Sarah Stacy-Baynes and Anne-Marie Chisnall—User testing: health booklets that work for people (PLAIN 2013)

Sarah Stacy-Baynes is the national information manager at the Cancer Society of New Zealand, and she teamed up with plain language specialist Anne-Marie Chisnall of Write Limited to work on twenty booklets for cancer patients and their families, covering topics from types of cancer and types of treatments to living well with cancer and managing symptoms and side effects. These booklets offer clear, evidence-based information to a general audience, and to ensure that they remain accurate, relevant, and useful, Stacy-Baynes and her team put each of them through a review process once every four to five years. Oncologists, nurses, and other health practitioners are consulted to ensure the content is up to date, and the team actively solicits user feedback. Not only does each booklet contain a feedback form at the back, which asks such questions as “Did you find this booklet helpful?”, “Did you find this booklet easy to understand?”, and “Did you have any questions not answered in the booklet?”, but it also undergoes rigorous user testing before publication or republication.

For these booklets Stacy-Baynes and Chisnall performed think-aloud testing, a method in which test subjects receive a document they’ve never seen before and talk about it as they go through it. Each testing session includes a tester, user, and note taker, and it may be recorded (video or audio). The tester uses a script to work with the participants, and they make sure the users are informed about confidentiality and other ethical issues.

The tester and user go through a warm-up exercise first, on an unrelated item such as a menu. Once testing begins, the tester can reflect or repeat what the user says but can’t directly ask the user any questions. However, the tester can coach the user to make sure he or she has thought about the visuals, for example. A video of a sample testing session can be found here.

To recruit testers, Stacy-Baynes and her team asked for volunteers at the cancer society and through Cancer Connect, a peer support group for cancer patients and their families. As a result, their pool of testers was a representative sample of their target audience. They also made sure to recruit Māori participants: each booklet is bilingual—in English and Te Reo Māori—a particularly important feature because, as Stacy-Baynes noted, of all ethnicities of women, Māori women have the highest incidence of lung cancer. The team found that testing five participants for each booklet gave them plenty of useful feedback.

They discovered through their testing that users

  • preferred that the cover image not be of a person—they and their families didn’t want to see pictures of sick people when the booklet was out on their coffee table (the booklets now feature photos of plants)
  • wanted to see pictures of the treatment facilities
  • wanted to see pictures of Māori
  • preferred simplified diagrams rather than detailed medical illustrations.

Stacy-Baynes did encounter problems during the project—for example, some clinicians reviewing the material were sometimes determined to include some content regardless of whether the readers wanted it. Keeping team members motivated and interested through the long process of testing and redrafting was also challenging, but the team gained a lot of information from user testing that they wouldn’t otherwise have found.

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