title: Barriers and facilitators for the implementation of an online clinical health community in addition to usual fertility care: a cross-sectional study.
abstract: BACKGROUND
  Online health communities are becoming more popular in health care. Patients and professionals can communicate with one another online, patients can find peer support, and professionals can use it as an additional information channel to their patients. However, the implementation of online health communities into daily practice is challenging. These challenges relate to the fact that patients need to be activated to (1) become a member (ie, subscription) and (2) participate actively within the community before any effect can be expected. Therefore, we aimed at answering 2 research questions: (1) what factors are associated with subscription to an online health community, and (2) which are associated with becoming an active participant within an online health community.
  
  
  OBJECTIVE
  To identify barriers and facilitators as perceived by patients for the implementation of an online health community.
  
  
  METHODS
  We performed a cross-sectional study. Three Dutch fertility clinics (2 IVF-licensed) offered their patients a secure online clinical health community through which clinicians can provide online information and patients can ask questions to the medical team or share experiences and find support from peers. We randomly selected and invited 278 men and women suffering from infertility and attending 1 of the participating clinics. Participants filled out a questionnaire about their background characteristics and current use of the online community. Possible barriers and facilitators were divided into 2 parts: (1) those for subscription to the community, and (2) those for active participation in the community. We performed 2 multivariate logistic regression analyses to calculate determinants for both subscription and active participation.
  
  
  RESULTS
  Subscription appeared to be associated with patients' background characteristics (eg, gender, treatment phase), intervention-related facilitators (odds ratio [OR] 2.45, 95% CI 1.14-5.27), and patient-related barriers (OR 0.20, 95% CI 0.08-0.54), such as not feeling the need for such an online health community. After subscription, determinants for participation consisted of aspects related to participant's age (OR 0.86, 95% CI 0.76-0.97), length of infertility (OR 1.48, 05% CI 1.09-2.02), and to intervention-related facilitators (OR 5.79, 95% CI 2.40-13.98), such as its reliable character and possibility to interact with the medical team and peers.
  
  
  CONCLUSIONS
  Implementing an online health community in addition to usual fertility care should be performed stepwise. At least 2 strategies are needed to increase the proportion of patient subscribers and consequently make them active participants. First, the marketing strategy should contain information tailored to different subgroups of the patient population. Second, for a living online health community, incorporation of interactive elements, as well as frequent news and updates are needed. These results imply that involving patients and their needs into the promotion strategy, community's design, and implementation are crucial.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Radboud University, Nijmegen, Netherlands. a.aarts@obgyn.umcn.nl
authors.forename: Johanna W M
authors.initials: JW
authors.lastname: Aarts
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Faber
authors.forename: Anne G
authors.initials: AG
authors.lastname: den Boogert
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Cohlen
authors.forename: Paul J Q
authors.initials: PJ
authors.lastname: van der Linden
authors.forename: Jan A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: Willianne L D M
authors.initials: WL
authors.lastname: Nelen
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007248:Infertility, Male / Q000628:therapy; D008297:Male; D034121:Reproductive Health Services
keywords: Internet; community networks; infertility; patient-centered care; quality of health care