A Comprehensive Analysis of Healthcare Websites Usability Features, Testing Techniques and Issues

Healthcare has evolved significantly over time, from traditional healthcare systems to cutting-edge medical technologies. As these technologies advance, researchers have become interested in their usability. The usefulness of healthcare websites helps to provide more precise medical information. A comprehensive review of the literature is required to identify usability features, techniques, and issues in healthcare websites over a specified time period. In this study, articles from the years 2017–2021 are reviewed from well-known digital libraries i.e, IEEE, ACM, and ScienceDirect that include papers from various conferences, magazines, books, and journals. Initially, the study found 10,512 titles based on the search string developed from the proposed research questions which were then further filtered down to a total of 55 papers. This systematic literature review (SLR) summarises and collects relevant data in response to pre-defined research questions. This analysis of existing research will help website designers and developers, in developing more user-friendly healthcare websites for the users. In the future, this SLR will help in determining the optimal solutions and developing a framework for the identified usability challenges and limitations. It also includes employing the usability evaluation tools discovered by researchers to identify and fix usability issues on websites.

or developers [1]. To make effective tools, more research 23 needs to be done on making interfaces that are easy for 24 users. Usability issues have a greater impact on users [2]. 25 As the Internet evolves, new online services in a variety of 26 The associate editor coordinating the review of this manuscript and approving it for publication was Orazio Gambino . forms may become available. As a result of this evolution, 27 its information must be accessible to a diverse group of 28 people. Due to the aging problem, elderly persons (those 29 aged 60 and above) have limited abilities and have had 30 difficulty in connecting with healthcare websites. In addition 31 to regulations and guidelines that aid in the promotion of 32 accessible and relevant web content, different accessibility 33 and usability problems arise, because the majority of websites 34 are not developed with these users in mind, the problems 35 that impact older persons have received little attention [3]. 36 To ensure compliance with the accessibility and usability 37 requirements, all important stakeholders must be included 38 in the websites design phase. The goal is to minimise their 39 VOLUME 10,2022 This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ The paper is organized as follows: Methodology for the 95 SLR is explained in Section II. The results are presented in 96 Section III. The discussion is presented in Section IV Limita-97 tions of the work are discussed in Section V. Conclusion and 98 future directions are given in Section VI.

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The amount of information available in healthcare websites 101 is rapidly increasing. Healthcare websites create a vast 102 amount of data on a daily basis, which limits their use. It is 103 possible to make a substantial contribution to the effective 104 development of healthcare websites by examining their 105 usability. Researchers play an important role in improving 106 the usability of these websites in this regard. From website 107 visitors to website developers, usability influence a multitude 108 of areas. features found on these sites. It also proposes a series of 179 guidelines to follow to complete a successful SLR with 180 particular objectives. Figure 1 depicts the processes required 181 to conduct a thorough systematic literature review [10].  to locate relevant articles that may be downloaded from 191 the various digital libraries that are identified. Based on 192 the information included in the articles, the inclusion and 193 exclusion criteria is established. The next step is to rank 194 articles based on numerical values given to the papers based 195 on their relevancy to the research questions as they analyze 196 how it is to add those articles to this SLR and also it impacts 197 on the overall quality of this research, the relevance rate of 198 papers to each question is shown in   researchers. In the future, designers will avoid these 220 issues, and researchers will address them.  publish high-quality articles. A list of keywords is compiled 240 while searching for relevant articles in these libraries. These 241 keywords have been kept as precise as possible, and concise 242 terminology have been chosen for the task at hand.

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Rather than employing shorter keywords, a combination 244 of words is applied, resulting in a large number of articles, 245 such as (usability of healthcare websites). To overcome this 246 issue, the paper used inclusion and exclusion criteria to ensure 247 that only relevant studies are included. Appropriate keywords 248 are selected to locate relevant articles. These keywords have 249 been chosen in combination with the research topic and 250 the intended suggested study. The search is filtered by a 251 date ranging from the year 2017 to 2021. As a result, 252 articles are found in the form of conference proceedings, 253 workshop papers, journal articles, books, and a variety of 254 other accessible resources. To find a collection of relevant 255 articles with the help of predefined keywords for searching, 256 all the digital resources are accessed and searched through a 257 manual process.  When it comes to SLR, selecting articles is a difficult task.    239 papers are included in this evaluation, all of which were 308 chosen solely on their titles. In the second phase, the papers 309 that are selected based on their titles are filtered using the 310 abstract of each paper, which is accomplished by reading 311 out the abstracts of relevant articles. A total of 84 papers 312 are chosen based on the abstract in the second stage of the 313 process.

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While at the third and final stage, papers are chosen 315 based on the content presented in the paper, which is deter-316 mined after the information has been thoroughly examined. 317 To extract the relevant information, a total of 55 papers are 318 selected for the final study for data extraction. All of this 319 process is carried out manually. Table 4 shows the inclusion 320 and exclusion criteria.

