BackgroundIn several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice.MethodsWe carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information.ResultsOur review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics.ConclusionsThere is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.

Functional foods and/or supplements may be used in the context of a healthy lifestyle or as a means to compensate for an unhealthy lifestyle. Adverse long-term and/or cumulative effects of functional food or supplement intake are of public health concern; it is therefore important to identify functional food and supplement users. The present study compared Dutch functional food and supplement consumers with non-consumers with regard to demographic and lifestyle factors. The consumption of the most common functional foods and supplements in 2000 was studied (yoghurt with extra lactic acid bacteria, cholesterol-lowering margarine, lemonade and sweets with extra vitamins and minerals, milk and margarine with extra Ca, Ca tablets, multivitamin and mineral supplements, and Echinacea supplements). Data were obtained from selfadministered questionnaires filled in by a consumer panel, aged 19 -91 years (response rate 76 %, n 1183), representative of the Dutch population. The number of daily consumers of functional foods or supplements appeared to be relatively low (daily use of multivitamin and mineral supplements, 20 %; all other products, 3 -9 %). Explanatory variables depended on the type of product; but gender, age, education, and vegetable intake were significant factors in the logistic regression model. Consumption of cholesterol-lowering margarines was more likely to be reported by individuals with a poorer subjective health (odds ratio 2·62 (95 % CI 1·15, 6·05)) and by smokers (odds ratio 2·93 (95 % CI 1·34, 6·40)). In conclusion, determinants of functional food or supplement use depended on the type of product, so generalisation of consumer characteristics over different foods is not legitimate. In addition to research on lifestyle factors, surveys about consumers' attitudes, norms and knowledge regarding functional foods in relation to actual dietary patterns and health risk profiles are necessary.

Surveying the literature on the assessment of quality of care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health care research, and dozens of measuring instruments were developed during the past decade. Quality of care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of quality of care from the patient's perspective. The authors consider patient satisfaction as an indicator of quality of care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure quality of care from the patient's perspective.

This article describes the development of a valid and reliable instrument to measure different dimensions of public trust in health care in the Netherlands. This instrument is needed because the concept was not well developed, or operationalized in earlier research. The new instrument will be used in a research project to monitor trust and to predict behaviour of people such as consulting "alternative practitioners". The idea for the research was suggested by economic research into public trust. In the study, a phased design was used to overcome the operationalization problem. In the first phase, a qualitative study was conducted; and, in the second, a quantitative study. In the first phase, more than 100 people were interviewed to gain insight into the issues they associated with trust. Eight categories of issues that were derived from the interviews were assumed to be possible dimensions of trust. On the basis of these eight categories and the interviews, a questionnaire was developed that was used in the second phase. In this phase, the questionnaire was sent to 1500 members of a consumer panel; the response was 70 percent. The analysis reveals that six of the eight possible dimensions appear in factor analysis. These dimensions are trust in: the patient-focus of health care providers; macro policies level will have no consequences for patients; expertise of health care providers; quality of care; information supply and communication by care providers and the quality of cooperation. The reliability of most scales is higher than 0.8. The validity of the dimensions is assessed by determining the correlation between the scales on the one hand, and people's experience and a general mark they would assign on the other. We conclude that public trust is a multi-dimensional concept, including not only issues that relate to the patient-doctor relationship, but also issues that relate to health care institutions. The instrument appears to be reliable and valid.