Tracking subjective symptom improvement from patient narratives in mobile health: An observational natural language processing study

Background Subjective symptom monitoring is central to patient-centered care but often relies on burdensome surveys prone to recall bias. Mobile health (mHealth) platforms increasingly collect user-generated reviews that may provide real-time insights into patient experiences. However, it remains unclear whether such unsolicited narratives can serve as valid indicators of perceived health outcomes, particularly in non-Anglophone contexts. Objective This study examines whether linguistic features from Chinese-language mHealth reviews can be used to identify signals related to patient satisfaction and perceived symptom improvement. Methods An observational study was conducted using 6,362 publicly available user-generated reviews from the WeDoctor mHealth platform. A natural language processing pipeline extracted sentiment polarity, a keyword-derived perceived improvement indicator, and TF-IDF features. Sentiment was analyzed using linear regression to predict satisfaction, while logistic regression and Random Forest models were used to identify reviews containing improvement-related expressions. Results Sentiment polarity significantly predicted satisfaction (β=0.351, p<0.001). Approximately 29% of reviews contained improvement-related expressions. The TF-IDF model achieved strong classification performance (F1-score = 0.945), with Random Forest showing slightly improved performance (F1-score = 0.953). Conclusion Patient narratives contain emotional and functional signals that support real-time, low-burden monitoring of satisfaction and perceived improvement, complementing traditional survey-based outcome measures.