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Running Head: HOSPITAL BRAND EQUITY 1

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Master thesis proposal

Hospital Brand Equity: the role of doctor reputation

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CHAPTER I

INTRODUCTION

HOSPITAL BRAND EQUITY 2

1.1 Research questions

The primary aspect of concern for this study is;

What is the role of doctor reputation in Hospital Brand Equity?

This is the main subject of concern which this research is out to solve. However, it

naturally leads to the cropping up of a host of other subsidiary questions which are

more or less prerequisites to the primary research question;

Does doctor reputation influence Trust positively?

Does doctor reputation influence Customer Satisfaction positively?

Does Customer Satisfaction influence Trust positively?

Does trust influence Relationship Commitment positively?

Does relationship Commitment influence Brand Loyalty positively?

Does trust influence Brand Awareness positively?

Does customer Satisfaction influence Brand Awareness positively?

Does brand Loyalty influence Brand Equity positively?

Does brand Awareness influence Brand Equity positively?

1.2 Background to the study

This research is integrating two separate frameworks. The management

framework based on Torres et al (2009) postulations and the marketing framework

based on Kim et al (2008) postulations. The hospital is regarded as a managerial

platform and then again as a marketing entity. These two conceptual frameworks are

overlapping. One leads to or depends on the other. On one hand the hospital is


regarded as a platform where management comes into play in order to coordinate the

efforts of the staff members and hospital assets so as to realise all the set objectives

explicitly. On the other hand, the hospital is regarded as a marketing entity where

there are limited patients who are willing and able to seek services from it and thus

the hospital needs to direct its efforts towards luring the patients to seek its services

specifically and to remain loyal.

Hospitals have over the years been primarily centers for the provision of

health care. They have grown by and by and have covered almost every locality in

most urban centers. This springing up of hospitals has led to a new turn of events in

the health care industry. Hospitals are engaging each other in cut throat competition

in an effort to survive in the ever dwindling market. They have turned to employing

marketing skills in conjunction with their professionalism in health care so as to win

the hearts of the ‘limited’ patients. This has led to hospitals seeking affiliations with

highly reputable doctors so as to build on their brand equity; which begs the question,

“What is the role of doctor reputation in Hospital Brand Equity?”

The fact that there is a dilemma in the role which the reputation of doctors

play in building Hospital Brand Equity is the key motivation to this study. Among

many services provided, going to hospital puts customers in one the most difficult

positions to choose from. This is more so considering its risk is related to customer’s

health. Which means brand equity plays an important role for hospitals, however, in

many countries it is legally not allowed to increase hospital brand equity through


advertising (Kirmani and Zeithaml, 1993). Under this rule, hospitals are considering

leaning on doctor reputation as a counter attack mechanism. Does doctors’ reputation

really have a positive impact in Hospital Brand Equity?

In the modern world, the pace of life becomes faster and faster, time seems to be

a scarcity even more. People confront the situation of making different choices almost

every minute, what to eat, what to wear, where to go, whom to meet, which to buy,

among others. Need is the reason. Thanks to the information we receive voluntarily or

passively, we form a certain kind of value system that helps us make all these

decisions. Most of the decisions that we make are involving other parties, a shop for a

product, a person for a communication, a hospital for a treatment etc. People always

want to make the right decisions to save time and enjoy the fulfilment of need, but

how? Experience tells us to make the right choice for many circumstances, but what

about the things we haven’t experienced. A new product, a new service, there are so

many new things waiting for us to try out, but how do we choose quickly and

correctly? Brand is a fast way to help us match a product or a service to our needs, it

is the gate to understand the things we haven’t experienced, and it is the name which

helps us to distinguish good or bad in those things we have experienced. Customer is

god, said by Lance Arrington (1991), companies and firms should focus on customer

need to form competitive advantages. Customers learn a company first through its

brand (Keller, 1993), the effectiveness of brand communication is important; brand

equity is a key to competitive advantage, business survival and success. Brand equity


became more and more popular among marketers and researchers (Cobb-Walgren et

al., 1995).

Brand equity has been studied by many scholars in the last decades. Branding

is important especially for service firms, service is intangible product, customer

perceives monetary, social, and safety risks in buying services, because it is not easy

to evaluate service before purchase, Berry (2000) tests strong brands increase trust in

intangible product, branding help customers better understand and visualize services.

Brand equity and customer relationship have been studied in many fields,

however in hospital market it still remains rather new, Kim, Kim, Kim, Kim, & Kang,

(2008) investigates structural relationships among brand equity and its factors,

(Torres, Vasquez-Parraga, & Barra 2009) points out the relationship among patient

loyalty, satisfaction, trust, relationship commitment and doctor reputation. Yet neither

academically nor practically, has the relationship between doctor reputation and

hospital brand equity been revealed. Thus, the purpose of this research is to shade

light on these controversial issues once and for all.

1.3 Objectives

1.3.1 Broad objective

To find out the role of doctor reputation in Hospital Brand Equity

This is the main objective of this study. It is broad and naturally answers or

requires the answering of other minor objectives. As stipulated by The Marketing

Accountability Standards Board (MASB), Hospital Brand Equity functions to

distinguish one hospital’s service as unique from those of others. This study majorly


aims at finding out the roe that the reputation of a doctor plays in making the services

of a particular hospital unique from those of the others.

