P-ISSN: 2827-9832
E-ISSN: 2828-335x
http://ijsr.internationaljournallabs.com/index.php/ijsr
781
THE INFLUENCE OF RELATIONSHIP MARKETING ON PATIENT
LOYALTY MEDIATED BY THE VALUE CO-CREATION BEHAVIOR OF
PATIENTS AT THE DENTAL AND ORAL EDUCATION HOSPITAL IN
JAKARTA
Cathrine Rahayu
Faculty of Economics and Business, Universitas Trisakti
cathrinerahayubudirahardja@gmail.com
ABSTRACT
This study aims to analyze the influence of relationship marketing on patient loyalty mediated by the value
co-creation of patient behavior which is divided into patient participation behavior and patient citizenship
behavior in patients of the Educational Dental and Oral Hospital (RSGMP) in Jakarta. The data collection
technique method uses non-probability sampling with a purposive sampling method. The respondents of
the study as many as 310 people were patients who had received dental and oral care at least 2 times in the
last 2 years at the RSGMP in Jakarta. The questionnaire was distributed via google form containing 31
statements answered based on five Likert scales. The analysis method used in this study is the Structural
Equation Model (SEM). The results showed that relationship marketing has a positive effect on patient
participation behavior and patient citizenship behavior. Patient participation behavior does not positively
influence patient loyalty, but patient citizenship behavior has a positive effect on patient loyalty.
Relationship marketing has a positive influence on patient loyalty. In addition, in the mediation variable, it
was found that patient participation behavior does not have a mediating influence between relationship
marketing on patient loyalty, while patient citizenship behavior has a partial mediation influence.
Keywords: relationship marketing; patient participation behavior; patient citizenship behavior; value
co-creation behavior; patient loyalty
This article is licensed under CC BY-SA 4.0
INTRODUCTION
Marketing in the field of services at this time is increasingly competitive in many aspects.
This condition encourages business people to increase the excellence of each of their businesses
to be able to survive in the market. In health institutions, patients have needs and expectations
in receiving maximum service. Patients also have the opportunity to choose a health institution
amid the large number of health institutions today. For this reason, health institutions are trying
to improve themselves to be able to meet expectations and maintain patient loyalty (Yıldırım
et al., 2022).
Consumers in general have changed their traditional roles and started looking for products
or services based on the information and personal needs with the help of technology. Good
relationships between consumers and service providers are needed today with consumers who
are at the center of the organization's operations. Forming relationships or good relationships
with consumers will also provide company marketing benefits. Marketing with this relationship
model is currently often done with a focus on retaining existing consumers rather than looking
for new consumers. Therefore, many companies are currently oriented toward relationship
marketing (Mubushar et al., 2020).
Patient loyalty to a health institution can be formed through good relationships between
patients and caregiving staff. These good relationships can continue to be built and improved
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
782 2, 3., February 2023
through relationship marketing. The focus of relationship marketing is on retaining existing
patients and providing good relationships beyond just services to patients. The marketing cost
of attracting new patients will be more expensive than retaining existing patients more
optimally. Therefore, maintaining a good relationship with patients through relationship
marketing will be very important for maintaining patient loyalty (Yıldırım et al., 2022).
An ever-changing and complex business environment can make it difficult for a single
company to sustain technical, economic, and social progress. Therefore, companies need to
continue to adapt to current circumstances through cooperation with customers and service
providers. This needs to be understood both by management to get new ideas and understand
the focus that needs to be fostered more than the company. Systematization of this process is
called value co-creation. Defined as a cooperative team process between service providers and
consumers that focuses on operational activities, and solution development, which can be
started by both producers and consumers (Preikschas et al., 2017).
Today's consumers are encouraged to proactively play a role in jointly creating services for
their well-being. However, lack of knowledge is sometimes the main barrier that hinders value
creation. This issue is quite important for consumers who need intensive interaction between
parties if there is a knowledge gap. Therefore, consumers need to be given more information
and education in order to get better value creation and services for their own welfare. That
science gap also exists within health institutions so this can be an important record for
management to improve (Pham et al., 2022).
In today's marketing world, marketing activities are formed with the aim of creating,
producing, and conveying value to consumers. An organization, especially a hospital, must be
able to play a role in the process of creating patient value. The concept of value is expressed as
a ratio between what is received and given by the consumer. In creating value in healthcare
efficiently, it is necessary to analyze patient feedback strategically. Value creation can be seen
through collaborative behavior between patients and healthcare providers or called patient
value co-creation (Samsa & Yüce, 2022).
Today patients have more information and more intense interactions with the health
institutions they go to. This changes the relationship between recipients and service providers
to be more collaborative. The importance of the relationship causes the organization to put the
consumer at the center of a business or organization. Value co-creation is a competitive strategy
used by organizations today. This is based on the fact that value does not come from a product
or service alone but is formed through a process and experience of consumption by consumers
(Nájera-Sánchez et al., 2022).
The health industry in Indonesia is currently experiencing a significant increase and
development. Indonesians today have higher expectations for healthy living. People are not
only looking for the health industry for curative or healing needs, but also for promotional and
preventive activities. The hospital industry is already very wide so that competition is getting
tougher. The standards owned by hospitals based on accreditation are also getting higher.
Therefore, hospitals in Indonesia need to improve the quality of their services even better in
order to form long-term relationships with consumers (Afifi & Amini, n.d.).
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
783 2, 3., February 2023
METHOD
The study uses hypothesis testing, aimed at testing its effect on independent variables,
namely relationship marketing, on dependent variables, namely patient loyalty mediated by
value co-creation variables. The unit of analysis of this study is patients who have received
services in the last two years at the Educational Dental and Oral Hospital (RSGMP) in Jakarta
with a minimum number of visits twice. Educational Dental and Oral Hospitals (RSGMP) in
Jakarta include Trisakti University RSGMP, the University of Indonesia RSGMP, Prof. Dr.
Moestopo University RSGMP (religious), and Yarsi University RSGMP. The basis of this
study is cross-sectional data where the data is obtained only within a predetermined period of
time and period.
