Marketing Intelligence & Planning

The nature and antecedents of brand equity and its dimensions

Ravi Shekhar Kumar Satyabhusan Dash Prem Chandra Purwar
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Ravi Shekhar Kumar Satyabhusan Dash Prem Chandra Purwar, (2013),"The nature and antecedents of
brand equity and its dimensions", Marketing Intelligence & Planning, Vol. 31 Iss 2 pp. 141 - 159
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The nature of
The nature and antecedents of brand equity
brand equity and its dimensions
Ravi Shekhar Kumar
XLRI School of Business & Human Resources, Jamshedpur, India, and
141
Satyabhusan Dash and Prem Chandra Purwar
Indian Institute of Management Lucknow, Lucknow, India

Abstract
Purpose The purpose of this paper is to examine the effect of brand experience on hospital brand
equity; also to assess the effects of different brand equity dimensions on overall customer-based
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hospital brand equity.

Design/methodology/approach Measurement items for each variable are developed by
integrating existing literature and qualitative in-depth interviews with patients who have either used,
or are using hospital services in India. Face-to-face interviews with patients were conducted to obtain
902 usable data points. Psychometric properties of the measurement instrument were satisfactory.
Data were analyzed using structural equation modelling to test the influences of different dimensions
of brand experience on brand equity dimensions and on overall hospital brand equity.
Findings The study found that brand experience is an important factor influencing hospital brand
equity. The study provides evidence that the brand experience dimensions (sensory, affective,
behavioural and intellectual) positively influence the five brand equity dimensions (brand awareness,
brand association, perceived quality, brand trust and brand loyalty). The study also confirms the
influence of brand equity dimensions (brand awareness, brand association, perceived quality, brand
trust and brand loyalty) on customer-based hospital brand equity.
Originality/value The distinctive contribution of this research is that it examines the effect of
brand experience on customer-based brand equity in the context of a credence-based service in an
emerging economy. Such a work is essential in understanding the importance of experiential
marketing in an emerging economy for building a strong service brand.
Keywords Hospitals, Patients, Brand equity, Brand experience, Hospital service, India
Paper type Research paper

Introduction
Research and practices in service marketing are in a state of evolution (Stuart and Tax,
2004). Initial focus was on service quality that was followed by service satisfaction.
However, increasingly researchers have realized that customer satisfaction is no
longer sufficient condition for accomplishment of sustainable competitive
advantage for a service provider. A vital element in attaining customer delight
and patronage behavior, particularly for competitive services where the
customer-service provider interface is high, deals with the delivery of memorable
personal experience (Stuart and Tax, 2004). Thus, the interest has shifted from
the notion of simply designing consistent service encounters to the staging of
memorable personal experiences because experience is unforgettable (Berry and
Bendapudi, 2003; Pine and Gilmore, 1999). Experience is one of the indicators
of service performance and results in better marketing and financial outcome for
the firm (Grewal et al., 2009; Pine and Gilmore, 1999). A memorable, unique and Marketing Intelligence & Planning
Vol. 31 No. 2, 2013
sustainable experience with a brand creates strong brand equity, especially for pp. 141-159
credence-attribute dominated service like healthcare. Building strong brand r Emerald Group Publishing Limited
0263-4503
equity is essential for differentiating a firms offerings from its competing brands DOI 10.1108/02634501311312044
 MIP (Yoo et al., 2000). The greater the credence attributes of service, the greater
31,2 is the importance of brand equity as a source of competitive advantage (Bharadwaj
et al., 1993).
Within services, healthcare processes are dynamic and complex systems that offer a
fertile arena for research. Marketing for healthcare service poses unique challenge
because in healthcare service delivery the interaction between the customer and service
142 provider is very high. This service is high in credence attributes because even after
the consumption of service its performance cannot be judged (Moorthi, 2002). It is one
of the most intangible of all services, often with high perceived risk. Branding is still
relatively new to the healthcare sector (Mangini, 2002) because of high regulation and
public scrutiny (Kotler and Clarke, 1987). Development of brand equity for healthcare
services is under-researched and unexplored (Kim et al., 2008), though brand equity is
one of the most important concepts in business practice as well as in academic research
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(Kim et al., 2008).

