites
 MedlinePlus.gov
 NIHSeniorHealth.gov
 Healthfinder.gov
 cdc.gov/aging
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53. Recommended Resources
 NIHSeniorHealth Toolkit
http://nihseniorhealth.gov/toolkit/toolkint.html
 Health literacy online: A guide to writing and
designing easy-to-use health Web sites
http://www.health.gov/healthliteracyonline/
Web_Guide_Health_Lit_Online.pdf
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54. Questions and Comments
Sabrina Kurtz-Rossi
Health Literacy Consultant
Kurtz-Rossi & Associates
Phone: 781-835-6488; Fax 781-391-4409
sabrina_kurtz-rossi@comcast.net
Member Clear Language Group
www.clearnlanguagegroup.com
Thank you
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