Variables and Measurements
In this study, independent variables, dependent variables, and mediation variables were
used as follows:
1. Relationship Marketing
In this study, relationship marketing used 16 items of questions based on research. The
question item is divided into four dimensions, namely Abdullah & Kanyan (2013) empathy,
trust, communication, and commitment. These question items include:
1. Doctors and employees at RSGMP are willing and ready to help with patient requests
2. Doctors and employees at RSGMP are sympathetic and can reassure patients
3. Doctors and employees at RSGMP are consistently polite, pleasant, and friendly to
patients
4. Doctors and employees at RSGMP are caring and give individual attention
5. These doctors and employees at the RSGMP show respect to patients
6. Doctors and employees at RSGMP are honest
7. Doctors and employees at RSGMP can account for the appointments given
8. Doctors and staff of RSGMP are responsible for and fulfill obligations
9. Doctors and staff of RSGMP give clear explanations and useful advice
10. Doctors and staff of RSGMP have knowledge and competence in answering questions
11. Communication with doctors and staff of RSGMP is easy to understand
12. RSGMP dentists and staff appreciate and implement customer advice to improve service
13. RSGMP dentists and staff build and maintain long-term relationships
14. RSGMP dentists and staff are committed to providing the best service
15. RSGMP dentists and staff provide good products and services at appropriate prices
16. RSGMP is consistent in providing quality service
2. Patient Loyalty
The patient loyalty variable in this study used three question items based on the study by .
These question items include: (Wang et al., 2011)
1. I will again come to this RSGMP in the future
2. I am committed to be on good terms with this RSGMP
3. Most likely I will still seek treatment to this RSGMP
3. Patient Participation Behavior
In this study, the value co-creation behavior variable was divided into two, namely patient
participation behavior and patient citizenship behavior. The mediation variable of patient
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
784 2, 3., February 2023
participation behavior uses four question items based on research. The question item is divided
into two dimensions, namely Zadeh et al (2019) information seeking and personal interaction.
These question items include:
1. I am looking for the latest information regarding this RSGMP
2. I am sharing this information about RSGMP with others
3. I am friendly to other patients who are treated at this RSGMP
4. I avoid abusive actions and language to other patients seeking treatment at this RSGMP
4. Patient Citizenship Behavior
The patient participation behavior mediation variable uses eight question items based on
research the question item is divided into four dimensions, namely Zadeh et al (2019),
advocacy, help, tolerance, and feedback. These question items include:
1. I recommend this RSGMP to others
2. I invite my friends and relatives to do the treatment at this RSGMP
3. I am helping other patients in this RSGMP who need help
4. I teach other patients about the registration and treatment system carried out at this
RSGMP
5. I accept the distractions and difficulties that may be encountered while doing treatment
at this RSGMP
6. I show tolerance for changes in this RSGMP system that I do not agree with
7. I share ideas that can improve services at RSGMP
8. I recommend this service at RSGMP to other consumers
Data Collection Methods
In data collection, data search techniques can be used, namely primary and secondary. In
this study, primary data were used. Primary data are data obtained directly from the source
through measurement, or self-calculation through questionnaires or the like. Primary data from
this study was obtained from the results of the distribution of questionnaires to patients of the
Educational Dental and Oral Hospital in Jakarta. The sampling method of this study is Hardani
et al (2020), non-probability sampling with a purposive sampling technique.
A population is a research object that can be humans, animals, objects, plants, or events that
are used as a source of data with certain characteristics in a study. Samples are a portion of the
population obtained through sampling techniques. (Hardani et al., 2020) The population of this
study was patients who had received dental and oral care at the Educational Dental and Oral
Hospital (RSGMP) in Jakarta, including Trisakti University Hospital, the University of
Indonesia RSGMP, Prof. Dr. Moestopo University RSGMP (religious), or Yarsi University
RSGMP. The patient must have received treatment at least twice at the relevant RSGMP, and
the treatment is carried out a maximum of the last 2 years.
The results of the frequency of the total respondents who participated in the study showed
a fairly even distribution. Most respondents were patients who received treatment at the
Trisakti University Dental and Oral Education Hospital (RSGMP) with a percentage of 26.8%
or as many as 83 people. Furthermore, the second most respondents came from patients at Yarsi
University RSGMP, which was 26.5% or as many as 82 people. Respondents who received
treatment at RSGMP Universitas Prof. Dr. Moestopo (religious) were 23.5% or as many as 73
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
785 2, 3., February 2023
people. Finally, the fewest respondents were patients who received treatment at rsgmp
Universitas Indonesia 23.2% or as many as 72 people.
The frequency results of respondents' profiles by gender showed a fairly balanced
comparison of 51% and 49%. Respondents with female sex were 51% or as many as 158
people. Respondents with the male gender were 49% or as many as 152 people.
In the profile of respondents based on age, divided by the range of 10 years each category
is <17 years, 17-25 years, 26-35 years, 36-45 years, 46-55 years, 56-65 years, and >65 years.
It was found that the majority of respondents in this study were in the age range of 17-25 years
with a percentage of 32.6% or as many as 101 people. The second highest age range of
respondents is at the age of 36-45 years with a percentage of 21% or as many as 65 people. The
age range between 26-35 years is 18.7% or as many as 58 people. Furthermore, in patients with
an age range of 46-55 years was 11.9% or as many as 37 people. In patients aged <17 years,
33 people were obtained or 10.6%. Respondents with the least age range were over 65 years
old and the age range of 56-65 years, 2.3% (7 people) and 2.9% (9 people), respectively.
Frequency results based on the number of treatments respondents have received in the past
two years, divided into patients who received treatment at least 2 times and more than twice.
Respondents who received treatment 2 times in 2 years were found to be 46.8% or as many as
145 patients. Respondents who received treatment more than twice in two years were 53.2%
or as many as 165 patients.
Test Instruments
The development of instruments in this study consists of validity tests and reliability tests.
Instrument tests are carried out so that the data obtained provide results in accordance with the
purpose of conducting research.
Validity Test
Validity tests are carried out to see the degree of accuracy between the data that occurs on
the object of study and the data reported by the researcher. Data that is declared valid is data
that has no difference between the results of the data provided by the researcher and the actual
data results of the study respondents. A statistical tool for validity testing, namely Hardani et
al (2020), using factor loading, means that the determination of indicators that are declared
valid or not will be determined by the size of the research sample. The basis for making validity
test decisions based on the number of samples includes:
Data Analysis Methods
The descriptive statistical method is a data analysis method used in this study. The method
of descriptive statistical analysis is a method that uses a set of activities and improvements in
various areas. Testing data and hypotheses directly (direct effect) in this study using SEM
(Structural Equation Model) with statistical software AMOS (Analysis of Moment Structures).