Despite significant interest in brand equity, little conceptual or empirical research
has addressed the effects of brand experience on brand equity. The work on hospital
brand equity is also limited (Kim et al., 2008). Blackston (1992) conceptualized trust
and satisfaction with company as dimensions of brand equity; Kim et al. (2008)
empirically tested brand awareness and brand loyalty as dimensions of brand equity in
Korean hospital context; and Chahal and Bala (2008) tested brand awareness, brand
association and brand loyalty as dimensions of brand equity. However, these studies
lack comprehensive outlook, as antecedents of brand equity dimensions are not well
explored in these studies. Experience with a service provider is the mechanism through
which brand equity is built (Berry, 2000). Research in the field of brand experience is
emerging to evolve, off late. A few studies (Labarere et al., 2004; Pettersen et al., 2004)
on patients experience with hospital have been conducted, but these studies lack a
comprehensive analysis of the focussed construct (patients experience). Our objective
in this study is to advance the theory and practice of service brand experience.
The primary motivation behind this study is to investigate the effects of brand
experience on customer-based brand equity for a credence-dominant service
(healthcare). Specifically, the present study has the following objectives: to examine
the effect of brand experience dimensions in building brand equity; to test the impact
of brand equity dimensions on overall customer-based hospital brand equity; and to
investigate the interrelationships among customer-based brand equity dimensions.
This paper should serve as a good starting point for researchers interested in the topic
of brand experience in the healthcare industry, especially in emerging market.
The present study is conducted in the emerging market context. The study focusses
on Indian hospital market. Indian healthcare market is one of the largest service sectors
in India (India Brand Equity Foundation (IBEF), 2010). It accounted for 4.2 percent of
Indias nominal GDP in 2011, though the global median of spending was 6.5 percent
of nominal GDP (WHO Statistics, 2011 as reported in CRISIL Research, 2011).
The healthcare spending in terms of GDP percentage is far lower in an emerging
economy like India than those in the developed economies (WHO Statistics, 2011 as
reported in CRISIL Research, 2011). Therefore, emerging economy presents a fertile
ground for the growth of healthcare industry. Moreover, Indian healthcare industry
has got a high business potential due to increased medical tourism which has been
predicted to be about US$2 billion by 2012 (IBEF, 2010).
An emerging market like India has five distinct characteristics market
heterogeneity, sociopolitical governance, chronic shortage of resources, unbranded
 competition and inadequate infrastructure that are quite different from the developed The nature of
economy (Sheth, 2011). The same is the case for Indian healthcare industry as well. brand equity
However, with increased health consciousness, increasing income, changing
demographic profile and increasing insurance coverage, healthcare industry
especially in India an emerging economy presents a high-growth potential (CRISIL
Research, 2011). The expected compounded annual growth rate of Indian healthcare
industry during 2010-2011 to 2015-2016 is 12 percent (CRISIL Research, 2011). 143
By 2025, Indian hospital market will require another 1.75 million hospital beds
with a US$86 billion investment (IBEF, 2010). This presents a huge potential for new
as well as existing players to build new hospitals. Indian hospitals, at the same time,
are characterized with huge competition (private players account for 68 percent of
healthcare spending; CRISIL Research, 2011). The present study, therefore, assumes
importance and has the potential to provide precise insights to the healthcare
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marketers in an emerging economy like India.

The study is presented in the following manner. First, we draw from the research
literature to define brand experience and its dimensions; and brand equity and its
dimensions. This is followed by development of the relational linkage between brand
experience dimensions and brand equity dimensions. Thus, we generate research
hypotheses and develop the proposed framework that explains the relationship
between brand experience dimensions and brand equity dimensions. Second, we
empirically test the developed hypotheses. Third, we discuss the practical and
theoretical implications of the results. Finally, we conclude with limitation and future
scope of research.

Literature review and hypotheses development

Brand experience
When exposed to information, experience is bound to happen. Customers consciously
and unconsciously feel experiences, and organize them into sets of impressions (Berry
and Carbone, 2007). Customer experience is defined as the internal and subjective
response that customers have to any direct or indirect contact with a firm. It covers
every aspect of a firms offering which may include the quality of care, advertising,
packaging, product and service features, ease of use and reliability (Meyer and
Schwager, 2007). Experience is a multi-dimensional variable with various researchers
conceptualizing it differently. Table I briefly covers the different conceptualizations
of experience. Holbrook and Hirschman (1982) conceptualized consumption experience
comprising of fantasy, feeling and fun. Otto and Ritchie (1996) listed hedonic, novelty,
stimulation, safety, comfort and interactive as dimensions of experience for tourism
experience. Schmitt (1999) conceptualized sense, feel, think, act and relate as
dimensions of customer experience. Pine and Gilmore (1998) suggested four realms of
experience namely, entertainment, education, estheticism and escape. Working on the
experiential value, Mathwick et al. (2001) empirically identified esthetics, playfulness,
service excellence, customer return on investment as the dimensions of experiential
value in online and offline shopping. Sensorial, emotional, cognitive, pragmatic,
lifestyle and relational are the dimensions proposed by Gentile et al. (2007). Chang and
Chieng (2006) empirically tested the effects of individual experience (sense, feel
and think) and shared experience (act and relate) on customer-brand relationship.
Coherent with customer experience definition, brand experience is defined as
subjective, internal and behavioral responses evoked by brand-related stimuli (Brakus
et al., 2009). It is a multi-dimensional phenomenon comprising of sensory, affective,
 MIP Experience dimension Relevant literature Context
31,2
Fantasies, feelings and fun Holbrook and Conceptual paper
Hirschman (1982)
Hedonic, novelty, stimulation, safety, Otto and Ritchie (1996) Airlines, hotels and tours
comfort, interactive and attractions
Entertainment, education, estheticism Pine and Gilmore (1998) Conceptual paper
144 and escape
Sense, feel, think, act, relate Schmitt (1999) Conceptual paper
Esthetics, playfulness, service excellence, Mathwicka et al. (2001) Empirical study of shopper
customer return on investment
Brand experience, transactional OLoughlin et al. (2004) Irish financial services
experience, relationship experience
Individual experience (sense, feel and Chang and Chieng Empirical study of coffee
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think), shared experience (act and relate) (2006) chain stores

Table I. Sensorial, emotional, cognitive, pragmatic, Gentile et al. (2007) A study on some brands
Summary of lifestyle and relational
conceptualizations Sensorial, affective, behavioral, Brakus et al. (2009) An empirical study on
of brand experience intellectual a variety of brands

behavioral and intellectual experiences of a customer with the brand (Iglesias et al.,
2011; Brakus et al., 2009). Brand experience is evoked by functional, mechanic and
humanic clues provided by the firm (Berry and Carbone, 2007).
The concept of service experience is described as the core of the service offering
and service design (Zomerdijk and Voss, 2010). It is a key concept in the emerging
paradigm of service-dominant logic and regards the service experience as the basis
of all business (Vargo and Lusch, 2008; Helkkula, 2011). In the present study, we
conceptualize brand experience comprising of four dimensions (sensory, affective,
behavioral and intellectual experience) as these four dimensions encompass each
aspect of experience (Brakus et al., 2009).

