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All Journal Proceeding Mulawarman International Conference on Tropical Public Health
Panuturi Ratih Elizabeth Thresna Sinaga
Mulawarman University
Public Health

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From SERVQUAL to Loyalty: A Review of Evidence in Primary Care Panuturi Ratih Elizabeth Thresna Sinaga
Mulawarman International Conference on Tropical Public Health Vol. 2 No. 2 (2025): The 4th MICTOPH
Publisher : Faculty of Public Health Mulawarman University, Indonesia

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Background : Service quality plays a vital role in shaping patient satisfaction and loyalty, yet most existing evidence comes from hospital settings. Understanding how service quality functions in primary care is crucial to improving patient experiences and strengthening health system trust. Objective : To map and synthesize empirical findings on the relationships between SERVQUAL dimensions, patient satisfaction, and patient loyalty in primary care services from 2020–2025. Research Methods/ Implementation Methods : A narrative review was conducted using 34 eligible studies that examined SERVQUAL dimensions—tangibles, reliability, responsiveness, assurance, and empathy—in relation to satisfaction and loyalty. Data were extracted on significant predictors, research design, and analytical approaches. Results : Responsiveness, empathy, and tangibles consistently showed the strongest influence on satisfaction, which often mediated the effect of service quality on loyalty. Findings for reliability and assurance varied by context. Most studies used cross-sectional survey designs with SEM-PLS analysis, and heterogeneity in instruments limited quantitative comparison. Conclusion/Lesson Learned : Evidence supports a quality–satisfaction–loyalty pathway in primary care. Future research should standardize instruments, include contextual variables such as financing models (e.g., BLUD), and adopt longitudinal designs to enhance causal interpretation and policy relevance
SERVICE QUALITY, PATIENT SATISFACTION, AND LOYALTY IN PRIMARY CARE: POLICY IMPLICATIONS FROM A NARRATIVE REVIEW Panuturi Ratih Elizabeth Thresna Sinaga; Ratno Adrianto
Mulawarman International Conference on Tropical Public Health Vol. 2 No. 2 (2025): The 4th MICTOPH
Publisher : Faculty of Public Health Mulawarman University, Indonesia

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Abstract

Background: Service quality is a key determinant of patient satisfaction and loyalty. While extensive evidence exists in hospital settings, findings in primary care remain fragmented, particularly in contexts undergoing health financing reforms. 1 Objective: This review aims to synthesize empirical evidence on the relationships between SERVQUAL dimensions, patient satisfaction, and patient loyalty in primary care settings. Methods: A narrative review was conducted on 34 primary empirical studies published between 2020 and 2025. Studies examining SERVQUAL dimensions—tangibles, reliability, responsiveness, assurance, and empathy—in relation to satisfaction and loyalty were included. Data were extracted and synthesized narratively, supported by an evidence frequency mapping. Results: Responsiveness, empathy, and tangibles consistently demonstrated strong associations with patient satisfaction. Satisfaction frequently mediated the relationship between service quality and loyalty, whereas direct effects of service quality on loyalty were inconsistent. Reliability and assurance showed variable effects across contexts. Most studies employed cross-sectional designs and SEM-PLS analytical approaches. Conclusion: Evidence supports a service quality–satisfaction–loyalty pathway in primary care. Contextual and financial factors, such as institutional financing models, may moderate these relationships and warrant further investigation using longitudinal and context-sensitive designs.
Co-Authors Adrianto, Ratno