Influences on Users’ Ability to Navigate

As the health care industry in the US increasingly expects individuals to manage their own health, there is a need for health management tools that are broadly accessible and useful. Online health (“e-health”) resources are often touted as a solution for the demands of individual health care management, but can also be difficult for individuals without computer skills. This is a problem for many groups with a higher need for health resources, including older adults, who often have less internet experience. A recent study assessed the influence of internet experience, cognitive ability, and the effect of a short-term training session on the ability to use the official Medicare website, hosts many resources for Medicare recipients, including enrollment, health information, tools to choose a doctor, and claims management. However, the shift to using the internet to host health resources may be a problem for citizens with limited computer experience or with lower cognitive abilities. For example, according to data from the Health and Retirement Survey, Medicare Part D enrollment is lower among people with lower cognitive abilities, who are also significantly less likely to enroll online.

For the study, researchers recruited a group of 61 participants from the ages of 45 to 97 residing in southern Florida. Participants either received one of two short-term training sessions (one using a multimedia format, the other a visual-only PowerPoint presentation) or, for comparison, did not receive training. On the first day of the study, participants were administered a variety of cognitive tests and a questionnaire that included questions about previous internet experience and health literacy. On the second day, the participants received their training, which was an overview about navigating the Medicare website (participants in the comparison group were instructed to browse the internet freely for a comparable length of time), before completing a variety of tasks on the website.

While performing the experimental tasks, which were based on three hypothetical health management scenarios, participants were measured on the accuracy of their responses to the scenario, the efficiency with which they used the website (based on the relationship of their accuracy to the amount of time the tasks took), and how well they navigated the website.

There were no statistically significant differences between the three groups. This should not be read as evidence that no training programs can be effective, however, due to the relatively small sample sizes in each group and the brevity of the training. Prior internet experience was a significant predictor in ability to use the website, and cognitive ability has an even larger effect on ability. These findings suggest that e-health websites should be designed to be more accessible to individuals with cognitive decline and other limitations, and point to how online self-management of health concerns is likely not as broadly attainable as is often portrayed.


Czaja SJ, Sharit K, Lee CC, et al. Factors influencing use of an e-health website in a community sample of older adults. Journal of the American Medical Informatics Association; (2012). E-pub ahead of print; doi:10.1136/amiajnl-2012-000876.


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