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Confirmatory Study on Brand Eq

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CONFIRMATORY STUDY ON BRAND EQUITY AND
BRAND LOYALTY: A SPECIAL LOOK AT THE IMPACT
OF ATTITUDINAL AND BEHAVIOURAL LOYALTY
Hardeep Chahal and Madhu Bala
The purpose of the study is to examine relationships between brand equity and brand loyalty (comprising
attitudinal and behavioural) which is not well explained in the marketing literature. Should brand loyalty be
considered as dimension ofbrand equity or an outcome of brand equity or as a moderatingfactor that acts
as a mediator between attitudinal loyalty and behavioural loyalty need to be confirmed? The present research
is pursued to confirm such relationships. A'total sample of300 respondents was selectedfrom Jammu city in
India to gather data on brand loyalty and brand equity from the users ofJammu healthcare services. Scaleitem analysis, both EFA and CFA analysis were appliedforfinalisation ofscale and model testing respectively.
The findings of the study support all three hypotheses i.e. brand equity is the resultant factor ofattitudinal
loyalty and results in behavioural loyalty (Modell), brand loyalty viz. both attitudinal loyalty and behavioural
loyalty can be considered as an indicator as well as an outcome ofbrand equity in healthcare sector (Model2
and ModeI3). Major limitation of the study is the use of convenient sampling since no comprehensive and
proper list was available for the persons residing in Jammu city. But at the same time respondents selected
were appropriate as they have adequate knowledge about hospitals, being associated with them for more
than one year.
Key Words: Brand Equity, Brand Loyalty, Attitudinal Loyalty and Behavioural Loyalty
INTRODUCTION
eveloping and building brand equity is gaining
significant attention among the academicians and
practitioners. Strong brand with positive equity
provides benefits like customer loyalty, higher market
share, higher margins, communication effectiveness etc
(Keller, 2001; Keller and Lehmann, 2003) to the firms.
Today worlds' top brands namely Microsoft, IBM, GE,
INTEL, Nokia etc. are well recognised world over and
their brand value is much higher than any other brand
(Interbrand, 2007). Efforts to develop such strong brands
and to identify different aspects of brand equity like how
to create, enhance and evaluate it etc., to ensure
competitive image and advantage in the market, have
been increasingly made by both practitioners and
academicians (Motameni and Shahrokhi, 1998 and
Seetharaman, Nadzir and Gunalan, 2001). However
research has focused primarily in relation to physical
D
goods (Berry, 2000). Services brand equity, on the other
hand, has received relatively little attention in the
academic literature, despite the fact that services currently
account for more than physical goods contribution to any
country's economy. There are several examples ofservice
brands which have created their place in the Indian visa-vis global markets. Jet, Kingfisher and Sahara in case
of airlines; Airtel and Reliance in case of communication
services; Apollo Group (largest healthcare service
provider in Asia and third largest in the world) in case of
healthcare, (Shanthi, 2006) are some best examples. The
service brand equity, as similar to physical goods, can
offer significant advantage to both consumers as well as
service providers. From consumer perspective, it is
primarily important because it associates product with
better services, good image etc and helps them in
processing information about particular brand (Krishnan
and Hartline, 2001). Even though a lot of research has
2 • Chahal and Bala
BRAND EQUITY, BRAND LOYALTY AND
HYPOTHESES FORMULATION
market the brand (Pitta and Katsanis, 1995). The literature
on brand equity focuses on fmancial and marketing aspects
of brand equity (Atlingan, Aksoy and Akinci, 2005; Kim,
Kim and An, 2003; Calderon, Cervera amd Molla, 1995
and Lassar, Mittal and Sharma, 1995). Financial aspect of
brand equity is concerned with determination of financial
value of brand for accounting, merger and acquisition
purpose (Pitta and Katsanis, 1995). Consumer's aspect of
brand equity is also known as marketing perspective of
brand equity. Marketing aspect of brand equity focuses on
cognitive aspect of consumer's towards brand. It has been
conceptualised differently by different authors. Aaker
(1991) defined brand equity in terms of set of assets
associated with the brand and these assets include brand
loyalty, brand awareness, brand association and perceived
quality. These assets were further tested and verified by
other authors viz Atilgan, Aksoy and Akinci (2005) and
Pappu, Quester and Cooksey (2005). Whereas Keller
(1993) viewed brand equity in terms of brand knowledge
that is brand awareness and brand image consumers
responses to the marketing activities of a particular brand.
