Helping patient educators meet health literacy needs: End-user testing and iterative development of an innovative health literacy editing tool.

Objective: The Sydney Health Literacy Lab (SHeLL) Editor is an online text-editing tool that provides real-time assessment and feedback on written health information (assesses grade reading score, complex language, passive voice). This study aimed to explore how the design could be further enhanced to help health information providers interpret and act on automated feedback.
Methods: The prototype was iteratively refined across four rounds of user-testing with health services staff ( N  = 20). Participants took part in online interviews and a brief follow-up survey using validated usability scales (System Usability Scale, Technology Acceptance Model). After each round, Yardley's (2021) optimisation criteria guided which changes would be implemented.
Results: Participants rated the Editor as having adequate usability (M = 82.8 out of 100, SD = 13.5). Most modifications sought to reduce information overload (e.g. simplifying instructions for new users) or make feedback motivating and actionable (e.g. using frequent incremental feedback to highlight changes to the text altered assessment scores).
Conclusion: terative user-testing was critical to balancing academic values and the practical needs of the Editor's target users. The final version emphasises actionable real-time feedback and not just assessment.
Innovation: The Editor is a new tool that will help health information providers apply health literacy principles to written text.
Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was primarily funded via the Lifespan Research Network seed funding. Development of the Editor was supported by a Lifespan Research Network seed funding grant at the 10.13039/501100001774University of Sydney. This user testing study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dana Mouwad reports administrative support was provided by Western Sydney Local Health district, Health Literacy Hub. Administrative support was provided by Western Sydney Local Health Distrcit, Health Literacy Hub. Academic authors were supported by National Health and Medical Research Council, Heart Foundation, and Western Sydney Local Health District. Members of the research team (JA, DMM, CB, KM) are directors of a health literacy consultancy (Health Literacy Solutions Ltd., Pty).
(© 2023 The Author(s).)