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final paper



        Bridging Medicine and Meditation:
The Benson-Henry Institute for Mind Body Medicine

                 Claire Berman
       Tufts University School of Medicine
               December 15, 2010

                              Table of Contents

1. Abstract…………………………………………………………………………………..3
2. Specific Aims…………………………………………………………………………….3
3. Background and Significance……………………………………………………………4
4. Research Design and Methods…………………………………………………………..7
      4.1 Needs Assessment……………………………………………………………..18
      4.3 Technology and Site Content……………………………………………….…37
      4.4 Design and Development…………………………………………...…………48
      4.5 Evaluation Plan………………………………………………………….…….56
      4.6 Marketing Plan………………………………………………………….….….61
      4.7 Staffing and Budget…………………………………………………..……….62
5. Conclusion………………………………………………………………………………63
Author Bio…………………………………………………………………………...……..64

Website Name: The Benson-Henry Institute for Mind Body Medicine
Tagline: Where Medicine and Meditation Meet

1. Abstract

On its current website, the Benson-Henry Institute for Mind Body Medicine (BHIMBM) is
described as “a non-profit scientific and educational organization dedicated to research, teaching,
and clinical application of mind/body medicine and its integration into all areas of health.” The
website for the BHIMBM is currently housed under the Massachusetts General Hospital site, and
the staff has been working for some time on updating the site’s design and content to be better
suited to the intended end user of the site: patients themselves. Through a close examination of
the needs and likely preferences of the target audience (patients with chronic disease and chronic
stress), I have identified a number of implications for the design of the new website which will,
hopefully, aid the BHIMBM in moving forward with the website redesign. Although time did
not allow each step outlined in this paper to be completed, the details of each step necessary to
the overall process have been included below. These include identifying goals, conducting a
needs assessment, conducting a competitive analysis and deriving design implications thereof,
designing the site, conducting formative and heuristic evaluations, and marketing the site.

2. Specific Aims

The Benson-Henry Institute for Mind Body Medicine’s (BHIMBM) goals are as follows.

Overall Goal

      Improve the health status of site users through mind body relaxation techniques

To achieve this overall goal, the site should:

      Have an immediate and sustaining visual appeal both to new and returning users in the
       target population
      Provide both new and returning users with information that is relevant to them
      Utilize a design which is inviting and which reflects the preferences of likely users of the
      Allow all sub-sets of users to locate relevant information quickly and easily
      Effectively communicate accurate, medically-founded information about mind body
       medicine, relaxation response, and resiliency
      Provide ways for users to become proficient in relaxation response and resiliency
      Provide ways for users to track individual progress
      Provide support for users through expert-generated content and networking features

The Benson-Henry Institute for Mind Body Medicine website is currently housed under the
website for the Massachusetts General Hospital. The BHIMBM website is needed in order to
provide patients with information and tutorials relating to mind body medicine and techniques,
particularly those who are referred to the BHIMBM website by a physician or insurance
provider. It provides a portal through which users from any geographic location can access this
information, as well as information relating to the Institute itself.

3. Background and Significance

3.1 Supporting Research

         Patients who access the internet for health find a wealth of information online,
information which has the potential to either offer benefits or pose risks. The benefits of using
the internet for health are numerous. For instance, e-patients can search anonymously for
information on conditions they may otherwise feel embarrassed to ask a friend, family member,
or health professional about. This may empower them with enough information (and bolster
them with courage from others’ stories) to approach their own healthcare provider about the
issue, resulting in early detection, preventive care, or effective treatment of a condition. Thus,
the internet can play a vital intermediary role in assisting patients in accessing care. For patients
who have already been diagnosed with an illness, the internet provides a way for them to confirm
or supplement what their doctor has told them about their diagnosis. Caregivers of patients can
also access information about the diagnosis of the person they care for, and how best to provide
that care. Both patients and caregivers can find communities of online supporters who are able
to provide important psychosocial support and may alleviate feelings of being alone or
misunderstood. This type of support can have a drastically positive mental health benefit for all
users, but particularly for those who are in more isolated living situations and who therefore do
not necessarily have access to such a support network in their immediate surroundings.
         On the other hand, there are several risks of using the internet for health information,
although The Social Life of Health Information states that harm resulting from searching for
health information on the internet was reported by 3% or less of users. The internet can be
completely overwhelming to some users due to the sheer volume of information available, and
also because it can be difficult for many users to identify which sites are trustworthy. This
means that some users may follow advice from unreliable sites or make important health
decisions without consulting their doctors, which could cause them (or others around them)
bodily or psychosocial harm. Some users may also give more credibility to information found
online than information from a doctor or a medical professional, which could also lead to
decisions which would endanger their health. Health information found online may be
applicable to some users, but many others may have much more complicated health conditions or
circumstances which would actually make the information found online less applicable for their
         There were elements in both Pew reports which confirmed much of the intuitive
knowledge I had about people who use the internet for health information; for instance, the fact
that women are more likely than men to look online for health information across the board,
which is in line with evidence that women are also more likely than men to ask more questions
of their doctors during appointments. At the same time, there were also many pieces of
information which were surprising to me. For instance, The Social Life of Health Information
states that older adults are actually less likely than their younger counterparts to consult a friend
or family member about their health issues, and less likely to use user-generated content. I was
surprised at this statistic because my general perception was that older adults would be more
likely to discuss their health issues with family and friends, particularly as many adults in the
upper age range might need to rely on others for some or all of their care. The report also states

that e-patients are more engaged in social media in general than non e-patients, indicating the
possibility that users who are more inclined towards social media in general may be, in turn,
more inclined to use the internet to find health information (or vice versa). This also indicates
that social media could be the interface which would resonate the most with many e-patients
(although not of every demographic group, as the report further details).
        Another interesting finding was that the majority of people who look for health
information online do not actually create content themselves. This was surprising to me at first,
but upon closer consideration, it makes sense that many people would go online in order to have
exactly that kind of one-sidedness in their search, at least in the initial stages. Otherwise, they
would likely rely simply on interactions with family, friends, or healthcare professionals for their
information instead of turning to the internet. One reason for this one-sidedness could be that
some users may not feel “seasoned” enough to offer their own opinions in writing. This is
supported by the contrasted findings from those e-patients suffering from chronic disease, who
offer contributions online at a much higher rate through blogs or postings in discussion forums,
according to Chronic Disease and the Internet. It could be that these users, because of their
long-term experience with their illness, feel “expert” enough to offer contributions, as opposed to
users performing initial searches about an illness they have little personal experience with. In
addition, users who suffer from chronic illness would have a greater need of ongoing support,
thus adding to their drive to contribute to such forums. Surprisingly, though, the report details
that these same users, while more likely to engage in social aspects of internet health use, are
actually less likely to be part of official social networking sites such as Facebook or MySpace.
And very surprising as well is the fact that chronically ill people, independent of the socio-
economical and age-related factors which may limit them, are still less likely to be accessing the
        There are several components of the information in these two reports which is relevant
for my topic. In particular, depending on the target audience of the Benson-Henry Institute for
Mind-Body Medicine, the factors detailing how the age of users is related not only to their
internet use, but also the ways in which they use the internet, will be relevant. Depending on the
types of patients they are trying to attract, the information in this report can also help to guide the
type of website interface used. Are they patients with chronic disease seeking a mind body
solution to pain or stress? If so, perhaps a more interactive forum could be part of the website
design, based on the findings of the Chronic Disease and the Internet report. Are they mainly
patients under the age of 30, or are they older patients? What types of reasons do they have for
coming to the Mind-Body Institute? As I am not yet aware of the specific target audience of the
Institute, it is difficult yet to say how the information in this report will be able to shape the
interface based on specific demographics. However, The Social Life of Health Information also
specifically reports on the types of users who seek out information on alternative treatments or
medicines and offers useful insights into the types of users searching for this information. In
particular, the report states that women are more likely than men to seek out such treatments
online, and that users between the ages of 18 – 29 have become significantly more active in
searching for these types of treatments, increasing from 22% to 34% between 2002 and 2008. In
addition, users who seek information on alternative care are likely to seek out at least one other
type of treatment, which could indicate that the pros and cons of other treatments should be
acknowledged in the text of alternative care websites.

3.2 Potential Risks and Benefits

It is important to identify the risks and benefits associated with redesigning the BHIMBM’s
website as part of the development process.

Some of the benefits of redesigning this site include:
    Redesigning the site will give the BHIMBM wider name recognition.
    The new layout will make it easier for users to navigate the site and will encourage them
      to become return users and to create a personalized profile.
    The new site will allow users to access a wider variety of information in different formats
      and will reach a larger audience
    A new site design will allow BHIMBM to receive funding/endorsement from Blue Cross
      Blue Shield (BCBS) and other healthcare organizations.

The overarching benefit will be wider exposure, both in terms of the site’s reach as well as the
exposure that a population of people suffering from chronic disease.

Some of the risks for this site include:
    The site will presumably attract users from all over the country who may solicit medical
      advice, which staff will have to be extremely careful to avoid for people living in areas
      for which they are not medically licensed.
    Staff will not necessarily have the opportunity to interact with and correct users if they
      are not properly performing the techniques they learn on the site.
    There is the potential for site content such as videos and audio files to be shared
      elsewhere on the internet.
    Some people may not feel that mind body techniques are relevant to their health problems
      and may dismiss the information found there because of this.
    Data relating to people who create personalized profiles or accounts could potentially be
      shared if security breach were to occur.
    A small possibility also exists that a user could receive bad or incorrect advice from
      another website user via the discussion forums or social media (meaning that close
      regulation or moderation will be needed for these aspects of the site).

The identified risks can all be tied back to the idea of monitoring; monitoring usage and sharing
of site materials, but also monitoring of individual patient status. Doctors who recommend the
BHIMBM site to their patients must be aware that it is still their responsibility to track their
progress, particularly doctors who practice outside of the range of states for which BHIMBM
doctors are licensed. For states in which they are licensed, BHIMBM doctor/staff must reach
explicit agreements for patient monitoring with referring primary care physicians and must
closely monitor the information being posted to discussion forums and blog posts by users.

4. Research Design and Methods

4.1 Needs Assessment

As part of the design process, it is necessary to conduct a needs assessment in order to determine
the needs of the audience(s) which we hope to reach with this site. The target audiences for the

BHIMBM website are patients, members of the general public, providers of medical care and
insurance, and corporations, where, in the latter instances, they would either promote the site
directly or a branded version of it.

The subgroups within these populations are defined as follows:
    Patients with chronic disease and/or stress who seek information about CAM on their
    People who are interested in and/or enthusiastic about CAM and the lifestyle and seek
       information on their own
    Medical providers referring patients with chronic disease and/or stress to the CAM
    Insurance providers who recommend a patient to the Center
    Corporations or companies wishing to offer their employees a way to relieve stress
    Corporations or companies wishing to organize a staff retreat

The sub-groups of users with the widest reach and the highest level of influence are the medical
providers and insurance providers because of the volume of patients they could potentially refer
to the Institute for services or information. In terms of potential volume of users, the
corporations/companies would be the next priority, and finally, individuals. The number and
variety of people visiting the site will depend on the buy-in of these key people in order to ensure
that maximum exposure and use of the information on the website. However, as the Mind Body
Institute has specified that the end user is the patient him/herself, the personas I developed are of
patients who have come to the site via these varying mechanisms, and not necessarily the
providers and companies themselves.

The four most important sub-groups in terms of the goals of the site are as follows:
    A person whose doctor recommends that they go to the site
    A person whose insurance provider recommends that they go to the site
    A person whose company makes the site available to them or recommends they go to the
    A person who comes to the site on his or her own

The four sub-groups will not actually differ drastically from each other in terms of basic
demographics, so many relevant characteristics can be generalized to all four sub-groups. It is
useful, however, to distinguish between people who come to the site because of an acute
problem, such as chronic disease and stress, and those people who come to the site because they
are interested in CAM and wish to utilize it in a preventive way. Some people will come to the
site because they have been instructed to do so, and others will seek out the site of their own
volition, which has obvious implications for their attitudes towards the site and how willing they
may be to search for information.

None of the sub-groups have significant limitations in terms of gender or age, and a generalized
adult population would consist of people age 18 and above. Other factors to consider would be
geographic location, type of access to internet (computer, mobile phone, etc.), and where the user
accesses the internet (at home, at work, at the library, etc.). People in urban areas may have be
more likely than rural dwellers to seek out the website because of an interest in the culture of

CAM, and people living in the Northeast, and particularly Boston, may have a higher rate of
recognition of the Benson-Henry Institute for Mind Body Medicine, or at least of Massachusetts
General Hospital.

People who come to the site because of acute distress due to chronic disease may tend to be older
(as conditions such as heart disease and diabetes tend to develop at a more advanced age). For
this group, feelings of desperation or high stress may accompany them to the site as they seek
ways to manage their illness. For those who are coming to the site out of pure interest, however,
information that is tailored too specifically towards a medically needy population may be a turn-
off. The site’s information will thus need to be presented in such a way that neither group is
turned off.

Personas are detailed descriptions of various potential users of a website. They are useful in
providing insight into the challenges and thought processes that a typical user would experience
in visiting the site being designed.

Proposed personas for each of these subgroups follow.

                                Cindy is a 50 year-old African-American woman living in St.
                               Louis, Missouri. She is unmarried and is the caretaker for her
                               three children; she often helps out her neighbor by watching her
                               two children as well. She is currently unemployed, having lost her
                               job as a storeroom manager for Home Depot two months ago, and
                               despite having a Bachelor’s degree, can’t find a new job in this
                               economy. Cindy has had high blood pressure for the last ten
                               years, which has been controlled by medication fairly well until
                               the last year. Her doctor has put her on several combinations of
                               medicine to reduce her BP, but lately, the results have always been
       the same – her blood pressure is still high, and she is increasingly more stressed, partly
       because of external life stressors, and partly because she always feels worried about her
       condition and how to provide for her children. Cindy has a regular cell phone, but can’t
       afford a Smartphone or a data plan. She has an old laptop in her home and can
       sometimes pick up a wireless signal from the neighbors, but it doesn’t handle videos or
       audio media very well, so she usually has to go to the library to watch any streaming
       videos online. One of her daughters, though, is quite internet savvy and is often able to
       find information online for Cindy. Cindy is able to navigate basic websites but may have
       some trouble with more advanced media due to limited internet exposure. She has no
       prior experience with CAM, but is getting rather desperate because her medications are
       not working, and so she is willing to try anything at this point.