Lassar, Mittal and Sharma (1995) conceptualised the
construct of brand equity with the help of five dimensions
such as performance, social image, value, attachment and
trustworthiness. Similarly Kim, Kim and An (2003)
measured brand equity with the application of brand
loyalty, brand awareness, perceived quality and brand
image. Out of these assets or dimensions of brand equity
brand loyalty is considered as the strongest path that leads
to brand equity (Atilgan Aksoy and Akinci, 2005). In fact
building brand in real sense means enhancing the brand
equity as the success of a brand in the long run depends on
its regular and loyal buyers (Amine, 1998). Brand loyalty
is the attachment of a consumer towards a brand and
thereby reflecting his stickiness towards a brand even if
the brand makes change in price or product features (Aaker,
1991). In the literature brand loyalty has been divided into
two categories: behavioural loyalty representing repeat
purchasing of a brand over a period of time by consumer.
However behavioural loyalty alone is not considered
enough to explain the various buying situations as there
are personal motives that provoke the consumer to buy
the same brand and therefore behaviour must be
Brand equity 'refers to stored value that is built up in a
brand to gain market advantage and this stored value can
be conceptualised in a number of ways like new product
trial and brand premium (McDonald, 1990). In other words
it is the power of the brand that is built in the minds of the
consumer on the basis of what he has learnt. seen, felt and
heard about brand (Keller, 1998). It has been frequently
described as the added value of a brand name to a product.
Brand equity results from qualitative strengths needed to
refers to strong cognitive elements of the consumer to
continue to re-buy the same brand (Mellens, Dekimpe and
Steenkamp, 1996 and Aaker, 1991). Although studies have
explored relationship between brand loyalty and brand
equity (Atilgon Aksoy and Akinci, 2005; Chaudhuri, 1995
and Aaker, 1991), evidence show that brand loyalty concept
has not been explored well i.e. should it be considered as
dimension ofbrand equity or as an outcome ofbrand equity
been contributed a great deal of insight into brand equity
in goods market (Mackay, 2001), there is limited
understanding of brand equity concept and its
measurement in service markets (Krishnan and Hartline,
2001). Yet it is important to evaluate brand equity in
service markets as branding plays an important role in
service companies by increasing consumes' trust and
enabling them to evaluate intangible features of services
and reducing risk in buying service (Krishnan and
Hartline, 2001). To move on brand equity trajectory and
to make a brand competitively different, the main
objective of the service firms should be to focus attention
on activities that contribute to service quality brand
development. Besides, service firms are found keen in
developing loyalty programmes to maintain long term
relationship with the customers (Raimondo, Miceli and
Costabile, 2008). As a well established brand name helps
in preserving brand loyalty (Lau, Chang, Moon and Liu,
2006) and a strong brand loyalty helps in enhancing brand
equity (Aaker, 1991 and Atilgan Aksoy and Akinci, 2005).
However its contextualisation is still yet to develop for
the service brands. This necessitates researchers,
academicians and the providers to understand and to
know what sources build a brand and this consequently
demands service provider's attention to identify various
sources of brand equity and how these sources affect
service brand equity.
This paper is organised in six sections. In the first
section, we present the theoretical background of brand
equity and brand loyalty and put forth a conceptual model
to demonstrate relationships between brand equity and
brand loyalty in a service (healthcare) sector. Next, we
describe our research design and methodology along with
a discussion on scale item analysis and sample design.
This is followed by data analysis section on considering
attitudinal brand loyalty as an antecedent, or as a
reflecting indicator or as an output variable. Lastly,
discussion, implications, limitations and future research
of the study are discussed.
accompanied with positive attitude. Thus attitudinal loyalty
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
Confirmatory Study on Brand Equity and Brand Loyalty • 3
or as a mediating variable between attitudinal and
behavioural loyalty? For example Aaker (1991) considered
brand loyalty both as source of brand equity and as an
outcome of brand equity. On the other hand Lassar, Mittal
and Sharma (1995) have viewed behaviour as a
consequence of brand equity instead of considering it in
brand equity construct. Again in 1995, Chaudhuri described
the direct effects ofbrand loyalty on brand equity outcomes
and indirect effect of attitude and habit on brand equity
outcomes via intervening variable of brand loyalty. Keller
(1998) on the other hand regarded brand loyalty as the
consequence ofbrand knowledge. However more recently,
Pappu, Quester and Cooksey (2005) has conceptualised
brand loyalty on the basis of consumer perception and
attitude and not on the basis of behaviour.
