Effect of clients’ Perceived Relational Benefits on

Brand Advocacy: Explaining the Mediating Role of

Satisfaction and Commitment
Introduction

To compete in such an interactive market, the marketing practitioners are agreed on a

view point to do more than simple marketing strategies, which are not considered to be enough
to achieve the competitive advantage. That is why, relationship marketing strategies has now
become an important tool for the organization and service firms to build and maintain the strong
relationship with their customers. The basic rule of relationship marketing is the creation and
maintenance of the long-term and strong relationship with the customers through various
relational benefits (Reynolds & Beatty, 1999). Satisfied customers provide financial resources as
well as create positive brand image and perform different Relationship marketing strategies
which are designed from customers’ point of view help the service providers that how to keep
the customers satisfied and committed, which finally convert them into brand advocates. In the
field of branding, human branding is getting the attention of the researchers. A reputable
personality playing the role of subject of marketing communication efforts may be referred as a
human brand.

The physician service sector is becoming one of the most important sector in the service
industry of the world. This sector provides the services to both inpatients and outpatients.
Physician service sector influences the world economy and its revenue was estimated to be more
than $26 million in To achieve the competitive advantage this sector is forced to do the best for
clients’ satisfaction and to make them committed clients. That is why, relationship marketing is
playing its role in satisfying the customers in all the services sectors

Keeping in mind the significance of the relationship marketing in the present era, it is
required to investigate and understand that how relationship marketing strategies are
implemented and how these take the effect, e.g. building and maintaining long-term relationship

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and brand advocacy. Therefore, this study is conducted in order to examine a parallel mediation
model in the field of relationship marketing, i.e; perceived relational benefits (confidence, social
and special treatment benefits) and relationship factors (satisfaction and commitment), based on
reviewing the literature and theories about perceived relational benefits, relationship factors and
brand advocacy.

1. 1 Problem Statement

Considering the fierce competition in the market, a lot of marketing strategies are planned
and implemented by the service providers. However, different marketing activities are adopted to
influence the customers like telemarketing, TV/radio advertisement, doorstep selling, direct mail,
and internet but empirical evidences prove that when the customers are not satisfied with quality
of service or product, they tend towards the competitors.

Relational benefits are found very important in order to satisfy the customers, enable
them to be committed with relationship and creating brand advocates. Therefore, knowing the
target consumers, in order to build and maintain the good relationship with them, so that they
become the brand advocates is an important problem. The challenge faced by the service
providers is how to attract the potential customers by focusing on creation of long-term
relationship with customers, make customers satisfied and committed, and creating brand
advocates, through relational benefits.

1. 2 Research Questions

This study is focusing on the following research questions. These questions have grabbed
the attentions of marketing practitioners and scholars.

1. Why often people give passionate and strong recommendations about a service provider
(Physician) to their colleagues, family members, friends and acquaintances?

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 2. What are the reasons of being brand advocates of the service provider (Physician)?

1. 3 Research Objectives

This current study aimed on the following research objectives:

1. To find the drivers of physicians’ brand advocacy from relationship marketing point of
view.

2. To test a conceptual parallel mediation model, which shows that “clients’ satisfaction”
and “clients’ commitment to relationship with service provider” are mediating the
relation between clients’ perceived relational benefits and physicians’ brand advocacy?

1. 4 Significance of Research

Significance of the present study can be assessed from the following points:

1. Present study is the first empirical study to check the parallel mediating role of
commitment and satisfaction between the relational benefits and brand advocacy.

2. No study found which relates the relational benefits to brand advocacy through the
satisfaction and commitment, in the context of Pakistan.

Literature Review

2.1. Customers’ Perceived Relational Benefits

A service firm in 1990s the researchers try to conduct a comprehensive research to

understand that why Even though there is harmony in arguments that the long-term relationship
between service provider and customers required that it must be perceived by both the parties

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and it must be beneficial to both of them relationship from customers’ point of view has been
neglected on a large scale. From supplier perspective, relationship may be defined as, “any to
define the relationship from customers’ point of view is more important. Therefore
“relationship” term can be used on the fulfilment of the following two conditions:

 The customers come again and again to purchase the products from the same
organization or acquire services from the same service provider (repeat purchase
behavior indicating the behavioral element of relationship); and

 Customers’ repeat purchase intentions must be grounded on some logical thoughts (it
indicates the intentional element of relationship).

Customers deliberately repurchase from the same firm to satisfy their needs in order to
build relationship with that firm and then to get different benefits from this relationship.