Brand experience dimensions

Sensory marketing appeals to the senses and creates experiences through five senses
sight, sound, touch, taste and smell (Schmitt, 1999). It is used to differentiate brands
by creating awareness among customers. Physical artifacts or mechanic clues of the
service provider are generally the indicators of sensory brand experience (Brakus et al.,
2009). One of the key principles of sense is cognitive consistency or sensory variety
(Schmitt, 1999). The cognitive consistency induces recall and recognition of a brand
while variety induces association. Sensory experience also provides esthetic pleasure,
excitement, beauty and satisfaction through sensory stimulation (Schmitt, 1999).
Sensory variety and cognitive consistency induces association with the brand, as
sensory experience gets linked to the memory in the mind. Brand association also gets
augmented through sensory and mental impressions stored in the mind (Chang and
Chieng, 2006). Thus, we hypothesize:
H1a. Sensory brand experience positively influences brand awareness.

H1b. Sensory brand experience positively influences brand association.

Affective brand experience is related to the moods and emotions of customers
toward the brand (Schmitt, 1999). It is generated through the humanic clues of service
 providers. It represents the outcome of feel marketing (Schmitt, 1999). Feel marketing The nature of
appeals to customers inner feelings and emotions, with the objective of creating brand equity
affective experience that range from mildly positive moods linked to a brand to strong
emotions like joy and pride (Schmitt, 1999). Feel marketing is the strategy and
implementation of attaching affect to the firm and the brand via experience providers
(Schmitt, 1999; Brakus et al., 2009). Emotional experiences facilitate creation and
reinforcement of brand associations (Chang and Chieng, 2006). Feel marketing 145
(affective brand experience) results in brand association. Strong feelings result from
contact and interaction, and they develop over time (Schmitt, 1999). They are related to
personal encounters and face-to-face interactions are an important source of strong
feelings (Schmitt, 1999). Perceived superiority or inferiority of service is affected by
affective brand experience of the service providers. Thus, we hypothesize:
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H2a. Affective brand experience positively influences brand association.

H2b. Affective brand experience positively influences perceived quality.

Behavioral brand experience is related to bodily experience aroused due to interaction

with the brand (Schmitt, 1999; Brakus et al., 2009). It is generated by both
the humanic and the functional clues of the brand. Behavioral brand experience is the
outcome of act marketing. Act marketing aims to affect bodily experience and
enriches customers lives by improving their physical experiences (Schmitt, 1999).
Perceived superiority or inferiority of brand is the result of behavioral brand
experience. In case of risky situations, behavioral brand experience provides the
ability to the buyer to assess the service providers ability to perform effectively
and reliably and concern in the customers best interests (Doney and Cannon, 1997).
Bodily experience also evokes the commitment by the buyer to the focussed brand.
Thus, we hypothesize:

H3a. Behavioral brand experience positively influences perceived quality.

H3b. Behavioral brand experience positively influences brand trust.

H3c. Behavioral brand experience positively influences brand loyalty.

Intellectual brand experience appeals to customers problem-solving thoughts

(Schmitt, 1999; Brakus et al., 2009). Intellectual brand experience is induced by think
marketing. Think marketing appeals to the intellect with the aim of generating
cognitive and problem-solving experiences (Schmitt, 1999). Such thoughtful experience
evokes customers convergent and divergent thinking (Schmitt, 1999). Brand
association is the result of thought experience (Chang and Chieng, 2006). Think
marketing also encourages customers to engage in elaborative and creative thinking
that may result in a revaluation of the brand (Schmitt, 1999). Elaborative thinking
experience affects brand quality assessment, trust building and commitment toward
the brand. Thus, we hypothesize:

H4a. Intellectual brand experience positively influences brand association.

H4b. Intellectual brand experience positively influences perceived quality.

 MIP H4c. Intellectual brand experience positively influences brand trust.
31,2
H4d. Intellectual brand experience positively influences brand loyalty.

Brand equity dimensions

Like brand experience, brand equity is also a multi-dimensional concept (Aaker,
146 1996; Yoo et al., 2000). Steadily growing literature on brand equity suggests
different dimensions of customer-based brand equity. A comprehensive literature
review on customer-based brand equity study was conducted to identify dimensions of
customer-based brand equity in the healthcare service. Hospital brand equity has been
conceptualized to be comprising of knowledge equity, benefit equity and relationship
equity of the focussed brand.
Brand awareness is one of the dimensions of brand equity. It is the ability of
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a customer to recognize or recall that a brand is a member of a certain product

category (Aaker, 1991). Aaker (1991, 1996) theorized brand awareness, as one of
the dimensions of customer-based brand equity. Keller (1993), working primarily on
customer knowledge, advocated brand awareness and brand image as dimensions
of customer-based brand equity. Yoo et al. (2000), Pappu and Quester (2006, 2008), Tong
and Hawley (2009) empirically validated brand awareness as one of the dimensions
of customer-based brand equity. Brand awareness is the part of knowledge equity.
The depth and breadth of brands awareness determine brand equity Keller (1993).
Hence, we hypothesize:

H5. Brand awareness positively affects customer-based brand equity.

