Vol. 8 No. 5 (2020): Business & Management Studies: An International Journal


Asisst. Prof. Dr., Kilis 7 Aralık University
Asisst. Prof. Dr., Kilis 7 Aralık University

Published 2020-12-25


  • Sağlık Hizmetleri Pazarlaması, Müşteri Odaklılık, Marka Güveni, Marka Prestiji, Marka Savunuculuğu
  • Healthcare Marketing Customer Orientation Brand Trust Brand Prestige Brand Advocacy

How to Cite

BOZKURT, İbrahim, & ÇOLAKOĞLU, E. (2020). THE EFFECT OF CUSTOMER ORIENTATION IN HEALTHCARE SERVICES ON BRAND TRUST, BRAND PRESTIGE, AND BRAND ADVOCACY. Business & Management Studies: An International Journal, 8(5), 3991–4016. https://doi.org/10.15295/bmij.v8i5.1658



Recently, many scientific and technological developments have occurred in the health sector as in all sectors. Thanks to these developments, the new methods and practices revealed provide extra advantages and convenience to patients and practitioners. (Bozkurt, 2020). Nowadays, people have become more searching and questioning. By gaining a comparative quality with the opportunity to access information more efficiently, they have become more sensitive about the personalization and quality of the service. Besides, the number of private hospitals and health centres has also increased (Zor and Biçer, 2020). Thus, in order to survive in the sector and the sustainability of the service between all public and private healthcare enterprises, intense competition has been entered. In this context, the brand concept, which is considered to be the determinant of the prestige, character and relations of the enterprise, which shapes and affects the purchasing decisions of consumers and the increase in competition between businesses and consumers (Demirgüneş & Avcılar, 2014) draws attention. Brands can create an emotional bond and relationship between consumers and institutions. Especially with the formation of this emotional attachment in healthcare, consumers can identify with the healthcare provider's brand. A brand is a promise by the hospital to provide its customers with the care they need. Health service branding requires the institution to reach the expected standards with its products and services and to prioritize how to manage consumer perceptions and emotions (Mangini, 2002). Continuous preference of healthcare institutions in order to meet the health service needs of all internal and external customers in the intensely competitive environment, and positive communication efforts by the customers and becoming the "advocate" of the brand will provide significant advantages.



This study aims to examine the impact of customer-oriented behaviour of institutions operating in the healthcare sector on the brand prestige, brand trust and brand advocacy behaviours of the patient. Considering the scarcity of studies on branding and marketing efforts of hospitals, which are important actors of health services, and the relationships observed between variables examined in the study, it is thought that the results obtained will contribute to the relevant literature academically. Healthcare institutions and organizations will be able to make significant contributions to marketing and brand managers by creating strong brands to gain a competitive advantage.




Although it has been studied extensively in other fields, it is the examination of the relationships between the concepts of customer orientation, brand prestige, brand trust and brand advocacy within the scope of healthcare marketing.




Quantitative Research Method



Two hundred fifty participants were selected using the convenience sampling method, which is one of the non-probability methods.



PLS structural equation model was used to test the hypotheses.




H1: Customer orientation has a positive effect on brand trust.

H2: Customer orientation has a positive effect on brand prestige.

H3: Customer orientation has a positive effect on brand advocacy.

H4: Brand trust has a positive effect on brand advocacy.

H5: Brand trust has a mediating effect between customer orientation and brand advocacy.

H6: Brand prestige has a positive effect on brand advocacy.

H7: Brand prestige has a mediating effect between customer orientation and brand advocacy.



According to the analysis results; it has been determined that the direct impact of customer orientation on prestige is significant; the direct impact of customer orientation on trust is significant; the impact of customer orientation on advocacy is significant; that prestige has a significant direct impact on advocacy; the direct effect of trust on advocacy is significant.



According to the analysis results, all hypotheses were accepted.



The results reached in the study were supported by the studies in the relevant literatüre (Berry, 2000; Swan vd.,1999; Frasquet vd., 2008; Schwepker Jr., 2003; Hanzaee ve Taghipourian, 2012; Baek vd.,2010; Choi vd., 2017;Dean, 2007; Kelley, 1992; Kotler ve Turner, 1993; Peck vd., 1999; Steenkamp vd., 2003; Jin vd., 2016; Turan, 2011; Mahjoub ve Naeij, 2015; Yapraklı ve Keser, 2017; Hwang ve Han, 2016; Hwang ve Hyun, 2012; Gilaninia vd., 2012; Jarvenpaa vd., 2000; Düzgün, 2015; Selvi, 2007; Anderson ve Weitz, 1989; Lee vd., 2016; Elliott ve Yannopoulou, 2007; Hassan vd., 2015).


