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Quality alone is not enough to be
trustworthy
The mediating role of sincerity perception
Jason Perepelkin
College of Pharmacy & Nutrition University of Saskatchewan,
Saskatoon, Canada, and
David Di Zhang
Edwards School of Business, University of Saskatchewan,
Saskatoon, Canada
Abstract
Purpose – The aim of this paper is to argue that quality alone is not enough; pharmacies need to
develop a rapport with their customers and convey sincerity. Community (retail) pharmacy is an
increasingly competitive industry. Service quality has been considered one of the key factors for
pharmacies to differentiate and develop competitive advantage. The customers’ perception of the
sincerity of the pharmacies mediates the relationship between quality and trust.
Design/methodology/approach – Through consumer intercept, we collected survey data from 150
customers in a western Canadian city who had lled a prescription at the pharmacy in the previous six
months. Data were analyzed using structure equation modeling.
Findings – Our data revealed that while overall service quality has a positive inuence on customer
trust, perception of sincerity has a more immediate impact. The relationship between quality and trust
was completely mediated through sincerity perception.
Originality/value – Service quality has been introduced to pharmacy management and produced
many good results. However, the measurement of service quality has historically emphasized on
physical evidence. The element of human interaction and subjective affective perceptions has been
largely ignored because it is difcult to measure, hence difcult to reward and implement. Our study
highlights the importance of personal interactions in the context of pharmacy quality management.
Keywords Service quality, Community pharmacy, Customer trust, Perceived sincerity, Service
personality
Paper type Research paper
Introduction and background
The landscape of the community (retail) pharmacy industry in Canada and elsewhere is
undergoing tremendous change (Bush et al., 2009;Dobson and Perepelkin, 2011;
Perepelkin and Dobson, 2010). With an increasingly larger portion of the market share
being captured by national and multinational corporations, the Canadian pharmacy
industry has become more competitive than ever before. Marketing and management
strategies for community pharmacies have emerged as an important research topic.
Prior studies have shown that community pharmacies can differentiate themselves from
the others by delivering superior service quality (White and Clark, 2010) and cultivating
a unique brand personality (Perepelkin and Zhang, 2011).
The current issue and full text archive of this journal is available at
www.emeraldinsight.com/1750-6123.htm
IJPHM
8,2
226
Received 22 February 2013
Revised 15 September 2013
Accepted 11 November 2013
International Journal of
Pharmaceutical and Healthcare
Marketing
Vol. 8 No. 2, 2014
pp. 226-242
©EmeraldGroupPublishingLimited
1750-6123
DOI 10.1108/IJPHM-02-2013-0006
While service quality is a common research theme in general business management,
research in service quality in the context of the community pharmacy industry, and
particularly the relationship between pharmacists and customers, is relatively limited. It
has been shown that pharmacy customers may seek different kinds of services from
different type of pharmacies (Dominelli et al., 2005); and various types of pharmacies
have different intentions and capabilities in delivering high quality services (White and
Clark, 2010). Little is known about the mechanism through which pharmacies enhance
quality and translate service quality into benets.
In this paper, we further examine how customers internalize the service encounters
and subjectively evaluate the experience and, ultimately, develop a trusting relationship
with community pharmacies. By understanding this mediating relationship,
pharmacies would realize that shopping at a community pharmacy is more than a
commercial transaction; rather, it is more of a personal experience. Accordingly,
pharmacy managers can look beyond service quality improvement at the physical and
objective levels, and move to develop personal relationships with pharmacy customers
to gain their trust and, therefore, long-term commitment.
Literature review
Management practices in community pharmacy
Pharmacies play an important role in the delivery of healthcare services (Gebauer, 2008).
Pharmaceutical expenditures account for a signicant portion of healthcare costs both
in the USA (Rizzo and Zeckhauser, 2009) and in Canada (CIHI, 2012). While healthcare
organizations are under tremendous pressure to control costs and continue to deliver
high quality care (Phillips and Garman, 2005), they need to transform their
administration, build trusting relationships with their stakeholders and communicate
the concept of change (Borkowski and Gordon, 2005). For example, it has been proposed
that community pharmacies should revamp their service platform by developing and
implementing drug therapy management services that are customer-focused and
relationship-based (Gurney, 2003) and that the role of community pharmacies should be
expanded from drug dispensing to include health management and advisory services
(White and Clark, 2010). Therefore, improving the management practice in community
pharmacies has paramount importance.
Rooted in custom chemist shops that compounded individual prescriptions,
community pharmacies are primarily distributors and retailers of mass-produced
pharmaceuticals (Tipton, 1999) and other clinically related services (Doucette et al.,
2012;Mansell and Perepelkin, 2011;Renberg et al., 2006). As such, a community
pharmacist would play a dual role of being both a businessperson and a healthcare
professional at the same time (Dobson and Perepelkin, 2011;Perepelkin and Dobson,
2010;Resnik et al., 2000). Community pharmacists understand the intrinsic relationship
between business protability and satisfying the customers by providing diligent
counseling services (Schulz and Brushwood, 1991). As a result, we believe pharmacies
management strategies should not only focus on the physical, objective and
transactional aspects. Instead, the pharmacy – customer relationship should be treated
as personal and experiential. In the following sections, we will review the literature on
pharmacy management and propose a model that delineates how pharmacy customers
internalize pharmacy service quality through a perceived sincerity, garnishing the
227
Quality alone is
not enough to be
trustworthy
pharmacy with trust. Then, we will describe a survey study to test our hypotheses.
Implications will also be discussed.
Building customer trust
Business protability is only one element in the multifaceted performance outcomes of
community pharmacies. Scholars have argued that customer-based perceptual
measures have long-lasting implications (Kohli and Jaworski, 1990). Some of these
customer-based indicators include customer satisfaction and trust; (Appendix 1). While
these are closely related constructs, we focus on customer trust as the outcome indicator
in this paper. Based on Morgan and Hunt’s (1994) conceptualization of trust, a customer
would trust a pharmacy when he/she has the condence in the pharmacy’s reliability
and integrity. Hess (1995) developed a multi-dimensional scale to capture customer trust
based on their assessment of the service provider’s altruism, honesty and reliability.