Brand association is the second dimension of customer-based brand equity. It is

anything linked in memory to a brand (Aaker, 1991). A link to a brand will be stronger
when it is based on many experiences or exposure (Aaker, 1996). Aaker (1991, 1996)
theorized brand association as one of the dimensions of customer-based brand equity.
Yoo et al. (2000), Pappu and Quester (2006, 2008), Tong and Hawley (2009) empirically
validated brand association as one of the dimensions of customer-based brand equity.
Brand association is another part of customers knowledge equity about the brand.
Hence, we hypothesize:

H6. Brand association positively affects customer-based brand equity.

Perceived quality is another core dimension of customer-based brand equity. It is

customers overall impression of the relative inferiority or superiority of the
organization and its services (Zeithaml, 1988). It represents benefit equity of patient
about the hospital. Aaker (1991, 1996) theorized perceived quality as one of the
dimensions of customer-based brand equity. Yoo et al. (2000), Pappu and Quester (2006,
2008), Tong and Hawley (2009) empirically validated perceived quality as one of the
dimensions of customer-based brand equity. Hence, we hypothesize:

H7. Perceived quality of hospital positively affects customer-based brand equity.

Brand trust is a dimension which has received wider attention from researchers to
assess customer-based brand equity. It is the confident expectations of the brands
perceived credibility and benevolence in situations entailing risk to the customer
 (Doney and Cannon, 1997). Blackston (1992), Lassar et al. (1995), Chaudhuri The nature of
and Holbrook (2001), Rios and Riquelme (2008), Burmann et al. (2009) conceptualized brand equity
brand trust as a dimension of customer-based brand equity, affecting overall
brand equity. Brand trust is a part of customers relationship equity with the brand.
Hence, we hypothesize:

H8. Brand trust positively affects customer-based brand equity. 147

Brand loyalty is the core dimension of customer-based brand equity. It is the
deeply held commitment to buy again or patronize a preferred product or service
consistently in the future, thereby causing repetitive same-brand or same brand-set
purchasing, despite situational influences and marketing efforts having the
potential to cause switching behavior (Oliver, 1997). Aaker (1991, 1996) theorized
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brand loyalty as one of the dimensions of customer-based brand equity. Yoo

et al. (2000), Pappu and Quester (2006, 2008), Tong and Hawley (2009) empirically
validated brand loyalty as the dimension of customer-based brand equity.
Brand loyalty is another part of customers relationship equity with the brand.
Hence, we hypothesize:

H9. Brand loyalty positively affects customer-based brand equity.

Hierarchical relationships of brand equity dimensions

In our conceptualization of customer-based brand equity, we have previously identified
five customer-based brand equity dimensions brand awareness, brand associations,
perceived quality, brand trust and brand loyalty. Previous studies (Pappu et al., 2005)
have established relationship among brand awareness, brand associations, perceived
quality and brand loyalty. There is also linkage between brand trust and brand loyalty
the former being antecedent to brand loyalty (Chaudhuri and Holbrook, 2001). Yoo et al.
(2000) have also suggested a possible causal order between customer-based brand
equity dimensions. Thus, it is predicted that brand awareness which is elementary
form of customer knowledge will positively affect brand association which is higher
degree of customer knowledge. Customers brand association will influence the
perception of superiority or inferiority of brands offering. The more a customer is
associated with the brand, the better the perception of service quality will be. In the
similar vein, perceived quality affects trust level in customer about the brand.
The higher the perceived quality, the higher will the trust in the brand. Further, it is
well established in the literature that brand trust leads to brand loyalty. A customer
having high trust in brand will be more committed toward that brand. Thus, we
hypothesize hierarchical relationships among the five customer-based brand equity
dimensions (i.e. brand awareness, brand associations, perceived quality, brand trust
and brand loyalty). Hence, we present the following hypotheses:

H10a. Brand awareness is positively related to brand association.

H10b. Brand association is positively related to perceived quality.

H10c. Perceived quality is positively related to brand trust.

H10d. Brand trust is positively related to brand loyalty.

 MIP Figure 1 presents the conceptual framework to be tested in this study. In this
framework we identify four dimensions of brand experience (sensory, affective,
31,2 behavioral and intellectual brand experience). These dimensions are antecedents to
five customer-based brand equity dimensions (brand awareness, brand association,
perceived quality, brand trust and brand loyalty). These dimensions ultimately impact
overall hospital brand equity.
148
Methodology
Integrating extant literature with in-depth semi-structured interviews with 60 patients
who have either availed of or are availing of hospital services in two Indian cities
(Lucknow and Delhi), and interactions with three physicians and five researchers, we
have developed a set of 20 hypotheses. The in-depth interviews with stakeholders were
conducted in June, July and August of 2010. Items for measuring each variable
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were adopted from existing literature and their psychometric properties were verified
through stakeholders (i.e. patients, physician and researchers) interviews. Table II
presents the source and details of items measuring the variables included in the study.
Research instrument was pretested in two phases (first with 85 data points and second
with 175 Indian patients who had availed of hospital services in the 12 months
preceding the survey). Psychometric properties of items were checked and items were
modified and deleted wherever necessary.
Following pretesting, the items included in the final questionnaire survey were
systematically randomized. The research instrument was administered to 902 Indian
patients who had availed of hospital services in the 12 months preceding the survey.
Face-to-face interviews were held by administering structured questionnaire during
May 2011 and January 2012. Sampling was done in two stages, first for choosing the
hospitals and then for choosing the respondents. In the first stage, disproportionate
stratified random sampling of hospitals was done for the Tier 1, Tier 2 and Tier 3
Indian cities and in the second stage, convenience sampling was done to get
responses from 902 individual customers of the chosen hospitals. Table III presents the
sample characteristics.

