Professional Documents
Culture Documents
net/publication/262575149
CITATIONS READS
78 6,437
3 authors:
Enrique Becerra
Pontifical Catholic University of Peru
12 PUBLICATIONS 79 CITATIONS
SEE PROFILE
All content following this page was uploaded by Elyria Kemp on 20 August 2014.
Abstract
Purpose – Brands can imbue unique meaning to consumers, and such meaning and personal experience with a brand can create an emotional
connection and relationship between the consumer and the brand. Just as many service providers have adopted branding strategies, marketers are
branding the health care service experience. Health care is an intimate service experience and emotions play an integral role in health care decision
making. The purpose of this paper is to examine how emotional or affect-based consumer brand relationships are developed for health care
organizations.
Design/methodology/approach – Empirical evidence from both depth interviews and data garnered from 322 surveys were integrated into a
conceptual model. The model was tested using structural equation modeling.
Findings – Results indicate that trust, referent influence and corporate social responsibility are key variables in establishing affective commitment in
consumer brand relationships in a health care context. Once affective commitment is achieved, consumers may come to identify with the health care
provider’s brand and a self-brand connection is formed. When such a phenomenon takes place, consumers can serve as advocates for the brand by
actively promoting it via word-of-mouth.
Practical implications – The findings provide insight for marketing managers in developing successful branding strategies for health care organizations.
Originality/value – This research examines the advantages of cultivating meaningful brand connections and relationships with consumers in a health
care context.
An executive summary for managers and executive Cleveland Clinic, Johns Hopkins, Memorial Sloan-Kettering
readers can be found at the end of this issue. and Massachusetts General Hospital have increased efforts to
reinforce their brands (Thomaselli, 2010). A brand is a
I must say that I have a special connection – even an emotional tie to my promise to consumers that the hospital will deliver on the kind
hospital. Every time I drive by the hospital with my three year old in the car, of care needed. It can drive business and growth for the
she says “that’s where I was born.” This is heart-warming. Besides, they have
great milkshakes there (Lauren).
organization, especially when high levels of satisfaction and
emotional commitment are present. Healthcare branding
Healthcare is one of the most important, yet personalized requires a solid, organized commitment to delivering unique
services a consumer experiences. In the US, it is expected that standards of consistency through the institution’s products
the healthcare industry will encounter unprecedented change and services. A successful branding strategy must address how
and growth as Baby Boomers mature and governmental to preserve equity and leverage equities to build trust as well
healthcare reform results in millions of newly insured patients as how to manage consumer perceptions and emotions
(Weiss, 2010; Sparer, 2011). Further, as more healthcare regarding the healthcare organization (Speak, 1996; Mangini,
2002).
options become available to consumers (e.g. minute clinics in
As aforementioned, healthcare is a highly personalized
drug stores, after-hour urgent care clinics), more competition
service. Just as brands for products comprise socio-
will exist within the industry. Marketing will play an integral
psychological attributes, brands for services and healthcare
role as hospitals compete on care and quality outcomes.
can imbue unique meaning to consumers. Such meaning and
Effective marketing strategy will require organizations to
personal experience with a brand can create a connection, or
develop a strong brand identity.
relationship, between the consumer and the brand. Fournier
In response to this growing challenge, preeminent
(1994, 1998) was one of the first to conceptualize consumer
healthcare organizations, including the Mayo Clinic,
brand relationships. In this metaphor, a consumer and a
brand are theorized as being in a dyadic relationship similar to
The current issue and full text archive of this journal is available at a relationship between two people. Developing consumer
www.emeraldinsight.com/0887-6045.htm brand relationships can be a challenging and complex process.
Brand relationships can take various forms. For example, a
consumer brand relationship may be cognitively-based and
Journal of Services Marketing simply habitual, or it can be emotionally based (Park et al.,
28/2 (2014) 126– 137
q Emerald Group Publishing Limited [ISSN 0887-6045]
2009; Thomson et al., 2005; Brakus et al., 2009; Grisaffe and
[DOI 10.1108/JSM-08-2012-0157] Nguyen, 2011). When an emotionally based relationship
126
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
127
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
committed, to brands (Park et al., 2009). Brand commitment Establishing affectively committed consumers in a
is an enduring desire to maintain a valued relationship with a healthcare marketing context can be invaluable. Many of the
brand (Lacy, 2007; Moorman et al., 1992). It refers to the individuals that were interviewed who expressed favorable
economic, emotional and psychological connections that the attitudes about their hospital alluded to an emotional bond or
consumer may have toward a brand (Evanschitzky et al., attachment they had developed with the hospital:
2006). Committed consumers are often willing to stay in an Now that I think about it, I guess you could say that I have an emotional
attachment to my hospital. My children were born there and our family has
exchange relationship as well as put forth effort to maintain gone there when the situation demanded it. We have been through some
the relationship. Commitment is recognized as an essential good times and some difficult times there [. . .] I guess deep down there is a
ingredient for successful long-term relationships (Beatty and connection there. I guess it was latent, but yes, when I think it over, there is
that special feeling I have towards the hospital and how it has served my
Kahle, 1988; Morgan and Hunt, 1994). family (Kay).
Researchers have identified distinct components of
commitment – one dimension is more emotional in nature Also, one of the interviewees was a nurse and commented on
and the other is more economic in structure (Allen and how her patients had vocalized an emotional attachment and
Meyer, 1990; Bansal et al., 2004). The economic type of commitment to the hospital where she worked:
commitment is known as calculative, or continuance I have had patients tell me that their entire family was born at a hospital.
commitment and the emotional type is called affective They have a special tie to the hospital and they also feel the hospital has a
special tie to the community (Rachel).
commitment. Continuance commitment stems from cost-
based calculations and results in commitment because of a
Healthcare is a very intimate and personalized service
need to stay in the relationship when no other comparable experience. Narratives from the individuals interviewed for
alternatives exist, or the costs of switching to other options are this research underscore the importance of connecting
too high (Allen and Meyer, 1990). However, affective emotionally with consumers. Such a connection can lead to
commitment differs from continuance commitment in that affective commitment and strong brand relationships.
the customer develops an emotional attachment to the brand However, several factors contribute to the development of
or organization (Allen and Meyer, 1990). Affective affective commitment between consumers and a brand.
commitment involves the desire to maintain a relationship Evidence from the marketing literature as well as findings
that the customer perceives to be of value (Morgan and Hunt, from the interviews conducted in this research identified
1994). Consumers who are affectively committed to a brand various factors. For example, trust, which has been well-
are less expensive to retain; less vulnerable to loss from supported in the literature, plays an important role in the
competitive efforts, brand blunders, or service failures; and foundation of a strong relationship (Morgan and Hunt,
are willing to pay a price premium (Bolton et al., 2000). 1994). In a healthcare context, trust is essential and is
128
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
predicated on a number of variables. Further, interviewees problems breathing and chest pains. He recounts his
alluded to additional factors that influence commitment. experience:
Specifically, referent influence as well as community What can I say – [my hospital] gives and stands for excellent care [. . .] I was
involvement were found to be major influences in given immediate attention when I went there. Twelve people in the ER were
trying to figure out what was wrong with me [. . .] Excellent care (Mark).
cultivating affective commitment between consumers and
healthcare organizations. A discussion of these precursors, or
antecedents, to affective commitment is delineated next. After such an experience, Mark only had positive attitudes
about the hospital he attended.
