THE INTERPLAY OF TRUST: MEDIATING AND MODERATING EFFECTS IN THE COMMUNICATION-LOYALTY RELATIONSHIP IN PRIVATE HOSPITALS IN VIENTIANE
Article Sidebar
Main Article Content
Abstract
Purpose: This study investigated the relational mechanisms linking communication effectiveness to patient loyalty within the private healthcare sector of Vientiane, Lao PDR. Rooted in the Social Exchange Theory (SET), the research specifically examined trust’s mediating and moderating role in translating service communication into behavioral commitment.
Study Design/Methodology/Approach: A quantitative research design involved a self-administered online questionnaire to gather data from 512 patients who had recently used private hospital services in Vientiane. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to evaluate the measurement and structural models.
Findings: The results offered strong empirical evidence of the direct effect of communication effectiveness on patient loyalty (β = 0.252, p < 0.001). Furthermore, the study identified trust as a critical mechanism: communication effectiveness significantly drives trust (β = 0.778, p < 0.001), which in turn boosts loyalty (β = 0.550, p < 0.001). Mediation analysis confirms that trust functions as a crucial partial mediator (β = 0.428, p < 0.001). However, the hypothesized moderating effect of trust was not significant (β = -0.002, p = 0.478), indicating that trust serves as a fundamental prerequisite rather than a conditional buffer in this high-risk context.
Originality/Value: This research advances SET by conceptualizing trust’s dual role in a transitional Southeast Asian economy. It challenges Western-centric models by showing that, in the Lao PDR’s developing healthcare market, trust acts as a “hygiene factor” essential for the relationship to exist, but does not amplify service inputs.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Chinese Journal of Social Science and Management Editorial Division
The Office of Research and Development, Panyapiwat Institute of Management
85/1 Moo 2, Chaengwattana Rd., Bang Talat, Pakkred, Nonthaburi 11120, Thailand
Tel. 02 855 01048 E-mail: cjssm@pim.ac.th
References
Alayed, T. M., Alrumeh, A. S., Alkanhal, I. A., & Alhuthil, R. T. (2024). Impact of privatization on healthcare system: A systematic review. Saudi Journal of Medicine & Medical Sciences, 12(2), 125-133. https://doi.org/10.4103/sjmms.sjmms_510_23
Attar, R. W., Amidi, A., & Hajli, N. (2023). The role of social presence and trust on customer loyalty. British Food Journal, 125(1), 96-111. https://doi.org/10.1108/BFJ-11-2021-1218
Chen, Y., Prentice, C., Weaven, S., & Hisao, A. (2022). The influence of customer trust and Artificial Intelligence on customer engagement and loyalty–The case of the home-sharing industry. Frontiers in Psychology, 13, 912339. https://doi.org/10.3389/fpsyg.2022.912339
Cochran, W. G. (1977). Sampling techniques (3rd ed.). John Wiley & Sons Inc.
García-Carrión, B., Del Barrio-García, S., Muñoz-Leiva, F., & Porcu, L. (2023). Effect of social-media message congruence and generational cohort on visual attention and information-processing in culinary tourism: An eye-tracking study. Journal of Hospitality and Tourism Management, 55, 78-90. https://doi.org/https://doi.org/10.1016/j.jhtm.2023.03.006
Hair Jr, J. F., Howard, M. C., & Nitzl, C. (2020). Assessing measurement model quality in PLS-SEM using confirmatory composite analysis. Journal of Business Research, 109, 101-110.
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117
Handayani, R., Ruswanti, E., Hilmy, M. R., & Adhikara, M. A. (2021). Communication effectiveness of doctors and patients, loyalty, word of mouth, on repurchase intentions at district public hospital Tangerang, Indonesia. Journal of Multidisciplinary Academic, 5(4), 334-340. http://www.kemalapublisher.com/index.php/JoMA/article/viewFile/605/592
Irgui, A., & Qmichchou, M. (2024). Contextual marketing and information privacy concerns in m-commerce and their impact on consumer loyalty. Arab Gulf Journal of Scientific Research, 42(3), 1150-1170. https://doi.org/10.1108/AGJSR-09-2022-0198
Jeerakamol, O. -U., Suksawas, W., & Soithong, P. (2024). Navigating trust: A comparative analysis of generalized and particularized trust on the quality of life of family caregivers in Lower Northern Thailand. Journal of Community Development Research (Humanities and Social Sciences), 17(2), 29-43. https://doi.org/10.14456/jcdr-hs.2024.11
Jenstad, L. M., Howe, T., Breau, G., Abel, J., Colozzo, P., Halas, G., Mason, G., Rieger, C., Simon, L., & Strachan, S. (2024). Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. Patient Education and Counseling, 119, 108040. https://doi.org/10.1016/j.pec.2023.108040
Kähkönen, T., Blomqvist, K., Gillespie, N., & Vanhala, M. (2021). Employee trust repair: A systematic review of 20 years of empirical research and future research directions. Journal of Business Research, 130, 98-109. https://doi.org/10.1016/j.jbusres.2021.03.019
Kehyayan, V., Yasin, Y. M., & Al-Hamad, A. (2025). Toward a clearer understanding of value-based healthcare: A concept analysis. Journal of Nursing Management, 2025, 8186530. https://doi.org/10.1155/jonm/8186530
Kidron, A., & Vinarski-Peretz, H. (2025). The influence of organizational trust and social exchange on organizational citizenship behavior: The mediating role of workplace spirituality. Journal of Organizational Effectiveness: People and Performance, 13(1), 129-146. https://doi.org/10.1108/JOEPP-08-2024-0410
Kim, J. H. (2019). Multicollinearity and misleading statistical results. Korean Journal of Anesthesiology, 72(6), 558-569. https://doi.org/10.4097/kja.19087
Kock, N. (2015). Common Method Bias in PLS-SEM: A full collinearity assessment approach. International Journal of e-Collaboration (IJeC), 11(4), 1-10. https://doi.org/10.4018/ijec.2015100101
Kock, N. (2017). WarpPLS user manual: Version 6.0. ScriptWarp Systems.
