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May , 2010

Designing for Health Consumer Engagement: The Multi-Channel Redesign of Diabetes.org

David Nickelson Psy.D, J.D.

American Diabetes Association

Director, Internet Strategy & Operations

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American Diabetes Association Overview

■ The nation's leading 501(C)3 nonprofit health organization providing diabetes research, information and advocacy

■ Founded in 1940, the ADA conducts programs in all 50 states and the District of Columbia.

■ The mission of the Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

■ To fulfill this mission, the ADA funds research, publishes scientific findings, provides information and other services to people with diabetes, their families, health professionals and the public. The Association is also actively involved in advocating for scientific research and for the rights of people with diabetes.

■ Diabetes.org: 17 million visits/year10 million unique visitors/year$20+ million in online revenue and sales (2010)

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Health Law, Policy, Technology and Association Experience

Clinical Psychologist

Attorney (Member, PA Bar)

AAAS Congressional Science Fellow/Legislative Assistant

Telehealth and Medicare

Health Information Privacy/HIPAA

Mental Health Parity

Health Care and Technology Immigration

Associate Executive Director, American Psychological Association

Developed successful online practitioner, consumer, and business portals

Product development , fulfillment, distribution, and marketing

Director, Internet Strategy & Operations, American Diabetes Association

Executive leader accountable for ADA’s award-winning Internet strategy, infrastructure, staffing, operations, development and revenue activities.

Full Profile: http://www.linkedin.com/in/dwnickelson

My Background

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Agenda

Where We Started

Channel to Audience Alignment and Setting the Methodology

Research and Persona Creation

Audience Driven Interactions

Audience and Product Decisions

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ADA’s Success Story

Site launched in 2004 based on how the organization viewed itself

Health Information provider

Site structure mimicked org structure

Siloed content and no engagement pathways

Audience segments were loosely defined for product development

The website contained over 19,000 pieces of content.

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Engagement -- A New Approach: Use All Channels Support Your Users

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Have Your Methodology in Place

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Project Phases & Deliverables

Research• Stakeholder Interviews• Discovery Workshop • Focus Group Activities/ Card

Sort

Architect• High Level Sitemap• Content Inventory • Site Model • Areas of Focus• Conceptual Wireframes• Finalized Wireframes • Specifications

Visual Design• Creative Strategy • Style Guide • Color Comp Usability Testing• Integration & Development

Phase

Deployment• Migration Planning• CMS Object Model (Publisher

Experience)• Front End Development• Development QA

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Where we started: Research!

Reviewed existing data Search logs and basic web traffic metrics

Initial content inventory

Message boards

Interviews and Surveys In-person interviews with key internal stakeholders

• Our content was not well-organized and there was too much of it

• We don’t give people clear options or help them find what they need

• Our site isn’t personal or engaging enough

• Our site only facilitates one-way conversation

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Build Consensus on:

• What ADA needed to succeed

• What diabetes.org needed to succeed

• Who should be served by diabetes.org

• What our constituents want to do online

• What online content and functionality helps them do what they want

More Research

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And More Research

• Interviewed with Call Center

reps

• Analyzed Search and

Keyword patterns of current

ADA site

• Conducted card sorts with

40 audience members using

top 100 keywords

• Overlaid keyword rank with

sorting cluster for priority

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Three themes emerged in terms of what our audiences were looking for:

Managing diabetes

Food and nutrition

Engagement (i.e.: volunteer, give, etc.)

That meant we needed to:

Focus our architecture, content and engagement opportunities on helping people manage diabetes and understanding food and nutrition as they pertain to the disease

Provide engagement opportunities that were contextual to the user’s experience on the site

Using the research and high level segmentation, ADA and Convio created 7 Constituent

Personas to focus the web site engagement paths and additional marketing efforts moving

forward

Creating our personas from research

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Diana – Adult with Type 2 Diabetes

Demographics43-years-oldMiddle incomeWorks full timeMarried, with 2 children

"I know nothing about diabetes and I’m overwhelmed. I want to know what to do, what to eat

and if it’s going to get worse."

DescriptionDiana works full-time as a paralegal in a busy office. She’s also a full-time mom to an 8-year-old daughter, 10-year-old son and 48-year-old husband.Diana was recently diagnosed with Type 2 diabetes and is worried about all of the ways it will affect her life, her job and her family.She’s heard conflicting advice from her friends, family and various doctors about what she should and shouldn’t eat and how often she should monitor her blood sugar.Diana hasn’t found a doctor she trusts and has questions about how to manage diabetes.