In an intensive competition, a customer must analyze his relationship with a certain firm
or service provider as a beneficial or not. This analysis is not only done in an isolated
perspective, but also by considering all the available competitors. When a customer analyze
these both aspects of relationship, he may found different groups which are narrowly related to
the main types of relationship among the companies/service provider and their customers. A type
of relationship which is considered as a highly valuable by the consumer while simultaneously
he is free to switch to some other companies or service This kind of dedicative relationship may
happen even in a case when the customer is not in a position to replace his relational partner on
the basis of some market conditions but he considered his relationship beneficial for him. It is
even more accurate when the supplier or service provider does not try to misuse his monopoly
power, while he may in position to exercise his opportunistic behavior. There is another type of
relationship which is less beneficial to customers and lack of availability of competitors (i.e. no
free choice to Predetermined constraints or hindrances on the basis of power avert customers
from termination of relationship or switching the relationship with his/her current relational
partner.

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 In order to motivate the customers to establish and maintain long-run and strong
relationship with the service providers, it is necessary to distinguish between the two main
groups of relationship motives. First group includes the benefits related to core products or These
second group of benefits are termed as “true relationship” between the company-customer
relationships Firms may create advantages through those relational benefits which are so
influential in company-customer relationship that customers find difficulty in replacing the
relational partner.

On the fulfillment of two basic conditions, customers show their willingness to establish
a long-run relation with a firm or service provider. First condition is that total benefits derived
from both products or service and relationship, while considering all the costs of that company-
customer relationship. Second condition is that the total benefits derived from that relationship
must be greater than or superior to all the other competitive alternatives available in the market.
Relational benefits approach through motivations is more effective in a dedicative type of
relationship. On the other hand, dependency approach is considered more promising to explain
the relationships which are based on different constraints (i.e; constraint-based).

Marketing activities of all the firms are centralized to a common goal, which is to
maximize the profit through customer retention. So, the relational benefits are considered as the
main source of Customers on getting the benefits form a firm also provide benefits to the firm in
the shape of their post purchase behavior, such as repeat purchase and giving recommendations
to others (Vazquez-Carrasco & Foxall, 2006). It is proved that in a long-term relationship, both
customers and firm/service provider are the beneficiaries. Relational benefits can be further
divided into three levels, which are personal level, company level and brand level benefits.
Personal level benefits are obtained in a situation where a customer is in relationship with a
single service provider or employee of a firm. For example, the relationship between clients and
physicians, analysts, dress designers, hair dressers and dentists, because a high intimate level of
relation exists between them. Company level benefits exist where a single customer is interacting
with the whole firm. These company level benefits exist in a business where the products or
services are highly standardized and a less intimate relation with customers. Finally, some

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customers are in relationship with specific brand Such kinds of benefits are called as brand level
of benefits.

differentiates between two types of relational motives by explaining the significance of

relational benefits in the achievement of long-term relationships. These relational motives
include the risk reduction desire of customers and customers’ social motives. Berry also
explained the main characteristics of a service on which the significance of risk reduction
depends upon. These four charateristics include the importance of service, involvement of
customers to the service, complexity and variability of the service. He also stresses that these
characteristics are strongly interrelated to one another, rather than being independent from one
another. He further argued that these risk reducing benefits are directly related with trust or
confidence. While considering the social needs of customers, Berry points out that people desire
for customized or individual treatment in a situation where a high intimate interaction exists
between an individual customer and a single employee of a firm or service provider.

Gwinner et al., (1998) proposed an extensive study on relational benefits from customer
perspective. On the basis of literature on relationship marketing and explorative empirical study,
they present a study containing four different kinds of relational benefits:

 First type of benefits are known as psychological or confidence benefits. These benefits
includes such kind of aspects which mainly focused on the uncertainty or risk reduction.

 Second category of benefits are titled as the social benefits. These benefits are comprised
on the emotional part of relationship between customer and service provider. Through
social benefits customers enjoy the positive aspect of their relationship. Customers tend
to interpret their relationship with the service provider, as they build a friendship with
them Vazquez-Carrasco & Foxall, 2006).

 Third group is named as economic benefits, which contains both the

monetary and non-monetary benefits (like special prices and time saving) which are

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 derived by customers from their respective relationship. Customers may receive some
special benefits from service providers; for example due to enduring and long-term
relationship a customer may get special prices from the organization. Paid and regularThe
fourth category, titled customization benefits by, which describe those type of advantages
that results from individualized or customized treatment by the employee of a firm or
service provider. Latterly it was suggested that last two types of benefits i.e. economic
benefits and customization benefits were considered by customers jointly as whole. It
leads to merge the economic and customization benefits which results in the formation of
a new category named as special treatment benefits. However, the psychological benefits,
were called as confidence benefits. Customers by developing strong relations with service
providers, expect to have better and satisfactory quality of core or basic services.

proposed different characteristics on the basis of psychological reasoning, required to

build relationship from customer perspective:

 The customers’ lust for the complexity reduction and to achieve more efficiency.