AMOS according to Suhartanto (2020) can visualize structural equation modeling using simple
drawing tools. Researchers used the Sobel Test to test the influence of mediations between
variables (indirect effect). Researchers also use SPSS (Statistical Package for Social Science)
to analyze statistical data (Hardani et al., 2020).
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
786 2, 3., February 2023
Hypothesis Test
This test is carried out with the aim of seeing whether each of the independent variables
has a significant influence on the dependent variable assuming that the other variables are
constant or fixed. Here is the basis of the decision-making of the hypothesis test:
- If a p-value > α 0.05 H0 is accepted, it means that there is no significant influence between
the two variables
- If the p-value α 0.05 H0 is rejected, it means that there is a significant influence between
the two variables
RESULTS AND DISCUSSION
Descriptive Statistics
Descriptive statistical tests are performed to describe and describe the data in detail.
Descriptive statistical tests are reviewed based on mean values and standard deviations. The
mean value is the average value of the respondent's answer, while the standard deviation value
indicates the variation of the respondent's answer. A standard deviation value that is closer to
zero means that respondents' answers are increasingly less varied. However, if the standard
deviation value is further away from the zero value, it can be interpreted that the respondent's
answer is increasingly varied.
In this study, descriptive statistical testing was carried out to explain in detail the picture
and conclusions based on the results of respondents' answers related to relationship marketing
variables, patient participation behavior, patient citizenship behavior, and patient loyalty. The
following is a table showing the results of descriptive statistical processing, where the mean is
the average of the data obtained from each statement.
The relationship marketing variable is divided into four dimensions, each of which has four
statement items. Based on the results of descriptive statistics in table 4.1, it was found that the
mean value of the relationship marketing variable statement item was 4.07. The results mean
that the average respondent thinks the RSGMP where they receive treatment has been able to
apply good relationships with consumers. The standard deviation value obtained in the
relationship marketing variable is 1.00527. The value indicates that respondents' responses are
quite varied.
Table 4.1 Descriptive Statistics of Relationship Marketing Variables
No.
Questionnaire
Mean
Standard
Deviation
Emphaty
1.
Doctors and employees at RSGMP are willing and ready
to help with patient requests
4.0129
0.90655
2.
Doctors and employees at RSGMP are sympathetic and
can reassure patients
4.1677
1.08428
3.
Doctors and employees at RSGMP are consistently
polite, pleasant, and friendly to patients
4.0548
0.99199
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
787 2, 3., February 2023
4.
Doctors and employees at RSGMP are caring and give
individual attention
4.0290
1.06540
Trust
5.
These doctors and employees at the RSGMP show
respect to patients
4.0387
0.88777
6.
Doctors and employees at RSGMP are honest
3.9548
0.85402
7.
Doctors and employees at RSGMP can account for the
appointments given
3.9226
1.06145
8.
Doctors and staff of RSGMP are responsible for and
fulfill obligations
4.2000
0.97808
Communication
9.
Doctors and staff of RSGMP give clear explanations and
useful advice
4.2323
1.07227
10.
Doctors and staff of RSGMP have knowledge and
competence in answering questions
4.1613
1.11468
11.
Communication with doctors and staff of RSGMP is easy
to understand
4.1742
1.03122
12.
RSGMP dentists and staff build and maintain long-term
relationships
4.1581
1.11369
Commitment
13.
RSGMP dentists and staff are committed to providing the
best service
3.9613
0.90938
14.
RSGMP dentists and staff provide good products and
services at appropriate prices
3.9968
1.08087
15.
RSGMP is consistent in providing quality service
4.1258
1.01461
16.
RSGMP dentists and staff build and maintain long-term
relationships
3.9290
0.91807
4.0700
1.00527
The first dimension of the relationship marketing variable is empathy which has four
statement items. The first statement item gets a mean value of 4.0129 which means the patient
agrees that RSGMP staff are willing and ready to help with the patient's request. The second
statement item received a mean value of 4.1677 which means the patient agreed that the
RSGMP staff had shown sympathy and could reassure the patient. The third statement item
earned a mean value of 4.0548 which means patients agree that RSGMP staff consistently show
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
788 2, 3., February 2023
a polite, pleasant, and friendly attitude. The last statement item for the empathy dimension
getting a mean value of 4,029 can be interpreted to mean that the patient agrees that the
RSGMP staff has been caring and giving individual attention to the patient.
The second dimension of the relationship marketing variable is trust. The first statement
item of the trust dimension getting a mean value of 4.0387 can mean the patient agrees that the
RSGMP staff shows respect for the patient. The second item of the statement getting a mean
value of 3.9548 can be interpreted to mean that the patient quite agrees that the RSGMP staff
has been honest. The third statement item getting a mean value of 3.9226 can mean patients
reasonably agree that RSGMP staff can account for the promises they make. The fourth
statement item of the trust dimension getting a mean value of 4.2 can mean the patient agrees
that RSGMP staff are responsible and can fulfill their obligations.
The third dimension of the relationship marketing variable is communication which has four
statement items. The first statement item got a mean value of 4.2323 so it was concluded the
patient agreed that the RSGMP staff could provide a clear explanation and useful advice. The
second statement item earned a mean value of 4.1613 so it was concluded that the patient
agreed to agree that RSGMP staff had knowledge and competence in answering questions. The
third statement item got a mean value of 4.1581 so it was concluded that the patient agreed to
agree that RSGMP staff can communicate well and are easy to understand. The fourth
statement item earned a mean value of 4.1742 so it was concluded the patient agreed to agree
that RSGMP staff could build and maintain a long-term relationship with the patient.
The fourth dimension of the relationship marketing variable is a commitment which has four
statement items. The first statement item received a mean value of 3.9613 which means that
patients quite agree that RSGMP staff are committed to providing the best service. The second
statement item gets a mean value of 3.9968 which means patients quite agree that RSGMP
staff provide good products and services at appropriate prices. The third statement item
received a mean value of 4.1258 which means patients agree that RSGMP staff are consistent
in providing quality services. The fourth statement item gets a mean value of 3.9290 which
means patients simply agree that RSGMP staff can build and maintain long-term relationships.
Table 4.2 Descriptive Statistics of Patient Participation Behavior Variables
No.
Mean
Standard
Deviation
Information Seeking
1.
4.1806
1.09704
2.
4.1742
1.00580
Personal Interaction
3.
4.0419
1.00235
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
789 2, 3., February 2023
4.