TechnologicalDiana has a Blackberry she uses for work so she can always be available via email.Being a busy mother of two, she doesn’t spend much time online for personal use – only a few minutes each night checking emails.Diana also recently got a Facebook account so she could watch over her kids’ pages and also keep up with her friends.

NeedsBeing recently diagnosed and still struggling to manage diabetes, Diana wants to find practical ways she can change her lifestyle to keep the disease under control.She’s still learning how to eat and test and would benefit from hearing others’ experiences to help her determine what’s good, bad and normal.Diana would like to know of some doctors in her area or some criteria to look for to help her find a good doctor.She’s interested in knowing what her rights are at work too now that she’s been diagnosed so she can know who she should tell and how to tell them.Diana wants to find ways to encourage a healthy lifestyle and eating habits for her children to prevent them from getting diabetes.

ScenarioAfter work one evening, Diana is feeling a little icky and decides she’s not up to making dinner. She picks up a pizza for the family and gets a salad for herself. When she gets home, she tests her blood sugar and realizes its extra high so she gets online to find out what the cause might be. So many sites have conflicting information that she really wants to talk to someone or hear opinions from others going through the same thing.

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Amanda - Parent

Demographics47-years-oldUpper incomeWorks as a full time momMarried, 3 kids

“I’d like quick resources to share with my busy husband about how

to react in an emergency”

DescriptionAmanda is a full time mom for her 3 kids, the oldest of which (Matthew) was just diagnosed with Type 1 diabetes at age 13. Her husband (Steve) works full-time as an architect.Amanda’s father-in-law has Type 1 diabetes, but she is relatively unfamiliar with the disease and is still working out the kinks of what Matthew can eat and when to test his blood sugar.Her husband works long hours and it’s been difficult for Amanda to educate him on the basics of taking care of Matthew. They have different styles of approaching the disease as Amanda tends to baby the kids and is always checking in on Matthew, where Steve would rather pretend everything’s okay.

TechnologicalAmanda spends a lot of time on their high-speed Internet during the day, doing research on diabetes, checking email and reading news. She doesn’t have a mobile device and isn’t interested in social networking sites.

NeedsAmanda would love a support group of other parents like her so she can learn from their successes and mistakes and try to do best by Matthew. She’d also like to learn from others about how they’ve coped with tension in their marriages since she and Steve seem to disagree so often nowadays.Since Matthew was just diagnosed, Amanda needs resources and talking points to use to inform his teachers and coaches at school about his disease.She’d like straightforward, factual information about what foods Matthew can eat and when to test so she can develop a plan that works for them.Amanda would also like quick resources and tip sheets she can use to educate Steve about what to do in case of an emergency and how to stay on track with their maintenance plan.

ScenarioFeeling more and more confident about which foods Matthew does well with and which foods aren’t so good, Amanda decides to create a spreadsheet with a “Good” and “Bad” column so she can display it in the kitchen for Steve and the rest of the kids to use as a reference. Thinking there must be something like this already available so she wouldn’t have to start from scratch, she starts Googling for resources.

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Relationship Pathways

After creating the personas, we needed to determine how each audience could reach our

engagement points through our new site architecture and content

Relationship pathways were created for each persona for testing of the website

Health Information

Help

Hope

Support

Donate

Join and Event (Fund raise)

Advocate

Volunteer

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Key eCRM Interactions

Action Alert

Site Register

Email Register

ContactForm

Live Chat

Message Boards

My Food Advisor

Volunteer Form

Donate

Family Link

Store Purchase

Ask the Expert

Step Out

Tour de Cure

Local Event

Forms Tools Monetary Events

Engagement

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Diana – Adult with Type 2

“I know nothing about diabetes and I’m overwhelmed. I want to know what to do, what to eat and if it’s

going to get worse."