 In order to make decisions customers utilize their knowledge and recall their memory
about their past experience.

 Lust for risk reduction that is achieved through the development and maintenance of
strong relationships with certain brands.

 Cognitive consistency is desired to be maintained through brand loyalty. Selecting the

alternatives all the times may provide an inconsistent information.

Fournier (1998) explained two mechanisms in which relationship and brand loyalty may
enhance. First, the brand’s own ability to be proved as a source of self-esteem for customers.
Being in touch with a specific brand of product or service over a longer time period in a personal
and familiar way, will enable the customers to increase their feelings of self-esteem. Second,

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customers may express the loyalty towards certain brands intentionally in order to create self-
identity. This kind of behavior depends on a supposition that other people assess the consumers
from the brands they use. Generally speaking, there are two different types of variables.
Variables which correlates positively with the decision of customer to be remained in
relationship are termed as relational benefits. On the other hand, variables which correlates
negatively with the decision of customer to be remained in relationship are termed as relational
barriers.

Literature on relationship marketing suggests four different kinds of benefits. These are
the psychological/confidence benefits, social benefits, special treatment benefits and the identity
related benefits. Social benefits and special treatment benefits have importance in such kind of
relationship where consumers are interacting directly with the service firm or their employees.
Identity related benefits are also considered to be important in customer-brand relationship.
While confidence benefits have importance for both type of relationship, that is where consumers
have direct relation with service firm or in relationship with specific brands

Significance of relational benefits cannot be assessed only through customers’ own

internal variables but some external factors are also contribute towards the significance of
relational benefits. These relational benefits are not only responsible for the attraction of
relationship, lack of relational barriers also help to make the relationship more attractive.
Existence of relational barriers may stop a customer to enter or continue a relation with the
service provider, even though the relationship is considered by customers as attractive.

Similarly, confidence or trust may increase when a customer receive customized, special
or additional services (special treatment). When consumers receive better results from their
relationship (i.e; social & special treatment benefits), they become more confident (confidence
benefit) in receiving the same outcomes from future

Through relational benefits customer loyalty can be Satisfaction plays a mediating role
between the relational benefits and behavioral outcome i.e. brand advocacy and continuity

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intentions (Sergios Dimitriadis, 2010).Confidence benefits are sometimes known as
psychological benefits which hve significant relation with commitment (Gwinner et al., 1998).

Social benefits include personal recognition, familiarity, and developing friendship with
the service provider. Customers may receive these types of benefits from strong relationship with
firm or service providers (Jackson, 1993). Social bonding among employees and customers
results in greater level of customers’ commitment with the

2.2. Customer Satisfaction

Customer satisfaction has been considered an important subject in the field of marketing
after the first study on customer effort, expectation and satisfaction. It is generally defined as the
post purchase evaluation about product and service (Oliver (1980) explained it as the result of
evaluation process in which pre-purchase expectations are compared with the post-purchase
performance.

Expectancy disconfirmation theory provide a largely accepted conceptualization about

customer satisfactionThis theory was given by Oliver, he suggested that satisfaction is the
difference between the desired and actual level of performance. He proposed two forms of
disconfirmation, positive and negative disconfirmation. When the actual performance found finer
than as was expected, it is called as positive disconfirmation, which is further called as
satisfaction. Contrary to this, if the actual performance found worse than expectations, it is
known as dissatisfaction. Literature supports that satisfaction affect significantly to the results of
business. Customer satisfaction has a positive impact on corporate profitability (Luo and
Homburg, 2007).

Satisfaction of channel member was defined as, when a firm feels positive working
relations with another firm by assessing all aspects of relationship. Therefore, according to this
point of Economic and noneconomic items were included in the satisfaction scale, however, it
varies considerably across the studies. Conceptually, the extent to which a satisfaction scale
captures the economic and non-economic dimensions should have an impact on both the
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antecedents that affect satisfaction as well as the consequences of the satisfaction. There are two
types of satisfaction, when the relationship is assessed primarily through the economic aspects
only, the result will be in the shape of economic satisfaction. On the other hand, when the
relationship is assessed through other aspects (noneconomic) the results will be in the shape of
noneconomic satisfaction.

Economic satisfaction can be defined as a partner’s positive response to economic

benefits that drift from his relational partner, (like volume of sale, profits etc). An economical
satisfied partner will consider his relationship successful regarding the goal achievement. He will
be a satisfied partner not only form relationship but also form the financial benefits.

