Understanding Telemedicine Communication Through Critical Incidents: A Grounded Theory Investigation of Patients’ Experiences

Abstract

The rapid expansion of telemedicine during the COVID-19 pandemic has transformed patient-provider communication, particularly in mental health and chronic care contexts. Yet, limited research has examined patients' nuanced perceptions of communication quality in telehealth settings from the lens of lived experiences. This dissertation investigates how patients evaluate provider communication in telemedicine by analyzing naturally occurring narratives shared on Reddit. Using a constructivist grounded theory approach, informed by the Critical Incident Technique (CIT), the study explores 84 critical incidents across 39 Reddit threads to identify how communication behaviors shape patients’ experiences of virtual care. Guided by three theoretical frameworks Patient-Centered Communication (PCCm), Social Presence Theory (SPT), and Media Affordance Theory (MAT) the analysis revealed 17 interrelated themes spanning relational behaviors (e.g., empathy, attentiveness), emotional presence (e.g., immediacy, affective expression), technological features (e.g., interactivity, anonymity), and contextual constraints (e.g., environmental disruptions, financial access). These themes reflect a multidimensional communication in which satisfaction depends not only on clinical outcomes but on the alignment between patient needs, provider engagement, and platform capabilities. Findings demonstrate that virtual care succeeds when communication is emotionally attuned, responsive, and structurally supported. At the same time, the study reveals theoretical tensions such as when provider empathy is insufficient to overcome technical or contextual barriers thereby extending existing models of telehealth communication. This research highlights how users make sense of care in emotionally charged digitally mediated contexts. In addition to advancing theory, the study offers concrete implications for healthcare providers, platform designers, and educators seeking to improve communication quality, emotional safety, and equity in virtual care delivery. The use of Reddit as a naturalistic data source also illustrates the potential of social media in capturing patient perspectives often missed in traditional research. This dissertation contributes to the growing body of research at the intersection of digital health communication and computer-mediated care by theorizing how social presence and media richness shape patient satisfaction in telehealth environments. It further demonstrates the value of Reddit as a data source for understanding patient voices in naturalistic, emotionally charged contexts. Implications are offered for health communication scholars, educators, and practitioners seeking to enhance relational quality and trust-building in virtual care delivery.