Message Boards

Live Chat

Email Register

Visit 1:

Visit 2:

Visit 3:

Googles for “diabetes recently

diagnosed”

Browses through “Living with Diabetes”

Message Boards

Visits site for info on what she can eat

My Food Advisor

Browses through “Food and

Fitness”

Visits site to browse through Message

Boards and My Food Advisor

Glad to find tips on selecting a

doctor

Email Register

My Food Advisor

Ask the Expert

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Amanda – Parent

“I’d like quick resources to share with my busy husband about how to react

in an emergency”

My Food Advisor

Message Boards

Donate

Visit 1:

Visit 2:

Visit 3:

Googles for “diabetes and

school”

Browses through “For Parents and

Kids”

Family Link

Clicks on an email to see a

new recipe

My Food Advisor

Browses “Food and

Fitness”

Visits the site to find support from others

Reads through the Message Boards and

feels compelled

Donate

Email Register

Family Link

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Deeper Engagement

Once someone decides to leave an email address and/or donation, what happens to continue the

engagement experience?

Based on how they interact with us, we put them on a conversion pathway through an email

series

• Series of 4-5 emails over a 31 day period aimed at increased engagement (larger/recurring gift, advocacy action, etc.)

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Deeper Engagement

Goal – convert Advocates to Donors

• Need to ensure they aren’t already donors

• Appeal based on the topic of the alert taken

Once Advocate becomes a Donor

• Move to another communication segment

• Appeals should be for larger and/or sustaining gifts

New Advocates

Repeated Thank You / Campaign Update /

Tell-a-friend

Appeal Stewardship Piece (i.e.

profile piece)

Thank You Auto-

responder with tell-a-

friend

Second appeal

Conversion Flow E-mail #1 E-mail #2

(7 days)E-mail #3 (14 days)

E-mail #4 (24 days)

E-mail #5 (31 days)

â â â â â

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Managing Content Inventory

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Creating Structure to Support Users, Technology, and the Business

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Wireframes

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Designing with Support of Testing, Data, and Success Metrics

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Personas post-launch

The Personas will serve as a long-term tool for the life of the new diabetes.org, and new product development.

They can be used repeatedly for future decision-making to ensure a consistent, user-centered approach

Using throughout the organization for:

Direct Mail Email Print Corporate Development Product Development Any other consumer facing

activity

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Three key takeaways

Consider your 3-4 priority audience groups and document a description of each

Consider how your mission, business goals and product goals apply to your audiences

Apply each persona to your website and products

Are there clear pathways for information each persona is seeking?

Are there relevant devices for each persona to engage that are prominent and natural?

Do you have a plan for following up with each group?

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David Nickelson Psy.D, J.D.

Director, Internet Strategy & Operations

(703) 299-5522dnickelson@diabetes.org

Connect with me on LinkedIn and Twitter

Twitter: DrDNickelson

LinkedIn: http://www.linkedin.com/in/dwnickelson

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Julia – Young Adult with Type 1 Diabetes

Demographics22-years-oldLower middle incomeWorks full timeSingle, no kids

“I’m embarrassed to ask my doctor how much alcohol I can

drink with diabetes.”

DescriptionJulia works full time as a school nurse. She’s had Type 1 diabetes for 7 years and takes care of many kids with diabetes.She lives an active lifestyle, surrounded by supportive friends and family and has learned to live comfortably with her disease.Julia is usually confident in her boundaries and limitations as a diabetic, but sometimes has questions she’s not comfortable asking her doctor.Now that she’s financially independent, she’s learning how expensive her testing supplies can be.

TechnologicalJulia doesn’t spend a ton of time online at work, but she does use her high-speed Internet at home to do research for work and for personal use after work as well.She likes to search for recipes, read celebrity gossip and keep up with friends on Facebook.

NeedsJulia is already comfortable with the basic facts about her disease but since college, she’s had questions about how well her system can handle alcohol.She’d like to connect with other diabetics her age to hear about their experiences living active lifestyles with diabetes. She loves exercise and the outdoors and wants to know what kinds of limitations she should be aware of.Julia would like to find opportunities to volunteer for diabetes research and possibly meet some new friends in the process.She’d like to stay up to date and learn about the latest treatments and would also like to know how to get assistance for her supplies.Being a school nurse, she’d also like information on how to help children with diabetes.

ScenarioAfter her morning workout, Julia gets online to check her email. She subscribes to a runners magazine and gets updates about events in her area about once a month. She scans through the email, and then sees an event to raise money for diabetes research, which sparks her attention.

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Stephanie – Young Caregiver

Demographics26-years-oldMiddle incomeWorks full timeEngaged to Mark, 32, who has Type 2 diabetes

“I want to be supportive and help raise awareness about diabetes and learn all I

can about the disease.”

