Usability check for the Health 2.0 Era

Usability it is not about computers: it is about people. This is the reason why, when talking about usability in the Era of eHealth, we begin our discussion with human behaviors.

by Leandro Agrò

Usability check for the Health 2.0 Era
Usability check for the Health 2.0 Era

Usability starts from our Vision

Usability it is not about computers: it is about people. This is the reason why, when talking about usability in the Era of eHealth, we begin our discussion with from human behaviors.

We all live in a complex multi-sensorial environment surrounded by large amounts of information. Our brain comes into contact with this environment through sensory organs. Of all these, sight is without question the sense which helps us interact the most with our surrounding environment.

Through our eyes (and eye movements) we can obtain information about the spatial and material nature of the visible world; we can make out the exact shape and identity of the elements within our view, and register their relative positions. If we keep our head still we can't see a full 360° angle but only 120°.

The sensitivity of the eye's retina, is not even, since its resolution is higher in a very limited area called the fovea. As humans, we need to quickly and continuously move our eyes, to compose the unfinished puzzle that we the perceive as reality. The magic of our vision happens through Rapid Eye movement, which through rapid periods of technical blindness and quick snapshots, lets the eye build the reality of our visible world from the tiny puzzle pieces it grabbed.

In technical terms

1. saccades: are movements that allow our brain to align the area of the eye with the highest resolution - the fovea - with the target we want to see.

2. fixations: are "pauses" that allow the eye to grab the images that our brain will compose and understand.

Why eye tracking is relevant for Health 2.0?

According Wikipedia: The term Web 2.0 is associated with web applications that facilitate participatory information sharing, interoperability, user-centered design, and collaboration on the World Wide Web. People behaviour is its driving essence.

From the web's Client-side, everything has changed! Web browser technologies based on "Ajax programming" allow the upload/download of new data from a server without requiring a full page reload. This is today's secret behind the beautiful dynamic of web user interfaces for online services like google maps, facebook, twitter, etc. The intrinsic dynamic of the web2.0 raises the level of fragmentation of user interactions -and- hides many relevant actions to the traditional methods employed to conduct usability tests (which just focuse on the record of the pages viewed by people and on the time they spend on a single page). As humans, we continuously drive our gaze throughout a web page in order to catch the information we need. Even if we are not aware of this process, this is how we transmit the visual stimuli to our brain in order to process it as information.

It's clear that knowing exactly where users tend to focus their attention is an extraordinary way to check the effectiveness of an interface or to make strategic choices. This is the reason why Eye tracking has become one of the best methods of measuring the usability of an interface.

The point of Eye tracking testing is neither about what you click nor how long you stay on a page, but WHY you click and HOW your gaze wanders across the webpage. To discover this we need to strongly track the users "gaze journey" throughout the webpage.

So how is the the usability level of the health websites?

We know that good Web 2.0 calls for e a rich user experience, user participation, dynamic content, metadata, web standards and scalability. and now comes the question: Does Health 2.0 have these characteristics?

Amongs the top 15 health websites we find a low level of user participation or engagement. The interactivity is lower than any other type of site (news, foods, sports...) while at the same time people tend to get lost trying to find the information that they need and deciding where to click for the right spot.


The user's journey through health-related websites may turn into a really unfortunate navigation exercise: before being able to grasp the meaning of the content, users often need to go through the trouble of accessing it via the page interface.

This is when eye tracking technology can be very handy and helps us. Eye tracking has shown us how users' glaze is continuously jumping from side to side in a webpage until the users find the information they need and click on the right spot to get more of it. We have noticed that a lot of the websites we have evaluated with eye tracking fail in driving users throughout the navigating and users keep on exploring the webpage in search for a clickable landing spot.

The methodologies that are usually applied to measure the usability of websites are blind to the "gaze wandering" by users because that kind of analysis just focuses on the click stream (such as the record of the viewed pages by users) and does not tell us anything about the quality of the users' stay on the page. Was the user reading? Was he/she lost in navigation? That's something that only eye tracking can tell us.

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