                                           Paul is a 35 year-old Caucasian male living in
                                           Newton, Massachusetts, a suburb of Boston. He is

married with no children, and he works as a Financial Broker in the city and commutes
for about an hour each day using public transportation. Paul feels that his health is pretty
good overall, but he has had a few anxiety attacks recently due to the high level of stress
from his job. His family has a history of heart attacks, and so he is worried about these
recent anxiety attacks and how his high level of stress may be putting him at higher risk
for having a heart attack himself. Recently, he has been looking for ways to relieve his
stress, particularly because his wife has been urging him to find ways to relax. He is a
little dubious about CAM himself, but his wife is so supportive of it that he is willing to
give it a try. Paul has an iPhone, which can stream videos and audio, and he uses it often
on his commute to work to look at the news and listen to music. Both Paul and his wife
have laptops, and although he uses the internet often at work, he also has high-speed
connection at home that he can use. Paul and his wife also have a landline, and they use
it about as much as they talk on their cell phones.

                                    Julia is a 25 year-old Hispanic woman who works at a
                                    non-profit organization in New York City. Julia is
                                    unmarried but lives with her boyfriend, Adam, who is
                                    in medical school. She graduated from college a few
                                    years ago and has had several different jobs, all in the
                                    non-profit sector, and has been used to having an
                                    extremely high level of stress at work, both because of
                                    the high-risk populations she works with as well as the
                                    heavy workload. She is an outreach counselor and
works long hours and many weekends, as do many of her colleagues. Her organization is
interested in doing a company wellness program to reward the employees’ hard work and
reduce their stress levels, one of a few non-profit trying this new “corporate” tactic.
Julia’s employer is encouraging employees to try out the techniques during paid lunch
breaks, but also in their free time away from work. Since Julia does not have much time
at home, she is considering using 2 – 3 lunch breaks per week to try out the techniques in
the staff room. Although she has never tried it before, Julia is open to the idea of CAM,
although her boyfriend thinks it’s a bunch of nonsense and doesn’t support her “wasting
her time” on such alternative methods of stress management. Julia has a Smartphone (not
an iPhone) which she uses as her primary phone (she does not have a landline) and has
high-speed internet access on her home computer. She likes to download new apps for
her phone, updates her Facebook status, and gets Twitter updates from her friends using

                         John is a 60 year-old Caucasian man living just outside Los
                         Angeles, California. He is retired and lives with his wife, Alice,
                         and has been a lifelong CAM enthusiast. He and his wife both
                         participate in yoga sessions several times a week, and have tried
                         many other alternative stress management techniques, including

       meditation. John’s previous job required him to use a computer often, and while he is
       fairly computer literate, he browses the web at a slower pace than his children do and
       doesn’t typically spend a large amount of time using the internet. He mostly goes online
       to read the news and get baseball stats, and has to make the font size larger in order to
       read due to his decreasing eyesight. If a video comes up on the screen, he can typically
       make it play but might occasionally have difficulty getting files to open or to enlarge the
       video screen on his monitor. John has a regular cell phone and uses it mainly for
       emergencies, as he also has a landline at home and prefers to have longer conversations
       using the landline. John heard about the Benson-Henry Mind Body Institute from his
       yoga instructor, who recently read a book by Dr. Benson called “The Relaxation
       Revolution,” and now he is excited to go online to find out what it is all about, and maybe
       to learn some new techniques if they are easy enough to locate on the website. He has a
       pretty strong network of yoga friends and would love to tell them about the website if he
       has a good experience with it.

These are accurate prototypical users, and I have accounted for many different variables within
each type of projected user. I imagine that the users who come to the BHIMBM website will be
of varying educational levels, and while they may have chronic disease or stress, they may not;
they may be there for preventive reasons, or simply because they enjoy some aspect of mind
body medicine. Users will have different types of technology available to them, and this
technology will be available to them in different kinds of spaces (both public and private). There
may be varying levels of support from those users with partners, and there may be varying levels
of support and knowledge from users themselves, depending on their own attitudes and prior
experiences with CAM.

In looking at personas, it is necessary to go beyond a basic description and to examine the day-
to-day life of each persona in order to gain understanding of the triggers which would prompt the
personas to visit the website being designed.

Therefore, I have developed “A day in the life of….” scenarios for each persona as follows.

      Cindy
       Cindy wakes up at around 6:00 a.m. to get her kids ready for school. She walks them to
       the bus stop at 7:15 a.m., waits for the bus with them, and then walks back home. She
       cleans the kitchen from breakfast, takes a shower, and then starts making some phone
       calls to local businesses to search for a job. She takes her medications on a daily basis,
       but can feel her stress level rising each time she takes them because she knows they are
       not working for her. Some days, she walks down to the library to check her email and
       hunt for jobs online, although there is a time limit for computer use there, and it is
       difficult for her to search very long for this reason. She stops at the grocery store
       sometimes on the way home from the library, and as she walks around selecting items,
       she gets progressively more stressed as she adds up the total she will have to pay at the
       check-out counter. She didn’t get any job leads today. Her daughter Tiffany, who is 16,
       accompanies her to the doctor in the afternoon for her check-up because she helps to
       remind Cindy to take medication, etc. The doctor tells Cindy that because medication
       does not seem to be lowering her blood pressure enough, she wants her to try some

    relaxation techniques which have been proven to help reduce stress levels in people with
    high blood pressure. She tells her that she should go to the BHIMBM website and watch
    some of the videos to learn how to do these techniques. Cindy has never heard of Mass
    Gen Hospital, much less the BHIMBM, but she figures that it can’t hurt to try out
    whatever it is that they do. She feels desperate to do something because she can’t stand
    being so worried and stressed all the time. Her daughter writes down the URL, and they
    go home.

    When they arrive home, Cindy makes the kids a snack, helps them with their homework,
    and then starts to make dinner. Cindy wants to cook healthy foods for her family, but
    sometimes she is so tired, and so busy with three kids, that she relies on convenience
    foods like fast food or frozen meals. By the time the younger kids go to bed at around
    8:30 p.m., she is completely exhausted and feels like a ball of stress. She desperately
    wants to feel healthy again.

    The next day, Tiffany (who has a SmartPhone) checks out the BHIMBM website and
    locates a few videos that Cindy can try out. She also reads a few stories about other
    people who have had similar conditions to Cindy. Tiffany prints out the stories at school
    and also downloads a few beginner audio podcasts as .mp3 files and loads them onto the
    laptop they have at home so Cindy can listen without connecting to the internet. While
    the kids are at school, Cindy first reads the materials that Tiffany printed out for her
    about how the relaxation response can help people with chronic disease. In particular,
    she reads a story about a woman similar to herself who was able to reduce her blood
    pressure because of this technique. Armed with new knowledge and feeling that self- and
    response-efficacy are fairly high, and feeling that the severity of her condition is also
    worsening, she listens to the audio podcasts which describe and guide users through the
    relaxation response. She takes a few notes and decides to try it out later that day, before
    the kids get home from school. She also decides to ask Tiffany to use her SmartPhone
    later to watch a few of the streaming videos to make sure she knows how to do the
    techniques properly.

   Paul
    Paul wakes up at around 5:30 a.m. and goes for a 30-minute run, then comes home and
    showers. He eats a quick breakfast with his wife (cereal and coffee), and they both leave
    for work at the same time. He starts to feel anxious as soon as he gets onto the bus
    because he is approaching his job, and work is incredibly stressful for him. On the way
    in to work, he checks the news on his iPhone, visiting a few websites and then streaming
    the morning news from

    He spends 10 hours at work with barely any time to take a break even for lunch. On the
    way home from work, he is sitting on the bus and starts feeling overwhelmed with the
    stress of his day. His breathing becomes rapid and he feels like he can’t get enough air.
    It passes after about ten minutes, but it is not the first anxiety attack he’s had in the last
    few months. He decides he needs to do something about this – he doesn’t want to end up
    having a heart attack at a young age like his father and grandfather did.

    When he gets home at around 7 p.m., he finds his wife at the kitchen table, reading a
    piece of mail. She shows it to him; it’s from his insurance company and is an
    advertisement encouraging insured patients to access the BHIMBM website and services
    to relieve stress. She urges him to check out the website to see if any of the information
    there might help him. He’s a bit reluctant to try out CAM, but is also feeling like it could
    possibly help reduce his stress, and thus, his risk for heart attack. With his wife’s support
    and still slightly dubious, he goes to the website and finds a link on the home page for
    “Feeling anxious? We can help!” The link takes him to a page with information about
    anxiety and which mind body techniques can help reduce his stress. He downloads a few
    instructional videos onto his iPhone and plans to watch them the next day on his way into
    work. After watching them the next day, he decides it’s something he can try. Although
    he is not yet sure of the response efficacy, he figures it will make his wife happy and may
    just work.

   Julia
    Julia gets up at around 6:30 a.m. and showers quickly before running out the door,
    holding a travel mug of coffee and a granola bar to eat on the way in to work. She has a
    commute of about 40 minutes on the subway. She arrives at work to find clients already
    lined up waiting in the lobby, and immediately feels her stress level rise. She gets to her
    desk and puts her coffee and granola bar down, forgetting about them until it’s almost
    lunchtime. She sits in the staff room at lunch, eating her food for a mere fifteen minutes
    before going back to work. She works at twelve-hour day, and arrives home at nearly
    7:30 p.m. feeling exhausted. Her boyfriend is in medical school and is at the hospital that
    night doing rounds, so she fixes a quick dinner and collapses onto the couch and flips on
    the TV. She wishes Adam were there so she could vent some of her feelings.

    The next day, she does it all over again, but at a meeting at work, her boss announces a
    new program for employees. He tells them all that the company has partnered with the
    BHIMBM to bring employees information on relaxation techniques and that they are
    encouraged to spend up to 3 lunch breaks per week trying out some of the relaxation
    techniques offered on the website. There will be someone trained to guide them through
    the relaxation response as a group, but they are all encouraged to visit the BHIMBM
    website in advance to learn more about the services and techniques. Julia tells Adam
    about it, who scoffs and says that CAM is just a bunch of nonsense, but Julia still decides
    to participate in the group sessions at work. She goes to the website during her lunch
    break at work the next day and isn’t able to watch videos there, but finds information on
    the basics of mind body medicine and the relaxation response, and how it can be useful
    for managing stress and help prevent other chronic conditions. Julia does not feel that her
    level of stress is dangerously high but, at the same time, does experience enough stress
    most days to the point that it disrupts her sleep occasionally and causes her to feel tired
    all of the time. Even though her boyfriend does not support it, she decides based on the
    knowledge she’s gained from the printed information on the site to participate in the
    group sessions for relaxation responses.

   John

       John does not usually set his alarm, but is usually up by about 5:30 a.m. The first thing
       he does in the morning is meditate for about 30 minutes. He then showers and has a cup
       of hot green tea, toast, scrambled eggs, and a small bowl of fruit. He reads the print
       version of the paper at breakfast, which he shares with his wife. He spends the morning
       at a yoga class with his wife, and then return home for a leisurely lunch. John volunteers
       in his community and spends the afternoon doing that before returning home in the late
       afternoon. He and his wife talk in the kitchen as they prepare dinner together – a
       vegetable pasta sauce with spaghetti and roasted garlic bread. In the evening, John and
       Alice watch a favorite television show and then read. At some point in the evening, John
       checks the internet for sports scores and for the news on the and He and Alice go to bed at around 10:00 p.m.

       The next morning in his yoga class, John’s teacher tells them about a Mind Body
       Medicine conference she was at recently, where she got a copy of a book called “The
       Relaxation Revolution.” He loves to read about mind body medicine, especially yoga
       and meditation, and he is excited to go online to find out more about this book. If the
       relaxation techniques are easy enough to locate on the website, he’ll try them out himself
       and probably recommend them to others. He has a pretty strong network of yoga friends
       and would love to tell them about the website if he has a good experience with it.

       He goes online and right away finds a link for “Mind Body Lifestyle” on the home page,
       which he clicks on to find information about the book he heard about, as well as other
       information about yoga and meditation (including text, video, and download-able
       podcasts which walk an individual through the steps of each kind of technique). The
       videos are easy to find and play from the same screen, and so John is able to play them
       without any problem. He finds the information he was looking for quickly and
       recommends the site to many of his friends in his next yoga class.

Using the information established with the four personas described above, the following design
strategies are implicated:

Overall Design
    The overall site design needs to be one that is inviting and enticing to the end user, i.e.
      the patient. Thus, physicians, insurance companies, and corporations wishing to use this
      information to refer individuals should, at the very least, be referred to a separate
      portal/page upon accessing the website, and they might actually benefit from having an
      entirely different site dedicated to them.
    The home page of the website should orient the different types of users according to their
      needs, with entry points indicating information for how to relieve chronic conditions, or
      about the CAM lifestyle in general, etc.
    All features of the website should be very easy to locate, and in particular, the features
      that people will look for first should be easily located within perhaps 10 seconds of
      arriving on the page, or they will likely lose interest or become frustrated (particularly the
      populations who are there because their doctor/insurer referred them there). Thus, when
      users find the page, they should see, right away, links that correspond to why they are

       there. Such links could include “How to manage chronic stress,” “How can Mind Body
       Medicine help me?,” “How to relax: try our techniques,” “CAM Lifestyle,” etc.
      The site should avoid any prescriptions about

    The site should be accessible from regular computers, laptops, and Smartphones/iPhones.
       Because some personas will not be able to access streaming content, or content with
       video/audio, there should be a combination of these features so that those users who are
       able to watch videos can, while those users who are not able to watch video can still get
       solid and interesting information from print.
    BHIMBM should consider sending news, tips, and updates (or reminders) to people who
       sign up on their website. These messages should be formatted to be accessible even on
       regular cell phones without internet access and small screens.
    Another feature which would be highly beneficial to the site would be an online
       discussion forum where users can discuss common challenges with each other and
    The site could also consider having a “Live Chat” feature in which a BHIMBM
       representative could be available to chat with people who have questions.

