How do patient feedback systems work in low- and middle-income countries? Insights from a realist evaluation in Bangladesh.

Abstract Background Well-functioning patient feedback systems can contribute to improved quality of healthcare and ultimately make health systems more accountable. We used realist evaluation to understand the functioning of patient feedback systems at frontline health facilities in Bangladesh. Methods We collected and analysed data in two stages using: document review; secondary analysis of data from publicly-available web-portals; in-depth interviews with patients, health workers and managers; non-participant observations of feedback environments; and stakeholder workshops. Stage 1 focused on identifying and articulating the initial program theory of patient feedback systems. In Stage 2, we iteratively tested and refined this initial theory, through analysing data and grounding emerging findings within substantive theories and empirical literature, to arrive at a refined program theory. Results…