Table 2.

Website changes based on focus group feedback.

Design element and subcategory			Original version		Final version
Accessibility
	Tiles	Links to each subsection of the corresponding section		A matrix of tiles for each subsection provides a larger surface area for users to click on the desired subsection.
	Search button	Absent		Users could search for specific keywords and be taken directly to relevant sections of the website.
	Voice-over	Absent		Recorded narrative descriptions of figures and graphs.
Website design (to satisfy the conditions of learning by Gagne et al [41])
	Gaining attention	Short, interesting factoids about the history, outcomes, and process, among other things, of UEa VCAb were included in a list of questions called “Did You Know?” to gain the attention of users (eg, “Did you know that the first UE VCA was performed in 1999?”).		No change
	Informing the learner of the objective	Each of the 8 main sections of the website starts with 1-2 sentences explaining the objective of that section.		No change
	Stimulating recall of previous learning	The “Myths and Facts” subsection under the “Hand/Arm Transplant” section allows for knowledge application by testing the user’s accurate knowledge of a topic.		No change
	Presenting the stimulus or content	The website content is presented in eight main sections: (1) “Hand and Arm Transplant,” (2) “Process,” (3) “Risks,” (4) “Recovery,” (5) “Options,” (6) “Decision-Making,” (7) “Resources,” and (8) “About Us.”		No change
	Providing learning guidance	The website uses video testimonials of UE VCA recipients, participants, and candidates as well as UE VCA providers to supplement reading-based learning.		No change
	Eliciting performance	The “Myths and Facts” section elicits performance by testing users’ knowledge of the accuracy of myth statements.		No change
	Providing feedback	The “Myths and Facts” section provides feedback by pointing out inaccuracies in the myth statement and providing correct information in the fact statements.		No change
	Enhancing retention and transfer	The “Question Prompt Sheet” under the “Resources” section provides a list of questions that patients can ask their physicians to learn about hand or arm transplantation. This list of questions enhances the patients’ retention of important UE VCA topics and offers transfer through real-world application in discussion with providers.		No change
Website tone and values
	Target audience	Participants expressed difficultly identifying the target audience of the website when visiting the home page.		The home page includes a statement that the website is designed to help individuals with UE amputations, their families, and health care professionals make informed treatment decisions.
Sitemap
	Reading level	Participants expressed difficulty in understanding subsection headers such as “voluntariness” and “psychosocial.”		Sitemap headers that were difficult to understand were replaced with lower-reading–grade-level language such as “optional treatment” and “emotional and social.”
Terminology
	Language sensitivity	The research team was concerned that the word “amputee” might be offensive to website users as it does not use “people-first” language.		All instances of the word “amputee” on the website were changed to “people with upper limb amputations.”
	Plain language	Participants urged that the website refrain from using medical jargon.		Website language was changed to use plain language.
Images and videos
	Diversity	Participants requested that images on the website display UE VCA recipients of diverse sexes, races or ethnicities, and nationalities.		The website included images of recipients from diverse backgrounds, including nationality, age, sex, and race or ethnicity.
	Cosmetic outcomes	Participants reported wanting to see images of the transplanted limb, including scarring.		Images displaying recipients using their UE VCA to do functional tasks while the scarring of the limbs was visible were included on the website.
	Functional outcomes	Participants wanted images to showcase UE VCA recipients doing functional tasks that might be difficult to perform living with an amputation.		More action shots were included to show recipients performing activities such as brushing their hair, doing hand therapy, and playing the guitar.
Data tables and graphics
	Diversity	Participants did not want the website to have the timeline of number of UE VCA surgeries performed in the United States stratified by the transplant recipients’ race and sex.		The graph showing number of UE VCAs performed stratified by recipient race was removed. The graph stratified by sex was retained to assure website users that UE VCA is available to both sexes.
	Relevance	Participants expressed that graphs showing willingness to authorize deceased donation of one’s own UE or of one’s deceased family member’s UE was irrelevant to them.		The graph of deceased donation willingness rates was removed.
	Detail	Participants expressed that the table outlining the costs of the UE VCA surgery and medications contained too much information.		Data about the projected cost of taking an immunosuppressive drug regimen were removed from the table.

^aUE: upper extremity.

^bVCA: vascularized composite allotransplantation.