Antecedents of affective commitment He indicated that if he needed immediate attention again,
Brand trust he would select the same hospital without equivocation.
Trust is everything when it comes to my healthcare provider (Ariel) Subsequently, it is proposed that when individuals have
favorable attitudes about a healthcare provider and its brand,
Brands play an integral role in service organizations because this will be positively related to feelings of reliability and
they foster trust from consumers for intangible performances confidence in the brand. Thus, the following is predicted:
(Zeithaml, 1981; Berry, 2000; Gummerus et al., 2004). H1a. Attitude toward the healthcare provider’s brand is
Branding in healthcare is very dependent on trust (Berry, positively related to trust.
2000; Beckham, 2000). The buyer surrenders completely to
the seller and in many cases even temporary lives in the
healthcare facility (Berry and Bendapudi, 2007). Perceived quality
Moorman et al. (1993, p. 82) defined trust as “a willingness to Perceived quality is the consumer’s subjective assessment
rely on an exchange partner in whom one has confidence.” about a product’s overall excellence in reference to
Morgan and Hunt (1994, p. 23) conceptualized trust as the competitive offerings (Zeithaml, 1988; Aaker, 1991).
perception of “confidence in the exchange partner’s reliability Similarly, service quality perceptions are generally defined as
and integrity.” Both definitions suggest that confidence and a consumer’s judgment of, or impression about, an entity’s
reliability are essential elements of trust. Furthermore, trust is overall excellence or superiority (Bitner and Hubbert, 1994).
generally viewed as an important ingredient for successful A number of factors can influence a consumer’s assessment of
relationships (Spekman, 1988; Berry, 1995). Morgan and quality, including personal product experience, special needs
Hunt (1994) proposed that trust, along with commitment, is and consumption (Yoo et al., 2000). High perceived quality
essential to successful relationships. According to Morgan and will foster trust in a brand and motivate a consumer to choose
Hunt (1994) the presence of trust and commitment in a a brand over competing products (Dodds et al., 1991;
relationship encourages marketers to work at cooperating with Netemeyer et al., 2004).
exchange partners, maintain a long-term orientation with According to Babakus et al. (1991), one form of quality in
partners, and consider high-risk actions that positively impact the healthcare environment refers to the manner in which the
the relationship. Subsequently, trust and commitment healthcare service is delivered to the patient. Often patients
promote efficiency, productivity, and effectiveness. are unable to accurately assess the technical quality of a
Using evidence from previous literature as well as findings healthcare service, thus “functional” quality is usually the
from interviews conducted in this research, it is proposed that primary determinant of patients’ quality perceptions
trust in a healthcare brand will be driven by several distinct (Babakus and Mangold, 1992; Donabedian, 1982).
factors: a consumers’ attitude toward the brand, perceived One of the interviewees was impressed with the way in
quality of the brand, prestige of the brand, and the display of which service was rendered to her during one of her visits to
customer-oriented behavior by the attending staff and her healthcare facility. This experience impacted her
physicians at the healthcare facility. These contributing perception of the quality of care she received:
factors are discussed next. You can find the nicest people [at my hospital]! The care I received there was
excellent. They must have asked me over 10 times if I was allergic to any
Attitude toward the brand medications and kept asking me what foot they were operating on. The nurse
Research from psychology suggests that when individuals had told me that they would ask me questions a number of times because
quality control was so important to them (Gabrielle).
have favorable attitudes toward an entity, they are more likely
to trust the entity (Rotter, 1980). Similarly, effective services
Research has shown that perceived quality is a primary
branding is contingent on the management of consumer
variable influencing the value perceptions of consumers
attitudes (Berry, 2000). Brand attitudes refer to an affective
(Zeithaml, 1988). These value perceptions, in turn influence
reaction to a brand, or a predisposition to respond in a
favorable or unfavorable manner to a brand (Lutz, 1975; Lutz consumers’ intentions to purchase products or services. One
et al., 1983; Burton et al., 1998). These attitudes can be of the interviewees expressed intentions to return to the
related to not only the functional benefits of the brand, but facility where she had surgery because of her favorable
also the symbolic and experiential benefits, including the assessment regarding the care she received:
sensations, feelings and cognitions evoked by a brand I had my surgery performed at [my hospital] mostly because it was where my
physician had admission privileges. However, I did really appreciate the
(Rossiter and Percy, 1987; Zeithaml, 1988; Brakus et al., anesthesiologist I had. He was very competent and I would go there again
2009). because of him (Ariel).
One of the individuals interviewed for this research
admittedly expressed apprehension about receiving As indicated, a consumer’s subjective assessment of quality
healthcare services and was often skeptical of advertising for a brand can influence perceptions of value as well as
claims from healthcare providers. However, in one instance, purchase intentions. Fundamentally, perception of quality is
the situation mandated it that he receive healthcare attention. related to confidence in the brand. As a result, the following is
He had to be rushed to the hospital because he was having proposed:
129
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
H1b. Perceived quality of the healthcare provider’s brand is enduring relationships are often based on emotional
positively related to trust. attachment (Gournaris, 2005). Thus, it is proposed that
trust in a healthcare provider’s brand can foster high levels of
Brand prestige affective commitment:
I don’t select hospitals just based on proximity – the standing and prestige of H1e. Trust is positively related to affective commitment for a
the hospital means something to me. I have one of the best doctors and he is
on staff at my hospital because of the great hospital that it is (Vera). healthcare provider’s brand.