Based on the reviewed literature, we therefore
propose three brand equity-brand loyalty relationship
models viz Modell, Model2 and Model3 that need to be
addressed in the literature. Modell proposes that brand
equity is the result of attitudinal loyalty which in tum
contributes to behavioural loyalty or in other words, brand
equity acts as a mediating variable between attitudinal
and behavioural loyalty (Figure 1). Model 2 indicates
that brand equity is the result of both behavioural loyalty
and attitudinal loyalty (Figure 2). Model3 reflects brand
equity as the indicator of both behavioural loyalty and
attitudinal loyalty (Figure 3). Per se, the following
hypotheses based are put forth to provide clear insight
into the brand equity and brand loyalty relation in
healthcare service context:
and Steenkamp (1996) and Sheth (1970). The items were
modified to fit in the healthcare sector. Attitudinal loyalty
(Amine, 1998; Mellens, Dekimpe and Steenkamp, 1996;
Sheth, 1970, Lassar, Mittal and Sharma, 1995; Kim, Kim
and An, 2003; Atilgan Aksoy and Akinci, 2005; Pappu,
Quaster and Cooksey, 2005 and Delgado and Munuera,
2005) were modified and selected to measure attitudinal
loyalty. The third measure i.e. brand equity is generally
measured in the studies using two items viz, excellent
performance of the unit as compared to other units (2)
continuously improved performance (Krishnan and
Heartline, 2001 and Delgado and Munuera, 2005). Both
items were retained as such to assess brand equity of
healthcare units.
Construction of Questionnaire
RESEARCH DESIGN AND METHODOLOGY
The finalisation of the scale was done in three stages.
Initially on the basis of scale item generation, and
discussions with academicians and medical professionals,
brand loyalty comprised 23 statements and brand equity
comprised 2 statements. In the second stage, pre-testing
of the questionnaire was conducted on 135 consumers,
which resulted in the selection of 17 items ofbrand loyalty
grouped under attitudinal loyalty dimensions (9) and
behavioural loyalty dimensions (8). The brand equity was
measured using only 2 items. Likert scale was used with
"'5" as "strongly agree" and "1" as "strongly disagree"
response from the respondents for loyalty and equity
constructs. Besides these, the respondents were asked to
name the hospital which is known to them and are ready
to provide relevant information regarding that hospital
(this was an open ended question), the years of their
attachment (multiple choice) and whether they have taken
any service from the hospital last time (yes or no), type
of treatment taken and demographic profile. Lastly, on
the basis scale- item analysis (Table 2), discussed in the
following section, brand loyalty scale finally comprised
of 8 items i.e. 4 under attitudinal loyalty and 4 under
behavioural loyalty. The brand equity is measured using
the same two items.
Generation of Scale Items
Scale Item Analysis
The measures needed for the study consisted of brand
equity and brand loyalty comprising attitudinal loyalty
and behavioural loyalty. The face and content validity of
the scale was confirmed with the help of reviewed
literature and discussions with prominent personalities.
Brand loyalty is measured under two heads attitudinal
loyalty and behavioural loyalty in the literature. The items
to measure behavioural loyalty were selected from the
studies undertaken by Amine, 1998, Mellens, Dekimpe
The scale items are further refined using scale item
analysis. Items with either less than 0.7 MSA or
correlation less than 0.3 or cross loading on two
Hypothesis 1: Brand equity is directly influenced
by the attitude of the consumer and results in
behaviour ofthe consumer (Figure 1).
Hypothesis 2: Both behaviour and attitude results
in brand equity (Figure 2).
Hypothesis 3: Brand equity results in behaviour
and attitude (Figure 3).
subsequent factors
Of
factor loading less than 0.50 or item
to total correlation (less than 0.50) were excluded in
various stages and scale analysis and accordingly alpha
values were determined for different stages. The
behavioural loyalty which earlier consisted of 8 items
was reduced to 5 items (in 4 stages) and attitudinal loyalty
VISION-The Journal of Business Perspective • Vol. 14 • Nos. 1& 2 • January-June 2010
4 • Chahal and Bala
comprised 9 items was reduced to 6 items in 4 stages on
the basis of selected criteria. The cronbach alpha value
ranged from 0.704 to 0.760 for behavioural loyalty and
for attitudinal loyalty it ranged from 0.847 to 0.841 in .
the last stage. The final brand loyalty scale consists of 13
items was finally analysed (Table2) along with the two
items of brand equity which resulted in identifying three
separate factors headed as behavioural loyalty, attitudinal
loyalty and brand equity, which explained about 66.95%
and 63.40% of variance (Table3).
under these construct were based on theory underlying
them, the need was to confirm that these items well
confirm the hypothesised structure of the scales before
the structural model is tested. The procedure followed to
examine the same was explained as under;
a.
At the outset exploratory factor analysis was
conducted individually for the three constructs
(perceived quality, brand loyalty and brand image).
b.
Items that were poorly related to their hypothesised
factors or those were associated with more than one
factor were deleted.
c.
