Article

Drivers of Brand Engagement: Global Business Review

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The Role of Brand Communities © 2019 IMI
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DOI: 10.1177/0972150919825516
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Sumanjit Dass1,2
Rahul Sethi3
Sapna Popli1
V. N. Saxena4

Abstract
Today, all major brands are engaging their stakeholders through online and offline brand communities,
fan clubs and social media groups, with the objective of attracting the right audience. Brand com-
munities have gained importance as a branding tool for marketers because they offer values difficult
to capture elsewhere. An engaged community transports results in numerous areas of the business.
The principal objective of this article is to explore brand communities of radiologist and how these
communities enhance brand engagement in medical equipment industry. The article has used a single
cross-sectional descriptive design and is based on the data collected from 152 users of a large medical
products company that comprised product managers from partner industries and radiologists across
India. The results from this study confirm the proposed model of interactions between variables and
revealed significant relationships between brand communities and brand engagement. The study high-
lights the significance of brand communities and their usage to enhance brand engagement, in high-value
and high-risk product market. The instruments used for the study are validated for the constructs of
brand trust, satisfaction, community and engagement.

Keywords
Brand satisfaction, brand trust, brand communities, brand engagement, healthcare, medical, high-value
high-risk products

Introduction
The Indian healthcare industry in the last 6 years (2010–2016) grew from US$59 to 160 billion, and it is
expected to touch US$260 billion by 2020 (Brand India, 2018). The burgeoning middle class and demand

1
IMT Ghaziabad, Ghaziabad, India.
2
ICFAI University, Dehradun, India.
3
Business Development, Healthcare Division, Barco Electronic Systems (P) Ltd, India.
4
Information Technology, ICFAI Business School, Dehradun, India.

Corresponding author:
Sapna Popli, IMT Ghaziabad, Raj Nagar, Ghaziabad 201001, India.
E-mails: sapnapopli@gmail.com; spopli@imt.edu
2 Global Business Review

for quality healthcare services have been fuelling this growth. Healthcare facilities, private–public
projects, medical diagnostic and pathological laboratories and the health insurance sector are further
providing the boost to the healthcare industry in India (Brand India, 2018). India imports about
70 per cent of medical devices (Ramkumar, 2016), mostly high-end, technological, medical devices for
diagnostic which include multiparameter monitors, defibrillators, transport monitors and radiology
scanners. The rise in imports of medical devices can be related to the growing investment by private
healthcare providers who continue to expand and set up state-of-the-art hospitals in India. Hospitals
groups such as Max, Fortis, Manipal, Aster DM and Apollo are now increasing their footprints in tier
II cities and offering premium services to attract medical tourism (Ramkumar, 2016).
The hospital and diagnostic centres grossed foreign direct investment (FDI) amounting US$5.25
billion between April 2000 and June 2018, as per the data published by the Department of Industrial
Policy and Promotion (DIPP). The hospital industry in India is predicted to rise to `8.6 trillion (US$132.84
billion) by 2022 from `4 trillion (US$61.79 billion) in 2017 at a CAGR of 16–17 per cent (Brand India,
2018). In emerging markets like India, companies like Barco, Eizo, Sony and NDS are bringing such
innovations that are closer to people (Mateo, 2010).
Healthcare providers want to take maximum advantage of this demand by increasing their presence
and services across the country, which has further led to increased investment in people, medical products
and devices in this industry (Tiwari, 2018). Medical products that are of high value like that of a radiology
imaging display, compared with the usual commercial displays, demand a very high involvement of the
consumer in its acceptance and percolation (Patterson, 1993; Samiee, 1994). Owing to the high value of
the product, the decision-making becomes complex with multiple stakeholders getting involved in the
purchasing decision, thereby prolonging the process.
It has thus become imperative that companies with high-value, high-risk product categories like that
of the hospital and medical equipment industry come together with all its stakeholders to form an
engaged community that enables and facilitates informed and a faster decision-making process for the
consumer. This article explores the association of brand communities and brand engagement and how
they can contribute and aid the complex decision-making process in such product categories.
The article is structured, to begin with, an introduction discussing the healthcare industry in India,
followed by a literature review of the four constructs of brand satisfaction, brand trust, brand community,
brand engagement and their associations. The constructs are then modelled through a conceptual
framework. The validation of the model is then presented using factor analysis and structured equation
modeling (SEM).