    The pictures should not be of medical personnel, but could rather be photos of techniques
      being demonstrated, a person meditating, etc.
    The website should feature firsthand accounts of how mind body medicine has changed
      the lives of real people, and these people should be prototypes of the different end users.
      Thus, there should be at least one person with chronic disease, one with chronic stress,
      and one with a pure interest in CAM lifestyles. Ideally, there would be a widget in the
      sidebar with three such “teaser” accounts with pictures, and when a user clicks on the
      widget, it would take them to a new page with the entire account from each person. Like
      the personas described above, these stories should feature people of different ages and
      geographic locations.
    Content should be in multi-media form and should include text as well as video and audio
      which can either be streamed online or downloaded for viewing/listening at a later time
      (perhaps when someone has more privacy to try out the techniques).
    Content should be both informational as well as tutorial. Content could feature doctors
      talking about the benefits of mind body medicine, testimonials from patients, videos of
      people demonstrating techniques, and instructional videos or audio files which talk a
      person through the technique.
    For purposes of multilingual audiences (i.e. Hispanic populations) the BHIMDM should
      consider offering some of these media files in Spanish (i.e. for someone like Julia, who
      may or may not feel more comfortable in English rather than Spanish).
    Text on the website should be available in several different font sizes (i.e. for John, who
      has trouble seeing smaller print online) and should also have printer-friendly versions for
      those users who prefer to read offline, or who have timed access to the internet (such as
      Cindy, who can only access the internet at the library).

Needs Assessment

For this particular website, I would conduct needs assessments by using several different tools.

      Use existing data
       Because the BHIMBM website is already in place under the Massachusetts General
       Hospital, I would want to look at any and all data which has already been compiled
       regarding this website, including who uses it, for what purpose, how often, and under
       what conditions. Such data would also ideally reveal what type of devices current users
       are accessing the site from, and using which internet browsers. If doctors use this site
       more than patients, perhaps the most practical solution would be to create an entirely new
       site for patients and to keep the current one for physicians and insurance companies to
       learn about referral programs and CME credits. If mostly patients use the current site,
       however, the opposite recommendation would be stronger. Thus, a comprehensive
       review of the data (either through a program such as Google Analytics or a customized
       program) would be very illuminating and would show site traffic, geographical location
       of site users, how long they stay on the site, which pages they view, and whether they are
       return or first-time users.

      Conduct Literature Review

       A literature review will be another important component to the needs assessment.
       Examining best practices of - and avoiding pitfalls already discovered by - other mind
       body practitioners will allow the BHIMBM to adopt relevant techniques for the target
       audience. Because the BHIMBM is already quite well-established in the field, the
       literature review could focus on specific target populations (i.e. people with certain health
       conditions, etc.) not only to inform website design, but also as information to share with
       the target audience itself via the website, newsletters, etc. It will be critical to review
       literature on mind body medicine and specifically which types of interventions have
       benefited individuals with certain chronic conditions.

      Focus Group Discussions
       Focus group discussions could be conducted by asking local physicians to recommend
       patients who would likely benefit from the techniques and services offered by the
       BHIMBM. This could also be advertised independently in hospitals, pharmacies, and
       doctor’s office with flyers so that patients could identify themselves as fitting into one
       group or another. However, the limiting factor of having patients self-select is that it
       might not accurately represent the views of patients who are referred by their doctors
       with no real interest in or motivation to try CAM.

       Focus group discussions would be held with a maximum of 12 people and each would
       ideally target a particular kind of user (but not limited to end users only). For this
       website, focus group discussions should be held for the following groups:

                     People with chronic disease (in particular, cardiovascular disease, high
                      blood pressure, etc.)

          Find out the most important outcomes they want to see from mind
           body medicine interventions
         How much they trust that mind body medicine could work for
         Which techniques they would be most willing to try/learn
         What kinds of applications/features they would like to see on the
           website (i.e. mobile reminders/alerts, videos, audio podcasts,
           discussion forum, etc.)
         General perceptions of mind body medicine
   People with chronic stress
         Find out the most important outcomes they want to see from mind
           body medicine interventions
         How much they trust that mind body medicine could work for
         Which techniques they would be most willing to try/learn
         What kinds of applications/features they would like to see on the
           website (i.e. mobile reminders/alerts, videos, audio podcasts,
           discussion forum, etc.)
         General perceptions of mind body medicine
   CAM enthusiasts
         Gauge likelihood of utilizing a Mass Gen site to find more
           information on mind body medicine, as opposed to other sites
         How much they trust the site if it is housed under Mass Gen
         Find out which features/applications CAM enthusiasts would most
           like to see on the website (i.e. mobile reminders/alerts, videos,
           audio podcasts, discussion forum, etc.)
         General perceptions of mind body medicine
   Physicians
         Find out percentage of patients they would be interested in
         Find out the primary reasons for referring patients to the site
         Find out what the needs are for each major condition cluster (i.e.
           chronic heart disease, chronic stress, etc.)
         What would they expect the website to deliver to these patients
         Ideas for useful features/applications for the website
         General perceptions of mind body medicine
   Insurance providers
         Find out percentage of patients they would be interested in
         Find out the primary reasons for referring patients to the site
         What would they expect the website to deliver to these patients
         Find out how they will advertise the site to the insured population
         Ideas for useful features/applications for the website
         General perceptions of mind body medicine
   Representatives from companies interested in utilizing the BHIMBM

                             Find out the primary reasons for referring employees to the site
                              (for primary support or a complementary part of a larger wellness
                             What would they expect the website to deliver to their employees
                             Find how they will advertise the site to employees
                             Will employees be accessing the site individually or in groups?
                             Ideas for useful features/applications for the website
                             General perceptions of mind body medicine

 After all focus groups have been conducted, the site will be designed with the information
collected in mind. After the site has been constructed, I would want to hold another round of
focus groups for each type of user in which they are able to log on to the site and explore its
features, providing feedback on usability, design, and content. This information would then be
used to tweak the site’s design to optimize the usability and accessibility of the site.

 4.2 Competitive Analysis

 Another vital step in creating a health website is to conduct a competitive analysis, a process through which strong and weak points of
 websites with a similar focus to the one being designed are defined. These points then contribute to the design of the health website
 by showcasing what works well on other sites, and what does not work well, thus allowing the designer to adopt the positive elements
 while avoiding the negative ones. In order to do this, the following areas were assessed with corresponding questions as follows:

1.    Purpose: How clear is the purpose of the site at a glance from name, tagline, and imagery?
2.    Target audience: Which population(s) does the website serve?
3.    Layout and navigation: How usable are the layout and navigation including labels and menus?
4.    Currency: When was the content published and reviewed? Is it dated?
5.    Authors: Are authors listed? Are their credentials available? Is there an advisory board?
6.    Readability: Is the content easy to understand? What reading level is it?
7.    Language: Is there any confusing language, jargon, or abbreviations?
8.    Organization: How informative is the home page? Are the purpose and the vision clearly stated?
9.    Branding: Is there branding, accreditation (HONcode or URAC), sponsorship, advertising, or clinician involvement?
10.   Design: How professional is the design? Characterize it (modern, dated, crisp, …)
11.   Section organization: How many sections does the website have? What are they?
12.   Expert-generated content: What are the expert-generated components (text, graphics, audio, video, blogs, directions/maps, ask the
13.   User-generated content: What are the user-generated components (discussion forums, blogs, user-submitted videos, wikis, social
      bookmarking, ratings, reviews)?
14.   Policies: How are user-generated components managed, organized, or moderated?
15.   Registration: Does the website offer registration, profiles, or personalization and, if so, what, when, and with what benefits?
16.   Add-ons: Can users sign up for supplemental features such as a mobile app or a newsletter?
17.   Financial: Can users donate, buy, subscribe to, or join anything?
18.   Users: Is there any information about users, through stories or testimonials, or number of users?
19.   Social media: Is social media used? Can content be shared?
20.   Overall assessment: What are the overall best and worst features of the site?

 In order to conduct a competitive analysis for the BHIMBM, four competing websites were identified both through conversations with
 the current BHIMBM Director and also through web searches using the terms “Mind Body Medicine” or “Mind Body Medicine
 Center.” In order to have slightly more variety for comparison, only three of the websites chosen for analysis reflect the work of

similar Mind Body Medicine Centers, and one is a site dedicated to CAM techniques, but which is not necessarily tied to a practice.
What follows is a detailed analysis of each site as it relates to the points outlined in the questions above, with a small screenshot of the
homepage of each preceding the chart.

Gaiam Yoga

Center for Mind Body Medicine

Mind Body Medicine Center

Mind Body Medicine

                                                    The Center for Mind Body                                                   Mind Body Medicine
                       Gaiam                                                           Mind Body Medicine Center
                                                             Medicine                                                      (http://www.mindbodymedici
                   (                                                      (

           The purpose of this website is not     The purpose of the website is       The logo for this website does       The homepage for this website
           completely clear at first glance.      more clearly discernable than it    not have a tagline, and the          does not explicitly state the
           The title, “Gaiam,” with the           is on Gaiam Yoga’s site. The        purpose is not immediately clear     purpose, although the logo,
           tagline of “live learn grow”           tagline is written in much larger   from a quick glance at the home      tagline, and content on the
           suggests some sort of personal         font than one might expect          page alone. Upon exploring the       home page allude to patient-
           wellness/growth, and the               across the center of the page:      navigational links, one finds that   oriented content. The front
           slideshow of images of people          “Science. Training. Community.      the very first option under “Our     page has a tiny slideshow of
           from around the world and nature       Outreach.” To reinforce those       Clinic” takes the user to the        people (presumably satisfied
           are also suggestive of a global        themes, there is a slideshow of     purpose of the site, meaning the     patients) with the heading
           sense of unity. However, users         photos with captions to explain     information is at least easily       “Learn how to feel fantastic!"
           who are not already familiar with      the images. These elements          located even if it is not on the     The tagline of “A Partnership
           Gaiam may not realize                  show users that the CMBM has a      homepage.                            for Wellness” may cause users
           immediately what the specific          variety of focus areas, including   However, in glancing quickly at      to wonder which partnership is
           purpose of the site is. Upon           professional trainings, global      the homepage, a user could           intended: the partnership
           further investigation, one finds the   relief efforts, and patient care.   likely discern that this site is     between mind and body,
           purpose on the home page (please       One can tell right away that the    aimed at patients, given the         between themselves and the
           see “Organization” section below).     center’s goal is to help people     navigational tabs of “Our            clinic, or perhaps between
           However, this is not at all apparent   around the world and that the       Clinic,” “Services Offered,”         clinicians themselves as they
           when one first glances through the     focus areas range from research     “Knowledge,” and “Classes and        work together at the clinic.
           website, as it is “below the fold”     to community outreach.              Seminars.”                           Based on this information, a
           and is in light gray font. Users are                                                                            user could deduce that the
           not likely to notice this.                                                                                      purpose of this site is to
                                                                                                                           achieve wellness through
                                                                                                                           various mind body techniques.
           The target audience for this           This website has a much more        Patients who are interested in       Patients who are interested in
 Target    website appears to be adults who       segmented target audience than      trying mind body medicine are        trying mind body medicine are
audience   are enthusiastic about CAM and         the Gaiam site. Its audiences       the target audience for this site.   the target audience for this site.
           wellness, and who are inclined to      include physicians, researchers,    Most of the content is addressed

             pursue spiritual solutions for       international partner                 to the “you” of the patient, who
             problems they are experiencing.      organizations, and donors.            is reading the text.
                                                  While there is a “Patient
                                                  Services” menu tab, it does not
                                                  appear to be geared towards
                                                  patients themselves; rather, it
                                                  seems to be geared towards
                                                  physicians who are searching on
                                                  behalf of patients.
             The layout of the site is simple and The layout of this site segments      The layout of the site is very      The layout of the site is
             is not overwhelmingly populated      the potential audiences across        user-friendly. There is a simple,   simplistic and does not appear
             with choices, which supports the     the top. The order in which the       calming, stationary image and       to be professional. Only half
             serene feel that the site is likely  menu tabs appear seems to imply       four main menu items to choose      of the web browser space is
             trying to achieve. However, the      that research is the most             from. Each main menu item has       being used, which crowds all
             labeling is difficult to decipher in important aspect of the Center’s      a drop-down menu with logical       of the site’s information into
             places. For example, the first tab   work, and the tab for “Patient        navigational choices. Finding       one side of the page and leaves
             is “About Gaiam” and the second      Services” appears almost at the       information is very                 a huge white space to the right.
             tab is “Gaia.” A user may not        end of the row, indicating that       straightforward (although it        The site is not especially
             understand the difference between the site is not aimed mainly at          could be improved by adding a       inviting and some of the site’s
             these two tabs. If one clicks on     patients. In addition, almost all     search box at the top right). The   components are difficult to
Layout &     both links, there is no real         of the other features on the home     navigation seems to be focused      find through exploring the
Navigation   explanation given for the            page (such as widgets or              on providing information which      sidebar links, and there is no
             difference, and it simply takes      advertisements for events at the      patients (not doctors or            search box.
             users to two different portals.      CMBM) focus on professional           researchers) would be visiting      The navigational links to the
             There is a slideshow on the front    development, and not patients.        the site to find.                   left are puzzling, as they
             page which uses an enormous          This implies a prioritization         The layout is not particularly      expand and redirect users in
             amount of space. The photos          process which has placed              fancy and does not feature any      different ways. If one clicks
             (while lovely and vivid) do not      practitioners and researchers         slideshow images. The images        on one of the choices under the
             give a user any hint that they are   above patients in their utilization   which do appear are almost all      “Clinical Expertises” tab, the
             actually hyperlinks and will re-     of the site (and could also mean      pictures of nature. In fact, much   site redirects to that part of the
             direct users to another part of the  that patients are not intended to     of the site’s essential framework   site, and in order to read about
             site, nor do they intimate clearly   utilize this site at all).            is stationary, which has the        another type of clinical
             which part of the site they might    The site also has a slideshow of      effect of making navigation very    expertise, one has to renavigate

