Optimizing Digital Health Platforms for Elderly Users

This paper, titled “Optimizing a digital health education platform for the elderly: influences on annotation and interaction design,” addresses the crucial need to improve digital health education accessibility for older adults. While digital health education offers significant benefits by overcoming space-time restrictions and providing vast information, elderly individuals often encounter challenges such as reading difficulties, low learning efficiency, and “digital panic” due to cognitive decline, physical function decline, and limited experience with digital devices. The research specifically focuses on optimizing the reading interface of digital health education platforms to enhance the reading experience for this vulnerable demographic.

The study investigates the impact of two independent variables on the elderly’s digital reading experience: hypertext annotation position and reading interaction mode. Hypertext annotations are explanatory notes or supplementary information, with the study focusing on pop-up window annotation, in-text annotation, and bottom annotation. Reading interaction modes refer to actions like scrolling and paging when content exceeds a single page. The research evaluates these variables based on their effects on several dependent measures: reading comprehension, vocabulary learning, cognitive load, and system usability.

A 3 × 2 two-factor experiment was conducted with 180 elderly participants aged 60–75 in China, using an Apple iPhone 12 to run the digital health education platform. The learning content was sourced from the U.S. Centers for Disease Control and Prevention (CDC) and translated into Chinese.

Key Findings of the Research:

The experimental results offer specific insights and recommendations for interface design:

• Reading Interaction Modes:
  • Scrolling was found to be superior to paging, leading to significantly lower cognitive load and higher system usability for elderly users. This is partly because scrolling allows for higher information integrity on a single page, which aids mental integration for users with declining memory.
  • However, no significant difference was observed between scrolling and paging in terms of reading comprehension.
• Hypertext Annotation Positions:
  • Different annotation positions showed significant differences in vocabulary learning and system usability.
  • Pop-up window annotation performed best in vocabulary learning. This is attributed to the pop-up remaining visible on mobile devices, allowing the annotation to stay closest to the glossed word, which aids concentration.
  • Both pop-up window annotation and bottom annotation demonstrated better system usability compared to in-text annotation. In-text annotation was found to interrupt normal reading by mixing content with annotations, forcing readers to engage with them and potentially reducing immersion.
  • Similar to reading interaction modes, no significant differences were found in reading comprehension or cognitive load across different annotation positions.
• Interaction Effects:
  • The study revealed significant interaction effects between hypertext annotation position and reading interaction mode on reading comprehension, vocabulary learning, and system usability.
  • Overall, the combination of scrolling with bottom annotation was found to be comparatively better across these measures.
  • For reading comprehension, scrolling performed better with in-text and bottom annotations, while paging was better with pop-up window annotations.
  • For vocabulary learning, scrolling excelled with pop-up window and bottom annotations, whereas paging was more effective with in-text annotation.
  • For system usability, scrolling was preferred with pop-up window and bottom annotations, while paging showed higher usability with in-text annotation.

Design Recommendations:

Based on these findings, the authors propose several design suggestions for digital health education platforms for the elderly:

• Prioritize the scrolling interaction method as it is often preferred by the elderly for its perceived accuracy.
• Utilize pop-up window annotations when vocabulary learning is a high priority, as it enhances focus on annotation content.
• Preferentially use the combination of scrolling and bottom annotation for an optimal overall effect in interface design.
• For elderly users less experienced with smartphones, the combination of scrolling and in-text annotation can simplify operations.

The study acknowledges limitations, including its focus on Chinese residents and mobile platforms, suggesting future research on diverse populations, reading material properties, and touch gestures.

Reference: Yi, M., Peng, C., & Wu, Q. (2025). Optimizing a digital health education platform for the elderly: influences on annotation and interaction design. Universal Access in the Information Society, 24, 1353–1368. https://doi.org/10.1007/s10209-024-01146-7