Journal of Aging Science

Influence of Perception on Service Satisfaction of Community Health Centers among Older Adults or their Families in Chongqing, China: A Path Analysis

Jing Luo^1,2,3, Zhihui Sha⁴, Tiantian Wu⁵, Chen Liu^6*, Chenghu Wang⁷ and Jing Luo^{8 1}Department of Medicine, Postdoctoral Mobile Station of School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
²Department of Traditional Medicine, Postdoctoral Workstation of Chongqing Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China
³Department of Medicine, School of Management, Chongqing University of Technology, Chongqing, People's Republic of China
⁴Department of Public Administration, Sichuan University, Chengdu, People's Republic of China
⁵Department of Social Development, South Western University of Finance and Economics, Chengdu, People's Republic of China
⁶Department of Pathology, Chongqing Banan Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China
⁷Department of Medicine, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China
⁸Department of Paediatrics, Children's Hospital to Chongqing Medical University, Chongqing, People's Republic of China
^*Correspondence: Chen Liu, Department of Pathology, Chongqing Banan Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China, Tel: +86 18983258500, Email:

Received: 01-Jul-2022, Manuscript No. JASC-22-17285; Editor assigned: 04-Jun-2022, Pre QC No. JASC-22-17285 (PQ); Reviewed: 18-Jul-2022, QC No. JASC-22-17285; Revised: 25-Jul-2022, Manuscript No. JASC-22-17285 (R); Published: 01-Aug-2022, DOI: 10.35248/2329-8847.22.10.284

Abbreviations

CHCs: Community Health Centers; AVE: Average Variance Extracted

Introduction

There are over 184 million individual’s ≥ 60 years of ages with at least one chronic disease in China in 2019 according to the National Health Commission. Most of these older patients living with certain underlying health conditions are outpatients, which has imposed a considerable health burden on China’s medical system. Since the establishment of hierarchical medical system in 2015 in China, Community Health Centers (CHCs) have served as the primary healthcare facilities for Chinese residents [1]. Due to their function orientation and service content, CHCs have thereafter become the main providers of medical treatment, rehabilitation and health management for older adults in communities or other institutions such as nursing facilities [2]. Although China has made substantial progress in improving primary care through dynamic policies, gaps still remain in quality of care, efficiency in care delivery and public satisfaction [3]. CHCs are now facing low awareness, low utilization as well as low satisfaction, towards their services among older adults in communities or other institutions in China. Very little attention has been paid to public perception on satisfaction with CHC services in present studies. It is tempting to figure out what perception factors affect the satisfaction with the present CHC services.

A variety of studies have put their efforts on the factors influencing the satisfaction with primary healthcare services among the public and on strategies for improving inadequate utilization. The education background and ability of health practitioners [4-5], patient privacy protection [6], awareness of medical service [7], health outcomes [8], expectation and perception [6,9,10] could affect patient satisfaction with primary healthcare services Uzochukwu et al. reported that in Nigeria higher accessibility of health centres, especially constant drug availability, was the key to raise customer satisfaction, and customers preferred to pay for higher quality primary health services [11]. Intriguingly, Ibeneme et al. has found that in Nigeria mothers’ satisfaction could work as a driver of their health-seeking behaviors, and it may receive less influence from mothers’ perception of their child’s recovery [12]. Different degrees of awareness and perception of primary healthcare services among patients could present distinct patterns of health seeking behaviors [9]. It is suggested that service utilization rate among patients could be improved by introducing services and encouraging engagement [7].

Subjective satisfaction and behavioral perception have been widely applied in the evaluation of primary healthcare services. We did the literature research and review to obtain relevant evidence on client satisfaction associated with perception in terms of primary healthcare services. Based on the previous findings, this paper constructed an evaluation model of satisfaction with CHC services in China from five aspects, public expectation, perceived quality, perceived value, perceived justice and perceived trust. With the satisfaction modelling, we hope to identify the factors influencing satisfaction with CHC services and explore the influence paths in Chongqing, China. Meanwhile, through the path analysis of field data, we want to see real attitudes of older adults and their families towards CHC services in Banan district of Chongqing, China. Taken together, we tried to provide some advices for helping solve the difficulties older adults are facing when requiring health care based on actual utilization of CHC services, in order to strengthen the function and status of China’s primary health service system.

