Journal of Management Research
ISSN 1941-899X
2016, Vol. 8, No. 4
Factors Influencing Consumer Choice of Private Dental
Care Provider in Saudi Arabia
Ala'Eddin Mohammad Khalaf. Ahmad
Associate Professor of Health Marketing, Faculty of Economics and Administration
King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia
E-mail: amahmed1@kau.edu.sa; aladdin.a.h@hotmail.com
Received: July 26, 2016
doi:10.5296/jmr.v8i4.10004
Accepted: Sep 23, 2016
Published: October 1, 2016
URL: http://dx.doi.org/10.5296/jmr.v8i4.10004
Abstract
This research is intended to explore the factors influencing consumer choice of private dental
care providers in Saudi Arabia. The current research is descriptive analytical. A purposive
sampling technique was employed to recruit 220 consumers who visited a private dental care
provider. This research showed that factors influencing consumers' choice (information
sources, dentist attributes, dental practice attributes, and demographics) had a positive effect
on consumers' choices of the private dental providers on the one hand. On the other hand, the
demographic factor had no effect on brand. The paper contributes to previous research by
adding to existing knowledge regarding the factors influencing consumer choice of private
dental care provider in Saudi Arabia. The paper makes key recommendations towards
studying the factors influencing the consumers' choice.
Keywords: information sources, dentist attributes, dental practice attributes, consumer choice,
dental practice, Saudi Arabia
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1. Introduction and Research Questions
A potential healthcare consumer, when looking for and deciding on a healthcare services
provider, considers his or her problems or questions (Kotler, 2001). This problem recognition
is often referred to as self-perceived need, self-assessed need, or subjective need, because it
refers to the need that the patient identifies (Lundegren, 2012). Since perceived need or
problem recognition initiates a potential healthcare consumer to actively pursue information
to choose a healthcare provider (Kotler, 2001) and the consumer behavior of choosing a
healthcare provider may differ according to perceived need, healthcare marketers and
healthcare providers who seek to promote their practice might wonder how the process by
which potential healthcare consumers’ choose their provider differs according to their
self-perceived need.
Perceived need varies from other needs such as normative need, expressed need, and relative
need. Normative need compares health indicators to asocial norm or predetermined desired
standards. Expressed need, or utilization, is worked out according to the consumer numbers
who actually used medical services. Relative need relates to the equity of services (Kuthy and
Siegal, 2003). Furthermore, perceived need can be categorized as the need for both
comprehensive and limited care. Perceived needs can be related to provider identified need
and provider type: general practitioner vs. specialist. Patients whose perceived need is
comprehensive care would be more likely to seek care from a general practitioner. These
patients include regular check-up patients who are interested in their general health and
wellbeing. Patients whose perceived need is limited care often identify their need according
to professional opinion, and would be more likely to obtain specialist care. These limited care
patients include emergency patients, because they perceive their need as being limited to the
particular emergency situation. Choosing a dentist involves risk or uncertainty to dental
consumers. According to Kotler, the amount of money involved in the decision, uncertainties,
and the level of consumer confidence over the decision can contribute to the level of risk
associated with the consumer decision (Kotler 2001, 98). When a dental consumer chooses a
dentist, he or she deals with the uncertainty of the outcome or consequences of the choice.
The dentist chosen may charge too much, give pain during the dental procedures, or not meet
the consumer's expectations. All of these consequences can be experienced only after the
decision. In a higher-risk decision-making such as dentist selection, consumers tend to rely
more on informal information sources such as word-of-mouth (WOM) (Mangold et al., 1990,
79-84).
Limited care patients and comprehensive care patients may use different processes for
choosing a dentist. However, there are strict limits to the amount of knowledge available
about this issue. Given the current trend of decision-making upon the participants of this
study, this work will try to investigate the determinants of the utilization of dental services
among Saudi Arabian citizens in Jeddah City. The research problem investigated the main
factors influencing consumers’ decision-making concerning private dental providers in
Jeddah city.