130
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
Healthcare providers can impact the lives of individuals in the When a consumer becomes affectively committed to a
community by providing services that improve health, brand, this connection can lead to brand advocacy (Fullerton,
increase access to care, save lives and train future caregivers. 2003). The consumer becomes an “evangelist” for the brand
Such investments in the community help to engender bonds and spreads positive word-of-mouth about the brand as well
and attachment toward the healthcare provider. As a result, as recruits others to become purchasers and users of the
the following is proposed: brand (Chakravarty et al., 2010). Hence, the following is
H3. Corporate social responsibility is positively related to hypothesized for consumers and healthcare brands:
affective commitment. H5. Affective commitment for the healthcare provider’s
brand is positively related to advocacy for the brand.
Outcomes of affective commitment A powerful endorsement was made by one of our interviewees
Affective commitment to a healthcare provider’s brand can be after she had been hospitalized for a stroke. She felt the care
fostered through trust, the influence of reference groups and she received at her healthcare facility was exemplary. After
investment in the community. When affective commitment is spending considerable time at the hospital during her
attained, an emotionally based relationship is established recovery, she began to develop a special connection to
between the consumer and the healthcare provider’s brand. hospital. She shares part of her experience:
Emotionally based consumer brand relationships can result in I was terrified because I did not know what was happening to my body [when
a strong connection between the consumer and the brand I had my stroke], but the care I received at [my hospital] was top-notch.
where qualities of the brand become aligned with the That hospital saved my life. It is a part of me now. I would recommend the
hospital to others because of the service that was given to me (Vera).
consumer’s self-concept. When such a connection develops,
a consumer is highly likely to become an advocate for the Clearly, Vera is now an evangelist for the healthcare provider.
brand and passionately promote it to others. Such outcomes She has a developed a personal connection with the brand
can be invaluable to the organization. because of the life-saving treatment and care she received. As
Self-brand connections a result, she is eager to recommend the brand to others.
Consumers sometimes become committed to brands that help Hence, individuals who develop a connection to the
them to create or represent their desired self-concepts healthcare provider may also be more likely to become
(Escalas and Bettman, 2003; Escalas, 2004). They often advocates for the brand. In fact, individuals that have formed
construct their self-identity and present themselves to others a connection to the brand may become fervent advocates for
through their product and brand selections (Escalas, 2004; the brand. Ergo, the following is proposed:
Escalas and Bettman, 2003). As consumers discover fit H6. Self-brand connection is positively related to advocacy
between their self-concepts and brand images, they may make
for the brand.
self-connections with a product or brand.
H7. Self-brand connection mediates the relationship
Self-connections are created when brands engender strong
between affective commitment and advocacy for the
and favorable brand associations from the consumer’s
brand.
perspective and can be used to satisfy psychological needs,
reinforce identity and allow an individual to connect to others Finally, as indicated previously, trust is often viewed as an
(Escalas, 2004; Escalas and Bettman, 2003; Wallendorf and essential ingredient in successful relationships. Many of our
Arnould, 1988). A strong self-connection with a brand allows interviewees expressed how important trust was in a
for easier and more frequent retrieval of thoughts and feelings healthcare provider. Those interviewees who had confidence
regarding the brand (Park et al., 2009). in their healthcare provider were willing to recommend their
Rachel, one of the interviewees employed as a nurse, shared provider to others. As a result, it is also predicted that trust in
how strong emotional commitment for the hospital from some the healthcare provider’s brand is related to advocacy:
of her patients had resulted in them becoming aligned with, H8. Trust in the healthcare provider’s brand is positively
and in many ways, identifying with the institution: related to advocacy.
I have had patients tell me that their entire family was born at a hospital.
They have a special tie to the hospital. They felt as though they were a part of
the hospital and the hospital was a part of the community (Rachel).
Method
Hence, it is proposed that when individuals become Measures
emotionally attached to a healthcare provider’s brand, they In order to test the proposed hypotheses and the model
may come to identify themselves with that brand. represented in Figure 1, a survey was conducted. All
Thus, the following is predicted: constructs, with the exception of referent influence, were
H4. Affective commitment to a healthcare provider’s brand measured using existing scales adapted for this study. The
is positively related to self-brand connection. items for referent influence were developed specifically for this
research, and the construct was measured using three items
Advocacy (e.g. I patronize my hospital because my family has for years).
Favorable communication about a brand from consumers can All scale items appear in the Appendix. Age and level of
accelerate new product acceptance and adoption (Keller, 1993). education were measured and controlled for in the study.
Advocacy in the form of word-of-mouth communication can be
the most influential source of information for the purchase of Procedure and sample
some products because it is perceived as originating from a less A convenience sample was obtained consisting of non-student
biased, more trustworthy source, which helps to lessen adults in a major metropolitan area in the southwestern part
consumer anxiety (Herr et al., 1991). of the USA. At the beginning of the survey, respondents were
131
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
asked to list the hospital they and their immediate family In order to assess discriminant validity, the Fornell and
currently attend for healthcare needs. After listing this Larcker (1981) test was performed. Discriminant validity is
information, respondents were asked specific questions that demonstrated when the average variance extracted from a
related to, and operationalized the constructs presented in construct is greater than the squared correlations between
Figure 1. that construct and other constructs in the model. The average
A total of 322 completed surveys were obtained; 40 percent variance extracted between each construct was greater than
of respondents were male and 60 percent were female. The the squared multiple correlations for each construct pairing.
mean age was 44. Mean household income was $103,134. A Composite reliabilities were also assessed to ensure that each
total of 6 percent of the respondents were high school construct exhibited internal consistency (ranged from 0.87 to
graduates, 36 percent reported having attended college, 44 0.97). All measures exemplified acceptable reliability by
percent were college graduates and 14 percent held graduate exceeding the recommended 0.7 threshold (Nunnally and
degrees. Bernstein, 1994). The results for the structural model follow.
Structural model
Results The structural model and hypotheses were evaluated after
attaining a validated measurement model. The model
The data were subjected to structural equation analysis in exhibited adequate fit x2 (1309.41); p-value (0.01); CFI
Lisrel 8.72. As recommended by Anderson and Gerbing (0.98); NNFI (0.98); (RMSEA (0.05); and SRMR (0.06).
(1988), a two-step procedure was used to first assess the Both direct and indirect effects were predicted between
model for construct and discriminant validity and then exogenous and endogenous variables. Results are presented in
hypotheses were tested in the structural model. Additionally, Table III.
statistical techniques, including the marker variable technique
(Lindell and Whitney, 2001; Malhotra et al., 2006), were
applied to ensure that findings were not inflated due to Table III Results of structural equations modeling (SEM) analysis
common method bias. Effects
Direct effectsa
Measurement model H1a: brand attitude on brand trust 0.14 *
Standard statistical techniques, including performing
H1b: perceived quality on brand trust 0.23 * *
exploratory factor analysis and examining item-to-total
H1c: brand prestige on brand trust 0.01
correlations, were conducted. Exploratory factor analysis
H1d: consumer oriented behavior on brand trust 0.23 * *
confirmed that each item loaded on the appropriate factor.
