Patient Satisfaction and Loyalty: Key Drivers of Positive Word-of-Mouth in Dental Primary Care Within Jeddah First Health Cluster,Saudi Arabia

Abstract

This study evaluates patient satisfaction with dental services provided in public primary care clinics within the Jeddah First Health Cluster, Saudi Arabia. A cross-sectional survey was conducted in the second half of 2024 across 7 public dental clinics in Jeddah First Health Cluster, Saudi Arabia. A structured, validated questionnaire assessed satisfaction across key service domains. Convenience sampling was used. A total of 421 patients (aged ≥ 12) participated. Ethical approval was granted, and informed consent was obtained verbally. A total of 421 patients participated, with the majority reporting high overall satisfaction (M = 4.51, SD = 0.45). Loyalty indicators were notably strong: intention to return (M = 4.69, SD = 0.51) and willingness to recommend the clinic (M = 4.54, SD = 0.54). Regression analysis identified meeting patient expectations (β = 0.65, P < .001) and technical proficiency (β = 0.28, P < .001) as the strongest predictors of satisfaction. Spearman correlation showed significant associations with examination thoroughness and alignment with expectations. The model explained 42% of satisfaction variance, F(5, 415) = 60.84, P < .001. This study found high patient satisfaction with public dental services, primarily driven by meeting patient expectations and the dental team's technical proficiency. These factors were strongly linked to intentions to return and recommend the clinic, indicating patient loyalty.

Keywords

patient satisfaction patient centered-care patient loyalty primary dental care Saudi Arabia

Introduction

The delivery of high-quality dental care is essential for maintaining oral health and overall well-being.¹ Patient satisfaction serves as a crucial indicator of the quality of healthcare services provided.² It reflects patients’ perceptions of the care they receive, encompassing aspects such as the competence of healthcare providers, the quality of facilities, and the overall experience.^3,4 Understanding patient satisfaction is vital for healthcare organizations to identify areas for improvement, enhance service delivery, and ultimately improve patient outcomes.⁵

In Saudi Arabia, the public dental healthcare system plays a pivotal role in providing accessible and free-of-charge dental care to the Saudi population.⁶ However, limited research has been conducted to comprehensively assess patient satisfaction with dental services in public dental clinics within the country. This lack of understanding hinders efforts to improve the quality of care and ensure that patients’ needs are being met.

Globally, numerous studies have explored patient satisfaction with dental services in various healthcare settings. For instance, a study found that patients were generally satisfied with the technical aspects of dental care but expressed concerns regarding communication and the overall dental experience.⁷ Similarly, studies highlighted the importance of patient-centered care and the need for improved access to dental services.^8,9

In the Saudi context, existing studies show general satisfaction with care quality, yet most focus on isolated aspects such as treatment outcomes or wait times, rather than offering a comprehensive view of patient experience.⁵

This study aims to fill that gap by comprehensively assessing patient satisfaction with dental services in public primary care clinics within the Jeddah First Health Cluster. The findings will offer valuable insights for policymakers, healthcare administrators, and dental professionals to improve service quality, enhance patient satisfaction, and ultimately support better oral health outcomes. Additionally, the study explores factors influencing overall satisfaction, loyalty, and the likelihood of recommending the clinic to others—key elements in effective patient engagement and outreach strategies.

Methodology

Study Design

This study employed a cross-sectional survey design to evaluate patient satisfaction with dental services provided in public primary dental care clinics within the Jeddah First Health Cluster, Saudi Arabia.

Participants

Patients who visited public primary care dental clinics in Jeddah First Health Cluster during the second half of 2024 were eligible to participate. Inclusion criteria included (1) being at least 12 years of age; (2) having received dental treatment at any primary dental care clinic within the Jeddah First Health Cluster within the study period; and (3) providing informed consent.

Survey Instrument

A structured questionnaire was designed to comprehensively assess patient satisfaction with dental services. Items were adapted from existing research,^10–12 covering the following dimensions:

Staff attitude: Professionalism, friendliness, and communication skills of dental staff.

Convenience of accessing dental care: Waiting times, appointment availability, and ease of scheduling appointments.

Effectiveness of pain management: Adequacy of pain control during dental procedures.

Overall quality of treatment: Quality of dental care, cleanliness of facilities, and patient education.

Respondents evaluated their satisfaction level using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Questionnaire Validation

Prior to data collection, the questionnaire underwent a rigorous validation process. A pilot study was conducted with 10 patients to assess its clarity, comprehensiveness, and acceptability. Feedback from the pilot study was used to refine the questionnaire and improve its face validity. Additionally, content validity from another 10 patients was established by ensuring that the questionnaire items adequately covered all relevant dimensions of patient satisfaction.

