Objectives: Most previous studies have portrayed patient satisfaction as a
rather simple outcome based solely on patient perceptions. The goal of this
pilot study was to determine if evidence could be found to support the vie
w that patient evaluation is a more complex process better explained by dra
wing on the theories of 'disconfirmation of expectations' and 'attribution'
. Methods: A qualitative methodological approach was chosen with data colle
ction being achieved by means of four focus group interviews comprising a t
otal of 25 participants (16 women and 9 men, mean age 43.8 years, standard
deviation of 14.45) representing a wider population of adults (over the age
of 18) who had attended for dental treatment within the previous 12 months
. Results: Analysis suggests that patient perceptions of dental practice al
one do not fully account for the way patients evaluate dentists. Disconfirm
ation of expectations does take place during the evaluation process. Equall
y, patients appear to apply the attributional concepts of 'duty' and 'culpa
bility' to determine either satisfaction or dissatisfaction. Conclusions: A
better understanding of patient satisfaction, and the evaluation process t
hat leads to satisfaction, can only be achieved if, in addition to patient
perceptions, other antecedent factors such as patient expectations and desi
res are considered. Disconfirmation and attribution theory do appear to pla
y an important role in this process and warrant further investigation.