This research answered the following questions:
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Journal of Management Research
ISSN 1941-899X
2016, Vol. 8, No. 4
Q1 What are the main factors influencing consumers’ decision-making concerning private
dental providers in Jeddah city?
Q2 Does the information source (personal information, commercial information sources, and
public information sources) influence consumers’ decision-making concerning private dental
providers in Jeddah city?
Q3 Do the dentist attributes influence consumers’ decision-making concerning private dental
providers in Jeddah city?
Q4 Do the dental practice attributes influence consumers’ decision-making concerning
private dental providers in Jeddah city?
Q5 Do the demographic characteristics of consumers influence their decision-making
concerning private dental providers in Jeddah city?
The current paper examined factors influencing consumers’ decision-making concerning
dentist practices and how patients differ in terms of consumer behavior in selecting a provider;
exploring reasons for the choice of a particular healthcare provider in a dental practice in
order for healthcare providers and marketers to better promote their practice depending on
their patient type.
2. Objectives of the Research
The research objectives are:
1- Identify the main factors which influence the decision-making in selecting a private dental
provider in Jeddah city.
2- Investigate the effect of certain factors (information sources, dentist attributes, dental
practice attributes, and demographics) on the decision-making concerning Saudi private
dental providers in Jeddah city.
3. The Research Rationale
This research is designed to increase the body of knowledge by investigating the factors
influencing consumers’ decision-making concerning the selection of dental practices in the
healthcare industry in Saudi Arabia. This research will contribute to the service marketing
discipline in finding out the role of these factors (information sources, dentist attributes,
dental practice attributes, and demographics) in delivering a better dental health service
within the service sector. This study will attempt to contribute to the marketing, knowledge
and health services marketing in particular by looking at the impact of information sources,
dentist attributes, dental practice attributes and demographic dimensions and patient
decision-making. This research will deal with a neglected area in KSA, which is the
marketing of health services. It is considered as new research in the diffusion of marketing in
the area of services to gain an understanding of the dental relevance effect and contribution of
these factors to Saudi private sector dental practices; such contributions will be beneficial
both academically and professionally.
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2016, Vol. 8, No. 4
4. Research Methodology
Developing an effective research design is one of the fundamental parts of any research
project. The research design determines: research methodology, the primary data collection
techniques (developing and designing the research questionnaire), research data analysis and
interpretation methods, which all affect the way the research aim and objectives are realized.
This study consists of descriptive analytical research of the relationships that may exist
between dependent and independent variables as per the research hypotheses. The research
design constructed here is based on the hypotheses formulated. These hypotheses were
formulated inductively using the researcher’s observation and from the literature. The
descriptive part describes and identifies the research factors, which constitute factors
influencing patient’s decision-making components in Saudi dental private sector hospitals. In
the analytical part, the research model is being tested through examining the relationship
between the factors influencing patient’s decision-making components in Saudi dental private
sector hospitals in order to explore how far patients perceive these factors when making their
decisions regarding the purchasing of these services.
4.1 The Research Population
The research population consists of all the consumers who visit private dental divisions at the
big private hospitals of more than 150-bed capacity in the city of Jeddah/KSA. The
population in this research is defined as all the dental divisions in the private hospitals of
Jeddah city. The numbers of dental clinics included in this research as a research population
were four hospitals (represented in their dental division). The research population consisted
of all the consumers who have visited any private dental clinic in these hospitals in 2015. The
average monthly visit was 8112. Therefore, all the dental consumers who were called and
invited to participate in the research survey were 360, and the respondents amounted to 220,
which is my study sample.
4.2 Primary Data Collection Methods
In this research, a quantitative approach is used for the purpose of gaining a comprehensive
picture of the issues in question. The research used questionnaire techniques to collect the
primary data. The research questionnaire was designed based on previous empirical literature.