Sensory brand Brand

experience awareness

Brand
Affective brand association
experience

Customer-based
Perceived brand equity
quality
Behavioral brand
experience

Brand trust
Figure 1. Intellectual brand
Conceptual framework experience
linking brand experience
to brand equity Brand loyalty
 Variable
Sensory brand experience
Affective brand experience
Behavioral brand experience
Intellectual brand experience
Brand awareness
Brand association
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Source Number of items
The nature of
brand equity
3 items adopted from Brakus et al. (2009) and 4
1 item developed for the study
3 items adopted from Brakus et al. (2009) and 4
1 item developed for the study
3 items adopted from Brakus et al. (2009) and 4
1 item developed for the study
149
3 items adopted from Brakus et al. (2009) 3
3 items adopted from Yoo et al. (2000) and 4
1 item adopted from Aaker (1996)
2 item adopted from Yoo et al. (2000), 1 item 4
adopted from Tong and Hawley (2009) and
1 item adopted Aaker (1996)

Perceived quality 4 items adopted from Dagger et al. (2007) 4

Brand trust 6 items adopted from Doney and Cannon (1997) 6
Brand loyalty 3 items adopted from Yoo et al. (2000) and 1 item 4 Table II.
adopted from Sichtmann (2007) Details of items
Overall brand equity 4 items adopted from Yoo et al. (2000) 4 measuring variable

Table IV presents the correlations between the variables included in the study.
The table shows high correlations among brand experience dimensions (sensory,
affective, behavioral and intellectual brand experience). There is also high correlation
among brand equity dimensions, brand experience dimensions and overall brand
equity. The high correlation values among variables provide preliminary indication of
support for the research hypotheses.

Results
Measurement model
Before testing the hypotheses, reliability and validity of measured items were
established. Composite reliability of each variable exceeded 0.6 (Bagozzi and Yi,
1988). To establish convergent validity, it was found that each item loading
exceeded 0.5 (Anderson and Gerbing, 1988). Table V presents the loading of each
item on its respective latent construct. The correlation matrix (Table IV) suggested
that correlation between two construct is significantly below 1. This proved the
discriminant validity of each construct. To provide rigorous test of the discriminant
validity, covariance among items was fixed to 1.00 and significantly lower w2 value
was reported for the unconstrained model in comparison to the constrained
model (Bagozzi and Phillips, 1982; Anderson and Gerbing, 1988). This supported the
discriminant validity of the variables. Overall goodness of fit of the measurement
model is satisfactory (w2(df ) 2,800.79(734); w2/df 3.82; CFI 0.92; IFI 0.92;
RMSEA 0.06; RMR 0.03).

Structural model
Structural equation modeling was used to estimate the parameters of the structural
model, and completely standardized solution was computed by AMOS 4. The
structural model specified brand experience dimensions (i.e. sensory brand experience,
affective brand experience, behavioral brand experience and intellectual brand
experience) as exogenous constructs. These constructs were selectively related to the
five brand equity dimensions (brand awareness, brand association, perceived quality,
 MIP Characteristics Category Number of respondents
31,2
Age group o21 55 (6.1%)
21-30 430 (47.7%)
31-40 175 (19.4%)
41-50 110 (12.2%)
150 51-60 66 (7.3%)
460 50 (5.6%)
No response 16 (1.8%)
Gender Male 595 (66.0%)
Female 305 (33.8%)
No response 2 (0.2%)
Education Illiterate 9 (1.0%)
Less than secondary (10th standard) 32 (3.5%)
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Secondary (10th standard) 37 (4.1%)

Senior secondary (12th standard) 68 (7.5%)
Graduate 375 (41.6%)
Diploma 43 (4.8%)
Post-graduate 306 (33.9%)
Phd 26 (2.9%)
No response 6 (0.7%)
Income oRs. 1,00,000 150 (16.6%)
Rs. 1,00,000-Rs. 2,00,000 179 (19.8%)
Rs. 2,00,001-Rs. 4,00,000 189 (21.0%)
Rs. 4,00,001-Rs. 6,00,000 113 (12.5%)
Rs. 6,00,001-Rs. 10,00,000 101 (11.2%)
4Rs. 10,00,000 111 (12.3%)
No response 59 (6.5%)
Type of patient Inpatient 369 (40.9%)
Outpatient 502 (55.7%)
No response 31 (3.4%)
Type of hospital Government hospital 325 (36.0%)
Private hospital 528 (58.5%)
No response 49 (5.4%)
Table III.
Sample characteristics Note: Figures in parentheses show the percentages to the total number of respondents

brand trust and brand loyalty), which are related to final construct (overall
hospital brand equity). Goodness-of-fit statistics, indicating the overall acceptability
of structural model analyzed, showed good fit with the data: w2(df ) 374.19 (19);
w2/df 19.69; CFI 0.96; IFI 0.96; RMSEA 0.14; RMR 0.03; GFI 0.94. The
hypothesized paths were significant. A detailed result of the path analyses is reported
in Table VI.