H1e: brand trust on affective commitment 0.50 * *
The measurement model was further validated for construct
H2: referent influence on affective commitment 0.17 * *
and discriminant validity by performing confirmatory factor
H3: community investment on affective commitment 0.48 * *
analysis. The final measurement model exhibited adequate fit
x2 (1151.06); p-value (0.01); CFI (0.98); NNFI (0.98); H4: affective commitment on self-brand connection 0.20 * *
RMSEA (0.05); and SRMR (0.04). H5: affective commitment on brand advocacy 0.55 * *
To test for convergent validity, factor loadings, along with H6: self-brand connection on brand advocacy 0.78 * *
the average variance extracted were calculated for each latent H8: trust on brand advocacy 0.71 * *
variable. Standardized factor loadings exceeded the 0.6 Age 0.02
threshold as recommended by Hair et al. (2006). Education 20.10 * *
Additionally, as seen in Table II, the average variance
extracted (ranged from 0.58 to 0.93) for each construct Indirect effectb
exceeded the recommended rule of thumb of 0.5 (Hair et al., H7: affective commitment on brand advocacy 0.55 * *
2006), which is an indication that the variance captured by Notes: aCompletely standardized solution; b
Standardized solution;
the construct is greater than the variance due to measurement *p , 0.05; * *p , 0.001
error.
Table II Means, standard deviation, reliability, average variance extracted and Pearson correlations
Means SD Reliability AVE BAtt BP PQ COB T CB CI AC SBC BA Ed
Brand attitude (BAtt) 5.86 1.67 0.97 0.91 1.00
Brand prestige (BP) 4.38 1.45 0.89 0.70 0.19 1.00
Perceived quality (PQ) 5.64 1.05 0.98 0.93 0.53 0.28 1.00
Customer-oriented behavior (COB) 5.28 1.13 0.89 0.73 0.37 0.34 0.59 1.00
Trust (T) 5.80 0.95 0.90 0.74 0.38 0.23 0.52 0.593 1.00
Co-behavior (CB) 3.71 1.64 0.88 0.71 0.00 0.15 0.02 0.044 0.02 1.00
Community investment (CI) 4.63 1.24 0.94 0.79 0.10 0.15 0.16 0.144 0.18 0.06 1.00
Affective commitment (AC) 3.93 1.48 0.96 0.89 0.04 0.22 0.08 0.152 0.09 0.29 0.14 1.00
Self-brand connection (SBC) 3.23 1.51 0.94 0.80 0.03 0.2 0.06 0.09 0.05 0.29 0.12 0.59 1.00
Brand advocacy (BA) 3.93 1.52 0.90 0.73 0.05 0.26 0.07 0.102 0.08 0.34 0.19 0.49 0.56 1.00
Education (Ed) 3.69 0.78 N/A N/A 0.00 0.02 0.00 0.00 0.00 0.01 0.00 0.02 0.00 0.02 1.00
132
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
H1a-H1d predicted that brand attitude, perceived quality, Especially germane in a healthcare context, this research
brand prestige and customer-oriented behavior would be identified two important constructs – reference influence and
positively related to trust. Results indicate that brand attitude, corporate social responsibility – that were also positively
perceived quality and customer-oriented behavior are related to affective commitment. Group members can provide
positively related to trust, but the relationship between ratification and support regarding usage of a product or
brand prestige and trust did not prove to be significant. Thus, brand. Further, a hospital’s contribution, or investment in the
H1a, H1b and H1d were supported, but H1c was not community, was critical in developing emotional bonds with
confirmed. Further, H1e predicted that trust would be consumers. Such actions help to signal to the consumer that
positively related to affective commitment. This hypothesis the healthcare provider cares about the community.
was supported. Further, results suggest that cultivating affective commitment
H2 proposed that referent influence would be positively in consumers is associated with the healthcare provider’s brand
related to affective commitment; H2 was validated. Similarly, becoming aligned with the consumer’s self-concept, creating a
H3 predicted that corporate social responsibility would be self-brand connection. When a self-brand connection is formed,
positively associated with affective commitment. The an individual comes to identify with the institution. Moreover,
significant relationship between corporate social results indicate that the consumer may also begin to serve as an
responsibility and affective was verified as well. Thus, advocate for the brand by actively promoting, and even
positive links between affective commitment and its defending it to others. Thus, developing strong, emotional
proposed antecedents – trust, referent influence and attachments with consumers will be invaluable to healthcare
corporate social responsbility – were all validated. providers in the growing competitive marketplace.
H4-H7 addressed the outcomes of affective commitment in
consumer brand relationships. H4 predicted that affective Managerial implications
commitment would be positively related to self-brand This research demonstrates the advantages of cultivating
connection. This hypothesis was supported. Additionally, meaningful brand connections and relationships with
H5 suggested that affective commitment would be positively consumers. Findings from this research can assist marketers
related to advocacy for the brand; H5 was confirmed. Self- in strategic planning. In the healthcare industry, proximity has
brand connection was hypothesized to be positively related to been a major driver of utilization (Beckham, 2001). However,
advocacy for the brand in H6. This predication was as healthcare costs increase and more healthcare options
supported. Next, H7 suggested mediation. Self-brand become available, marketers can be more strategic in their
connection was predicted to mediate the relationship efforts to target desired consumer segments and differentiate
between affective commitment and advocacy for the brand. their organizations by delivering valued brand experiences
Results indicate that self-brand connection mediates the (Brakus et al., 2009).
relationship between affective commitment and advocacy for In delivering unique and differentiated brand experiences,
the brand, given the significance of the indirect effect (Cohen healthcare providers should effectively position the
and Cohen, 1983; Kenny et al., 1998). Finally, H8 predicted organization and its brand as a valued contributor to health.
that trust would be positively related to advocacy for the As suggested in this research, ensuring consumer engagement
brand. This relationship was supported. Age as a control and an enduring emotional connection to the organization is a
variable in the analysis did not prove to be significant; vital part of achieving this task.
however, the effect on education was significant and negative.
Emotional connection
Consumer sensitivity and emotional response play a major
Discussion role in healthcare where trust and caregiving must co-exist.