The current research used the questionnaire as the primary data collection method. The
components of factors (cultural, social, personal, psychological and information availability)
were measured on a 5-point Likert-scale ranging from very important (5) to not important at
all (1). The type of questions used in constructing the questionnaire were the ranking type. A
ranking question asks the respondent to place items in a rank order so as to determine their
significance to the respondent.
The researcher in this study tried to ensure that the questionnaire’s length would not limit
respondents from fully filling out the questionnaire. The approximate timescale for
completing the questionnaire was between 15 and 20 minutes, which was ensured in this
study.
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ISSN 1941-899X
2016, Vol. 8, No. 4
After the questionnaire was constructed, the next step was to include an introductory
paragraph to explain to respondents the survey’s purpose and to encourage a high response
rate. The cover letter used in this research attempts to motivate the respondents to answer the
questions very seriously. The letter explained the purpose of the research, clarified its
importance and the significance of filling out the questionnaire, and assured the respondents
that strict privacy would be observed with regard to information provided. In general, the
cover letter for a drop and collect questionnaire needs to be more detailed than the
introductory statement in a personal interview.
4.3 Research Hypotheses
1. There is a significant relationship between personal information sources of the patients
and decision-making regarding selecting a private dental provider in Jeddah.
2. There is a significant relationship between public information sources of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
3. There is a significant relationship between commercial information sources of the
patients and decision-making regarding selecting a private dental provider in Jeddah.
4. There is a significant relationship between dentist attributes of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
5. There is a significant relationship between dental practice attributes of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
6. There is a significant relationship between variable demographic characteristics of the
patients and decision-making regarding selecting a private dental provider in Jeddah.
5. Results and Discussion
5.1 Results
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2016, Vol. 8, No. 4
Table 1. Frequency and Percentage for Demographic Information
Variable
Age
Gender
Nationality
Educational level
Do you have a dental
insurance
Income level
Frequency Percentage
Under 20
20
9.1
20-30
96
43.6
31-40
60
27.3
41-50
40
18.2
Over 50
4
1.8
Total
220
100.0
Male
148
67.3
Female
72
32.7
Total
220
100.0
Saudi
160
72.7
Non-Saudi
60
27.3
Total
220
100.0
Secondary school or less
64
29.1
Bachelor’s degree
112
50.9
Masters degree
28
12.7
Doctoral degree
16
7.3
Total
220
100.0
Yes
68
30.9
No
152
69.1
Total
220
100.0
2000SR-5000SR
76
37.5
Above 5000-10,000SR
60
27.3
Above 10,000-20,000SR
60
27.3
Above 20,000SR
24
10.9
Total
220
100.0
Table 1 shows that:
1. The highest percentage for “Age” reached (43.6%) for age category 20-30years, but the
lowest percentage reached (1.8%) for age over 50.
2. The highest percentage for “Gender” reached (67.6%) for male, but the lowest percentage
reached (32.7%) for female.
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2016, Vol. 8, No. 4
3. The highest percentage for “Nationality” reached (72.7%) for Saudi, but the lowest
percentage reached (27.3%) for non-Saudi.
4. The highest percentage for “Educational Level” reached (50.9%) for Bachelor’s degree,
but the lowest percentage reached (7.3%) for Doctoral degree.
5. The highest percentage for “Do you have dental insurance” reached (69.1%) for no, but
the lowest percentage reached (30.9%) for yes.
6. The highest percentage for “Income Level” reached (34.5%) for 2000SR-5000SR, but the
lowest percentage reached (10.9%) for above 20,000SR.
5.2 Hypotheses Test
There is a significant relationship between information sources of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
To verify the hypothesis, a multiple regression equation has been applied to study the impact
of the sources of information to make a decision regarding choosing a dental provider.
Table 2. Result of regression for relationship between information sources of the patients and
decision-making regarding selecting
Independent variables
Beta
T
Sig.
R
Personal Information
0.19
2.43 0.02
Commercial Information Sources
0.16
1.98 0.05 0.28
Public Information Sources
0.15
1.61 0.11
R Square
0.08
F
Sig.