Relationships between brand experience dimensions and brand equity dimensions

Empirical support was found for the relationships between brand experience
dimensions and brand equity dimensions as hypothesized through H1a-H4d. Sensory
brand experience is significantly related to brand awareness (b 0.61, po0.01) and
brand association (b 0.15, po0.01). Affective brand experience is significantly
related to brand association (b 0.24, po0.01) and perceived quality (b 0.27,
po0.01). Behavioral brand experience is significantly related to perceived quality
(b 0.13, po0.01), brand trust (b 0.23, po0.01) and brand loyalty (b 0.14,
 SBE ABE BBE IBE BAw BAs PQ BT BL OBE
The nature of
brand equity
SBE 1.00
ABE 0.87** 1.00
BBE 0.79** 0.84** 1.00
IBE 0.78** 0.82** 0.82** 1.00
BAw 0.61** 0.61** 0.61** 0.61** 1.00 151
BAs 0.71** 0.73** 0.69** 0.70** 0.72** 1.00
PQ 0.79** 0.78** 0.74** 0.74** 0.66** 0.77** 1.00
BT 0.76** 0.74** 0.74** 0.74** 0.64** 0.73** 0.80** 1.00
BL 0.78** 0.76** 0.71** 0.72** 0.62** 0.73** 0.76** 0.81** 1.00
OBE 0.66** 0.66** 0.62** 0.61** 0.60** 0.68** 0.68** 0.71** 0.77** 1.00 Table IV.
Pearson correlation
Notes: SBE, sensory brand experience; ABE, affective brand experience; BBE, behavioral brand among dimensions of
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experience; IBE, intellectual brand experience; BAw, brand awareness; BAs, brand association; brand experience and
PQ, perceived quality; BT, brand trust; BL, brand loyalty; OBE, overall brand equity. **po0.01; *po0.05 brand equity

po0.01). Intellectual brand experience is significantly related to brand association

(b 0.15, po0.01), perceived quality (b 0.16, po0.01), brand trust (b 0.18, po0.01)
and brand loyalty (b 0.17, po0.01).

Relationships between brand equity dimensions to brand equity

As hypothesized, brand awareness (H5), brand association (H6), perceived
quality (H7 ), brand trust (H8) and brand loyalty (H9) emerged as significant
dimensions of brand equity. Brand equity was positively related to brand
awareness, brand association, perceived quality, brand trust and brand loyalty.
The relationship of brand loyalty (b 0.49, po0.01) to brand equity was stronger
than the relationships of brand association (b 0.12, po0.01), brand awareness
(b 0.12, po0.01), brand trust (b 0.11, po0.01) and perceived quality (b 0.08,
po0.05) to brand equity.

Relationships between brand equity dimensions

As hypothesized, there is a hierarchical relationship among brand equity dimensions
through H10a-H10d. Empirical support was found for the relationships between
brand awareness and brand association (b 0.40, po0.01), brand association and
perceived quality (b 0.37, po0.01), perceived quality and brand trust (b 0.49,
po0.01) and between brand trust and brand loyalty (b 0.58, po0.01).

Relationships between brand experience dimensions and brand equity

The results for research hypotheses lead to the development of a new set of
hypotheses, which links brand experience dimensions to overall hospital brand
equity. Each brand experience dimension indirectly influences brand equity through
brand equity dimensions. Because every brand equity dimension contributes
positively to overall brand equity, if brand experience dimensions affects brand
equity dimension positively, it is expected to lead to an increase in brand equity.
Therefore, we hypothesize:

H11a. The level of brand equity is positively related to the extent to which sensory
brand experience is perceived to be high.
 MIP Factor
31,2 Variable loading

Sensory brand experience (CR 0.832)

This hospital affects my senses positively 0.780
This hospital pleases my senses 0.779
152 This hospital forms a good impression on my senses 0.713
The appearance of this hospital pleases me 0.699
Affective brand experience (CR 0.837)
I am in better mood after being treated at this hospital 0.773
This hospital puts me in a better mood 0.769
I have positive emotions about this hospital 0.755
This hospital induces positive feelings and emotions within me 0.700
Behavioral brand experience (CR 0.834)
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Treatment at this hospital gives me enough energy to do what I want to do 0.788

I become more active after being treated at this hospital 0.753
I feel healthier after being treated at this hospital 0.745
I feel energetic after being treated at this hospital 0.695
Intellectual brand experience (CR 0.783)
This hospital stimulates positive thoughts within me 0.783
This hospital encourages me to think confidently 0.761
I engage in positive thinking when I am treated at this hospital 0.671
Brand awareness (CR 0.750)
I can quickly recall this hospital 0.720
I can recognize this hospital among other competing hospitals 0.693
I am aware of this hospital 0.619
I can recognize the symbol or logo of this hospital 0.581
Brand association (CR 0.765)
I admire this hospital 0.778
This hospital has a unique image in my mind as compared to other competing hospitals 0.732
Some characteristics of this hospital come to my mind quickly 0.623
It is difficult to forget this hospital 0.535
Perceived quality (CR 0.837)
I believe this hospital offers service superior service in every way 0.789
The overall quality of the service provided by this hospital is excellent 0.753
The quality of the service provided at this hospital is impressive 0.741
The service provided by this hospital is of high standard 0.713
Brand trust (CR 0.867)
This hospital is genuinely concerned about my well-being 0.757
This hospital is honest and sincere in addressing my concerns 0.747
When making important decisions, this hospital takes care of my welfare 0.746
This hospital is trustworthy 0.737
I believe in the information provided by this hospital 0.674
This hospital keeps the promise that it makes before starting my treatment 0.667
Brand loyalty (CR 0.830)
If anyone asks me which hospital to choose, I will recommend this hospital 0.765
I will not choose any other hospital if this hospital is ready to treat my health problems 0.744
I consider myself loyal to this hospital 0.728
This hospital would be my first choice in future for any health problem 0.726
Table V. Overall brand equity (CR 0.826)
Confirmatory factor Even if another hospital has the same facilities as this hospital, I would prefer to
analysis results of choose this hospital 0.769
variables in the
measurement scale (continued)
 Factor
The nature of
Variable loading brand equity
If another hospital is not different from this hospital in any way, it seems smarter
to choose this hospital 0.744
If there is another hospital as good as this hospital, I prefer to choose this hospital 0.723
It makes sense to choose this hospital instead of any other hospitals, even if they 153
are the same 0.709
Note: CR, composite reliability Table V.