1.3.2 Specific Objectives:

According to Philip, Wong , Armstrong and Saunders (2008) a service provider’s

reputation carries with it the knowledge of the needs and wants of the consumers

targeted and hence causes the delivery of the desired satisfactions. This implies that

the reputation of a doctor plays a role in satisfying the clients. If and when one gets

satisfied with something, he tends to build trust in it. Bearing this in mind, this

research aims at;

To find out whether doctor reputation influence Trust positively.

To find out whether doctor reputation influence Customer Satisfaction

positively.

To find out whether Customer Satisfaction influence Trust positively.

Philip, Wong, Armstrong and Saunders (2010) stipulate that companies build strong

Relationship Commitment so as to create value for their clients as well as for their

selves. This suggests that it increases brand loyalty. The fact that it creates value for

their clients suggests that the clients build trust in it and hence this research aims at;

To find out whether trust influence Relationship Commitment positively.

To find out whether Relationship Commitment influence Brand Loyalty

positively.


There are very many brands that are coming up every very often. With the hastily

rising force of globalization, the difference between marketing within a hospital's

local country and marketing in outside markets is fading very rapidly. Bearing this in

mind, hospitals should move with speed to reorganise their marketing tactics to meet

the test of the overall marketplace on top of maintaining their competitive edge within

local markets (Joshi and Mohan, 2005) . Hospitals are thus embracing the aspects of

building trust and customer satisfaction so as to enhance brand awareness and loyalty.

Therefore this research aims at;

To find out whether trust influence Brand Awareness positively.

To find out whether customer Satisfaction influence Brand Awareness

positively.

To find out whether brand Loyalty influence Brand Equity positively.

To find out whether brand Awareness influence Brand Equity positively.

CHAPTER II

2. Literature review

2.1 Overview

The relationship between doctor and patient is of prime significance in the

general health service. It is an exclusive connection which relies on trust as well as

confidence linking the parties involved for the delivery of excellent health care.

Efficient communication between the doctor and patient is a vital clinical utility in

constructing a curative doctor-patient association, which is the engine and fuel of


medicine. Much dissatisfaction from patients and numerous complaints are as a result

of the collapse in the relationship between doctor and patient (Ha, Anat, &

Longnecker, 2010). Torres et al., (2009) investigated the bond between patient

commitment, patient loyalty, patient trust and patient satisfaction as directed to

doctors.

2.2 Doctor reputation

A hospital is a professional service provider; doctors are the main assets of

hospitals. Torres et al., (2009) researches on the relationship among doctor reputation,

patient satisfaction, trust, commitment and loyalty, showed that patient satisfaction

and trust are affected by doctor reputation. A good doctor reputation increases patient

satisfaction and trust in a doctor. This leads to the formulation of this research’s prime

hypothesis that;

The doctor reputation plays a major role in enhancing Hospital Brand Equity.

When a hospital is affiliated with a highly reputed doctor, say for instance Benny

Carson, the brand name of that hospital is enhanced, just like John Hopkins Hospital

in this case.

A person’s reputation represents third-party experiences with a relationship

partner (Einwiller, 2003), or secondhand rumors that produce one’s general beliefs

about the subject of the rumors (McKnight & Chervany, 2001). Reputation is most

often analyzed in individual level. It is a mechanism for evaluating risk of interaction;

Dalton and Croft (2003) suggest such risk evaluating is important for any social


exchange. Accordingly, this issue can be transferred into doctor reputation easily; and

doctor reputation can be treated as a mechanism for patients to evaluate risk of

interacting with the hospital. That is to say, doctor reputation gives ability to

anticipate future outcome of the service. Positive doctor reputation signals of high

level of trustworthiness and low level of risk, and therefore can play a role of catalyst

in making a decision to revisit and recommend to others. In business literature

reputation is linked to both customer satisfaction and trust. It can positively and

directly influence satisfaction (Andreassen, 1994) A person’s reputation affects

others’ trust in that person (Casalo, Flavi_an, & Guinalı´u, 2007). Doctor’s reputation

has a role in how patients gain trust in their hospitals. Patient satisfaction and trust are

affected by doctor reputation. A good doctor reputation increases patient satisfaction

and trust in a doctor (Torres et al., 2009). Thus leading to the formulation of

hypotheses regarding doctors’ reputation and customer satisfaction considering the

research question that;

Doctor reputation influence Customer Satisfaction positively.

A highly reputed doctor is more likely to instil the notion of total satisfaction on the

patients he treats as compared to the lowly regarded doctors.

The reputation of a doctor plays a major part in how patients grow trust in their

providers of medical service. Mechanic & Meyer (2000) established that relationships

in the medical field are usually initiated on the foundation of recommendations of

friends and family, consequently trust primarily may be founded on reputation.