Methodology

Data sources

This study was based on questionnaire data from the Third-party Investigation and Evaluation of Service Quality of Aged Care Institutions in Chongqing and the Third-party Evaluation of Service Quality of Community Aged Care Service Stations in Banan District of Chongqing from January, 2019 to June, 2019. A total of 1438 aged care institutions under Chongqing's jurisdiction were taken into the third-party evaluation on service quality by the Civil Affairs Bureau of Chongqing in 2019. As a third-party evaluation institution, we undertook the quality evaluation of aged care institutions and CHCs in Banan district of Chongqing. This evaluation was mainly based on the survey on service condition, service supply and patient satisfaction in CHCs. A total of 16 CHCs in Banan district of Chongqing were included into the survey. Older adult’s ≥ 60 years of ages themselves or their families were the respondents of the survey. The participants should be full-time residents and could individually response to questions.

This study was approved by the institutional review board at Chongqing Medical University, Chongqing, China. Verbal informed consent was obtained from all the respondents before the start of each interview during this study.

Survey method

After being stratified by age into three groups of roughly equal numbers of samples, namely, 0-30 years old, 30-59 years old, and 60 years old and over, a total of 385 samples were randomly obtained. All samples were obtained by well-trained interviewers through filed investigation in the form of well-modified questionnaire. The interviewers were trained by Chongqing's old-age service institutions, and could accurately identify the respondents and explain the contents of questionnaire. The questionnaire was constituted by three parts, basic information, expectation and choices, satisfaction and recognition, with a total of 13 questions. Basic information included age, gender, education background, household registration, health insurance status and family information. The second part involved degree of awareness to CHC services, degree of satisfaction with CHC services, and utilization status of CHC services. The third part investigated respondents' satisfaction and recognition of CHC services from three aspects, perceived quality, perceived fairness and perceived value.

Data analyses

Smart PLS 3.0 software was used for partial least squares structural equation modeling in this paper, and SPSS version 17 software platform offered statistical analysis. Based on the existing research findings relating to satisfaction and perception of CHC services, hypothesized causal connections between relevant variables were firstly made to establish the satisfaction model. Then Cronbach’s α was used to test the internal consistency of these constructs which refers to the reliability of the data, and Average Variance Extracted (AVE) was used to assess convergent validity of the variables related to the proposed constructs. Cronbach α>0.6 and AVE>0.5 were accepted in this research. Furthermore, the maximum likelihood estimation method was chosen for estimating all model path coefficients. An effect was considered significant at P<0.05.

Results

Hypotheses

We did the literature research and review to obtain relevant evidence on public satisfaction associated with perception in terms of primary healthcare services. Variables were mainly summarized from 20 studies [13-31]. Based on the existing research findings, we proposed several hypotheses between six variables including service expectation, perceived quality, perceived value, perceived trust, perceived fairness and public satisfaction, and established the satisfaction model in regards to CHC services as shown in Figure 1 Constructs and the conceptual model based on literature review. The details of hypotheses of the existing relevant researches are available in Supplementary Table 1 Hypotheses and literature sources.

Figure 1: Constructs and the conceptual model based on literature review.

Table 1:  Hypotheses and literature sources.

Reliability and validity tests

Factor analysis was used to test the Composite Reliability (CR), convergent validity and discriminant validity of variables. Cronbach α is a measure used to estimate the reliability of each factor in the model, and CR is a measure used to check the internal consistency between constructs. The alpha value of Cronbach greater than 0.6 is regarded reliable. As shown in Table 1 results of reliability and validity tests, the Cronbach's value (α) for all constructs were in between 0.688 and 0.875, and all the constructs passed the reliability test. The CR scores of all constructs were greater than 0.826, which was higher than the conventional benchmark of 0.70, indicating that the internal consistency of each variable of the model is generally satisfactory. In addition, the loadings values of all measurement indicators were greater than 0.7, and the AVE values of the six constructs were all above 0.5, indicating that all the indicators satisfied the convergent validity requirement. Good discriminant validity can be reached if the square root of the AVE of a factor is greater than the correlation coefficient of the factor and others. In this study, the square root of the AVE of each construct was greater than the correlation coefficient of other constructs, indicating that each construct has high discriminant validity between each other, and the correlations between constructs are within a controllable range. The details of reliability and validity of the constructs are available in Table 1 Results of reliability and validity tests and Supplementary Table 2 Results of the discriminant validity analysis.