Hypothesis Hypothesized relationship Path coefficient Decision

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Relationship between brand experience dimensions and

brand equity dimensions
H1a Sensory brand experience-brand awareness 0.51 (0.61)** Supported
H1b Sensory brand experience-brand association 0.14 (0.15)** Supported
H2a Affective brand experience-brand association 0.21 (0.24)** Supported
H2b Affective brand experience-perceived quality 0.28 (0.27)** Supported
H3a Behavioral brand experience-perceived quality 0.14 (0.13)** Supported
H3b Behavioral brand experience-brand trust 0.21 (0.23)** Supported
H3c Behavioral brand experience-brand loyalty 0.15 (0.14)** Supported
H4a Intellectual brand experience-brand association 0.14 (0.15)** Supported
H4b Intellectual brand experience-perceived quality 0.16 (0.16)** Supported
H4c Intellectual brand experience-brand trust 0.16 (0.18)** Supported
H4d Intellectual brand experience-brand loyalty 0.18 (0.17)** Supported
Relationship between brand equity dimensions and
brand equity
H5 Brand awareness-brand equity 0.14 (0.12)** Supported
H6 Brand association-brand equity 0.14 (0.12)** Supported
H7 Perceived quality-brand equity 0.08 (0.08)* Supported
H8 Brand trust-brand equity 0.13 (0.11)** Supported
H9 Brand loyalty-brand equity 0.49 (0.49)** Supported
Relationship between brand equity dimensions
H10a Brand awareness-brand association 0.44 (0.40)** Supported
H10b Brand association-perceived quality 0.41 (0.37)** Supported
H10c Perceived quality-brand trust 0.43 (0.49)** Supported
H10d Brand trust-brand loyalty 0.68 (0.58)** Supported
Relationship between band experience and brand equity
H11a Sensory brand experience-brand equity 0.16 (0.16)** Supported
H11b Affective brand experience-brand equity 0.13 (0.13)** Supported
H11c Behavioral brand experience-brand equity 0.21 (0.19)** Supported
H11d Intellectual brand experience-brand equity 0.24 (0.23)** Supported Table VI.
Path analytic results
Notes: Path coefficient: unstandardized coefficient (standardized coefficient). **po0.01; *po0.05 of hypotheses

H11b. The level of brand equity is positively related to the extent to which
affective brand experience is perceived to be high.

H11c. The level of brand equity is positively related to the extent to which
behavioral brand experience is perceived to be high.
 MIP H11d. The level of brand equity is positively related to the extent to which
31,2 intellectual brand experience is perceived to be high.

These hypotheses were tested using an analysis of indirect effects of brand

experience on brand equity. In structural model, no direct paths between brand experience
dimensions and brand equity were specified. Instead, as conceptualized previously,
154 brand equity was indirectly influenced through brand equity dimensions. Thus,
the effect size of brand experience dimensions on brand equity was computed on the
basis of indirect relational routes between brand experience dimension and overall
hospital brand equity. Empirical support was found for the indirect relationships
between sensory brand experience and brand equity (b 0.16, po0.01), affective
brand experience and brand equity (b 0.13, po0.01), behavioral brand experience
and brand equity (b 0.19, po0.01) and between intellectual brand experience and
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brand equity (b 0.23, po0.01).