Non-economically satisfied partners feel good at personal level to remain in relation

because they think that their relational partner is respectful and concerned with his relation.

Customer satisfaction has been considered an essential determining factor of long-term

customer behavior for a long time (Oliver, 1980), that is why; service firms gradually implement
significant efforts in chasing customer satisfaction. Even though, researchers find difficulty to
give a clear definition of satisfaction, but it is widely accepted that it is the result of evaluation
process, and this evaluation based approach is considered to be most acceptable and effective
mode of estimating the a study on investigating the antecedents of customer satisfaction in the
sector of retail banking. They proposed that quality dimensions of service, service problems,
service features, and service recovery are the antecedents of satisfaction. They further proposed
that bank’s ability of service recovery and service problems have significant effect on
satisfaction.

Research on customer satisfaction has formulated two main kinds of assessments:

cumulative and transaction-specific satisfaction. Satisfaction that is purely transaction-specific is
actually based on customers’ experience with a service encounter. Research on transaction-
specific nature of Cumulative satisfaction was grown and emphasized in early 1990s, it was
defined as customers’ overall experience with the service providers or with a product. This
concept is same as the economic psychology and the social economy, where satisfaction is
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considered as synonymous of the utility of consumption. These both consequences of study on
satisfaction are complementary to each other, but not to compete one another. Research which is
purely transaction-specific, focus on satisfaction obtained from a product or service at particular
time and from a particular transaction. Cumulative satisfaction focuses on evaluation for an
unlimited period of time.

In services sector, customer satisfaction is the difference of expectations about service

and post consumption experience. Satisfaction is purely a subjective construct as the satisfied
customers proved defective to competing service providers. Satisfaction is the function of
expectation and the perception about disconfirmation (Oliver, 1980).

An individual’s expectations may results into following three forms: First, when the
performance level of a product is exactly the same as was expected, such expectation
is called as confirmed expectation. Second, when the performance level of product
remain poor than was expected, such expectation is called as negatively
disconfirmed or dissatisfaction. Third, when the performance level of product found
better than was expected, such expectation is called as positively disconfirmed or
satisfaction.

ASCI model of satisfaction contains three basic determinants of cumulative satisfaction

which are value, quality, and expectations. Many financial and business performance measures
are systematically related to cumulative satisfaction.It is of no wonder to accept that customer
satisfaction is an important component of the business accountancy, management, stockholder
and performance of business measures

In their study They said that, when the expectations of customers are fulfilled or they
receive more than their expectations, they report a greater level of satisfaction. Customer
satisfaction and expectations always go hand in hand. Whenever the attempts were made to
understand the customer satisfaction, it results many significant insights. For instance, it was
found that perceived quality and disconfirmation affect customer satisfaction greater than
customers’ expectations conducted an analysis on Swedish customer satisfaction, which showed
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that satisfaction is the consequent of perceived disconfirmation and quality. Customer
satisfaction is considered an important factor to increase the profitability by retaining the
customers. There are many behavioral objectives of customer satisfaction, one of these
objectives is to increase the rate of customer retention (said that, maintaining satisfaction level at
higher level will create and increase the reputation of firm. So, the price sensitivity of customers
can be reduced through satisfaction.

Customer satisfaction has a significant relation with loyalty, repeat purchase intentions
and positive word of mouth (Dimitriades, 2006).Generally speaking, customer retention highly
depends on the satisfaction, that is higher the satisfaction higher will be the customer retention.
Considering the immense importance of customer satisfaction endorsed the attitude of
researchers, who conducted different studies in order to investigate the antecedents of
satisfaction (Satisfaction may be measured through subjective requirements (for example,
customers and emotions) and objective factors (such as functional products and services).
Disconfirmation model of satisfaction has been integrated with the effects of attribution, equity
(fairness and justice), and emotion. Reciprocity concept, especially customer perception about
fairness and equality, are in the center of marketing. So, a customer feels satisfied when he is
treated equally in exchange transactions, especially when there are prospects for upcoming
interactions with same person or firm. Equity is considered as an essential antecedent of
satisfaction. Clients have both negative and positive states which systematically influence
satisfaction.

Literature supports that customer satisfaction results in repurchase behavior and positive
recommendations through word of mouth i.e; brand advocacy and these are the strong indicators
of loyalty. Hospitality management and marketing literature paid great attentions to the relation
of satisfaction and behavioral intentions, and a lot of studies in the literature supported that
significant relationship exists between customer satisfaction behavioral intentions (Anderson and
Sullivan, 1993). So, it is assumed that satisfied customers are more engaged in repeat purchase
behavior and positive word of mouth (brand advocacate proposed the four antecedents of
customer satisfaction: which include customer concept, empowerment of customers, response
capacity of interactions and customer value management.