Table 2: Results of reliability and validity tests.

Path analysis

T-test was carried out on the measured results of PLS paths, and the results are shown in Table 2 Path analysis results of included hypotheses. The smaller the P-value, the stronger the evidence that a hypothesis should be rejected. P-values less than 0.05 were used to reject the null hypotheses. According to the results, hypotheses H7 (expectation affects perceived fairness), H8 (perceived fairness positively affects public satisfaction), H9 (expectation affects perceived trust) and H11 (perceived trust positively affects public satisfaction) failed the test, while the other 11 hypotheses passed the test. R-squared is commonly used to measure the goodness of fit of the paths in a model. An R-squared of 10% or even less could have some information but generally indicate low goodness of fit, thus the path is not recommended to take into consideration. As shown in Table 1 Results of reliability and validity tests, the R² value of the model related to perceived quality was 0.038, which shows a low goodness of fit. Taken together, 10 hypotheses were finally verified as shown in Table 2 Path analysis results of included hypotheses.

Influence intensity

A revised satisfaction model was obtained after eliminating the untenable hypotheses and irrelevant paths. Then total effect of each prior variable on the satisfaction with CHC services among older adults or their families as well as the indirect effect of each path was calculated. The details of the revised satisfaction model and its influencing paths are shown in Figure 2 Correction diagram of influence paths towards satisfaction.

Figure 2: Correction diagram of influence paths towards satisfaction.
Note: A, B, C, D, E and F refer to perceived quality, perceived fairness, perceived trust, perceived value, public satisfaction, and service expectation, respective.

There were five paths influencing the final satisfaction of CHC services among older adults or their families. Service expectation, perceived quality and perceived value were the direct influencing factors. The final contributions of service expectation (F), perceived quality (A) and perceived value (D) to public satisfaction (E) were -0.191, 0.508 and 0.441, respectively. Service expectation had a negative impact on public satisfaction, while perceived quality and perceived value presented a positive impact. It could indicate that the higher the expectation for the CHC services, the lower the public satisfaction with. In particular, older adults had higher expectation for both medical care and nursing care in CHCs, and their satisfactions would go down when the actual condition did not match their expectations. While public satisfaction could be raised when the respondents see higher quality in CHC services and deems the services more valuable than before. The details of the total effect of public satisfaction of CHC services are available in Supplementary Table 3 Total effect of public satisfaction of CHC service.

Table 3: Results of the discriminant validity analysis.

In addition, there were two indirect influencing paths, and both were based on perceived value. Both perceived quality and public expectation could affect public satisfaction by way of influencing perceived value. The influence coefficients of the two indirect paths (perceived quality → perceived value → public satisfaction, service expectation → perceived value → public satisfaction) were 0.224 and -0.087, respectively. Judgment on the quality of CHC services could affect public satisfaction in a direct manner, and also go first to an intermediate stage, namely, judgment on the value of CHC services, and further affect the final satisfaction. The public believe that the higher the quality of CHC services, the more worthwhile the government's investment and the more cost-effective the service consumption. Thus, higher satisfaction would be definitely achieved at CHC side. This is a positive influence path. In another indirect influencing path, high expectation for CHC services among the public may arouse a bad impression on service value when the public deems the services not cost-effective, which would therefore lower the service satisfaction (Table 4-6).

Table 4: Path analysis results of included hypotheses.

Table 5: Total effect of public satisfaction of CHC service.

Table 6: The effect of indirect influencing paths.

Discussion

Primary health care is imperative for the establishment of a strong healthcare system that ensures better health outcomes, effectiveness and efficiency, as well as health equity [32]. As the first-contact, continuous, comprehensive, and coordinated care providers, CHCs are increasingly valued in chronic disease management [33-34]. There are a wide range of factors determining the service satisfaction among visitors seeking medical treatment from CHCs. According to literature review, the success of a health facility largely depends on client perception of health care quality due to its impact on client satisfaction based on services provided. Furthermore, satisfaction of clients could also influence utilization of health care facilities in some degree.