Research has demonstrated that even satised customers have high defection rates
(Deming, 1986;Jones and Sasser, 1995;Reichheld, 1996;Stewart, 1997). However,
customers who trust the service providers are more likely to develop a solid and lasting
customer commitment (SanMartin et al., 2004). Trust is an important sub-process for
regulating consumer patronage and subsequent recommendation intentions (Vlachos
et al., 2009). Customer trust is also an important stepping stone for building customer
relationships (Kim et al., 2009) and customer loyalty (Cho and Hu, 2009;Eisingerich and
Bell, 2008). Following Oliver’s (1997) conceptualization of satisfaction and loyalty,
Harris and Goode (2004) empirically tested the cognitive – affective – conative – action
loyalty sequence and highlighted customer trust as the pivotal driver of loyalty. With
some minor adjustments, the quality – satisfaction – trust – loyalty chain holds true
across cultures (Kassim and Abdullah, 2009). Evidence has also shown that trusting the
service provider as being benevolent is the bridge that links customer satisfaction and
customer loyalty (Kantsperger and Kunz, 2010).
Building consumer trust has become an important goal for companies that have a
direct impact with consumer health (Meijboom et al., 2006). Research has shown that
competence and credibility would build trust, which, in turn, leads to better customer
relationships, reputation and repurchase intentions (Sichtmann, 2007). A prior
experimental study on trust formation revealed that consumers with high involvement
and high anxiety build their trust primarily via a central route of information
processing; conversely, consumers with low involvement and low anxiety build their
trust via a peripheral route that rely upon heuristic cues (Yang et al., 2006). Because
visiting a pharmacy is likely to be a high involvement and a high anxiety situation, a lot
of thinking processes are likely to take place in the customer’s mind. Few studies,
however, have reported how to build customer trust in the context of community
pharmacy.
Improving service quality
Service quality is the customers’ perceived level of performance assessment relative to
their expectations (Parasuraman et al., 1985). While some have debated on whether
service quality is a simple assessment of performance outcome (Cronin and Taylor,
1992) or a relative construct, whereas consumers actively compare their experience with
their expectations (Parasuraman et al., 1994), researchers generally agree that better
service quality leads to higher levels of customer satisfaction (Gotlieb et al., 1994;Oliver,
IJPHM
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228
1997;Zeithaml et al., 1988). There is a rich body of literature documenting service
quality’s important implication on customer satisfaction and beyond. Zeithaml et al.
(1988) suggested a number of strategies for companies to improve service quality, by
better understanding customer needs, effectively designing and implementing service
programs and managing communications to customers. Service quality is most
frequently measured using the SERVQUAL instrument (Parasuraman et al., 1988). This
scale has multiple dimensions including tangibles, reliability, responsiveness, empathy
and assurance.
Service quality can be been shown to be an excellent source for competitive
advantage in various settings. For example, in retailing, Kiker and Kiker (2008) reported
that by providing superior customer service and overall quality, small independent
stores were able to compete with larger corporate stores. In the nancial service setting,
Eisingerich and Bell (2008) found that by improving communications with customers,
companies can enhanced customers’ service quality perception, obtain customer
trust and effectively differentiating themselves from competitors. Furthermore, a
meta-analysis showed that service quality has a large effect on customer satisfaction,
attitudinal loyalty and purchase intention (Carrillat et al., 2009).
The community pharmacy industry has been faced with ever-decreasing
reimbursement for healthcare service (acknowledging that progress is being made in
certain locations), increased scal restraint and shortage of critical professionals
(Ruffell, 2012). A need exists for nding creative solutions to improve efciency and
effectiveness in the delivery of healthcare services (Arthur, 2005). Leatherman et al.
(2003) recommended better alignment of nancial incentives for superior quality
healthcare. They argued that government policies and reimbursement plans should
support changes that improve service quality and benet societal stakeholders.
However, service quality and customer trust do not necessarily follow a simple linear
relationship. Firms need to actively engage in communicating with the customers and
educating them about the service knowledge to strengthen customer trust (Eisingerich
and Bell, 2008).
Because research in pharmacy service quality remains limited, ndings in the
existing literature is somewhat mixed. Some found no difference in service quality
among pharmacies that provide a wide range of different services (Tipton, 1999); others
found independent pharmacies to have lower rates of dispensing errors and higher
levels of customer satisfaction in comparison to chain pharmacies (Bond and Raehl,
2001;Briesacher and Corey, 1997;Kalsekar et al., 2007). Based on evidence from other
industries, the positive relationship between having superior service quality and
enhanced customer trust is clear. Hence, we hypothesize that this relationship would
also exist in the context of community pharmacy industry.
H1. Service quality has a positive impact on customer trust of community
pharmacies.
Conveying sincerity
Sincerity is the quality of being honest and genuine, and free from duplicity. At a
personal level, sincerity has been identied as a key success factor for salespeople
(Woodbury, 1984). In the context of being one of brand personality dimensions, sincerity
means down-to-earth, honest, wholesome and cheerful (Aaker, 1997). Brand personality
is the human associations made with a brand (Aaker, 1997;Davies, 2008;Keller, 1998);
229
Quality alone is
not enough to be
trustworthy
it can be extended to reect the values and actions of the corporation that produces the
brand (Keller and Richey, 2006). The perceived corporate brand personality can provide
diagnostics which may be used to guide re-branding, positioning and other marketing
strategies (Smith et al., 2006).
The relationship between consumer-perceived corporate brand personality and
consumer attitude and loyalty has been widely documented in the literature. A favorable
corporate brand personality has been cited as one of the most critical and consistent
predictors of both attitudinal and behavioral loyalty to that brand (Anisimova,
2007). Preserving and reinforcing the essence of brand personality can enhance the
long-term viability of a brand’s equity (Van Rekom et al., 2006). Within a
competitive environment, retail branding has been identied as an effective tool for
independent pharmacists and pharmacies to improve their competitive positions
(Schmidt and Pioch, 2005).