Satisfaction of the patient along with trust is influenced by the reputation of the doctor

(Torres et al., 2009). The reputation a person’s in business is related to trust and

customer satisfaction. The latter can also be affected by the corporate image (Bloemer

& de Ruyter, 1998; LeBlanc & Nguyen, 1996). The reputation of a person’s

influences the trust of others’ towards that person (Casalo, Flavian, & Guinaliu,

2007), predominantly in relationships that are long-term which incorporate historical

events that represent reliability (Anderson & Weitz, 1989). It is also possible to

establish trust at the start of a relationship (Einwiller, 2003). These lead to the

formulation of this research’s hypothesis regarding doctors’ reputation and trust in the

research questions that;

Doctor reputation influence Trust positively.

When a patient is poised to receives treatment from a highly reputable doctor, he or

she is more likely to develop confidence and trust in the treatment that he is about to

receive.

2.3 Factors related to doctor reputation and brand equity

Kim et al., (2008) discussed from a customer relationship management

perspective about brand equity in hospital marketing, the results have shown trust,

customer satisfaction, relationship commitment all have positive influence on brand

loyalty and brand awareness, and brand awareness has strong positive influence on

hospital brand equity. In addition, patient satisfaction and trust are affected by doctor

reputation. A good doctor reputation increases patient satisfaction and trust in a


doctor. Torres et al., (2009) researched on the process of patient loyalty formation, the

factors doctor reputation, trust, customer satisfaction and relationship commitment

and the result has revealed a sequential process from trust to satisfaction to

relationship commitment and finally to building loyalty. These lead to the

construction of a model that explain the relationships among doctor reputation, brand

equity and the influencing factors for building successful brand equity: trust,

satisfaction, relationship commitment, brand loyalty, and brand awareness:

Based on researches, the factors related to doctor reputation and brand equity

are as follows:

RelationshipCommitment

Trust

BrandLoyalty

CustomerSatisfaction

DoctorReputation

BrandEquity

Brand Awareness


(1) Trust.

(2) Customer satisfaction.

(3) Relationship commitment.

(4) Brand loyalty.

(5) Brand awareness.

Each factor is discussed in turn below.

2.3.1. TRUST

Trust is defined as the perceived credibility and benevolence of a target party

(Doney and Cannon, 1997). Customer trust relies on interactions involving reliability,

durability, and integrity between at least two parties who mutually believe that one’s

actions are devoted to the interest and benefit of the other party in the relationship

(Peppers & Rogers, 2004). Accordingly, the first dimension focuses on the objective

believability of an exchange partner, as in an expectancy that one can rely on the

partner's word or written statement. The second dimension is the extent to which one

partner is genuinely interested in the other's welfare and motivation to seek joint

gains. In the health care context, if trust is formed, patient would rely on doctor’s

word and doctor is truly interested in patient’s welfare to benefit mutually.

Considering this, an hypothesis related to the research question that links trust and

relational commitment can be drawn that;


Trust influence Relationship Commitment positively.

When one trusts a particular phenomenon, he or she is more likely to develop

relational commitment to the phenomenon as compared to when there is no trust.

Sharma & Patterson (1999) have found that trust precedes commitment in

business-to-customer relationships. More specifically, Torres et al., (2009) tested trust

in doctors to patient’s relationship commitment.

Mayer, Divan, & Schoorman (1995) described the trust of a patient as being

present when a patient is ready to admit his susceptibility to a trustee’s conduct. This

readiness is founded on the basis that the patient permitted the trustee to carry out a

tremendously significant act for him and anticipated to get a positive comeback from

the trustee, all though it may be hard to examine and manage the trustee’s comeback.

Doney & Cannon (1997) disclose that this trust comes from an exhibition of

dependability and generosity by the trustee which can be known by us. This

knowledge definitely increases the awareness of the trustee’s brand and hence the

formulation of the research hypothesis that;

Trust influence Brand Awareness positively.

When one trusts something it is more likely that he and those around him shall be

more aware of the brand.

Nevertheless, Kristof, Gaby & Dawn (2001) suggested that the degree of the

trust is influenced by the height of reliance on and tribute that the user shows towards

the provider of the service. Berry, Parish, Janakiraman, Ogburn-Russell, Couchman,

& Rayburn (2008) recount trust in doctors to the relationship commitment of the


patient’s so as to “advance our comprehension of the relationship between the patient

and the physician

2.3.2. CUSTOMER SATISFACTION

Customer satisfaction involves both customers’ expectations and perceptions

of received services (Zeithaml & Bitner, 2002). Customers' good experiences create

satisfaction, many studies states that when products or services exceed customers'

expectations, they intend repurchasing. Customers who have confidence in a company

will continue to buy its products or services that satisfy them. If people do not obtain

their expectations, they will become dissatisfied. Customer satisfaction has been

found to affect trust in service encounters (Selnes, 1998; Flavian, Guinalı´u, &

Gurrea, 2006) by increasing customer trust (Singh & Sirdeshmukh, 2000). This draws

the hypothesis in view of the research questions that;

Customer Satisfaction influence Trust positively.

When one is satisfied by something, he is more likely to trust in it.

According to Kim et al., (2008), customer satisfaction can affect brand

awareness of a hospital. Regarding relationships in health services, Leisen and Hyman

(2004) and Torres et al., (2009) tested the relationship between customer satisfaction

and customer’s trust in medical service provider. Bearing this in mind, a hypothesis

answering a research question is formulated as;

Customer Satisfaction influence Brand Awareness positively.


