The Role of Service Provider’s Rapport Behavior on Customers’ Empathy

The study is intended to explore the validity of the component system of the rapport behavior of service providers. The purpose of this study was to understand how the components of the rapport behavior of service providers affect rational and emotional empathy. This study is intended to understand the relationship between rational and emotional empathy and customer satisfaction and the effect of customer satisfaction on revisit intentions. The main purpose was to identify the moderating effect of perceived authenticity on the causal relationship between rapport behavior, empathy, and customer satisfaction and revisit intentions. The sampling method used in this study was the judgment sampling, which is a method in which the researcher selects those study subjects that are thought by the researcher to be the most suitable samples for the purpose of the study. The total questionnaire period was a total of three months, from March 15 to May 15, 2020. The total number of valid samples was 1668. Uncommonly attentive behavior, courteous behavior, information-sharing, and connecting behavior, which are components of the rapport behaviors of service providers, were found to have positive effects on rational empathy with the service provider, but common grounding behavior, which is also a component of the rapport behaviors of service providers, was found to have no statistically signicant effect on rational empathy with service providers. The rapport behaviors of service providers are judged to play an important role in maintaining and developing strong ties through long-term and continuous interactions with customers. tests


Introduction
To survive in a market dominated by erce competition, service rms and individuals understand the imperative to attract and create new customers and strengthen their relationships with regular and longterm customers (to keep them as current customers). Although attracting new customers is also considered strategically vital in companies that provide services, using stable and future-oriented servicemarketing strategies through the formation of strong relationships with existing customers is regarded as highly e cient over the long term. From the standpoint of customers who are provided with services, the formation of friendly relationships with such service providers can bring social, psychological, economic, and personal bene ts (Gwinner et al., 1998). For service providers and customers to form productive longterm relationships, then, factors such as intimacy, consideration, acquaintance, trust, and rapport must be considered (Gremler & Brown, 1998). This study treats the service industry as an intangible product as well as an intangible asset. That is, given the characteristics of the service industry, human interactions are essential and account for most activity in the industry. Given these characteristics, the concept of rapport behavior on the part of service providers could play a major role in explaining the formation of bene cial relationships between service providers and their customers.
All service sectors have their distinct characteristics. Service sectors that trade in tangible goods need more active and concrete implementation of service-management systems. Providing customized services by identifying customer propensities through contact between service providers and customers that involves counseling and conversational analysis enables providers to increase purchases of related services or products, encourages customers to develop intimacy with service providers, and elicits positive responses and empathy, enhancing customer loyalty and strengthening revisit intentions.
Empathy plays a decisive role in the formation of emotional and rational ties in social groups. In the service industry, positive evaluations of service providers' rapport behavior enable customers to develop empathy (Blair, 2005;Singer, 2006). The formation of rational and emotional empathy is an essential concept in marketing.
The paradigm of business administration, in which sensitivity and design are regarded as important, has an effect on service-marketing strategies. To create customer impressions that go beyond customer satisfaction, continuous and long-term interactions with customers are more important than ever before. Consistent with this trend, it is essential to explore key rapport behaviors in which service providers engage. Marketing managers need to understand how customer perceptions and evaluations of such rapport behaviors affect the formation of rational and emotional empathy.
This study is designed to assess the validity of certain salient examples service providers' rapport behavior. The purpose of the study is to understand how such rapport behaviors affect rational and emotional empathy. One objective is to understand the relationship between rational and emotional empathy and customer satisfaction as well as the effects of customer satisfaction on revisit intentions.
Another goal is to identify the moderating effects of perceived authenticity on the causal relationship between rapport behaviors and empathy, customer satisfaction and revisit intentions.