Using the cronbach alpha (?) estimate (less than
0.7), item to total correlation (less than 0.5), factor
loading (less than 0.50) and cross-loadings criteria,
items insignificantly related were deleted in
respective sub constructs (Table 2 and Table 3).
d.
These steps were repeated until clear factor emerged
under each construct (Table 2).
e.
Lastly overall exploratory factor analysis was
conducted to see that these factors do not merge
with other factors (to check the unidimentionality
of the scale). At this stage 3 items were found to be
cross loaded to more than one factor and were
eliminated. This last step resulted in the formation
ofthree factors i.e. attitudinal loyalty (with 4 items),
behavioural loyalty (with 4 items) and brand equity
(with 2 items).
Sample Design
For measuring brand loyalty and brand equity
components in healthcare sector of India and thereby
formulating various strategic action plans for maintaining
and improving better services to the patient's, primary
data was collected from 300 respondents who fulfill three
criteria i.e. (i) age above 20 years (ii) he/his family
member have visited the hospital (s) and (iii) minimum
four years experience. The sample was selected from
Jammu city only. In the beginning, a list of wards from
Jammu municipality was taken to select the respondents
(the total number ofwards turned out to be 71). The region
was geographically divided into four zones and each zone
was represented in four blocks i.e. block I, block II, block
III and block IV. The wards falling in different areas were
grouped in their respective block. To have significant
representation from each geographical region, one ward
each from each block was selected (i.e. block I, block II,
block III and block IV) randomly (Table 1). About 75
respondents each from four blocks were contacted
conveniently for data collection purpose, and thereby
making the sample size as 300. A brief outline of the
demographic information of the respondents is shown in
Table 1. Out of the total respondents 163 were male (54.3
%) and 137 were female (45.7 %). Further, 29 respondents
(9.7 %) were older than 50 years, 143 respondents (47.7
%) were between 35-50 years, 128 respondents (42.7 %)
fell in the category of between 20-35 years. The monthly
income of the respondents fall in the category of: below
5000 (15.7%), 5000-10000 (35.7%), 10000-15000
(37.7%) and above 15000 (10.7%). The type of treatment
taken by the respondents like ENT (13.7%), skin (10.3),
surgery (23.7%) and other services (52%) (Table 1).
DATA ANALYSIS
Unidimensionality, Reliability and Validity
The measurement properties (reliability and validity)
were analysed for attitudinal loyalty, behavioural loyalty
and brand equity measures. As the development of items
High loadings (above the threshold value of 0.50.)
of all the items indicate convergent validity while loading
on only one factor indicates unidimentionality of the
construct. Lastly, no factors consist of two sets of items
loading highly on it to indicate discriminant validity (Hair
et al., 2003). It simultaneously checked unidimensionality
of the measures. After establishing unidimensionality, the
reliability of the scale was assessed with the usage of
cronbach alpha (for internal consistency). The overall
reliability alpha (?) value for final behavioural loyalty
scale came out to be 0.760 and for attitudinal loyalty it
came out to be 0.841 and for the overall scale it was .814.
All the values indicate good reliability values, being
above the threshold limit of 0.70 (Hair et al., 2003).
Further composite reliability is examined for all three
models. The composite reliability values for all the three
latent models came out to be 0.78, 0.77 and 0.47
respectively. After examining the individual fitness,
composite reliability for the three models was calculated
(Model 1=0.87, Model 2=0.88 and Model 3=0.89)
indicate high internal consistency of the models.
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
Confirmatory Study on Brand Equity and Brand Loyalty • 5
Relationships between Brand Loyalty and Brand
Equity
The exploratory factor analysis performed on the reduced
scale identified three factors christened as behavioural
loyalty, attitudinal loyalty and brand equity. The three
proposed relationships between attitudinal and
behavioural loyalty (components of brand loyalty) and
brand equity (Figures I, 2 and 3) were examined for
Modell, Model2 and Model3 with the aid of Structural
Equation Model using AMOS (Analysis of Moments
Software). The initial application of confirmatory factor
analysis relationship indicated somewhat poor fit of the
models. The improvement in the model fit as such is
attained through the addition of model parameters. Using
modification indices criteria greater than three
(Diamantopoulos and Sigsaw, 2000), the covariance
between the measurement errors of functioning of the
hospital and overall performance of the hospital; usually
availed services and recommend the hospital to friends
and family, usually availed services and generally visited
hospital and lastly excellent performance and improved
performance in the first model in the respective order
helped in the attairunent of fit model (Baggozi, 1983).
