Understanding and improving health information portal usage: a taxonomy of usage issues

There is increasing use of consumer health information portals (HIPs) for the provision of trusted, quality-assessed information to the public. However, the issues of HIPs that hinder users from successful searches remain poorly understood in eHealth literature. HIP usage is characterised by its underlying socio-technical architecture and the complex requirements of health information searching. Research on consumer health information searching has concentrated on issues relating to user searching skills and medical knowledge gaps, while little has been published about the intrinsic issues of HIPs that impact usage outcome. This study aims to fill such literature gaps. In addition, this study also addresses a shortage in the literature on applied research that can translate into tangible improvement for HIPs. This objective is currently hindered due to the lack of systematic understanding of usage issues. The research sets to produce a knowledge framework that can provide a full understanding of the factors affecting usage outcomes in HIPs. The central research question pursued in this research is: What can we learn about the usage issues in order to improve HIPs? This research employs a unique research design in order to explicate authentic understanding of HIP issues. Based on a design science methodology framework, this research develops a taxonomy of usage issues, and evaluates its validity and utility. The research design comprises: • A literature analysis to conceptualise a taxonomy of usage issues; • A usage data analysis to validate the taxonomy, by analysing issues contributing to actual failed searches in an operational HIP; • A user study using a think-aloud protocol to confirm the usage issues from the perspective of users. The user study identifies issues that were not visible from usage data but perceived as significant by users; and • An examination of the practical utility of the taxonomy for improving HIP design, centred on the concept usage-driven improvements, which refer to improvements based on insights from usage rather than dictated by system designers. The research contributed new understanding on HIP usage issues and practical improvement. Insights from the usage data analysis and the user study provided specific evidence of the deficiencies of content, user and system factors that impacted the usage outcomes. The results highlighted various gaps between the content and the user information needs, and the recurring usage issues. Such identified issues lead to implications for the improvement of HIPs. Findings from this study confirmed the prevalence of user issues as reported in the literature, but further identified the shortcomings of the system support for these issues. Such results suggest the necessity of a user-centred design for HIPs. The research outcomes highlight that the current design of HIPs is not effective and sustainable in meeting the users’ changing needs, as well as in addressing the identified deficiencies in user searching. The concept of usage-driven improvement, which is grounded on the analytical understanding of HIP issues, is proposed and demonstrated as a viable solution to improve and sustain HIPs. The research contributed a solution guideline and prototypes to realise such approach.