Design for Vulnerable Users

Health services reach people at moments when they have the least capacity to adapt to a product. Someone waiting on results, managing pain, caring for a parent, or booking care in a second language uses the same screens as everyone else, but with less attention, time and confidence to spare. Digital inclusion data from Australia shows the scale of the gap. The 2025 Australian Digital Inclusion Index puts 20.6 per cent of Australians in its 'excluded' or 'highly excluded' groups. Its overview sets higher rates for particular groups against that national figure, including 66.5 per cent of people aged 75 and over. A health service built only for confident, well-connected users can leave out many of the people who need to use it.

Who 'vulnerable' covers

The word is not a single group, and the published guidance tends to list barriers rather than labels. The GOV.UK Service Manual points to circumstances such as unstable housing and caring duties that leave little time; to low digital confidence; to limited literacy or English; to lacking a printer or reliable internet; and to missing documents such as a passport or fixed address. The NHS service standard adds people with differing physical, mental health, social, cultural or learning needs, and names older people, people on low incomes and Black and minority ethnic communities.

The Australian index shows how these overlap. In the same overview, the rate is 54.5 per cent for people who did not finish secondary school, 45.2 per cent for public housing residents and 40.9 per cent for First Nations people, and the index score for people with disability sits 11.4 points below that of people without disability. A review for the Older People's Commissioner for Wales also notes that age combines with other factors, with older women affected more. Age alone is a weak guide: in the Australian Bureau of Statistics 2018 health literacy survey of adults, 8 per cent of people aged 65 and over said it was difficult to navigate the healthcare system, against 19 per cent of those aged 18 to 24.

Thinking, memory and ageing

The W3C Web Accessibility Initiative describes cognitive and learning disabilities as affecting perception, memory, language, attention and understanding, and names conditions such as dementia, ADHD, autism and dyslexia. Its page on older users describes age-related changes in vision, dexterity, hearing, short-term memory and concentration, and observes that content built to be accessible for disabled people also tends to work better for older people. Its supplemental guidance sets out design objectives such as preventing and correcting errors, reducing memory demands, keeping focus and making help easy to reach.

Often temporary, often situational

Vulnerability is not always a fixed trait. Microsoft's Inclusive 101 guidebook describes a spectrum of permanent, temporary and situational limitations. Its example is one arm: a person with a permanent disability, someone with an arm injury and a parent holding a baby all benefit from the same design. Applying that to health is this article's own extension: a frightening diagnosis or weeks of caring for a parent can narrow attention for a while, though these sources do not measure that. The GOV.UK guidance on assisted digital support adds that a person's support needs change as their skills and confidence grow.

What this changes in the design

• Forgiving flows. Make mistakes easy to notice and undo, keep partly finished work, and give people enough time. The W3C lists giving enough time as one of the WCAG guidelines that address cognitive accessibility.
• A human alternative. GOV.UK describes phone, in-person and webchat help for people who cannot or will not finish a task online, and the NHS standard asks for assisted digital support to cover gaps. The Wales review recommends against digital by default without offline options.
• Plain language and other languages. Barriers named for people with low literacy or limited English are a design problem to solve, not a user failing.
• Research with the people affected. GOV.UK asks teams to recruit participants who represent all of a service's users and to test as they go.
• Room for a carer or representative. Some people manage their health with help from family or carers, so a way to authorise that help belongs in the design from the start.

Trauma-informed design

Trauma-informed practice is an approach to health and care built on the understanding that trauma exposure can affect a person's neurological, biological, psychological and social development, and can create barriers to using services. England's Office for Health Improvement and Disparities (2022) lists six principles: safety, trustworthiness, choice, collaboration, empowerment and cultural consideration. Australia's Blue Knot Foundation names the first five and asks for them to apply at every level, from policy to informal practice, including how a service is delivered. Scotland's National Trauma Transformation Programme describes the aim as recognising when someone may be affected, adapting how work is done, and doing no harm. This concerns how a service behaves, not care or treatment.

For screens, a 2026 focus-group study of sexual and reproductive health tools in British Columbia (23 participants) mapped its recommendations onto the five principles. Paraphrased, they include:

• Choice and control. Let people decide how deeply to engage with a sensitive topic, offer text, audio or video, split information into small portions, and allow a section to be skipped.
• Predictability. Avoid pop-ups, auto-playing video and moving banners.
• Careful wording. Use empathetic, inclusive language, and put a content warning at the top of the page that needs it, not one notice sitewide.
• Easy exit and privacy. Provide quick-exit controls, options to use a service anonymously and to clear search history, and plain information on how data is handled.
• Visible people and support. Show who created and reviewed content, and link to crisis lines or helplines where relevant.

This is one small study in one setting. The authors of a 2023 review protocol argue that digital health tools can inadvertently cause psychological trauma, for example through unintended exposure of personal information. Test the list with the people affected rather than treating it as a checklist.

Two situations

Shared access to a patient portal. A 2024 secret shopper study tried to set up proxy access to another adult's portal across 17 healthcare organisations. Of 24 attempts, 15 succeeded and 9 did not; among the successes, 8 took under an hour and 6 took more than a day. The barriers reported included paper forms needing signatures, support staff who were unavailable or unsure, and hard-to-follow navigation. A 2025 study of a shared-access programme for older adults found that many patients and care partners kept using the patient's own login instead of registering for shared access.

An illustrative case, not drawn from any one source: an older adult who is new to a condition starts a message to a clinic on a portal, is called away, and returns to find the session has expired and the text is gone. Guidance on preventing errors, reducing memory demands and allowing enough time all point at the same fix: save work as it is written and make it possible to reach a person if the screen stops helping.

Related Showcase card

• Target Size (Minimum) - designing for a hand under real conditions (moving, one-handed, under stress) rather than an average pointer.