Several researchers have made case for developing context-specic measures of
perceived sincerity (Arora and Stoner 2009). For example, Braunstein and Ross (2010)
developed a brand personality typology that is specic to sports, including a sincere
sport brand. To the best of our knowledge, there is no pharmacy-specic brand
personality scales. Aaker’s (1997) original scale remains one of the most widely used
measurement tool in a diverse industry context including hotels (Lee and Back, 2010),
toys and video games (Lin, 2010), fast food (Sophonsiri and Polyorat, 2009), and country
of origin (Purkayastha, 2009). Aaker’s (1997) brand personality scale included 42 items
over ve dimensions, including sincerity, excitement, competence, sophistication and
ruggedness and described as follows:
(1) sincere brand is perceived as honest and down-to-earth;
(2) excitement refers to being daring and spirited;
(3) a brand is perceived as competent when it is reliable and intelligent;
(4) sophisticated brands are charming and upper-class; and
(5) rugged brands are tough and outdoorsy.
A prior study demonstrated that the different dimensions of brand personality do not
work in unison and only the sincerity dimension is the most relevant and predictive in
building customer trust in the context of community pharmacy (Perepelkin and Zhang,
2011). For this reason, we retained only the sincerity dimension for this study.
Several prior studies have reported that the sincerity dimension of brand personality
has the strongest inuence on brand trust compared to other brand personality
dimensions (Folse et al., 2012;Sung and Kim, 2010). Sincere brands are found to be
associated with family values and high morals (Maehle et al., 2011). Researchers have
explored the consumers’ perceptions of corporate brand personalities of various types of
pharmacies and found that personality differences exist among national chain
pharmacies and independent community pharmacies; consumers appear to identify
sincerity as the most relevant and important corporate personality in the pharmacy
industry context, and trust those pharmacies who are perceived to be sincere (Perepelkin
and Zhang, 2011). Other brand personality dimensions, such as excitement and
sophistication, were found to be related to brand affect, but not brand trust (Sung and
Kim, 2010).
IJPHM
8,2
230
H2. Perceived sincerity has a positive impact on customer trust of community
pharmacies.
Sincerity mediates the relationship between service quality and trust
The positive relationship between service quality and customer trust has been well
argued and documented in the literature; however, quality alone may not be enough.
Customers do not choose a service provider simply on quality but also on integrity
(Lynch, 1992). Perepelkin and Zhang (2011) demonstrated that, in the community
pharmacy context, perceived sincerity is a strong predictor of customer trust. Yet
sincerity cannot be articially manufactured; it stems from genuine service quality. In
other words, having good service quality is the starting point, not the end point.
The relationship between service quality and customer trust can be subject to the
inuence of a third variable. One type of inuence from a third variable is moderation.
For example, a prior study showed that by educating customers, a company can
inuence not only the relationship between service quality and trust but also the relative
importance among various elements of service quality (Eisingerich and Bell, 2008).
The relationship between service quality and customer trust may also be mediated
by a third variable. As Oliver (1997) conceptualized and Harris and Goode (2004)
empirically demonstrated, the formation of customer loyalty goes through a chain of
events, from cognitive, affective, to conative and then action. Recognition of service
quality would be the customer’s cognitive process of evaluating the service provided.
The perception of the service provider as being sincere would be the internalized
affective reaction to the service provider. Trust would be the conative mind-set, a
positive tendency, toward the ultimate re-purchase action. Other scholars have also
modeled internalized affective perceptions, such as satisfaction, as the mediating
construct between service quality and loyalty (Xu et al., 2006).
Furthermore, customers would go through an attitude formation process after each
service encounter episode, and over the long-term, accumulate episodic value and
develop into relationship value (Dorai and Varshney, 2012). It is the customers’
perceptions of the relationship value with the service provider that ultimately leads to
loyalty behaviour.
There is a potential virtuous feedback loop here as well. Agreeable corporate personality
would contribute to employee satisfaction and loyalty (Davies, 2008); employee satisfaction
and loyalty are also related to the quality of the service they provide.
H3. Perceived sincerity mediates the relationship between service quality and
customer trust.
Research methods
Procedure
In this study, we used the consumer intercept method to survey customer’s experiences
with, attitudes toward, and knowledge about, various retail pharmacies. Prior studies
assessing service quality and trust have commonly used surveys and interviews to
investigate consumer perceptions. We used consumer intercept in this study in lieu of
other more frequently used methods, such as telephone survey or mail survey because
as the customer leaves the store, their memory of the service encounter is still fresh and
less biased due to selective reconstruction of memory. With pharmacy management
consent, we randomly contacted pharmacy customers at three different pharmacies in a
231
Quality alone is
not enough to be
trustworthy
medium-sized western Canadian city as they were leaving the store after purchase. We
self-identied as university researchers with no commercial afliation with the stores, and
invited the customers who were aged !18 years to participate in our study. After
completing the questionnaire, each participant was provided with a $5.00 (CDN) gift
certicate to a national coffee shop chain. These three pharmacies include one in a
cooperative-owned grocery store pharmacy (Co-op), one pharmacy store belonged to a
national chain (Chain) and one pharmacy located in a western Canadian chain grocery store
(Grocery). All three pharmacies catered to retail customers, hence are all community
pharmacies. We received completed 50 questionnaires in each of the stores, with a total of
150 responses. The sample was slightly biased in gender, with 64 per cent of the participants
being female. Participants’ age varied between 18 to !80 years, with a medium age of
approximately 50 years. Family income was also widely distributed, from "$20,000 group
to !$100,000 group, with an average family income estimated at approximately $80,000. On
average, participants visit the pharmacy approximately once a month.
Using chi-square analysis, we compared the age, gender and income of respondents
from each pharmacy. The results indicated that the respondent groups from each
pharmacy did not differ in income. However, those that frequented the Chain store tend
to be younger than those that frequented the Co-op and Grocery stores; more male
participants frequented the Co-op store than the others.