This paper, from the perspective of subjective perception, endeavors to identify the factors influencing public satisfaction with CHC services in Banan district of Chongqing, China, and explore the influence paths associated with the satisfaction. Several perception related variables that serve as potential drivers to public satisfaction were chosen out based on literature review. Through influence path analysis, we found that service expectation, service quality and value recognition were the main factors affecting service satisfaction of CHCs. In addition, both perceived quality and service expectation could affect public satisfaction through perception or judgment on value of CHC service.

Service expectation as a direct influence factor

The influence coefficient of service expectation was -0.191. Service expectation has a negative impact on the satisfaction with CHC services. It is necessary to adjust the public expectation, or even reduce it to achieve increase in service satisfaction. Excessive public expectation in certain time has no positive significance to the evaluation of satisfaction. CHCs should show their actual present condition without exaggeration to the public. CHCs and relevant government agencies should inform the public by providing real information and policies to the public through face-to-face communication or social media. It is necessary to promote public participation and guide the public to have rational expectations on present services CHCs can provide at its healthcare level. As service receivers, the public tend to exaggerates their needs and raise their expectations. Once their roles turn to service providers and regulators, the public would have more rational considerations in not just service satisfaction. Rational expectation for healthcare services based on the function positioning and value orientation of CHCs among the public may present a positive impact on service satisfaction.

Perceived value as a direct influence factor

The influence coefficient of perceived value of CHC service was 0.441. Perceived value has a direct, positive impact on the satisfaction with CHC services. In addition, the influence coefficients of the two indirect paths were 0.224 and -0.087, respectively. We can conclude that value recognition of CHC services is an important driver to public satisfaction. Both perceived quality of care and service expectation could affect public value recognition and further the public satisfaction with CHC services. Thus, the present situation of CHCs starves for dynamic health publicity to cultivate existing sources and foster appropriate incentives to enhance value recognition. Various means of publicity should be leveraged to ensure that the public stays informed with healthcare knowledge and government’s policies provided by CHCs and its staffs. For example, mass media can serve as a forum for health education among young generations, while on-the-spot or face-to-face demonstration or interpretation would be efficient among older adults. Health education should concentrate on imparting health-related knowledge and attitudes, and focus on function positioning and value orientation of CHCs. In addition, incorrect and improper knowledge should be prevented or reduced at primary healthcare level when carrying out health education activities, which could in some degree dispel mistrust and disrespectfulness towards CHCs. Furthermore, CHCs should show their crucial and irreplaceable role in protecting public health and addressing health crisis. Undoubtedly, for instance, Chinese health care system including CHCs has done a great job in quelling COVID-19 pandemic and further defending in China. Taken together, public value recognition could be reached and enhanced among different communities from many aspects.

Perceived quality as a direct influence factor

We found through path analysis that perceived quality of CHC services could directly (influence coefficient: 0.508) or indirectly (through influence on perceived value of CHC services) affect public satisfaction towards CHC services. Policy and financial inputs, and the introduction of well-trained health provider’s especially general practitioners are of great importance. Governments and relevant authorities have to lean forward and fast-track resources to primary health care, for example, in terms of training of medical staff, medical equipment and instruments and financial protection. In some degree, improvement on the quality of CHC services can serve as a means to help gain value recognition, which is consistent with the indirect influence path (perceived quality → perceived value → public satisfaction) we found in the study. Thus, for instance, professional performance in the basic medical service and accessibility,8 and job satisfaction of primary care providers[35-36] can affect the public value recognition towards CHCs. In terms of site location, we should take into account the distribution density of CHCs, floor space, and accessibility (topography, transportation, etc.). CHCs should be allowed to provide paid services within their capabilities. Service items can be adjusted or established according to public needs to increase the income of CHCs. It is necessary to form a virtuous cycle between government funding, service providing and social evaluation, which could further restore the status of or reinforce the role of a CHC.

Lack of fairness and trust towards CHC service

Path analysis has shown that there are direct connections between perceived fairness, perceived trust, perceived quality, and perceived value. This indicates that perceived quality and perceived value of CHC services could further affect public evaluation or judgment on fairness and trust in CHCs and the stuff. But perceived fairness and trust have neither direct influence on final satisfaction nor indirect with the help of other variables. These suggest that lack of trust and fairness in CHC services does exist among older adults or their families in Banan district of Chongqing, China. Low awareness to CHC services, low utilization of CHC services, and low appraisals from the public could contribute to the lack. There is still a great disparity between urban and rural CHCs as well as between areas in service quality and care efficiency [37-38]. In regards to the existing lack of trust and fairness, CHCs should first and foremost ensure the availability of basic health services including children's health care and chronic disease management, and increase awareness to and utilization of CHC services especially among older adults. In addition, we can take health equity as the breakthrough point. CHCs should narrow the gaps in basic health service items and service quality between areas, and adhere to principle of equal treatment, so as to enhance positive public perception to fairness and trust.