The same procedure was adopted for checking the fitness
of Models 2 and 3. It was interesting to mention that the
covariance measurement error variables which were corelated in model I were also found to be correlated in
models 2 and 3 (except excellent performance and
improved performance). A methodological reason for
them to be covariated might be because of presence of
causal relationships and secondly all measurement might
share some common data collection bias. Thus all the
effort resulted in the overall fitness of the model. The
results of each model are explained as under:
Modell: Brand Equity as the Resultant Factor of
Attitudinal Loyalty and Results Behavioural Loyalty
Although initial application of confirmatory factor
analysis relationship indicated somewhat poor fit of the
model but using modification indices criteria greater than
three (Diamantopoulos and Sigsaw, 2000) fitness was
found to be quite acceptable (Figure 3). As per the
threshold values, the various model fit indices such as ?2
/ df =2.967, CFI= 0.933 and RMSEA=0.081 indicate
moderate fitness of the model. Further all the four
indicators of attitudinal loyalty viz. selection of the
hospital based on expertise skill of the staff, availability
of state of art technology, functioning of the hospital and
overall performance of the hospital are quite significant
with standardised regression weights (SRW) ranging
between 0.494 and 0.844. The predictive ability of
availability of the state of art technology is highest
followed by expertise skill of the staff and functioning
of the hospital. The effect of attitudinal loyalty on brand
equity is found to be quite good with SRW as 0.695.
Further the consequent effect of brand equity on
behavioural loyalty is found even more high
(SRW=0.906). Among the four indicators of behavioural
loyalty, recommending the hospital to friends, family and
others is affected maximally in comparison to usually
availed services and generally visited hospital on account
of brand equity. The overall result support the
hypot~esesl i.e. brand equity is directly influenced by
the attItude of the consumer results in behaviour of the
consumer.
Model2: Behavioural Loyalty and Attitudinal Loyalty
.
as the Indicators of Brand Equity
The effect of both attitudinal loyalty and behavioural
lo.ya.lty on brand equity was tested on Model 2 (Figure 5).
Sundar to modell, after using modification indices fitness
criteria the model 2 is found to be quite acceptable. Akin
to the results ofModel I all the indicators were significantly
contributing to their respective constructs of attitudinal
loyalty and behavioural loyalty. Availability of technical
facilities and recommending the hospital to other variables
has highest impact on the attitudinal and behavioural
loyalty respectively. However the model portray that
attitudinal loyalty has little influence on brand equity
(SRW=0.133) in comparison to behavioural loyalty
(SRW=0.502). This seems to be quite acceptable as
behaviour is always followed by attitude. Further unlike
~odel I excellent performance (SRW=0.720) is impacting
highly towards brand equity in comparison to continued
improved performance (SRW=0.569). Overall the
hypothesis relating to attitudinal loyalty and behavioural
loyaltyas the indicator ofbrand equity also stands accepted.
Model 3: Brand Equity as an Indicator of Behavioural
Loyalty and Attitudinal Loyalty
The third model considers both attitudinal loyalty and
behavioural loyalty as the reflective indicators of brand
equity. The measurement indicators ofattitudinal loyalty
and behavioural loyalty are again found to be significant
in the modified model, after correlating variables using
modification indices. The results indicate that brand
equity impacts behavioural loyalty (SRW=O.896) more
in comparison to attitudinal loyalty (SRW=0.691). It is
also interesting to find that same indicators i.e.
availability of state of art and recommend the hospital
to others as examined in model I and model 2 are highly
contributing to their respective constructs. These results
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
6 • Chahal and Bala
were accepted as brand equity reflects attitudinal loyalty
and behavioural loyalty. Hence hypothesis 3 is also
accepted.
DISCUSSION
Overall the comparative analysis ofthree models indicates
significant relationship between brand equity and
attitudinal loyalty and behavioural loyalty, whether as
an antecedent or as a mediator or as a consequential
indicator. Similar to the findings ofAaker (1991) the study
results indicate that brand loyalty (i.e. attitudinal loyalty
and behavioural loyalty) serves as an indicator as well
as an outcome of the brand equity (Models 2 and 3). As
such all the four indicators of attitudinal loyalty advocate
that patient's select the hospital on the basis of significant
criterion namely expertise skill of the staff, availability
of state of art technology, functioning of the hospital and
overall performance of the hospital. Subsequently, the
so developed positive attitude of consumer brings him
again to the same hospital to get services from it and
thereby recommending it to others including friends and
relatives. This positive word ,of mouth process is
significant in establishing good image of the hospital in
the later period.