lead one to. In addition, the first     images, but it is relatively          simple. This framework stays in         via that tab. However, this is
picture that comes up in the            unobtrusive in the amount of          place no matter which part of the       not mirrored by the navigation
slideshow is the only one which is      space it takes up. The images         site one visits, making it very         under “Mind Body Clinicians;”
NOT hyperlinked, meaning that a         are mainly of patients from           easy to start browsing again            if a user clicks on this tab, all
user who tried to click on this first   around the world receiving the        from the homepage, to link              of the choices suddenly appear
picture would deduce that the           treatments described on the site.     directly to a new topic, and to         in the left sidebar underneath
pictures are just there as imagery,     The slideshow does not link           navigate each new page. The             “Mind Body Clinicians.” This
and not as links. (S)he might not       users to another part of the site,    clinic’s logo at the top of the         is confusing because the
keep trying with the ensuing            but if a user hovers the mouse        page does not link back to the          methods are not parallel to
pictures, undermining the whole         over an image, it freezes and a       home page. Rather, there is a           each other.
point of linking various parts of       caption appears, which describes      separate text-based link to home        Another confusing aspect of
the site to the slideshow photos.       the location and type of session      in the top right corner. In the         navigation occurs if one clicks
There are also many parts of the        being depicted. This                  same corner, there is a link for        on “Biofeedback FAQs;” the
site which are not done in a            informational slideshow is            “Contact.” These two links are          site performs a very strange
parallel way; for instance, “Gaia”      especially positive in that the       not in an intuitive spot on the         action and the homepage gets
is the only menu item with an           size does not overwhelm the           site.                                   pushed below the screen,
additional drop-down menu, even         entire home page.                     The navigation always takes             where users cannot see it. A
though “Solutions for Living”           There is a very convenient            place within the same internet          user who does not realize
goes to another site which could        search button at the top right,       tab, meaning users are not              where the navigational bar
easily also have a drop-down            which is an intuitive place for       redirected to a different tab or        went would not be able to find
menu’s worth of items. There are        many users to look for this tool.     window when they click on               his/her way back to the main
several themes for the Gaiam            There are two different menu          links. Users with any sort of           page from this part of the site.
website, including Lifestyle,           bars at the top; one small text-      movement impairments may find           This site’s logo also does not
Soulmates (a dating service), and       based strip of navigational links     it difficult to navigate the site, as   redirect back to the home page,
Yoga Club. It would be much             which orient users to information     users must click on the text            which is counterintuitive for
more easy to navigate (and to be        about the CMBM itself (About          within a navigational box, and          users. There is a very small
aware of all options) if these were     Us, Events, etc.) and another,        not just the box itself, to get         slideshow of smiling people on
all listed together, perhaps even as    larger one directly below it          from page to page, which                the home page who appear to
a drop-down menu under one              which segments users by their         requires some precision clicking.       have been helped by mind
categorization. As it is, users may     purpose in coming to the site         The front page has three                body medicine, but the images
not find all of the content available   (Research, Professional               snapshots of information in the         are not hyperlinked, so users
to them.                                Trainings, Patient Services, etc.).   main body of the page: an               cannot see how specifically
When one does go to another             The rest of the home page gives       explanation of mind body                they were helped, and there is

section of the site (for instance, by   a brief snapshot or “teaser” of    medicine, information about free      no complementary
clicking on the “Gaia” tab), the        various other pages (such as       weekly lectures, and information      “testimonials” section.
site redirects to another page by       Events, News, etc.) and features   about a book by one of the            There is also a “Recent
opening up a new window/tab.            four separate boxes directly       doctors at the clinic. On the         Updates” section with only one
This makes it easy to return to the     underneath the image slideshow     right, users have the option of       recent update featured. This is
original page tab, but is also          of Professional Trainings and      signing up for a newsletter.          a simple text box with a
confusing because users may not         Global Relief Trauma.              When navigating to other parts        hyperlink to a full article.
be sure of how/why all of these                                            of the site, the space to the right   And in reality, the story there
linked page entities are connected,                                        of the main photo becomes a           links back to an already-
as the logos are not all the same.                                         health news story of interest.        existing part of the site on how
                                                                           This amount of information is         to manage a certain health
The bottom strip of options on the                                         not overwhelming to a user and        issue, which does not fit into
site is the most clear; there, users                                       likely answers the first question     the idea of a “recent update.”
can decide to see videos, find a                                           that many users would want to         This would discourage users
“cue to action” (“Transform your                                           have answered as soon as              from checking back for recent
Life”) and find an explanation of                                          possible while looking at this        updates because it undermines
Gaiam. It is obvious that these                                            site: what is mind body               the purpose of that particular
photos are hyperlinks.                                                     medicine? This layout decision        widget.
The Gaiam Store is found three                                             orients users right away to the
times on this home page, which                                             information they are likely
may be a turn-off to some users; it                                        seeking. In general, users would
is at the top of the entire site, is                                       likely be able to find the
one of the navigational image                                              information they are looking for
hyperlinks, and an entire third of                                         fairly easily, as the menu items
the page at the bottom is taken up                                         are labeled very clearly and
with exhaustive lists of                                                   simply.
merchandise available.
Overall, the navigation is not as
straightforward as it could be.
Users may be confused about
which kind of information would
be found in certain links, and may
not realize that some of the links

              even exist.

              The content on the front page is      The content on the front page is The content on the website is          The content on the website is
              copyrighted to Gaiam as of 2010.      copyrighted to The Center for    copyrighted to the Mind Body           not copyrighted to any
Currency      Several of the links take users to    Mind Body Medicine as of 2010. Medicine Center as of 2010.              organization and is not dated.
              separate websites, whose content
              is not dated or reviewed.
              The content on the main site is       The authors of specific pieces of  There are some pieces of content     None of the content is
              attributed to Gaiam. The articles     the website are not actually cited which are identified as being        attributed to specific authors.
              from the “Gaia” site, which is        at the end of the sections because excerpted from a book by one of      The site does list the clinicians
              linked from the navigation toolbar,   the sections are typically         the doctors (the book advertised     on the site and describes their
              lists an author’s name and the        overviews of literature available, on the home page), but for the       specialties. On some parts of
              magazine source for most articles.    etc. However, members of the       most part, authors of specific       the site, users are invited to
              Most of the articles on the linked    center are pictured consistently   pieces of text are not identified.   contact a specific person at the
 Authors      sites attribute content to authors    throughout the website. Seeing     However, the credibility of the      practice for more information.
              and/or a book or magazine source.     the faces of the authors who       site can be seen in the list of      However, the site does not
                                                    have been published adds the       doctors at the clinic in the left    otherwise call out credible
                                                    elements of credibility and        sidebar. This list appears no        sources for the information.
                                                    personalization to the site.       matter which part of the site a
                                                                                       user visits, serving as a constant
                                                                                       reminder of the expertise
                                                                                       available at the clinic.
              The language seems to be geared       The language used in certain       Content on this site at first        The reading level of text on
              towards people with at least a 12th   sections of the site would be well appears to be at a reading level     this website is fairly high, with
              grade reading level, if not people    above a 12th grade reading level appropriate for patients, likely       many long or confusing words
              who are in (or have graduated         (particularly in the Research and because of the consistent use of      used. Like the Mind Body
Readability   from) college. Many of the            Professional Training pages).      “you,” which makes the text feel     Medicine Center’s site, this
              sentences are rather long and have    This is also true in the Patient   very individually tailored.          site also uses the word “you”
              multi-syllabic words, which might     Services page, where there is      In reality, though, the text uses    frequently, giving the text a
              confuse someone of a lower            very little information and the    many words that low-literacy         more personal tone. Some
              education or literacy level.          links redirect users back to the   and low health literacy readers      parts of the site are written in a

               In addition, the video that plays on   Research pages for more               may not understand. The               simpler format, but other parts
               the “About Gaiam” home page has        information. Although this site       readability seems to be different     are at a literacy level that is
               fast-paced speech with many            is intended for researchers and       depending on the specific site        higher than what some users
               words that users with low literacy     clinicians, it is important to note   page.                                 will be able to comprehend.
               levels would not understand.           that users with low literacy
                                                      levels or low health literacy – or
                                                      even low CAM literacy! – would
                                                      likely not understand the
                                                      information on these pages.
               The site uses some jargon, and         This site also uses some jargon.      This site does use some jargon,       This site uses some jargoned
               although many users in the target      For example, Biofeedback,             but also classifies jargoned          words, particularly for various
               audience (who are CAM                  Meditation, and Guided Imagery        words into more familiar clusters     illnesses and treatments.
               enthusiasts and have some              are listed under “Patient             of terms for those readers who        Categories such as
               knowledge of the lifestyle and         Services.” However, many new          might be unfamiliar with some         Biofeedback and
               techniques) would likely be            patients would not be familiar        of the terminology. For               Psychopharmacology are listed
               familiar with terms such as            with what those terms mean and        instance, there is a page which       as options in one of the
               “yoga,” “illumination,” and            whether they should try them.         lists the types of blood tests the    expanding menus, and some
               “transformational learning,” users     There is a .pdf document of           clinic can perform. The tests are     patients may not be familiar
               who are completely new to the          FAQs that patients can download       listed in medical terms, but are      with these terms.
               CAM lifestyle may not be sure          which answers some of these           classified according to disorder
               about what some of these words         questions, although the terms are     (i.e. “Metabolism and Energy
               mean. This may turn them off to        not necessarily explained in          Production” or “Heart Disease
               further exploring the site and/or      detail.                               Risk Factors”). Even so, many
               mind body medicine.                                                          patients coming to the site may
                                                                                            feel unsure of the meaning of
                                                                                            some of the words used in the
             As mentioned above, the home             The purpose and vision are not        The home page has carefully           Although difficult to navigate,
             page is not very clearly organized.      on the homepage itself, but if a      targeted information. The             the site’s organization is
             The labels for some menu items           user clicks on the “About Us”         purpose is not immediately            actually fairly intuitive in the
             are not clear, and the purpose of        tab, the purpose is stated to be:     visible, but it is the first option   classifications of various
             the Gaiam website is tucked in           “The Center for Mind-Body             on the drop-down menu under           information. The home page
             light, difficult-to-see font below       Medicine is a non-profit, 501(c)      “Our Clinic,” which a user could      does not call it out directly as

           almost all of the other content. In     (3), educational organization        easily locate:                      the purpose, but if one reads
           addition, there is some                 dedicated to reviving the spirit     “The purpose of MindBody            the explanation of mind body
           segmentation for “Investors,” but       and transforming the practice of     Medicine Center is to provide       medicine on that page, one
           it is in light gray font below all of   medicine. The Center is              medical care which educates and     finds this as part of the
           the main photos and links, and as       working to create a more             empowers people to reverse          explanation:
           such is very difficult to find.         effective, comprehensive and         disease using the using the         “We assist people with stress
           The purpose is listed as:               compassionate model of               fundamental healing principles      sensitive physical and/or
           “Gaiam is a lifestyle media             healthcare and health education.     of mindbody medicine. The           emotional problems to become
           company that focuses on                 The Center’s model combines          Center represents the               aware of their unique
           conscious solutions for personal        the precision of modern science      convergence of the best of          responses to stress and to learn
           transformation. We offer the            with the wisdom of the world’s       traditional medical practice with   skills for making healthy
           resources you need to achieve self-     healing traditions, to help health   the emerging science of             changes.”
           growth, live a healthy lifestyle or     professionals heal themselves,       integrative medicine, thereby
           to positively transform your life.      their patients and clients, and      providing a much needed
           Our personal growth media               their communities.”                  alternative to the outdated
           empowers you to create your own                                              medical model which focuses on
           personal development path toward                                             treating disease with drugs and
           the life transformation you seek.”                                           surgery.”
           There is no HonCode or URAC             There is no HonCode or URAC          There is no HonCode or URAC         There is no HonCode or
           accreditation on the main site or       accreditation on this website.       accreditation on this website.      URAC accreditation on this
Branding   any of the sub-sites. The only          The only branding is from the        The only branding is from the       website. The only branding is
           branding is from Gaiam and Gaia.        CMBM itself.                         Mind Body Medicine Center.          the Mind Body Medicine logo.
           The design of the main page             The design of the page is at a       The design is simple and            The design of this site is
           appears to be very professional. It     medium level of                      straightforward, and it has a       simple to a fault. There is too
           is earthy in tone with light greens     professionalism. The home page       professional, clean feel to it.     much unused space to the right
           with a slightly modern feel. The        is rather cluttered, and the page    There is not much color on the      of the text, giving the
           large and very professional-            has a slightly amateur feel to it.   site, nor are there many other      information that is there a
 Design    looking photos of nature and of         The color scheme in particular       special features beyond text and    unnecessarily cramped feel.
           people from around the world send       does not feel particularly           photos. There is really no          The site looks unprofessional,
           messages of inclusion and               welcoming, as the tones seem to      movement on this site, which        with almost no color used.
           outreach.                               be attempting an “earthy” feel       may be intended to create a         The colors which are used are
                                                   but are instead accomplishing        serene web experience. Some         not well-matched. The site’s
                                                   more of a slightly neon one. The     users may become bored with         logo is in a neon pink color,

                                                    grainy photographs (while             this, though, particularly ones     and the font is a loopy cursive
                                                    depicting wonderful                   who are comparing the site to       which makes the site look
                                                    interventions) also enhance this      other sites with social media and   somewhat sloppy. The only
                                                    amateur feel and makes the site       interactive features.               movement on the site is the
                                                    feel slightly dated or faded.                                             slideshow of small images of
                                                    However, the site still manages                                           people smiling. There are no
                                                    to appear credible even despite                                           other special features and no
                                                    this, due to the quality of formal                                        other images.
                                                    content it contains.
               The website has ten main sections:   The website has two                   The website has four main           The website has six main
               About Gaiam                          navigational bars; the first one is   sections:                           sections:
               Gaia                                 at the top under the search box       Our Clinic                          Home
               Solutions for Living                 and has the following sections:       Services                            Mind/Body Connection
               Make a Difference                    Events                                Knowledge                           Clinical Expertises
               Blog                                 Press                                 Classes & Seminars                  Mind Body Clinicians
               Spiritual Cinema                     About Us                                                                  Audio Tapes
               Yoga Club                            Contact Us                                                                Contact
               Illumination University              Home
               Soulmates                            The second one is larger and
               Eco Travel                           spans the whole page with drop-
               There are also links across the      down menus and is segmented as
               bottom for:                          follows:
                                                    Research & Resources
               Contact us                           Professional Training &
               Investors                            Education
               Gaiam Catalogs                       Global Trauma Relief
               Customer Service                     Partnerships & Collaboration
                                                    CMBM Certified Practitioners
                                                    Patient Services
                                                    Donors Circle & Membership