When one is satisfied by a product, it is more likely that he and those around him shall

be more aware of the product’s brand.

Howard & Sheth (1969) proposed that customer satisfaction can be described by

appraisal as well as customer comparison. They postulated that the satisfaction of

customer was a single type of cognition state that assessed response founded on

purchase appropriateness following the making of the purchase. The satisfaction of

the customer has been established to influence service reception by improving or

raising customer trust (Flavian, Guinaliu, & Gurrea, 2006; Roman, 2003). The

association may engage a process of triumphant transactions, customers getting

satisfied, customers progressively relying on a provider of a service and also

customers progressively trusting the root of the satisfaction (Ravald & Gronroos,

1996; Torres et al., 2009). Cardozo (1965) said that customer satisfaction guide to

repeated purchase conduct and buying of further products offered by the same

provider. Concerning associations in health care services, Leisen & Hyman (2004)

examined the association between customer’s trust and customer satisfaction in heath

care service providers.

2.3.3. RELATIONSHIP COMMITMENT

Berry and Parasuraman (1991) believe relationships are built on the

foundation of mutual commitment. Relationship commitment involves an enduring

desire to keep an identified relationship mainly because it is considered valuable to


the involved parties (Garbarino & Johnson, 1999).To attain the trust and satisfaction

of patients, physicians need to establish a relationship that meets patients'

expectations in term of being supportive and actively involving them in decision-

making (Montaglione, 1999). Customer commitment has been shown to be crucial in

the formation of customer loyalty (Oliver, 1999; Fullerton, 2003), particularly when

commitment is based on shared values and customer sympathy with the service

provider. More specifically, recent studies on hospital marketing have underscored the

importance of the effects of relationship commitment on the loyalty of a patient to a

hospital (Kim et al., 2008; Torres et al., 2009). In this regard, a hypothesis tackling a

research question in this study is formulated as;

Relationship Commitment influence Brand Loyalty positively.

When one is more relationally committed to a product or service, he is more likely to

develop loyalty to that brand.

Moorman, Zaltman, and Deshpande (1992) described relationship

commitment as a lasting wish to uphold a valued association. A valued association is

present when the association is regarded as important. ‘Lasting wish to uphold’

generally means that a dedicated partner requires the relationship to last for an

indefinite period and is ready to work at upholding it. Morgan & Hunt (1994)

described commitment as a trade partner trusting that a continuing relationship with a

counterpart is so significant as to merit utmost effort to uphold it. They regard

relationship commitment as key to all relational interactions amid the service


providers and the customers. Certainly, previous studies on health care marketing

have highlighted the significance of the influences of relationship commitment

towards the loyalty that a patient has regarding a hospital (Kim et al., 2008); (Torres

et al. 2009).

2.3.4. BRAND LOYALTY

Loyalty is ‘‘a deeply held commitment to rebuy or repatronize a preferred

product/service consistently in the future, thereby causing repetitive same-brand or

same brand-set purchasing, despite situational influences and marketing efforts having

the potential to cause switching behavior’’ (Oliver, 1999, p34). Aaker (1991, 1996)

argues that brand equity is a multidimensional construct that consists of brand loyalty,

brand awareness, and other proprietary brand assets. Aaker (1991) also proposes

measuring brand equity through price premiums, brand loyalty, perceived quality, and

brand awareness.

Oliver (1997) stated true loyalty includes both behavioral and attitudinal

components. Behavioral loyalty alone reflects repeated purchase and has to be

accompanied by attitudinal loyalty to adequately represent what customer loyalty is.

Customer commitment is what distinguishes true loyalty from repeated purchase or

spurious loyalty (Jacoby & Kyner, 1973; Amine, 1998). True loyalty may generate

word-of-mouth communication which can attract new patients and produces


potentially positive cognitive and affective attitudes toward the hospital. Thus

considering the research question of this study that links brand loyalty and brand

equity, a hypothesis is formulated as;

Brand Loyalty influence Brand Equity positively.

When one is more loyal to a given brand, it is more likely that the brand shall enjoy

higher levels of brand equity from him and the people around him.

Loyalty is an intensely detained commitment to re-patronize or re-buy a favorite

product and / or service constantly in the future, thus leading to recurring same brand-

set or same-brand buying, in spite of situational pressures and marketing powers

having the possibility to cause alternative deeds (Oliver, 1999). True loyalty can

produce word-of-mouth contact which can lure new patients as well as make

potentially positive attitudes toward the healthcare service provider (Torres et al.,

2009). Detailing how the doctor patient loyalty is created needs investigative the past

history of customer loyalty. Three major antecedents that explain the course that

patients pursue in getting loyal to their health providers are satisfaction, commitment

and trust with the doctors. A major antecedent on the healthcare service provider’s

part is reputation. The existence and improvement of these attributes would not only

produce but also uphold the procedure of creating patient loyalty (Torres et al., 2009).

