Understanding Kerala Ayurveda's Brand Formation: The Serial Mediating Roles of Affection, Connection and Passion in the Relationship between Service Quality and Clinical Excellence

Abstract

Purpose – This study investigates the comprehensive brand formation process in Kerala's Ayurveda healthcare sector. It examines a holistic framework where service quality, destination image, convenience, and perceived value influence clinical excellence and satisfaction, serially mediated by emotional brand attachment dimensions (affection, connection, and passion), ultimately leading to brand formation and loyalty.
Design/Methodology/Approach – A structured questionnaire comprising 16 multi-item constructs (64 Likert-scale items) was administered to 143 patients across multiple Ayurveda hospitals, clinics, resorts, and massage centers in Kerala. The study employs descriptive statistics, full correlation analysis, and serial mediation analysis utilizing all questionnaire variables to test the hypothesized comprehensive framework.
Findings – The results validate the serial mediation pathway (Service Quality → Affection → Connection → Passion → Clinical Excellence → Brand Formation). Additionally, destination image and perceived value emerge as significant antecedents, while treatment satisfaction and overall satisfaction act as parallel mediators bridging clinical excellence with brand loyalty. The comprehensive model explains 68.4% of the variance in brand formation.
Practical Implications – The study provides actionable insights for administrators, policymakers, and tourism stakeholders on leveraging comprehensive service design, emotional engagement, and destination branding to strengthen Kerala's position as a global Ayurveda leader.
Originality/Value – This research is the first to empirically examine a fully integrated model of Kerala Ayurveda brand formation, utilizing all dimensions of patient perception—from service quality and destination image to emotional attachment and loyalty.