Modell reproduced behaviour as the consequence
of brand equity and brand equity as the outcome of
attitude of the consumers which confirmed the views
of Pappu, Quaster and Cooksey (2005) and Lassar,
Mittal and Sharma (1995). For instance the steady and
longitudinal positive perception of patients towards
.hospital services build as a result of qualitative services
recognised in terms competence, prescription quality
of doctors and nurses along with other facilities and
atmosphere factors will always indicate their satisfaction
towards hospital performance. This consequently will
result in not only in visiting the same hospital for same
or different treatments but also recommending it to
known persons, which reflects the behavioural loyalty
of the patient. In other words it is the confidence or
feeling of the patient's that generates brand equity of
the hospital. This confidence gets translated into loyalty
and their willingness to visit the same hospital again
and recommend to others. The model2 result indicates
that attitudinal loyalty and behavioural loyalty impact
each other and affects brand equity. This indicate that
attitudinal loyalty with some unique associations like
expertise skill of the staff availability of state of art,
functioning and overall performance of the hospital
creates and build positive perception and ultimately
impact his behaviour and visa versa. Thus, both
attitudinal as well as behavioural loyalty is significant
for enhancing the equity of the hospital in the form of
its performance. In Model3 where brand equity directly
affect brand loyalty (both attitudinal loyalty and
behavioural loyalty), exp lains the rationale behind this
fact that consumers prefer to trust famous brand names
(Lau, Chang, Moon and Liu, 2006) especially in
healthcare. As such high service brand hospitals will
always be associated by the consumers with high
attitudinal loyalty and behavioural loyalty. In conclusion
we can say that increasing brand loyalty means ensuring
brand equity which further develops the behaviour of
the consumer.
Implications of the Study
The study has number of implications. Firstly from
theoretical and research perspective the study provides
an understanding that brand loyalty can be considered
as an indicator as well as a consequence of brand equity
in healthcare sector. Secondly from consumer's
perspective behavioural loyalty is important indicator
in comparison to attitudinal loyalty in judging brand
equity specifically as patients consider usually availed
services from the same hospital, recommending it to
others and generally visited hospitals as important for
assessing behavioural loyalty. The attitudinal loyalty on
the other hand, is found to be the function of indicators
such as expertise skill of the staff, availability of state
of art, functioning of the hospital and overall
performance ofthe hospital. Due to more awareness and
more refined services available to the consumers, they
can be more choosier of the services and as such select
those services which they consider perfect, especially
in case of healthcare where the question of their quality
of life arises. This means consumers would select
hospital on the basis ofcertain significant characteristics
such as trust, positive perception, preference,
availability of doctors and quality (attitudinal loyalty)
and generally visit such hospitals and also recommend
the same to others (behavioural loyalty). The managerial
implication of the study reflect that healthcare service
providers can consider the aforesaid factors such as good
expertise skill of the staff technical facilities available,
image of the hospital in delivering qualitative
customised services as these factors build trust and
positive feeling towards the hospital. This all
subsequently enhance attitudinal loyalty as well as
behavioural loyalty. To sustain competition in the
healthcare market it is very important for the hospitals,
both public as well as private to increase patient
satisfaction to build attitudinal and behavioural loyalty.
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
Confirmatory Study on Brand Equity and Brand Loyalty • 7
Limitations and Future research
The study is not free from limitations. Firstly, data was
collected conveniently i.e. only those persons were
contacted who were willing to provide information
relating to healthcare. Secondly, there is a need to
explore the relationship between brand loyalty and brand
equity specifically in terms attitudinal loyalty and
behavioural loyalty as the results of the study were
moderate as per the goodness of fit indexes and as such
these findings are required to be tested in similar settings
with large randomly selected respondents. The study
can be further extended to know the dependency of the
brand loyalty on brand equity or visa versa not only in
healthcare sector but also in other service sectors. The
other important antecedents and mediating variables of
loyalty and brand equity relationship such as tangibility,
training, funds etc. should be considered in future
research to contextualise brand equity in healthcare and
other sectors.
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FIGURES AND TABLES
Outcome ofbrand
equity
Source of brand
equity
Attitudinal
Loyalty
....
Brand Equity
...
....
....