2.3.5. BRAND AWARENESS

Aaker (1991) defines it as the ability of a potential buyer to recognize or recall

a brand as a member of a certain product category. Keller (1993) further states brand


awareness has two dimensions: brand recall and brand recognition. Brand recognition

is the basic step of brand communication, where the firm communicates the products’

attributes to customers until the brand name is associated to brand name. In hospital

marketing, word-of-mouth communication which generated by true loyalty could help

build brand recognition. Brand recall means customer’s memory brings back brand

name when it is under certain circumstances. Aaker (1991) states brand awareness is a

sign of quality and commitment, helping consumers become familiar with a brand and

consider it at the point of choice. Moreover recent studies on hospital marketing have

underscored the importance of the effects of brand awareness on the brand equity of a

hospital (Kim et al., 2008). These postulations lead to the formulation of another one

of this research’s hypothesis that;

Brand Awareness influence Brand Equity positively.

When one is more aware of a given brand, it is more likely that the brand shall enjoy

higher levels of brand equity from him and the people around him.

2.4. Brand equity

Aaker (1991) defines brand equity as a set of assets (or liabilities) linked to a

brand’s name and symbol which adds to the value provided by a product or service to

a firm and/or that firm’s customers. Keller (1993) states brand equity can be seen as

the value added to the product, or the perceived value of the product in consumers'

minds. Several researchers discuss brand equity based on two dimensions: consumer


perception and consumer behavior. Aaker (1991) suggests measuring brand equity

through price premium, loyalty, perceived quality, and brand associations. Viewing

brand equity as the consumer's behavior toward a brand, Keller (1993) proposes

similar dimensions: brand awareness and brand knowledge. Thus, past studies tend to

identify brand equity as a multidimensional construct consisting of brand loyalty,

brand awareness, brand knowledge, customer satisfaction, perceived equity, brand

associations, and other proprietary assets (Aaker, 1991, 1996; Blackston, 1995; Cobb-

Walgren et al., 1995; Na, 1995). Other studies tend to regard brand equity and other

brand assets, such as brand knowledge, brand awareness, brand image, brand loyalty,

perceived quality, and so on, as independent but related constructs (Keller, 1993;

Kirmani and Zeithaml, 1993). Keller (1993) claims, a positive customer based brand

equity can lead to better revenue, higher price, lower cost, higher profit, and

consumer’s willingness to seek new channels, more effective marketing

communication etc. In hospital marketing, Kim et al., (2008) has suggested hospital

can succeed in creating positive brand equity by managing relationships with their

customers well.

3. Methodology

3.1. Overview


A research framework will be designed to test the previously mentioned

hypothesized relationships among doctor reputation, trust, customer satisfaction,

relationship commitment, brand loyalty, brand awareness and brand equity in the

hospital market. This research employs the use of Structural equation modelling.

Statistical data shall be collected and used to test as well as to estimate causal

assumptions (Sewall, 1921)

3.2 study design

A cross-sectional study will be used to test the strength of association between the

variables. It is the study design of choice because it is inexpensive, takes a short time,

and offers more feasibility (Punch, 2005)

3.3 Study Area

Due to the practical necessity and restraint of research capability, the research will be

conducted in one city in China. Subjects are taken from the patients in Xi’an region.

The sample size will contain 200 patients. A standardized questionnaire will be placed

on the internet, it consisted of items for measuring the dimensions of brand equity,

and overall brand equity, as well as demographic questions. The research shall

therefore majorly concentrate and collect first hand information from the Chinese city

of Xi’an. Being that the questionnaire shall also be placed on the internet; the research

shall also collect information from the wide world (Punch, 2005)

.

3.4 Target population


The targeted population for this study shall be the patients. They are the consumers

for healthcare services. They are the best placed to tell whether or not the reputation

of doctors in the health care industry affects the Hospital Brand Equity. A directly

affected target population should be chosen (Punch, 2005). The people in Xi’an City

of China fall sick just like all the people all over the globe. They go out in pursuit of

medical care. They are faced with the dilemma of choosing the best health care centre

to visit for treatment from the host of health care centres in the city. This puts them in

a position to be able to weigh the different degrees of Hospital Brand Equity that the

numerous health centres have. They are the spectators and participants in the brawl

against hospitals. Being that there are a number of both highly and lowly reputed

doctors in the City, the habitants of the City are a very good source for answering the

question of whether or not the reputation of doctors has a hand in the Brand Equity of

Hospitals.

3.5 Inclusion and exclusion criteria

The inclusion criterion is well articulated so as to collect data from the right

population and in an ethical manner (Cohen, Mannion and Morrison, 2000). The

population which shall be specifically included in this study are the people who seek

health care services from health care centres and are over 18 years of age. These are

people who are grown up enough. They are capable of authentically choosing right

from wrong. They are not easily manipulated by unreasonable information. These


people are also most likely footing their own healthcare bills. This make them feel the

pinch of any dissatisfaction resulting from poor healthcare services. They are thus the

best source of information (Punch, 2005).

The inclusion criterion also stipulates that the population to be considered

viable for the research should also be willing to participate in the study (Cohen,

Mannion and Morrison, 2000). They are required to append their signature in that

effect. Any questionnaires which shall be filled without the respondent’s consent shall

be considered null and void for the research. These kinds of respondents are most

often than not blatant lies. They are made as a result of aspects like force or peer

pressure which is not good for an authentic research.

