Encouraging Consumer Use of Hospital Quality Information: Both Cognitive and Emotional Appeals Contribute

Abstract

BackgroundThis qualitative study explores consumers’ knowledge, perceptions, and reported propensity to use hospital quality information and proposes a communication strategy aimed at supporting the use of a prototypical decision-support tool for choosing a hospital.MethodsEight focus groups (total n = 77) in geographically diverse sites were conducted with Medicare beneficiaries and people aging into the Medicare Program. Each group discussed a series of issues including overall hospital quality awareness, knowledge, attitudes, and behaviors related to hospital choice-making in general, attitudes and perceptions related to the CAHPS Hospital Survey (HCAHPS) information and potential uses specifically, and discussion related to communication messages and themes that might encourage consumer action around such decision-support tools. ResultsParticipants generally believed that hospitals differed in quality, but typically based their impressions on personal experiences and reports of family/friends. There was little awareness of the availability of evidence-based hospital quality information or of the various organizations that promoted such information. Most initially believed that such information, even if available, would not be useful to them personally. Few believed that they had the time or the ability to make an informed choice and many felt constrained by geography or health plan coverage. Differences between hospitals on clinical measures were not seen as immediately useful to these participants. However, differences between hospitals in measures of consumer experiences (reflected in sample HCAHPS reports) were seen as relevant once skepticism about hospitals’ ability to “game” their results was allayed. Still, participants often had difficulty distinguishing between their generally strong confidence in their own physician and the quality of the hospital and its professional staff; most reported that the doctor’s opinion would override HCAHPS findings. Participants reinforced the need to highlight the objectivity of the information to build credibility and trust, but also noted that emotional features, such as reducing anxiety and peace of mind resulting from making a good choice were also important. Many participants also noted that the tool, because of its widespread use, could contribute to overall improvement of hospital and health care quality. ConclusionsA message framework that includes both cognitive and emotional appeals with a clear behavioral call to action can be useful to organizations interested in enhancing consumer engagement in public reporting of hospital quality.