ObjectiveTo examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation.DesignComputer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback.ParticipantsContributors posting comments about the NHS between March 2013 and September 2015.ResultsOverall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback.ConclusionsAlthough technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The findings also reveal a significant overlap between the four key themes in the ways that care is evaluated by patients.

A recent (2016) Office for National Statistics report stated that dementia is now 'the leading cause of death' in England and Wales. Ever fixated with the syndrome (an unfailingly newsworthy topic), the British press was quick to respond to the bulletin, consistently headlining that dementia was the nation's 'biggest killer', while (re)formulating other aspects of the report in distorting and emotive metaphorical terms. In this paper we examine how the media, through use of a recurring set of linguistic and visual semiotic tropes, portrayed dementia as an agentive entity, a 'killer', which remorselessly attacks its 'victims'. Such a broadly loaded and sensationalist representation, we argue, not only construed dementia as a direful and pernicious disease, but also, crucially, obscured the personal and social contexts in which the syndrome is understood and experienced (not least by people with dementia themselves). This intensely lurid type of representation not only fails to address the ageist misinformation and common misunderstandings that all too commonly surround dementia, but is also likely to exacerbate the stress and depression frequently experienced by people with dementia and their families.

This article explores and critically evaluates the potential contribution to discourse studies of topic modelling, a group of machine learning methods which have been used with the aim of automatically discovering thematic information in large collections of texts. We critically evaluate the utility of the thematic grouping of texts into 'topics' emerging from a large collection of online patient comments about the National Health Service (NHS) in England. We take two approaches to this, one inspired by methods adopted in existing topic modelling research and the other using more established methods of discourse analysis. In the study, we compare the insights produced by each approach and consider the extent to which the automatically generated topics might be of use to discourse analysts attempting to organise and study sizeable datasets. We found that the topic modelling approach was able to group texts into 'topics' that were truly thematically coherent with a mixed degree of success, while the more traditional approach to discourse analysis consistently provided a more nuanced perspective on the data which was ultimately closer to the 'reality' of the texts it contains. This study thus highlights issues concerning the use of topic modelling and offers recommendations and caveats to researchers employing such approaches to studying discourse in the future.

This study critically examines the ways in which the nationwide Diabetes UK/Tesco public health promotion campaign (2013)(2014) sought to raise awareness of Type 2 diabetes. Conducting a multimodal critical discourse analysis of six campaign images, we identify the presence of fearinducing, stigmatising and commercial strategies, through which the campaign emphasises the dangers of diabetes and advocates personal responsibility for assessing both individual and others' risk of the disease. Specifically, three discursive techniques are deployed in this campaign to achieve these ends: (1) the depiction of grief and amplification of diabetes-related danger, (2) the promotion of diabetes risk and responsibilization of individuals for their health, and (3) the commercial branding and framing of the Diabetes UK/Tesco partnership as providing tools for diabetes prevention and management. Our findings raise concerns about the moral legitimacy of using fear-inducing and commercial strategies in public health campaigns, strategies which do little to address the environmental factors which are associated with increasing rates of the disease.

Commercial stock images are existing, artificially-constructed visuals used by businesses and media outlets to articulate certain values, assumptions and beliefs. Despite their pervasiveness and accessibility, little is known about the ways in which stock images communicate meanings relating to health and illness. This study examines a broad range of common stock images which depict dementia and aging, revealing the tendency for older people with dementia to be represented in objectifying and de-humanising termsemphasizing disease and deficit at the expense of the whole person, while precluding any possibility of enduring personhood. As well as introducing a multimodal critical discourse approach which can be adopted by other researchers examining the ideological underpinnings of health and illness imagery, this study underscores the importance of critically interrogating stock photographya much neglected, yet profoundly influential, cultural resource that can shape the ways we think about and respond to illness and disease.