The exclusion criterion is employed to lock out those who are not considered

viable to take part in the research study (Punch, 2005). These are deemed to provide

unreliable information which shall compromise the effectiveness of the research.

They are the children who are below 18 years of age. These are considered as not

mature enough to give satisfactory information for effective determination of the

research question.

The exclusion criterion also locks out the people who did not consent to

participate in the study (Cohen, Mannion and Morrison, 2000). If one is not willing to

take part in the study, he should not be compelled to do the contrary. He would end up

doing it grudgingly and offer extremely non reliable information.

3.6 Sampling technique and sample size


Patients in comprehensive care clinic meeting the inclusion criteria will be selected

from the general public using systematic random sampling method until the required

sample size is obtained (Cohen, Mannion and Morrison, 2000). The sampling interval

is: K=Sampling frame (N)/Sample size (n/). The sample size will be determined by

the formula:

n= Z²P(1-P)

d²

n = sample size,

Z = Z statistic for a level of confidence, (for 95% confidence Z= 1.96)

P = expected prevalence or proportion (50%) and

d = precision (in proportion of one; if 5%, d = 0.05)

n= (1.96)2x 0.5x 0.5/ (0.05)2 = 384

3.7 Research instrument and Data collection techniques

The population in the inclusion criteria are the major sources of data apart from the

recorded literature from which I shall seek information. These people are very

dependable sources of data if the data is collected correctly (Cohen, Mannion and

Morrison, 2000). I shall make it my personal duty and responsibility to see to it that

the data is suitable and dependable. The core mode of collecting data that I shall

employ is;

- Using questionnaires


The chief instrument that I am going to employ in this research study is the

personally prepared questionnaire. I have individually written up the questionnaire so

as to increase its efficiency to the subject of my research (Cohen, Mannion and

Morrison, 2000). The instrument (questionnaire) shall not need the correspondent to

disclose his or her personal identity. Generally speaking, correspondents feel more

comfortable to tell the truth incognito (Cohen, Mannion and Morrison, 2000. I have

made most of the parts of the questionnaire ‘ticking’ affair. The correspondents are

only required to tick the appropriate choice in most parts. This serves to make simpler

the effort of the correspondents. Majority of the people do not fancy doing too much

writing or have limited time to spare (Punch, 2005). In addition, I have also made

short the questions and strictly to the point. This shall serve to evade forcing the

respondents to read a lot of literature. I have as well used basic simple language. This

shall be understandable by every single individual who comprehends Basic English. I

have finally left a space at the foot of the questionnaire which shall directs or allow

the respondents to provide whatever data they consider pertinent to the subject which

is not tackled by the questionnaire.

Using the questionnaires, I will also manage to get to a wide range and

enormous number of the respondents through the internet (Cohen, Mannion and

Morrison, 2000). This broadens the scope of the study. It in turn shall lead to a more

decisive resolution.


The questionnaire bears questions that need the respondents to give their age

and marital status. This gives the research a picture of the level of maturity of the

respondent and hence the degree to which his response can be relied upon (Cohen,

Mannion and Morrison, 2000). It also requires the respondent’s education level which

hence shows the level of comprehension of the respondent. Another question is the

employment status of the employee which shows whether or not the respondent

personally feels the pinch of spending his hard earned money or the money he spends

on health care service is provided for by a third party (Punch, 2005).

There is a minimum of two questions in the questionnaire for each of the

relational factors as in the research question to enhance the effectiveness of the

collection of reliable data (Punch, 2005). The questions are also not leading questions.

The respondents are supposed to reason by themselves and provide answers for the

questions in the questionnaire without undue influence from the nature or structure of

the questions themselves (Cohen, Mannion and Morrison, 2000).

I shall commence by searching for information in the recorded literature. This

provides the general research question background (Cohen, Mannion and Morrison,

2000). It gives a base and foundation on which the research shall be made around. At

last I will employ the use of questionnaires for research data collection.

There are a host of risks to the process of collecting data (Punch, 2005). These

may cause the collection of incorrect information which shall eventually lead to the

making of erroneous conclusions. The risks are principally:


- respondents lying Intentionally

- barriers in Language and accents

- respondents illegible handwriting

- experts postulating contradicting views

These risks may generate a huge threat to the valid nature of the study (Cohen,

Mannion and Morrison, 2000). So as to restrain these challenges, I am going to

employ a host of counter measures. I will collect information from numerous

respondents so as to dilute off the data from the respondents who are lying

intentionally (Punch, 2005). I will also tape record the interviews so as to look for a

third party’s aid in situations where the accent or the language is a barrier to efficient

communication. I shall also use third parties to enable me in interpreting what

illegible handwritings are conveying. So as to sort out the issue of the contradicting

views postulated by the experts, I will use the gathered evidence which I shall have

from the other sources of information.

3.8 Data analysis

Each collected data will be cleaned, checked for completeness, coded and

analyzed with EPI-info program (Cohen, Mannion and Morrison, 2000). Relevant

tables and figures will be used to display results. Range and mean will be analyzed

and appropriate tables, graphs and percentage will be displayed (Fielding, 2004).

