Healthcare quality through the eyes of bloggers: content analysis of non-solicited narratives about patient experiences with healthcare (Preprint)

BACKGROUND Patient experiences constitute an independent dimension of health care quality that can be solicited by structured surveys or at dedicated online platforms. Unsolicited spontaneous patient narratives are much less used but potentially valuable means for gauging patient experiences. OBJECTIVE Our aim was to explore patient experiences in spontaneous patient blogs submitted during one decade to an online health forum. METHODS 1662 non-solicited individual blogs on patient experiences posted between 2009 and 2018 on a Hungarian internet forum were randomly sampled. 20% (n=346) of the blogs were used for qualitative content analysis. A coding framework was constructed based on previous research and taxonomies to analyse content, including specific experiences or episodes. Major categories and subcategories were constructed within the three major dimensions (structure, process, outcome) of Donabedian’s framework for health care quality. RESULTS Majority of blogs described a specific experience (94.2%) in healthcare; almost 40% occurred in tertiary care; 29.5% of the blogs even identified a specific hospital or department. 55.2% of the bloggers were patients themselves, and the majority (92.7%) were dissatisfied with the reported experience. Issues were most frequently related to physicians (65.2%). In terms of Donabedian’s dimensions, problems with human resources dominated “Structure” (74.1%) such as not enough or incompetent staff. Waiting time and access to care (69.19%) comprised the most frequent complaints of material resources within “Structure”. Within “Process”, episodes related to examination (42.86%) accounted for most of the complaints. Outcomes were identified in 60% of the blogs, and deterioration, complication, readmission, or death was reported in 62% of these episodes. CONCLUSIONS Donabedian’s model of healthcare quality was appropriate for the categorization of patient experiences. Regular monitoring of spontaneous patient reports is recommended to utilize them for healthcare quality improvement especially if reports provide specific details.