6.32 0.00
Table 2 shows there is a significant positive relationship between information sources of
patients and decision-making regarding selecting a private dental provider in Jeddah, where
the values of (R, R Square, F) reached (0.28, 0.08, 6.32), Sig.(0.00). Therefore, the general
hypothesis is accepted.
1. There is a significant relationship between dentist attributes of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
To verify the hypothesis,a multiple regression equation has been applied to study the impact
of the dentist attributes to make decisions while choosing your dental provider.
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2016, Vol. 8, No. 4
Table 3. Result of regression for relationship between dentist attributes of the patients and
decision-making regarding selecting a private dental provider in Jeddah
Independent variables
T
R
Dentist attributes
1.8 0.12
R Square
0.01
F
Sig.
3.26 0.05
Table 3 shows there is a significant positive relationship between dentist attributes of the
patients and decision-making regarding selecting a private dental provider in Jeddah, where
the values of (R, R Square, F) reached (0.12, 0.01, 3.26), Sig.(0.05). Therefore, the general
hypothesis 2 is accepted.
3- There is a significant relationship between dental practice attributes of the patients and
decision-making regarding selecting a private dental provider in Jeddah.
To verify the hypothesis,a multiple regression equation has been applied to study the impact
of the dental practice attributes to make decisions while choosing a dental provider.
Table 4. Result of regression for relationship between dental practice attributes of the patients
and decision-making regarding selecting a private dental provider in Jeddah
Independent variables
T
R
R Square F
Dental practice attributes 3.00 0.20 0.04
Sig.
9.00 0.00
Table 4 shows there is a significant positive relationship between dental practice attributes of
the patients and decision making-regarding selecting private dental provider in Jeddah, where
the values of (R, R Square, F) reached (0.20, 0.04, 9.00), Sig.(0.00). Therefore general
hypothesis 3 is accepted.
This part includes results of the study depending on the impact of personal variables on the
answers of the respondents:
Gender:In order to study domains due to gender variable, T-test was applied;Table (4-10)
shows that.
Table 5. Result of T-test on domains (information sources, dentist attributes, dental practice
attributes) due to gender
Domain
Information Sources
Dentist Attributes
Dental Practice Attributes
Male
Female
Male
Female
Male
Female
75
Mean
4.26
4.18
3.95
3.75
3.90
3.70
S.D
0.55
0.91
0.79
0.98
0.70
0.96
T
0.82
Sig.
0.41
1.63
0.11
1.60
0.09
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Table 5 shows the T. values for the information sources, dentist attributes, dental practice
attributes, according to gender (0.82, 1.63, 1.63), by Sig. (0.41, 0.11, 0.09). This indicates
there are no significant differences due to gender.
5.1 Research discussion
Two hundred and twenty patients from different private hospitals in Jeddah city were included
in this research. The research sample consists of males and females, with the number of males
being approximately double the number of females. The research sample also used different
demographic data, e.g. nationality, income level, and education level.
Analysis shows that the information sources influence the purchasing decision-making of the
target market. The information sources in this research consist of three types, namely personal,
commercial, and public. These results are consistent with Coe’s (2013) study, where he found
that the comprehensive care patients are more likely to use information sources. The research
also concurs with Al-hussyeen’s (2009) study, where she found that personal information plays
a role in attracting new patients. Also Anastasios et al. (2001) found that patients are satisfied
regarding information in oral health.
The dentist attributes in this study were significant, and the researcher found that there is a
significant relationship between dentist attributes and patient decision-making. The results are
supported by Coe (2013) on dentist attributes. Al-hussyeen (2009) found that satisfaction with
dental care was found to be significant, with high quality of dental care. Also, Anastasios(2001)
found that empathy and assurance were placed at the top of the patients’ priorities.
Dental practice attributes have a significant influence on consumer behavior. These findings
are consistent with other researchers’ findings. Coe (2013) found that one of the most valuable
factors in choosing a dental service was that the dental practice must be covered by an
insurance network, and have a convenient physical location. Additionally, Newborn (2006)
found that there is an importance in the attribution of the concept of duty and culpability.