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 Satisfied and loyal customers are more willing to spread favorable word of mouth and
brand advocacy of the firm Oliver, 1980; A person’s willingness to give strong
recommendations to others is a tool to assess the customer’s overall level of satisfaction. A
positive significant relation found between satisfaction and positive word of mouth. Satisfied
customers were found highly engaged in favorable word of mouth as compared to customers
who are dissatisfied

Xueming Luo & Christian Homburg (2007) conducted a research to find the overlooked
consequences of customer satisfaction. Even though, there is empirical evidence that satisfaction
is a key antecedent of firms’ profitability, but literature has principally overlooked two secondary
consequences of satisfaction, which are, advertisement and promotional efficiency of a firm and
human capital performance of firm. Xueming Luo & Christian Homburg (2007) proposed that
customer satisfaction enhance the efficiency of advertisement and promotional investment.
These results can be interpreted that there is a possibility that satisfied customers generates free
advertising through word-of-mouth and help in saving the marketing costs. Moreover, customer
satisfaction has impact on human capital performance of company. Meta-analysis on customer
satisfaction shows that expectation level of customers about goods or services, disconfirmation
of expectations of customers, performance level of goods or service as direct measure of
satisfaction, affect of the processing mechanism as measure of satisfaction, and equity i.e.
fairness, deservingness judgement, and rightness that consumers compare what others receive,
are the key antecedents/determinants of satisfaction. While consequences of satisfaction are
complaining behavior of consumer to seller or service provider, repurchase or revisit intentions
of consumers, and word of mouth behavior of consumers in front of other customers (David M.
Szymanski & David H. Henard, 2001).

2.3. Customers’ Commitment to Relationship

Commitment can be defined as a persistent desire and attitude relating to a particular firm
and brand elaborated the concept of commitment in the following manner: it is the continuity of
relationship with relational partner through explicit or implicit bonding. According to Gruen et
al. (2000) commitment is a psychological attachment to an organization.

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Meyer in the following way:

“It is binding forces that compel the individuals to target based course of
actions. Such as, commitment is differentiable from exchange based forms
of motivation and from target-relevant attitudes and can influence
behavior even in the absence of intrinsic motivation or positive attitudes.”

Commitment is a binding force representing the psychological state of mind which

explains the customers’ relationship with the Another view explains commitment as a wish of
carrying on the relation even though by sacrificing to continue that relation (Anderson and
Weitz, 1992). Customers, who are committed, are more likely to continue the relation with their
service provider brands because they build sincerity and attachment with their brands.
Relationship marketing highly depends on the role of commitment as it helps in creating or
maintaining the relationship. Commitment is a test tool that can be exercised to test the customer
loyalty. Genuine customer loyalty is backed by the commitment, without commitment the loyalty
is superficial (Taco Commitment is the result of attachment of one partner to another in an
interchange transaction (Gruen et al., 2000). When customers are willing to remain in relation
with their service providers, it shows that commitment exists there (Morgan and Haunt, 1994).
An attitude to continue the relationship with relational partner represents the overall commitment
of that Fullerton, 2003). For a long period of time it has been considered that commitment is a
unidimensional construct (Morgan and Haunt, 1994).

, on the basis of both economic and non-economic conditions. In the service sector, a
strong relation between affective commitment and both dimensions of loyalty (attitudinal and
behavioral loyalty) as compared to calculative commitment. Fullerton (2011) in study of three
service sectors (banking, hair-dressing, autos-repairing) reports that affective commitment has
positive effect on consumer advocacy.. There is confusion in the literature In this research,
commitment is taken as an attitudinal commitment. Commitment implies a willingness from
relational partners, who are ready for short-term sacrifices in order to gain benefits in long run,
from this relation (Anderson & Weitz, 1992). There are various definitions of commitment in the
literature but the common of these definitions is that it is explained as an encumbrance to switch

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the relational researchers of marketing have conceptualize the construct of commitment at global
level. Researchers of relationship marketing have identified three different motivations for the
willingness to continue the relation (Allen and Meyer, 1990). Kim and Frazier (1997) explained
the different dimensions of commitment. Intentions to continue the relationship with relational
partner is called continuance commitment. Sense of binding among the relational partners is
called affective commitment. Behavioral commitment was defined as the willingness to provide
help in needy times.