Rapport behavior
It is no exaggeration to say that changes in the industrial paradigm in recent times have shifted the central axis of industry from manufacturing to service. Currently the service industry is experiencing erce competition. To provide better services, service rms are using customer-oriented service policies and strategies to improve facilities and enhance quality. Service rms strive to secure loyal customers beyond ensuring merely positive customer responses and customer satisfaction. In the service industry, customer satisfaction management is recognized as an essential strategic tool for gaining competitive advantage.
Service-oriented companies are developing and strengthening individual customized services and are implementing strategies to increase economic bene ts by providing services that t individual types of customers by identifying personal characteristics of customers.
"Rapport" is de ned as "a close and harmonious relationship in which persons or groups related with each other understand and communicate with each other while sharing each other's feelings and thoughts." In counseling psychology, rapport is a relationship that enables the counselee to feel stable and comfortable based on trust and empathy, facilitating effective communication that improves interactions between the patient and the counselor (Norfolk et al. 2009). In other words, rapport re ects the establishment of a good feeling that forms when individuals feel a sense of fellowship in their interactions, have good relationships with individuals through bonds of sympathy, or enjoy relationships based on mutual understanding. Rapport has been conceptualized as a positive relationship between two individuals, and the scope of rapport has been expanded to include relationships where one individual recognizes the other individual (Bernieri, 1988;DePaulo & Bell, 1990). Some studies have indicated that the concept of rapport is connected to interpersonal relationships, in which individuals form a sense of fellowship with each other and perceive that they interact pleasantly (Ashforth & Humphrey, 1993;Bernieri et al. 1996;Weitz et al. 1992).
Friendly greetings, smiles, listening attitudes, and sociality in individuals who provide services are factors that affect the formation of rapport (Ford and Etienne, 1994). Rapport behavior can be developed by paying close attention to how another individual communicates and listening intently to the other individual (Hollman & Kleiner, 1997). The elements that underlie the formation of rapport include nonverbal behaviors such as gestures, eye contact, and mirroring postures (Tickle-Degnen & Rosenthal, 1990), and these non-verbal behaviors are as important as means of expression as verbal communication (Delmonte, 1991). In a study of hotel services, Weitz et al. (1992) found that rapport behavior is formed through both verbal and non-verbal communication. They also emphasized the importance of engaging in dialogue with customers, arguing that both verbal and non-verbal aspects should be considered in reducing the psychological distance between service providers and customers and helping fruitful relationships form (Sundaram & Webster, 2000). In addition, Hwang et al. (2016) who studied the formation of rapport between professional casino dealers and customers, indicated that the personal attributes of dealers that were leading variables in the formation of rapport include professionalism, likeability, and a customer orientation.  Gremler and Gremler (2008), studying rapport behaviors used by employees in service and sales in retail and distribution from the viewpoints of customers and employees, proposed ve types of rapport behaviors: uncommonly attentive behavior, common grounding behavior, courteous behavior, connecting behavior, and information-sharing behavior. This study adopts these types of rapport behavior in its theoretical framework. In the following sections we consider each of these types in turn.

Customer Empathy
Empathy involves understanding another individual's experiences from that individual's viewpoint, as if that individual's experiences are one's own experiences. This places one individual in the place of the other, initiating a process that can occur without thinking (Eisenberg & Miller). In addition, empathy is feeling the experiences of other individuals together with those individuals, or looking at the world through another's eyes and stimulating vicarious emotional responses that acknowledge the emotional experiences of another individual (Hoffman, 1977). As such, empathy can be seen as the starting point for altruistic behaviors that involve understanding and helping others (Batson et al. 1987).
Psychologists have found that empathy is helpful for understanding and considering another individual (Bylund & Makoul, 2005;Shih et al. 2013), suggesting that empathy is an essential element on otherperson-oriented behaviors that encourage respect for others and avoid con ict situations (Guerney 1977) while considering and understanding others (Coke et al. 1978). An individual's ability to understand and accept the role of others makes it easier predict others' behaviors and promotes interactions so that the individual can respond appropriately to a given situation (Eisenberg and Miller, 1987;Pedersen and Pope, 2010). In particular, individuals with greater ability to feel empathy often develop a stronger sense of responsibility, can e ciently and skillfully encourage and accept others, and can help another individual develop through effective and active interactions (Pedersen and Pope, 2010). Empathy as such can involve understanding the behavior of others and imagining their roles, which is known as cognitive empathy. On the other hand, experiencing another individual's emotions vicariously and forming the intention to understand others' feelings or emotions is known as sentimental empathy. In this study, the term "rational empathy" will be used to mean cognitive empathy and the term "emotional empathy" will be used to mean sentimental empathy.