Sampling and Data Collection

The required sample size was calculated using the Raosoft online sample size calculator (http://www.raosoft.com/samplesize.html), based on an estimated weekly patient population of 1366 across the 7 participating public dental clinics. Using a 95% confidence level, a 5% margin of error, and a response distribution of 50%, the minimum recommended sample size was 300 participants. A convenience sampling method was utilized to recruit participants from 7 primary care centers within the Al-Thagher Hospital network. To enhance the statistical power of the study and account for potential exclusions due to incomplete responses, data collection continued beyond this minimum. A total of 421 completed and valid responses were ultimately included in the final analysis. This larger sample allowed for more robust subgroup comparisons and a broader representation of the patient population served by the participating clinics. Questionnaires were distributed to patients attending the participating primary dental clinics during the study period. Verbal informed consent was obtained from all participants prior to their involvement in the study, and the return of completed questionnaires was considered as an indication of voluntary participation. For participants under the age of 18, both parental consent and participant assent were obtained in accordance with ethical guidelines.

Data Analysis

All statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 29.0. Descriptive statistics were used to summarize the demographic characteristics of the sample and examine the distribution of responses to the questionnaire items. Cronbach's alpha was used for internal consistency reliability of the questionnaire. It evaluates how closely related the items on a scale are to each other. A high Cronbach's alpha indicates that the items are measuring a single underlying construct. Inferential statistics, such as Spearman correlation and multiple linear regression, were employed to correlate satisfaction with different variables and identify factors associated with patient satisfaction. Statistical significance was set at a P-value of < .05.

Results

Demographic Characteristics of the Study Sample

Four hundred twenty-one responses were received. In terms of age, the majority of participants were between 16 and 45 years old, with 36.8% falling within the 16 to 30 age group. Gender distribution was relatively balanced, with 49.9% male and 50.1% female. The educational level of participants was predominantly university (52.3%), followed by secondary (41.8%) and postgraduate (5.9%). Regarding dental clinic visits, a significant portion (45.4%) visited frequently (more than twice a year), while 35.4% visited regularly (1-2 times a year). A smaller percentage visited occasionally (16.9%) or for the first time (2.4%). Table 1 provides data that reveals insights into the demographics and dental clinic visitation patterns of a sample of 421 individuals.

Table 1.

Demographic Characteristics of the Study Sample (n = 421).

Variables	TotalN = 421N (%)
Age
< 15	48 (11.4)
16-30	155 (36.8)
31-45	93 (22.1)
46-60	85 (20.2)
> 60	40 (9.5)
Gender
Male	210 (49.9)
Female	211 (50.1)
Education level
Secondary	176 (41.8)
University	220 (52.3)
Postgraduate	25 (5.9)
How often do you visit the dental clinic?
First time	10 (2.4)
Occasionally (less than once a year)	71 (16.9)
Regularly (1-2 times a year)	149 (35.4)
Frequently (more than twice a year)	191 (45.4)

Descriptive Results of Patients Experience Items and Reliability of Constructs

The descriptive statistics and reliability analysis presented in Table 2 provide valuable insights into patients’ experiences and their perceptions of various aspects of dental care. As Table 2 indicates, patients reported high levels of overall satisfaction, with strong ratings across key service dimensions.

Table 2.

Descriptive Statistics and Reliability Analysis Results.

