**5. Discussion**

This study discusses the impact of mobile technologies on DPR and pays special attention to the antecedents of poor DPR during mobile medical consultation. Figure 3 summarizes our key findings.

**Figure 3.** Antecedents of poor DPR in the mobile medical context.

First, inappropriate information providing, information interpreting and relationship maintaining behaviors of doctors and users are the direct causes of poor DPR in mobile consultation. From the perspective of users, mobile technologies have the potential to empower users with more medical knowledge and greater decision power over their health conditions [12]. However, their doctors fail to provide adequate support to realize the potential, which leads to user dissatisfaction and poor DPR. In specific, we find that some doctors fail to provide the etiology analysis, diagnostic basis, clear operational advice, or targeted answers to users' questions. Moreover, some doctors ignore users' emotional needs during communication and fail to provide a timely reply, an active inquiry, emotional comfort and/or a friendly service attitude to their worried users. From the doctors' perspective, we find that some users fail to provide adequate or accurate diagnostic clues for their doctors, and some others fail to interpret the advice correctly due to limited medical knowledge or conflicting medical opinions. Moreover, we highlight that the emotional needs of doctors have been overlooked during doctor-user communication. Although doctors expect trust, respect, and understanding from users [18], they are susceptible to doubts and even personal remarks from users. These inappropriate communication behaviors directly lead to the dissatisfaction of doctors and users in mobile consultation services.

Second, doctor-user communication is compromised by CMC, which is the underlying cause of poor DPR in mobile consultation. The connectivity feature of mobile applications might lead to increased workload for doctors or information conflicting and overloading for users. Accordingly, for doctors, an overwhelming amount of workload may reduce the amount of time that doctors spend on each user, which may result in inadequate information providing and information interpreting. Meanwhile, users are more likely to be exposed to conflicting medical information, which might weaken their trust towards their doctors [14].

Features of text-based communication and asynchronism create barriers in medical information providing, information interpreting, and relationship maintaining behaviors for both users and doctors. For users, it is difficult to provide sufficient diagnostic clues to their doctors via texts and pictures. Moreover, lacking visual clues of doctors may weaken users' trust toward their doctors. For doctors, lacking visual clues and asynchronous communication increase the difficulty to diagnose and interpret users' symptoms, increase the time cost to provide a medical suggestion and increase the difficulty of perceiving users' emotion [33,34].

The misbehaviors of users along the relationship maintaining dimension can be partly explained by the anonymity nature of mobile communication. In anonymous communication, people are more inclined to express negative emotions towards others compared to face-to-face communication because of reduced social presence [53]. Therefore, in mobile consultation users are more likely to an overt and explicit expression of negative emotions, which leads to poor DPR.