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20, 158. https://doi.org/10.1186/s12912-021-00684-2
Lauwers, E. D. L., Vandecasteele, R., McMahon, M., De Maesschalck, S., & Willems, S. (2024). The patient perspective on diversity-sensitive care: A systematic review. International Journal for Equity in Health, 23, 117. https://doi.org/10.1186/s12939-024-02189-1
Lee, C. (2021). Patient loyalty to health services: The role of communication skills and cognitive trust. International Journal of Healthcare Management, 14(4), 1254-1264. https://doi.org/10.1080/20479700.2020.1756111
Liu, H., Jiang, J., Yu, L., & Liu, X. (2025). The impact of hospital competition on healthcare quality: Evidence from China’s healthcare reform. Frontiers in Public Health, 13, 1543884. https://doi.org/10.3389/fpubh.2025.1543884
Liu, S., Li, G., Liu, N., & Hongwei, W. (2021). The impact of patient satisfaction on patient loyalty with the mediating effect of patient trust. Inquiry, 58, 469580211007221. https://doi.org/10.1177/00469580211007221
Lyu, J., & Ratasuk, A. (2024). Determinants of customer trust in rural e-commerce in Zhengzhou, China: A case study of Taobao Villages. Panyapiwat Journal, 16(2), 105-124. https://so05.tci-thaijo.org/index.php/pimjournal/article/view/272351
MacKay, L. J., Chang, U., Kreiter, E., Nickel, E., Kamke, J., Bahia, R., Shantz, S., & Meyerhoff, H. (2024). Exploration of trust between pediatric nurses and children with a medical diagnosis and their caregivers on inpatient care units: A scoping review. Journal of Pediatric Nursing, 78, e1-e30. https://doi.org/10.1016/j.pedn.2024.05.030
Ministry of Health, Lao PDR. (2023a). Human resources for health development strategy by 2030 Lao PDR. World Health Organization. https://extranet.who.int/uhcpartnershiplivemonitoring/system/files/doc_attachments/Eng_Human%20Resources%20for%20Health%20strategy_23Jan2024.pdf
Ministry of Health, Lao PDR. (2023b). Lao People’s Democratic Republic digital health strategy 2023-2027. World Health Organization. https://extranet.who.int/countryplanningcycles/sites/default/files/public_file_rep/LAO_Lao_People-Digital-Health-Strategy_2023-2027.pdf
Naing, N. L., & Ratasuk, A. (2025). Contributions of the SERVQUAL model in promoting patients’ revisit intentions through trust and brand image in the private hospital in Yangon. Asia Social Issues, 18(5), e275055. https://doi.org/10.48048/asi.2025.275055
Nguyen, N. X., Tran, K., & Nguyen, T. A. (2021). Impact of service quality on in-patients’ satisfaction, perceived value, and customer loyalty: A mixed-methods study from a developing country. Patient Preference and Adherence, 15, 2523-2538. https://doi.org/10.2147/PPA.S333586
Ratasuk, A. (2022a). Contributions of product quality, service quality, store ambiance, and promotion on customer loyalty: The mediating role of brand identity in convenience store coffee chains in Bangkok. Journal of ASEAN PLUS+ Studies, 3(1), 11-28. https://so06.tci-thaijo.org/index.php/aseanplus/article/view/257327
Ratasuk, A. (2022b). The role of cultural intelligence in the trust and turnover of frontline hotel employees in Thailand. Humanities, Arts and Social Sciences Studies, 22(2), 348-358. https://doi.org/10.14456/hasss.2022.32
Ratasuk, A. (2024a). The importance of food hygiene in building customer trust and repurchase intentions in Bangkok street food for sustainable development. NIDA Development Journal, 64(2), 49-76. https://doi.org/10.14456/ndj.2024.8
Ratasuk, A. (2024b). The structural equation model development of how mindfulness promotes employee creativity in the restaurant business. Humanities, Arts and Social Sciences Studies, 24(2), 326-340. https://doi.org/10.69598/hasss.24.2.267535
Ratasuk, A., & Charoensukmongkol, P. (2019). The role of team trust and team conflict on innovative performance of multicultural teams in the restaurant. Thammasat Review, 22(2), 1-18. https://sc01.tci-thaijo.org/index.php/tureview/article/view/205119
