Understanding online review behaviors of patients in online health communities: an expectation-disconfirmation perspective

Purpose Although online health communities (OHCs) and online patient reviews can help to eliminate health information asymmetry and improve patients' health management, how patients write online reviews within OHCs is poorly understood. Thus, it is very necessary to determine the factors influencing patients' online review behavior in OHCs, including the emotional response and reviewing effort. Design/methodology/approach Based on expectation-disconfirmation theory, this study proposes a theoretical model to analyze the effects of service quality perception (i.e. outcome quality and process quality perceptions) and disconfirmation (i.e. outcome quality and process quality disconfirmations) on patients' emotional response and reviewing effort. The authors test the research model by using empirical data collected from a popular Chinese OHC and applying ordinary least squares (OLS) regression and zero-truncated negative binomial (ZTNB) regression models. Findings Both service quality perception and disconfirmation have a positive effect on patients' positive emotional intensity in textual reviews, and disease severity enhances these relationships of process quality. Moreover, there is an asymmetric U-shaped relationship among service quality perception, disconfirmation and reviewing effort. Patients who perceive low service quality have higher reviewing effort, while service quality disconfirmation has the opposite relationship. Specifically, patients' effort in writing textual reviews is lowest when perceived outcome quality is 3.5 (on a five-point scale), perceived process quality is 4 or outcome quality and process quality disconfirmations are −1. Originality/value This study is the first to examine patients' online review behavior and its motivations and contributes to the literature on online reviews and service quality. In addition, the findings of this study have important management implications for service providers and OHC managers.