Hypotheses and Theoretical Model
Hypotheses Because rapport can create intimate relationships between service providers and customers, it strengthens cohesion in ties and fosters pleasant relationships formed through interactions between workers and customers. Uncommonly attentive behaviors appear as unexpected behaviors in service providers or as behaviors that differ from the usual behaviors, as they involve paying special attention to customers. When customers receive special attention during service encounters, they have pleasant and comfortable experiences leading to the formation of emotional bonds between service providers and customers as well as great effects on customers' positive emotions (Gremler & Gwinner, 2000;Kleine & Baker, 2004). Common grounding behaviors are similar in concept to mutual interest and involve service providers' intentional or unintentional identi cation of topics of common interest with customers. In cases where customers recognize their similarities with service providers, the chances of improving rapport by enhancing the quality of the relationship and the attractiveness of the other party may increase, and sales are highly likely to increase as well (Clark et al. 2003;Crosby et al. 1990;Jones et al. 1998).
Courteous behaviors, which are based on a service provider's authenticity, contribute greatly to the formation of rapport in the relationship between the service provider and the customer. Courteous behaviors instill in customers the idea that they are being treated well, fostering mutual respect between service providers and customers, consequently resulting in the development of emotional bonds (Drigotas & Rusbult, 1992;Hazan & Shaver, 1994). Connecting behaviors create a friendly atmosphere, comfort, warmth, joy, and fun, and contribute to the formation of strong ties and pleasant relationships, which in turn can create a sense of closeness to a service provider (Deci & Ryan, 2000). Information-sharing behaviors enable service providers to better understand customers, obtain information from customers and share information with customers to manage customers' needs e ciently, and are a very important means of creating rapport with customers. Information-sharing behaviors include knowledge-sharing, giving advice, and asking questions to understand customer needs, which together contribute to the formation of pleasant relationships with customers (Menon and Dube, 2000). Therefore, as can be inferred from the abovementioned studies, the rapport behaviors of service providers are expected to be closely connected to the formation of empathy with customers and, furthermore, empathy is expected to affect consumers' attitudes or behaviors. Based on the above discussion, the following hypotheses are proposed: H1. Behaviors that foster rapport-uncommonly attentive behavior (H1-1), common grounding behavior (H1-2), courteous behavior (H1-3), information-sharing behavior (H1-4), and connecting behavior (H1-5)will affect rational empathy.
H3. Rational empathy and emotional empathy will affect customer satisfaction.
H4. Customer satisfaction will affect revisit intentions.
Most previous studies of perceived authenticity have reported that authenticity has positive effects on consumer attitudes. This means that even if consumers are aware of companies' CSR activities, it will be di cult to expect positive effects of CSR activities if consumers do not perceive them to be authentic. Consumers must perceive authenticity for CSR activities to be successful and enhance consumer attitudes, corporate images, and brand attitudes. As reviewed, recently perceived authenticity can be said to be a key factor in determining customer responses. Given the foregoing, perceived authenticity is expected to play a moderating role in rapport behavior in the causal relationships between rapport behavior, empathy, customer satisfaction, and revisit intentions. Based on this discussion, the following hypotheses are proposed: H5. Perceived authenticity will have a moderating effect when a service provider's rapport behaviors affect rational and emotional empathy.
H6. Perceived authenticity will have a moderating effect when rational and emotional empathy affect customer satisfaction.
H7. Perceived authenticity will have a moderating effect when customer satisfaction affects revisit intentions.
The purpose of this study was to understand how behaviors that foster rapport between service providers and consumers affect rational and emotional empathy. See Figure 1 for a depiction of the research model.