Ratasuk, A., & Gajesanand, S. (2022a). Does food safety build customer trust? The mediating role of perceived risk in food delivery service in Bangkok during the COVID-19 pandemic. Asia Social Issues, 16(2), e253719. https://doi.org/10.48048/asi.2023.253719
Ratasuk, A., & Gajesanand, S. (2022b). Roles of food safety on customer repurchase intentions: The mediation of perceived risk and trust in food delivery service in Bangkok during COVID-19. Journal of Business Administration, 45(175), 71-93. https://doi.org/10.14456/jba.2022.16
Ratasuk, A., Naing, N. L., & Tantaworranart, P. (2025). Enhancing patient trust in Yangon’s private hospitals: Impact of service quality using SERVQUAL model on brand image. University of the Thai Chamber of Commerce Journal Humanities and Social Sciences, 45(2), 1-14. https://so06.tci-thaijo.org/index.php/utccjournalhs/article/view/278544
Ratasuk, A., & Naing, N. L. (2025). Can communication effectiveness promote patients’ revisit intentions through trust and perceived value? A study of private hospitals in Yangon. Journal of Public Health and Development, 23(3), 212-229. https://doi.org/10.55131/jphd/2025/230317
Raunaq, F. F., Islam, S., Anam, M. Z., & Bari, A. B. M. M. (2025). Assessing the challenges to digital technology adoption in the healthcare sector: Implications for sustainability in emerging economies. Informatics and Health, 2(2), 194-209. https://doi.org/10.1016/j.infoh.2025.09.001
Rohita, T., & Nurkholik, D. (2025). Determinants of patient loyalty in healthcare: The multifaceted influence of demographics and nurses’ caring behavior. Journal of Public Health and Pharmacy, 5(2), 262-273. https://doi.org/10.56338/jphp.v5i2.5704
Sharkiya, S. H. (2023). Quality communication can improve patient-centred health outcomes among older patients: A rapid review. BMC Health Services Research, 23, 886. https://doi.org/10.1186/s12913-023-09869-8
Sheehan, J., Laver, K., Bhopti, A., Rahja, M., Usherwood, T., Clemson, L., & Lannin, N. A. (2021). Methods and effectiveness of communication between hospital allied health and primary care practitioners: A systematic narrative review. Journal of Multidisciplinary Healthcare, 14, 493-511. https://doi.org/10.2147/jmdh.S295549
Simon, M., Danner, S., Saavedra, S., Flowers, F., Jackson, A., Ross, J., Abbas, H., Adetoro, E., Ekong, A., Osei, C., Francone, N., Alhalel, J., Masinter, L., & Lazar, D. (2021). The complex interplay of communication and trust in healthcare delivery. Harvard Public Health Review, 39(10), 54111. https://doi.org/10.54111/0001/mm5
Stafford, L., & Kuiper, K. (2021). Social exchange theories: Calculating the rewards and costs of personal relationships. In P. Schrodt, K. M. Scharp, & D. O. Braithwaite (Eds.), Engaging theories in interpersonal communication: Multiple perspectives (pp. 379-390). Routledge. https://doi.org/10.4324/9781003195511-33
Tabish, S. A. (2024). Health care marketing. In S. A. Tabish (Ed.), Health care management: Principles and practice (pp. 435-458). Springer. https://doi.org/10.1007/978-981-97-3879-3_20
Wünderlich, N. V., Blut, M., Brock, C., Heirati, N., Jensen, M., Paluch, S., Rötzmeier-Keuper, J., & Tóth, Z. (2025). How to use emerging service technologies to enhance customer centricity in business-to-business contexts: A conceptual framework and research agenda. Journal of Business Research, 192, 115284. https://doi.org/10.1016/j.jbusres.2025.115284
Zhang, X., & Liu, S. (2022). Understanding relationship commitment and continuous knowledge sharing in online health communities: A social exchange perspective. Journal of Knowledge Management, 26(3), 592-614. https://doi.org/10.1108/JKM-12-2020-0883
Zhao, Z., Zhang, Z., Yang, C., Li, Q., Chen, Z., & Yin, W. (2024). The influence of patient experience and patient trust on willingness to see a doctor based on SOR theory. BMC Health Services Research, 24, 1278. https://doi.org/10.1186/s12913-024-11775-6
