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Open Access Highly Accessed Research article

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews

Olga C Damman1*, Michelle Hendriks1, Jany Rademakers1, Diana MJ Delnoij23 and Peter P Groenewegen14

Author Affiliations

1 NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands

2 Centre for Consumer Experience in Healthcare, PO Box 1568, 3500 BN, Utrecht, the Netherlands

3 TRANZO (Scientific Centre for Transformation in Care and Welfare), Faculty of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands

4 Department of Human Geography, Department of Sociology, Utrecht University, PO Box 90115, 3508 TC, Utrecht, the Netherlands

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BMC Public Health 2009, 9:423  doi:10.1186/1471-2458-9-423

Published: 20 November 2009



To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet.


Using semi-structured cognitive interviews, interviewees (n = 20) were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information.


We identified twelve themes from consumers' thoughts and evaluations. These themes were categorized under four important areas of interest: (1) a response to the design; (2) a response to the information content; (3) the use of the information, and (4) the purpose of the information.


Several barriers to an effective use of comparative healthcare information were identified, such as too much information and the ambiguity of terms presented on websites. Particularly important for future research is the question of how comparative healthcare information can be integrated with alternative information, such as patient reviews on the Internet. Furthermore, the readability of quality of care concepts is an issue that needs further attention, both from websites and communication experts.