    • RESULTS of the ARTICLE


As a result of the analysis, it was determined that the customer-oriented behaviours of the hospitals have a direct and positive effect on brand prestige, brand trust, and brand advocacy. Also, it was found that brand prestige and brand trust play a partial mediating role in the effect of customer orientation on brand advocacy.




The positive attitudes of employees who strive to meet customer expectations at the highest level, the brand prestige of the organization and the increase of trust in the institution are also crucial for the success of the institutions. The finding that these concepts indirectly contribute to the increase of customers who advocate the institution and its brand, thanks to their mediating role, shows that these two concepts, such as at least customer orientation, are the concepts that should be focused on in the marketing strategies of hospitals.




One of the limitations of the study is that it was conducted only in Gaziantep and in two (one state and one private) hospitals. Another limitation is that only the relationships between the selected variables were examined. Conducting future studies in different regions and covering more hospitals will contribute to a more generalizable examination of the subject. Besides, increasing the variables examined by the literature and examining the relations between them in terms of various characteristics of the participants will contribute to the development of the results obtained in this study.


Download data is not yet available.


  1. Akdağ, R. (2008), Türkiye Sağlıkta Dönüşüm Programı ve Temel Sağlık Hizmetleri Kasım 2002-2008, T.C. Sağlık Bakanlığı Yayın No:770, Ankara.
  2. Alabay N. (2010), Geleneksel Pazarlamadan Yeni Pazarlama Yaklaşımlarına Geçiş Süreci, Süleyman Demirel Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 15(2), 213-235.
  3. Anderson, E., & Weitz, B., (1989), Determinants of Continuity in ConventionalIndustrial Channel Dyads, Marketing Science, 8(4), 291-380.
  4. Baek, T. H., Jooyoung K. & Jay H. Y. (2010), The Differential Roles of Brand Credibility and Brand Prestige in Consumer Brand Choice, Psychology & Marketing, 27 (7), 662-678.
  5. Bagozzi, R. P., & Yi, Y. (1988), On the Evaluation of Structural Equation Models. Journal of the Academy of Marketing Science, 16(1), 74–94. https://doi.org/10.1007/BF02723327
  6. Baydaş, A., & Aydın, S. (2017), Marka Sadakatinin Tüketicilerin Satın Alma Davranışı Üzerindeki Etkisinin Belirlenmesine Yönelik Ampirik Bir Çalışma. İktisadiyat, 1(1), 61-90.
  7. Berry, L. L. (2000), Cultivating Service Brand Equity, Journal of the Academy of MarketingSciences, 28 (1), 128-137.
  8. Bloemer, J., Ko de R. & Martin, W. (1999), Linking Perceived Service Quality and Service Loyalty: A Multi-Dimensional Perspective, European Journal of Marketing, 33(1/2), 1082-1106.
  9. Brady, M. &Cronin Jr, J. (2001), Customer Orientation: Effects on Customer Service Perceptions and Outcome Behaviors, Journal of Service Research, 3(3), 241-251.
  10. Bozkurt, İ. (2020), Teknoloji Kabul Modeli Çerçevesinde Sağlık Profesyonellerinin Yeni Tedavi Yöntemlerini Kullanma Eğilimlerinin İncelenmesi (Özel Hastane Örneği), Gevher Nesibe Journal IESDR, 5(7), 88-100.
  11. Chaudhuri, A. & Holbrook, M.B. (2001), The Chain Effects from Brand Trust and Brand Effect to Brand Performance: The Role of Brand Loyalty, Journal of Marketing, 65(1), 31-93.
  12. Chakravarty, A., Liu, Y. & Mazumdar, T. (2010), The Differential Effects of Online Word-of-Mouth and Critics' Reviews on Pre-Release Movie Evaluation, Journal of Interactive Marketing, 24(3), 185-197.