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In Table 3, the procedure for selecting of key studies for 322 the proposed systematic literature review is shown. Figure 5 323 represents the selection of papers through title, abstract, and 324 content. Figure 6 shows the year and type of the final number 325 of papers. Table 5 presents details of years for the total 326 number of papers for the study. Table 6 depicts the ranking 327 of articles based on filtering for quality assessment. Figure 8 328 shows the total percentage of papers selected from respective 329 libraries.

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A ranking criteria is applied for the quality assessment after 332 the inclusion/exclusion step on the final papers. These papers 333 are explained in detail below. This process shows how much 334 a paper is similar to the research question. 335 VOLUME 10, 2022    summed value is more than or equal to 2, indicating that 359 the paper is most relevant to the selection criteria. Figure 9 360 shows the quality assessment of articles after filtering 361 diagrammatically.      The results of this SLR are provided systematically so that 441 it is easy for everyone to extract their relevant information 442 efficiently.

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In the next discussion section IV will discuss previous 444 work done on usability evaluation, usability heuristics 445 provided by Nielsen, usability metrics, 5 basic principles 446 of usability, some equations to calculate usability, and the 447 results of this paper will also be discussed. Limitations of the 448 research are further analysed in section V which will provide 449 a gateway for the researchers to work on.      (by making it simple) is one of the most challenging aspects 472 of web design. The usability of a website is driven by two 473 objectives: clarity and utility, and designers must prioritize 474 both. In other words, web designers are tasked with the 475 responsibility of building websites that not only appears 476 nice but also perform as expected by users, which is not an 477 easy task even for the most experienced designer. These are 10 fundamental principles of user interface 482 design. They are referred to as ''heuristics'' since they are 483 more similar to general guidelines and specific usability 484 recommendations proposed by Nielsen [68], as seen in 485 Figure 11.    interacts with the interface. When it comes to determining 502 the usability of a website, it is often calculated during 503 user testing. The researcher is critical in documenting and 504 monitoring the activities completed by users during usability 505 assessments. Several of the duties include ''finding a doctor's 506 contact information'' and ''locating a therapy for an illness'', 507 particularly when browsing healthcare websites. While Jacob 508 Nielsen, inventor of ''NN Groups'' recommends a minimum 509 of five people for the usability test, the findings are more 510 acceptable with twenty users.

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During usability testing, researchers record the behaviors 512 of users and calculate these measures. Let's take a closer 513 VOLUME 10, 2022 look at how these metrics are measured and how a successful 514 measurement may be accomplished. Because of the fact that human is not a machine, it will 568 make errors during the interaction. The total number of 569 errors cannot be zero. Due to the inherent human tendency 570 to make errors, users must commit errors during usability 571 testing. According to Jeff Sauro in his book, ''just 10% 572 of tasks are completed without error.'' The success rate 573 and error rate of a product can be used to determine its 574 effectiveness. Additionally, these indicators are used to assess 575 efficiency.

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Usability is frequently used to refer to a user's ability to 578 effectively perform a task on time. Nonetheless, the task time 579 metric is simple, and it may be completed with maximum 580 efficiency. It is common practise to utilize task time metrics to compare 591 the performance of a product to prior versions or to compete 592 with other products. While the time difference is frequently 593 minimal, keep in mind that a short task time does not always 594 imply a flawless design.

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One of the most fundamental methods of evaluating effi-597 ciency is time-based efficiency, which considers how long an 598 activity takes and how effectively it is completed.
There are several satisfaction indicators accessible. Users are 601 prompted to complete a questionnaire during usability testing 602 to collect data for these metrics. UX researchers should utilize this statistic since it's simple 605 but effective. When a task is completed, a single question is 606 asked, as shown in figure 12. This is much simpler than all 607 those intricate computations.

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The core of user experience is captured by SEQ. The job 609 may take a user longer to complete, but the other metrics did 610

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• Product-oriented view: shows that usability can be 633 judged in terms of the product's ergonomic features.

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• User performance view: determines usability by looking 635 at how a user interacts with a product, with a focus on 636 either; 637 Acceptability: determines whether or not the 638 product will be used in the actual world.

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Ease-of-Use: simplicity of using the product. 640 Usability refers to the ease with which an interface may 641 be used. The study revealed that usability is crucial when 642 it comes to designing healthcare websites. The web user 643 interface should be simple to navigate. Patients should always 644 be able to use the user interface in a simple and easy way [7]. 645

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The current study used a sample size of 55 publications to 647 extract usability features, techniques, and issues. However, 648 these articles were chosen in accordance with pre-defined 649 inclusion/exclusion criteria. The majority of the researchers 650 of the chosen publications are academics. They may lack 651 knowledge in the field of web development. To validate the 652 current study's conclusions, we will perform an empirical 653 investigation in the healthcare web development industry. 654 Following are some of the limitations of this work: Usability of healthcare websites is a problem that must be 668 resolved. Since doctors and patients are the primary users 669 of these websites, their usability must be the main focus 670 during the design process. The proposed research found 671 usability features, methodologies, and issues for the websites 672 presented in Tables 7, 8, and 9 respectively. The current 673 research is an endeavour toward a comprehensive report 674 on healthcare websites usability.