3.9 Ethical consideration


To cater for ethical issues relating to the study; Permission to carry out the

research study will be sought from all the related bodies of authority including the

concerned authorities at the study area (Kellett, 2005a). Informed consent will be

sought from all the study participants. Confidentiality, anonymity and privacy will be

fully guaranteed.

Some people may argue that the process of collecting data from a certain class

of individuals in the community is not ethical (Cohen, Mannion and Morrison, 2000).

They claim that handing questionnaires to, conducting observations or carrying out

interviews with these people is ignorance of ethics. These elite people in the society

may include politicians, religious leaders, police officers among others. I strongly

disagree with this since the ethical attribute of these activities is entirely based on the

approach by which they are carried out. I will carry out these activities with extreme

respect as well as professionalism. This will get rid of all aspects of immorality in

data collection.

3.10 Validity and Reliability

The instrument of research will be tested for reliability by use of the

Cronbach’s coefficient alpha estimate. In case all the values for all dimensions will be

ranging say between 0.90 and 0.97, which in essence exceeds the least alpha of 0.70

(Hair, Black, Babin, Anderson, & Tatham, 2010), then the measures of the constructs

will be deemed reliable. The Pearson correlations will be calculated so as to identify

the correlations that exist between the variables. In addition to that, the mean score of


the several items for a construct will be calculated because a solitary construct in the

prepared questionnaire will be measured by numerous items, and the result will be

used in a supplementary analysis like a regression analysis and correlation analysis

(Wang & Benbasat, 2007). In accordance to Field (2005), the coefficient of

correlation must not go further than 0.8 so as to evade multicollinearity. If the

uppermost correlation coefficient will be less than 0.8, then there will be no

multicollinearity dilemma in this research.


Reference

Selnes, F. (1998). Antecedents and consequences of trust and satisfaction in buyer–

seller relationships. European Journal of Marketing, 2, 305–332.

Sharma, N., & Patterson, P. (1999). The impact of communication effectiveness and

service quality on relationship commitment in consumer, professional services.

Journal of Services Marketing, 13, 151–170.

Singh, J., & Sirdeshmukh, D. (2000). Agency and trust mechanisms in relational

exchanges. Journal of the Academy of Marketing Science, 28, 150–167.

Zeithaml, V., & Bitner, M. J. (2002). Services marketing (2nd ed.). New York:

McGraw-Hill=Irvin.

J.F. Ha, D.S. Anat, and N. Longnecker. Doctor-patient communication: A review.

Ochsner J. 2010, 10 (1): 38-43.

R.L. Oliver. Whence consumer loyalty? J Marketing. 1999, 63: 33-44.

E. Torres, A.Z. Vasquez-Parraga, and C. Barra. The path of patient loyalty and the

role of doctor reputation.

Health Market Q. 2009, 26: 183-197.

C. Moorman, G. Zaltman, and R. Deshpande. Relationships between providers and

users of market research: the

dynamics of trust within and between organizations. J Market Res. 1992, 29 (3): 314-

328.


K.H. Kim, K.S. Kim, D.Y. Kim, J.H. Kim, and S.H. Kang. Brand equity in hospital

marketing. J Bus Res. 2008,

61: 75-82.

R.C. Mayer, J.H. Divan, and F.D. Schoorman. An integrative model of organizational

trust. Acad Manag Rev.

1995, 20 (3): 709-734.

D.W. Kristof, O.S. Gaby, and I. Dawn. Investments in consumer relationships: A

cross-country and cross-industry

exploration. J Marketing. 2001, 65 (4): 33-50.

L.L. Berry, J.T. Parish, R. Janakiraman, L. Ogburn-Russell, G.R. Couchman, W.L.

Rayburn, et al. Patients’

commitment to their primary physician and why it matters. Ann Fam Med. 2008, 6: 6-

13.

L. Casalo, C. Flavian, and M. Guinaliu. The influence of satisfaction, perceived

reputation and trust on a

consumer’s commitment to a website. J Market Comm. 2007, 13: 1-17.

S. Einwiller. When reputation engenders trust: An empirical investigation in business-

to-consumer electronic

commerce. Electron Market. 2003, 13: 196-209.

J.F. Hair, B. Black, Babin B., R.E. Anderson, and R.L. Tatham. Multivariate Data

Analysis: A Global Perspective,

Pearson Education Inc., NJ, 2010.


Aaker DA. Measuring brand equity. New York: Free Press;1991.

Aaker DA. Building strong brands. New York: Free Press;1996.

Amine, A. (1998). Consumers’ true brand loyalty: The central role of commitment.

Journal of Strategic Marketing, 6, 305–319.

Andreassen, T. (1994). Satisfaction, loyalty and reputation as indicators of customer

orientation in the public sector. International Journal of Public Sector Management, 7,

16–34.

Berry LL. Cultivating service brand equity. J Acad Mark Sci2000;28(1):128-37.

Berry LL, Parasuraman A. Marketing service: competing through quality. New York:

Free Press; 1991.

