tant. Another issue in standardization is that people’s expectations and desires about how things look change over time. If there is not room for modification, people may not pay attention to a site or to the available information there.

Another participant noted that many of the presenters talked about the importance of obtaining user feedback and observing users, which is very important in the development of these health information technology (IT) systems.

Kukafka commented that while there may be a need for standards in terms of exchange between systems, there has been little discussion about tailoring or personalizing content, which is what the data and research indicate people find most salient. It appears that people today want something targeted specifically for them at the time they need it. If one can assess a person’s literacy level, one can provide that person with exactly what he or she needs. One is spared the issues associated with population-based approaches to communication, issues such as whether one should present all information at a 6th-grade level. What happens when the information is at a 6th-grade level but the person accessing it is at the 12th-grade level? Does that put them off? In terms of improving health, providing individuals with tailored messages may well be a successful approach.

Tailoring and personalizing content are critical, Seidman agreed, not only because of issues such as health literacy, but also because content needs to be provided at the action level. For example, in attempting to get someone to quit smoking, providing information to that person if he or she is in the pre-contemplation stage will not be as effective.

Another issue, one participant said, is whether measurements should focus on process or outcome. That is, should one measure what needs to be learned concerning an individual’s interaction with information technology, or should one measure whether the interaction between an individual and the technology resulted in that person doing what he or she should—for example, taking the medication appropriately? What does it take to get the proper reaction or behavior?

It was pointed out that many people using the Internet or other IT tools are not looking for information in order to take action. Instead they are trying to understand something they have just been told.

One participant said that in the broader eHealth world it does not appear that the people designing health information technology (HIT) systems have an understanding of the issues of health literacy or their importance. Yet there have been several presentations about development of systems that did focus on the health literacy needs of their users. Is there any guidance that the presenters can give about how to bring these issues to the broader eHealth world?

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