We used structural equation modeling (SEM) with Amos 20 to analyze the data. The
power of a SEM test is dependent upon the number of specied parameters and sample
size. MacCallum and Austin (2000) surveyed !500 published papers that used SEM and
found about 20 per cent of the papers had "100 cases in the data. Kline (2005) suggests
that 200 cases would be considered as “large”. MacCallum et al. (1996) provided a rough
table for estimating statistical power in SEM with degrees of freedom (df) and root mean
square error of approximation (RMSEA). A full SEM with both measurement models
and structural relationships between multi-dimensional latent variables would have
about 100 df. A sample size of 132 would yield a statistical power equal to 0.80 for a
close-t model (RMSEA #0.08). Our sample size of 150 supports a reasonable power of
0.80. In the specication of SEM models, we followed the two-step approach as
recommended by Anderson and Gerbing (1988).
Measurement
Service quality. We measured service quality using a slightly modied version of
SERVQUAL (Parasuraman et al., 1988). The 22 items in the scale are distributed among
the ve dimensions of service quality:
(1) tangibility;
(2) reliability;
(3) responsiveness;
(4) assurance; and
(5) empathy.
Participants were asked to rate the pharmacy they have just visited on a 5-point Likert
scale to indicate their agreement with the item description, such as “XXX pharmacy
provides their services at the time they promised to do so”, from “1” being “strongly
disagree” to “5” being “strongly agree”. The four items measuring the tangibility
IJPHM
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232
dimension demonstrated good scale reliability, with Cronbach’s
!
#0.805. Similarly,
items all loaded well on the intended dimensions – reliability (
!
#0.897), responsiveness
(
!
#0.728), assurance (
!
#0.880) and empathy (
!
#0.883). The ve dimensions are
strongly and signicantly correlated with each other. Overall, the 22 items would
exhibit excellent scale reliability with Cronbach’s
!
#0.950 if the construct were treated as
unidimensional. In the subsequent SEM analyses, service quality was specied as a
second-order latent variable. A conrmatory factor analysis indicated that every dimension
loaded signicantly on the second-order latent variable, with factor loadings !0.88,
demonstrating good convergent validity (Anderson and Gerbing, 1988).
Perceived sincerity. The sincerity dimension of Aaker’s (1997) brand personality scale
was used to measure customers’ perceptions of the pharmacy’s sincerity. Respondents
were asked to rate the pharmacy that they has just visited on a 5-point Likert scale to
indicate their degree of agreement with each item description, such as “XXX pharmacy
is down-to-earth”, from 1 #strongly disagree, to 5 #strongly agree. A scale reliability
analysis revealed that the measurement scale performed well with Cronbach’s
!
values
being 0.95. In the subsequent SEM analyses, perceived sincerity was specied as a
rst-order latent variable with 11 indicators. A conrmatory factor analysis suggested
that all indicators loaded on the latent variable signicantly and positively, with all
factor loadings !0.5 showing good convergent construct validity.
Customer trust. Hess’ (1995) perceived brand trust scale was modied to measure
customers’ perceived trust toward the pharmacy that they had just visited. This scale
includes 11 items over three dimensions (altruism, honesty and reliability). Respondents
were asked to rate the pharmacy that they had frequently visited on a 5-point Likert
scale to indicate their degree of agreement with each item description, such as “XXX
pharmacy will do whatever it takes to make me happy”, from 1 #strongly disagree to
5#strongly agree. The respective subscales that measure altruism,honesty and
reliability dimensions demonstrated acceptable-to-good-scale reliability, with
Cronbach’s
!
#0.86, 0.67 and 0.85, respectively. In the subsequent SEM analysis,
customer trust was specied as a second-order latent variable. A conrmatory factor
analysis showed signicant and positive loading of the three expected dimensions, with
factor loading !0.75 showing good convergent validity.
The discriminant validity of the three constructs in this study was tested by
calculating the condence interval ($two standard errors) around the correlation
coefcient estimates of each pair of the constructs (Anderson and Gerbing, 1988). None
of the condence intervals contains the value of 1, demonstrating sufcient discriminant
validity among major variables (see Table I).
Table I
Condence interval of
correlations among major
constructs
Construct pair
Standardized
correlation
coefcient
Standard
error
Condence interval
Lower bound Upper bound
Service quality and customer trust 0.29* 0.05 0.19 0.39
Perceived sincerity and customer trust 0.53* 0.02 0.49 0.57
Service quality and perceived sincerity 0.39* 0.19 0.01 0.77
Note: *p"0.01
233
Quality alone is
not enough to be
trustworthy
Testing hypothesized relationships using SEM
Model #1: Service quality and customer trust. As Parasuraman et al. (1988) originally
specied, the 22 measurement items of service quality were organized into ve
dimensions – tangibility, reliability, responsiveness, assurance and empathy. Service
quality was specied as a second-order latent variable. Similarly, we specied overall
customer trust as a second-order latent variable with three dimensions (altruism,
honesty and reliability). We expect overall service quality to have a direct and positive
inuence on customer trust (Figure 1).
The result suggested that our model t well with the data. Although there is no
universally agreed upon standard for assessing the quality of SEMs, the conventional
approach has been to examine a basket of criteria against a set of rule-of-thumb
acceptable levels. For example, the model is expected to exhibit a reasonably small error
in relation to its complexity (
"
2
/df "2), RMSEA should be low ("0.08), Tucker – Lewis
Index (TLI, also known as non-normed t index) and normed t index should be high
(NFI !0.90) and comparative t index should be high (CFI !0.90) (Bentler, 1990;
Joreskog, 1978;Kline, 2005).
With this group of criteria in mind, our model #1 exhibited a reasonable good t
(chi-square #896, df #486,
"
2
/df #1.84, NFI #0.78, CFI #0.88, TLI #0.86 and
RMSEA #0.075). The relationship between service quality and customer trust was
positive and signicant (standardized regression weight
#
#%0.36, p"0.001, R
2
#
0.127). Service quality explains about 12.7 per cent of the variance in customer trust. H1
was supported.
Model #2: Perceived sincerity and customer trust. Next, we added perceived sincerity
to formulate our second model, with perceived sincerity to have direct inuence on
customer trust. In this model, sincerity was specied as a latent variable with 11
measured indicators (Figure 2).