Summary of findings Emotions are inherent in the type of buying decisions that
Creating emotionally based consumer brand relationships can individuals make for their family and themselves in the
result in substantial reward for service organizations. This healthcare marketplace. Thus, effective marketing for
research examined how emotional or affect-based consumer healthcare organizations should consider consumer emotions.
brand relationships are developed for healthcare This research demonstrated that trust, referent influence and
organizations. Findings indicate that trust is a key variable corporate social responsibility are positively related to
in establishing affective commitment in consumer brand consumer emotional commitment for a healthcare provider’s
relationships. Healthcare is an intimate service. In many brand. Marketing communications that appeal to consumers’
cases, the individual not only surrenders very personal attitudes about the organization by communicating
information to the healthcare provider, but also his or her competence and patient-centric qualities will be effective in
physical and psychological well-being; therefore, trust is cultivating trust and thus, emotional connections with
essential. consumers. Further, given the importance of referent
Results demonstrate that trust is predicated on a influence, promoting a family-friendly environment
consumer’s attitude toward the brand, perceived quality and (e.g. flexible visiting hours, comfortable rooms) and
customer-oriented behavior. Findings were not significant for emphasizing the importance of family and friends in the
the proposed relationship between brand prestige and trust. healing process may also help to foster emotional commitment
The lack of significance may have been due to the product from consumers. Hospitals have created maternity wards which
category. Prestige has been used as a surrogate for exemplify the family-friendly philosophy. Such an emphasis is
dependability and reliability for various products (Vigneron important since women make approximately 80 percent of
and Johnson, 1999). However, since healthcare is such a healthcare decisions for their families (US Department of
personal sometimes vital service, variables related to actual Labor, 2012), and are thus a viable consumer segment to target
performance may be stronger antecedents of trust. for healthcare services.
133
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
Finally, events sponsored by healthcare providers such as investigation”, Health Services Research, Vol. 26 No. 6,
health fairs, picnics in the park, working with underserved and pp. 767-786.
disadvantaged members of the community are activities that Babakus, E., Remington, S.J., Lucas Jr, G.H. and Carnell,
signal to the consumer that the hospital cares about their C.G. (1991), “Issues in the practice of cosmetic surgery:
home – their community. Such efforts are effective at creating consumers’ use of information and perceptions of service
bonds between the brand and the consumer. quality”, Journal of Healthcare Marketing, Vol. 11 No. 3,
As marketers engage in endeavors to understand and pp. 12-18.
improve the experience their brand provides for their Baek, T.H., Kim, J. and Yu, J.H. (2010), “The differential
customers, operative implementation and controls systems roles of brand credibility and brand prestige in consumer
will be required. However, such effective marketing will help brand choice”, Psychology and Marketing, Vol. 27 No. 7,
differentiate healthcare brands and allow them to achieve pp. 662-678.
competitive advantage in the marketplace. Bansal, H.S., Irving, P.G. and Taylor, S.F. (2004), “A three-
component model of customer commitment to service
Limitations and future research providers”, Journal of Academy of Marking Science, Vol. 32
Although this research makes important contributions to No. 3, pp. 109-250.
understanding how emotionally based consumer brand Bearden, W.O. and Etzel, M.J. (1982), “Reference group
relationships are formed in healthcare, future research is influence on product and brand purchase decisions”,
warranted. First, given the cross-sectional nature of the data Journal of Consumer Research, Vol. 9, pp. 183-194.
in this study, no causal relationships could be established. Beatty, S.E. and Kahle, L.R. (1988), “Alternative hierarchies
Future studies might assess the link between performance and of the attitude-behavior relationship: the impact of brand
actual satisfaction and how such outcomes contribute to the commitment and habit”, Journal of Academy of Marketing
creation of consumer brand relationships. Science, Vol. 16, pp. 1-10.
Additionally, respondents for the quantitative component of Beckham, D. (2000), “Marketing v. branding”, Health Forum
this research were from one geographical area. They were also Journal, Vol. 43 No. 2, pp. 64-70.
highly educated, with 58 percent of the sample having Beckham, D. (2001), “20 years of healthcare marketing”,
attained a college degree. Future research might survey Health Forum Journal, July/August, pp. 37-40.
individuals from various regions of the country with more Berry, L.L. (1995), “Relationship marketing of services –
diverse educational backgrounds. Furthermore, given the growing interest, emerging perspective”, Journal of the
comparisons that have been made between healthcare systems Academy of Marketing Science, Vol. 23, pp. 236-245.
in the USA and other countries, a cross-cultural study might Berry, L.L. (2000), “Cultivating service brand equity”,
yield additional insight. Journal of the Academy of Marketing Sciences, Vol. 28 No. 1,
In this research, the healthcare provider was limited to pp. 128-137.
hospitals. Future research might examine how emotionally Berry, L.L. (2010), “Effectively branding and selling services
based consumer brand relationships are developed for other commentaries”, Journal of Services Research, Vol. 13 No. 1,
entities in the healthcare industry, including pharmacies, pp. 4-36.
clinics, and the group practices of physicians and dentists. Berry, L.L. and Bendapudi, N. (2007), “Healthcare: a fertile
Healthcare is a service that most consumers will have to field for service research”, Journal of Services Research,
enlist at some point in their lives. It is a very personal service Vol. 10 No. 2, pp. 111-122.
experience where relationship building is important. As the Berry, L.L. and Seltman, K. (2008), Management Lessons
landscape for healthcare services undergoes significant change from Mayo Clinic: Inside One of The World’s Most Admired
in the USA, research opportunities abound for exploring Service Organizations, McGraw-Hill Professional, New
effective marketing and branding strategies for healthcare York, NY.
providers. Bitner, M.J. and Hubbert, A.M. (1994), “Encounter
satisfaction versus overall satisfaction versus quality: the
customer’s choice”, in Rust, R.T. and Oliver, R.W. (Eds),
References Service Quality: New Directions in Theory and Practice, Sage,
Aaker, D.A. (1991), Managing Brand Equity, Free Press, San Thousand Oaks, CA, pp. 72-94.
Francisco, CA. Bolton, R., Kannan, P.K. and Bramlett, M.D. (2000),
Aiello, M. (2010), “Emotional advertising is still most effective”, “Implication of loyalty programs and service experiences
Media Health Leaders, May 12, available at: www. for customer retention and value”, Journal of the Academy of
healthleadersmedia.com/page-2/MAR-250897/Emotional- Marketing Science, Vol. 28 No. 1, pp. 95-108.