A commitment that came into existence due to the Fullerton, 2003). An affectively
committed person with the organization, enjoys his affiliation with that organization (Allen and
Meyer, 1990). It is an individual’s desire-oriented attachment to an organization or service
provider. Customers or employees remain with relationship because they want to continue that
relation From consumer perspective, it is a binding force that binds the consumers with service
providers. It shows consumer’s psychological bonds (Gruen et al., 2000) In some cases,
customers even implicitly show love for a certain service provider, firm or brand (Fullerton,
2003). Actually affective commitment is a kind of bonding state that links customers to firm or
service provider on the basis of identification and attachment.; Morgan and Haunt, 1994).

Extent to which an individual feels bounded with his Fullerton, 2003; Gruen et al., 2000).
It is based on switching costs, dependence and side-bets (Allen and Meyer, 1990). It is cost-
based attachment of an individual to an organization or a service provider. He feels that he has to
stay in relationship with a particular organization or service provider. These individuals remain
in relationship because they need to remain in relation with that organization or service provider
(Meyer, Allen and Smith, 1993). Continuance commitment exhibits the presents an idea of
“constraint-based relationship” according to this notion, consumers are not in a position to end
the relation with service providers on the basis of social, economic, and psychological costs.
Concept of continuance commitment is very similar to above mentioned notion of “constraint-
based relationship”. Lack of availability of alternatives is another reason of continuance It is also
psychological state that came into existence where customers face significant psychological or
economic switching costs and consequently found rare alternatives beyond this relationship.

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 In marketing literature, normative commitment is defined as when It is an obligation-
oriented attachment of an individual to an organization or service provider. These individuals
remain in relationship because they think it is the right thing to do, as they ought to be remained
in the relationship with service providers. Normatively committed individual with a firm feel that
maintaining relationship is the best option to select (Allen and Meyer, 1990).

offered a model of customer commitment. He proposed that customer commitment is the

blend of three drivers that are economic, social, and resource drivers, it is the result of
commitment–trust theory (Morgan and Hunt 1994). Theory states that trust and commitment,
both are three basic relational bonds between customers and firm, which are firms must laid
down the foundation of marketing relationships with their customers on financial bonds.

Another approach presented that success of marketing relationships highly depends on

the existence of relational contents, which are divided into social, economic, and resource
contents. Resource contents comprise on the valuable resources, offered by service providers that
cannot be available from alternatives. When a customer utilize these social, economic and
resource contents of a firm, he feels binding in maintaining the relationship with the firm. he
explained that social bonds are independent from financial bonds. All the researchers are agreed
on a common point that the more benefits a customer receive from a firm, more he will show
commitment to maintain the relations with firm. Literature shows that consumer commitment
plays a role of mediator between trust and customer satisfaction which ultimately results in
positive word of mouth. explained two different kinds of determinants of commitment. They
categorized the determinants of commitment into behavioral determinants and marketing
determinants. Behavioral determinants of commitment includes communication between
manufacturer and distributor, continuity of relation, power to maintain the relationship, and trust
of the distributor on the manufacturer. Marketing determinants of commitment includes
dependence of distributor-manufacturer on each other, investment specific to a channel
relationship, and product salability. In business to business (B2B) context, Alhassan G. of
commitment in the field of industrial markets relationship. In the study of relationship marketing
for non-profit sector, Keith point out that relationship switching costs, relationship benefits, and
shared values are the key antecedents of commitment in relationship. In business to business

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(B2B) context of services business investigated the role of basic three psychological constructs
as antecedents of affective commitment in the financial service sector. proposed that the main or
key determinants of importer’s commitment are opportunism behavior and cultural sensitivity of
exporter, environment and transaction specific investment of importer. Russell Lacey (2014)
examined that relationship drivers of commitment and proposed that there are three drivers of
consumer commitment that are economic drivers, social drivers, and resource drivers. Economic
drivers of commitment comprise on economic value and switching cost, social drivers of
commitment are the combination of customer identification and shared values while resource
drivers of commitment are composed on confidence benefits and preferential treatment.
propensity to terminate the relationship is highly dependent on relationship commitment. In the
study of relationship marketing in not for profit sector, Keith out that acquiescence, propensity
to leave, and cooperation are the ultimate consequences of commitment. Josée Bloemer et al.
(2003) assess the consequences of affective commitment, which are word of mouth, repeat
purchase behavior, price sensitivity and complaining behavior. Russell Lacey proposed increased
purchase intention and conducted a research on service firms to check the role of commitment,
where he found that commitment behaves as a partial mediator between the relation of service
quality and loyalty. Findings also show that affective commitment has a positive impact on
advocacy intentions of customers and a negative impact on switching behavior. Continuance
commitment has mixed effects (i.e. both positive and negative impacts) on switching behaviors
and have a positive impact on the advocacy behavior.