Survey Procedure and Data Collection
This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study. The survey in the study was carried out in accordance with relevant guidelines and regulations. A statement to con rm that all experimental protocols were approved by a named Institutional Review Board(IRB) of Kyonggi University.
The study was conducted by administering a questionnaire to service-industry employees. To select service sectors, the service industry was divided into producer-oriented and consumer-oriented services according to the standard classi cation method and each of the two sectors was classi ed into service segments. Producer service segments support corporate management activities ( nance, insurance, accounting, law, advertising, and service segments formed through outsourcing), while consumer service segments are services provided directly to consumers (retail, food, lodging, entertainment, culture, art, hospitals, car services, hotels, airlines). The questionnaire rst included questions about gender, industry, income, educational background, and service sectors as demographic elements. Thereafter, the questionnaire was organized with questions related to rapport behavior, cognitive and emotional empathy, customer satisfaction, revisit intention, and perceived authenticity set as control variables.
Before beginning the main questionnaire survey, a preliminary survey was conducted with 20 students in a department of business administration. The degree of understanding of the questions in the questionnaire, mistyping, and editing status were checked. In addition, reliability and factor analyses were conducted. Questionnaire surveys were conducted with employees in the service industry through visits, e-mails, and faxes. The methods for collecting the data included visit surveys, online surveys, and faxed surveys.
Studies in social sciences are valid when samples are selected while considering accuracy, validity, and representativeness to identify the relative frequencies, sizes, and distributions of the variables or relationships between variables that enable quantitative descriptions of the social and psychological attributes of the population of interest. To de ne such population clearly, factors such as the subjects of the study, the sample units, scope, and time should be clearly xed. The population in the study was composed of individuals who had experienced the relevant service. The sampling method used in this study was judgment sampling, which is a method in which a researcher selects study subjects that are believed by the researcher to be the most suitable respondents for the purpose of the study. The questionnaire was administered over a three-month period, from March 15 to May 15, 2019. The total number of valid responses was 1,668.

Operational de nition and variable measurement
In this study, rapport is de ned as trust, harmony, and cooperation in human relationships. Rapport is formed naturally even when we do not consciously attempt to form it. In existing studies, the following behaviors have been classi ed as rapport behaviors: uncommonly attentive behavior, common grounding behavior, courteous behavior, connecting behavior, and information-sharing behavior (Gremler & Gwinner, 2008). A total of 15 question items were composed to measure rapport behaviors.
In general, empathy is commonly de ned as the ability to understand and emotionally respond to others' emotional states and experiences (Decety & Lamm, 2009;Eisenberg, 2000;Singer, 2009). Whereas emotional empathy is the ability to share others' emotional experiences, cognitive empathy is the ability to accept the mental views of others (Cox et al., 2012). Question items related to rapport behaviors used in previous studies were modi ed and supplemented to t this study. Three items each were composed for cognitive empathy and emotional empathy (Decety & Lamm, 2009;Eisenberg, 2000;Singer, 2009).
In this study, consumer satisfaction is de ned as consumers' cognitive states generated when consumers feel that they have been properly compensated for the prices they pay as buyers as well as their subjective evaluations of the degree to which their needs and preferences induced by acquisition or consumption of provided products or services have been met (Czepiel, 1990: Howard & Sheth, 1969. Based on existing studies, three items were modi ed and supplemented to t this study.
In this study, revisit intentions are regarded as consumer intentions to patronize service providers they have previously used. Based on previous studies, four items were modi ed and supplemented to t this study.
In this study, authenticity is de ned as having true and affectionate righteousness and heart, true love, and unique or original properties the object. Authenticity is related to reality, actuality, and truth, not fakeness, falsehood, or hypocrisy (Bruner, 1994;Neff and Harter, 2002;Snyder, 1979). Based on previous studies, a total of three items were modi ed and complemented to t this study.
Questionnaire items based on operational de nitions of the variables were extracted from previous studies and modi ed to t the contents of this study. A 5-point Likert scale was used throughout the questionnaire, where 'not at all so' counts as 1 point, 'moderate' counts as 3 points, and 'very much so' counts as 5 points. That is, it can be said that higher scores indicate more positive responses. First, four items were measured for a basic demographic analysis, including questions about gender, age, education, income, and service-industry segments.

Descriptive statistics
The study reports the proportions of the population by gender, age, education, and income in Table 1. The eventual sample consisted of 806 men and 862 women who lled out 1,668 questionnaires. Employees of rms in the consumer-oriented service sector comprised 65% of the sample (1,446 respondents) while 35% of the sample (584 respondents) work in the producer-oriented service sector. Nearly 70% of respondents had earned college-level degrees. We tested the scales for dimensionality, reliability, and validity using exploratory factor analysis (EFA) before assessing the hypothesized relationships shown in Figure 1. Cronbach's alphas exceeded the standard acceptance norm of .70 for all variables. Reliability was measured at .938 for fteen items with which we measured rapport behavior, .917 for six items with which we measured customer empathy, .880 for three items with which we measured customer satisfaction, and .886 for four items with which we measured revisit intention. We rst performed principal components factor analysis with varimax rotation on the initial items, employing a factor weight of 0.50 as the minimum cutoff value. As shown in Table 2, the factor loadings of the items in the measures range from 0.564 to 0.918, demonstrating convergent validity at the item level.  Table 3, discriminant validity was assessed by comparing the correlations of components with average variance extracted (AVE). The nal indicator of convergent validity is AVE, which measures the amount of variance captured by a construct in relation to the amount of variance that is attributable to measurement error. To demonstrate convergent validity, the AVE for a study should meet the standard of 0.5. The AVE for the measurement indexes in this study falls between .672 and .837, and the means of the squares of the correlation coe cients fall between .274 and .632, which indicates that AVE is higher than the means of the squares of the correlation coe cients (r²). This also satis es the requirement of discriminant and convergent validity for research hypothesis model veri cation.  Table 4 and Figure 2, and they indicate that the the rapport behaviors that foster rapport have positive effects on rational empathy (γ= .

