Participant Characteristics
Table 1 presents a description of the study sample demographics. As shown in Table 1, 67% of the participants were female and more than 60% were under 59 years old. More than 72.7% had attained upper secondary level education or higher, with 27.4% having attained tertiary level education or higher. Approximately 37.9 of the respondents have full-time work, 24.2% were retired. Most FCs were related to the patients of dementia as daughters (30.5%), followed by spouses (24.2%), sons (21.1%), daughters-in-law (15.8%), and other relatives (8.4%).
Table 1
Demographic characteristics of respondents
|
|
Frequency
|
Percent
|
Sex
|
male
|
31
|
32.6
|
|
female
|
64
|
67.4
|
Age
|
age <50
|
26
|
27.4
|
|
age 50-59
|
31
|
32.6
|
|
age 60-69
|
22
|
23.2
|
|
age >=70
|
16
|
16.8
|
Education
|
no formal education
|
6
|
6.3
|
|
primary school
|
12
|
12.6
|
|
secondary school
|
29
|
30.5
|
|
diploma
|
22
|
23.2
|
|
higher education
|
26
|
27.4
|
Occupation
|
full-time work
|
36
|
37.9
|
|
part-time work
|
8
|
8.4
|
|
retirement
|
23
|
24.2
|
|
others
|
28
|
29.5
|
Relationship with the case
|
spouse
|
23
|
24.2
|
|
daughter
|
29
|
30.5
|
|
son
|
20
|
21.1
|
|
daughter in law
|
15
|
15.8
|
|
others
|
8
|
8.4
|
Result of impact of range of performance analysis (IRPA)
The IRPA uses stated performance as well as implied importance to identify the impact of service attributes on satisfaction. As stated in the description of IRPA, both RI and PI were calculated by using dummy variables and regression analysis (see steps 1 and 2 in analytical framework). In Table 2, RICS indicates the sum of RI and PI for each service attribute. PI, RI, and RICS are then used to calculate the SGP, DGP, and IA of each attribute.
The further step of IRPA uses the performance score of each attribute and its RICS to position them in a grid (Figure 1). For example, the four quadrants within the tangibles were distinguished using the grand mean values of the APS (4.51) and the RICS (.51) scores. Figure 1a shows that attribute 1 (barrier-free environment) should be reviewed carefully because it was significantly lower than the grand mean of the APS score; it has a low APS score (4.32) and the highest RICS (.635) score (see table 2). Overall, Figure 1 reveals that higher attention should be directed toward attributes 1 (barrier-free environment), 5 (appropriate services), 6 (concern services), 9 (care-giving processes), 13 (reliable services), and 16 (professional knowledge), because their performances (APS scores) are below average, but they have above average RICS values. On the other hand, attributes 3 (fire and safety compliance), 10 (timely service), and 20 (demand coordination) should be given medium priority because their RICS values and performance (APS scores) are above average. Lastly, attributes 2 (neat and tidy appearance), 4 (comfortable environment), 7 (service attitude), 8 (professional care), 12 (care skills), 14 (sense of security), 15 (good manners), and 19 (patient privacy) should be of lowest priority because their RICS values are below average, while their performance (APS score) is above average.
Table 2
Attribute impact-range and asymmetry of services
|
|
RI
|
PI
|
RICS
|
SGP
|
DGP
|
IA index
|
APS
|
Classification
|
Impact
|
Tangibles
|
|
|
1
|
Barrier-free environment
|
0.255
|
-0.375
|
0.635
|
0.402
|
0.598
|
-0.197
|
4.32
|
Dissatisfier
|
High
|
2
|
Neat and tidy appearance
|
0.251
|
-0.129
|
0.381
|
0.659
|
0.341
|
0.318
|
4.56
|
Satisfier
|
Low
|
3
|
Fire and Safety compliance
|
0.205
|
0.375
|
0.580
|
0.353
|
0.647
|
-0.293
|
4.52
|
Dissatisfier
|
High
|
4
|
Comfortable environment
|
0.144
|
-0.302
|
0.444
|
0.324
|
0.676
|
-0.351
|
4.63
|
Dissatisfier
|
Low
|
Reliability
|
|
|
5
|
Appropriate services
|
0.187
|
-0.677
|
0.867
|
0.216
|
0.784
|
-0.569
|
4.59
|
Frustrator
|
High
|
6
|
Concern services
|
0.213
|
0.494
|
0.707
|
0.301
|
0.699
|
-0.397
|
4.57
|
Dissatisfier
|
Median
|
7
|
Service attitude
|
0.089
|
-0.324
|
0.409
|
0.218
|
0.782
|
-0.565
|
4.68
|
Frustrator
|
Low
|
8
|
Professional care
|
0.057
|
0.336
|
0.393
|
0.145
|
0.855
|
-0.710
|
4.63
|
Frustrator
|
Low
|
Responsiveness
|
|
|
9
|
Care-giving processes
|
0.204
|
0.400
|
0.604
|
0.338
|
0.662
|
-0.325
|
4.53
|
Dissatisfier
|
High
|
10
|
Timely service
|
0.191
|
