The experience economy meets the examination room: Rethinking service quality, perceived value, and behavioral loyalty in primary healthcare
Patient satisfaction is increasingly recognized as a key indicator of healthcare service quality and an important determinant of patient retention in primary healthcare systems. This study examines patient satisfaction with services provided at primary health centers (PHCs) in Kerala, India, and analyzes the influence of service quality on patient satisfaction and revisit practices. Primary data were collected from 400 patients across three regions of Kerala: South (Thiruvananthapuram), Central (Ernakulam), and North (Kozhikode), using a structured, self-administered questionnaire. The study employed multivariate analysis of variance (MANOVA), univariate analysis of variance with Bonferroni comparisons, exploratory factor analysis (EFA), confirmatory factor analysis, and structural equation modeling (SEM). The 15-item patient satisfaction construct showed excellent reliability (Cronbach’s α = 0.954) and strong convergent validity (average variance extracted = 0.887; composite reliability = 0.940). EFA identified two latent dimensions, “satisfied with facilities at PHCs” and “fair treatment ensuring privacy,” explaining 71.80% of total variance (Kaiser–Meyer–Olkin test = 0.942). MANOVA revealed significant differences in patient satisfaction across age groups (Wilks’ λ = 0.755, F = 2.502, p < 0.05). SEM results showed that service quality significantly influences patient satisfaction (standardized regression weight [SRW] = 0.913, p < 0.001), which, in turn, affects revisit practices (SRW = 0.842, p < 0.001). The findings provide valuable evidence for strengthening patient-centered primary healthcare delivery in Kerala and similar developing healthcare systems.
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