ArticlePatient preference and adherence2026
Silent Dissatisfaction Despite High Patient Satisfaction Scores: A Pilot Cross-Sectional Survey of Urban Patients with Prior Rural Care Experience at a Tokyo Dental Clinic.
Article in Patient preference and adherence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: This pilot study examined whether patients who had experienced medical care in both urban and rural areas perceived differences in healthcare service experiences, negative emotions, and unvoiced concerns. The study focused on comparative perception and silent dissatisfaction that may not be captured by conventional patient satisfaction surveys. Patients and Methods: A cross-sectional, anonymous, self-administered paper questionnaire was conducted at a cooperating dental clinic in Tokyo. The questionnaire addressed hospital visit experiences in urban and rural areas by the same healthcare recipient. The dental clinic was used as a pragmatic field site; the survey asked about medical care experiences rather than dental satisfaction. Descriptive statistics were calculated for 90 respondents. Results: Among 90 respondents, 38 (42.2%) reported that they strongly or somewhat perceived differences between urban and rural care experiences, whereas 48 (53.3%) reported little or no difference and 4 (4.4%) were missing. Among the 38 respondents who perceived differences, 17 (44.7%) reported negative emotions such as inconvenience, discomfort, dissatisfaction, or endurance. Among the 20 respondents for whom expression of concerns was applicable, 7 (35.0%) communicated their concerns to the facility, whereas 13 (65.0%) did not. Among respondents with perceived differences who answered the comparison item, 8 of 32 (25.0%) reported that they recognized the feelings because they compared facilities across regions. Conclusion: High satisfaction scores and low complaint rates should not be interpreted as evidence that dissatisfaction is absent. These pilot findings are consistent with, but do not directly test, a reference-point interpretation. Larger multi-site studies using validated instruments are needed to examine the proposed mechanism and its implications for patient feedback systems.
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