The Magazine of the Usability Professionals' Association
By Kris Engdahl, Kristen Leclerc, and Beth Loring
Last winter, we ran a usability study in our lab with adults aged 75 and above. This age group is often classified as the "older-old" population, as opposed to the "younger-old" population of 60-75. We had done considerable research with this older-old population before, and we knew to expect higher-than-average cancellation rates because of participants' health and transportation issues. But when a light snow wreaked havoc with our testing schedule, we decided to take the research to our participants. In doing so, we discovered that field testing and field research work especially well with older adults.
We've conducting over 100 interviews and field tests with adults 75 and older in the past two years, mainly in the area of consumer products and home healthcare devices.
One of our first challenges, as in any study, was finding the right participants. For us, this meant people aged 75 and older with a variety of health-related issues who would allow us to conduct interviews in their homes. In recruiting this population, the following strategies worked well for us:
We found that senior housing facilities and assisted living facilities gave us great access to potential participants. Focusing on these facilities also cut down on the travel time between interviews. When we explained our study to the directors at the centers, they often became great advocates for our research. They circulated information for us and, in some cases, even arranged for us to speak to their residents to explain our studies. This allowed us to clarify the purpose of the research and reassure residents that we were not selling anything. Having someone they trusted vouch for us helped our participants feel more comfortable with our studies.
Paper flyers and internet postings that targeted caregivers, as opposed to older adults themselves, proved very effective. Again, this provided older adults with the reassurance that someone they trustóoften a son or daughteróhad learned about the study and found it legitimate. When working through caregivers, however, it is important to ensure that the actual participants themselves have agreed to participate and are not being pressured by their caregivers.
Networking was an effective way to locate older adult participants. For example, one of us had a late cancellation for a study that involved an international client who was leaving the next day. At the last minute, she was able to replace the participant with the mother of the contractor who was working on her house!
Our early round of interviews also provided excellent networking opportunities. Our first participants told their friends about the study, who then wanted to participate in later rounds of testing. However, this method has potential pitfalls. For example, we encountered a group in one senior housing center who took down posted flyers because they wanted to reserve participation for their circle of friends.
Maintaining clear and open communication while we interacted with older-old participants contributed to the success of our studies. Being trustworthy, patient, and punctual also enhanced our interactions during the sessions.
To support the visual decrements of aging, we increased the font size in our flyers and used bold text. We also needed to support the effects of aging on cognitive functions such as memory. We made flyers as straightforward as possible, with simple sentence structure and no unnecessary details. In a diary study, we provided a list of clearly stated reminders, labeled, ìImportant things to remember,î for participants to reference on their own. Consistency also proved to be important. In an early study, our informed consent form had the line for the signature first and the line for the printed name second, while our cash receipt form had the order reversed. When we presented the second form, some of the oldest participants signed the Name line and then were embarrassed when they read "Signature" on the next line. In subsequent studies, we fixed the forms to present the name and signature in a consistent order.
Figure 1: Inconsistency between signature lines on forms can cause problems
We were able to support hearing impairments by speaking loudly and clearly, and in some cases, participants asked us to sit on the side nearest their "good ear."
As with written communication, we strove to be clear and concise and to avoid long, detailed instructions. Asking older adults to retain many details at once taxes their working memory, which becomes especially vulnerable with age. We chunked the information, stated each point clearly, and left time for questions between topics.
Older adults are often targets for scams, so it was important for us to be open about our research and to answer all questions, even if we had to repeat ourselves. During a recruiting presentation at one assisted living facility, we were careful to state that we were not selling anything and that we would pay honoraria for participation. Still, in the end, some residents asked how much it would cost for them to participate in our study.
We limited our team to one or two interviewers, so that we would not overwhelm participants, and made sure to tell them ahead of time how many of us to expect.
We also invited caregivers to be present for interviews, both for their peace of mind and for participants' reassurance. One caveat, however, is that sometimes caregivers, who feel very connected to their loved ones and want to help, may answer for the participant. In these cases, we gently redirected the question, saying, for example, "Now, Mary, what do you think?" We were careful to ask for participants' permission before recording or taking photographs. We asked them during the screening call and again at the beginning of the interview. We used portable video cameras to record usability tests. For field interviews, we took digital photographs and handwritten notes.
Figure 2. Equipment for recording usability tests in the participant's home
Arriving on time is very important in establishing participants' trust. Our participants were often anxious for us to arrive at their homes. To ensure on time arrival, we allowed extra travel time to account for unforeseen delays, such as traffic. Participants often expressed appreciation for our punctuality and found this gesture considerate and courteous. It set a positive tone for our sessions.
