Journal List > J Korean Acad Nurs > v.46(1) > 1003140

Hwang and Sim: Structural Equation Modeling for Public Hospital Quality of Care, Image, Role Performance, Satisfaction, Intent to (Re)visit, and Intent to Recommend Hospital as Perceived by Community Residents



The study purposes were to construct and test structural equation modeling on the causal relationship of community residents' perceived quality of care, image, and role performance with satisfaction, intention to (re)visit and intention to recommend hospital.


A cross-sectional survey was conducted with 3,900 community residents from 39 district public hospitals. The questionnaire was designed to collected information on personal characteristics and community awareness of public hospitals. Community awareness consisted of 6 factors and 18 items. The data were collected utilizing call-interview by a survey company. Research data were collected via questionnaires and analyzed using SPSS version 20.0 and AMOS version 20.0.


Model fit indices for the hypothetical model were suitable for the recommended level: χ2=796.40 (df=79, p <.001), GFI=.93, AGFI=.90, RMSR=.08, NFI=.94. Quality of care, image, and role performance explained 68.1% of variance in community awareness. Total effect of quality of care process factors on satisfaction (path coefficients=3.67), intention to (re)visit (path coefficients=2.67) and intention to recommend hospital (coefficients=2.45) were higher than other factors.


Findings show that public hospitals have to make an effort to improve community image through the provision of quality care, and excellent role performance. Support for these activities is available from both Central and Local Governments.

Figures and Tables

Figure 1

Conceptual framework.

Figure 2

Path diagram for the hypothetical model.

Table 1

General Characteristics of Participants (N =3,900)


*Use experience means whether participants were inpatients or outpatients at public hospitals in the past one year or not.

Table 2

Results of Hypothesis Testing

Table 3

Standardized Direct, Indirect, and Total Effects for the Hypothetical Model



This paper was supported by the Sehan University Research Fund in 2015.

CONFLICTS OF INTEREST The authors declared no conflict of interest.


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