Digital Strategies for Health Communication Design and Content

1. Digital Strategies for Health CommunicationDesign and Content Lisa Gualtieri, PhD, ScM, Course Director Tufts University School of Medicine July 23, 2014

2. From yesterday

3. US Search Engine Market Share • Google is the dominate player • Google also dominating globally (Yandex (RU), Baidu (CN)) • Google’s average daily searches exceed 5 billion in 2012 • Reason why efforts are typically around Google’s algorithm

4. The SERP (Search Engine Results Page) User-generated keyword Paid Search Results Organic Search Results

5. Health websites educate and/or support • Most organizations want site to be attractive, compelling, and fresh • As appropriate for organization’s goals and target audience • Especially important for • First time visitors • People in need as opposed to casual browsers • Draw people in • Give them a reason to explore and stay • (Also make it easy for them to find what they want!)

6. What is important for website success? • The site appeals to the target audience • Understand purpose immediately • Trust site content • The site is usable by the target audience • The site is live and all links work • Labels are clear • Tasks can be formulated and completed • The site helps people achieve their goals • Where can these break down?

7. Managing a website project • What is needed for success? What are obstacles and challenges? (Internal and external) • Plan • Design • Implement & select technology • Roll-out and market • Maintain, revise, and update • Where should testing and feedback be interjected? Site capacity? Key performance indicators? • Can an organization change through this process?

8. The “launch has been an unfortunate disaster!” • What were the HealthCare.gov goals • Why did the site achieve such visibility? • What went wrong and could it have been avoided? • By the processes we are learning in class? • By other means?

9. Was this the first website that didn’t work? • For the first time in history, a president apologized for a website • Many previous “debacles” • According to the Standish Group, 94% of large federal information technology projects over the past 10 years were unsuccessful • More than half were delayed, over budget, or didn’t meet user expectations, and 41.4% failed completely

10. Total failure? • In the fall, nearly 20 million Americans visited the site since it opened but only about 500,000 managed to complete applications for insurance coverage and an even smaller subset of those applicants actually obtained coverage

11. Fred Trotterauthor of "Hacking Healthcare" • The federal government has very conservative mechanisms for purchasing off-the-shelf software and creating new software. That puts a lot of constraints on them

12. Why? • The government has to follow a code called the Federal Acquisition Regulation “that all but ensure that the companies that win government contracts, like the ones put out to build HealthCare.gov, are those that can navigate the regulations best, but not necessarily do the best job”

13. What could have happened differently? • In house development vs outsourcing • 3 key issues in testimonies • the short time left for end-to-end testing • the decision to go live on October 1 • ditching a feature allowing consumers to window shop shortly before the site went live • Fred Trotter: like draft, people born in January can sign up now…

14. Registration/account setup • How much can you do or see before registering? • Problems that can arise • When people can’t self-service online and you have no competitors, they call you • Instructions for creating usernames and password require a great deal of concentration, and if users don’t understand the instructions, they will need to keep creating usernames and passwords until they are accepted, wasteful and causing cognitive strain • Account setup is the first in a series of web-based interactions that users will need to conduct on HealthCare.govand a poor experience will impact how people feel not only about subsequent interactions with the site, but how they feel about the service in general and the Affordable Care Act as a whole

15. Simple steps • Know your audience and why they are there • Do they need to be “sold”? • Do they know what they are doing? • Calls to action should be clear and visible • Expectations arise from other sites

17. Graphics

18. Work flow • Replace the graphic with the information that answers the following questions: • How much time will this take? • Do I need any special information ready before I start? • Is this part of a larger process? The Marketplace application is mentioned – where does that fit into the big picture?