Advertising-is-Still-Most-Effective (accessed 2 May 2012). Bowen, H.R. (1953), Social Responsibility of the Businessman,
Allen, N.J. and Meyer, J.P. (1990), “The measurement and Harper, New York, NY.
antecedents of affective, continuance and normative Bowlby, J. (1973), Attachment and Loss, Vol. 2: Separation,
commitment to the organization”, Journal of Occupational Anxiety, and Anger, Penguin Books, London.
Psychology, Vol. 63 No. 1, pp. 1-18. Brady, M. and Cronin Jr, J. (2001), “Customer orientation:
Anderson, J.C. and Gerbing, D.W. (1988), “Structural effects on customer service perceptions and outcome
equation modeling in practice: a review and behaviors”, Journal of Service Research, Vol. 3,
recommended two-step approach”, Psychological Bulletin, pp. 241-251.
Vol. 103 No. 3, pp. 411-423. Brakus, J.J., Schmitt, B.H. and Zatantonello, L. (2009),
Babakus, E. and Mangold, G.W. (1992), “Adapting the “Brand experience: what is it? How is it measured? Does it
SERVQual scale to hospital services: an empirical affect loyalty?”, Journal of Marketing, Vol. 73, pp. 52-68.
134
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
Burton, S., Lichtenstein, D.R., Netemeyer, R.G. and oriented strategy to customer contact service employees”,
Garretson, J.A. (1998), “A scale for measuring attitude Journal of Marketing, Vol. 64, pp. 35-50.
toward private label products and an examination of its Herbig, P. and Milewicz, J.W. (1993), “The relationship of
psychological behavioral correlates”, Academy of Marketing reputation and credibility to brand success”, The Journal of
Science Journal, Vol. 26, pp. 293-306. Consumer Marketing, Vol. 10 No. 3, p. 18.
Chakravarty, A., Liu, Y. and Mazumdar, T. (2010), “The Herr, P.M., Kardes, F.R. and Kim, J. (1991), “Effects of
differential effects of online word-of-mouth and critics’ word-of-mouth and product-attribute information of
reviews on pre-release movie evaluation”, Journal of persuasion: an accessibility-diagnosticity perspective”,
Interactive Marketing, Vol. 24 No. 3, pp. 185-197. Journal of Consumer Research, Vol. 17 No. 4, pp. 454-462.
Chaudhuri, A. and Holbrook, M.B. (2001), “The chain of Hirschman, E.C. (1992), “The consciousness of addiction:
effects from brand trust and brand affect to brand toward a general theory of compulsive consumption”,
performance: the role of brand loyalty”, Journal of Journal of Consumer Research, Vol. 19, pp. 155-179.
Marketing, Vol. 65 No. 2, pp. 81-93. Hoffman, K.D. and Ingram, T.N. (1992), “Service provider
Cohen, J. and Cohen, P. (1983), Applied Multiple Regression/ job satisfaction and customer-oriented performance”,
Correlation Analysis for the Behavioral Sciences, 2nd ed., Journal of Services Marketing, Vol. 6 No. 2, pp. 68-78.
Lawrence Erlbaum, Hillsdale, NJ. Hrebiniak, L.G. (1974), “Effects of job level and participation
Dodds, W.B., Monroe, K.B. and Grewal, D. (1991), “Effects or employee attitudes and perceptions of influence”,
of price, brand and store information on buyers’ product Academy of Management Journal, Vol. 17 No. 4, pp. 649-662.
evaluations”, Journal of Marketing Research, Vol. 28 No. 3, Hudson, L.A. and Ozanne, J.L. (1988), “Alternative ways of
pp. 307-319. seeking knowledge in consumer research”, Journal of
Donabedian, A. (1982), Explorations in Quality Assessment and Consumer Research, Vol. 14, pp. 508-521.
Monitoring: The Criteria and Standards of Quality, Health Keller, K.L. (1993), “Conceptualizing, measuring and
Administration Press, Ann Arbor, MI. managing customer-based brand equity”, Journal of
Escalas, J.E. (2004), “Narrative processing: building Marketing, Vol. 57, pp. 1-22.
consumer connections to brands”, Journal of Consumer Keller, K.L. and Aaker, D.A. (1992), “The effect of
Psychology, Vol. 14 Nos 1/2, pp. 168-180. sequential introduction of brand extensions”, Journal of
Escalas, J.E. and Bettman, J. (2003), “You are what they eat: Marketing Research, Vol. 29, pp. 35-50.
the influence of reference groups on consumers’ Kenny, D.A., Kashy, D.A. and Bolger, N. (1998), “Data
connections to brands”, Journal of Consumer Psychology,
analysis in social psychology”, in Gilbert, D., Fiske, S. and
Vol. 13 No. 3, pp. 339-348.
Lindzey, G. (Eds), The Handbook of Social Psychology, Vol. 1,
Evanschitzky, H., Iyer, G.R., Plassmann, H., Niessing, J. and
Oxford University Press, New York, NY, pp. 233-268.
Meffert, H. (2006), “The relative strength of affective
Kim, J.Y., Moon, J., Han, D. and Tikoo, S. (2004),
commitment in securing loyalty in service relationships”,
“Perceptions of justice and employee willingness to
Journal of Business Research, Vol. 59 No. 12, pp. 1207-1213.
engage in customer-oriented behavior”, Journal of Service
Fornell, C. and Larcker, D.F. (1981), “Evaluating structural
Marketing, Vol. 18 No. 4, pp. 267-275.
equation models with unobservable variables and
Kirmani, A., Sood, S. and Bridges, S. (1999), “The
measurement error”, Journal of Marketing Research,
Vol. 16, pp. 39-50. ownership effect in consumer responses to brand line
Fournier, S.M. (1994), “A consumer-brand relationship stretches”, Journal of Marketing, Vol. 63 No. 1, pp. 88-101.
framework for strategic brand management”, Doctoral Krishnan, B.C. and Hartline, M.D. (2001), “Brand equity: is
dissertation, University of Florida. it more important in services?”, Journal of Services
Fournier, S.M. (1998), “Consumers and their brands: Marketing, Vol. 15 No. 5, pp. 328-342.
developing relationship theory in consumer research”, Lacy, R. (2007), “Relationship drivers of customer
Journal of Consumer Research, Vol. 24 No. 4, pp. 343-373. commitment”, Journal of Marketing Theory and Practice,
Fullerton, G. (2003), “When does commitment lead to Vol. 15 No. 4, pp. 315-333.
loyalty?”, Journal of Services Research, Vol. 5 No. 4, Larkin, M.O. (2007), “Strategic management”, Healthcare
pp. 333-344. Strategic Management, Vol. 25 No. 11, pp. 2-3.