4.1387
0.94001
4.1339
1.0113
The patient participation behavior variable is divided into two dimensions, each of which
has two statement items. Based on the results of descriptive statistics in table 4.2, it was found
that the mean value of the patient participation behavior variable statement item was 4.1339.
The results mean that the average respondent has had the behavior to participate in activities
and treatments at the RSGMP where they receive treatment. The standard deviation value
obtained in the patient participation behavior variable is 1.0113. The value indicates that
respondents' responses are quite varied.
The patient participation behavior variable is divided into two dimensions, namely
information seeking and personal interaction with two statement items in each dimension. The
first statement item on the information-seeking dimension gets a mean value of 4.1806 which
can mean that the patient agrees to have participated in seeking the latest information from the
RSGMP where the patient receives treatment. The statement item of both dimensions of
information seeking to get a mean value of 4.1742 can be interpreted to mean that the patient
agrees to have participated in terms of sharing information about RSGMP with others. In the
second dimension of personal interaction, the first statement item getting a mean value of
4.0419 can be interpreted to mean that the patient agrees to have been friendly to other patients
who are treated at RSGMP. The statement item of both dimensions of personal interaction
getting a mean value of 4.1387 can be interpreted to mean that the patient agrees to have
avoided actions and abusive language to other patients seeking treatment at RSGMP.
The patient citizenship behavior variable is divided into four dimensions, each of which has
two statement items. Based on the results of descriptive statistics in table 4.3, it was found that
the mean value of the patient citizenship behavior variable statement item was 3.9718. The
results mean that the average respondent has had more involvement in activities and treatments
at the RSGMP where they receive treatment. The standard deviation value obtained in the
patient citizenship behavior variable is 1.02151. The value indicates that respondents'
responses are quite varied.
Table 4.3 Descriptive Statistics of Patient Citizenship Behavior Variables
No.
Questionnaire
Mean
Standard
Deviation
Advocacy
1.
I recommend this RSGMP to others
4.1645
1.06824
2.
I invite my friends and relatives to do treatment at
this RSGMP
3.9613
1.01372
Help
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
790 2, 3., February 2023
3.
I am helping other patients in this RSGMP who need
help
3.9581
1.01837
4.
I teach other patients about the registration and
treatment system carried out at this RSGMP
3.9452
1.02093
Tolerance
5.
I accept the distractions and difficulties that may be
encountered while doing treatment at this RSGMP
3.8645
1.03077
6.
I show tolerance for changes in this RSGMP system
that I do not agree with
3.9935
1.03027
Feedback
7.
I share ideas that can improve services at RSGMP
3.9419
1.04115
8.
I recommend this service at RSGMP to other
consumers
3.9452
0.94863
3.9718
1.02151
The four dimensions of the patient citizenship behavior variable include advocacy, help,
tolerance, and feedback. In the first dimension, namely advocacy, there are two items of
statements. The first statement item getting a mean value of 4.1645 could mean that patients
agree to recommend RSGMP where they receive treatment from others. The second statement
item getting a mean value of 3.9613 can be interpreted to mean that patients are quite amenable
to inviting their friends and relatives to carry out treatment at the relevant RSGMP.
Furthermore, in the second dimension, namely, help, there are two statement items. The first
statement item getting a mean value of 3.9581 can be interpreted to mean that the patient quite
agrees to have helped other patients in this RSGMP who need help. The second statement item
getting a mean value of 3.9452 can be interpreted to mean that the patient agrees enough to
have participated to teach other patients about the registration and treatment system carried out
at the RSGMP.
In the next dimension, the first statement item gets a mean value of 3.8645 which means the
patient is quite amenable to accepting the distractions and difficulties that may be encountered
while carrying out the treatment. The second statement item of the third dimension gets a mean
value of 3.9935 which means the patient is sufficiently amenable to demonstrate tolerance if
there is a change in the associated RSGMP system that is less approved.
The fourth dimension of the patient citizenship behavior variable is feedback which is also
divided into two statement items. The first statement item gets a mean value of 3.9419 which
means that the patient is quite willing to share ideas that can improve services at the relevant
RSGMP. The statement item of both dimensions of feedback received a mean value of 3.9452
which means that the patient is willing to recommend services at the relevant RSGMP to other
consumers.
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
791 2, 3., February 2023
Table 4.4 Descriptive Statistics of Patient Loyalty Variables
No.
Questionnaire
Mean
Standard
Deviation
1.
I will again come to this RSGMP in the
future
4.2903
0.88473
2.
I am committed to be on good terms with
this RSGMP
4.0806
1.03808
3.
Most likely I will still seek treatment to this
RSGMP
3.9548
0.75763
4.1086
0.89348
The patient loyalty variable has three statement items. Based on the results of descriptive
statistics in table 4.4, it was found that the mean value of the patient loyalty variable statement
item was 4.1086. The results mean that the average respondent has had loyalty to the RSGMP
where they receive treatment. The standard deviation value obtained in the patient loyalty
variable is 0.89348. The value indicates that respondents' responses are quite varied.
The first statement item gets a mean value of 4.2903 which means that the patient agrees to
come back to the relevant RSGMP in the future. The second statement item gets a mean value
of 4.0806 which means that the patient agrees to commit to good relations with the relevant
RSGMP. The third statement item received a mean value of 3.9548 which means the patient
reasonably agrees that there is a high probability of returning to seek treatment at the relevant
RSGMP.
Hypothesis Testing Results
Hypothesis testing in this study was carried out using statistical methods using Structural
Equation Model (SEM) analysis. This method is used to predict changes in independent
variables associated with changes in dependent variables. The fault tolerance limit used is 5%.
The basis for making the decision is that if the p-value ≤ 0.05 then H0 is rejected, meaning that
there is a significant relationship with the conclusion of the hypothesis supported. If the p-value
> 0.05 then H0 is accepted meaning that there is no significant relationship with the conclusion
that the hypothesis is not supported. The following in table contains the results of hypothesis
testing.