Model 2 also exhibited a reasonable good t (chi-square #1688, df #892,
"
2
/df #1.89,
NFI #0.69, CFI #0.82, TLI #0.81 and RMSEA #0.077). The relationship between
Figure 1.
Service quality and
customer trust
Figure 2.
Sincerity and customer
trust
IJPHM
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234
sincerity and customer trust was positive and signicant (
#
#0.63, p"0.001, R
2
#
0.400). Service quality and sincerity jointly explains about 40 per cent of the variance in
customer trust. H2 was supported.
What is also very interesting is that when the construct of perceived sincerity was
introduced into the model, the relationship between service quality and customer trust
became insignicant (
#
#0.08, p#0.271). One way to interpret this situation is that
when considered individually, both service quality and perceived sincerity are
signicant predictors for customer trust; when considered together, sincerity is perhaps
a stronger and more direct predictor for customer trust. According to Baron and Kenny
(1986), this is a good indication of a mediation relationship.
Model #3: Sincerity as mediator. Baron and Kenny (1986) suggest testing a series of
regression models to detect mediation relationship. This type of mediation relationship
is relatively easy to specify in SEM. Our third model species sincerity as the mediator
between service quality and customer trust (Figure 3).
This mediation model exhibited a good t (chi-square #1655, df #891,
"
2
/df #1.86,
NFI #0.67, CFI #0.83, TLI #0.81 and RMSEA #0.076), with some small
improvements of t over Model #2. As expected, the relationship between service
quality and sincerity was positive and signicant (
#
#0.48, p"0.001); the relationship
between sincerity and customer trust was also positive and signicant (
#
#0.63, p"
0.001, R
2
#0.429). The direct relationship between service quality and customer trust is
not signicant (
#
#0.04, p#0.621). This indicates that the inuence of service quality
on customer trust is completely mediated via the perception of sincerity. H3 was
supported. About 43 per cent of the variance in customer trust was explained in this
model.
Discussion, limitations and future research
Service quality has been cited as an important aspect of pharmacy management.
However, the pharmaceutical products that pharmacies distribute are largely
standardized. Accordingly, it is very difcult for community pharmacies to differentiate
by the products they offer. In an industry where large market share is dominated by
chain stores, services are often standardized. Furthermore, recent events in the
Canadian pharmacy landscape prove that ownership of pharmacies is becoming
increasingly concentrated within a few major retailers; evidence is shown in the June
Figure 3.
Sincerity as the mediator
235
Quality alone is
not enough to be
trustworthy
2013 purchase of Safeway Canada (including 199 in-store pharmacies) by Sobeys, and in
July 2013 Loblaws (the largest food retailer in Canada) announced it would purchase the
largest retail pharmacy chain in Canada, Shoppers Drug Mart (SDM); the Loblaws –
SDM deal resulted in !25 per cent of the community pharmacies in Canada being
controlled by one organization.
It is difcult for a community pharmacy to gain competitive advantage based on the
objective aspects of service quality. Nevertheless, customers feel differently when they
visit different pharmacies. This is because going to a pharmacy is a highly personal and
emotional affair. We believe the customers’ trust of the pharmacy has more to do with
the customer’s perception of the character of the pharmacists than the actual product
they dispense. Paradoxically, personality characteristics have not been studied
extensively in the context of pharmacy management.
Perepelkin and Zhang (2011) explored the concept of brand personality in the
pharmacy context. They found, for example, customers perceive various pharmacies to
have different personality – some were more competent, others were more exciting, or
sophisticated, etc. What is more important, they found that pharmacy customers would
trust the store that they perceived as more sincere. In this paper, we hypothesized that it
is this perception of sincerity that directly links to customer trust. We are not saying that
service quality is unimportant; it is. But service quality alone is not enough. Community
pharmacies must do more to engage the customers personally and convey sincerity in
the person-to-person relationship. Ultimately, the intended impact of our research is to
better serve the community, particularly those customers who need pharmacy services,
whether they realize it or not. With this end goal in mind, we believe our ndings from
this study have implications for all pharmacies.
Our research has limitations. One of the limitations is the small sample size due to
research budget constraint. Another limitation is that the sample derived from
consumer intercept would be considered as a convenience sample. Accordingly, the
representativeness of the sample and the generalizability of our ndings should be
taken into consideration. We anticipate future research on a larger scale would produce
more insightful results.
We accept the trade-off between specicity and generalizability. We chose to
examine three specic pharmacies in one single city in Western Canada. Idiosyncratic
factors may put additional limitations on our ndings. For example, the particular
grocery store pharmacy in our study had recently undergone a major renovation and
upgrade. That may have skewed the customers’ enthusiasm. Moreover, each pharmacy
is unique. The competitive strategy or performance by any pharmacy in our study
cannot and should not be interpreted as applicable to all community pharmacies, even
within the same larger organization. We hope that because our study is specic, our
ndings can provide particularly useful insights and practical recommendations to the
pharmacies in our study.
References
Aaker, J.L. (1997), “Dimensions of brand personality”, Journal of Marketing Research, Vol. 34
No. 3, pp. 347-356.
Anderson, J.C. and Gerbing, D.W. (1988), “Structural equation modeling in practice: a review and
recommended two-step approach”, Psychological Bulletin, Vol. 103 No. 3, pp. 411-423.
IJPHM
8,2
236
Anisimova, T.A. (2007), “The effects of corporate brand attributes on attitudinal and behavioural
consumer loyalty”, The Journal of Consumer Marketing, Vol. 24 No. 7, pp. 395-405.
Arora, R. and Stoner, C. (2009), “A mixed method approach to understanding brand personality”,
The Journal of Product and Brand Management, Vol. 18 No. 4, pp. 272-283.
Arthur, J. (2005), “Rx for improvement: a case study in an outpatient pharmacy”, The Journal for
Quality and Participation, Vol. 28 No. 1, pp. 36-40.