Conclusion

This paper provides an overall outline of perception factors influencing service satisfaction of CHCs as the typical primary care facilities using survey data from Banan district of Chongqing, China. Survey respondents focused on older adults who are the main visitors in CHCs, and other social individuals living with older adults. Five influence paths have been obtained in this study. We found that service expectation, perceived quality and perceived value were the main factors directly affecting public satisfaction towards CHC service. Among indirect paths, both perceived quality and service expectation could affect public satisfaction by way of influencing perceived value of CHC services. So subjective perception on the satisfaction with CHC services could be largely affected by expected outcomes, quality of health care and value of service at least among the public in Chongqing. Therefore, in order to improve service satisfaction in CHCs among older adults and their families, we need to increase public awareness to CHC services, and promote the publicity of function positioning and value orientation of CHCs, and thus incrementally facilitate the construction of rational service expectation among healthcare receivers. Most importantly, much more efforts should be paid to quality of healthcare services of CHCs. In addition, there is a lack of fairness and trust in CHCs among the public. Subjective perception of quality and value of CHC services could affect that of fairness and trust in CHCs. Positive public perception of fairness and trust could in turn help improve service satisfaction. Besides, various aspects such as accessibility, policy and financial inputs, introduction and training of health providers should be taken into consideration for the further development of CHCs.

Limitations and Future Research

This study is based on the field survey in Banan district of Chongqing, China, so the conclusion can only summarize the characteristics of public perception of primary healthcare services in Banan district. Likewise, older adults or their families are the respondents in the survey, and their attitude or subjective judgement towards health services of CHCs cannot represent the opinions of all social individuals.

The research used the public satisfaction model, and was based on the subjective perception of health services of CHCs. Personal subjective perception relies on personal assumptions, beliefs or opinions, and is easily influenced by the surrounding environment, thus personal subjective feelings and expressions would be dynamic at different times. Besides, an expressed opinion may not reflect the true feelings of a patient.

Based on the above two limitations, we should in future research further expand the scope of investigation and increase sample size. In addition, great importance should be paid to accuracy of survey data. Moreover, we should follow up the same survey samples to study the influence of changes in social environment on public subjective feelings, such as the change of public perception towards CHC services after COVID-19 pandemic.

Declaration

Supplementary Information

The supplementary material available at online.

Acknowledgements

We thank the community of Banan district and the 395 families for their participation in our study.

Author contributions

All authors have read and approved the manuscript. JL, CL and ZHS made substantial contributions to conception and design of the study. JL and CL involved in drafting the manuscript or revising it critically for important intellectual content. CHW TTW and JL involved in the survey and data analysis.

Availability of data and materials

The datasets supporting the conclusions of this article are available from the corresponding author on reasonable request.And the supplementary material online includes the data.

Funding

The design of the study and collection, analysis, and interpretation of data and writing the manuscript were all funded by the Chongqing Banan Hospital of Traditional Chinese Medicine and Chongqing Federation of Social Sciences (2018QNSH40).

Competing interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This study does not contain any studies with animals performed by any of the authors.

Ethics approval and consent to participate

Study (including the data collection of older adults or their families’ questionnaire) is received approval by the medical ethics committee of the Chongqing Hospital of Traditional Chinese Medicine and the community of Banan district. And there are no respondents are under 18 years old.

Informed consent

For this type of study informed consent is not required

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

REFERENCES

1. Shi J, Jin H, Shi L, Chen C, Ge X, Lu Y, et al. The quality of primary care in community health centers: Comparison among urban, suburban and rural users in Shanghai, China. BMC Fam Pract. 2020;21(1):1-0.

   [Crossref] [Google Scholar] [PubMed]

2. Li X, Wang F, Yuan SS. Research on the status quo of the community health service center participation in the integration of elderly care and medical services. Chin J Health Policy. 2018;11(11):51-55.
3. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: Progress and gaps in universal health coverage. The Lancet. 2019;394(10204):1192-1204.