Table 4.5 Hypothesis Test Results 1-5
Hypothesis
Estimate
ρ-
value
Decision
H1 : There is a positive influence of
Relationship Marketing on Patient
Participation Behavior
0,974
0,000
H1 supported
H2 : There is a positive influence of
Patient Participation Behavior on
Patient Loyalty
0,191
0,180
H2 is not
supported
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
792 2, 3., February 2023
H3 : There is a positive influence of
Relationship Marketing on Patient
Citizenship Behavior
0,970
0,000
H3 supported
H4 : There is a positive influence of
Patient Citizenship Behavior on Patient
Loyalty
0,336
0,017
H4 supported
H5 : There is a positive influence of
Relationship Marketing on Patient
Loyalty
0,929
0,000
H5 supported
The first hypothesis tests the effect of relationship marketing on patient participation
behavior with the sound of hypothesis zero (H0) and alternative hypothesis (Ha) as follows:
H0 : There is no positive influence of relationship marketing on patient participation
behavior
Ha : There is a positive influence of relationship marketing on patient participation
behavior
Based on the hypothesis test results in the table above, the first hypothesis has an estimated
value of 0.947 with a p-value of 0.000 (≤ 0.05) then it is stated that Ha is supported (H0 is
rejected). Therefore, it is concluded that relationship marketing positively affects patient
participation behavior.
The second hypothesis tests the effect of patient participation behavior on patient loyalty
with the sounds H0 and Ha as follows:
H0 : There is no positive influence of patient participation behavior on patient loyalty
Ha : There is a positive influence of patient participation behavior on patient loyalty
Based on the hypothesis test results in the table above, the second hypothesis has an
estimated value of 0.191 with a p-value of 0.180 (> 0.05) then it is stated that Ha is rejected
(H0 is supported). Therefore, it is concluded that there is no positive influence between patient
participation behavior and patient loyalty.
The third hypothesis tests the influence of relationship marketing on patient citizenship
behavior with the sound of the null hypothesis (H0) and the alternative hypothesis (Ha) as
follows:
H0 : There is no positive influence of relationship marketing on patient citizenship behavior
Ha : There is a positive influence of relationship marketing on patient citizenship behavior
Based on the hypothesis test results in the table above, the third hypothesis has an estimated
value of 0.970 with a p-value of 0.000 (≤ 0.05) then it is stated that Ha is supported (H0 is
rejected). Therefore, it is concluded that relationship marketing positively affects patient
citizenship behavior.
The fourth hypothesis tests the influence of patient citizenship behavior on patient loyalty
with the sound of the null hypothesis (H0) and the alternative hypothesis (Ha) as follows:
H0 : There is no positive influence of patient citizenship behavior on patient loyalty
Ha : There is a positive influence of patient citizenship behavior on patient loyalty
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
793 2, 3., February 2023
Based on the results of the hypothesis test in the table above, the fourth hypothesis has an
estimated value of 0.336 with a p-value of 0.017 (≤ 0.05) then it is stated that Ha is supported
(H0 is rejected). Therefore, it is concluded that patient citizenship behavior positively affects
patient loyalty.
The fifth hypothesis tests the effect of relationship marketing on patient loyalty with the
sound of the null hypothesis (H0) and the alternative hypothesis (Ha) as follows:
H0 : There is no positive influence of relationship marketing on patient loyalty
Ha : There is a positive influence of relationship marketing on patient loyalty
Based on the hypothesis test results in the table above, the fifth hypothesis has an estimated
value of 0.929 with a p-value of 0.000 (≤ 0.05) then it is stated that Ha is supported (H0 is
rejected). Therefore, it is concluded that relationship marketing positively affects patient
loyalty.
To test hypothesis six, namely the role of Patient Participation Behavior in mediating the
relationship between Relationship Marketing and Patient Loyalty, the model will be divided in
half to compare. The first model is a model that only shows the direct influence of Relationship
Marketing on Patient Loyalty. While the second model has included the variable Patient
Participation Behavior which mediates the influence of Relationship Marketing with Patient
Loyalty.
According to Baron and Kenny (1986), the Patient Participation Behavior variable becomes
a mediating variable if it meets several conditions. The conditions are: (a) there must be a
significant influence between Relationship Marketing and Patient Participation Behavior, (b)
there must be a significant influence of Patient Participation Behavior on Patient Loyalty, (c)
if the direct influence of Relationship Marketing on Patient Loyalty In model one it is
significant, compared to model two it becomes insignificant or remains significant but the
significance value decreases. The results of testing hypothesis six can be seen in the following
table:
Figure 4.2 Model 2: The role of Patient 2Participation Behavior in mediating the
influence of Relationship Marketing on Patient Loyalty.
Relationship
Marketing
Patient Loyalty
Patient
Participation
Behavior
Relationship
Marketing
Patient Loyalty
Figure 4. 1 Model 1: The direct influence of Relationship Marketing On Patient
Loyalty.
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
794 2, 3., February 2023
According to Baron and Kenny (1986), the Patient Participation Behavior variable becomes
a mediating variable if it meets several conditions. The conditions are: (a) there must be a
significant influence between Relationship Marketing and Patient Participation Behavior, (b)
there must be a significant influence of Patient Participation Behavior on Patient Loyalty, (c)
if the direct influence of Relationship Marketing on Patient Loyalty In model one it is
significant, compared to model two it becomes insignificant or remains significant but the
significance value decreases. The results of testing hypothesis six can be seen in the following
table:
Table 4.6 Hypothesis Testing Results 6
Type
Estimate
p-value
Conclusion
Model 1
The influence of Relationship
Marketing on Patient Loyalty
0,929
0,000
There are positive and
significant influences
Model 2
The influence of Relationship
Marketing on Patient Participation
Behavior
0,974
0,000
Condition a fulfilled
(Sig)
There is an influence of Patient
Participation Behavior on Patient
Loyalty
0,191
0,180
Condition b not met
(No Sig)
The influence of Relationship
Marketing on Patient Loyalty
0,816
0,000
Condition c met (Sig)
Source: Data processed using AMOS 21 (Attached)
From the table, it can be seen that in model two with the condition that there is an influence
of Relationship Marketing on Patient Participation Behavior (p-value = 0.000; condition a).
However, the condition of the influence of Patient Participation Behavior on Patient Loyalty
is not significant (p-value = 0.180; condition b) even though the condition of the influence of
Relationship Marketing on Patient Loyalty is significant (p-value = 0.000; qualified c). Thus
hypothesis six stating that Patient Participation Behavior has a mediating role in influencing
Relationship Marketing against Patient Loyalty is not supported.
To test hypothesis seven, namely the role of Patient Citizenship Behavior in mediating the
relationship between Relationship Marketing and Patient Loyalty, the model will be divided in
half to compare. The first model is a model that only shows the direct influence of Relationship
Marketing on Patient Loyalty. Meanwhile, the second model has included the variable Patient
Citizenship Behavior which mediates the influence of Relationship Marketing with Patient
Loyalty.