Baron, R.M. and Kenny, D.A. (1986), “The moderator-mediator variable distinction in social
psychological research: conceptual, strategic, and statistical considerations”, Journal of
Personality and Social Psychology, Vol. 51 No. 6, pp. 1173-1182.
Bentler, P.M. (1990), “Comparative t indexes in structural models”, Psychological Bulletin,
Vol. 107 No. 2, pp. 238-251.
Bond, C. and Raehl, C. (2001), “Pharmacists’ assessment of dispensing errors: risk factors, practice sites,
professional functions, and satisfaction”, Pharmacotherapy,Vol.21No.5,pp.614-626.
Borkowski, N. and Gordon, J. (2005), “Entrepreneurial organizations: the driving force for
improving quality in the healthcare industry”, Journal of Health and Human Services
Administration, Vol. 28 Nos 3/4, pp. 531-549.
Braunstein, J. and Ross, S. (2010), “Brand personality in sport: dimension analysis and general
scale development”, Sport Marketing Quarterly, Vol. 19 No. 1, pp. 8-16.
Briesacher, B. and Corey, R. (1997), “Patient satisfaction with pharmaceutical services at
independent and chain pharmacies”, American Journal of Health-System Pharmacy, Vol. 54
No. 5, pp. 531-536.
Bush, J., Langley, C. and Wilson, K. (2009), “The corporatization of community pharmacy:
implications for service provision, the public health function, and pharmacy’s claims to
professional status in the United Kingdom”, Research in Social and Administrative
Pharmacy, Vol. 5 No. 4, pp. 305-318.
Carrillat, F.A., Jaramillo, F. and Mulki, J.P. (2009), “Examining the impact of service quality: a
meta-analysis of empirical evidence”, Journal of Marketing Theory and Practice, Vol. 17
No. 2, pp. 95-110.
Cho, J.E. and Hu, H. (2009), “The effect of service quality on trust and commitment varying across
generations”, International Journal of Consumer Studies, Vol. 33 No. 4, pp. 468-476.
CIHI (2012), Drug Expenditures in Canada 1985 to 2011, Canadian Institute for Health
Information, Ottawa, ON.
Cronin, J.J. and Taylor, S.A. (1992), “Measuring service quality: a reexamination and extension”,
Journal of Marketing, Vol. 56 No. 3, pp. 55-68.
Davies, G. (2008), “Employer branding and its inuence on managers”, European Journal of
Marketing, Vol. 42 Nos 5/6, pp. 667-681.
Deming, W.E. (1986), Out of the Crisis, Massachusetts Institute of Technology Centre for
Advanced Engineering Study, Cambridge, MA.
Dobson, R. and Perepelkin, J. (2011), “Pharmacy ownership in Canada: implications for the
authority and autonomy of community pharmacy managers”, Research in Social and
Administrative Pharmacy, Vol. 7 No. 4, pp. 347-358.
Dominelli, A.C., Marciniak, M.W. and Jarvis, J. (2005), “Service preferences differences between
community pharmacy and supermarket pharmacy patrons”, Health Marketing Quarterly,
Vol. 23 No. 1, pp. 57-79.
Dorai, S. and Varshney, S. (2012), “A multistage behavioural and temporal analysis of CPV in
RM”, Journal of Business and Industrial Marketing, Vol. 27 No. 5, pp. 403-411.
237
Quality alone is
not enough to be
trustworthy
Doucette, W., Nevins, J., Gaither, C., Kreling, D., Mott, D., Pedersen, C. and Schommer, J. (2012),
“Organizational factors inuencing pharmacy practice change”, Research in Social and
Administrative Pharmacy, Vol. 8 No. 4, pp. 274-284.
Eisingerich, A.B. and Bell, S.J. (2008), “Perceived service quality and customer trust”, Journal of
Service Research, Vol. 10 No. 3, pp. 256-268.
Folse, J.A.G., Netemeyer, R.G. and Burton, S. (2012), “Spokescharacters: how the personality traits
of sincerity, excitement, and competence help to build equity”, Journal of Advertising,
Vol. 41 No. 1, pp. 17-32.
Gebauer, H. (2008), “Robust management policies for positioning pharmacies as healthcare service
providers”, European Management Journal, Vol. 26 No. 3, pp. 175-187.
Gotlieb, J.B., Grewal, D. and Brown, S.W. (1994), “Customer satisfaction and perceived quality:
complementary or divergent construct”, Journal of Applied Psychology, Vol. 79 No. 6,
pp. 875-885.
Gurney, M.K. (2003), A Study of Community Pharmacy Practice Sites: Time, Management and
Patient Care Activities. (PhD. 3113727), The University of Wisconsin – Madison, WI,
available at: http://proquest.umi.com/pqdweb?did#765157421&Fmt#7&clientId#
12306&RQT#309&VName#PQD (accessed 8 September 2009).
Harris, L.C. and Goode, M.M.H. (2004), “The four levels of loyalty and the pivotal role of trust: a
study of online service dynamics”, Journal of Retailing, Vol. 80 No. 2, pp. 139-158.
Hess, J.S. (1995), “Construction and assessment of a scale to measure consumer trust”, in
Stern, B.B. and Zinkhan, G.M. (Eds), AMA Educator’s Conference, Enhancing
Knowledge Development in Marketing, Vol. 6,American Marketing Association,
Chicago, IL, pp. 20-26.
Jones, T.O. and Sasser, W.E.J. (1995), “Why satised customers defect”, Harvard Business Review,
Vol. 73 No. 6, pp. 408-418.
Joreskog, K.G. (1978), “Structural analysis of covariance and correlation metrics”, Psychometrika,
Vol. 43 No. 4, pp. 443-477.
Kalsekar, I., Sheehan, C. and Peak, A. (2007), “Utilization patterns and medication adherence
in patients with type 2 diabetes: variations based on type of pharmacy (chain vs
independent)”, Research in Social and Administrative Pharmacy, Vol. 3 No. 4,
pp. 378-391.
Kantsperger, R. and Kunz, W.H. (2010), “Consumer trust in service companies: a multiple
mediating analysis”, Manageing Service Quality, Vol. 20 No. 1, pp. 4-25.