  13. Choi, Y. G., Ok, C. M. & Hyun, S. S. (2017), Relationships Between Brand Experiences, Personality Traits, Prestige, Relationship Quality, and Loyalty: An Empirical Analysis of Coffeehouse Brands. International Journal of Contemporary Hospitality Management, 29(4), 1185-1202.
  14. Dean, A.M. (2007), The Impact of the Customer Orientation of Call Center Employees on Customers' Affective Commitment and Loyalty, Journal of Service Research, 10 (2), 161-173.
  15. Değermen, A. (2008), Hizmet Personelinin Müşteri Odaklı Davranışlarının Müşterilerin Algılamaları Üzerindeki Etkisinin Saptanmasına Yönelik Bir Araştırma, Öneri Dergisi, 8 (30), 185-193.
  16. Demirgüneş, B., &Avcılar, M. Y. (2014), Şehir markası oluşturma: Şehirde oturanların memnuniyet düzeyleri üzerine bir uygulama, A. Tan (Ed.), 19. Ulusal Pazarlama Kongresi Bildiri Kitabı, Gaziantep, 557-570.
  17. Drucker, Peter F. (1954), The Practice of Management, Harper and Row, New York.
  18. Du, S., Bhattacharya, C. B. &Sen, S. (2007), Reaping Relational Rewards from Corporate Social Responsibility: The Role of Competitive Positioning, International Journal of Research in Marketing, 24 (3), 224-241.
  19. Düzgün, Z. (2015), Tüketicilerin Pazarlama Karması Algısı ve Satın Alma Tarzlarının Müşteri Memnuniyeti, Markaya Duyulan Güven ve Tüketici Temelli Marka Değeri Üzerindeki Etkileri, Yüksek Lisans Tezi, Doğuş Üniversitesi Sosyal Bilimler Enstitüsü.
  20. Elliott, R. & Yannopoulou, N. (2007), The Nature of Trust in Brands: A Psychosocial Model, European Journal of Marketing, 41 (9/10), 988-998.
  21. Erdoğmuş, İ. & Büdeyri-Turan, I. (2012), The Role of Personality Congruence, Perceived Quality and Prestige on Ready-to-Wear Brand Loyalty, Journal of Fashion Marketing & Management, 16(4), 399-417.
  22. Ertaş O. (2008), Rekabet Ortamında Müşteri Odaklı Pazarlama İletişimi: Mersin Beymen Mağazası, (Basılmamış Yüksek Lisans Tezi), Ankara Üniversitesi, Sosyal Bilimler Enstitüsü, Halkla İlişkiler ve Tanıtım Anabilim Dalı, Ankara.
  23. Fırat, A. F. (1999), The Construction of Identity, Gender, and Consumption, The Transnational Politics of Gender and Consumption Conference, Berkeley, CA.
  24. Fornell, C., & Larcker, D. F. (1981), Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. Journal of Marketing Research, 18(1), 39-50. https://doi.org/10.2307/3151312
  25. Frasquet, M., Cervera, A., & Gil, I. (2008), The impact of IT and customer orientation on building trust and commitment in the supply chain. The International Review of Retail, Distribution and Consumer Research, 18(3), 343-359.
  26. Fullerton, G. (2003), When Does Commitment Lead to Loyalty?,Journal of Service Research, 5(4), 333–344.
  27. Gilaninia, S., Hossein G., Ali M. & Rahimi M. (2012), The Differential Roles of Brand Credibiity and Brand Prestige in the Customers' Purchase Intention, Kuwait Chapter of Arabian Journal of Business and Management Review, 2 (4), 1-9.
  28. Hair, J. F., Sarstedt, M., Hopkins, L. ve Kuppelwieser, V. G. (2014). Partial Least Squares Structural Equation Modeling (PLS-SEM): An Emerging Tool in Business Research. Europen Business Review, 26(2), 106–121. doi:10.1108/EBR-10-2013-0128
  29. Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2017), A primer on partial least squares structural equation modeling (PLS-SEM) (2nd ed.). SAGE Publication.
  30. Hanzaee, K.H. & Taghipourian M.J., (2012), The Effects of Brand Credibility and Prestige on Consumers Purchase Intention in Low and High Product Involvement, Journal of Basic and Applied Scientific Research, 2 (2), 1281-1291.
  31. Hassan, M., Rafi, A., & Kazmi, S. S. (2016), Impact of Differentiated Customer Service, Brand Trust, Brand Commitment, and Brand Salience on Brand Advocacy, International Review of Management and Marketing, 6(4S), 232-238.