Review of Literature

Brand Community
Communities can be simply defined as a group of people who come together and interact with one
another towards a common interest. Extant research has proved that brand communities not only motivate
better reach but also add value to the consumer’s journey cycle (McAlexander, Schouten, & Koenig,
2002). Existing research supports the formation of communities as a part of marketing strategy
(McAlexander et al., 2002; Muniz & O’Guinn, 2001; Stokburger-Sauer, 2010). Brand communities are
similar to traditional communities where people advocate, help and support a cause with the only
difference being that in brand communities there are no geographical boundaries (Cova & Pace, 2006;
Muniz & O’Guinn, 2001). Today communities exist in physical and virtual form because of the advent
of technology and the internet. Whether physical or virtual, communities are symbols of traditions,
Dass et al. 3

socially shared consciousness coupled with responsibility towards the society (Muniz & O’Guinn, 2001;
Schau, Muñiz Jr, & Arnould, 2009). Brand communities are responsible at large for creating social
awareness about the brand and have a pivotal role in co-creating a legacy for the brand and its consumers
(Muniz & O’Guinn, 2001). A brand community provides its members with a platform for exchanging
experiences, emotions, feeling about the brand and gain more information and knowledge (Constantin,
Platon, & Orzan, 2014; Fuller, Matzler, & Hoppe, 2008).
Brand communities are considered to be a ‘possible path’ to the ‘Holy Grail of brand loyalty’
(McAlexande et al., 2002; Muniz & O’Guinn, 2001; Thompson & Sinha, 2008). Brand communities
help the marketer to understand the relationship that the consumer shares with the brand, be it positive
or negative (Constantin et al., 2014). Apart from developing customer loyalty, brand communities also
derive engagement. A participative community increases not only the engagement between the brand and
its customers but also induces loyalty (Casaló, Flavián, & Guinalíu, 2007; Koh & Kim, 2004), love
(Cova & Pace, 2006; Vernuccio, Pagani, Barbarossa, & Pastore, 2015) and trust (Chaudhuri & Holbrook,
2001; Jang, Olfman, Ko, Koh, & Kim, 2008) in them.

Brand Communities in Medical Fraternity

Brand communities have been long accepted and appreciated as a tool for marketing effectively in the
consumer’s goods and durables sector. Consumer’s durables that include whole bunch of goods from
automobiles, electronics, jewellery to toys have been the first into community building. For example,
HOG community by Harley-Davidson owners group, PlayStation community by SONY, Lego Ideas, a
creative online community from Danish toy production company ‘Lego’ for enthusiasts and users who
would find, innovate and submit ideas for new toy designs, have been one of the early starters into
community building.
BeingGirl from the fast-moving consumer goods (FMCG) major Procter and Gamble also has been
one of the successful early adopters which has reaped the benefits of brand communities. Brand
communities are now becoming more important with the service industry too, the SAP community
network (SCN) from SAP, Oracle community from IT major Oracle have been using the community to
create competitive differences in the business-to-business (B2B) segment.
Healthcare segment too is taking baby steps towards the building of brand communities (Deaso,
2016). With on-line communities like PatientsLikeMe, HealthBoards, HealthUnlocked communities,
patients can easily network with other patients in the community. Here, the patients can share their
medical experiences to let the participating brands gain knowledge through these discussions to improve
their medical outcomes. In healthcare industry satisfaction with the service obtained is most important.
Brand satisfaction, one of the most important constructs in any business, is vital for the healthcare
industry that has characteristically been slower to adopt practices that place a heavy focus on customer
satisfaction. According to the American Customer Satisfaction Index 2017 for Utilities, Shipping and
Health Care report, hospitals have accomplished a customer satisfaction score of 75 out of 100 for the
second year in a row. This placed the healthcare industry 32nd in customer satisfaction behind banks,
supermarkets and gasoline stations even in a developed country like US.
However, most of these communities are restricted to discussion of disease, patients and medicines.
There are only a few healthcare communities in India that discuss on an extensive variety of topics such
as clinical specialities, technologies, stakeholders and medical practitioners or about hospitals, devices,
healthcare and its education, and/or providing support to patients (Demiris, 2006).
In India, such communities with businesses are at an early stage and more so with healthcare industries.
With this view, the article discusses the healthcare imaging communities where the consumer (Radiologist)
is connected with the brand in a physical or virtual community through the scientific conference, clinical
workshops and medical shows.
4 Global Business Review

Radiology is a close-knit community, where the members often share their experiences with other
radiologist related to the matter of best practices, technologies, trends and devices used. Even from
an industry perspective, the radiologists are critical to their business, as many times one radiologist
would visit other facilities to see what is used and understand the reasons for using a particular solution
and recommend it to their companies. Similarly, companies use their existing users (radiologists) as a
reference for new prospects and use their facility to give product demonstrations for their solutions.
These communities are focused on topics related to medicine and radiology. Such brand communities
could offer an exclusive set of benefits for brand engagement and consumer experience through feedback,
advocacy and support that defines an engaged community.

