1. IVF patients' preferences
in service design
Jan Kremer & Wouter Tuil
Radboud University Nijmegen MC

2. INTRODUCTION
2001
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3. INTRODUCTION
• Preliminary research (Haagen et al. 2003)
– Patients are online (81%)
– Patients are on the internet for medical purposes (54%)
– Patients want online interaction with their physician (69%)
– Patients want online access to their medical records (82%)
• Based on these findings the virtual IVF clinic
was created
Human Reproduction Vol.18, 2073, 2003
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4. VIRTUAL IVF CLINIC
2003
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5. VIRTUAL IVF CLINIC
• Interactive website
– General information
– Personal information
– Communication
• Promote patient empowerment
• Safe, secure and efficient
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6. VIRTUAL IVF CLINIC
Generic Personal
Communication
Information information
• IVF treatment • Medical record • Chat
• Clinic • Dayplanner • Discussion forum
• FAQ • Embryo-pictures • E-mail
• Stories • Prognosis
• Links • Correspondence
• Literature
• Videos
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13. RESEARCH QUESTIONS
1. Use and usefulness of the website
1. What are the time-dynamics of the website?
• Weeks, Treatment phase
2. Types of online behavioral styles?
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14. METHODS
• Questionnaire (n=54)
– Demographics
– Usefulness of the website
• Automated logging of viewed pages (n=1050)
– User
– Requested functionality
– Date & time
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15. 1. USE AND USEFULNESS
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16. USE and USEFULNESS
Useful
General information (top 3)
1. Frequently Asked Questions 88 %
2. Information about the clinic 67 %
3. Information about the treatment 63 %
Personal information (top 3)
1. Medical Record 96 %
2. Day planner 92 %
3. Embryo photos 79 %
Communication
1. E-mail 77 %
2. Discussion forum 73 %
3. Chat 58 %
Saturday, April 21, 2012 Tuil et al. Hum Reprod. 2006: 2955-9. 16

17. USE and USEFULNESS
Useful Pageviews
General information (top 3)
1. Frequently Asked Questions 88 % 7,9
2. Information about the clinic 67 % 8.8
3. Information about the treatment 63 % 62,2
Personal information (top 3)
1. Medical Record 96 % 36,0
2. Day planner 92 % 30,4
3. Embryo photos 79 % 50,1
Communication
1. E-mail 77 % 2,4
2. Discussion forum 73 % 139,5
3. Chat 58 % 45,3
Saturday, April 21, 2012 Tuil et al. Hum Reprod. 2006: 2955-9. 17

18. TIME DYNAMICS
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19. PAGEVIEWS OVER TIME
Communication (34.2%) General information (25.4%)
Personal Information (17.9%) Navigation (22.4%)
6000
5000
pageviews
4000
3000
2000
1000
0
1 2 3 4 5 6 7 8 9 10
weeks after first visit
Saturday, April 21, 2012 Tuil et al. Fertil Steril. 2009; 953-6 19

20. PAGEVIEWS PER TREATMENT PHASE
Generic Information Patient specific Communication
Pageviews per visitor per day (CI)
Information
12
10
8
6
4
2
0
T1 T2 T3 T4 T5 T1 T2 T3 T4 T5 T1 T2 T3 T4 T5
T1: pretreatment T2: stimulation T3 opu&et T4: luteal phase T5: posttreatment
Saturday, April 21, 2012 Tuil et al. Fertil Steril. 2009; 953-6 20

21. 3. BEHAVIORAL STYLES
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22. BEHAVIORAL STYLES (factor analysis)
Individual Generic information Communication
Content Type
information style style style
Medical records 0.89 0.23 0.30
Treatment information 0.89 0.30 0.30
Personalised prognosis 0.80 0.31 0.22
FAQ 0.67 0.40 0.12
Downloadable documents 0.67 0.39 0.29
Day planner 0.46 0.41 0.23
Literature 0.20 0.71 0.17
General information 0.45 0.62 0.23
External links 0.25 0.62 0.17
Website help 0.20 0.61 0.13
Hospital information 0.48 0.60 0.23
Bulletin board (viewing) 0.38 0.24 0.86
Bulletin board (posting) 0.14 0.14 0.83
Chatroom 0.24 0.25 0.62
Saturday, April 21, 2012 Tuil et al. Hum Reprod. 2008:2501-5 22

23. BEHAVIORAL STYLES (prevalence)
Individual Generic Communication
n (%)
information style information style style
None of the
○ ○ ○ 411 (35.7%)
styles
One of the styles ● ○ ○ 195 (17.0%)
○ ● ○ 156 (13.6%)
○ ○ ● 52 (4.5%)
Two of the styles ● ● ○ 138 (12.0%)
● ○ ● 66 (5.7%)
○ ● ● 60 (5.2%)
All three styles ● ● ● 72 (6.3%)
Saturday, April 21, 2012 Tuil et al. Hum Reprod. 2008:2501-5 23

24. BEHAVIORAL STYLES (dominance)
40% 38%
35% 33%
30% 29%
25%
20%
15%
10%
5%
0%
Generic information Personal Information Communication
12 november 2008 Tuil et al. Hum Reprod. 2008:2501-5 24

25. DETERMINANTS OF BEHAVIORAL STYLES
Personal information style:
 Sharing emotions (p=0.028)
 Paid employment (p=0.007)
Generic information style:
 Depression (p=0.028)
Communication style:
 Anxiety (p=0.005)
 Paid employment (p=0.021)
Saturday, April 21, 2012 Tuil et al. Hum Reprod. 2008:2501-5 25

26. CONCLUSIONS
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27. CONCLUSIONS
• The majority of functions are used and perceived as useful
– Discussion forum is used most frequently
– Personalized information is valued as most useful
• Usage varies greatly over time
– High number of page views during the OPU and ET
– Information at the beginning and communication at the end of treatment
• There are three types of online behavior styles
– Personal information, generic information and communication
– Anxiety, depression and employment are determinants of these styles
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28. Patients play a crucial role
in service design
@JKNL and @WouterTuil