Gournaris, S.P. (2005), “Trust and commitment influences Lichtenstein, D.R. and Bearden, W.O. (1989), “Contextual
on customer retention: insights from business-to-business influences on perceptions of merchant-supplied reference
services”, Journal of Business Research, Vol. 58 No. 2, prices”, Journal of Consumer Research, Vol. 16, pp. 55-66.
pp. 126-140. Lichtenstein, D.R., Ridgway, N.M. and Netemeyer, R.G.
Grisaffe, D.B. and Nguyen, H.P. (2011), “Antecedents of (1993), “Price perceptions and consumer shopping
emotional attachment to brands”, Journal of Business behavior: a field study”, Journal of Marketing Research,
Research, Vol. 64, pp. 1052-1059. Vol. 30, pp. 234-245.
Gummerus, J., Liljander, V., Pura, M. and Riel, A. (2004), Lindell, M.K. and Whitney, D.J. (2001), “Accounting for
“Customer loyalty to content-based web sites: the case of common method variance in cross-sectional research
an online health-care service”, Journal of Services Marketing, designs”, Journal of Applied Psychology, Vol. 86 No. 1,
Vol. 18 No. 3, pp. 175-186. pp. 114-121.
Hair, J., Babin, B., Anderson, R. and Tatham, R. (2006), Lutz, R.J. (1975), “Changing brand attitudes through
Multivariate Data Analysis, 6th ed., Prentice Hall, New modification of cognitive structure”, Journal of Consumer
York, NY. Research, Vol. 1 No. 4, pp. 49-59.
Hartline, M.D., Maxham, J.G. III and McKee, D.O. (2000), Lutz, R.J., MacKenzie, S.B. and Belch, G.E. (1983),
“Corridors of influence in the determination of customer- “Attitude toward the ad as a mediator of advertising
135
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
effectiveness: determinants and consequences”, Advances in community”, Journal of the Academy of Marketing Science,
Consumer Research, Vol. 10 No. 1, pp. 532-539. Vol. 35 No. 3, pp. 357-368.
McAlexander, J.H., Schouten, J.W. and Koenig, H.F. (2002), Sparer, M. (2011), “US healthcare reform and the future of
“Building brand community”, Journal of Marketing, Vol. 66 dentistry”, American Journal of Public Health, Vol. 101
No. 1, pp. 38-54. No. 10, pp. 1841-1844.
McCracken, G. (1988), The Long Interview, Sage Speak, K.D. (1996), “The challenge of healthcare branding”,
Publications, Newbury Park, CA. Journal of Healthcare Marketing, Winter, pp. 40-42.
Malhotra, N.R., Kim, S.S. and Patil, A. (2006), “Common Spekman, R.E. (1988), “Perceptions of strategic vulnerability
method variance in IS research: a comparison of alternative among industrial buyers and its effect on information
approaches and a reanalysis of past research”, Management search and supplier evaluation”, Journal of Business
Science, Vol. 52 No. 12, pp. 1865-1883. Research, Vol. 17 No. 4, pp. 313-326.
Mangini, K. (2002), “Branding 101”, Marketing Health Steenkamp, J., Bendict, E.M., Batra, R. and Alden, D.L.
Services, Vol. 22 No. 3, pp. 20-23. (2003), “How perceived brand globalness creates brand
Meyer, J.P. and Allen, N.J. (1991), “A tree-component value”, Journal of International Business Studies, Vol. 34
conceptualization of organizational commitment”, Human No. 1, pp. 53-65.
Resource Management Review, Vol. 1 No. 1, pp. 61-89. Suh, T., Houston, M.B., Barney, S.M. and Kwon, I.W.
Moorman, C., Zaltman, G. and Deshpande, R. (1992), (2011), “The impact of mission fulfillment on the internal
“Relationships between providers and users of marketing audience: psychological job outcomes in a services setting”,
research: the dynamics of trust within and between Journal of Service Research, Vol. 14 No. 1, pp. 76-92.
organizations”, Journal of Marketing Research, Vol. 29, Thomaselli, R. (2010), “Health-care reform stokes spending
pp. 314-329.
by top hospitals, clinics”, Advertising Age, 28 June, available
Moorman, C., Deshpande, R. and Zaltman, G. (1993),
at: http://adage.com/article/news/health-care-reform-stokes-
“Factors affecting trust in market research relationships”,
spending-top-hospitals-clinics/144696/ (accessed 2 May
Journal of Marketing, Vol. 57, pp. 81-102.
2012).
Morgan, R.M. and Hunt, S.D. (1994), “The commitment-
Thomson, M., MacInnis, D.J. and Park, C.W. (2005), “The
trust theory of relationship management”, Journal of
ties that bind: measuring the strength of consumers’
Marketing, Vol. 58 No. 3, pp. 20-38.
Muniz Jr, A.M. and Schau, H.J. (2005), “Religiosity in the emotional attachments to brands”, Journal of Consumer
abandoned Apple Newton brand community”, Journal of Psychology, Vol. 15 No. 1, pp. 77-91.
Consumer Research, Vol. 31 No. 4, pp. 737-747. Turker, D. (2008), “Measuring corporate social
Murray, K.B. and Schlacter, J.L. (1990), “The impact of responsibility: a scale development study”, Journal of
services versus goods on consumer’s assessment of Business Ethics, Vol. 85 No. 4, pp. 411-427.
perceived risk and variability”, Journal of the Academy of US Department of Labor (2012), “General facts on women
Marketing Science, Vol. 18, pp. 51-65. and job-based health”, available at: www.dol.gov/ebsa/
Netemeyer, R., Krishnan, B., Pullig, C., Wang, G., Yagci, M., newsroom/fshlth5.html (accessed 3 May 2012).
Dean, D., Ricks, J. and Wirth, F. (2004), “Developing and Vigneron, F. and Johnson, L.W. (1999), “A review and a
validating measures of facets of customer-based brand conceptual framework of prestige-seeking consumer
equity”, Journal of Business Research, Vol. 57, pp. 209-244. behavior”, Academy of Marketing Science Review, Vol. 9
Nunnally, J.C. and Bernstein, I.H. (1994), Psychometric No. 1, pp. 1-17.
Theory, 3rd ed., McGraw-Hill, New York, NY. Wallendorf, M. and Arnould, E.J. (1988), “My favorite
Onkvisit, S. and Shaw, J.J. (1989), “Service marketing: image, things: a cross-cultural inquiry into object attachment,
branding and competition”, Business Horizons, Vol. 32, possessiveness and social linkage”, Journal of Consumer
pp. 13-18. Research, Vol. 14, pp. 531-547.