               Expert-generated content is what        This site is almost entirely         All of the content on this site is   All of the site’s content is
               largely populates the site,             comprised of expert-generated        expert-generated. Much, if not       expert-generated. The authors
               including text, graphics, videos        content. The Research section        all, of the content appears to       are not identified, but the
               describing Gaiam and instructional      contains many abstracts and full-    have been written by the             collective “we” used
               yoga videos, and the Gaiam Blog         text .pdfs of articles, as well as   clinicians themselves, although      throughout the text implies that
               (which says “Experts and                forthcoming literature on mind       the authors of most of the text      it is the voice of the clinicians
  Expert-      enthusiasts share their experiences,    body medicine. This content is       are not identified. The expert-      themselves. The expert-
 generated     how-to's and answers on living          mainly text-based, but there is      generated content is made up         generated content is made up
  content      greener, getting healthier and          also a blog under “Food as           entirely of text.                    almost entirely of text, with the
               living a more fulfilling life.”). On    Medicine” featuring videos and                                            exception of the slideshow on
               the blog, the left sidebar features a   images.                                                                   the homepage of smiling faces
               list of experts who regularly                                                                                     and the pictures of the
               contribute content. The faces and                                                                                 clinicians.
               voice of experts appear often on
               this site, lending it credibility.
               Users are able to comment on            Users are able to comment on         There is no user-generated           There is no user-generated
               and/or share blog posts via social      and/or share blog posts via social   content on this site. Users are      content on this site. Users are
   User-       media (Twitter, Facebook, and           media. However, there are            able to send a private email via     able to send a private email to
 generated     RSS feeds).                             really no comments on the blog       an inquiry form to the clinic, but   one of the clinicians, but that is
  content                                              at this point, and it is therefore   that is the most interactive         the most interactive feature of
                                                       difficult to gauge readership and    feature of the site.                 the site.
                                                       interactivity levels.
               There may be policies regulating        There may be policies regulating     There are no policies mentioned      There are no policies
               how comments are moderated, but         how comments are moderated,          on this site. There is nothing to    mentioned on this site. There
               this is not apparent without            but this is not apparent without     regulate, however, as user-          is nothing to regulate,
               actually going through the process      actually going through the           generated content is not part of     however, as user-generated
               of posting a comment.                   process of posting a comment.        the site’s design.                   content is not part of the site’s
               There does not appear to be a         There is no place for users to         There is no place for users to       There is no place for users to
               place for users to register or create register or create a personalized      register or create a personalized    register or create a
Registration   a profile on the main website. One profile on this site.                     profile on this site.                personalized profile on this
               of the Gaia pages, “Gaia                                                                                          site.
               Soulmates,” allows users to create

            a dating profile. “Gaiam Yoga
            Club” and “Spiritual Cinema
            Club” also have a way for users to
            create a profile. Thus, many of the
            website offshoots allow users to
            register, but they are not able to
            log in from the central main page.
            There is a newsletter available       On each page, there is a small         Users can sign up for a              There do not appear to be any
            from the Gaiam home page, as          blue heart with the text “Join         newsletter. The sign-up sheet        applications that users can sign
            well as many of the linked pages      Us!” next to it. This is not a         does not indicate frequency of       up for.
            (including the Gaiam Yoga, Gaiam      familiar icon (like Twitter or         newsletter updates.
            Soulmates, Gaiam Store, and           Facebook would be). By
            Illumination University, for          clicking this, one has the option
            example). RSS feeds of the blog       of signing up for a bi-weekly
            and Gaiam Life are available. The     newsletter, to donate to the
            Gaiam Store also offers users a       CMBM, or to become a
            “special offers” email.               volunteer or intern.
            Users can shop in the Gaiam shop      At the end of descriptions of          Users may purchase a book            Users can presumably
            and can subscribe to a “news and      projects around the world, users       written by one of the clinic’s       purchase the audio cassette
            offers” email list.                   see a “Donate Now” button.             doctors on this website (via a       tapes on meditation and
                                                  This button also appears at the        link that redirects to               relaxation, although there is no
                                                  bottom of the homepage. The   Otherwise, there        price listed and they must first
                                                  financial pleas do not overwhelm       are no solicitations for donations   call a number in Boston to find
                                                  the site, however, and they            or to visit an online store.         more information. It must be
                                                  appear in logical places (i.e. after                                        noted that this is a very
                                                  a user has read about the work                                              outdated form of media to be
                                                  being done, he or she can choose                                            offering patients, as the
                                                  whether to donate, as opposed to                                            majority are likely to prefer
                                                  having a “donate now” button on                                             .mp3 or CD format instead. It
                                                  every single page).                                                         could also be the case that the
                                                                                                                              site is simply very outdated.

               Testimonials appear on several        Testimonials appear throughout      Testimonials are done in an           There are no actual
               pages, including the Spiritual        the site, and are mainly from       interesting way on this site.         testimonials on this site. The
               Cinema Circle (which offers video     professionals who have attended     Instead of being identified           closest users get to peer
               testimonials) and the Yoga Club       trainings and found them to be      initially by the person’s first       reviews is the slideshow of
               (which offers testimonials in         useful in their practices.          name or initials, they are labeled    smiling faces under the
               print).                                                                   by symptom. This serves to            heading of “Learn how to feel
                                                                                         invite site visitors to identify      fantastic!” One can only
                                                                                         with testimonials according to        assume that these people
                                                                                         which symptoms resonate the           previously felt less than
                                                                                         most with them.                       fantastic, and that the
                                                                                                                               improvement is due to their
                                                                                                                               experiences at this clinic.
               Users can visit the blog and          If users can locate the “Food as    There are no social media             There are no social media
               “Retweet” or share blog posts on      Medicine” blog on the site, they    aspects to this site.                 aspects to this site.
               Facebook.                             can share the blog posts as
               The Gaiam store invites users to      Tweets or through Facebook.
Social Media   find them on Facebook, Twitter,       The rest of the site does not
               YouTube, or to get their RSS feed.    incorporate social media.
               However, none of these are
               available from the main
               Overall, this site looks              Overall, the information on this    This site seems to be focused on      While this site is focused on
               professional and has a color          site appears to be very credible    the patient in so many ways,          communicating information to
               scheme which seems to support its     (even despite the lack of           which is what makes the lack of       patients about the services the
               purpose, using earthy tones which     accreditation) because much of it   potential user involvement on         clinic offers, it is one that users
               do not overwhelm, but rather,         stems from peer-reviewed            the site so interesting. The entire   would likely not return to
  Overall      welcome the user. It offers a large   journal articles and research.      site is aimed at patients or          because of the lack of
assessment     amount of self-paced instructional    The site is aimed mainly at         potential patients of the clinic      engagement. There are no
               content, a wonderful feature which    practitioners and researchers,      but offers no opportunities for       opportunities, or cues to
               the BHIMBM should consider            and the average patient             users to participate or interact      action, which would prompt
               modeling (but should, in contrast,    interested in finding out about     with each other. However,             users to get involved; no
               offer at no charge). The language     mind body techniques may not        everything else on the site is        newsletter, no social media, no
               is geared towards people who are      find much of interest/value here.   extremely well-done; the              blog, and no personalized

     CAM enthusiasts and may be off-      Much of this information is         organization is clear, navigation   profiles. The organization is
     putting for people who come to the   targeted specifically towards       simple, content well-organized.     intuitive and the information
     site with no prior CAM               people who are already very         As a site which is aimed at the     offered is well-targeted in
     experience. The navigation is one    savvy in their knowledge of         same audience as the                terms of content (which type of
     aspect of the site which BHIMBM      CAM or at least of medicine.        BHIMBM’s new site will be,          information patients would
     can learn from and do better; this   While this could be a model for     this site has many good features    want to know), but is not given
     site seems to be the central point   how the Benson-Henry Institute      which can be modeled on the         at a literacy level which would
     of entry to many other themed-       for Mind Body Medicine could        BHIMBM site.                        include all patients. The site’s
     sites, and the connections between   segment a page designed                                                 static feel is one that the
     the sites and topics are not made    specifically for the users who                                          BHIMBM site should avoid by
     very clear.                          would be referring patients (i.e.                                       providing opportunities for
                                          physicians, insurance companies,                                        patients/users to interact with
                                          and companies), this does not                                           the site and with each other.
                                          have much that can be applied to
                                          a site designed for the end user:
                                          the patient him or herself.

Note: Other websites which should be explored for further competitive analysis, but which were not examined for this paper, include:

What I learned from the competitive analysis that I can:


    Incorporate a blog on topics which formative research demonstrates will interest target audiences (possibly even different
       blogs aimed at different audiences).
    The videos on yoga techniques on the Gaiam website are excellent and could be models for instructional content on the
       BHIMBM site.
    The style of self-paced learning opportunities with yoga and other techniques on the Gaiam website would likely appeal to
       patients new to mind body medicine.
    The BHIMBM should consider having a welcome video on the home page.
    Attribute information to credible sources as much as possible.
Center for Mind Body Medicine:
    If a slideshow is desired, BHIMBM should consider having a smaller one depicting various BHIMBM techniques with
       captions or as hyperlinks to further information about a certain technique.
    Segmentation of audiences across top will allow users to self-identify the information most relevant to them.
    Images of institute staff could be featured to add the element of personalization.
Mind Body Medicine Center:
    Use a simple and clean layout which does not overwhelm the senses or cause stress/anxiety due to navigation.
    Offer clear explanations of all aspects of mind body medicine and of jargon on the site.
    Provide a list of clinicians associated with the clinic, along with explanations of their specialty areas.
    The BHIMBM should consider having patient testimonials clustered by symptoms so that users can identify which stories will
       resonate with them the most. These testimonials should either not assign geographical location to patients, or should show a
       wide range of geography in terms of where patients are located around the country.

      Label menu items in a simple and intuitive way (“Our Clinic,” “Services,” “Knowledge,” Classes & Seminars”) so users can
       easily find what they are looking for.
      Explain the process of coming to the clinic for an appointment.
      Offer a simple, clear explanation of what mind body medicine is; this could appear on the home page, but should at least in a
       very easily located place on the site.

Do differently

    The BHIMBM should not feature shopping links or information unless they are well- and sparsely positioned.
    Users should have free access to learning opportunities offered through the site.
    BHIMBM should make social media links more prominent by placing them on the home page and throughout the site in a
       consistent location in the browser.
    BHIMBM’s purpose must be very clear from the homepage (if possible, from the tagline).
    Audience segmentation should be obvious from the home page.
    Because many visitors to the site will not yet be CAM enthusiasts, keep jargon to a minimum and avoid language that overly
       emphasizes the spiritual and transformational side of things; this should be kept in balance because it can turn many people off,
       particularly if they are already suspicious of CAM and want a more traditional medical basis for their treatment.
    BHIMBM should make a personalized sign-in available, ideally where patients can access saved pages, instructional videos
       they’ve chosen for their library, and communicate with clinic staff.
    All video and audio content should be narrated at a slow or medium pace and in simple, clear, jargon-free language to ensure
       that users of all levels of health literacy and comprehension can understand and/or perform the content.
Center for Mind Body Medicine:
    All content should written at an appropriate and consistent literacy level for each audience.
    Content should be available in changeable font size, or larger font size, for those readers who are older or have visual
Mind Body Medicine Center:
    BHIMBM should not use text-based navigation within drop down menu boxes (this makes it difficult to click on the correct
       link within that tab).
    All navigation should be uniformly done to avoid confusion (i.e. all or none text-based).
    A clear tagline should appear after the logo.

Do better

    All links and navigation should be labeled and organized in a logical way, and if pictures are hyperlinked, they should be
       clearly labeled so that users know exactly where they will be re-directed if they click on the photo.
    BHIMBM should consider offering discussion forums where patients can interact with each other and with clinic staff.
       Discussion forums should be targeted to people who are there for different reasons (audience segmentation).
    BHIMBM should consider segmenting the audience like the Center for Mind Body Medicine does, but as the end user for the
       BHIMBM is the patient, information for patients should be the most prominent, with optional tabs for health care providers or
    The essential page framework should be consistent for every piece of the website.
Center for Mind Body Medicine:
    There must be appropriate and clear explanations of mind body techniques offered, which will be completely new to most
    If research is cited, explanations should be written for a lay audience, possibly with the option of downloading the full article
       as a .pdf document if a user wants to read it.
Mind Body Medicine Center:
    The logo of the BHIMBM at the top of the page should be a navigational link which will redirect users to the home page.
    The site should incorporate a search box at the top right of at least the home page, if not every page because this is the most
       intuitive placement for it.
    Options for all standard links such as “Home” and “Contact” should be in intuitive and consistent places on the website.
    The BHIMBM should incorporate innovative ways for users to participate in the content on the site (blog, discussion forum,
       ask the expert, etc.)
    The BHIMBM should incorporate social media (Facebook page, Twitter, RSS feed) in targeted ways which will support its
       goals for patients and providers.
    If possible, the BHIMBM should incorporate videos and audio
Mind Body Medicine:
    All navigation throughout the site should be done in a parallel way to ensure that users do not become confused or frustrated.
    The BHIMBM should offer audio files which will guide users through relaxation techniques, but these should be downloadable
       as .mp3s, not on audio cassette tapes.
    The BHIMBM site should have as few main menu items as possible, which will make clear to users where they should look for
       further information by using carefully chosen categories.

      4.3 Technology and Content

      Based on the competitive analysis and needs assessments as outlined earlier in this paper, the
      following chart is a description of design decisions for the revised BHIMBM website. For this
      portion of the design process, the same twenty areas as outlined in the Competitive Analysis
      section (Section 4.2) were examined and the questions associated with each area were posed
      once again in order to assist in the decision-making process. (Note: The full list of these
      questions can be found on page 18 of this paper.)