  32. Hashmi, F. K. H., Khalid, F., Akram, M. A., Saeed, U. & Rizwan, M. (2014), An Empirical Study of Brand Loyalty on Samsung Electronics in Pakistan, Journal of Sociological Research, 5 (1), 350-364.
  33. https://sozluk.gov.tr/ Erişim tarihi 02.10.2020
  34. Hwang, J. & Hyun, S.H. (2012), The Antecedents and Consequences of Brand Prestige in Luxury Restaurants, Asia Pacific Journal of Tourism Research, 17(6).
  35. Hwang, J. & Han, H. (2016), A Model of Brand Prestige Formation in the Casino Industry. Journal of Travel and Tourism Marketing, 33, 1106–1123.
  36. Hulland, J. (1999), Use of partial least squares (PLS) in Strategic Management Research: A Review of Four Recent Studies, Strategic Management Journal, 20(2), 195–204. https://doi.org/10.1002/(sici)1097-0266(199902)20:2<195::aid-smj13>3.0.co;2-7
  37. Jarvenpaa, S.L., Tractinsky, N. & Vitale, M. (2000), Consumer Trust in an İnternet Store, Information Technology and Management, 1(1-2), 45-71.
  38. Jin, N.P., Line, N. &Merkebu, J. (2016), The Impact of Brand Prestige on Trust, Perceived Risk, Satisfaction, and Loyalty in Upscale Restaurants, Journal of Hospitality Marketing and Management, 25 (5), 523-546.
  39. Kelley, S. W. (1992), Developing Customer Orientation among Service Employees, Journal of the Academy of Marketing Science, 20(1), 27–36.
  40. Kemp, E., Jillapalli, R., & Becerra, E. (2014), Healthcare Branding: Developing Emotionally Based Consumer Brand Relationships. Journal of Services Marketing, 28(2), 126–137. https://doi.org/10.1108/JSM-08-2012-0157
  41. Kim, J. Y., Han, D., Moon, J., & Tikoo, S. (2004), Perceptions of Justice and Employee Willingness to Engage in Customer-Oriented Behavior, Journal of Services Marketing, 18(4), 267–275. https://doi.org/10.1108/08876040410542263
  42. Kirmani, A., Sood, S., & Bridges, S. (1999), The Ownership Effect in Consumer Responses to Brand Line Stretches, Journal of Marketing, 63(1), 88–101. https://doi.org/10.2307/1252003
  43. Kotler P. & Turner R.E. (1993), Marketing Management-Analysis, Planning, Implementation and Control, Canadian, 7Th Ed., Prentice Hall. Inc.
  44. Lau, G. T. & Lee, S. H. (1999), Consumer's Trust in a Brand and the Link to Brand Loyalty, Journal of Market Focused Management, 4, 341-370.
  45. Lee, S-H., Workman, J. E. & Jung, K. (2016), Brand Relationships and Risk: Influence of Risk Avoidance and Gender on Brand Consumption, Journal of Open Innovation: Technology, Market, and Complexity,2(14), 1-15.
  46. Mahjoub, H. & Naeij, A. K. (2015), The Impact of Prestige, Consumer Personality and Self-Concept on Brand Loyalty, The International Journal Of Business and Management, 3 (4), 392-398.
  47. Mangini, K. (2002), Branding 101, Marketing Health Services, 22(3), 20-23.
  48. Marsden, Paul, Samson, Alain and Upton, Neville (2005), Advocacy Drives Growth. Brand Strategy (198), 45-47. ISSN 0965-9390
  49. Melancon, J. P., Noble, S. M., & Noble, C. H. (2010), Managing Rewards to Enhance Relational Worth, Journal of the Academy of Marketing Science, 38(3), 341–362. https://doi.org/10.1007/s11747-010-0206-5
  50. Morgan, R. M. & Hunt, S. D. (1994), The Commitment-Trust Theory of Relationship Marketing. Journal of Marketing, 58(3), 20-38.
  51. Motowidlo SJ & Van Scotter JR (1994), Evidence That Task Performance Should Be Distinguished from Contextual Performance, Journal of Applied Psychology, 79, 475–480.
  52. Naktiyok, A., (2003), Yönetici Değerleri ve Pazar Yönlülük Bir Uygulama, Erciyes Üniversitesi İİBF Dergisi, 20(Ocak-Haziran), 95-116.