Moderating Effects of Perceived Authenticity
As shown in Table 5, the hypothesized model was estimated separately for each of the two groups (e.g., high-and low-authenticity rapport behavior). The values of selected t indexes for multi-sample analysis of the path model with equality-constrained direct effects are reported in Table 5, which shows the standardized solutions (Bentler, 1992;Byrne, 1994;Kline, 1998 The tests show in addition that interaction between rational and emotional empathy and customer satisfaction (Δχ²=5.869, p=.015 for rational, Δχ²=19.438, p=.000 for emotional) were not signi cant. The tests also show that interaction between customer satisfaction and revisit intentions (Δχ²=23.362, p=.000) was signi cant. It was hypothesized that the effects of rapport behavior on customer empathy, satisfaction, and revisit intentions would be stronger in groups with high perceived authenticity than that in those with low perceived authenticity.

Conclusions And Discussion
This study was designed to check the validity of rapport behaviors in which service providers engage and to understand how speci c rapport behaviors affect rational and emotional empathy, the relationship between rational and emotional empathy and customer satisfaction, and the effects of customer satisfaction on revisit intentions. Another purpose of this study was to understand the moderating effects of perceived authenticity on rapport behaviors in causal relationships between rapport behaviors and empathy, customer satisfaction, and revisit intentions. A summary of the results of the analysis and tests of the hypotheses follows. Uncommonly attentive behavior, courteous behavior, information-sharing, and connecting behavior, which are rapport behaviors, were found to have positive effects on rational empathy with service providers, but common grounding behavior, which is also a service provider rapport behavior, was found to have no statistically signi cant effect on rational empathy with those providers.
The results of the analysis of the relationship between rapport behaviors and emotional empathy with service providers are as follows. It was found that uncommonly attentive behavior, courteous behavior, information-sharing, and connecting behavior, which are rapport behaviors, have positive effects on emotional empathy with service providers. However, common grounding behavior, which is also a rapport behavior, was found to have no effect on emotional empathy with service providers. Rational empathy and emotional empathy with service providers are closely related to customer satisfaction, and customer satisfaction is regarded as an important element in determining revisit intentions.
It was found that when common grounding behavior, information-sharing behavior, and connecting behavior affect rational empathy with service providers, the authenticity of those rapport behaviors plays a moderating role. It was found, however, that when uncommonly attentive behavior and courteous behavior affect rational empathy with service providers, the authenticity of rapport behaviors does not play a moderating role. This indicates that there is no difference between groups with high authenticity and groups with low authenticity.
It was found that when common grounding behavior and information-sharing behavior affect emotional empathy with service providers, the authenticity of rapport behaviors plays a moderating role. It was also found, however, that when uncommonly attentive behavior, courteous behavior, and connecting behavior affect emotional empathy with service providers, the authenticity of rapport behaviors does not play a moderating role. It was found in addition that, when rational or emotional empathy with service providers affects customer satisfaction, the authenticity of rapport behaviors plays a moderating role and that when customer satisfaction affects revisit intentions the authenticity of rapport behaviors plays a moderating role.