DescriptionStephanie works full time as a teacher. She and Mark, now engaged, have been dating since high school. Since Mark’s diagnosis two years ago, they’ve been learning together about how he should eat, exercise and monitor his blood sugar. Stephanie tries her best to be supportive by cooking low carb meals and joining Mark as he exercises, but she’s also realized that she doesn’t have to live like she has diabetes just because Mark does.

TechnologicalStephanie uses high-speed Internet at work and at home, but doesn’t connect with a mobile device.She spends lots of time online for work to help her plan lessons for school and keep her students informed on their class website.She also stays in touch with her family and college friends via email, Twitter, Facebook and has recently started a website for her and Mark’s wedding.

NeedsThanks to Mark’s doctor, Stephanie has access to a lot of information for people with diabetes. She needs information on how to be supportive for Mark without letting diabetes consume her life.Since she and Mark will be living together soon, Stephanie would also like access to some fun new recipes she can try that Mark can enjoy. She only has a few in her repertoire right now and they’re starting to get a little boring.Seeing how diabetes has affected Mark’s life and her own, Stephanie would love to find a creative way to support diabetes research, either through a local run or coordinating it into their wedding somehow.

ScenarioJust home from work, Stephanie gets online to make some updates to her wedding website. She also checks her email and scans a newsletter she gets weekly with recipe ideas. Not seeing any recipes that are diabetes-friendly, she looks at some of her bookmarked recipe websites to find some ideas for what to make for dinner tonight when Mark comes over.

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Garrett – Adult At-Risk

Demographics42-years-oldMiddle incomeWorks full timeSingle, no kids

“I’d like to know some specific warning signs of diabetes.”

DescriptionGarrett works full time as a database administrator. He works long hours and doesn’t have time for exercise or to think about healthy eating.Garrett knows he’s overweight and at-risk for diabetes since both of his parents are diabetic.He knows that some diabetes symptoms are fatigue, blurred vision and irritability, but because of his work conditions, he’s been suffering from all of these conditions for the past 5 years.

TechnologicalGarrett is always online, whether on his iPhone, workstation or laptop at home. He’s working most of the time, but also finds time for personal detours to check email, Facebook and play online games.

NeedsSince Garrett knows his risk level is high, he’d like to know about some more specific symptoms to watch for so he can be sure to take care of himself.Even though he currently doesn’t exercise or eat healthily, he’d be willing to make a change if he knew about some easy ways to do so that would fit with his busy, workaholic lifestyle.Since he’s already been affected by diabetes with both parents, Garrett would like to know about ways he can support diabetes research and get involved in the community.

ScenarioAfter a phone conversation with his Mom, Garrett is concerned about his risk of getting diabetes. He’s asked his Mom to email him some resources and she sends him several links about the warning signs to watch for and lifestyle changes to prevent diabetes. Garrett spends some time clicking through his Mom’s links so he can ease both of their worries.

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Greg – Adult with Type 1 Diabetes

Demographics 34-years-oldUpper middle incomeWorks full timeSingle, with 1 child

“I’d like some hope that things will get easier in the future.”

DescriptionGreg works full time as a financial analyst. He’s recently divorced and his wife takes care of his 3-year-old son.He has had Type 1 diabetes since he was 17 and has learned to care for himself but has constantly suffered from depression.He has also faced some discrimination at work. To avoid this, he often tries to ignore or forget about the disease and pretend like nothing is wrong, which results in dangerous highs and lows.Greg’s ex-wife wanted him to consider anti-depressants or a support group to help him cope with the disease, but Greg could never find the time.

TechnologicalGreg is always on his iPhone, either for work or texting with friends.He has a high-speed Internet connection at home and goes online for several hours a day before and after work to check and update his Facebook page, monitor his stocks and his Fantasy sports teams.

NeedsGreg needs to know that it’s okay to be depressed and frustrated about diabetes so he’ll be more comfortable expressing himself. He could also benefit from a private, anonymous venue where he can share his thoughts or even talk to someone knowledgeable via chat.Greg needs to learn about simple ways to keep diabetes under control that won’t make him feel like an outsider so he will stop ignoring the disease.He would also like to stay up to date about diabetes research and news to give him hope that life with diabetes may get easier. He’d definitely be interested in supporting any legislation in favor of diabetes research, affordable healthcare, or making life in general easier for diabetics.