   [Crossref] [Google Scholar] [PubMed]

4. JA AM, JL GM, RM LG. A survey on the satisfaction of the users of the Zaidin-Sur de Granada Health Center (1998). Rev Sanid Hig Publica. 1992;66(3-4):225-231.

   [Google Scholar] [PubMed]

5. Ferreira PL, Raposo V, Tavares AI. Primary health care patient satisfaction: Explanatory factors and geographic characteristics. Int J Qual Health Care. 2020;32(2):93-98.

   [Crossref] [Google Scholar] [PubMed]

6. Ardey R, Ardey R. Patient perceptions and expectations from primary health-care providers in India. Fam Med Prim Care Rev. 2015;4(1):53.

   [Crossref] [Google Scholar] [PubMed]

7. Parast L, Tucker JS, Pedersen ER, Klein D. Utilization and perceptions of drop-in center services among youth experiencing homelessness. J  Behav Health Serv Res. 2019;46(2):234-248.

   [Crossref] [Google Scholar] [PubMed]

8. Sun X, Li Y, Liu S, Lou J, Ding Y, Liang H, et al. Enhanced performance of community health service centers during medical reforms in Pudong New District of Shanghai, China: A longitudinal survey. PloS one. 2015;10(5):0125469.

   [Crossref] [Google Scholar] [PubMed]

9. Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E. Using Q-methodology to explore people’s health seeking behavior and perception of the quality of primary care services. BMC pub Health. 2014;14(1):1-9.

   [Crossref] [Google Scholar] [PubMed]

10. Aldosari MA, Tavares MA, Matta-Machado AT, Abreu MH. Factors associated with patients’ satisfaction in Brazilian dental primary health care. PloS one. 2017;12(11):0187993.

    [Crossref] [Google Scholar] [PubMed]

11. Uzochukwu BS, Onwujekwe OE, Akpala CO. Community satisfaction with the quality of maternal and child health services in southeast Nigeria. East Afr Med J. 2004;81(6):293-299.

    [Crossref] [Google Scholar] [PubMed]

12. Ibeneme GC, Nwaneri AC, Ibeneme SC, Ezenduka P, Strüver V, Fortwengel G, Okoye IJ. Mothers’ perception of recovery and satisfaction with patent medicine dealers’ treatment of childhood febrile conditions in rural communities. Malar J. 2016;15(1):1-9.

    [Crossref] [Google Scholar] [PubMed]

13. Zeithaml VA, Berry LL, Parasuraman A. The nature and determinants of customer expectations of service. Journal of the academy of Marketing Science. 1993;21(1):1-2.

    [Crossref] [Google Scholar] [PubMed]

14. Qazi A, Tamjidyamcholo A, Raj RG, Hardaker G, Standing C. Assessing consumers' satisfaction and expectations through online opinions: Expectation and disconfirmation approach. Comput Hum Behav. 2017;75:450-460.

    [Crossref] [Google Scholar]

15. Rodríguez PG, Villarreal R, Valiño PC, Blozis S. A PLS-SEM approach to understanding E-SQ, e-satisfaction and e-loyalty for fashion e-retailers in Spain. J Retail Consum Serv. 2020;57:102201.

    [Crossref] [Google Scholar]

16. Naveen BR, Gurtoo A. The Cause Effect Relationship Model of Service Quality in relation with Overall Satisfaction. Transp Res Procedia. 2020;48:1694-1721.

    [Google Scholar]

17. Bernardo M, Marimon F, del Mar Alonso-Almeida M. Functional quality and hedonic quality: A study of the dimensions of e-service quality in online travel agencies. Inf Manag. 2012;49(8):342-347.

    [Crossref] [Google Scholar]

18. Lai WT, Chen CF. Behavioral intentions of public transit passengers-the roles of service quality, perceived value, satisfaction and involvement. Transp Policy. 2011;18(2):318-325.

    [Crossref] [Google Scholar]

19. Lin TC, Wu S, Hsu JS, Chou YC. The integration of value-based adoption and expectation-confirmation models: An example of IPTV continuance intention. Decis Support Syst. 2012;54(1):63-75.