Variables	Descriptive statistics			Cronbach's alpha
Variables	M	Mdn	SD	Cronbach's alpha
Dental Patients Experience Satisfaction
I was satisfied with my visit to the dental clinic today	4.32	4.00	0.65
I would recommend the dental clinic to family and friends	4.54	5.00	0.54
I likely would return to the clinic for future dental care	4.69	5.00	0.51
Overall satisfaction of patient experience^a	4.51	4.66	0.45	0.70
Dental Staff Attitude
Satisfied with dental staff friendliness	4.00	4.00	0.84
Satisfied with dental staff professional communication	4.31	4.00	0.61
Feel respected and valued as a patient	4.15	4.00	0.72
Satisfied with dental staff responsiveness to my questions or concerns	4.11	4.00	0.84
Dental staff provide clear explanations about my dental treatment	4.13	4.00	0.77
Overall satisfaction of dental staff attitude^b	4.15	4.00	0.56	0.67
Administrative staff (reception)
My overall experience with the dental clinic's administrative staff (reception, billing, etc) is excellent	4.33	5.00	0.77
Convenience Access
Convenience to schedule my appointment	3.93	4.00	0.82
Convenience to access the clinic	4.08	4.00	0.93
satisfied with the waiting time	4.23	4.00	0.76
Satisfied with waiting area cleanliness and comfort	4.16	4.00	0.85
Easy to find parking or public transport options near the clinic	4.14	4.00	0.91
Easy to navigate within the clinic	4.00	4.00	0.82
Overall satisfaction of convenience of accessing dental services^c	4.08	4.33	0.55	0.73
Pain Management
Informed about pain management options before the procedure	4.24	4.00	0.93
Pain managed during the procedure	4.28	5.00	0.80
Dental staff adequately addressed my concerns about pain before the procedure	4.21	5.00	1.03
Experienced discomfort or pain after your dental procedure	4.23	4.00	0.75
Satisfied with post-procedure pain management and advice	4.17	4.00	0.82
Overall satisfaction of pain management^d	4.22	4.20	0.60	0.72
Quality of Dental Treatment
Satisfied with the technical proficiency of the dental team	4.37	4.00	0.54
Satisfied with the infection control practices in the clinic	4.35	4.00	0.61
Satisfied with the quality of dental treatment	4.15	4.00	0.86
Satisfied with the thoroughness of the dental examination	4.31	4.00	0.59
Dental treatment met my expectations	4.49	5.00	0.62
My dental problems and concerns were addressed during the visit	4.34	4.00	0.59

Dental Patient Experience items combined.

Items (friendliness, professional communication, and feel respected and valued) combined.

Convenience access construct items combined.

Pain Management construct items combined.

In addition to overall satisfaction, the study assessed patient loyalty through 2 behavioral intention items: the likelihood of returning to the clinic for future care and the willingness to recommend the clinic to family and friends. As shown in Table 2, both items received consistently high ratings, indicating a strong sense of loyalty and positive sentiment toward the dental services provided.

Patients also expressed a high level of satisfaction with their visit to the clinic on the day of the survey, suggesting that services are effectively meeting expectations and needs.

As for specific service aspects, Table 2 shows that dental staff attitude and communication were rated positively, and the convenience of accessing services received moderately high ratings. Patients also rated pain management favorably, and the quality of dental treatment was among the highest-rated aspects, reflecting confidence in the care provided.

Overall, these findings highlight a strong pattern of patient satisfaction across multiple service dimensions and support the effectiveness of the clinic's approach to patient-centered care.

Spearman Rank Correlation Analysis Results

The correlation matrix revealed significant positive correlations between overall patient satisfaction and several key factors: dental staff attitude (r_s = 0.14) and pain management (r_s = 0.14). Additionally, patients’ satisfaction was significantly correlated with the technical proficiency of the dental team (r_s = 0.24), thoroughness of dental examinations (r_s = 0.42), and the alignment of treatment with patient expectations (r_s = 0.51) (Table 3).

Table 3.

Spearman Rank Correlation Analysis Results.

	1	2	3	4	5	6	7	8	9	10	11	12
1—Overall satisfaction of patient experience	–
2—Overall satisfaction of dental staff attitude	.14**	–
3—Overall satisfaction of convenience of accessing dental services	.02	.40**	–
4—Overall satisfaction of pain management	.14**	.45**	.45**	–
5—Satisfaction with dental staff providing clear explanations about my dental treatment	−.06	−.08	.05	.23**	–
6—Overall Satisfaction with the dental clinic's administrative staff (reception)	.00	.18**	.49**	.36**	.13**	–
7—Satisfaction with the technical proficiency of the dental treatment	.24**	−.05	−.13**	.11*	.51**	.01	–
8—Satisfaction with the infection control practices in the clinic	.03	.49**	.33**	.63**	.06	.47**	.14**	–
9—Satisfaction with the quality of dental treatment	−.06	.30**	.27**	.45**	.13**	.41**	−.06	.55**	–
10—Satisfaction with the thoroughness of the dental examination	.42**	.34**	.18**	.15**	.07	.24**	.37**	.25**	.28**	–
11—Dental treatment met my expectations	.51**	.25**	.31**	.23**	−.02	.12**	−.03	.16**	.22**	.61**	–
12—My dental problems and concerns were addressed during the visit	−.26**	.37**	.34**	.30**	.18**	.35**	−.05	.43**	.31**	.00	−.26**	–

*Correlation is significant at the .05 level (2-tailed).