ScenarioOn the subway on the way home from work, Greg is reading the news and checking email on his iPhone. He’s signed up to get Google Alerts when diabetes appears in the news and receives an article about some new research that needs congressional support. Greg clicks to read the full article, then does a Google search for how he can alert his congressman to vote in favor of this legislation.

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Nancy – Older Caregiver

Demographics 64-years-oldUpper incomeRetiredMarried to David, 66, who has Type 2 diabetes

“Now that David’s getting older, I need to be prepared to care for him and know what

health risks to watch for.”

DescriptionNancy and David are retired and David’s had Type 2 diabetes for 12 years.David recently retired from his job as an attorney and his long hours didn’t allow him to devote enough time to losing weight and eating right like Nancy’s been encouraging him to do.Nancy has read about long-term health effects of diabetes and is worried that David may be at risk for heart disease or kidney failure. She wants to know what she can do to help prevent it.

TechnologicalNancy spends a couple of hours online each day, keeping up with her grandkids through email and reading their family blogs.She doesn’t connect with a mobile device and isn’t into social networking.

NeedsNancy needs information about what the health risks are for older adults with Type 2 diabetes and some techniques for educating David on what he can do to prevent these risks.She’d like to be prepared to take care of David in any situation and wants to know what specific tasks would be required of her in any scenario.Nancy needs to be knowledgeable about the signs and symptoms of all of these health risks and needs to know what kind of medical care David needs now that he’s getting older too.

ScenarioAfter a day of golfing, David comes home and looks exhausted. Nancy gets him to check his blood sugar and they discover it’s extremely high. After calling the doctor and making an appointment for the next day, Nancy gets online to search for “diabetes complications” so she can be prepared for any news they may get at the doctor’s office.

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Julia – Young Adult with Type 1

“I’m embarrassed to ask my doctor how much

alcohol I can drink with diabetes.”

Message

BoardsVolunteer

Form

Live Chat Email

Register

Visit 1:

Visit 2:

Visit 3:

Local Event

Googles for “alcohol and

diabetes”

Comes to diabetes.org in Food section

Live Chat

Visits site for info on testing supply costs

Message

Boards

Browses through “Living with Diabetes”

Clicks on an email to find info about an event

Browses “Community

Events”

Local Event

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Stephanie – Young Caregiver

“I want to be supportive and help raise awareness

about diabetes and learn all I can about the disease.”

My Food

Advisor

Message

Boards

Tour de Cure

Visit 1:

Visit 2:

Visit 3:

Googles for “diabetes recipes”

Browses through “Food

and Fitness”

My Food

Advisor

Visits site to look for more

recipes

Action Alert

Takes interest in the “How to Help”

section

Visits site for recipes and

Message Boards

Learns about a “Tour de Cure”

event in her area

Tour de Cure

Email Register

Action Alert

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Garrett – Adult At-Risk

“I’d like to know some specific warning signs of

diabetes.”

Live Chat

My Food

Advisor

StepOut

Visit 1:

Visit 2:

Visit 3:

Clicks on a link from his mom

to “Prevention”

Browses through “Food and

Fitness” section

My Food

Advisor

Visits the site for easy

exercise tips

Action Alert

Takes interest in “How you

can Help”

Receives ADA email and visits site to read an

article

Sees promo for a “Step

Out” event in his area

Step Out

Email Register

Action Alert

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Greg – Adult with Type 1

“I’d like some hope that things will get easier in the

future.”

Message

Boards

Live Chat

Donate

Visit 1:

Visit 2:

Visit 3:

Receives Google Alert

email and clicks to read article

Browses “Diabetes in the News”

Action Alert

Visits the site to check for new news

Message

Boards

Finds good info in “Living with

Diabetes”

Visits site again for the Message

Boards

Finds great advice on

dealing with discrimination

Donate

Email Register

Action Alert

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Nancy – Older Caregiver

“Now that David’s getting older, I need to be prepared

to care for him and know what health risks to watch

for.”

Ask the Expert

Message

Boards

Donate

Visit 1:

Visit 2:

Visit 3:

Googles “diabetes

complications”

Browses “Complications”

and has questions

Ask the Expert

Visits the site to find

healthy eating tips

Message

Boards

Explores “Food and Fitness”

Visits site concerned

about a health risk

Finds great advice in the

Message Boards

Donate

Email Register

Live Chat

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Methodology

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Methodology

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Methodology

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Methodology

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Methodology