2.4. Brand Advocacy

Advocacy can be explained as an action of defending, pleading and recommending for a

particular person, product, firm (Jillapalli & Wilcox, 2010; Hill et al., 2006). When customers
devotedly give strong and positive recommendations about product, service, person or brands,
actually they are playing the role of advocates of that object (Anderson 1998; Fullerton, 2003).

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Brand advocacy influences the other customers’ behaviors and their judgments (Zeithaml, Berry,
and Parasuraman, 1993).

Consumption experience is communicated by the customers may be positive or negative,

which is called word of mouth (Zeithaml et al., 1996). Complaining behavior of customers,
When consumers describe the pleasant consumption experience to other people, they actually
express a positive word of mouth (Anderson, 1998). Positive word of mouth is a type of brand
advocacy (Harrison & Walker, 2001). Minor difference exists between positive word of mouth
communication and brand advocacy, to describe positive attributes of a product, service, firm,
person or brand is called positive word of mouth while defending, pleading and giving strong
recommendations of an object to others is brand advocacy. When customers are continuously
satisfied and pleased with the service provider, they become advocates of that service provider
(Luo and Homburg, 2007). “Consumers themselves become brand Brand advocates are different
from the fan and followers of a particular brands, fans and followers may like a product or
service but not all of them may recommend that product or service to others explains in his book
“Brand Advocates” that there are two types of brand advocates, visible and hidden advocates.
Visible advocates are the brand ambassadors of an object who are paid for being advocates.
There are some hidden advocates who are not being paid and are engaged in talking up in
meetings, recommending the objects or service providers over the coffee and dinner.

Justin Kirby and Paul Marsden offered brand advocacy pyramid which is divided into
three levels of customers. Bottom level consists on those people who are highly satisfied with
brand and willing to continue using the same product, these people are called brand adopters.
Middle level consists on those customers who are satisfied with their brand and show high level
of brand loyalty and brand affinity, such customers are called brand adorers. Apex level of
pyramid consists on the brand advocates

The concept of word of mouth is not a new one. After World War II it becomes a
scientific term when there was a rise of positive communication research in the United States
(Brooks, Robert C. Jr, 1957). This scientific research presented the following definition (Arndt,
Word of Mouth Advertising, p. 3):

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 “Oral communication between communicator and receiver, in which
receiver perceives it as non-commercial, relating of a product, service or
a brand.”

This definition consists of three components. First component of definition consists on

interpersonal communication. This element defines the word of mouth, outside the media and
other impersonal channels available to consumers. In addition, the code of communication is
language. Therefore less tangible forms are not eligible for the "word of mouth" label on
themselves. Secondly, word of mouth from marketing standpoint is commercial. The message is
in commercial entities, product categories, brands and marketing (Dichter & Ernest, 1966). Lastly,
even if the contents of word of mouth are commercial, communicators are not considered to be
motivated in the market, or not be perceived.

The advocacy of the company to the interests of customers, and they advocate about the
company through purchasing its products and help to make efficient products. If customers
advocate others regarding positive association, the client acquisition costs diminish, and
preferences of customers rises. This may lead to an increase in sales due to clients, and their
friends also purchase the products of that company. This ultimately leads to higher profits

In competitive environment, it is very important for companies and service providers to

build positive brand image, creating distinctive identification, create impressive experiences
about brands, and shape significant word of mouth While developing the brand strategies, one
must have to understand the brand image held by the current customers (D. Aaker, 1996). Such
kind of understanding will help the companies and service providers to find the difference
between the desired and actual image of a product or service in customers’ mind Brand
promotion is defined as the extent to which retailers actively recommend or endorse any
particular brand in a product category for the retail customer. The branding is a particularly
valuable to manufacturers in commercial environments, where vendors influence the choice of
brand and asset purchase decisions. The sales effort is conceptualized as the intensity of efforts
towards selling actively, recommend, and support for a specific brand compared with other
brands. Both branding and sales efforts are essential to influence customer choice at the point of

19
purchase. Although the influence of the retailers is minimized largely through classes
characterized by a low risk or involvement, product researchers have empirically shown that
customers seek and act on the recommendations provided by the retailers’ products that present
greater risks. For example, focusing on appliances sold in traditional retail stores, Sweeney,
Soutar, and Johnson (1999) found a main role of retailers in the induction of product choice. In
fact, inform the customer perceptions of the readiness of retailers to help have the greatest impact
on the willingness to buy a product because even product quality is perceived. Subsequently,
Sweeney, Soutar, and Johnson proposed that "the development of the effectiveness and prestige
of this source of information should be given greater consideration" (1999, p. 100) by
manufacturers and retailers. According to the literature on relationship marketing, both branding
and sales efforts are conceptualized as individual behavioral outcomes it is say, the retailers
become brand advocates voluntarily and spend effort benefiting a specific brand, as a result of
the relations of deep and enduring brands that are induced by manufacturers and their
representatives. In this study, the psychological connection relationships embodied in the brand
centered between retailers and manufacturers' brands is represented by

