LAUSR

Abstract Background Patient initiative is an important feature of online doctor–patient communication that is linked with better communication quality and can help doctors make treatment recommendations. It was defined as the level of patient's active participation in the stage of information gathering. Improving the quality of diagnosis information exchange (QDIE) can promote the quality of doctor's treatment recommendation (QDTR) associated with patient initiative. We aimed to examine how patient initiative influences the QDTR and determine the mediating role of QDIE in the quality of doctor–patient communication. Methods This study was based on 500 hypertension communication exchanges from 2013 to 2018 collected from the Spring Rain Doctor website in China (n=158 doctors and three to five exchanges for each doctor). QDIE and QDTR were measured by 27 and six items adapted from the textbook of Physical Diagnosis History and Examination, 2017 hypertension clinical practice guidelines of the American College of Cardiology, the SEGUE framework for teaching and assessing communication skills, and the Calgary-Cambridge observation guide. We assessed these items for the quality of information (relevancy, completeness, timeliness, and understandability). Patient initiative was measured by the score of patient's initiative behaviours at the stage of information gathering. We tested the mediating effect of QDIE on the effect of patient initiative on QDTR using the PROCESS procedure in SPSS (version 22.0), controlling for doctors' professional titles and working years and their hospitals' grades. Findings Patient initiative had significant effect on QDTR (c′=1·11, p=0·04). QDIE significantly mediated the effect of patient initiative on QDTR (a × b=0·29; 95% bias-corrected bootstrap CI 0·11–0·60). The paths from patient initiative to QDIE and from QDIE to QDTR were significant (a=0·61, p Interpretation In online doctor–patient communication, patient initiative can help doctors make high-quality treatment recommendations. Furthermore, QDIE seems to be a crucial element in understanding the effect of patient initiative on QDTR. Funding National Natural Science Foundation of China (71774059).