  53. Peck, H., Adrian, P., Martin C. & Moira, C. (1999), Relationship Marketing: Strategy and Implementation, Butterworth Heinemann: Oxford.
  54. Rizwan, M., Javed, P. A., Aslam, J., Khan, R. & Bibi, H. (2014), The Relationship of Brand Commitment, Brand Credibility, Perceived Quality, Customer Satisfaction and Brand Loyalty: An Empirical Study on Stylo Shoes, Journal of Sociological Research, 5(1), 377-404.
  55. Schwepker Jr, C. H. (2003), Customer-Oriented Selling: A Review, Extension, and Directions for Future Research. Journal of Personal Selling & Sales Management, 23(2), 151-171.
  56. Seiling, JG. (2001), The Meaning and Role of Organisational Advocacy: Responsibility and Accountability in the Workplace, Greenwood Publications, Westport, CT.
  57. Selvi, S. (2007), Müşteri Sadakati, Birinci Baskı, Ankara, Detay Yayıncılık.
  58. Steenkamp, J.E.M., Rajeev B. & Dana L.A. (2003), How Perceived Brand Globalness Creates Brand Value, Journal of International Business Studies, 34 (1), 5365.
  59. Swan, John E., Michael R. Bowers & Lynne D., Richardson (1999), Customer Trust in the Sales Person: An Integrative Review and Meta-Analysis of the Empirical Literature, Journal of Business Research, 44 (2), 93-107.
  60. Şaylan O. & Tokgöz E. (2020), Marka Güveni ve Marka Sadakati İlişkisinde Marka Özdeşleşmesinin Düzenleyici Rolü, Business & Management Studies: An International Journal (BMIJ), 8(1), 144-163.
  61. Özgür, E. Ö. (2015), Algılanan Örgütsel Prestij, Örgütsel Özdeşleşme ve Öğrenci Başarısı Arasındaki İlişkilerin İncelenmesi. Yayınlanmamış Yüksek Lisans Tezi, Mevlana Üniversitesi Sosyal Bilimler Enstitüsü.
  62. Turan, I. B. (2011), The Role of Personality Congruence, Perceived Quality and Brand Prestige on Brand Loyalty. (Yayımlanmamış Yüksek Lisans Tezi). Marmara Üniversitesi Sosyal Bilimler Enstitüsü, İstanbul.
  63. Türkiye Sağlık Raporu, (2014), https://sosyolojivefelsefe.files.wordpress.com/2015/01/ tc3bcrkiye-sac49flc4b1k-raporu-2014.pdf Erişim Tarihi, 01.07.2020
  64. Uzunoğlu, E. (2007), Müşteri odaklı pazarlama anlayışına göre değer yaratma: Bir model olarak Değer İletim Sistemi, Eskişehir Osmangazi Üniversitesi İktisadi ve İdari Bilimler Dergisi, 2(1), 11-29.
  65. Yang, Z., Xu Z. &Da-hai D., (2006), A Reexamination of Customer Orientation and Business Performance: From a Cultural Perspective, Management Science and Engineering ICMSE '06 International Conference, 5-7 Oct. 2006, Lille, 1355 – 1359.
  66. Yapraklı, Ş. & Keser, E. (2017), Marka Prestiji ve Kredibilitesinin Marka Sadakati Üzerine Etkisi: Otomotiv Sektöründe Bir Uygulama, Uluslararası İktisadi ve İdari İncelemeler Dergisi, 22, 163-180.
  67. Yıldırım, H.H., (2013), Türkiye Sağlık Sistemi: Sağlıkta Dönüşüm Programı Değerlendirme Raporu, Sağlık ve Sosyal Hizmet Çalışanları Sendikası, Ankara.
  68. Yousaf U., Zulfıqar R., Aslam M., & Altaf, M. (2012), Studying Brand Loyalty in the Cosmetics Industry, LogForum, 8 (4), 327-337.
  69. Wong, K. K. K. (2013), Partial Least Squares Structural Equation Modeling (PLS-SEM) Techniques Using SmartPLS, Marketing Bulletin, 24(1), 1-32.
  70. Wong, K. K. K. (2016), Mediation Analysis, Categorical Moderation Analysis, and Higher-Order Constructs Modeling in Partial Least Squares Structural Equation Modeling (PLS-SEM): A B2B Example Using SmartPLS. Marketing Bulletin, 26, 1-22.
  71. Zeithaml, V.A. (1981), How Consumer Evaluation Processes Differ between Goods and Services, in Donnelly, J.H. and George, W.R. (Eds), Marketing of Services, American Marketing Association, Chicago, IL, 186-190.
  72. Zor, M.G, & Biçer, D.F., (2020), Hastaların Sağlık Kuruluşu Tercihlerinde Marka İmajının Etkisi, BMIJ, 8(3), 3655-3689.