Using Gaze Tracking as a Research Tool in the Deaf Health Literacy and Access to Health Information Project: Protocol for a Multisite Mixed Methods Study and Preliminary Results

Sara Champlin, Jessica Cuculick, Peter C Hauser, Kelley Wyse, Michael M McKee, Sara Champlin, Jessica Cuculick, Peter C Hauser, Kelley Wyse, Michael M McKee

Abstract

Background: Previous studies have identified the internet as a major source of health information. Reliable and accessible sources of web-based health information are critical for cultivating patient-centered care. However, the accessibility and use of web-based health information remains largely unknown for deaf individuals. We used gaze-tracking technology to understand the navigation and use of web-based health information by deaf adults who communicate with sign language and by hearing adults.

Objective: This paper discusses our protocol for implementing gaze-tracking technology in a study that included both deaf and hearing participants. We report the preliminary results and lessons learned from the implementation of the protocol.

Methods: We conducted gaze-tracking sessions with 450 deaf signers and 450 hearing participants as a part of a larger, multisite mixed methods research study. Then, we conducted qualitative elicitation interviews with a subsample of 21 deaf and 13 hearing participants, who engaged in a search task and reviewed their gaze recordings. To our knowledge, no study has implemented a similar research protocol to better understand the experiences of deaf adults. As such, we also examined research staff notes and observations from team meetings regarding the conduct of gaze-tracking data to delineate lessons learned and best practices for research protocols in this area.

Results: Findings from the implementation of this study protocol highlight the use of gaze technology with deaf participants. We developed additional protocol steps to minimize gaze disruption from either lipreading or communicating in sign language. For example, research assistants were often unable to maintain eye contact with participants while signing because of the need to simultaneously point at the computer monitor to provide instructions related to gaze study components, such as the calibration process. In addition to developing ways to effectively provide instructions in American Sign Language, a practice exercise was included in the gaze tracker session to familiarize participants with the computer and technology. The use of the playback feature permitted a deeper dialogue between researchers and participants, which we found vital for understanding the experiences of deaf participants.

Conclusions: On the basis of our experience using the study protocol through a large research project, incorporating gaze-tracking technology offers beneficial avenues for better understanding how individuals interact with health information. Gaze tracking can determine the type and placement of visual content that attracts attention from the viewers of diverse backgrounds, including deaf individuals. The lessons learned through this study will help future researchers in determining ideal study designs, such as suitable protocols and participant characteristics (eg, deaf signers), while including gaze trackers in their projects. This approach explored how different ways of presenting health information can affect or enable visual learners to engage and use health information effectively.

International registered report identifier (irrid): RR1-10.2196/26708.

Keywords: accessibility; deaf; disabilities; gaze tracking; health information seeking; mobile phone; online health information.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sara Champlin, Jessica Cuculick, Peter C Hauser, Kelley Wyse, Michael M McKee. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.09.2021.

Figures

Figure 1
Figure 1
Sample stimuli from left to right: (1) actual Centers for Disease Control and Prevention webpage, (2) experimental study stimuli with pictures, (3) experimental study stimuli without pictures.
Figure 2
Figure 2
Examples of heat maps and gaze diagrams collected in this study: (a) Example heat map: group of low health literacy hearing participants (left), group of low health literacy deaf participants (right)—the gradient of colors (green to red) indicate the density of visual attention (low to high, respectively); (b) Example gaze plot of asthma survey component.
Figure 3
Figure 3
Example Area of Interest tool.
Figure 4
Figure 4
Example video replay. The participant searches for information about deep vein thrombosis.