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
795 2, 3., February 2023
Figure 4.3 Model 1: The direct influence of 3Relationship Marketing on Patient Loyalty
Figure 4.4 Model 2: The Role of Patient 4Citizenship Behavior in Mediating the Effect
of Relationship Marketing on Patient Loyalty
According to Baron and Kenny (1986), the variable Patient Citizenship Behavior becomes
a mediating variable if it meets several conditions. The conditions are: (a) there must be a
significant influence between Relationship Marketing on Patient Citizenship Behavior, (b)
there must be a significant influence of Patient Citizenship Behavior on Patient Loyalty, (c) if
the direct influence of Relationship Marketing on Patient Loyalty In model one it is
significant, compared to model two it becomes insignificant or remains significant but the
significance value decreases. The results of testing hypothesis seven can be seen in the
following table:
Table 4.7 Hypothesis Test Results 7
Type
Estimate
p-
value
Conclusion
Model 1
The influence of Relationship
Marketing on Patient Loyalty
0,929
0,000
There are positive and
significant influences
Model 2
The influence of Relationship
Marketing on Patient Citizenship
Behavior
0,970
0,000
Condition a fulfilled
(Sig)
There is an influence of Patient
Citizenship Behavior on Patient
Loyalty
0,336
0,017
Condition b fulfilled
(Sig)
Relationship
Marketing
Patient Loyalty
Relationship
Marketing
Patient Loyalty
Patient Citizenship
Behavior
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
796 2, 3., February 2023
The influence of Relationship
Marketing on Patient Loyalty
0,677
0,000
Condition c met (Sig)
Source: Data processed using AMOS 21 (Attached)
From the table, it can be seen that in model two with the condition that there is an influence
of Relationship Marketing on Patient Citizenship Behavior (p-value = 0.000; condition a). The
condition of the effect of patient Citizenship Behavior on Patient Loyalty is significant (p-value
= 0.017; condition b). The condition of the influence of Relationship Marketing on Patient
Loyalty is significant (p-value = 0.000; qualified c). The estimated value in model 1 > when
compared to the estimated value of model 2c, which is 0.929 > 0.677. Thus hypothesis seven
stating that Patient Citizenship Behavior has a partial mediating role in influencing
Relationship Marketing against Patient Loyalty is supported.
DISCUSSION
Hypothesis 1
The first hypothesis tests the positive influence of relationship marketing on patient
participation behavior. The results of this study show that relationship marketing positively
affects patient participation behavior. Research by Mubushar et al., 2020 places relationship
marketing as a mediating variable between corporate social responsibility and value co-
creation mediated by relationship marketing. In this study, relationship marketing was proven
to have a positive effect as a mediator on customer participation behavior. (Mubushar et al.,
2020) In line with the results of this study, research by Murae et al., 2019 found that there is a
good relationship between consumers and companies which can be seen from participation
behavior and this is formed from the relationship marketing built by the company. (Murae et
al., 2019)
Hypothesis 2
The second hypothesis tests the positive influence of patient participation behavior on
patient loyalty. The results of this study show that patient participation behavior positively
does not affect patient loyalty. The results of Xu et al (2021), study are in line with the
statement that customer participation does not directly affect consumer loyalty, but the value
formed by consumers in the participation process is a source of comfort and good experience
for consumers so they can later form loyalty. There are different research results, they
concluded that there are several factors that affect brand loyalty, namely perceived experience
value, brand trust, brand image, and customer participation behavior. In line with the results
of the research of (Chen et al., 2022), Kim and Hyun see the relationship between customer
participation behavior and repurchase intention mediated by relationship commitment.
Several studies state that relationship commitment is a parameter that is closely related to the
formation of customer loyalty. In the study, it was found that customer participation behavior
has a positive effect on relationship commitment (Kim & Hyun, 2022).
Hypothesis 3
The third hypothesis tests the positive influence of relationship marketing on patient
citizenship behavior. The results of this study show that relationship marketing positively
affects patient citizenship behavior. Research conducted by Cheng et al (2022), looks at the
relationship between a relationship marketing and customer citizenship behavior and mediated
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
797 2, 3., February 2023
by customer perceived value. Relationship marketing in the study was divided into financial
relationship marketing activities, social relationship marketing activities, and structural
relationship marketing activities. According to the results of the study, it was found that
financial relationship marketing activities have no effect on customer citizenship behavior. As
for social and structural relationship marketing activities, it is known to have a positive effect
on customer citizenship behavior. Research by Mubushar et al (2020) places relationship
marketing orientation as a mediating variable for customer citizenship behavir. Through this
research, it was found that relationship marketing orientation has an indirect influence on
customer citizenship behavior so it is still in line with this research.
Hypothesis 4
The fourth hypothesis tests the positive influence of patient citizenship behavior on patient
loyalty. The results of this study show that patient citizenship behavior positively affects
patient loyalty. The research divides the dimensions of Albuquerque & Ferreira (2022), value
co-creation behavior into participation and citizenship behavior. Based on this research, it was
found that there is a close relationship between these two dimensions to the loyalty of
consumers in the food and beverage industry. Studies state that in the service industry,
especially health, customer value positively affects consumer loyalty. In the research
conducted by Priantoro & Yudiana (2021) looking at the influence of tourist value co-creation
behavior on destination loyalty mediated by perceived value. It was found that the variable
tourist cizenship behavior, which is a dimension of value co-creation behavior, has an
influence on destination loyalty as an extra role behavior. This is also in line with research
conducted Xu et al (2021) on corporate consumers in China. It was found that customer
citizenship behavior has a positive and significant influence on consumer loyalty (Hu et al.,
2020).
Hypothesis 5
The fifth hypothesis tests the positive influence of relationship marketing on patient loyalty.
The results of this study show that relationship marketing positively affects patient loyalty.
The results of the study by Yıldırım et al (2022), are in line with research that looks at the
influence of relationship marketing on hospital loyalty, it was found that relationship marketing
has a positive influence on patient loyalty mediated by patient satisfaction. Furthermore, in
line with research that looks at the influence of relationship marketing on consumer loyalty in
hospital service businesses. They stated that relationship marketing has a positive effect on
consumer trust and consumer loyalty. Another study was conducted to Afifi & Amini (2018),
to examine the role of relationship marketing in medical tourism services. It is stated that in
this context an increase in trust, cooperation, and commitment which is a dimension of
relationship marketing facilitates the formation of satisfaction and loyalty from consumers.
