section summarizes the results for each goal.
1: To assess the range of health-information-seeking behaviors in
the AIAN population
AIAN interviewees had used computers before, although their skills
varied. Intermediaries and college students had the most experience
using computers. The location for going online varied. Intermediaries
were more likely to use computers at work, whereas patients reported
using computers at home, the medical center, and work.
the interviewed intermediaries use computers and the Internet to
find health information, or they request staff to access the Internet
on their behalf. A total of 56 percent use the Internet 8 to 50
hours per week. The intermediaries reported that they consider Government
sites to be authoritative sources of information. A few of them
currently use healthfinder® to access health information.
most participants had used the Internet, most had not used healthfinder®
(17 percent of Alaska Native patients and 0 percent of Navajo students)
before our meeting. As many as 52 percent of the Alaska Native patients
used the Internet to find health information. They had experience
using sites such as WebMD, Yahoo, PubMed, the National Institutes
of Health, and the Anchorage Daily News. A total of 62 percent
of the Navajo students had used the Web to find health information.
They also use Yahoo and WebMD.
the rural areas, community health aides
or community health representatives provide primary care and
emergency care via telephone supervision or telemedicine. Recruited
by the village, these individuals, who do not have any formal medical
training, are responsible for delivering health information to tribal
members. Community health aides or community health representatives
are trained in basic first aid, patient education, health promotion,
disease prevention, making home visits, taking vital signs, and
assisting in case management. Some are Internet savvy and often
e-mail the trainers to request additional health information.
Alaska villages have schools with computers and Internet capabilities.
They also have clinics that sometimes offer computers. At Chickaloon
Village, computers with Internet capability were reserved primarily
for villagers to do job searches. (See appendix
A, Chickaloon Village.) Reservations face significant economic
barriers, such as high startup charges, to Internet access. Several
technology initiatives are under way to address this problem; for
example, one initiative seeks to connect tribal colleges with wireless
Savoy, Chairwoman of the Piscataway Conoy Confederacy and Subtribes,
Inc., of Maryland, sends out health information regularly to her
tribal members through e-mail. Tribal members contact her for reliable
health information, especially for preventative care such as health
another thing that they do: Okay, have you done it?
If I havent done it, they wait for me to do it. Ive
had more tests done that my doctor said I dont need. Still,
if I want the rest of the tribal members to go in for some of
these check-ups, I have to do it first.
Savoy, Piscataway Conoy Confederacy and Subtribes, Inc., of Maryland
2: To identify tasks that AIAN individuals want to accomplish on
a health information Web site
achieve this goal, interviewers gathered information specifically
about what AIAN populations would do on a site.
the most significant tasks, from the perspectives of the AIAN population,
are the following:
information on traditional/holistic healing practice and methods
up information about herbs
updates on recent health news (daily)
how diabetes affects people
information on alternative nutrition
strategies for mental/spiritual wellness
information on exercise
traditional ways to Western biomedicine
user-friendly summaries of studies
information on drugs
information on users and their tasks is provided in appendix
3: To understand how healthfinder® can best serve the AIAN population
were asked the question, How can healthfinder® best serve
AIAN populations? Most respondents were very pleased that
ODPHP was conducting these interviews. The face-to-face contact
is extremely important when working with AIAN communities. It shows
commitment and builds trust. In addition, this approach facilitates
expert reviews, as Dr. Ted Mala, Director of Tribal Relations at
the Alaska Native Medical Center, suggests:
think that what youre doing is wonderful. I think its
extremely important for you to be here, extremely important for
the face-to-face contact. I think that you should develop in your
time here a list of people that your office can use to bounce
things off with
people who are really in tune with the tribes
to look at this and critique in a good way.
~Dr.Ted Mala, Alaska Native Medical Center
respondents also talked about how important it was to keep the information
updated. Ursula Knoki-Wilson, Director of Midwifery Services at
Chinle Comprehensive Health Care Facility, commented:
it up and keep it updated. Come back again to field test. Thats
important because thats the way you get our opinions. You
get consultation that way, whereas if you just have a telephone
consultation, then you dont know the person. You dont
know their commitment to it, and things like that.
Knoki-Wilson, Chinle Comprehensive Health Care Facility
also wanted more information about traditional healing, diabetes,
domestic violence and sexual abuse, hepatitis, fetal alcohol syndrome,
HIV/AIDS, environmental issues, asthma, eye care, Indian health
policy, individual tribes and their culture, insurance policies,
womens health, and research data.
for improving the resources and usefulness of healthfinder®
for AIAN populations are not included in this report.
4: To investigate the overall usability of healthfinder®
During our interviews, we asked participants to accomplish specific
tasks. As evaluators, we watched participants interact with the
interface. We noted the decisions and choices they made as they
tried to perform efficiently. We were specifically interested in
ascertaining the following information:
differences between expressed preferences and actual use (including
patterns for searching and filtering)
the main sites usefulness to special populations
navigation strategies on the main site and Just for You
Preferences Versus Actual Performance
users were asked to perform a task on www.healthfinder.gov,
43 percent used the search bar, while 57 percent of users chose
to accomplish the task by other means. (See table
Table 2: When users were asked
to accomplish a task on healthfinder®,
they chose to use these options on the site.
using the text search bar, users expressed the following preferences.
Some suggested that they wanted to be able to search within each
section of www.healthfinder.gov,
especially within the AIAN section, or have an advanced search option
right next to the search bar.
felt that the search results were overwhelming. When they tried
to narrow the search, all users could not figure out what the drop-down
menu choices meant. (See figure 5.) The choices
available in the drop-down menu for type of information
were especially confusing to users.
Figure 5: Screen capture of
what users saw when they selected the narrow your search
link while using the text search.