Moreover, Al-hussyeen (2009) found that convenient appointments, friendly staff and modern
dental clinics have a significant influence when choosing a dental practice.
Lastly, most of the literature review results were consistent with the current research. Besides
that, the previous studies were conducted in different countries around the world, which means
there are some similarities with different cultures regarding this topic.
6. Conclusion and Recommendation
The consumers / patients who visit dental clinics normally search for good, sufficient
information from different sources; this is because dental services have many providers in
Jeddah city, representing several sectors and different levels of quality and prices.
Dental practices in Jeddah city used many sources in order to promote their services, because
of the huge competition in the field. Regardless, most dental clinics do not use TV
advertisements. This is due to the high cost of advertisement and the availability of other
useful sources.
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The dentist attributes play a crucial role during the process of choosing a dental provider by
patients. This is due to the patient logically paying attention to the quality of care, which
represents the technical quality in different aspects (quality, appearance, reputation).
Therefore, dental practices must pay attention to the above-mentioned aspects. In particular,
there is huge competition in the Jeddah dental market.
The dental practice attributes also play a crucial role during the process of choosing a dental
provider by patients. This is due to the patient logically being attracted by certain factors
representing satisfaction and comfort, which is shown by different aspects (convenient office
times, waiting times, and staff attitude). Therefore, dental practices should pay attention to
the above-mentioned aspects.
7. Limitations and Avenues for Future Research
Although this research provides useful and valuable insight, there are some limitations, which
may limit generalizability:
1.
Distributing the research questionnaire suffered from certain problems, because of the
dental practices being in different places in Jeddah city.
2.
Some research respondents refused to accept the research questionnaire.
3.
This research has been conducted in a single health service industry, dental
practices,which implies that the research results can only be considered to be generalizable to
general private sector hospitals in Jeddah city.
In conducting this research,it was clear that several areas could benefit from further research
and future study. These areas include:
1.
Studying other health service sectors, e.g. public sector (MOH hospitals or Armed
Forces Hospitals) in order to develop a model that represents the health service sector more
generally, rather than representing the dental practices alone.
2.
The same model could be used in a comparative study between the dental services and
private hospitals in general.
References
Aafke V, Diana D., Roland D., & Jany R. (2012). Determinants of patient choice of
healthcare providers: a scoping review. Health Services Research, 12(272).
Al-Hussyeen AJA. (2009). Factors affecting utilization of dental health services and
satisfaction among adolescent females in Riyadh city. The Saudi Dental Journal, 22(1), 19-25.
http://dx.doi.org/10.1016/j.sdentj.2009.12.004
Anastasios K., Mando K., Demetra H., & Vassilis P. (2001). Expectations and perceptions of
Greek patients regarding the quality of dental health care. International Journal for Quality in
Health Care, 13(5), 409-416. http://dx.doi.org/10.1093/intqhc/13.5.409
77
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Journal of Management Research
ISSN 1941-899X
2016, Vol. 8, No. 4
Armstrong G., & Kotler P. (2013). Marketing: An Introduction. 11th edition, Pearson.
Coe J., & Qian F. (2013). Consumers’ choice of dentist by self-perceived need. International
Journal
of
Pharmaceutical
and
Healthcare
Marketing,
7(5).
http://dx.doi.org/10.1108/IJPHM-04-2013-0012
Creswell J. (2003). Research Design –Qualitative, Quantitative and Mixed Methods and
Approaches.Second Edition, Thousand Oaks, Calif, Sage Publication.
Grembowski D., Milgrom P., & Fiset L. (1988). Factors influencing dental decision making.
Journal
of
Public
Health
Dentistry,
48(3),
159-67.
http://dx.doi.org/10.1111/j.1752-7325.1988.tb03186.x
Heaton L., Smith T., & Raybould T. (2004). Factors influencing use of dental services in
rural and urban communities: considerations for practitioners in underserved area. Journal of
Dental Education, 68(10), 1081-9.