Park, C.W., Priester, J.R., MacInnis, D.J. and Wan, Z. (2009), Weiss, R. (2010), “How will leading healthcare execs face the
“The connection-prominence attachment model (CPAM)”, challenges ahead?”, Marketing Health Services, Fall, pp. 3-5.
in MacInnis, D. (Ed.), Handbook of Brand Relationships, Yoo, B., Donthu, N. and Lee, S. (2000), “An examination of
M.E. Sharpe, New York, NY, pp. 327-341. selected marketing mix elements and brand equity”, Journal
Phillips, J., Noble, S.M. and Noble, C.H. (2011), “Managing of the Academy of Marketing Science, Vol. 28 No. 2,
rewards to enhance relational worth”, Journal of the pp. 195-211.
Academy of Marketing Science, Vol. 39 No. 3, pp. 341-362. Zeithaml, V.A. (1981), “How consumer evaluation processes
Rossiter, J.R. and Percy, L. (1987), Advertising and Promotion differ between goods and services”, in Donnelly, J.H. and
Management, McGraw-Hill, New York, NY. George, W.R. (Eds), Marketing of Services, American
Rotter, J. (1980), “Interpersonal trust, trustworthiness, and Marketing Association, Chicago, IL, pp. 186-190.
gullibility”, American Psychologist, Vol. 35 No. 1, pp. 1-7. Zeithaml, V.A. (1988), “Consumer perceptions of price
Ryan, G.W. and Bernard, H.R. (2000), “Data management quality and value: a means end model and synthesis of
and analysis methods”, in Densin, N. and Lincoln, Y. evidence”, Journal of Marketing, Vol. 52 No. 3, pp. 2-22.
(Eds), Handbook of Qualitative Research, Sage Publications,
Thousand Oaks, CA, pp. 769-802.
Schouten, J.W. and McAlexander, J.H. (1995), “Subcultures Further reading
of consumption: an ethnography of new bikers”, Journal of
Consumer Research, Vol. 22 No. 3, pp. 43-61. Fredicks, D. (2011), “The decline of traditional healthcare
Schouten, J.W., McAlexander, J.H. and Koenig, H.F. (2007), marketing: why word-of-mouth is more relevant than ever”,
“Transcendent customer experience and brand Marketing Health Services, Summer, pp. 3-5.
136
Healthcare branding Journal of Services Marketing
Elyria Kemp, Ravi Jillapalli and Enrique Becerra Volume 28 · Number 2 · 2014 · 126 –137
Low, G.S. and Lamb, C.W. (2000), “The measurement and Referent influence
dimensionality of brand associations”, Journal of Product (Likert seven-point scale)
and Brand Management, Vol. 9 No. 6, pp. 350-370. .
I patronize my hospital because my friends use it.
MacInnis, D.J., Park, W.C. and Priester, J. (2009), “Why .
I patronize my hospital because my family has for years.
brand relationships?”, in MacInnis, D. (Ed.), Handbook of .
I use my hospital because people who are important to me
Brand Relationships, M.E. Sharpe, New York, NY, use it.
pp. 9-10.
Syverson, A. (2011), “Pass ‘the mayo effect’: how the Mayo’s Community investment – corporate social
clinic brand is naturally bolstered by its patient-centric responsibility (Turker, 2008)
experiences”, Target Marketing, Vol. 43 No. 12, pp. 12-13. (Likert seven-point scale)
Wallendorf, M. (1991), “We gather together: the .
My hospital emphasizes the importance of its social
consumption ritual of Thanksgiving Day”, Journal of responsibilities to the society.
Consumer Research, Vol. 18 No. 1, pp. 13-31. .
My hospital contributes to campaigns and projects that
promote the well-being of the society.
Appendix. Measures .
My hospital targets sustainable growth which considers
future generations.
Brand attitude (Lichtenstein and Bearden, 1989) .
My hospital makes investment to create a better life for
(7-point scale) future generations.
My overall attitude towards the hospital I currently attend is: .
My hospital implements special programs to minimize its
.
Good/bad. negative impact on the natural environment.
.
Pleasant/unpleasant.
. Favorable/unfavorable. Affective commitment (Meyer and Allen, 1991)
.
Positive/negative. (Likert seven-point scale)
.
I feel emotionally attached to my hospital.
Perceived quality (Keller and Aaker, 1992) .
I feel like part of the family at my hospital.
(7-point scale) .
I feel a strong sense of belonging to my hospital.
Please indicate the extent to which the following adjectives
describe the quality of care you receive at your hospital: Self-brand connection (Escalas and Bettman, 2003)
.
Inferior/superior. (Likert seven-point scale)
.
Low quality/quality. .
My hospital reflects who I am (not at all/extremely well).
.
Excellent/poor (R). .
I can identify with my hospital (not at all/extremely well).
.
I feel a personal connection to my hospital (not at all/very
Brand prestige (Kirmani et al., 1999) much so).
(Likert seven-point scale) .
I (can) use my hospital to communicate who I am to other
.
I enjoy the prestige that comes with going to my hospital. people (not at all/extremely well).
.
I think my hospital is exclusive. .
I think my hospital (could) help(s) me become the type of
.
I think my hospital has high status. person I want to be (not at all/extremely well).
.
I consider my hospital to be “me” (it reflects who I
Customer-oriented behavior (Kim et al., 2004) consider myself to be or the way that I want to present
(Likert seven-point scale) myself to others) (not “me”/“me”).
.
The staff at my hospital is always willing to help patients .
My hospital suits me well (not at all/extremely well).
and/or their guardians.
.
The staff at my hospital is willing to cheer up patients Advocacy (Phillips et al., 2011)
when they are down. (Likert seven-point scale)
.
The staff at my hospital is always willing to resolve .
I try to get my friends and family to patronize my hospital.
patients’ complaints. .
I seldom miss an opportunity to tell others good things
.
The staff at my hospital is willing to consider the things about my hospital.
not requested by patients and/or their Guardians. .
I would defend my hospital to others if heard someone
speaking poorly about my hospital.
Brand trust (Chaudhuri and Holbrook, 2001) .
I would bring friends/family to my hospital if they needed
(Likert seven-point scale) care because I think they would like it.
.
I trust the care that I receive from health professional at
this hospital.
Corresponding author
.
I rely on the care I receive from this hospital.
.
I feel safe at my hospital. Professor Elyria Kemp can be contacted at: ekemp@uno.edu
137