**Correlation is significant at the .01 level (2-tailed).

Multiple Linear Regression Analysis for Predictors of Overall Satisfaction of Patient Experience

Multiple linear regression results found in Table 4 showed that dental staff attitude, technical proficiency, thoroughness of examination and meeting patients’ expectations together significantly predicted overall satisfaction with dental experience, F (5, 415) = 60.84, P < .001, R² = .42. The predictors accounted for 42% of variation in overall satisfaction. For instance, meeting patients’ expectations is the strongest predictor, with a standardized beta coefficient (β = .65, P < .001). This indicates that patients who feel their expectations are met are more satisfied overall. In addition, patients’ satisfaction is significantly predicted by the technical proficiency of the dental team (β = .28, P < .001). This shows that the higher the technical proficiency of the dental team, the greater the overall satisfaction. On the other hand, the other variables, for instance, dental staff attitude and thoroughness of examination, do not significantly contribute to overall satisfaction while controlling for other predictors.

Table 4.

Multiple Linear Regression Analysis for Predictors of Overall Satisfaction of Patient Experience.

					Collinearity statistics
Variables	B	SE	Beta	P	Tolerance	VIF
Dental staff attitude	−0.01	0.03	−0.02	.66	.79	1.26
Pain management	−0.12	0.03	−0.16	<.001*	.79	1.27
Technical proficiency	0.23	0.04	0.28	<.001*	.68	1.48
Thoroughness of examination	0.00	0.04	−0.01	.93	.43	2.33
Meeting patients’ expectations	0.47	0.04	0.65	<.001*	.49	2.04

Abbreviation: VIF, variance inflation factor.

*P value < .05.

It's important to note that the collinearity statistics (tolerance and variance inflation factor [VIF]) are within acceptable ranges (tolerances are above .20 and VIFs—below 10), indicating that there's no significant multicollinearity among the predictors, which is a good sign for the validity of the model.

Discussion

Among patients who utilized dental primary care services at Jeddah First Health Cluster, patients expressed a high level of overall satisfaction with their dental clinic visits. This suggests that the clinic is effectively meeting the needs and expectations of its patients. A significant majority of patients indicated they would recommend the dental clinic to family and friends, and expressed a strong intention to return for future care. These responses reflect not only satisfaction, but also indicators of patient loyalty and potential for positive word-of-mouth. Upon deeper analysis, this loyalty appears to be driven by specific factors: the perceived quality of care, trust in the dental team, and how well the treatment aligned with patient expectations. These elements are central to patient-centered care and contribute to building long-term relationships and reinforcing the clinic's positive reputation within the community. Our findings are consistent with previous research showing that patients generally report positive experiences in dental care settings.¹³ Studies have highlighted the significant impact of effective communication, individualized care, and pain management on enhancing patient satisfaction and promoting favorable behavioral outcomes such as loyalty and advocacy.¹⁴

In the current study, the dental staff's attitude was rated positively, with a mean score of 4.15. This emphasizes the importance of interpersonal skills in dental care. Studies have consistently highlighted the positive impact of compassionate and empathetic dental professionals on patient satisfaction and overall treatment outcomes.^15,16 The convenience of accessing dental services was rated moderately high. Also, pain management was rated favorably, indicating that patients were generally satisfied with the pain control measures provided. Effective pain management is crucial for a positive dental experience and can contribute to patient compliance with treatment recommendations.^17,18 In addition, the quality of dental treatment received high ratings from the responded patients, suggesting that the dental services provided met their expectations. Previous studies have emphasized the importance of high-quality dental care in fostering patient satisfaction and trust.^19,20

The correlation analysis highlights several significant factors that contribute to overall patient satisfaction in the dental practice. A positive correlation of 0.14 between dental staff attitude and patient satisfaction suggests that a friendly and approachable demeanor from dental professionals is associated with increased patient satisfaction. A similar correlation of 0.14 between pain management and patient satisfaction indicates that effective pain control during dental procedures is crucial for positive patient experiences. A stronger correlation of 0.24 between technical proficiency and patient satisfaction emphasizes the importance of the dental team's skill and expertise in delivering quality dental care. A notably high correlation of 0.42 between the thoroughness of dental examinations and patient satisfaction underscores the value of comprehensive assessments in building trust and ensuring patient well-being. The strongest correlation of 0.51 between alignment of treatment with patient expectations and patient satisfaction highlights the critical need for open communication and collaborative decision-making to meet patients’ individual needs and preferences. The findings of this study are generally consistent with existing research on patient satisfaction in dental care. The identified factors, including dental staff attitude, pain management, technical proficiency, thoroughness of dental examinations, and alignment of treatment with patient expectations, are all known to play significant roles in shaping patient experiences and satisfaction.¹²