Kassim, N. and Abdullah, N.A. (2009), “The effect of perceived service quality dimensions on
customer satisfaction, trust, and loyalty in e-commerce settings: a cross cultural analysis”,
Asia Pacic Journal of Marketing and Logistics, Vol. 22 No. 3, pp. 351-371.
Keller, K.L. (1998), Strategic Brand Management: Building, Measuring, and Managing Brand
Equity, Prentice-Hall, Englewood Cliffs, NJ.
Keller, K.L. and Richey, K. (2006), “The importance of corporate brand personality traits to a
successful 21st century business”, Journal of Brand Management, Vol. 14 Nos 1/2,
pp. 74-81.
Kiker, D.S. and Kiker, M. (2008), “Lou’s Thrifty Way Market: an examination of sources of
competitive advantage in the grocery store industry”, The Business Review, Cambridge,
Vol. 11 No. 2, pp. 71-75.
Kim, D.J., Ferrin, D.L. and Rao, H.R. (2009), “Trust and satisfaction, two stepping stones for
successful E-commerce relationships: a longitudinal exploration”, Information Systems
Research, Vol. 20 No. 2, pp. 237-257.
IJPHM
8,2
238
Kline, R.B. (2005), Principles and Practices of Structural Equation Modeling, 2nd edn., Gulford
Publications, New York, NY.
Kohli, A.K. and Jaworski, B.J. (1990). “Market orientation: the construct, research propositions,
and managerial implications”, Journal of Marketing, Vol. 54 No. 2, pp. 1-18.
Leatherman, S., Berwick, D., Iles, D., Lewin, L.S. Davidoff, F., Nolan, T. and Bisognano, T. (2003),
“The business case for quality: case studies and an analysis”, Health Affairs, Vol. 22 No. 2,
pp. 17-30.
Lee, J.S. and Back, K.J (2010), “Examining antecedents and consequences of brand personality in
the upper-upscale business hotel segment”, Journal of Travel and Tourism Marketing,
Vol. 27 No. 2, pp. 132-143.
Lin, L.Y. (2010), “The relationship of consumer personality trait, brand personality and brand
loyalty: a empirical study of toys and video games buyers”, The Journal of Product and
Brand Management, Vol. 19 No. 1, pp. 4-17.
Lynch, J. (1992), “Hear it from the heart”, Managing Service Quality, Vol. 3 No. 1, pp. 379-383.
MacCallum, R.C. and Austin, J.T. (2000), “Applications of structural equation modeling in
psychological research”, Annual Reviews of Psychology, Vol. 51 No. 1, pp. 201-236.
MacCallum, R.C., Browne, M.W. and Sugawara, H.M. (1996), “Power analysis and determination
of sample size for covariance structure modeling”, Psychological Methods, Vol. 1 No. 2,
pp. 130-149.
Maehle, N., Otnes, C. and Supphellen, M. (2011), “Consumers’ perceptions of the dimensions of
brand personality”, Journal of Consumer Behaviour, Vol. 10 No. 5, pp. 290-303.
Mansell, K. and Perepelkin, J. (2011), “Patient awareness of specialized diabetes services provided
in community pharmacies”, Research in Social and Administrative Pharmacy, Vol. 7 No. 4,
pp. 396-405.
Meijboom, F.L.B., Visak, T. and Brom, F.W.A. (2006), “From trust to trustworthiness: why
information is not enough in the food sector”, Journal of Agricultural and Environmental
Ethics, Vol. 19 No. 5, pp. 427-442.
Morgan, R.M. and Hunt, S.D. (1994), “The commitment-trust theory of relationship marketing”,
Journal of Marketing, Vol. 58 No. 3, pp. 20-38.
Oliver, R.L. (1997), Satisfaction: A Behavioral Perspective on the Consumer, McGraw Hill, New
York, NY.
Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1985), “A conceptual model of service quality
and its implications for future research”, Journal of Marketing, Vol. 49 No. 3, pp. 41-50.
Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1988), “SERVQUAL: a multi-item scale for
measuring consumer perceptions of service quality”, Journal of Retailing, Vol. 64 No. 1,
pp. 12-40.
Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1994), “Reassessment of expectations as a
comparison standard in measuring service quality: implications for further research”,
Journal of Marketing, Vol. 58 No. 1, pp. 111-124.
Perepelkin, J. and Dobson, R. (2010), “Inuence of ownership type on role orientation, role afnity,
and role conict among community pharmacy managers and owners in Canada”, Research
in Social and Administrative Pharmacy, Vol. 6 No. 4, pp. 280-292.
Perepelkin, J. and Zhang, D.D. (2011), “Exploring the personality of community pharmacies”,
International Journal of Pharmaceutical and Healthcare Marketing, Vol. 5 No. 3,
pp. 175-193.
239
Quality alone is
not enough to be
trustworthy
Phillips, F.S. and Garman, A.N. (2005), “Barriers to entrepreneurship in healthcare organizations”,
Journal of Health and Human Services Administration, Vol. 28 Nos 3/4, pp. 472-484.
Purkayastha, S. (2009), “Brand personality: an empirical study of four brands in India”, IUP
Journal of Management Research, Vol. 8 No. 4, pp. 7-20.
Reichheld, F.F. (1996), The Loyalty Effect, Harvard Business School Press, Boston, MA.
Renberg, T., Lindblad, A. and Tully, M. (2006), “Exploring subjective outcomes perceived by
patients receiving a pharmaceutical care service”, Research in Social and Administrative
Pharmacy, Vol. 2 No. 2, pp. 212-231.
Resnik, D.B., Ranelli, P.L. and Resnik, S.P. (2000), “The conict between ethics and business
in community pharmacy: what about patient counseling?’”, Journal of Business Ethics,
Vol. 28 No. 2, pp. 179-186.
Rizzo, J.A. and Zeckhauser, R. (2009), “Generic script share and the price of brand-name drugs: the
role of consumer choice”, International Journal of Health Care Finance and Economics,
Vol. 9 No. 3, pp. 291-316.
