How involvement in healthcare relates to attitudes towards the healthcare system: A participatory panel survey in Fryslân, the Netherlands

Background The Dutch healthcare system faces significant pressure from population ageing, resource constraints, and provider shortages, particularly in peripheral regions like Fryslân. Public attitudes toward healthcare reforms are crucial here as they affect the acceptability and sustainability of systemic changes, yet the influence of direct involvement (as patients or providers) on these attitudes remains underexplored. Methods We conducted a participatory panel survey among 3,230 residents of Fryslân to examine how direct involvement in healthcare, as a patient, provider, or both, relates to attitudes toward the healthcare system. The survey was co-developed and interpretated with Experts by Experience (EbE). Data were weighted to reflect the population, with missing values imputed. We used linear regression and post-hoc interaction analyses to assess how healthcare involvement and demographic factors (age, income, education) shaped views on satisfaction with the healthcare system and support for reform. Results Inhabitants generally had neutral attitudes towards the healthcare system, expressing moderate satisfaction and mild support for reforms. Direct involvement had a limited overall impact; however, healthcare providers showed more negative attitudes. Age was a significant predictor, with younger inhabitants (especially healthcare providers) showing greater dissatisfaction. The EbE involvement notably enhanced survey clarity and contextual relevance while fostering mutual learning. Conclusions This study highlights the necessity for a nuanced understanding of attitudes towards healthcare systems, emphasizing the interplay of demographic characteristics. They also underscore the need for both general and tailored reform strategies that incorporate diverse perspectives when strengthening healthcare systems, including those beyond patients and providers alone, to achieve legitimate and sustainable healthcare reforms.