0.483
|
0.674
|
0.283
|
0.717
|
-0.433
|
4.6
|
Frustrator
|
High
|
11
|
Consultation services
|
0.239
|
0.161
|
0.400
|
0.598
|
0.403
|
0.195
|
4.51
|
Satisfier
|
Median
|
12
|
Care skills
|
0.207
|
0.066
|
0.273
|
0.758
|
0.242
|
0.516
|
4.56
|
Delighter
|
Low
|
Assurance
|
|
|
13
|
Reliable services
|
0.149
|
-0.304
|
0.449
|
0.332
|
0.668
|
-0.336
|
4.66
|
Dissatisfier
|
High
|
14
|
Sense of security
|
0.182
|
0.000
|
0.182
|
1.000
|
0.000
|
1.000
|
4.73
|
Delighter
|
Low
|
15
|
Good manners
|
0.191
|
-0.036
|
0.231
|
0.827
|
0.173
|
0.654
|
4.69
|
Delighter
|
Low
|
16
|
Professional knowledge
|
0.174
|
0.314
|
0.488
|
0.357
|
0.643
|
-0.287
|
4.66
|
Dissatisfier
|
High
|
Empathy
|
|
|
17
|
Special needs care
|
0.093
|
0.104
|
0.197
|
0.472
|
0.528
|
-0.056
|
4.46
|
Hybrid
|
Low
|
18
|
Patient-centered care
|
0.196
|
-0.042
|
0.236
|
0.831
|
0.169
|
0.661
|
4.49
|
Delighter
|
Low
|
19
|
Patient privacy
|
0.127
|
-0.315
|
0.447
|
0.284
|
0.716
|
-0.432
|
4.51
|
Frustrator
|
Median
|
20
|
Demand coordination
|
0.154
|
-0.806
|
0.964
|
0.160
|
0.840
|
-0.680
|
4.52
|
Frustrator
|
High
|
RI: reward index; PI: penalty index; RICS: range of impact on customer satisfaction (|PI|+RI); SGP: satisfaction-generating potential (RI/RICSi); DGP: dissatisfaction generating potential (|PI|/RICSi); IA: impact-asymmetry (SGPi-DGPi); APS: attribute performance score.
|
Result of Impact-asymmetry analysis (IAA)
To compute the potential asymmetry effects of attributes on customer satisfaction, a satisfaction-generating potential (SGP) and dissatisfaction-generating potential (DGP) were arithmetically derived for each attribute (see Table 2). Additionally, the category of attributes (satisfiers, dissatisfiers, hybrids, frustrators, and delighters) were identified by computing impact asymmetry (IA) scores. Moreover, another two-dimensional grid was constructed, with RICS values (X-axis) and IA scores (Y-axis), where the iso-impact line was drawn at IA = 0.
Figure 2(a-e) presents each factors’ IAA results. Among the tangible attributes (Figure 2a), attributes 1 (barrier-free environment), followed by 3 (fire and safety compliance)—both categorized as dissatisfiers due to negative IA—had the greatest impact on RICS values. Furthermore, attribute 4 (comfortable environment) was identified as a dissatisfier due to low impact on customer satisfaction (RICS = .444), whereas attribute 2 (neat and tidy appearance) was classified as a delighter with minimal impact on CS (RICS = .381).
Among reliability attributes (Figure 2b), attribute 5 (appropriate services) was categorized as a high impact frustrator (RICS = .867), attributes 7 (service attitude) and 8 (professional care) were low impact frustrators (RICS[7] = .409; RICS[8] = .393), and attribute 6 (concern services) was median impact dissatisfier (RICS = .707).
Regarding responsiveness attribute (Figure 2c), attribute 9 (care-giving processes) was identified as a high impact dissatisfier (RICS = .604), whereas attribute 10 (timely service) was classified as a high impact frustrator (RICS = .674). Additionally, attributes 11 (consultation services) and 12 (care skills) were categorized as moderate impact satisfier and minimal impact delighter (RICS[11] = .400, RICS[12] = .273) for CS, respectively.
Among assurance attributes (Figure 2d), attributes 13 (reliable services) and 16 (professional knowledge) were categorized as high impact dissatisfiers (RICS[13] = .449; RICS[16] = .488). However, attributes 14 (sense of security) and 15 (good manners) were recognized as high impact delighters, with low RICS impact (RICS[14] = .182; RICS[15]= .232).
Lastly, among empathy attributes (Figure 2e), attribute18 (patient-centered care) was classified as a low impact delighter (= .197), whereas attribute 17 (special needs care) was identified as a low impact hybrid. Notably, attributes 19 (patient privacy) and 20 (demand coordination) were categorized as moderate (RICS[19] = .447) and high (RICS[20] = .964) impact frustrators for CS, respectively.
In summary, we obtained four delighters, two satisfiers, one hybrid, seven dissatisfiers, and six frustrators. Attributes have “medium impact“ (6,9) and “high impact” (1,3,5,9,10,13,16,20) on satisfaction and can easily generate dissatisfaction if the performance of this attribute is poor.