    [Google Scholar]

20. Zhang H, Lu Y, Gupta S, Gao P. Understanding group-buying websites continuance: an extension of expectation confirmation model. Internet Res. 2015. [Crossref] [Google Scholar] [PubMed]
21. Ingvardson JB, Nielsen OA. The relationship between norms, satisfaction and public transport use: A comparison across six European cities using structural equation modelling. Transp Res. A: Policy Pract. 2019;126:37-57.

    [Crossref] [Google Scholar]

22. Christensen T, Lægreid P. Trust in government: The relative importance of service satisfaction, political factors, and demography. Public Perform Manag Rev. 2005;28(4):487-511

    [Google Scholar]

23. Namkung Y, Jang SS. The effects of interactional fairness on satisfaction and behavioral intentions: Mature versus non-mature customers. Int J Hosp Manag. 2009;28(3):397-405.

    [Google Scholar]

24. Culnan MJ, Armstrong PK. Information privacy concerns, procedural fairness, and impersonal trust: An empirical investigation. Organ Sci. 1999;10(1):104-115.

    [Crossref] [Google Scholar]

25. Hong IB. Understanding the consumer's online merchant selection process: The roles of product involvement, perceived risk, and trust expectation. Int J Inf Manage. 2015;35(3):322-336.

    [Google Scholar]

26. Koufaris M, Hampton-Sosa W. The development of initial trust in an online company by new customers. Inf Manag. 2004;41(3):377-397.

    [Google Scholar]

27. Konuk FA. The influence of perceived food quality, price fairness, perceived value and satisfaction on customers’ revisit and word-of-mouth intentions towards organic food restaurants. J Retail Consum Serv. 2019;50:103-110.

    [Crossref] [Google Scholar]

28. Lin GY. Anonymous versus identified peer assessment via a Facebook-based learning application: Effects on quality of peer feedback, perceived learning, perceived fairness, and attitude toward the system. Comput Educ. 2018;116:81-92.

    [Crossref] [Google Scholar]

29. McKnight DH, Choudhury V, Kacmar C. The impact of initial consumer trust on intentions to transact with a web site: a trust building model. J Strateg Inf Syst. 2002;11(4):297-323.

    [Crossref] [Google Scholar]

30. Davis R, Sajtos L, Chaudhri AA. Do consumers trust mobile service advertising? Contemp Manag Res. 2011;7(4).

    [Crossref] [Google Scholar]

31. Han H, Lee MJ, Kim W. Role of shopping quality, hedonic/utilitarian shopping experiences, trust, satisfaction and perceived barriers in triggering customer post-purchase intentions at airports. Int J Contemp Hosp Manag. 2018.

    [Google Scholar]

32. Shi L. The impact of primary care: a focused review. Scientifica. 2012. [Crossref] [Google Scholar] [PubMed]
33. Wang Z, Shi J, Wu Z, Xie H, Yu Y, Li P, et al. Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability? Int J Health Plan Manag. 2017;32(3):317-328.

    [Crossref] [Google Scholar]

34. Shi L, Lee DC, Liang H, Zhang L, Makinen M, Blanchet N, et al. Community health centers and primary care access and quality for chronically-ill patients-a case-comparison study of urban Guangdong Province, China. Int J Equity Health. 2015;14(1):1-7.

    [Crossref] [Google Scholar] [PubMed]

35. Zhang Z, Shi G, Li L, Bian Y. Job satisfaction among primary care physicians in western China. BMC Fam Pract. 2020;21(1):1-0.

    [Crossref] [Google Scholar] [PubMed]

36. Wang H, Jin Y, Wang D, Zhao S, Sang X, Yuan B. Job satisfaction, burnout, and turnover intention among primary care providers in rural China: Results from structural equation modeling. BMC Fam Pract. 2020;21(1):1-0.

    [Crossref] [Google Scholar] [PubMed]

37. Chen A, Feng S, Zhang L, Shi L. Comparison of patients’ perceived quality of primary care between urban and rural community health centers in Guangdong, China. Int J Environ Res Public Health. 2020;17(13):4898.

    [Crossref] [Google Scholar] [PubMed]

38. He X, Li L, Bian Y. Satisfaction survey among primary health care outpatients in the backward region: An empirical study from rural Western China. Patient Prefer Adherence. 2018;12:1989.

    [Crossref] [Google Scholar] [PubMed]