19. Progress

20. Username and password • Benefits to using email address for username: • Email addresses are easier for users to remember. • The email address is a unique identifier. • It’s standard practice on millions of other websites. • It reduces error rates because people don’t have to parse the overly complicated criteria. • It simplifies the process by eliminating the creation of a unique username. • And it could reduce the number of screens in this account set up process by merging the screen that currently collects email with the screen that currently asks the user to set a username and password. • Simplify password requirements • As with the username, password criteria are incredibly confusing: • Between 8-20 characters • Must contain a lower case letter, an upper case letter AND 1 number • Must be different than your past 6 passwords (What? Where? In all the web?) • Cannot contain your username • Cannot contain these symbols: +?<>()’”/\&

21. Is this necessary?

22. Can this site be saved?

23. Progress?

24. In practice: current examples Am I supposed to click? Is this really it? I just want to see how much it will cost! I thought this was about learning? What do I need to learn?

25. In practice: current examples Do I have to read it all?

26. Further progress?

27. What do you need to know? • How design helps heath communication provide value • How to think about effective content design • Important whether you create, hire, or manage

28. Why might you consider other approaches?

29. Digital has many advantages over brochures beyond “reach” • Searchable • Updatable • Opportunities for participation and feedback • Where people are! • Are there limitations to digital?

30. 59% of US adults say they have looked online for health information in the past year. • 35% of U.S. adults say they have gone online specifically to try to figure out what medical condition they or someone else might have • 39% of online health seekers say they looked for information related to their own situation. Another 39% looked for information related to someone else • 69% track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health: • 60% of U.S. adults say they track their weight, diet, or exercise routine. • 33% of U.S. adults track health indicators or symptoms, like blood pressure, blood sugar, headaches, or sleep patterns. • 12% of U.S. adults track health indicators or symptoms for a loved one

31. Where to start? • 77% of online health seekers started last session at a search engine • 13% say they began at a site that specializes in health information, like WebMD • 2% started their research at a more general site like Wikipedia • 1% started at a social network like Facebook

32. 59% of US adults look for health information online • When asked about the last time they had a serious health issue, they turned to: • 70% of U.S. adults got information, care, or support from a doctor or other health care professional • 60% got information or support from friends and family • 24% got information or support from others who have the same health condition. 

34. What do they find?

35. Content • The elements of a website are all content or “digital assets” • Content should be created and edited for which target users: • Typical or average user? • Neediest? • Lowest reading literacy skills? • Lowest health literacy skills?

36. How people use content on the web • Web users • Skim and scan • Read summaries • Age differences • Screen size • Browse and search • Minimal penalty to guessing wrong • Use of “back” button • Impact of load time and other problems

37. How people read online and how much people read Average webpage: 20%

38. Good health website text • Is conversational • Can be scanned • Answers people’s questions • Lets user get what they want • Stay longer or return if successful • How does social media fit in? • How long • How visual • What does it take you to • How shareable • How does mobile fit in? • How long • How visual

39. Content • New content can be created by • Experts • Users • Existing content can be • Surfaced • Repurposed

40. Names, taglines, and logos immediately brand websites

41. Stories • Stories are personal and convey emotional content • Resonate with reader while conveying useful information • More about experience of illness than disease facts • Stories convey without clichés: “You are not alone” and “We are here to help”

42. My investigation • A few examples from non-health websites • Many examples from health websites • Interviews with • Rebecca Brookes, Vermont Dept of Health • Beth Sanders Moore, CancerForward

43. Non-health example • Love stories on February 14, 2014 Google story doodle • Prepared by Ira Glass of This American Life

45. Interview with Rebecca Brookes, Vermont Dept of Health • Rebecca Brookes: “people listen to people they trust and who don’t have a vested interest.” • Smoking cessation & weight loss stories • A message coming from a person like them resonates: “I lost weight because I didn’t feel pretty enough for my husband” • Rebecca said, “How can you argue with this?”

47. Interview with Beth Sanders Moore, CancerForward • Beth Sanders Moore has her own cancer story • She has read every story that’s been submitted whether it made it through the publication process or not • “They’re not all upbeat or hopeful, but they’re all real and to me, compelling. There are so many, many facets to cancer survivorship and contexts in which people fight cancer.” • CancerForward Survivor Stories: Everyone Has A Wonderful Story, But How To Tell It? http://blog.cancerforward.org/2014/03/17/cancerforward-survivor-stories-everyone-has-a-wonderful-story-but-how-to-tell-it#more-1272

50. Many formats