The research was conducted by Sousa & Alves (2019), using the division of Borishade et al
(2022) relationship marketing dimensions into trust, communication, commitment, and conflict
handling. Based on this research, all dimensions have tested positive for consumer
loyalty.(Borishade et al., 2022)
Hypothesis 6
The sixth hypothesis examines the role of patient participation behavior in mediating the
influence of relationship marketing on patient loyalty. The results of this study show that
patient participation behavior does not mediate the influence of relationship marketing with
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
798 2, 3., February 2023
patient loyalty. Research conducted by placing Torkzadeh et al (2021) participation behavior
as a mediating variable of customer engagement to customer satisfaction. It was found that
participation behavior only partially affects the relationship between the two variables. In
contrast to research that places Torkzadeh et al (2021), customer participation behavior as a
mediating variable that connects relationship benefits to repurchase intention. It was found
that customer participation behavior has a positive effect on linking the two variables. Other
studies place customer Kim & Hyun (2022), participation behavior as a variable that
moderates brand image and customer engagement. It was found that customer participation
has a moderate influence on both variables (Chen et al., 2022).
Hypothesis 7
The seventh hypothesis tests the role of patient citizenship behavior in mediating the
influence of relationship marketing on patient loyalty. The results of this study show that
patient citizenship behavior partially mediates relationship marketing and patient loyalty.
Research by Hu et al (2020), places customer citizenship behavior as a mediating variable that
connects business model design and consumer loyalty. The results of the study found that
customer citizenship behavior mediated the two variables partially, in line with the results
obtained in this study. The results of a fairly different study were obtained by those who
placed customer citizenship as a mediating variable that connects corporate citizenship and
consumption behavior. It was found that customer citizenship significantly mediated these two
variables (Yoon & Park, 2021).
CONCLUSION
Based on the results of the research and discussion processed in the previous chapter, it can
be concluded that out of the seven hypotheses in this study, there are 5 hypotheses that are
supported, and 2 hypotheses that are not supported. Relationship marketing positively affects
patient participation behavior, patient citizenship behavior, and patient loyalty. Relationship
marketing is useful as an instrument for forming long-term relationships between consumers
and service providers, this is in line with the value co-creation that can occur if there is a
collaboration between the two parties. The long-term relationships that are trying to be built
from this collaboration are expected to generate consumer loyalty.
Patient citizenship behavior has a positive effect on patient loyalty, but patient
participation behavior does not affect patient loyalty. In participation behavior, a patient
provides behavior to help the organization, while in citizenship behavior a patient will give a
more voluntary role to be involved in an organization. This can be related to its effect on
loyalty because when a consumer or patient gives his or her involvement voluntarily, the
consumer is indirectly loyal to the organization. Helpful or participating behaviors in the
context of participation behavior have not had a major influence on the patient's loyal attitude
towards the associated RSGMP.
Suggestion
Further research can be carried out on different research objects, for example in private
dental clinics and dental clinics together with a wider scope than RSGMP. Further research
can be done by adding or changing other variables that can affect patient loyalty such as
positive Word of Mouth, consumer satisfaction, and repurchase intention.
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
799 2, 3., February 2023
REFERENCES
Abdullah, F., & Kanyan, A. (2013). Managing the Dimensions of Relationship Marketing in
the Food Service Industry. In Journal of Management (Vol. 37).
Afifi, I., & Amini, A. (n.d.). Factors Affect to Relationship Marketing for Creating Customer
Loyalty in Hospital Services Business. ASEAN Marketing Journal, 10(2).
https://doi.org/10.21002/amj.v10i2.9111
Afifi, I., & Amini, A. (2018). Factors Affect to Relationship Marketing for Creating Customer
Loyalty in Hospital Services Business. ASEAN Marketing Journal, 10(2), 91–108.
https://doi.org/10.21002/amj.v10i2.9111
Albuquerque, R. P., & Ferreira, J. J. (2022). Service quality, loyalty, and co-creation behavior:
a customer perspective. International Journal of Innovation Science, 14(1), 157–176.
https://doi.org/10.1108/IJIS-06-2021-0101
Borishade, T., Ogunnaike, O., Kehinde, O., & Aka, D. (2022). Relationship marketing and
loyalty of mobile phone customers. Innovative Marketing, 18(3), 38–47.
https://doi.org/10.21511/im.18(3).2022.04
Cheng, Z., Chen, X., & Cui, X. (2022). How do relationship marketing activities contribute to
customer citizenship behavior in the context of cross-border e-commerce? International
Journal of Innovative Computing, Information and Control, 18(6), 1957–1967.
https://doi.org/10.24507/ijicic.18.06.1957
Chen, L., Halepoto, H., Liu, C., Yan, X., & Qiu, L. (2022). Research on Influencing
Mechanism of Fashion Brand Image Value Creation Based on Consumer Value Co-
Creation and Experiential Value Perception Theory. Sustainability (Switzerland), 14(13).
https://doi.org/10.3390/su14137524
Ding, X., You, X., Zhang, X., & Yu, Y. (2022). Can Patients Co-Create Value in an Online
Healthcare Platform? An Examination of Value Co-Creation. International Journal of
Environmental Research and Public Health, 19(19).
https://doi.org/10.3390/ijerph191912823
Frasquet-Deltoro, M., Alarcón-del-Amo, M. del C., & Lorenzo-Romero, C. (2019).
Antecedents and consequences of virtual customer co-creation behaviours. Internet
Research, 29(1), 218–244. https://doi.org/10.1108/IntR-06-2017-0243
Hardani, Andriani, H., Ustiawaty, J., Utami, E. F., Istiqomah, R. R., Fardani, R. A., Sukmana,
D. J., & Auliya, N. H. (2020). Qualitative & Quantitative Research Methods Book.
https://www.researchgate.net/publication/340021548
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
800 2, 3., February 2023
Hu, B., Huang, W., Yan, S., Liu, G., & Zhang, T. (2020). Business Model design and customer
loyalty: The mediating role of customer citizenship behavior. Sustainability (Switzerland),
12(17). https://doi.org/10.3390/su12177047
Izogo, E. E., & Mpinganjira, M. (2022). Social media customer behavioral engagement and
loyalty among hotel patrons: does customer involvement matter? International Journal of
Tourism Cities, 8(3), 636–657. https://doi.org/10.1108/IJTC-04-2021-0070
Kim, S.-J., & Hyun, B.-H. (2022). Effects of Psychological Variables on the Relationship
between Customer Participation Behavior and Repurchase Intention: Customer Tolerance
and Relationship Commitment. https://doi.org/10.3390/economies
Kotler, P., & Keller, K. L. (2016). Marketing management (15th ed.). Pearson.