Ruffell, B. (2012), State of the industry report: a national overview. Canadian Healthcare Network,
available at: www.canadianhealthcarenetwork.ca/pharmacists/news/professional/state-of-
the-industry-report-a-national-overview-17092 (accessed 11 January 2013).
San Martin, S., Gutierrez, J. and Camarero, C. (2004), “Trust as the key to relational commitment”,
Journal of Relationship Marketing, Vol. 3 No. 1, pp. 53-77.
Schmidt, R.A. and Pioch, E.A. (2005), “Community pharmacies under pressure – can branding
help?”, International Journal of Retail and Distribution Management, Vol. 33 Nos 6/7,
pp. 494-504.
Schulz, R. and Brushwood, D. (1991), “The pharmacist’s role in patient care”, Hasting’s Center
Report, Vol. 21 No. 1, pp. 12-17.
Sichtmann, C. (2007), “An analysis of antecedents and consequences of trust in a corporate brand”,
European Journal of Marketing, Vol. 41 Nos 9/10, pp. 999-1015.
Smith, A.C.T., Graetz, B.R. and Westerbeek, H.M. (2006), “Brand personality in a
membership-based organization”, International Journal of Nonprot and Voluntary Sector
Marketing, Vol. 11 No. 3, pp. 251-266.
Sophonsiri, S. and Polyorat, K. (2009), “The impact of brand personality dimensions on brand
association and brand attractiveness: the case study of KFC in Thailand”, Journal of Global
Business and Technology, Vol. 5 No. 2, pp. 51-62.
Stewart, T.A. (1997), “A satised customer isn’t enough”, Fortune, Vol. 136 No. 21, pp. 112-113.
Sung, Y. and Kim, J. (2010), “Effects of brand personality on brand trust and brand affect”,
Psychology and Marketing, Vol. 27 No. 7, pp. 639-661.
Tipton, D. (1999), “Levels of service in independent community pharmacies: a strategic group
analysis”, Health Marketing Quarterly, Vol. 16 No. 2, pp. 65-80.
Van Rekom, J., Jacobs, G., Verlegh, P.W.J. and Podner, K. (2006), “Capturing the essence of a
corporate brand personality: a Western brand in Eastern Europe”, Journal of Brand
Management, Vol. 14 Nos 1/2, pp. 114-124.
Vlachos, P.A., Tsamakos, A., Vrechopoulos, A.P. and Avramidis, P.K. (2009), “Corporate social
responsibility: attributions, loyalty, and the mediating role of trust”, Academy of Marketing
Science Journal, Vol. 37 No. 2, pp. 170-180.
White, L. and Clark, C. (2010), “Stakeholders’ views of service quality in community pharmacy: a
qualitative study”, Health Marketing Quarterly, Vol. 27 No. 1, pp. 48-65.
IJPHM
8,2
240
Woodbury, H.H. (1984), “My commitment to life insurance”, Life Association News, Vol. 79 No. 11,
p. 201.
Xu, Y., Goedegebuure, R. and van der Heijden, B. (2006), “Customer perception, customer
satisfaction, and customer loyalty within Chinese security business: towards a mediation
model for predicting customer behavior”, Journal of Relationship Marketing, Vol. 5 No. 4,
pp. 79-104.
Yang, S.-C., Hung, W.-C., Sung, K. and Farn, C.-K. (2006), “Investigating initial trust toward
e-tailers from the elaboration likelihood model perspective”, Psychology and Marketing,
Vol. 23 No. 5, pp. 429-445.
Zeithaml, V.A., Berry, L.L. and Parasuraman, A. (1988), “Communication and control processes in
the delivery of service quality”, Journal of Marketing, Vol. 52 No. 2, pp. 35-48.
Appendix 1. Measurement of constructs in this study
Quality measure – modied, based on ServQual (Parasuraman et al., 1988)
• The pharmacy has up-to-date equipment
• The pharmacy’s physical facilities are visually appealing
• The pharmacy’s employees are well dressed and appear neat
• The appearance of the physical facilities of pharmacy is in keeping with the type of services
provided
• When a pharmacy promises to do something by a certain time, it does so
• When you have problems, the pharmacy is sympathetic and reassuring
• The pharmacy is dependable
• The pharmacy provides its services at the time it promises to do so
• The pharmacy keeps it records accurately
• The pharmacy does not tell customers exactly when services will be performed
• You do not receive prompt service from the pharmacy’s employees
• Employees at the pharmacy are not always willing to help customers
• Employees at the pharmacy are too busy to respond to customer requests promptly
• You can trust the employees at the pharmacy
• You feel safe in your transactions with the pharmacy’s employees
• Employees at the pharmacy are polite
• Employees get adequate support from the pharmacy to do their jobs well
• The pharmacy does not give you individual attention
• Employees at the pharmacy do not give you personal attention
• Employees at the pharmacy’s do not know what your needs are
• The pharmacy does not have your best interests at heart
• The pharmacy does not have operating hours convenient to all their customers
Trust – modied, based on Hess’ (1995) customer trust
• There are no limits to how far the pharmacy staff will go to solve a problem I might have
• The pharmacy staff is genuinely committed to my satisfaction
• The pharmacy staff will do whatever it takes to make me happy
• When I see the pharmacy advertisement, I believe the information in it is accurate
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Quality alone is
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trustworthy
• Most of what the pharmacy staff says about medications is true
• I think some of the pharmacy’s claims about its pharmacy services are puffed up to make
them seem better than they really are
• If the pharmacy makes a claim or promise about its products, it’s probably true
• My pharmacist is very reliable
• I feel I know what to expect from my pharmacist
• If I had another prescription lled at the pharmacy I feel like I would know what to expect
Perceived sincerity – modied, based on perceived sincerity dimension in Aaker’s (1997) brand
personality
• Down-to-earth
• Family-oriented
• Small-town feel
• Honest
• Sincere
• Real
• Wholesome
• Original
• Cheerful
• Sentimental
• Friendly
Corresponding author
Jason Perepelkin can be contacted at: jason.perepelkin@usask.ca
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