Blackston M. Copy-testing and brand equity: what's the connection? J Adv Res

1995;35:RC2–7 [January–February].

Casalo, L., Flavi_an, C., & Guinalı´u, M. (2007). The influence of satisfaction,

perceived reputation and trust on a consumer’s commitment to a website. Journal of

Marketing Communications, 13, 1–17.

Cobb-Walgren, C.J., Beal, C. and Donthu, N. (1995), Brand equity, brand

perderences, and purchase intent, Journal of Advertising, Vol.24 No. 3, pp. 25-40.

Dalton, J., & Croft, S. (2003). Managing Corporate Reputation: The New Currency.

London: Thorogood.

Doney PM, Cannon JP. An examination of the nature of trust in buyer–seller

relationships. J Mark 1997;61:35–51 [April].


Eduardo Torres, Arturo Z. Vasquez-Parraga & Cristobal Barra (2009): The Path of

Patient Loyalty and the Role of Doctor Reputation, Health Marketing Quarterly, 26:3,

183-197

Einwiller, S. (2003). When reputation engenders trust: An empirical investigation in

business-to-consumer electronic commerce. Electronic Markets, 13, 196–209.

Flavi_an, C., Guinalı´u, M., & Gurrea, R. (2006). The role played by perceived

usability, satisfaction and consumer trust on website loyalty. Information &

Management, 43, 1–14.

Fullerton, G. (2003). When does commitment lead loyalty? Journal of Service

Research, 5, 333–345.

Garbarino, E., & Johnson, M. (1999). The different roles of satisfaction, trust, and

commitment in customer relationships. Journal of Marketing, 63, 70–87.

Jacoby, J., & Kyner, D. (1973). Brand loyalty vs. repeat purchasing behavior. Journal

of Marketing Research, 10, 1–9.

Keller, K.L. (1993), “Conceptualizing, measuring, and managing customer-based

brand equity”, Journal of Marketing, Vol. 57 No. 1, pp. 1-22.

K.H.Kim et al., Brand equity in hospital marketing, J Bussiness Research 61(2008)75-

82.

Kirmani A, Zeithaml VA. Advertising, perceived quality, and brand image. In: Aaker

DA, Biel AL, editors. Brand equity and advertising: advertising's role in building

strong brands. LEA; 1993. p. 143–62.


Kohli R, Piontek F, Ellington T, VanOsdol T, Shepard M, Brazel G. Managing

customer relationships through e-business decision support applications: a case of

hospital–physician collaboration. Decis Support Syst 2001;32:171–87.

Lance Arrington, (1991) "The customer is God", Managing Service Quality, Vol. 1

Iss: 1, pp.23 - 26

Leisen, B., & Hyman, M. R. (2004). Antecedents and consequences of trust in a

service provider: The case of primary care physicians. Journal of Business Research,

57, 990–999.

McKnight, D., & Chervany, N. (2001). Conceptualizing trust: A typology and e-

commerce customer relationship model. In R. H. Sprague (Ed.), Proceedings of 34th

Annual Hawaii International Conference on System Science (HICSS 2001) (pp. 32–

38). Los Alamitos, CA: IEEE Computer Society.

Montaglione, C. (1999). The physician–patient relationship: Cornerstone of patient

trust, satisfaction and loyalty. Managed Care Quarterly, 7, 5–21.

Na, 1995 Na WB, Measuring brand power: a model using preference regression.

Unpublished PhD Thesis, NTU of Singapore, 1995.

Oliver, R.L. (1997), Satisfaction: A Behavioral Perspective on the Consumer,

McGraw-Hill, New York, NY.

Oliver, R. L. (1997). Satisfaction: A behavioral perspective on the consumer. New

York: McGraw-Hill.

Oliver, R. L. (1999). Whence consumer loyalty? Journal of Marketing, 63, 33–44.


Pappu R, Quester P. Does customer satisfaction lead to improved brand equity? An

empirical examination of two categories of retail brands. J Prod Brand Manag

2006;15(1):4-14.

Peppers, D., & Rogers, M. (2004). Managing customer relationship. Hoboken, NJ:

John Wiley and Sons.

Cohen, L., L. Mannion, and K. Morrison. 2000 Research methods in education.

London: RoutledgeFalmer.

Kellett, M. 2005a. How to develop children as researchers: A step-by-step guide to

teaching the research process. London: Paul Chapman Publishers.

Punch, K.F. 2005. Introduction to social research: Quantitative and qualitative

approaches. London: Sage.

Fielding, M. 2004. Transformative approaches to student voice. British Educational

Research Journal 30, no. 2: 295–312.

Kotler Philip, Gary Armstrong, Veronica Wong, John Saunders (2008). "Marketing

defined". Principles of marketing (5th ed.).

Kotler Philip, Gary Armstrong, Veronica Wong, John Saunders (2010). "Marketing

defined". Principles of marketing (5th ed.).

Joshi, Rakesh Mohan, (2005) International Marketing, Oxford University Press, New

Delhi and New York ISBN 0-19-567123-6

Wright, Sewall S, (1921) Correlation and causation. Journal of Agricultural

Research 20: 557-85.

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