PERCEIVED SERVICE QUALITY, PERCEIVED VALUE AND HEALTH LITERACY AS PREDICTORS OF SATISFACTION, TRUST AND LOYALTY AMONG PATIENTS WITH CHRONIC DISEASES IN PRIMARY HEALTHCARE INSTITUTIONS IN MAOMING, CHINA: A CROSS-SECTIONAL STUDY

Abstract

Background: Primary healthcare institutions are expected to provide accessible, continuous and person-centred care for patients with chronic diseases. However, patient-reported determinants of satisfaction, trust and loyalty in primary healthcare remain insufficiently understood, particularly in non-metropolitan Chinese settings. Objective: This study assessed patient perceived value (PPV), perceived service quality (PSQ), patient health literacy (PHL), patient satisfaction (PS), patient trust (PT) and patient loyalty (PL), and examined whether PPV, PSQ and PHL predicted PS, PT and PL among chronic disease patients in Maoming, China. Materials and Methods: A cross-sectional survey was conducted among 600 outpatients with chronic diseases from 10 primary healthcare institutions, including six township health centres and four community health service centres. Structured questionnaires measured PPV, PSQ, PHL, PS, PT and PL. Descriptive statistics, group comparisons, simple linear regression and multivariable linear regression were performed using SPSS. Results: No significant gender differences were observed. Significant age-group differences were observed for all six variables. Mean scores for PPV, PSQ, PHL, PS, PT and PL were 3.307 ± 0.495, 3.451 ± 0.405, 1.691 ± 0.515, 3.410 ± 0.688, 3.474 ± 0.847 and 3.398 ± 0.618, respectively. In simple linear regression, compared with patients aged 18–44 years, those aged 45–59 years reported lower PS (t = −2.734, p = 0.006), whereas those aged ≥60 years reported lower PS, PT and PL (all p < 0.001). PPV, PSQ and PHL remained independently and positively associated with all three outcomes (all p < 0.001). In the final multivariable models, higher PPV, PSQ and PHL scores were independently and positively associated with higher PS, PT and PL scores (all p < 0.001). Conclusion: Satisfaction, trust and loyalty were mainly associated with modifiable patient-facing factors. Improving perceived service quality, perceived value and health-literate communication may strengthen these relational outcomes and support sustained primary-care use.