                                                           Justification based on         Justification based on
                                                             needs assessment              competitive analysis

                  The BHIMBM site should have            While some of the users         Several of the other sites
                  a logo with a tagline that very        may be CAM enthusiasts          from the competitive
                  clearly identifies its purpose as it   who are already familiar        analysis did not explicitly
                  relates to the end user (in this       with mind body medicine         state the purpose, and it
                  case, the patient). The site           and/or the BHIMBM,              detracted from the site’s
                  should also define mind body           many of the site’s users        appeal and clarity.
                  medicine at least briefly on the       will be people who have
                  home page or at least in an            been referred to the site by
                  easily-located space on the site.      a third party. Their level of
                                                         knowledge will vary and
                                                         thus, the purpose must be
                                                         very clearly stated.
                The main target audience for the         Users will not be inclined      The site which targeted
                site should be patients of the           to stay on this site if they    physicians, the CMBM,
                BHIMBM. Practitioners,                   do not feel that the most       had quite a lot of jargon
                insurance companies, and                 prominent information on        and information that was
                organizations hoping to refer            the site is written for them,   written in a very technical
                patients or employees to the site        as patients. If the site        way. This type of
                should either be directed to a           targets physicians or           information would not be
                separate site, or should have a          insurance providers with        accessible to the lay user,
                separate tab (i.e. “For                  patients as the secondary       particularly if they are not
Target audience Providers”) to click on from the         audience, users will be         yet familiar with CAM in
                home page. This page will                confronted with clinical        any form.
                provide information about the            jargon that will not serve to
                Institute, services offered, etc.        create an inviting
                from a provider’s perspective.           environment. Users will
                                                         not be inclined to stay on
                                                         the site unless information
                                                         is appropriated targeted for
                                                         content, reading level, and

             The layout should include the        The personas described        Several of the sites from
             following:                           earlier show that many        the competitive analysis
                  BHIMBM logo and                users will be completely      had an overwhelming
                    tagline in top left           new to mind body              amount of information,
                  Appropriate branding           medicine. They may also       which was arranged in a
                    should appear as per          have been referred by a       way that made it nearly
                    requirements (BCBS and        third party and may feel      impossible to find specific
                    Mass Gen)                     dubious about whether         information. The sites
                  Search bar on top right        mind body medicine could      which had the calmest feel
                  Login toolbar at top of        really work. Thus, the site   were the ones which had a
                    page                          will need to be able to       very simple layout with
                  Simple layout on               locate information very       choices arranged in a
                    homepage; users should        easily and quickly or else    logical manner. In
                    be able to locate             they may become               addition, the sites which
                    information quickly and       frustrated and leave the      did not have a search
                    with ease                     site. Pictures of people      engine built in were
                  Navigational bar across        engaging in mind body         particularly frustrating.
                    the top with 5-6 different    techniques may help           Users who come to this
                    headings.                     personalize the site. The     site should be able to find
                                                  top navigational bar should   information in multiple
                  A slideshow of small
                                                  not be overcrowded with       ways: through the
                    images depicting mind
                                                  choices; rather, 5-6 very     navigational bar, through
                    body techniques in action
Layout &                                          targeted entry points         links on the home page,
                    could appear in the
Navigation                                        should appear there, with     and through the search
                    middle of the screen.
                                                  further choices in drop-      engine. Advertisements
                    Slideshow pictures will
                                                  down menus.                   and donate buttons serve
                    NOT be hyperlinked but
                                                                                to detract from the
                    may have captions
                                                                                purpose of the site and
                    appearing as
                                                                                make readers doubt the
                                                                                information found there.
                  There should be a list of
                    topics in a sidebar next to
                    the slideshow that will
                    segment users right away
                    (i.e. “How to manage a
                    chronic health
                    condition,” “How to
                    manage chronic stress,”
                    “How Mind Body
                    Medicine Can Help
                    You,” etc.)
                  Testimonials should be
                    linked from the home
                    page; they could be
                    labeled as:
                    - “Success Stories”
                    - “How Mind Body

                     Medicine Helped Me”
                     - they could also be
                     clustered by symptom so
                     that users can easily find
                     a success story which
                     will resonate with them
                     the most.
                   Links to all social media
                     and blogs should appear
                     on the home page.
                   Shopping/donation
                     should not appear on the
                     home page, if at all
                   There should be an FAQ
                     or Ask the Expert section
                     featured somewhere on
                     the homepage.
              Content should be dated and         Dating content will
              reviewed appropriated as per        increase credibility and set
Currency      BHIMBM guidelines.                  the temporal context for
                                                  site visitors.
              If not at the end of each page,     Many users (such as Cindy,     The sites which cited
              authors should be listed            Paul, and Julia) will have     authors had more
              somewhere central on the site.      been referred by a medical     credibility attached to
              In addition, the BHIMBM             doctor or their insurance      their site than those which
              should try to have a mix of         company and may need to        did not.
 Authors      experts generating content,         see validation that
              including CAM experts, medical      traditional medicine is part
              doctors, and patient experts.       of mind body techniques.
              This will enhance credibility for
              all users, whether they be CAM
              enthusiasts or CAM doubters.
              Content for patients should be      Users will have very           The sites whose content
              written at a 10th - 12th grade      different educational          was at a high reading level
              reading level if possible.          backgrounds and thus, in       were full of jargon and
              Additional materials at higher      order to include the           were difficult to
              reading levels could appear as      maximum number of users,       understand. A user needs
              links or extra documents.           reading level should be at a   to understand right away
                                                  level which most adults        how the information is
              Content for providers will not be   would likely understand. If    relevant for their situation,
              held to this same restriction on    they struggle to understand    and several of the sites
              reading level.                      the information, they will     examined seemed to be
                                                  have no motivation to stay     oblivious to the patient’s
                                                  on the site or to learn the    needs. This will drive

                                                   techniques described there.    users away.

               All jargon must be explained      Some users who are new to        The websites which used
               very clearly, and where possible, CAM, like Cindy or Julia,        jargon did not do a good
               non-medical and non-CAM           may be intimidated by or         job of explaining the
               terminology should be used to     skeptical of over-use of         terminology, which could
               explain techniques and benefits.  jargon. Users who are not        drive users away or cause
 Language                                        particularly internet-savvy,     them to give up on the
                                                 like John, may not be able       site.
                                                 to easily search for words
                                                 they do not understand in a
                                                 separate window or
                                                 browser tab.
               The purpose of the site should be Particularly for users who       The sites which did not
               very clear from the homepage.     are new to CAM and are           include the purpose and
               The vision should be linked from being referred, it will be        vision may confuse users
               one of the drop-down menus so     important to find the            who are new to CAM, and
Organization   users can locate it easily. The   purpose of the site right        do not appear to be
               homepage’s imagery and links      away so they can                 cohesive. This does not
               should clearly convey what the    understand why they are          invite a user to venture
               purpose is as well.               there and what the site can      further into the site.
               If possible, HONcode or URAC Branding, particularly Blue           The sites which appeared
               branding should appear. In        Cross Blue Shield, will          without branding are not
               addition, Mass Gen and Blue       offer higher credibility to      as high in their credibility.
               Cross Blue Shield branding        users. Not all users will be     This will be especially
               should appear on the site as per  familiar with the                important for users who
               contractual requirements.         Massachusetts General            are referred to the
 Branding                                        Hospital branding, but           BHIMBM site with
                                                 even for those who are not,      doubts about how well
                                                 being affiliated with a          mind body medicine can
                                                 medical hospital will likely     really work. If they see
                                                 improve credibility.             branding of well-known
                                                                                  entities, they may trust the
                                                                                  site more.
               The design should be organic        The people coming to the       The design of the Mind
               and simple. It should not be        site, as described in the      Body Medicine Center
               overwhelmingly modern, nor          personas, are going to be      was the easiest to navigate
               should it be overwhelmingly         from a wide variety of         and the simplest design,
  Design       earthy, because either extreme      backgrounds. Some may          and it was the most user-
               would have the potential to         come for medical reasons,      friendly. This is the type
               resonate negatively with part of    while others come because      of design that should be
               the target audience. Minimal        of their lifestyle choices.    emulated.
               color should be used as accents.    Thus, the site must not give

                                                   either demographic priority
                                                   in its design and feel. A
                                                   simple design with
                                                   minimal colors and a
                                                   balance between modern
                                                   and nature will appeal to
                                                   all users.
               There should be at most, 5 – 6      Users will be overwhelmed      The easiest site to
               main navigational headings          if there are too many          navigate was, once again,
               across the top, the first 5 of      options crowding the           the Mind Body Medicine
               which should be geared towards      screen. Information should     Center because it had only
               patients, and the last of which     be organized in a logical      four choices across the top
               can be a tab which is geared        way that will make it easy     which led to further
               towards referring agents who are    to locate the specific         choices in drop-down
               interested in learning more about   information desired so that    menus.
               the institute before sending        users do not become
               patients to the site.               frustrated with searching
                                                   and leave the site
               Main menu tabs could be:            altogether. The last thing
                                                   this site should do is cause
               About Us                            further stress to people
               >About BHIMBM                       who are seeking stress-
               >About Dr. Benson (w/ link to       relief and ways to relax.
               >Meet our Staff
               >Services Offered
               >Classes and Seminars
               >Contact Us
               Mind Body Medicine
               >Mind Body Medicine
               >What is the Relaxation
               Reponses Resiliency Program?
               >Relaxation Response and
               specific Medical Conditions
               Online Learning Tools
               >Relaxation Response
               Instructional Videos
               >Resiliency Instructional Videos
               >Ask the Expert
               Online Communities
               >Create your page
               >Discussion Forum
               >Social Media
               Success Stories

            >Clusters by Symptom
            >Clusters by Technique
            For Providers
            >Relaxation Response
            Resiliency Program
            >Who can I refer to BHIMBM?
            >How can I develop a
            partnership with BHIMBM?

            Each tab will have a drop-down
            menu as suggested above, which
            will allow users to choose a
            more specific topic. However, a
            user should come to a landing
            page if they click on one of the
            tabs listed above which will
            provide a brief explanation and
            the same choices from the drop-
            down menu.
            The BHIMBM website will have
            a variety of content from experts,
                 Moderation and
                     comments on discussion
                     forum posts by users
                 Newsletter (potentially)
                 Series of video, text, and
                     audio content on
                     Relaxation Response
                     Resiliency Program
                     (RRRP) in two parts
 Expert-         Expert Patients may
generated            contribute to discussion
 content             forum or other interactive
                 Ask the Expert section
                     (not clinical)
                 For some users located in
                     Massachusetts and
                     surrounding states where
                     clinicians at BHIMBM
                     are licensed, live chat or
                     Skype could also take
                     place with a more clinical
                 Eventually, tutorials or

                        information about the
                        relaxation response as it
                        relates specifically to
                        certain diseases will be
                        part of the site.
                 User-generated content will
                      Discussion forum
                      Testimonials
                      Blog post comments
                      Results from surveys on
                        site for stress level, etc.

                 If BHIMBM decides to have a           Policies which regulate        The competitive analysis
                 blog, comments on posts should        appropriate and accurate       did not reveal any clearly
                 be moderated by an expert (i.e.       information will ultimately    listed policies. Users
                 clinician, staff member, or expert    protect the end users (the     would benefit from seeing
                 patient) to avoid having incorrect    patients) from mis-using       these clearly listed.
                 or inappropriate information          techniques and possibly
                 posted.                               also from being harmed
                                                       through mis-information or
                 The discussion forum will also        bad advice.
                 need to be monitored,
                 particularly the support group
                 component (to ensure that
                 comments are appropriate and
                 will not cause emotional

                 Policies should be listed at the
                 top of the blog and discussion
                 forum so users are aware of
                 The website will allow users to       Users who come to this site    The sites with
                 create a personalized profile.        who have never had             personalized log-in had a
                 They will be able to save video       experience with CAM            stronger feel of
                 and podcast links to their page       before (like Cindy, Paul, or   community to them.
                 and track progress in various         Julia) may not feel like       Users will feel more
                 techniques. Users will be able to     they are part of this          welcome and like they are
                 take a self-assessment for their      movement or the CAM            getting a more
                 stress level, and will re-take this   community. Having a            personalized experience if
                 test at various intervals to track    personalized sign-in will      this feature is part of the
                 their progress. This username         act as the bridge that gives   site.
                 will also allow them to be a part     them cyber space in the
                 of discussion forums.                 CAM community. This, in

            Information collected through          turn, will increase the
            registration will allow BHIMBM         likelihood that they
            to track users by various pieces       continue to return to the
            of demographic information and         site and with the
            their activity on the site, and will   techniques. It will also
            thus improve evaluation of the         help users with navigation
            site.                                  by allowing them to save
                                                   links to videos, podcasts,
                                                   or other content in their
                                                   profile, making it easier to
                                                   locate each time they
            Users will be able to sign up for      Users who are new to mind      Other sites did not offer
            a newsletter and mobile                body medicine will benefit     any mobile applications,
            applications. These applications       from mobile reminders          but they did offer a
            should be compatible with a            about appointments, taking     newsletter. Mobile
            variety of mobile phones,              time to relax each day, or     applications would engage
            include regular non-droid cell         about new opportunities on     users even further.
            phones. Basic mobile features          the site. This will make
            could include:                         them feel more engaged
                 text message reminders           with the site and with mind
                    for appointments made at       body medicine. It will also
                    the BHIMBM                     remind them to continue to
                 text message reminders           visit the site.
                    about an upcoming
                    learning opportunity on
                    the site
                 text message reminders
                    about the next
                    installment of an
                    instructional series of
                    videos or podcasts
                 text message reminder to
                    meditate or interrupt the
                    flow of the day to do the
                    relaxation response
                 Links to short videos to
                    be sent to droid phones
            Users will not be prompted to          Users may be suspicious of     Other sites with such
            donate money to the BHIMBM.            motives if there are           components lost
            There will be a link to purchase       requests for money             credibility, or at least, lost
            Dr. Benson’s book, “Relaxation         transactions on the site.      focus because the
            Revolution,” but this link should                                     opportunities to make
            be only for this item and should                                      purchases clouded the
            not link to a wider store (which                                      purpose of the site.
            may confuse site visitors in

               terms of affiliation and motives).

