Exploring Patients’ Views Toward Giving Web-Based Feedback and Ratings to General Practitioners in England: A Qualitative Descriptive Study

Background Patient feedback websites or doctor rating websites are increasingly being used by patients to give feedback about their health care experiences. There is little known about why patients in England may give Web-based feedback and what may motivate or dissuade them from giving Web-based feedback. Objective The aim of this study was to explore patients’ views toward giving Web-based feedback and ratings to general practitioners (GPs), within the context of other feedback methods available in primary care in England, and in particular, paper-based feedback cards. Methods A descriptive exploratory qualitative approach using face-to-face semistructured interviews was used in this study. Purposive sampling was used to recruit 18 participants from different age groups in London and Coventry. Interviews were transcribed verbatim and analyzed using applied thematic analysis. Results Half of the participants in this study were not aware of the opportunity to leave feedback for GPs, and there was limited awareness about the methods available to leave feedback for a GP. The majority of participants were not convinced that formal patient feedback was needed by GPs or would be used by GPs for improvement, regardless of whether they gave it via a website or on paper. Some participants said or suggested that they may leave feedback on a website rather than on a paper-based feedback card for several reasons: because of the ability and ease of giving it remotely; because it would be shared with the public; and because it would be taken more seriously by GPs. Others, however, suggested that they would not use a website to leave feedback for the opposite reasons: because of accessibility issues; privacy and security concerns; and because they felt feedback left on a website may be ignored. Conclusions Patient feedback and rating websites as they currently are will not replace other mechanisms for patients in England to leave feedback for a GP. Rather, they may motivate a small number of patients who have more altruistic motives or wish to place collective pressure on a GP to give Web-based feedback. If the National Health Service or GP practices want more patients to leave Web-based feedback, we suggest they first make patients aware that they can leave anonymous feedback securely on a website for a GP. They can then convince them that their feedback is needed and wanted by GPs for improvement, and that the reviews they leave on the website will be of benefit to other patients to decide which GP to see or which GP practice to join.


Introduction
Introduction to research: nature and purpose of research, confidentiality and permission (consent). (Interview length: approximately 45 minutes.)

Explain terms used in the interview
 Feedback -relates to review, ratings and complaints that you may give or have given to your GP  Feedback about your GP -it means in relation to the experience of a consultation that you have had with your GP  Explain that the questions relate to both positive and negative feedback.

GP use
 Roughly, how many times have you had a consultation/appointment with a GP in the past year?

Awareness of option to give feedback about GP
Are you aware that you can give feedback about your experience of a consultation/appointment with a GP? What methods are you aware of? (If online mentioned, can you name any of the websites?) Explain the two terms: Paper-based feedback and online feedback here using vignettes 1 & 2 where appropriate.

History of 'feedback about GP' -if any
Have you ever given feedback about your GP? (both online and offline)

Perceived motives/non-motives for leaving feedback about your GP
 What would be your reasons, if any, for leaving feedback about your GP using paperbased methods? Would these be the same reasons for leaving feedback online?  What would be your reasons, if any, for not leaving feedback about your GP using paper-based methods? Would these be the same reasons for leaving feedback online?

Perceived motivations for leaving feedback about your GP
 What type of experience, if any, would motivate you to leave paper based feedback about your GP offline? Is this the same for online feedback?  When are you more likely to leave feedback using paper-based methods: when you've had a negative experience or a positive experience? Is this the same for online feedback?  Are you more likely to leave paper-based feedback when you've had an extreme experience? Is this the same for online feedback? Provider preference  If you had the option, which of the following three organisations would you prefer to leave paper-based feedback with about your GP: 1) the GP practice 2) an independent organisation 3) a NHS organisation? Why? Is this the same for online too?  From the three aforementioned methods, which provider would you trust more to do something with your feedback? And why? Is this the same for online and paperbased feedback?

Specific to Online feedback
 Do you believe leaving feedback online will be more effective than leaving it through paper-based methods? If yes, why? If no, why not?
 Do you think your GP will take the feedback you leave online more seriously that the feedback you leave through paper-based methods? If yes, why? If no, why not?
 Do you think you would find it easier to leave feedback online than through other methods? If yes, why? If no, why not?
 Say you had an extreme negative experience when you saw a GP, are you more likely to write to the GP practice with that feedback or are you more likely to leave that feedback online?
 Say you had an extreme positive experience when you saw a GP, are you more likely to write to the GP practice with that feedback or are you more likely to leave that feedback online? Overall preference on best method to give feedback about GP  From the following thirteen methods, which three methods would you most prefer to use to leave feedback about your GP (use vignette 3)?

Other
(The options are: 1) face to face directly to your GP 2) paper-based form that you fill in and place in a comments box at the surgery 3) face to face to the practice manager 4) through the receptionist 5) through the PALs 6) email the practice manager 7) public online website 8) text message (to practice) 9) through an app, and 10) through social media 11) Email the GP directly 12) NHS national patient survey 13) private form on GP website a. Why? b. Which three methods would you least prefer to use to leave feedback about your GP? Why? c. Would you want to use a different method to give negative and positive feedback, or is it the same?  From the following seven methods you could use to give feedback about your GP, could you rank which you prefer the most? (use vignette 4) The options are 1) email GP 2) email practice 3) online website 4) text message 5) through an app, and 6) social media 7) private form on GP website a. Why have you ranked them in this way? (most preferred, and least preferred) b. Would you want to use a different method to give negative and positive feedback, or is it the same?

Experience of rating websites
 Have you ever used a rating website? (Like trip advisor or amazon reviews?)  What was your experience of it?
 Have you ever left feedback on a rating website? If yes, why? If no, why not?
Intention to give feedback, online and offline  In the near future, do you intend to give feedback about your GP? a. If yes, would that be online or using paper-based methods? Why? b. If no, why not?  Has this interview changed your knowledge about giving feedback online to your GP?

Participant background
Age (note gender down) 6. Ending -Any further things they'd like to add and thank them.
Would you be interested in taking part in further research?
Do you know anyone else that might be interested in taking part in this study?