As busy researchers, we were aware of all that we wanted to cover in our interviews. But our participants treated us like company in their homes and, as guests, it was important to allow time for them to tell us about their families, and not to jump right into the interview questions.
In answering questions, participants sometimes needed to give us more detail than we really needed. For example, we might ask how long they lived in their current residence, and they would answer with a story about when and how their spouse died, how their children worried about them remaining in their family home and encouraged them to move into the senior housing facility where they currently lived. Paying attention to these stories not only showed respect for our hosts, it gave us valuable insight into our participants' lives, including their use of our clients' products.
To account for this deep level of communication, we allowed about 50 percent more time for these interviews than we would with a younger population.
Probing is a standard interviewing technique, but with older adults, we sometimes found it necessary to probe around even simple statements. For example when we asked, "How is your general health?"the majority said, "Good." However, further probing indicated some had had cancer, heart surgery, respiratory disease, or other ailments. For these participants, ìgoodî seemed to mean "Good for someone my age," or "Good, considering all I've been through."
In probing, we were careful not to be intrusive, which can be a delicate balance. While we wanted to know of any health concerns that affected our research, we did not want to elicit medical information that was personal and/or confidential. When one participant offered to show us all his medications, we politely declined.
As we interviewed older participants, we learned more about how they related to the research in general and how they understood their participation in our studies.
Our participants took their involvement in our studies very seriously. Only one of sixty participants in our diary studies dropped outóand she did so because she was hospitalized. Participants were also highly motivated to complete their diaries accurately. To help aid their memory, some carried note pads and recorded activities as they occurred so that they would not forget. We have conducted similar diary studies with younger participants and did not find nearly this level of commitment.
A number of participants told us that being involved in the research was a positive experience for them because it made them feel needed and valued. Several said they were pleased to be able to do something that would help others in the future. The research also appeared to stimulate some older participants because it encouraged active engagement in a task. One of the facility directors reported that she felt that our diary study actually "exercised" the memories of residents at her facility.
Figure 3. One participant's schedule of activities on the refrigerator
As with other studies, we paid our older participants at the end of each interview. While a number of participants told us they would have been happy to participate "for free," they clearly appreciated the honoraria we gave them. Compensation not only supplemented their income, but it helped express the value we placed on their time.
Older participants are each unique and vary in many different ways There is huge variation among persons of any age in personality, as well as cognitive and physical functionality. We saw participants of the same age who could hardly walk and others who exercised for an hour or two per day. While some participants had little activity beyond watching television, we took pictures of one 93-year-old's calendar and refrigerator door, which indicated a life full of activities and responsibilities. We met an 88-year-old who still tutors teens in a city school.
We were amazed at how frank and open our participants were in our interviews. They sometimes told us things they wouldn't tell their children--that they took naps in the middle of the day, for example. One woman told us that she was looking forward to going to her next home. We asked where she was moving, and she responded "Heaven...I hope."
Our fieldwork with older-old adults opened our eyes to their needs and their strengths. By being trustworthy and adapting our communication to meet their needs, we were able to recruit participants and conduct successful field studies.
As with any study, we became sensitive to the issues facing our target population. With our older participants, we found ourselves looking ahead at our own future and wondering how we will fare. Thankfully, our work in this area has the potential to positively influence the lives and health of current and future senior citizens.
Kris Engdahl is a usability consultant at the Bentley Design and Usability Center. She has over seventeen years of experience addressing usersí needs as a usability specialist and a technical writer. She has worked on a variety of products ranging from solutions for very technical users to consumer products. Kris holds an MS in Human Factors from Bentley College.
Kristen Joffre Leclerc is an independent usability consultant with over ten years of behavioral and usability research experience. She has worked on evaluations in a wide range of areas, including consumer products, e-commerce, retail, software, health, and education. Kristen holds a degree in psychology from the University of Virginia.
Beth Loring is director of research and usability at Farm Design, a medical device development consultancy. She has over twenty years experience in product design and usability, with expertise in user requirements gathering, interface design, and usability testing. Beth holds an MS in Engineering Design from Tufts University and is a Certified Human Factors Professional. She recently coauthored Moderating Usability Tests: Principles and Practices for Interacting with Joseph Dumas (Morgan Kaufmann Publishers, 2008).
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This article was originally printed in User Experience Magazine, Volume 8, Issue 1, 2009.
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