References

    1. Jacobs W, Amuta AO, Jeon KC. Health information seeking in the digital age: an analysis of health information seeking behavior among US adults. Cogent Soc Sci. 2017 Mar 13;3(1):1–11. doi: 10.1080/23311886.2017.1302785.
    1. Fox S, Duggan M. Health online 2013. Pew Research Center. 2013. [2021-07-15].
    1. Murphy M. Dr Google will see you now: search giant wants to cash in on your medical queries. The Telegraph. 2019. [2021-07-15].
    1. Barry MJ, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012 Mar;366(9):780–1. doi: 10.1056/nejmp1109283.
    1. Karnam S, Raghavendra P. Hybrid Doctors: The need risen from informed patients. J Clin Diagn Res. 2017;11(2):ZI01–ZI04. doi: 10.7860/jcdr/2017/23163.9200.
    1. Karras E, Rintamaki LS. An examination of online health information seeking by deaf people. Health Commun. 2012 Aug 19;27(2):194–204. doi: 10.1080/10410236.2011.575539.
    1. Mackert M, Mabry-Flynn A, Champlin S, Donovan EE, Pounders K. Health literacy and health information technology adoption: the potential for a new digital divide. J Med Internet Res. 2016 Oct 04;18(10):e264. doi: 10.2196/jmir.6349. v18i10e264
    1. Mitsutake S, Shibata A, Ishii K, Oka K. Associations of eHealth literacy with health behavior among adult internet users. J Med Internet Res. 2016 Jul 18;18(7):e192. doi: 10.2196/jmir.5413. v18i7e192
    1. Panzer K, Park J, Pertz L, McKee M. Teaming together to care for our deaf patients: insights from the deaf health clinic. J Am Deaf Rehab Asso. 2020;53(2):60–77.
    1. Suggs LS. A 10-year retrospective of research in new technologies for health communication. J Health Commun. 2006 Jan;11(1):61–74. doi: 10.1080/10810730500461083.R290MM21271W745L
    1. Valdez R, Rogers C, Claypool H, Trieshmann L, Frye O, Wellbeloved-Stone C, Kushalnagar P. Ensuring full participation of people with disabilities in an era of telehealth. J Am Med Inform Assoc. 2021 Feb 15;28(2):389–92. doi: 10.1093/jamia/ocaa297. 5988542
    1. Koonin LM, Hoots B, Tsang CA, Leroy Z, Farris K, Jolly B, Antall P, McCabe B, Zelis CB, Tong I, Harris AM. Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January-March 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct 30;69(43):1595–9. doi: 10.15585/mmwr.mm6943a3. doi: 10.15585/mmwr.mm6943a3.
    1. Cuan-Baltazar J, Muñoz-Perez M, Robledo-Vega C, Pérez-Zepeda M, Soto-Vega E. Misinformation of COVID-19 on the internet: infodemiology study. JMIR Public Health Surveill. 2020 Apr 09;6(2):e18444. doi: 10.2196/18444. v6i2e18444
    1. Murray JJ. Improving signed language and communication accessibility during COVID-19 pandemic. Hearing J. 2020. [2021-07-16]. .
    1. Paludneviciene R, Knight T, Firl G, Luttrell K, Takayama K, Kushalnagar P. Perception of COVID-19 physical distancing effectiveness and contagiousness of asymptomatic individuals: cross-sectional survey of deaf and hard of hearing adults in the United States. J Med Internet Res. 2021 Feb 25;23(2):e21103. doi: 10.2196/21103. v23i2e21103
    1. Limaye RJ, Sauer M, Ali J, Bernstein J, Wahl B, Barnhill A, Labrique A. Building trust while influencing online COVID-19 content in the social media world. Lancet Dig Health. 2020 Jun;2(6):277–8. doi: 10.1016/s2589-7500(20)30084-4.
    1. Goldberg L, Lide B, Lowry S, Massett H, O'Connell T, Preece J, Quesenbery W, Shneiderman B. Usability and accessibility in consumer health informatics current trends and future challenges. Am J Prev Med. 2011 May;40(5 Suppl 2):187–97. doi: 10.1016/j.amepre.2011.01.009.S0749-3797(11)00086-9
    1. Zeng X, Parmanto B. Web content accessibility of consumer health information web sites for people with disabilities: a cross sectional evaluation. J Med Internet Res. 2004 Jun 21;6(2):e19. doi: 10.2196/jmir.6.2.e19. v6e19
    1. Mitchell RE. How many deaf people are there in the United States? Estimates from the Survey of Income and Program Participation. J Deaf Stud Deaf Educ. 2006 Oct 12;11(1):112–9. doi: 10.1093/deafed/enj004.enj004
    1. Moreland CJ, Paludneviciene R, Park JH, McKee M, Kushalnagar P. Deaf adults at higher risk for severe illness: COVID-19 information preference and perceived health consequences. Patient Educ Couns. 2021 Mar 17;:A. doi: 10.1016/j.pec.2021.03.020. (forthcoming)S0738-3991(21)00191-9