Behavioural
Loyalty
Model l:- Brand Equity as the Resultant Factor of Attitudinal Loyalty
and Results in Behavioural Loyalty
Figurel
Behaviour and Attitude
Brand Equity
Model 2:- Behavioural Loyalty and Attitudinal Loyalty as the
indicators of Brand Equity
Figure 2
[
Brand Equity
Behaviour and Attitude
J
Model 3:- Brand Equity as an Indicator of Behavioural Loyalty
and Attitudinal Loyalty
Figure 3
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
Confirmatory Study on Brand Equity and Brand Loyalty • 9
0,
0,
~
0,
°
~SART
~FUNC
04
°
~-c!J
0,
0,
0
8
PERF
~G
e7
~--
error2
Modell
Brand Equity as the Resultant Factor of Attitudinal Loyalty and Results in Behavioural Loyalty
Figure 4
KeyWords
EXP= Expertise skill ofthe staff
SART=Availability ofstate ofart
FUNC= Functioning ofthe staff
PERF=Overallperformance of
the hospital
EXPER=Excellent performance
in comparison competitors
IMPER=Continuously improved
performance
SERVE= Usually availed services
RECO=Recommend tofriends andfamily
RECOO=Recommend to others
VISIT=Generally visited hospital
0,
&_1_~L--_-----'
0,
&--~L--_-----'
0:_1_~L--_-----'
error
0-~L.-----.-J
0,
8·_1_~,--
8_1_~,--_-----,
0,
°
__
8·_1_~,--_-----,
0,
Attitudinal
Loyalty
Brand Equity
0,
Behavioural
Loyalty
8-~~
Model 2
Behavioural Loyalty and Attitudinal Loyalty as the indicators of Brand Equity
KeyWords
EXP= Expertise skill ofthe staff
SART=Availability ofstate ofart
FUNC= Functioning ofthe staff
PERF=Overall performance of
the hospital
Figure 5
SERVE= Usually availed services
RECO=Recommend tofriends andfamily
RECOO=Recommend to others
VISIT=Generally visited hospital
EXPER=Excellent performance
in comparison competitors
IMPER=Continuously improved
performance
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
10 • Chahal and Bala
0,
error3
0,
o
Attitudinal
Loyalty
0,
0,
Brand Equity
o
1
0,
error2
Model 3
Brand Equity as an Indicator of Behavioural Loyalty and Attitudinal Loyalty
Figure 6
KeyWords
EXP= Expertise skill ofthe staff
SART=Availability ofstate ofart
FUNC= Functioning ofthe staff
PERF=Overall performance of
the hospital
SERVE= Usually availed services
RECO=Recommend to friends andfamily
RECOO=Recommend to others
VISIT=Generally visited hospital
EXPER=Excellent performance
in comparison competitors
IMPER=Continuously improved
performance
Table 1:- Demographic Profile of the Respondents
Particulars
Gender
Male
Female
Age (in years)
20-35
35-50
Above 50
Monthly Income (in Rs)
Below 5000
5000-10000
10000-15000
Above 15000
Health Insurance Taken
Yes
No
Frequency
Percent (%)
163
137
54.3
45.7
128
143
29
42.5
47.7
9.7
47
107
113
15.7
35.7
37.7
10.7
32
104
191
34.7
63.7
Particulars
Education
Illiterate
Matriculatel+2
Graduate
Post Graduate+
Frequency
Percent (%)
6
57
140
97
2.0
19.0
46.7
32.3
135
54
94
15
45.0
18.0
31.3
5.0
41
13.7
31
71
299
10.3
23.7
52.0
Occupation
Service Class
Business
Profession
Dependent
Type of Treatment Taken
ENT
Skin
Surgery
Any Other
VISION-The Journal of Business Perspective • Vol. 14 • Nos. 1 & 2 • January-June 2010
Confirmatory Study on Brand Equity and Brand Loyalty • 11
Table2:- KMO Values, Number of Items Deleted, Total Number of Items after Deletion and Cumulative
of Factor Analysis
S.No
KMO Values
after Deletion
of Items
Corrected
Item - Total
Correlation
%
at Each Stage
Cronbach
Value if
Item Deleted
Cronbach
alpaha Value
(Overall Scale)
Number
of Items
Deleted
Total
Number of
Items after
Deletion
Cumulative
0/0
Behavioural Loyalty
1
0.671
-
-
0.704
-
8
66.66
2
0.685
0.162
0.731
0.735
1
7
60.34
3
0.726
0.367
0.723
0.724
1
6
61.83
4
0.716
0.229
0.760
0.760
1
5
51.27
Attitudinal Loyalty
1
0.819
-
-
0.847
-
9
58.57
2
0.816
0.450
0.845
0.845
1
8
61.93
3
0.796
0.445
0.843
0.843
1
7
67.14
4
0.818
0.476
0.837
0.841
1
6
56.25
Overall Scale Analysis
1
0.816
-
-
0.849
-
13
66.95
2
0.796
1
12
60.25
0.753
*
*
0.840
3
*
*
0.814
2
10
63.40
Key Note: *Cross loading values
Table 3:- Factor Wise Mean Score Values, Factor Loading Values and Percentage Variance
Mean Score
Values
Std.
