In late 2008, The American Diabetes Association set out to accomplish more than just a redesign of its 9 million visitor-per year flagship web site, www.diabetes.org: it set out to develop an integrative, multichannel visitor experience designed to engage health care consumers "where they were at" while thoughtfully and appropriately moving them into deeper and more helpful engagement pathways. This session will outline the research, process, and approach that brought together a wide range of health care consumers, stakeholders, and vendors to create a web site (and more) that can create a committed, long-term health care web relationship with every visitor to the new www.diabetes.org.

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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/year
10 million unique visitors/year
$20+ million in online revenue and sales (2010)
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My Background
 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
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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 Visual Design
• Stakeholder Interviews • Creative Strategy
• Discovery Workshop • Style Guide
• Focus Group Activities/ Card Sort • Color Comp Usability Testing
• Integration & Development Phase
Architect
• High Level Sitemap Deployment
• Content Inventory • Migration Planning
• Site Model • CMS Object Model (Publisher
• Areas of Focus Experience)
• Conceptual Wireframes • Front End Development
• Finalized Wireframes • Development QA
• Specifications
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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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More Research
 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
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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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Creating our personas from research
 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
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Diana – Adult with Type 2 Diabetes
Demographics "I know nothing about diabetes and I’m
43-years-old overwhelmed. I want to know what to do, what to eat
Middle income and if it’s going to get worse."
Works full time
Married, with 2 children
Description
Diana 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.
Technological
Diana 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.
Needs
Being 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.
Scenario
After 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
Demographics “I’d like quick resources to share
47-years-old with my busy husband about how
Upper income to react in an emergency”
Works as a full time mom
Married, 3 kids
Description
Amanda 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.
Technological
Amanda 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.
Needs
Amanda 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.
Scenario
Feeling 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
Forms Tools Monetary Events
Contact Ask the
Form Expert
Tour de
Site Live Cure
Register Chat
Store Local
Email Purchase Event
My Food
Register Advisor
Donate Step Out
Volunteer Message
Form Boards
Family Action
Link Alert
Engagement
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Diana – Adult with Type 2
Live Ask the Email
Chat Expert Register
Message My Food
Boards Advisor
Googles for Browses Message
Visit “diabetes recently through “Living Boards
1: diagnosed” with Diabetes”
Visits site for Browses through My Food
Visit 2: info on what “Food and Advisor
she can eat Fitness”
“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." Visits site to browse
Glad to find tips Email
through Message
Visit 3: Boards and My Food
on selecting a Register
doctor
Advisor
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Amanda – Parent
Message Family Donate
Boards Link
My Food Email
Advisor Register
Googles for Browses through Family
Visit “diabetes and “For Parents and Link
1: school” Kids”
Clicks on an Browses My Food
Visit 2: email to see a “Food and Advisor
new recipe Fitness”
“I’d like quick resources to share with
Visits the site to Reads through
my busy husband about how to react the Message Donate
in an emergency” Visit 3: find support
Boards and
from others
feels compelled
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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
Conversion
Flow E-mail #1 E-mail #2 E-mail #3 E-mail #4 E-mail #5
(7 days) (14 days) (24 days) (31 days)
    
New Thank You Repeated Appeal Stewardship Second
Advocates Auto- Thank You / Piece (i.e. appeal
responder Campaign profile piece)
with tell-a- Update / Tell-
friend a-friend
 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
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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) 299-5522
dnickelson@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
Demographics “I’m embarrassed to ask my
22-years-old doctor how much alcohol I can
Lower middle income drink with diabetes.”
Works full time
Single, no kids
Description
Julia 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.
Technological
Julia 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.
Needs
Julia 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.
Scenario
After 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
Demographics
26-years-old “I want to be supportive and help raise
Middle income awareness about diabetes and learn all I
Works full time can about the disease.”
Engaged to Mark, 32, who has Type 2 diabetes
Description
Stephanie 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.
Technological
Stephanie 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.
Needs
Thanks 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.
Scenario
Just 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
Demographics “I’d like to know some specific warning signs
42-years-old of diabetes.”
Middle income
Works full time
Single, no kids
Description
Garrett 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.
Technological
Garrett 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.
Needs
Since 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.
Scenario
After 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 “I’d like some hope that things
34-years-old will get easier in the future.”
Upper middle income
Works full time
Single, with 1 child
Description
Greg 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.
Technological
Greg 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.
Needs
Greg 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.
Scenario
On 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 “Now that David’s getting older, I need to
64-years-old be prepared to care for him and know what
Upper income health risks to watch for.”
Retired
Married to David, 66, who has Type 2 diabetes
Description
Nancy 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.
Technological
Nancy 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.
Needs
Nancy 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.
Scenario
After 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
Live Messag Local
Chat Volunteer
e Event
Email
Form Boards
Register
Googles for Comes to
Visit 1: “alcohol and diabetes.org in
Live
diabetes” Food section Chat
Visits site for Browses through
Visit 2: info on testing “Living with
Messag
supply costs Diabetes” e
Boards
“I’m embarrassed to ask
Clicks on an Browses
my doctor how much Local
Visit 3: email to find info “Community
alcohol I can drink with about an event Events” Event
diabetes.”
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Stephanie – Young Caregiver
Messag Action Tour de
e Alert Cure
My Email
Boards
Food Register
Advisor
Googles for Browses
Visit 1: “diabetes through “Food
My
recipes” and Fitness” Food
Advisor
Visits site to Takes interest in
Visit 2: look for more the “How to
Action
recipes Help” section Alert
“I want to be supportive
and help raise awareness Visits site for Learns about a
about diabetes and learn “Tour de Cure” Tour de
Visit 3: recipes and
event in her Cure
all I can about the disease.” Message Boards
area
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Garrett – Adult At-Risk
My Action Step
Food Alert Out
Live Email
Advisor
Chat Register
Clicks on a link Browses through
Visit 1: from his mom “Food and
My
to “Prevention” Fitness” section Food
Advisor
Visits the site Takes interest
Visit 2: for easy in “How you
Action
exercise tips can Help” Alert
“I’d like to know some
specific warning signs of Receives ADA Sees promo
diabetes.” email and visits for a “Step Step
Visit 3: site to read an Out” event in Out
article his area
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Greg – Adult with Type 1
Live Action Donate
Chat Alert
Messag Email
e Register
Boards
Receives Browses
Visit 1: Google Alert “Diabetes in
Action
email and clicks the News” Alert
to read article
Visits the site Finds good
Visit 2: to check for info in “Living
Messag
new news with Diabetes” e
Boards
“I’d like some hope that Finds great
Visits site again Donate
things will get easier in the advice on
future.”
Visit 3: for the Message
dealing with
Boards
discrimination
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Nancy – Older Caregiver
Messag Live Donate
e Chat
Ask the Email
Boards
Expert Register
Browses
Googles
Visit 1: “diabetes
“Complications” Ask the
and has Expert
complications”
questions
Visits the site
Visit 2: to find Explores “Food Messag
healthy eating and Fitness” e
tips
“Now that David’s getting Boards
older, I need to be prepared
Visits site Finds great
to care for him and know concerned advice in the Donate
what health risks to watch Visit 3: about a health Message
for.” risk Boards
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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
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