    1. Barnett S, McKee M, Smith SR, Pearson TA. Deaf sign language users, health inequities, and public health: opportunity for social justice. Prev Chronic Dis. 2011 Mar;8(2):A45. A45
    1. Kushalnagar P, Hill C, Carrizales S, Sadler GR. Prostate-Specimen Antigen (PSA) screening and shared decision making among deaf and hearing male patients. J Cancer Educ. 2020 Feb 23;35(1):28–35. doi: 10.1007/s13187-018-1436-3. 10.1007/s13187-018-1436-3
    1. Pollard RQ, Barnett S. Health-related vocabulary knowledge among deaf adults. Rehabil Psychol. 2009 May;54(2):182–5. doi: 10.1037/a0015771.2009-07289-008
    1. McKee MM, Paasche-Orlow MK, Winters PC, Fiscella K, Zazove P, Sen A, Pearson T. Assessing health literacy in deaf American sign language users. J Health Commun. 2015 Oct 29;20 Suppl 2(sup2):92–100. doi: 10.1080/10810730.2015.1066468.
    1. Valentine G, Skelton T. ‘An Umbilical Cord to the World’ : The role of the internet in D/deaf people's information and communication practices. Inf Commun Soc. 2009 Feb;12(1):44–65. doi: 10.1080/13691180802158573.
    1. McKee MM, Hauser PC, Champlin S, Paasche-Orlow M, Wyse K, Cuculick J, Buis LR, Plegue M, Sen A, Fetters MD. Deaf adults' health literacy and access to health information: protocol for a multicenter mixed methods study. JMIR Res Protoc. 2019 Oct 09;8(10):e14889. doi: 10.2196/14889. v8i10e14889
    1. Fajardo I, Abascal J, Canas J. The role of working memory and long term memory in Deaf users’ hypertext navigation: review of guidelines for web accessibility. In: Stary C, Stephanidis C, editors. User-Centered Interaction Paradigms for Universal Access in the Information Society. Berlin: Springer; 2004. pp. 320–5.
    1. Champlin S, Lazard A, Mackert M, Pasch KE. Perceptions of design quality: an eye tracking study of attention and appeal in health advertisements. J Comm Healthcare. 2014 Dec 04;7(4):285–94. doi: 10.1179/1753807614y.0000000065.
    1. Robins D, Holmes J, Stansbury M. Consumer health information on the web: the relationship of visual design and perceptions of credibility. J Am Soc Inf Sci. 2009 Oct 02;61(1):13–29. doi: 10.1002/asi.21224.
    1. Duchowski A. Eye Tracking Methodology: Theory and Practice. Switzerland: Springer; 2017. pp. 1–251.
    1. Kok EM, Jarodzka H. Before your very eyes: the value and limitations of eye tracking in medical education. Med Educ. 2017 Jan 01;51(1):114–22. doi: 10.1111/medu.13066.
    1. Falck-Ytter T, Bölte S, Gredebäck G. Eye tracking in early autism research. J Neurodev Disord. 2013 Sep 26;5(1):28. doi: 10.1186/1866-1955-5-28. 1866-1955-5-28
    1. Tang I, Tsai Y, Lin Y, Chen J, Hsieh C, Hung S, Sullivan WC, Tang H, Chang C. Using functional Magnetic Resonance Imaging (fMRI) to analyze brain region activity when viewing landscapes. Landsc Urban Plan. 2017 Jun;162:137–44. doi: 10.1016/j.landurbplan.2017.02.007.
    1. Whelan ME, Morgan PS, Sherar LB, Orme MW, Esliger DW. Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review. Prev Med. 2017 Jun;99:185–96. doi: 10.1016/j.ypmed.2017.02.004.S0091-7435(17)30052-X
    1. Fetters M. The Mixed Methods Research Workbook: Activities for Designing, Implementing, and Publishing Projects. Thousand Oaks, California, United States: Sage Publications Inc; 2019. pp. 1–312.
    1. Henry SG, Fetters MD. Video elicitation interviews: a qualitative research method for investigating physician-patient interactions. Ann Fam Med. 2012 Mar 12;10(2):118–25. doi: 10.1370/afm.1339. 10/2/118
    1. Henry S, Forman J, Fetters M. 'How do you know what Aunt Martha looks like?' A video elicitation study exploring tacit clues in doctor-patient interactions. J Eval Clin Pract. 2011 Oct;17(5):933–9. doi: 10.1111/j.1365-2753.2010.01628.x.
    1. Creswell J, Clark V. Designing and Conducting Mixed Methods Research. Thousand Oaks, California, United States: Sage Publications Inc; 2007. pp. 1–488.
    1. Tobii Pro X3-120 - discontinued. Tobii Pro. [2021-07-16].
    1. What is eye tracking? Tobii Tech. [2021-07-16].
    1. Glasses, lenses, and eye surgery. Tobii Support. 2017. [2021-07-16]. .

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe