Table 4 Themes illustrating limitations and strengths of the ANSWER design

1. Authenticity: Participants were able to relate to the patient stories, as they cover different age groups and sexes. However, some preferred real actors as compared to the animated characters.

• …it seems like real information, real people talking about the disease, pros and cons, you know, the fear to take it, uh, the fears or stopping it could happen; are they going to be able to work? The fear of losing a job. So those are real situations. It just makes the site a little more human and realistic. It’s not just scientific information. (Jamie – female, age group: 35–49; C1)

• (On ‘Rosa: About RA video’) I kind of related to it just because, well…, because my daughter’s, like I did have problems, like I did start flaring up. I was in remission and then I flared up after. So I was kind of relating to her …and then hearing her (Rosa) talk to her father really made me sad to actually go back to my parents’ place while my husband was working and stay there for the week. It was tough, but yeah, I can relate to it. (Amy – female, age group: 20–34; C1)

• I think the information is very plentiful, but I think what people, what the layman person to look at this website is going to need to know more personable, real stories from people that are like not acting, not – you know people that are actually taking the drug on a regular basis what they’re going through. (Rosemary – female, age group: 35–49; C1)

• It might be good overall if these were real video clips (with actors). (Sheila – female, age group: 50–64; C2)

2. Information accuracy about living with arthritis: Key feature of RA was fairly portrayed.

• People surrounding, you know, patients, um, with RA, they don’t know like…that tiredness you feel at all times the people around you they don’t really understand. So if someone in my family or within, you know, a family watches this they might go like, oh it’s true, I mean she’s not like making it up, um, she is actually tired; it’s part of the information, so that’s something that haven’t seen in any of the websites to be honest. (Jamie – female, age group: 35–49; C1)

3. Modeling shared decision-making: Some participants commented on the ability of ANSWER to provide examples of active and engaged patients.

• I think we’re moving away from the old style where you just did whatever your doctor told you and didn’t ask questions. And (ANSWER) is helpful in expanding people’s thinking about it. As far as I can see it touched on the key decision point. So it’s good for that. (Theresa – female, age group: 50–64; C1)

4. Ease of use: Participants commented on the user friendliness, but they were also hoping for a more sophisticated software product

• It was user-friendly definitely. Yeah, I feel it wasn’t sophisticated enough. I mean methotrexate is a big name and it was a little gimmicky at some point (of the video presentation), maybe because of the graphics you know. (Jane – female, age group: 50–64; C2)