Kenneth R., Adrian S., & Gail B. (1997). Factors Affecting the Decision to Seek Health Care:
The Voice of Adolescents. Journal Of The American Academy Of Pediatrics, 100(6),
922-930. http://dx.doi.org/10.1542/peds.100.6.922
Laudon K.C. (2007). Management Information Systems. Upper Saddle River: Pearson. p. 229.
ISBN 978-0-13-157984-2.
Mon Mand NorkhafizahSH. (2011). Factors influencing patient satisfaction with dental
appearance and treatments they desire to improve aesthetics. Oral Health, 11(6).
Newsome P., & Wright G. (1999). A review of patient satisfaction: 2. Dental patient
satisfaction: an appraisal of recent literature. British Dental Journal, 186, 166-170.
http://dx.doi.org/10.1038/sj.bdj.4800053a
Palmer A. (2001). Principles of Services Marketing, Third Edition, McGraw-Hill Publishing
Company, UK.
Appendix
Research Questionnaire
Section One: Demographic Data
This section is designed to collect general information about the respondents and their hospitals.
Please tick the appropriate box in the following questions:
1.1 Age
Under 20
20-30
31-40
41-50
over 50
1.2 Gender
Male
Female
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1.3 Nationality
Saudi
Non-Saudi
1.4 Educational LevelSecondaryschool or less
Bachelor’s degree
Mastersdegree
Doctoral degree
1.5 Do you have dental insurance
Yes
No
1.6 Income Level
2000SR-5000SR
Above 5000-10,000SR
Above 10,000-20,000SR
Above 20,000SR
Section Two:
General question
When you first decided on this provider, were you seeking care from.................
A specific dentist who practices in the practice
The dentistry practice in general
From your point of view, how significant is your agreement of each of the following statements. You are kindly
1
2
3
4
important
Very
Important
important
Neutral
Not very
Degree of Agreement
at all
important
asked to mark (X) in the appropriate box that expresses your viewpoint on the following:
5
1- Information sources
In this section, we are asking about information sources you used when
selecting the dental provider. Please rate the source only if you used it.
-
How important were the following personal information sources to your dentist selection process?
1
2
3
4
Family
Friends
Former or current patients
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Other dentist
Physical or other healthcare professional
-
How important were the following commercial information sources to your dentist selection process?
Yellow Pages
Clinic website
Magazine/newspaper advertisement
Brochure/pamphlet
Television
-
How important were the following public information sources to your dentist selection process?
The internet
Magazine/newspaper articles
Insurance directory
Dental associations
City or county health services
Heard doctor speak
3- Dentist attributes
In this section, we are seeking information about dentist or
characteristics that you might have considered important in selecting
your dentist. Please note that we want to know about your dentist
selection process BEFORE your first visit.
-
Please indicate how important each attribute listed below was in helping you decide to come to the
dental provider.
Quality of care
Dentist's concern for patients/sensitivity
Personal appearance of the dentist
Reputation of the dentist
Dentist provides personal attention to diagnosis and aftercare
Professional competence of dentist
Dentist uses most up-to-date techniques
Explanation of treatment/your participation in the treatment decision
Number of years experience of the dentist
The dentist is in my insurance network
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Dental practice attributes
In this section, we are seeking information about dental office attributes
or characteristics that you might have considered important in selecting
your dentist. Please note that we want to know about your dentist
selection process BEFORE your first visit.
Atmosphere/appearance of the clinic
Attitude/helpfulness of staff
Reasonable waiting time to get appointments
Price
Convenient physical location
Convenient office hours
Whether the dentist accepts credit cards or provides credit
Ability to get appointment at convenient times
Time spent waiting in office
Whether the dentist's office will prepare insurance forms
Assigned dentist
Dentist provides you estimate of fees
Parking is convenient
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