Cochran, Executive Director of the Alaska Native Science Commission,
expressed her concern as she tried to gather information on asthma:
I typed in Native American plus asthma. Two hundred documentsI
dont want to go through 200 documents. Im trying to
figure out a way that I dont have to do this. I need to
narrow this better. [User selects narrow your search
link.] I just expanded from documents into documents and organizations.
Best matches first. Were going to leave that where it is.
Types of information [paused for a while]
I think Ill
stay with all at this point, although Im just concerned
that were going to get back to the same thing as before.
Well, this is interesting. I wonder what alternative medicine
will bring up? Okay, so Im keeping this in English, and
Im going to submit this. Okay, hmm. It says that the Internet
resource I selected is based at a university. Im just not
exactly sure where I want to go with this.
Cochran, Alaska Native Science Commission
users who did not use the search bar, the experience was smoother.
No user had problems looking up a topic alphabetically.
I see, theres an alphabet. I love alphabets, so I would
actually probably go under traditional or Native. [User selects
Native Americans.] This is it. I love this right here. This is
exactly where I would want to be, in something like this.
Anderson, Alaska Native Medical Center
user expressed a preference for having the A-Z choice on her results
page so that she would not have to keep going back to the A-Z list.
Site Versus Linking Site
users select a document, most of them are not sure whether they
are leaving www.healthfinder.gov.
More experienced users are aware that they are leaving the site
only because they wait for the page to load and check to determine
whether the page looks different.
usability tests demonstrated that users seemed to be confused about
whether healthfinder® is a portal site or a destination site.
In this study, it seemed that users would wait until information
loaded to figure out where they were. They did not seem to mind
that it was a portal site. Users seemed to be most interested in
finding information that supported them in answering specific questions
they were researching.
Strategies on the Entire Site and the Just for You Section
navigated easily through www.healthfinder.gov
using the browsers Back button or selecting the apple
logo or selecting Home. However, many users experienced trouble
getting back to www.healthfinder.gov
once they selected a document that automatically put them in a second
window. Users who were more Internet savvy had no trouble closing
the second window. However, if they did not know how to close the
second window, they would continue using the browser Back button
or try the browser Home button until they gave up.
few users noticed the refine your search link (shown
in figure 6). One user selected refine
your search because she wanted to narrow her search to Alaska
Native. However, once this person saw the choices offered in the
refine your search page, she got interested in broader
topics (shown in figure 7).
Figure 6: Screen capture of
topic search page.
Figure 7: Screen capture of
refine your search page.
5: To understand how users experience the current Just for
You section on healthfinder®
were asked how they experienced the current Just for You
Specifically, they were asked to respond to the following requests:
differences between expressed preferences and actual use
whether AIAN users want a separate section such as Just
for You" or whether they would rather search the main healthfinder®
patterns for searching and filtering
Preferences Versus Actual Performance
asked what people thought they would find at the Just for
You link, the majority of participants expected information
to be filtered specifically for them. Often they expressed the expectation
of reading personal information.
expected more Just for You, maybe like talk with your
kids when they have problems with their health.
student, age 53
guess it pertains to you, as like your health and just some things
that youre curious about, like if youre aching or
somethings wrong with you. I thought there would beI
dont knowjust topics after topics about symptoms that
you could develop.
~Navajo student, age 18
they clicked on the Just for You link, we again asked
participants if what they expected to find was already there. (See
figure 8.) The results are provided in table
3. Even those who said that this was what they expected to find
noted that there was a mix of audiences here. Most users thought
the Just for You section was valuable and interesting.
Figure 8: Screen capture of
Table 3: Responses when asked,
Is this what you were expecting? after showing participants
the Just for You section.
confusion was caused by the differences in meaning in content groupings.
For example, there is currently a list that includes men, women,
infants, teens, adults, seniors, etc.
of all, youre not going to have infants clicking on this,
right? They dont know how to use a computer. My other thought
was Whats the difference between a man, an adult,
and a senior? Cant you be all three? I would say a
better way would be to break it down by ages: man, women. Maybe
men on one side, then ages; women on another column and ages.
So then the question is Are you a man thats a parent?
Are you a woman thats a parent? Are you a man thats
a caregiver? Its just a little confusing.
Ted Mala, Alaska Native Medical Center
users saw the prototype site (see table 4
and figure 9), the reaction was enthusiastic.
Overall, their expectations were met because the users who answered
no meant that they were surprised and pleased with what
they found. In fact, all users said that the AIAN section was interesting
and valuable to them. The medicine wheel image was well received,
and all topics, especially Traditional Medicine, elicited
excited remarks, such as This looks really really good.
I would send this out to my staff. Im clicking
on traditional medicine because I cant stand it anymore.
Yeah, theres some good stuff here!
Table 4: Responses when asked,
Is this what you were expecting? after showing participants
the AIAN section.
Figure 9: Screen capture of
prototype, as tested.
for a Separate Section
asked whether they would prefer to go to a Just for You
section or to the main site for AIAN concerns, the majority of participants
stated that they prefer an AIAN section. (See table
5.) However, they noted that they would prefer to see the AIAN
section from the homepage, for example, a link directly to the AIAN
section from the homepage.
Table 5: Preference for a separate
Just For You section for AIAN populations.
really excited because what youre doing with these cultural
Web sites is really important. Im excited you guys are considering
this. I really admire this agency thats doing this, to have
this, to have somebody working on it.
Anderson, Alaska Native Medical Center
Patterns for Searching and Filtering
participants saw the top 20 topics, they were eager to dive into
them and learn more about each topic. Some users did not see the
A-Z list. However, once they did, they easily found their way to
resources. The prototype did not have a search bar, so some people
commented about wishing they could search within this section.
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