<![CDATA[Background: Online sales have widened access to personal-use medical devices in Indonesia, but repeat purchasing is difficult to sustain because buyers must judge safety, authenticity, service reliability, and provider credibility at the same time. How these judgments combine to create loyalty remains insufficiently resolved. Objective: The study tested whether value co-creation (VCC), brand image (BI), e-service quality (ESQ), and customer perceived value (CPV) explain customer satisfaction (CS) and customer loyalty (CL), and whether CS carries any of those effects to CL. Methods: Survey data from 301 Indonesian consumers who had bought personal-use medical devices at least twice during the previous six months were analyzed with PLS-SEM in SmartPLS 3.0. Results: VCC (T = 2.341; p = 0.019) and BI (T = 2.206; p = 0.027) were associated with CS; CPV (T = 0.617; p = 0.541) and ESQ (T = 1.836; p = 0.064) were not. CL was associated with CS (T = 2.857; p = 0.004), ESQ (T = 2.852; p = 0.004), VCC (T = 5.386; p < 0.001), and BI (T = 3.255; p = 0.001), but not CPV (T = 1.377; p = 0.168). All four CS-mediated paths were non-significant. Conclusion: In this market, loyalty is explained more convincingly by direct relational, brand, and service effects than by a common satisfaction-mediated mechanism. Customer participation, brand credibility, and dependable digital service therefore deserve managerial priority.]]>
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