               Testimonials will be a part of the   Users who come to the site       The Mind Body Medicine
               site and will incorporate stories    may feel lost in terms of        Center’s site grouped
               from a variety of types of users.    finding information that         testimonials this way, and
               Segmentation will be detailed        will pertain to their specific   it was a very effective and
               and audience segmentation will       situation. They may also         user-friendly way to
               appear by disease/symptom so         doubt whether mind body          organize success stories.
               that users can self-identify which   medicine can, in fact, help
               stories they believe will most       them heal from a chronic
               resonate with them:                  medical condition. Having
                                                    testimonials clustered by
               Chronic heart disease                symptom will not only
               High blood pressure                  improve navigation for
               Cancer                               users (they will not have to
               Diabetes                             click through a list of
   Users       Chronic Stress/Stress                names until they find a
               Management                           story that resonates with
               Mind Body/CAM Lifestyle              them), but will also
                                                    showcase the variety of
               There will also be several video     medical conditions for
               testimonials which users can         which mind body medicine
               play if their internet connection    can be a powerful tool.
               will support streaming video.        This will improve the
                                                    credibility of mind body
               Users should be encouraged to        medicine to users who may
               submit their own success story       feel doubtful of its possible
               through the website. The             effects.
               BHIMBM should then edit the
               stories and organize them
               Social media to be used on this      Users will want to see a
               site include:                        reason to come back to the
                                                    site. They will need a
                     Twitter                       reason to share the site
                     Facebook page for fans        with others. Social media
                      of the BHIMBM site            tools can do that by
Social Media
                     Users can subscribe to        providing a support
                      RSS feed of the blog (if      community
                      there is a blog)
                     Blog with expert-
                      generated content
                      (experts can include

                    clinicians, yoga
                    instructors, etc. AND
                    may also include
                    particularly active users
                    who have become
                    experts of sorts in a
                    particular technique)
                   Discussion forum for
                    registered users
                    (segmented into support
                    groups and informational

             Overall, the site should:            Because the site’s target     Some of the ineffective
                 Stand separate from the         audience potentially          components of other sites
                    Mass Gen site (if             encompasses all adults, the   from the competitive
                    possible) to avoid a          site should be welcoming      analysis included having
                    marketing feel                and have content that is      too much information or
                 Create a welcoming              accessible in a variety of    too many navigational
                    environment for users         formats to account for        choices for users on the
                 Maintain a                      different internet access     home page, which caused
                    clinical/medical focus        and literacy levels.          the site to feel cluttered
                 Have a design which is                                        and overwhelming. On
                    simple, organic and                                         the other end of the
                    exudes modern earthiness                                    spectrum was the
                 Create a calming                                              oversimplified design with
                    cyberspace experience                                       few options and only
                    which will not cause                                        static content. The
                    users further stress due to                                 BHIMBMB’s site would
  Overall                                                                       be best positioned so that
                    poorly organized
assessment                                                                      it has a simple layout
                    information or confusing
                    layout                                                      which is easy to navigate
                 Create reasons for users                                      and has many
                    to return to the site                                       opportunities for users to
                                                                                become engaged in an
                 Create reasons for users
                                                                                online community for
                    to share the site’s content
                                                                                support and knowledge
                    with others via social
                 Create a personal space
                    for users on the site
                    (registration profile)
                 Provide information
                    relevant for all users,
                    whether they are coming
                    to the site both due to
                    medical reasons or

   Make information
    available at a reading
    level which will be
    understood by the
    majority of users (likely
    10th – 12th grade reading
   Offer content in a variety
    of forms, including
    video, audio, and text, so
    that users of different
    learning styles and users
    with different internet
    access will be able to
    retrieve appropriate
   Offer as much
    instructional content as
    possible free of charge to

4.4 Design and Development

Using the information gained from the competitive analysis and technology and content
decisions outlined above, mock-up designs were produced as follows. The first several are
included to showcase some of the evolution of the site’s design, with the final mock-up at the

Home page:
Figure 1 (Version 1 of the site):

Figure 2 (Version 2 of the site):

The site as seen in Figure 1, Version 1
appears quite “boxy”, and the
alignment was not correctly done. In
addition, the branding was
inconsistent (with BCBS branding
appearing at the bottom of the page),
and without a search bar. The logo of
the BHIMBM was also changed to
make it more visually appealing, and
more images were added to the
“Spotlight” sections. In addition, the
right side of the page was fleshed out
with more of the social media options.

Figure 3 (Third and final version of

site used during formative/heuristic evaluation):

Please see below for a detailed analysis of Figure 1, Version 3 resulting from preliminary
formative and heuristic evaluations performed as part of the course. Several key notes about the
site follow the screen shot.

The changes made from Figure 2 (the second version) include separating the larger box on the
side so that it would appear less “boxy” and adding different images to avoid depicting only
females on the homepage. The new pictures are more balanced, both in terms of gender as well
as the type of relaxation activity being performed (i.e. meditation as well as jogging). In
addition, the “track your stress level” box was added to the homepage to highlight this feature of
the site which may entice users to become more engaged with the site content.

      The “Relaxation Response in the News” will have rotating stories pulled from various
       sources (source for featured story:
      The other spotlight can also rotate to feature various other techniques to induce the
       relaxation response that users may not be aware of, such as long-distance running.
      Each individual page (especially pages with content about techniques or medical claims)
       should have a “last updated” message particular to the content on that page.
      The rotating slideshow at the top will feature various people (both male and female and
       of different ethnic backgrounds) performing techniques. Pictures should feature
       everyday people in recognizable locations to maximize the way in which users identify
       with the pictures.

Online Tutorials sub-page:

Only one sub-page was created for this site as part of the mock-up. The “Online Tutorials” page
was chosen because it is a page that nearly every user will be very likely to visit and utilize,
whether they are a patient who has been referred by a third party or a CAM enthusiast. One can
see that the basic framework of the site remains the same from the homepage to the sub-page,
which is meant to increase usability by keeping the site consistent from page to page and
enabling easier navigation. Users will come to a landing page of sorts and will choose from the
type of technique they wish to learn about, which will then take them to another page dedicated

specifically to that technique (i.e. meditation) and which will offer a range of instructional
content aimed at users of varying skill levels.

Results of Preliminary Formative and Heuristic Evaluation

        As part of the course, a mock formative evaluation was performed on December 7, 2010,
in addition to a preliminary heuristic evaluation with all class participants in response to the
home and sub-page mock-ups seen above. Summarized below are the results of these

Positive elements of appeal
    All pictures are appealing and interesting.
    The color scheme is “good” and inviting (positive responses to blue).
    The tagline helped the responder understand that medicine and meditation could be
       linked, and made it more appealing for her to explore the website further.

Suggestions to improve appeal
    In order to get a new users to “buy in” to meditation, there should be a free, 15-minute
      video or audio file which will instruct users in how to meditate.
    The BHIMBM should consider offering a free trial of all content to users.
    Having many different audio files in mp3 format would increase appeal.
    The BHIMBM should consider having some sort of user rankings, whether it be for video
      or audio content, or tests, etc. to increase user participation in the site.
    The site should have more color because it is rather text-heavy.
    The background color on the entire screen should not be white.
    The amount of information on the home page is slightly overwhelming, and the responder
      was not sure where to look first.
    Skeptical users may not find the website very relevant because the pictures are mostly of
      healthy people or healthy people with stress, not with chronic disease.
    The site should use headers and labels or headlines that highlight the disease connection.
    More should be done to draw in a person who suffers from disease and may be skeptical
      about the site.
    The term “chronic stress” may not speak to someone with chronic illness and should
      possibly be changed or not made as prominent.

Positive elements of usability
    Navigation bar labels are very clear and succinct.
    The navigation makes it apparent that it is geared towards a patient.

Suggestions to improve usability
    Instead of having a logo for the BHIMBM, perhaps the background of the Mind Body
      Institute could appear as a faded image of the Massachusetts General Hospital.

      Something that might have the most impact on the homepage would be to list out some of
       the diseases in the sidebar so that people can see the variety of conditions which can be
       improved through mind body techniques (i.e. with a list of 5 – 8 diseases).
      The links and information in the right sidebar is disconcerting ; it shows that the
       BHIMBM is up to date and modern, but skeptics will want to see more of the benefits
       before they sign up for anything. The sidebar elements could be combined into smaller
      Users should be able to see which page they are under by noticing highlighting around
       the tab they have chosen in the sidebar.
      Have a snippet of a testimonial in the sidebar with a picture that links to a full page of
      Show a picture of an expert with a sample question under “Ask the expert” section.
      For the discussion forum, a snippet of a recent post could be featured and dated (although
       this would require some sort of RSS feed to avoid having to physically find quotes).

   While the time did not suffice to completely redesign the website after this evaluation, a
second mock-up incorporating some of these suggestions was done. A screen shot of the revised
homepage follows:

   Revised sub-page (with a newly highlighted “Online Tutorials” tab):

    Further revisions and improvements are necessary to incorporate all preliminary issues
raised, and further/ongoing formative evaluations will be necessary once this has been

Implications and Explanations of Design

     The appeal of the BHIMBM site to first-time users is critical for many reasons. For one,
users who visit the site for the first time will decide very quickly if this is a site which appeals to
them and which can help them. The appeal must be immediate for such users. In addition,
because many first-time users will have been referred to the site by a third party (namely, a
physician, insurance provider, or company/corporation), there may be a high level of skepticism
accompanying them to the site. If we re-examine the personas as described earlier in the paper,
we can see that the majority of them, namely Cindy, Paul, and Julia, would fit this description.
None of them know much about mind body medicine, much less about the potential health
benefits, and they would likely come to the site with a certain expectation of a clear tie-in to
more Western medical ways of thinking. They may also become easily frustrated if information
is not easily accessible to them or if it is difficult to navigate the site. Therefore, there is an extra
onus on the BHIMBM site to win such users over to the validity of mind body medicine, and to
do so very quickly. For John, the persona who is a CAM enthusiast, the excitement about the
techniques may be enough to encourage him to try out the techniques on his own; however, for
users such as Cindy, Paul, and Julia, the site must achieve a higher enough level of a buy-in to
actually try these techniques out for themselves. At the same time, the site must also appeal to
users in a way that will encourage them to return to the site over time.
     My design meets the needs of first-time visitors in several ways. First, it provides a
straightforward layout so that first-time users can easily locate information relevant to them. The
logo and tagline are simple to understand and convey the purpose of the site (see end for list of
all other taglines considered). Navigational buttons across the top are clearly labeled and divided
into logical types of information, so that a user can tell right away which button to click on in
order to find out what kind of online instructional content the website offers (Online Tutorials),
or where to go to find out about the BHIMBM itself (About Us). Secondly, because many first
time users will have been referred by physicians or insurance providers to the site, they will need
to find information immediately on the home page not only about what mind body medicine is,
but also about how mind body medicine relates to the condition they may have been struggling
with for a long period of time (and which traditional medicine has not helped). The design of the
site addresses this potential concern from the homepage in two ways. Users will be linked to
expert-generated explanations of how mind body medicine can be useful for various conditions
(they can choose which type of audience they are, i.e. “I have chronic stress,” or “I am interested
in mind body medicine,” etc. and will be directed to an explanation of the specific link between
mind body medicine and that particular condition/lifestyle). Users are also linked to user-
generated (and edited) testimonials clustered by symptom (users can identify the symptom they
are experiencing and read about success stories related to that specific symptom). Third, after
reviewing other content, users may want to find out about how they can be engaged with the
website; they can see immediately from the homepage several links to social media, a newsletter,
mobile applications, an RSS feed, a discussion forum, and where to sign up for a personalized
account. There is also a navigational tab labeled “Community.”
     Users who are return visitors will also find the ease of navigation in finding information they
want to read or view again. All links to social media, the potential blog, and the discussion
forum (in which they may already be engaged) are easily located on the home page. Repeat
users who visit the site to find new instructional video or audio files will be able to locate them

right away through the Spotlight section or through the “Online Learning” button in the top
navigational bar.
     The design is very conducive to user engagement through the social media involved,
particularly the links to Twitter and Facebook, which encourage users to share content. Users
are also invited to subscribe to an RSS feed and join a discussion forum. They can also become
engaged by taking a stress test, submitting a question about mind body medicine to an expert,
and by creating a personalized account.
     The site will be appealing to the intended audience through the simple layout which will be
welcoming without being overwhelming. The site will immediately address the concerns many
users may have as patients who have been referred to the site by a third party (such as by
defining mind body medicine and demonstrating the success of mind body techniques to treat
many medical conditions). The design will make it easy for them to find the information they
need and will provide ways to network not only with other users, but also (potentially) to interact
with clinic staff. Colors are simple and convey an organic feel, yet the site still appears to be
within the clinical (and for many users, trusted) realm. The site is also usable for the intended
audience. All personas as described previously would be able to navigate this site because
information is easily located from the home page. It will contain a mix of media formats so that
all users can access content regardless of internet speed.
     The site must be effective in improving the health status of the target population in order to
achieve its overall goal. This site will effectively help the intended audience in several ways.
For many users, it will open a window into a new way of treating chronic illness or stress by
providing accurate and appropriate information on mind body medicine/techniques. Users will
be presented with information which may be new to them, which is current, and which is
medically founded in order to build trust in the mind body techniques shared on the site. It will
allow users to track their own progress in reducing stress. The site will provide the “cue to
action” to begin using mind body techniques by providing the actual instructional content (in
several different media formats) to learn how to use these techniques. In addition, the site will
also channel various forms of support for users, including ways to reach out to experts or to
connect with other patients who may be experiencing similar struggles (i.e. through the
discussion forum).

Additional taglines which were considered include:

      Meditation for Health
      Bringing the Relaxation Response to Everyone
      Mind Body Medicine for Everyone
      Relaxation Techniques for a Healthier You
      Relaxation Techniques for a Healthier Life
      Everyday Relaxation Techniques
      Mind Body Techniques for (Your?) Health
      Helping Your Mind Help Your Body
      Your Experts in Relaxation for Health
      Where Medicine and Meditation Meet
      Relaxation for Resiliency and Health
      Bringing the Relaxation Response to Everyone
      Mind Body Medicine for Everyone

      Relaxation Techniques for a Healthier You
      Relaxation Techniques for a Healthier Life
      Everyday Relaxation Techniques
      Mind Body Techniques for (Your?) Health
      Helping Your Mind Help Your Body
      Your Experts in Relaxation for Health
      Where Medicine and Meditation Meet
      Relaxation for Resiliency and Health
      Find Relaxation to Feel Better (or Get)
      Your Body/Mind on Relaxation
      Your Body/Mind on Meditation

4.5 Evaluation Plan

Because the BHIMBM site will be utilized by many different populations (and sub-sets of
populations, as evidenced by the personas outlined earlier in the paper), evaluation will be an
incredibly important component of site development. In order to evaluate this website, the goals
of the website (as outlined in the first section of this paper) must be kept in mind at all times.
Evaluation from users and experts at many different stages will not only shed light on potential
confusion or stumbling blocks users may encounter within the website, but will likely also help
determine whether audiences will need to be further segmented into separate websites (i.e.
patients vs. providers) for the site to be more effective. The following is a detailed plan for
evaluation of the BHIMBM website.

a) Formative Evaluation
Formative evaluations, or evaluations conducted to obtain user feedback, will be conducted
throughout the process of site development as follows.

At least two evaluations should be done with sub-sets of users in the early stages of
development. The first should be done in the very early stages with a mocked-up version of the
site’s pages with at least the major elements of the site’s organization and content, and the
second should be done before the site goes live with a functioning version of the site (including
as many videos and other instructional content as possible). At least 3 - 5 users in each of the
following population sub-sets should be included in the first session, and 10- 12 in the second
session: people with chronic disease, people with chronic stress, CAM enthusiasts, and referring
providers (providers of medical care or medical insurance). People with chronic disease and
chronic stress can be recruited by posting fliers in several doctor’s offices or through doctor
referrals, and CAM enthusiasts could be recruited with fliers in yoga studios or through a
Craigslist advertisement. Thus, these users would self-identify as conforming to one of these
categories unless they are referred by a doctor. Referring providers can be recruited through
direct calls to local medical practices. All participants will receive $15 for spending about one
hour evaluating the site. The goals of these earliest formative evaluations are:

           o to gauge the appeal of the design for users in the target population
           o to gauge audience expectations for the site and each sub-page

           o to gauge how intuitively site content is organized (usability)
           o to gauge how well information about mind body medicine is communicated to
             and understood by users (effectiveness)
           o to identify major design and information gaps which would deter potential users
             from wanting to venture further into the website

Information gathered will be reviewed and compiled and will inform continuing design of the
site. Evaluation at this stage will allow for re-formatting or re-design of aspects of the website
found to be problematic or incomplete before the site goes live.

