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<p>Understanding how customer experience and engagement translate into behavioral intention is central to service and relationship marketing. Yet, these mechanisms remain underexplored in highly regulated health services, particularly in emerging markets. While dominant theories posit direct or satisfaction-mediated effects of experience and engagement on intention, these relationships may weaken under institutional and contractual constraints. Grounded primarily in expectation–disconfirmation theory, this study examines how such constraints reshape loyalty formation in Brazil’s Supplementary Health Subsector (SSS). Using survey data and partial least squares structural equation modeling (PLS-SEM), we test a serial mediation model in which experience enhances engagement, engagement elevates satisfaction, and satisfaction operates as the principal gateway to behavioral intention. Results show that direct effects of experience and engagement on intention attenuate under regulation, while satisfaction plays a dominant mediating role, with significant differences across operator types. The findings refine loyalty mechanisms in regulated services and offer managerial and policy insights for governance in hybrid healthcare systems.</p>

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The role of customer experience, engagement, and satisfaction on behavioral intention: reconfiguring loyalty mechanisms in regulated health services in an emerging market

  • 期刊论文

  • 发表日期：

    2026年2月12日

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  • Claudimar Pereira da Veiga,
  • Luiza Peixoto Bicalho,
  • Ana Paula Drummond-Lage,
  • Luis Felipe Dias Lopes,
  • Zhaohui Su,
  • Cássia Rita Pereira da Veiga

摘要

Understanding how customer experience and engagement translate into behavioral intention is central to service and relationship marketing. Yet, these mechanisms remain underexplored in highly regulated health services, particularly in emerging markets. While dominant theories posit direct or satisfaction-mediated effects of experience and engagement on intention, these relationships may weaken under institutional and contractual constraints. Grounded primarily in expectation–disconfirmation theory, this study examines how such constraints reshape loyalty formation in Brazil’s Supplementary Health Subsector (SSS). Using survey data and partial least squares structural equation modeling (PLS-SEM), we test a serial mediation model in which experience enhances engagement, engagement elevates satisfaction, and satisfaction operates as the principal gateway to behavioral intention. Results show that direct effects of experience and engagement on intention attenuate under regulation, while satisfaction plays a dominant mediating role, with significant differences across operator types. The findings refine loyalty mechanisms in regulated services and offer managerial and policy insights for governance in hybrid healthcare systems.