Literature supports that brand advocacy has many important consequences. Relationship
marketing scholars and practitioners are in a view that advocacy helps to increase the level of
sales. Researchers are agree on view that advocacy increase the sales more than the ads. People
rely more on the words of their family members, friends, colleagues and acquaintances instead of
ads on different electronic and print media (Rob Fuggetta (2012), Brand Advocates, John Wily &
Sons). Another important consequent of brand advocacy is business growth. An increasing chain
of customer

Marketing researchers find different antecedents of brand advocacy. Trust on the

relationship with the professor and positive disconfirmation (satisfaction) towards the brand or
service providers (professors) are the basic factors that make the customers satisfied enough to
give strong and passionate recommendations of their professors to the other students (Jillapali &
Wilcox, 2010). Customers’ loyalty is another important antecedent of customer advocacy.
Corporate social responsibility is an important antecedent of brand advocacy. Firms or service
providers who consider the importance Customer loyalty is effected from different kinds of

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commitment, it was found that when the client's participation is based on the exchange values
and identification, it has significant impact evenly on retention and loyalty behaviors. On the
other side when the client's commitment is based on the costs of switching and dependence, it
has mixed effects on customer loyalty. This commitment ultimately affect the brand advocacy
(Gordon Fullerton, 2003).

Customer satisfaction and commitment were found important antecedents of customer

advocacy during the study of investigating Customer satisfaction and commitment were found
the essential antecedents of brand advocacy (Fullerton, 2011). Literature shows that consumer
commitment plays a role of mediator between trust and customer shows a strong relation
between affective commitment and both dimensions of loyalty (attitudinal and behavioral
loyalty) as compared to calculative commitment. Fullerton (2011) in study of three service
sectors (banking, hair dressing, autos-repairing service) reports that affective commitment has
positive impact on advocacy behavior.

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RESEARCH METHODOLOGY

3.1. Research Population and Sample

Population of the study comprised on the persons (patients) who have ever visited the
clinic of any physician during their whole life and remain in relation with their physicians since
last three months. Data is collected from districts of Punjab.

3.2. Research Design and Instruments

By nature it is an inductive and confirmatory research. Survey research method was

adopted through self-administered questionnaial 1997 to collect information from a relatively
smaller group of people, who are considered as the accurate representatives of a relatively larger
group of people. Survey research method is considered as an appropriate research design for this
study on the basis of the following points: nature of research being descriptive, availability of
quantitative instruments and a relative short period of time and the superficiality of response of
respondents

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Conceptual Model

Confidence
Benefits
Clients’
Satisfaction

Physicians’ Brand
Social Advocacy
Benefits
Clients’
Commitment

Special Treatment
Benefits

Proposed Hypothesis
Following are the fourteen proposed hypothesis to test the proposed parallel mediation model:
H1 : Confidence benefits have a significant relationship with clients’ satisfaction.

H2 : Confidence benefits have a significant relationship with clients’ commitment to relationship

with the physician.

H3 : Social benefits have a significant relationship with clients’ satisfaction.

H4 : Social benefits have a significant relationship with clients’ commitment to relationship with
the physician.

H5 : Special treatment benefits have a significant relationship with clients’ satisfaction.

H6 : Special treatment benefits have a significant relationship with clients’ commitment to

relationship with the physician.

H7 : Customer satisfaction has a significant relationship with brand advocacy.

H8 : Clients’ commitment has a significant relationship with brand advocacy.

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H9 : Clients’ satisfaction plays a mediating role between the relationship of confidence benefits
and physicians’ brand advocacy.

H10 : Clients’ satisfaction plays a mediating role between the relationship of social benefits and
physicians’ brand advocacy.

H11 : Clients’ satisfaction plays a mediating role between the relationship of special treatment
benefits and physicians’ brand advocacy.

H12 : Clients’ commitment plays a mediating role between the relationship of confidence
benefits and physicians’ brand advocacy.

H13 : Clients’ commitment plays a mediating role between the relationship of social benefits and
physicians’ brand advocacy.

H14 : Clients’ commitment plays a mediating role between the relationship of special treatment
benefits and physicians’ brand advocacy.

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