How Brand Trust Mediates the Effects of Service Quality on Loyalty: An Illustration From Medical Tourism Context

The growth of the medical tourism market attracts new countries to compete for customers. Thailand, once among the top five destinations, was displaced from the list in 2010 (Tourism Review 2010). International accreditation alone is not enough to maintain competitiveness; marketing plays an important role in the maintenance of sustainable competitiveness. It is important to better understand the attitudes and behaviors of international tourists. Service marketing studies have consistently reported that, either through behaviors or attitudes, service quality, perceived value and satisfaction are correlated with loyalty (Akbar 2010; Cronin, Brady, and Hult 2000). In addition, brand trust is theoretically reported to be a key determinant of loyalty in brand relationship studies (Chaudhuri and Holbrook 2001; Delgado-Ballester and Munuera-Aleman 2001; Matzler, Grabner-Kräuter, and Bidmon. 2008). There are few studies that report on the interrelationships among these variables, although several independent studies have evaluated the service quality-value-satisfaction-loyalty model (Choi, Cho, Lee, Lee, and Kim 2004; Cronin, Brady, and Hult 2000; Wang, Lo, and Yang 2004) and the trust-loyalty model in relationship studies (Chaudhuri and Holbrook 2001; Delgado-Ballester and Munuera-Aleman 2001; Doney and Cannon 1997). Despite the well-recognized significance of all of these variables to the development of loyalty in the service market, no study has examined the interrelationships among all of these variables that could affect consumer loyalty or the mechanisms by which these variables contribute to the enhancement or reduction of loyalty. Consequently, a unified model is needed to clarify these interrelationships. This research aims to fill the above-mentioned gap in the literature. The main objective of this research is to propose brand trust is a key determinant of loyalty and a mediator between service quality and loyalty. We postulate that brand trust can reduce the impact of frustration that results from long-distance communication, language barriers, and other issues and can thus enhance medical tourism. In addition, brand trust can make the traditional service quality-loyalty model more understandable in the medical tourism context. To determine whether brand trust is a powerful mediating variable, the study compares the SEM results with those of the Cronin, Brady, and Hult (2000) service quality-loyalty model and research model (see Figure 1).