Health Problem Solving by Older Persons Using a Complex Government Web Site: Analysis and Implications for Web Design
Sara J. Czaja, Joseph Sharit, Chin Chin Lee, Sankaran N. Nair, Mark S. Hernández, Nelida Arana, Shih-Han Fu · 2011 · ACM Transactions on Computer-Human Interaction · doi:10.1145/1952383.1952386
Summary
This study examined how older adults (ages 50-85) navigate Medicare.gov to complete a realistic health-related task: finding quality ratings for home health care agencies. The researchers recruited 112 participants stratified by age decade (50s, 60s, 70s, 80s) and conducted detailed observations using Hierarchical Task Analysis (HTA) combined with Human Failure Modes and Effects Analysis (HFMEA) to identify where cognitive difficulties occurred. The task required participants to navigate through multiple pages, understand different types of quality measures, compare agencies using a checklist tool, and interpret PDF documents—a complex information-seeking scenario typical of government health portals. Researchers decomposed the task into 7 major steps and 39 sub-steps, tracking success and failure points throughout. Sessions lasted up to 30 minutes, with participants receiving brief assistance if completely stuck to allow continued observation of subsequent steps. The methodology represents an important contribution: applying industrial safety analysis techniques (HFMEA) to web usability research. This allowed systematic identification of failure modes, their causes, and their downstream effects on task completion. The approach bridges human factors engineering with accessibility research, providing a replicable framework for analyzing complex web-based problem-solving tasks.
Key findings
Results were sobering: only 2 of 98 completing participants successfully finished all task steps, with mean task performance of 2.84 out of 7 steps (SD=1.98). Age and computer experience were significant predictors of success—each additional year of age decreased the odds of reaching key navigation points by 4-6%, while internet experience increased success odds by 6-15% per year. Critical failure points included: scrolling requirements that caused "cognitive fixation" (users failing to scroll and missing essential content), ambiguous link labels (e.g., "Check out home health agencies in your area" vs. "Find and compare the quality of home health agencies"), PDF document handoffs that disrupted the web experience, and hidden navigation elements positioned below the fold. Many participants exhibited "satisficing" behavior—clicking the first plausible-looking link rather than reading all options. Notably, subjective usability ratings did NOT correlate with actual task performance. Participants rated their own success higher than their actual completion rates warranted, suggesting that self-report measures may be inadequate for evaluating accessibility for older users. The study found significant correlations between cognitive abilities (perceptual speed, working memory, verbal ability) and task performance, confirming that age-related cognitive changes directly impact web navigation success.
Relevance
This research provides crucial evidence for designing government and health websites that older adults can actually use. The 8-step design framework derived from findings emphasizes: placing critical information above the fold, providing explicit navigation cues, using unambiguous labels, minimizing cognitive load through progressive disclosure, avoiding PDF handoffs, and supporting error recovery. For accessibility practitioners, the study demonstrates that WCAG compliance alone may be insufficient—cognitive accessibility requires understanding how older users actually process and navigate information. The HTA+HFMEA methodology offers a practical tool for identifying accessibility barriers before deployment. The disconnect between perceived and actual usability underscores why user testing with representative older populations is essential, rather than relying on self-reported satisfaction. The findings directly inform WCAG 2.0 guidelines around predictable navigation (3.2), input assistance (3.3), and readable content (3.1), while highlighting gaps that newer cognitive accessibility guidance addresses. For organizations serving older populations—healthcare, government, financial services—this research makes a compelling case for age-inclusive design as a core requirement, not an afterthought.
Tags: older adults · cognitive accessibility · health information seeking · web usability · government websites · problem solving · hierarchical task analysis · cognitive aging
Standards referenced: WCAG 2.0 · WAI-AGE