Examples of questions which would be included in the first survey for each sub-set are detailed

                      People with chronic disease and chronic stress:
                           Before they see the website:
                                 o What kind of information would expect to see on a website
                                     for a mind body medicine institute?
                                 o Do you think that mind body medicine could help your
                           Upon seeing the website:
                                 o When you look at the site, how do you feel?
                                 o Is the color scheme appropriate for this site? Why or why
                                     not? If not, what colors do you think would be better?
                                 o Does this site look like it would be easy to navigate?
                                 o Is the information on the home page the information that
                                     you would most like to know about mind body medicine
                                     and chronic disease?
                                 o Please try to find a video about how to meditate. Next, try
                                     to find the place to sign up for social media.
                                 o What do you expect to find when you click on each link?
                                 o Would you be tempted to create a personalized page for
                                     this site?
                                 o Please find an explanation on the site of how mind body
                                     medicine can help people with chronic disease.
                                 o What appeals to you most/least about this homepage?
                                 o How do you feel about the name and tagline of the site?
                                 o What do you think is missing from the homepage?
                           After seeing the website:
                                 o Did the site fall below, meet, or exceed your expectations?
                                     In what way(s)?
                                 o After looking at the site, do you feel that mind body
                                     medicine could help your chronic health condition?
                                 o Would you be tempted to return to this site? Why or why
                      CAM enthusiasts

                              Before seeing the site:
                                  o What are your expectations for a site on mind body
                                       medicine which is housed under a medical facility?
                              Upon seeing the website:
                                  o When you look at the site, how do you feel?
                                  o Is the color scheme appropriate for this site? Why or why
                                       not? If not, what colors do you think would be better?
                                  o Does this site look like it would be easy to navigate?
                                  o Is there information on the homepage that you feel would
                                       suit what you would be looking for in a mind body
                                       medicine site?
                                  o Please find an explanation on the site of how mind body
                                       medicine can help people with chronic disease
                                  o Please try to find a video about how to meditate. Next, try
                                       to find the place to sign up for social media.
                                  o What do you expect to find when you click on each link?
                                  o Would you be tempted to create a personalized page for
                                       this site?
                                  o What appeals to you most/least about this homepage?
                                  o How do you feel about the name and tagline of the site?
                                  o What do you think is missing from the homepage?
                              After seeing the website:
                                  o Did the site fall below, meet, or exceed your expectations?
                                       In what way(s)?
                                  o After looking at the site, do you feel that this website would
                                       offer information that is relevant and useful to you?
                                  o Would you be tempted to return to this site? Why or why

In addition, formative evaluations should be performed with the same population sub-sets for
instructional content is added to the site. For instance, if a new video or audio file is added in
order to instruct users on a certain aspect of the relaxation response or resiliency, a formative
evaluation using 5 – 10 patients from each sub-group of end users (patients and CAM
enthusiasts) should be performed, with each individual able to try various techniques in different
settings. (Not all users will be able to find a quiet place to learn about techniques, and evaluation
should thus mirror this possibility for distractions while learning.) Audience members can be
recruited using the same methods outlined above and will be compensated $15 for each hour
spent in the evaluation. This evaluation has the following goals:

           o to gauge audience interest in each technique
           o to gauge how well the target audience understands the positive effects of the
             technique and believes that they can perform the technique themselves
           o to evaluate how clearly the technique is communicated to the audience
           o to evaluate how well users are able to apply mind body techniques as described in
             instructional content

           o to evaluate the quality of the instructional content from the points of view of users
             and providers who will be recommending this content

Sample questions for each sub-group are as follows:

                     Patients/CAM enthusiasts:
                          Before they see the video/hear the audio file:
                                o What have you heard about this technique, if anything?
                                o What are your expectations for what this video/audio file
                                   can help you to achieve?
                          Upon seeing/hearing the instructional content:
                                o What do you think about the instructor in this video/audio
                                o Did the instructor use appropriate language? Why or why
                                o Were there any points where you felt confused or could not
                                   follow what the instructor was saying?
                                o Do you feel you performed the technique as the instructor
                                   explained it?
                                o What could make the video/audio file better?
                          After seeing the website:
                                o Did the video/audio file fall below, meet, or exceed your
                                   expectations? In what way(s)?
                                o Would you be likely to seek out further videos/audio files
                                   from the BHIMBM website to become more advanced in
                                   this technique? Or to learn new techniques?

Further formative evaluation will be needed whenever major design changes are proposed and
when new instructional content is added to the website.

b) Heuristic Evaluation
Heuristic evaluations, or evaluations performed by experts, should take place throughout the
design of the website to ensure quality of design, informational content, and organization.
Various experts, including web designers, physicians, and mind body experts, should contribute
to ensure that all content and design elements are of the highest and most professional quality

The goals of such heuristic evaluations will be:
    to produce and evaluate the site design, ensuring that it complies with professional
    to provide direction for type of necessary content/appeal based on the needs of patients
      with chronic illness and/or chronic stress and resulting design implications
    to provide direction for type of necessary content/appeal for CAM enthusiasts
    to evaluate the accuracy of all content on the site, including descriptive and instructional

Design professionals will be involved at every stage, with one core team producing the design,
and other professional designers should be consulted as outsiders to the project to provide further
input or suggestions for improvement in design.

Mind body experts will include physicians who are specifically trained in this area and could
also include certified instructors in the various techniques offered through the BHIMBM website
(yoga, meditation, etc.). Such experts will produce nearly all of the site’s content, but should
also play an active role in reviewing all content – including instructional videos/audio files - for
accuracy and clarity.

Physicians will be asked to review the design and content of the website in much the same way
that end users (patients and CAM enthusiasts) will, but with an expert eye for the types of
outcomes desired for patients with chronic illness and stress, and for what their patients would
likely expect from the BHIMBM website. Examples of questions pertaining to the overall site
design and content are:

                      Referring Providers (Medical professionals and Insurance Providers)
                           Before seeing the site:
                                 o What kind of information would expect to see on a website
                                    for a mind body medicine institute?
                                 o Do you think that mind body medicine could you’re your
                                    patients/clients with chronic health conditions like heart
                                    disease, high blood pressure, or stress?
                           Upon seeing the site:
                                 o What strikes you about the site when you first look at it?
                                 o Is the color scheme appropriate for this site? Why or why
                                    not? If not, what colors do you think would be better?
                                 o Does this site look like it would be easy to navigate?
                                 o What do you expect to find when you click on each link?
                                 o Is there information on the homepage that you feel would
                                    suit what you would be looking for in visiting a mind body
                                    medicine site which your patients would be referred to?
                                 o Is the information most relevant to you easily located?
                                 o How do you feel about the name and tagline of the site?
                                 o What do you think is missing from the homepage?
                           After seeing the site:
                                 o Did the site fall below, meet, or exceed your expectations?
                                    In what way(s)?
                                 o After looking at the site, do you feel that this website would
                                    offer information that is relevant and useful to your patients
                                    in terms of the chronic conditions they would have?
                                 o Would you refer your patients/clients to this site? Why or
                                    why not?

Physicians should also review the instructional content with the same expert eye to provide
insight into the clarity of videos/audio files, and so they can ultimately inform the BHIMBM

whether they would feel comfortable recommending such content to their patients with chronic
disease and/or stress. Because BHIMBM is expecting much, if not most, of its site traffic to
come by way of physician and insurance provider referrals, getting their expert opinions
regarding how well the videos address the needs of their patients (as well as confirmation that
they would recommend the content to their patients) will be key.

                     Referring Providers (Medical professionals and Insurance Providers)
                          Before they see the video/hear the audio file:
                                o What have you heard about this technique, if anything?
                                o What are your expectations for what this video/audio file
                                   can help your patients achieve?
                          Upon seeing/hearing the instructional content:
                                o What do you think about the instructor in this video/audio
                                o Did the instructor use appropriate language? Why or why
                                o Were there any points where you felt confused or could not
                                   follow what the instructor was saying?
                                o Do you feel you performed the technique as the instructor
                                   explained it?
                                o What could make the video/audio file better?
                          After seeing the website:
                                o Did the video/audio file fall below, meet, or exceed your
                                   expectations? In what way(s)?
                                o Would you be likely to recommend video/audio files from
                                   the BHIMBM website to your patients?

4.6 Marketing Plan

        Because the BHIMBM site already exists, there are presumably many marketing channels
in place. However, my recommendations for a marketing plan are geared towards the new focus
on patients, particularly those who are referred from a physician and/or insurance company, and
who may have varying degrees of skepticism about how mind body techniques can really help
them. Because of this, the site should be advertised within the arena of trusted medical
information where possible. This could include

      The general Massachusetts General Hospital home page should have a link to the Mind
       Body Institute’s site in a prominent place.
      The site should be marketed in particular to physicians through professional association
       newsletters, mailers, or emails inviting them to browse the site and offering concrete
       ways for them to recommend the site to their patient.
      If Blue Cross Blue Shield will be providing funding for this site, they should send out
       information about the site via paper mailers, fliers, and emails to people enrolled with
       their insurance.

              BHIMBM should investigate websites aimed at various sectors of companies (private and
               public) and place ads in newsletters or on those websites for company wellness programs;
               companies which are interested in partnering with BHIMBM for employee wellness
               programs would then make the information available to their employees.
              The BHIMBM will place ads on highly frequented online health sites, including general
               sites such as WebMD and/or sites particular to the types of chronic disease being targeted
               with mind body techniques (chronic heart disease, diabetes, etc.).
              The BHIMBM will also use social media, particularly a Facebook page and Twitter feed,
               to market the new site.
              Locally, the BHIMBM will partner with pharmacies to place advertisements with
               prescriptions for patients or as posters in waiting areas, and in waiting rooms at partner
               doctor’s offices.
              Also locally, the BHIMBM will advertise in other highly trafficked areas in Boston,
               particularly along the subway and bus system.
              If the BHIMBM wishes actively to attract CAM enthusiasts, they should consider:
                    o partnering with another popular site for with complementary relaxations
                       techniques which would not be in competition with their own
                    o locally, advertising in larger gyms or yoga/meditation centers

        4.7 Staffing and Budget

        The website will require the following staff and approximate budget for creating, evaluating, and
        updating the website. The following are very rough estimates and it will be necessary to obtain
        actual pricing estimates for all equipment and software, as well as individual staff/consultant
        salaries before the budget can accurately reflect the costs involved with revising the current site.

            Required Staff                          Equipment/Miscellaneous Costs                Budget
Creation     Contracted web designer (full-         Computer(s)                                $50,000
               time for development)                 Web software
             BHIMBM expert staff time for           Video/audio recording
               content creation and production        equipment
               (videos, audio files, and text)       Bandwidth to upload and
             Potentially, professional               maintain site
               editor/writer for all content         Domain Name
Evaluation   Team of 3 -5 external evaluators       Computers and internet                     $20,000
               for each of 5 – 7 evaluations (both    connection for
               formative and heuristic),              formative/heuristic evaluations
               estimated to last a total of 10 – 14  Per diem payments for all
               days ($150/day/evaluator for 14        evaluation participants
               days)                                 Stationary
Maintenance  1 staff member to update site          Web software (license renewals)            $60,000/year
              regularly (part-time – 20 hrs/week)  Video/audio recording
             Additional staff time as-needed for     equipment

                 ongoing development of                   Bandwidth for website
                 video/audio content                       maintenance
                BHIMBM physicians/staff and              Domain name
                 expert patients to manage social
                 media and discussion forum (10
                Medical research articles to inform
                 techniques and/or post for users to
Total                                                                                           $130,000.00
                                                                                                (for dev’t and
                                                                                                first year of

        5. Conclusion

        There is enormous potential for the Benson-Henry Institute for Mind Body Medicine to do a
        great deal of good as a result of redesigning its site. The wider availability of materials will
        encourage a higher level of utilization by users who may not have found solutions to their health
        problems with more traditional Western medicine. By following a careful progression of re-
        design (including conducting needs assessments, competitive analyses, and formative and
        heuristic evaluations at key points throughout the process), it will be possible for the BHIMBM
        to craft a website which will not only win the confidence of mind body medicine skeptics, but
        will also encourage long-term use of stress-reducing mind body techniques. Users as different as
        Cindy, Paul, Julia, and John (see Personas section above) will be able to come to the site and
        find the information they are seeking and need in order to succeed with this goal; moreover, they
        will feel like they are a part of the site through the personalized account they can create and the
        various social media they can join. Through designing a website that is carefully targeted
        towards the end user him or herself, the BHIMBM will be able to achieve its goal of improving
        the health status of its website users through relaxation response techniques.

Author Bio

My name is Claire Berman. I am 27 years old and am working towards a Master of Science in
Health Communication at Tufts University School of Medicine. My interest for this topic arose
out of a class discussion about mind body medicine, and I wanted to develop a website design for
this topic in particular because the project is for a website that will actually be developed. I
consider it to be invaluable experience to work on the design for a real website, and also to learn
more about mind body techniques. I would actually consider myself a former skeptic of mind
body approaches to health, but through the research for this project, I have come to realize that I
had many misconceptions about these techniques and that the mind can be a very powerful tool
in treating the body. I believe that many people in my target population also share these
misconceptions and because of these, are missing out on therapies which could relieve the pain
or discomfort of chronic illness. I want to bridge that gap through the work on this website; by
viewing alternative therapies through the eyes of the average person who may not know much
about them, I hope that the BHIMBM website will open up a new world of therapy and healing
to people who are feeling desperate about their conditions.


Center for Mind Body Medicine. (2010). Retrieved from

Fox, S., & Jones, S. (2009). The social life of health information. Pew Internet and American
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Fox, S., & Purcell, K. (2010). Chronic disease and the internet. Pew Internet and American Life
        Project. Washington, D.C. Retrieved from

Gaiam Yoga. (2010). Retrieved from

Mind Body Medicine. (n.d.) Retrieved from

Mind Body Medicine Center. (2010). Retrieved from

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