Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Understanding patient satisfaction is a central theme in today's healthcare landscape. The role of patient expectations and its impact on patient satisfaction has not been well understood in the context of a viable theoretical model. Thibault and Kelly's Theory of Interpersonal Relations and constructs of expectations in relationships are used to develop a framework for identifying the main factors driving both expectations and satisfaction. Measures are developed for comparison level of current outcomes compared to expectations (CL), comparison level of alternatives to care (CLalt), investment in selecting a physician, and prior satisfaction. Participants included a random sample of 500 primary care patient and 500 specialty care patients visiting an outpatient medical office in the South. Results indicated that CL, CLalt, and the interaction of CL-CLalt explain 47% of the variance in patient satisfaction. Specifically, CL significantly influenced satisfaction only when alternatives to care were considered more attractive. Emotional investment in selecting a physician correlated with satisfaction while overall investment and research investment was not a significant correlate. Prior satisfaction was also determined to have a positive relationship with satisfaction, however no significant relationship with CL and CLalt. Future research is needed to evaluate constructs of patient satisfaction, CL, CLalt, investment, and prior satisfaction in relation to other care settings, targeted patient demographic populations, and potentially other theoretical models (e.g. equity, communal.)

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.