Discovering what patrons value in a consumer health library service using laddering interviews




Laddering interviews, customer value determination


Background: Librarians at Preston Medical Library sought to understand whether marketing research techniques could be adapted to libraries to better understand what patrons value. Specifically, this study sought to learn why patrons continue using a consumer health information service, develop insights to improve the service, and a methodology to use with other patron groups.

Case Presentation: Librarian researchers conducted customer value research using laddering interviews, an interview technique utilized in marketing research to learn users’ goals in using a product or service. The PML research team interviewed six frequent users of a medical library’s consumer health information service. Researchers conducted laddering interviews, covering patron views of basic attributes of the service, leading on to consequences of their interaction with it, and finally discussing what they hoped to achieve in using the service. The results were visualized in customer value hierarchy diagrams, graphically showing relationships between valued attributes of a product or service, how the patron used it, and how that helped patrons achieve goals. This allowed the research team to identify which features of service contribute the most to patron satisfaction.

Conclusion: Customer value learning utilizing laddering interviews enables librarians to see their service through the patrons’ eyes, focusing on those aspects of the service that they view as most important. This study allowed librarians to learn that users desired to feel more in control of their health and gain peace of mind by obtaining trusted information. The library’s work in providing information leads to self-empowerment for these patrons.

Author Biographies

James Michael Lindsay, Preston Medical Library University of Tennessee, University of Tennessee Medical Center, Knoxville, TN.

Head of Collections & Access Services, Associate Professor

Courtney Wombles, Medical Librarian, Lincoln Memorial University, Harrogate, TN.

Medical Librarian, Lincoln Memorial University

David Petersen, Preston Medical Library, University of Tennessee Graduate School of Medicine, Knoxville, TN.

Assistant Professor, Research & Learning Services Librarian


Earl M, Oelschlegel S, Breece A. Impact of a consumer and patient health information service on user satisfaction, attitudes, and patient-health care professional interactions. J Consum Health Internet. 2012; 16(2): 192-212. DOI: 10.1080/15398285.2012.673460.

Grabeel KL, Luhrs J, Roberts RE, Earl M. How one library’s health information center expanded its marketing plan. Med Ref Serv Q. 2019; 38(3): 218-27. DOI: 10.1080/ 02763869.2019.1623612.

Woodruff RB, Gardial SF. Know Your Customer: New Approaches to Understanding Customer Value and Satisfaction. M. Stahl, editor. Cambridge, MA: Blackwell Publishers, Inc.; 1996. 338 p. (Blackwell Business Dimensions in Total Quality Series) ISBN 1-55786-553-1.

Collins M. It’s All About the Customer. 2019 Feb 9. 2018. [Lecture]. University of Tennessee, Haslam College of Business.

Reynolds TJ, Gutman J. Laddering theory, method, analysis, and interpretation. J Advert Res. 1988;28(1):11–31.

Wansink B. New techinques to generate key marketing insights. Marketing Research. 2000; 12(2):28-36.

Voss R, Gruber T, Szmigin I. Service quality in higher education: The role of student expectations. J Bus Res. 2007;60(9):949-959. DOI:10.1016/j.jbusres.2007.01.020.

Gruber T, Frugone F. Uncovering the desired qualities and behaviours of general practitioners (GPs) during medical (service recovery) encounters. J Serv Manag. 2011; 22(4):491-521. DOI: 10.1108/09564231111155097.

Jung Y, Park J. An investigation of relationships among privacy concerns, affective responses, and coping behaviors in location-based services. Int J Info Manage. 2018;43:15–24. DOI: 10.1016/j.ijinfomgt.2018.05.007.

Wang P, Xu J, Wu Y. Preschool children's preferences for library activities: Laddering interviews in Chinese public libraries. Libr Inf Sci Res. 2019;41(2):132-138. DOI: 10.1016/j.lisr.2019.03.001.

Xiao L, Mi C. A qualitative approach to understand consumer groups and decision making process in online group buying: An exploratory study. Int J Web Serv. 2019;16(2):24–46. DOI: 10.4018/ijwsr.2019040102.

Zhang N, Yuan Q. (2020). The means-end cognitions of perceived information quality in academic social networking sites. J Librariansh Inf Sci. 2020;52(3):781–791. DOI: 10.1177/0961000619871612.

Zhao Y, Xu X, Peng X, Song S. (2018). Understanding the determinants and dynamic process of user exodus in social networking sites: Evidence from Kaixin001. J Assoc Inf Sci Technol. 2018;69(4):553–565. DOI: 10.1002/asi.23974.

Preston Medical Library. Patron Value Interview. “Joy”. [Audio Recording]. 2019 Feb 12. [2021 Dec 6].

Preston Medical Library. Patron Value Interview: “Dee”. [Audio Recording]. 2020 Nov 12. [2021 Dec 6].

Preston Medical Library. Patron Value Interview: “May”. [Audio Recording]. 2021 Jul 27. [2022 Feb 8].

Preston Medical Library. Patron Value Interview: “Betty”. [Audio Recording]. 2021 May 21. [2022 Feb 8].

Preston Medical Library. Patron Value Interview: “Keith”. [Audio Recording]. 2020 Jan 20. [2022 Jan 24].

Preston Medical Library. Patron Value Interview: “Robert”. [Audio Recording]. 2019 Feb 13. [2019 Feb 13].

Keller A. National Social Norms Center. Michigan State University. 2019. [Internet]. Accessed 7 December 2022.

Fincham J. (2008). Response rates and responsiveness for surveys, standards, and the journal. Am J Pharm Educ. 2008;72(2):43.

Baker S, Edwards R, Doidge M. (2012). How many qualitative interviews is enough?: expert voices and early career reflections on sampling and cases in qualitative research. National Centre for Research Methods, Southampton. [Internet]. [accessed 7 Dec. 2022].

University of Tennessee Medical Center. Health Information Center. 2017. [Internet]. [accessed 7 Dec. 2022].