Deviation
Factor
Loading
Expertise skill of the staff
4.03
0.93
0.867
Availability of state of art
4.01
1.11
0.811
Functioning of the hospital
4.15
4.03
0.98
0.99
0.714
0.675
Usually availed services
3.97
0.92
0.800
Recommend to friend and family
4.11
0.92
0.736
Recommend to others
4.14
0.89
0.636
Generally visited hospital
4.12
0.88
0.591
Continuously improved performance
3.87
1.12
0.851
Excellent performance
3.97
1.07
0.736
Dimensions of Brand Loyalty and Brand Equity
of
Variance
0/0
Fl:- Attitudinal loyalty
Overall performance
26.69
F2:-Behaviouralloyalty
21.21
F3:-Brand Equity
Cumulative % of Variance
Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy
Rotation converged in 5 iterations.
15.50
63.401
0.753
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1&2· January-June 2010
12 • Chahal and Bala
Table 4:- Model wise SRW and CR Values
Modell
SRW
CR
Relationships
0.695 4.68
Brand Equity <-Attitudinal Loyalty
0.906 4.46
Behavioural
Loyalty <--Brand
Equity
0.494
PERF< ---Attitudinal Loyalty
FUNC< ---0.628 8.30
Attitudinal Loyalty
SART< ---0.844 7.82
Attitudinal Loyalty
0.727 7.62
EXP< ---Attitudinal Loyalty
0.452
VISIT< ---Behavioural
Loyalty
0.890 6.81
RECOO< ---Behavioural
Loyalty
RECO< ---0.565 6.39
Behavioural
Loyalty
0.386 6.26
SERV< ---Behavioural
Loyalty
EXPER < ---0.466
Brand Equity
IMPER < ---0.368 5.51
Brand Equity
Chi-square
86.052
df
29
CMIN/DF
2.967
RMSEA
0.081
CFI
0.933
Model 2
SRW CR
Relationships
0.133 1.18
Brand Equity <-Attitudinal Loyalty
Brand Equity <-0.502 3.91
Behavioural
Loyalty
0.494 PERF< ---Attitudinal Loyalty
0.628 8.30
FUNC< ---Attitudinal Loyalty
0.844 7.82
SART< ---Attitudinal Loyalty
0.727 7.62
EXP< ---Attitudinal Loyalty
0.452
VISIT< ---Behavioural
Loyalty
RECOO< ---0.890 6.81
Behavioural
Loyalty
RECO< ---0.565 6.39
Behavioural
Loyalty
SERV< ---0.386 6.26
Behavioural
Loyalty
EXPER < ---0.720
Brand Equity
IMPER < ---0.569 5.51
Brand Equity
Chi-square
86.052
df
29
CMIN/DF
2.967
RMSEA
0.081
0.933
CFI
Model 3
Relationships
Attitudinal Loyalty
<--Brand Equity
Behavioural
Loyalty <-- Brand
Equity
PERF< ---Attitudinal Loyalty
FUNC< ---Attitudinal Loyalty
SART< ---Attitudinal Loyalty
EXP< ---Attitudinal Loyalty
VISIT< ---Behavioural
Loyalty
RECOO< ---Behavioural
Loyalty
RECO< ---Behavioural
Loyalty
SERV< ---Behavioural
Loyalty
EXPER < ---Brand Equity
IMPER < ---- Brand
Equity
Chi-square
df
CMIN/DF
RMSEA
CFI
SRW
0.691
CR
5.11
0.896
4.41
0.492
-
0.628
8.30
0.847
7.82
0.727
7.61
0.446
-
0.901
6.67
0.550
6.29
0.382
6.26
0.466
-
0.370
5.51
75.416
28
2.693
0.075
0.944
Key Note: CR= Critical ratio and SRW= Standardised Regression Weight
Hardeep Chahal ([email protected]) is an Associate Professor in the Department of Commerce, Jammu University.
Her research interest focuses on Services Marketing with emphasis on consumer satisfaction and loyalty, Service Quality, Brand Equity
and Market Orientation. She has published articles in International Journal of Business and Globalisation, International Journal of
Indian Culture, Business and Management, Journal of Health Management, Total Quality Management and Excellence, Vikalpa,
Metamorphosis, Decision, Journal of Social Work, Vision -The Journal of Business Perspective, Journal of Services Research and
Journal of Rural Development. She has also co-edited books on Research Methodology in Commerce and Management and Strategic
Service Marketing. She currently serves on the editorial board of the International Journal of Health Quality and Assurance (Emerald),
Journal of Services Research (India), and the Journal of Social Sciences (University of Jammu).
Madhu Bala ([email protected]) is Lecturer, Government Higher Secondary School, Sarthal, Kistwar, Jammu and Kashmir. Her
area of research is Service Brand Equity in healthcare sector. She has participated and presented papers in various national seminars
and conferences and workshops across the country.
VISION-The Journal of Business Perspective· Vol. 14· Nos. 1 & 2· January-June 2010
Reproduced with permission of copyright owner.
Further reproduction prohibited without
permission.
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