Discussion
The present study explores the relationships between brand experience and
brand equity. Specifically, the relational linkages between four dimensions of brand
experience (sensory, affective, behavioral and intellectual brand experience) and
brand equity along with the role of five brand equity dimensions on overall brand
equity were analyzed using structure equation modeling technique. The study has
found important implications for the effects of brand experience on brand equity.
Theoretically, the present study provides insights into the emerging topic of brand
experience and its relationships with customer-based brand equity.
An experience is the basis of elaborative information processing (Brakus et al.,
2009). This study takes an experiential view of brand equity development. The
proposed framework presents brand experience as an antecedent to brand equity
dimensions. The framework identifies four dimensions of brand experience (sensory,
affective, behavioral and intellectual brand experience) and their consequences.
We have suggested the more a brand induces positive experience, the more satisfied
a customer will be with the brand. Therefore, positive brand experience results in
strong brand equity.
Sensory brand experience positively affects customer knowledge about the brand
(i.e. brand awareness and brand association). Sensory brand experience in the form of
impressions on the senses, pleasure to senses and affect toward senses positively shape
brand awareness and brand association. Affective brand experience positively affects
brand association and perceived quality. Affective brand experience covers the mood,
emotions and feeling of customer toward the brand. The mood, emotion and feeling of
customer toward the brand positively influence brand association and perceived
quality of service. Behavioral brand experience affects perceived quality, brand trust
and brand loyalty. Healthier, energetic and action-oriented behaviors are the indicators
of behavior brand experience. These behaviors induce perception of quality, trust in
the brand and commitment toward the focussed brand. Intellectual brand experience
positively affects brand association, perceived quality, brand trust and brand loyalty.
Positive thinking, positive stimulation, confident thinking enhances brand association,
perceived quality, brand trust and brand loyalty.
Consistent with Brakus et al. (2009) theorizing on brand experience, we have
suggested the sensory experience to envisage design and esthetics perceptions and
usages, the affective experience to envisage emotional judgments, the intellectual
 experience to envisage creative usage of the brand, and the behavioral experience to The nature of
envisage specific actions and physiological reactions. By providing a rigorous test of brand equity
the relationships, this study makes important contribution to the emerging experiential
marketing theory.
This paper also presents the results of an analysis of the determinants of service
brand equity in the context of a high credence service (i.e. hospital services). Although
there is a growing body of research which assesses customer-based brand equity in 155
relation to physical goods, few studies have explored this topic in a service context.
This study offers enhanced understanding of service brand equity dimensions that
influence overall hospital brand equity. Brand loyalty, brand trust, brand awareness,
brand association and perceived quality are positively related to overall hospital
brand equity. Since hospital brand equity is impacted through these five dimensions,
marketers should take advantage of the strength of these dimensions. Study has
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suggested that brand loyalty is the most significant contributor of brand equity.
The present study has also suggested hierarchical relationships between brand
equity dimensions: brand awareness leading to brand association; brand association
leading to perceived quality; perceived quality leading to brand trust; and brand trust
leading to brand loyalty.

Conclusions
As much as 60 percent of consumption in emerging markets so far has been for
unbranded products and services (Sheth, 2011). The trend looks to be similar for Indian
hospital services as well. For such market, consisting of unbranded competition for
services, market development delivers better financial performance than market
orientation (Sheth, 2011). The distinctive contribution of this research arises from how
to build a strong brand of hospital in an emerging economy like India where hospital
services are not only constrained by many factors (e.g. inadequate infrastructure and
inadequate medical professional) but also present a huge growth potential. In this
study we examined the effects of different dimensions of hospital brand experience on
customer-based brand equity in the context of a high credence service in India, an
emerging economy, for building strong brand.
This work is important as it helps us in understanding the importance of
experiential marketing in building a strong service brand. To build a strong brand, the
firm needs to stage a total customer experience that resonates, pleases, communicates
effectively and differentiates the organization from the competition (Berry and
Carbone, 2007). Given the recent business trend to conscientiously build strong brand
equity, a better understanding of the relationships between customers brand
experience and brand equity will help the efforts of practitioners in their pursuit of
building a strong brand. Hence, the following academic and practical implications
could be derived to provide guidelines for the marketers to help them in improving
their firms brand value.
Experience is a distinct economic offering of the firm (Pine and Gilmore, 1998).
As firms offerings have become more commoditized, the experience of customer with
service providers will matter most (Pine and Gilmore, 1998). Brand experience captures
and describes what customer thinks about the brand. First, this study will assist
marketer in appreciating the key role of brand experience in building brand equity.
Strategically, brand experience is a bridge between a companys effort and brand
equity. A memorable and positive experience generates a strong brand. In hospital
services, the customer no longer wants only healing but also personal transformation
 MIP which can be obtained through positive experience. While choosing a medical facility,
31,2 one unconsciously becomes detective and looks for clues to decipher the future
performance. In such a situation brand experience acts as source of information to help
a customer in choosing the service. This study attempts to provide original insights to
marketing theorists and practitioners about the significance of practicing experiential
marketing for building strong brand equity for a credence-dominant service.
156 Second, the study provides insight into the service brand equity and its dimensions.
This study investigated brand equity dimensions in hospital service that is considered
to be high credence. It identified five dimensions of service brand equity brand
awareness, brand association, perceived quality, brand trust and brand loyalty.
Focussing on developing and maintaining the determinants of brand equity will aid
marketer in positioning their service in the market, and hence influencing the choice
behavior. Practitioners must also appreciate that brand equity is a major influencer on
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the customers selection process, especially for a service as it acts as a risk reliever
(Mourad et al., 2011). Hence, practitioners should derive insight from this study in
building strong brand equity. The study also throws light on the hierarchical
development of brand equity dimensions. Marketer can also exploit this piece of
information in building a strong brand.

Limitation and future scope of research

The present study concentrates on hospital services. We acknowledge the need for
future research to empirically observe the effects of brand experience in building brand
equity in other service and product contexts. Replication of this study with different
product and service category will enhance the generalizability of the findings of this
study. Empirical support to the proposed framework in different settings will throw
further light on the significance of brand experience in building brand equity.
Second, the data collected for this study is cross-sectional. Future research can be
done using longitudinal study design as customers instinctively compare each new
experience, positive or otherwise, with their previous ones and judge it accordingly
(Meyer and Schwager, 2007). Longitudinal data will throw light on the changing
pattern of customer perceptions about the brand. This will help marketers in taking
corrective actions to build a strong brand.
Experience is dependent on expectations, and expectations can be shaped by
market conditions, the competition, and the customers personal situation (Meyer
and Schwager, 2007). Hence, brand experience may vary for different market
conditions (e.g. downturn, high/low growth, etc.). Therefore, we suggest the future
work to explore the moderating effects of marketing conditions and personal variables
for the relationship between brand experience and brand equity.
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Corresponding author
Ravi Shekhar Kumar can be contacted at: rshekharkumar@gmail.com

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