Managerial Implications
This study provides diverse academic and practical implications. First, this study is based on questionnaire surveys administered to consumers who have experienced multiple service sectors. From a theoretical perspective, the study contributes an exploratory study of service providers' rapport behaviors in a way that organizes our conceptual understanding, enabling us to re-examine the validity of individual rapport behaviors. In particular, this study examined speci c rapport behaviors, such as uncommonly attentive behaviors, common grounding behaviors, courteous behaviors, information-sharing behaviors, and connecting behaviors, through exploratory factor analysis after deriving question items by referring to the literature on rapport behaviors. In addition, this study also identi ed causal relationships that contribute to the formation of empathy with service providers by considering rational empathy and emotional empathy as separate types of empathy.
The study's understanding of the causal relationship between rapport behaviors providers and the formation of empathy and customer satisfaction or revisit intentions provides a variety of opportunities for follow-up studies. It provides valuable information for studies that would seek to identify and con rm causal relationships between service provider behaviors and factors that predispose customers to experience satisfaction by focusing on individual rapport behaviors and individual forms of empathy. The service providers' rapport behaviors were found to play an important role in maintaining and developing strong ties through long-term and continuous interactions with customers.
The study's contribution also includes insights into interpersonal relationships between service providers and customers who purchase services. Such relationships were found to be an important factor in maximizing customer satisfaction and the economic bene ts for the relevant service rms. This study demonstrates that the bene ts of such relationships are achieved only when continuous and strong relationships between service providers and customers are formed and maintained. The ndings of this study con rm the causality of rapport behaviors based on the fact that service providers should make efforts to read customers' emotions and obtain positive responses from a long-term and continuous perspective.
In service industries, regarding encounters between services and customers, the issue of service quality and other issues have been studied. It is no exaggeration, however, to say that studies focusing on the rapport behaviors of service providers remain insu cient. Here cases were applied to the scales and measurement items developed to measure the effects of rapport behaviors. This study contributes signi cant value to the generalization of the ndings through the veri cation of the validity of the questionnaire items. Services are intangible products and assets. From this viewpoint, studies that analyze service sectors as producer-oriented and consumer-oriented services to investigate emotional responses between service providers and customers in diverse service encounters and factors that predispose customers to form empathy as well as causal relationships, are quite insu cient. This study also makes an academic contribution by highlighting service providers' rapport behaviors to examine the effects of individual rapport behaviors.
Rapport behaviors are recognized as a very important part of the job of an employee who works in a service sector. Rapport behaviors as such contribute to the formation of relationships with customers regardless of the duration or number of encounters that occur in service situations (Gremler and Gwinner, 2000). As can be seen in the ndings reported in this study, service providers' rapport behaviors play a vital role in the formation of customers' rational and emotional empathy. The ndings as such suggest a means of improving service quality overall.
When the authenticity of service providers' rapport behaviors is added to the formation of rational and emotional empathy, such behaviors contribute greatly to the formation of relationships with customers. It can be said that the greater the authenticity of service behaviors the more important the roles they will play in the formation of relationships with customers, inducing positive customer responses and building long-term relationships.
The ndings of this study present diverse indicators for practice. First, rapport behaviors are a very important factor in service industries in forming rational empathy in customers and inducing positive emotions in providers' relationship with customers. Employees who provide services should not only have conversations with customers and share professional knowledge and information about the service but also make efforts to form intimacy or bonds and empathy through emotional interactions. Rapport behaviors as such are judged to be capable of fostering empathy in customers, bringing about customer satisfaction through emotional exchanges with customers, and doubling providers' economic gains.
Given that services are diverse and intangible assets and products, there may be human interactions and emotional interactions that are always induced by services. Service providers should take note of customers' emotional responses and strive to establish interactions based on thoughtful consideration of customers' needs, emotional communion, and professional knowledge to form positive ties. In service sectors as well, the importance of the rapport behaviors analyzed here should be recognized and educational programs could improve service providers' rapport behaviors. When establishing service marketing strategies, the study ndings as such should be referred to so that they can help service rms establish relationships with long-term customers, securing the loyalty of such customers and enhancing their satisfaction.
The ndings presented in this study untangle the process of forming relationships with customers from the perspective of service providers. The process through which customers' positive responses are reproduced as satisfaction and satisfaction is reproduced as service rms' economic gains has been explained. In service industries, efforts should be made to develop and educate practitioners about several key rapport behaviors to improve service quality. Hereafter, service rms should focus on developing service providers' rapport behaviors to encourage the formation of customer empathy, which is a means of securing not only customer satisfaction but also economic gains.

Declarations
Con ict of Interest: Author A declares that he/she has no con ict of interest. Results of Path Analysis