Luu, T. T. (2019). CSR and Customer Value Co-creation Behavior: The Moderation
Mechanisms of Servant Leadership and Relationship Marketing Orientation. Journal of
Business Ethics, 155(2), 379–398. https://doi.org/10.1007/s10551-017-3493-7
Malhotra, N. K., Uslay, C., & Bayraktar, A. (2016). Relationship Marketing Re-Imagined
Marketing's Inevitable Shift from Exchanges to Value Cocreating Relationships Marketing
Strategy Collection. Business Expert Press.
Malik, M. I., & Ahsan, R. (2019). Towards innovation, co-creation and customers' satisfaction:
a banking sector perspective. Asia Pacific Journal of Innovation and Entrepreneurship,
13(3), 311–325. https://doi.org/10.1108/apjie-01-2019-0001
Marcos, A. M. B. de F., & Coelho, A. F. de M. (2021). Service quality, customer satisfaction
and customer value: holistic determinants of loyalty and word-of-mouth in services. TQM
Journal. https://doi.org/10.1108/TQM-10-2020-0236
Mubushar, M., Jaafar, N. B., & Rahim, R. A. (2020). The influence of corporate social
responsibility activities on customer value co-creation: the mediating role of relationship
marketing orientation. Spanish Journal of Marketing – ESIC, 24(3), 309–330.
https://doi.org/10.1108/SJME-12-2019-0101
Murae, Y., Ho, B. Q., Hara, T., & Okada, Y. (2019). Two Aspects of Customer Participation
Behaviors and the Different Effects in Service Delivery Evidence from Home Delivery
Services. Journal of Marketing Development and Competitiveness, 13(1), 45–58.
Nájera-Sánchez, J. J., Martinez-Cañas, R., García-Haro, M. Á., & Martínez-Ruiz, M. P. (2022).
Exploring the knowledge structure of the relationship between value co-creation and
customer satisfaction. Management Decision. https://doi.org/10.1108/MD-07-2021-0930
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation
Behavior of Patients at the Dental and Oral Education Hospital in Jakarta
801 2, 3., February 2023
Pham, T. A. N., Le, H. N., Nguyen, D. T., & Pham, T. N. (2022). Customer service co-creation
literacy for better service value: evidence from the health-care sector. Journal of Services
Marketing, 36(7), 940–951. https://doi.org/10.1108/JSM-09-2021-0323
Preikschas, M. W., Cabanelas, P., Rüdiger, K., & Lampón, J. F. (2017). Value co-creation,
dynamic capabilities and customer retention in industrial markets. Journal of Business and
Industrial Marketing, 32(3), 409–420. https://doi.org/10.1108/JBIM-10-2014-0215
Priantoro, M. A., & Yudiana, F. E. (2021). The Effect of Relationship Marketing, Experential
Marketing and Sharia Marketing Characteristics on Customer Loyalty of Sharia Bank
With Customer Satisfaction as Intervening Variable. MALIA: Journal of Islamic Banking
and Finance, 5(2), 109. https://doi.org/10.21043/malia.v5i2.11800
Rubio, N., Villaseñor, N., & Yagüe, M. (2020). Value Co-creation in Third-Party Managed
Virtual Communities and Brand Equity. In Frontiers in Psychology (Vol. 11). Frontiers
Media S.A. https://doi.org/10.3389/fpsyg.2020.00927
Samsa, Ç., & Yüce, A. (2022). Understanding customers hospital experience and value co-
creation behavior. TQM Journal. https://doi.org/10.1108/TQM-09-2021-0282
Sousa, B. M., & Alves, G. M. (2019). The role of relationship marketing in behavioural
intentions of medical tourism services and guest experiences. In Journal of Hospitality and
Tourism Insights (Vol. 2, Issue 3, pp. 224–240). Emerald Group Holdings Ltd.
https://doi.org/10.1108/JHTI-05-2018-0032
Sudarti, K., & Hidayah, N. (2022). The role of value co-creation in improving marketing
performance. Ekobis, 23(1), 1–15.
Thaichon, P., Liyanaarachchi, G., Quach, S., Weaven, S., & Bu, Y. (2020). Online relationship
marketing: evolution and theoretical insights into online relationship marketing.
Marketing Intelligence and Planning, 38(6), 676–698. https://doi.org/10.1108/MIP-04-
2019-0232
Torkzadeh, S., Zadeh, A. H., & Zolfagharian, M. (2021). Customer Engagement and
Participation Behavior: The Underlying Mechanisms of the Virtual Servicescape and
Service Outcomes. https://doi.org/10.2979/eservicej.13.2.01
Wang, H. L., Huang, J. Y., & Howng, S. L. (2011). The effect on patient loyalty of service
quality, patient visit experience and perceived switching costs: Lessons from one Taiwan
university hospital. Health Services Management Research, 24(1), 29–36.
https://doi.org/10.1258/hsmr.2010.010011
Xu, F., Tan, J., Lu, L., Li, S., & Qin, L. (2021). How does value co-creation behavior affect
destination loyalty? A role switching perspective. Journal of Theoretical and Applied
The Influence of Relationship Marketing on Patient Loyalty Mediated by the Value Co-Creation Behavior of
Patients at the Dental and Oral Education Hospital in Jakarta
802 2, 3., February 2023
Electronic Commerce Research, 16(5), 1805–1826.
https://doi.org/10.3390/jtaer16050101
Yıldırım, Y., Amarat, M., & Akbolat, M. (2022). Effect of relationship marketing on hospital
loyalty: the mediating role of patient satisfaction. International Journal of Pharmaceutical
and Healthcare Marketing, 16(3), 337–353. https://doi.org/10.1108/IJPHM-01-2021-
0010
Yoon, S., & Park, Y. (2021). Does citizenship behaviour cause ethical consumption? Exploring
the reciprocal locus of citizenship between customer and company. Asian Journal of
Business Ethics, 10(2), 275–292. https://doi.org/10.1007/s13520-021-00130-1
Zadeh, A. H., Zolfagharian, M., & Hofacker, C. F. (2019). Customer–customer value co-
creation in social media: conceptualization and antecedents. Journal of Strategic
Marketing, 27(4), 283–302. https://doi.org/10.1080/0965254X.2017.1344289