The multiple linear regression results of this study align with previous research on patient satisfaction in dental care. The significant impact of meeting patients’ expectations on overall satisfaction underscores the importance of patient-centered care in dentistry. Dental practices that prioritize understanding and addressing patients’ individual needs and preferences are more likely to achieve high levels of satisfaction. In addition, the positive association between technical proficiency and patient satisfaction reinforces the importance of providing high-quality dental care. Skilled and knowledgeable dental teams can contribute to positive patient experiences and outcomes. While enhancing access to care remains a priority, it is equally critical to ensure that dental providers possess the necessary skills to meet patients’ evolving expectations. The positive association between technical proficiency and patient satisfaction observed in this study highlights a key area for development within primary dental care. Patients often evaluate their experience based on how confident they feel in the provider's skills and how well their concerns are addressed. If dentists are not clinically updated, or if they fail to communicate effectively or show empathy, improvements in access may not translate into better outcomes. Dentists must strive to see care from the patient's perspective, continually enhancing not only their clinical competencies but also their communication abilities and emotional intelligence. These attributes are essential for creating a truly patient-centered experience that fosters trust, satisfaction, and long-term loyalty. While the study provides valuable insights, it became evident that patients often evaluated satisfaction primarily based on their interactions with dental staff and clinical services, rather than the broader care system. As such, a qualitative follow-up study could help explore patient perceptions in more depth and clarify how individuals interpret and prioritize different aspects of dental care experiences. This would offer a richer context for identifying specific areas for improvement within the public dental care model.

Conclusion and Implications

This study demonstrates a high level of overall patient satisfaction with primary dental care services in public clinics. The findings highlight 2 key predictors of satisfaction: meeting patient expectations and the technical proficiency of the dental team. These factors were strongly associated with positive evaluations of care, including patients’ intention to return and willingness to recommend the clinic.

While these insights are valuable, several limitations must be acknowledged. First, the use of convenience sampling may limit generalizability and introduce selection bias. However, all eligible patients attending the selected clinics during the recruitment period were systematically approached and offered the opportunity to participate, thereby reducing exclusion bias. Second, although the sample size was appropriately calculated based on a weekly clinic population of ∼1366 patients, representativeness across all 7 clinics cannot be fully assured due to possible differences in response rates.

Additionally, the study provides a snapshot of patient experiences at a specific point in time within a single health cluster, which may limit the generalizability of the findings to other regions or contexts. Future research should consider using stratified or probabilistic sampling methods, include broader geographical coverage, and explore a more comprehensive set of predictors. A particularly important direction for future inquiry involves examining the perspectives of nonreturning patients, as their experiences could yield critical insights into service gaps and opportunities to improve patient retention.

Policy and Practice Implications

The findings carry important implications for both policy development and clinical practice in public dental care settings.

Structured appointment time for quality care. To enable dentists to effectively listen to and address patients’ needs, policy-makers should consider implementing minimum appointment duration guidelines. Compressed time slots often compromise communication, examination thoroughness, and personalized care—key drivers of patient satisfaction. Allowing for sufficient time in primary dental care visits would support better diagnosis, patient education, and stronger provider-patient relationships.

Performance-based incentives for high-quality care. Policies should incorporate incentive structures that recognize and reward dental providers who consistently receive high satisfaction ratings and demonstrate strong communication and technical skills. These incentives could be financial or career-related (eg, professional development opportunities or leadership roles) and linked to a transparent, patient-informed evaluation framework.

Continuous training mandates. Mandating regular clinical and interpersonal skills training, including courses in communication, empathy, and emotional intelligence, can help ensure dentists remain aligned with evolving standards in patient-centered care. Accreditation or licensing renewal could be tied to such continuous professional development.

Differentiated resource allocation based on performance and demand. Clinics with high patient volumes and strong satisfaction metrics should receive priority access to resources, such as additional staffing or infrastructure upgrades, to sustain quality and meet growing demand. Conversely, facilities showing consistent performance issues may receive support in the form of coaching, restructuring, or temporary management oversight.

Enhanced focus on equity and personalization. Recognizing that patient needs vary by age, gender, and socioeconomic background, policies should encourage personalized care models. These might include cultural competence training and flexible service designs tailored to specific population needs, especially adolescents, the elderly, and marginalized communities.

Footnotes

Acknowledgments

Many thanks to the Department of Research & Studies at Jeddah Health Affairs for their research facilitation services.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

This study protocol was reviewed and approved. The study has been granted an exemption from requiring written informed consent since it is a self-administered questionnaire. The need for written informed consent was waived by the Institutional Review Board holding the National Registration number with NCBE-KACST, KSA: (H-02-J-002) based at Jeddah Health Affairs. IRB Log No (A01942) 04/06/2024. Those who responded to the questionnaire assumed agree to take part in the study.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Marwah A. Afeef

Statement of Human and Animal Rights

Not applicable.

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