Antecedents of Brand Community

Brand communities are triads between customer, brand and consumer, where the focus is more consumer-
centric than brand-centric (McAlexander et al., 2002). It comprises customers who identify themselves
with the brand (Brand identification) or are satisfied (Brand satisfaction) by its offerings (Algesheimer,
Dholakia, & Herrmann, 2005; Carlson, Suter, & Brown, 2008). Extant research has identified brand
satisfaction and brand trust to be the key enablers to brand communities (Kuenzel & Vaux Halliday,
2008; Tsai, Huang, & Chiu, 2012; Wang & Emurian, 2005)
Brand Satisfaction
The constructive attitude that gets developed by a consumer because of the company’s relationship with
marketing orientation and the consumer’s own consumption experience with a particular product is
satisfaction (Bhat, 2012; Kaur & Gupta, 2012; Parasuraman, Berry, & Zeithaml, 2002). It is the final
outcome or experience encountered by a consumer from a brand’s product or service.
Brand satisfaction is a measure of how well the brand has met or exceeded the expectations and
strengthened the relationship between the consumer and the brand (Aaker, 1996; Algesheimer et al.,
2005; Engel, Blackwell, & Miniard, 1990; Roy, 2011). Grisaffe and Nguyen (2011) expressed brand
satisfaction as a collective gratification derived by a consumer from his total experience with the brand
through various touch-points that include his search, purchase condition, usage and utility derived from
the whole process (Hirschman & Holbrook, 1982; Hoch, 2002; Hoch & Ha, 1986; Hui & Bateson, 1991;
Kerin, Varadarajan, & Peterson, 1992) .
Brand satisfaction is a consumer’s cognitive and emotional outcome of consistent performance
that matches customer expectation about a brand (Ganesan, 1994). The cognitive component is a
customer’s evaluation of the perceived performance to his expectation standards and deliverables
(Liljander & Strandvik, 1997; Wirtz, 1993). Happiness, disappointment and surprise form the
emotional component (Cronin Jr, Brady, & Hult, 2000; Liljander & Strandvik, 1997; Oliver &
Westbrook, 1993; Yu & Dean, 2001).
Prior experience with a brand also shapes a consumer’s reaction towards the brand and leads to
satisfaction in case of both positive and negative experience (Ganesan, 1994). Satisfaction with a brand
can also let consumers seek out and network with like-minded consumers who share their spirit, need
and enthusiasm (Algesheimer et al., 2005) in the form of communities (McAlexander et al., 2002)
Satisfaction that a consumer experiences with the brand leads to the long-term and sustainable
relationships (Anderson & Narus, 1990; Mann & Sahni, 2011; Sahin, Zehir, & Kitapçı, 2011) in the form
of brand trust (Kuenzel & Vaux Halliday, 2008; Schau et al., 2009; Wang & Emurian, 2005), brand
loyalty (Dick & Basu, 1994; Liu, Li, Mizerski, & Soh, 2012) and brand community (Algesheimer et al.,
Dass et al. 5

2005). This positive affective state could thus encourage further brand community participation and
brand advocacy driving long-term value for the company (Lawer & Knox, 2006).
Brand Trust
Brand trust is defined as the feeling of safety and security held by a consumer leading to the reduction of
risk for the consumer. A consumer experiences this feeling after his interaction with the brand, thereby
creating informed perceptions about the reliability of the brand (Delgado-Ballester, Munuera-Aleman, &
Yague-Guillen, 2003; Kaur & Gupta, 2012). The relationship between the brand and the consumer
is hugely dependent on brand trust (Elliott & Yannopoulou, 2007; Mann & Sahni, 2011). A brand that offers
the feeling of security, honesty and dependability to its consumers generates brand trust in the process
(Doney & Cannon, 1997). Trust plays a vital role for future interactions between the brand and the consumer
by strengthening the quality and expectations of an on-going relationship (Doney & Cannon, 1997;
Moorman, Zaltman, & Deshpande, 1992). Trust leads to cooperative behaviour and reduces uncertainty
and opportunistic behaviour, thereby enhancing the level of interaction in a brand community, which is
beneficial for both the brand and the consumer (Morgan & Hunt, 1994; Tsai et al., 2012).
Brand trust in healthcare is very critical as healthcare is an intimate service experience and emotions
play an integral role in healthcare decision-making (Kemp, Jillapalli, & Becerra, 2014). Every transaction
in healthcare touches a human life directly or indirectly (Hopkins, 2017).

Brand Engagement as an Outcome of Brand Communities

Literature indicates that individuals with a higher level of brand engagement tend to have a higher recall
of specific brand and lasting memory and reduced price sensitivity for their favourite brands (Franzak,
Makarem, & Jae, 2014; Sprott, Czellar, & Spangenberg, 2009). Brand engagement provides useful new
insights to marketers to improve, enhance and differentiate the customer experience from the competition
(Franzak et al., 2014).
Customer-based brand engagement is defined as ‘the level of a customer’s motivational, brand related,
context-dependent state of mind characterised by specific levels of cognitive, emotional and behavioural
activity in brand interactions’ (Brodie, Ilic, Juric, & Hollebeek, 2013; Hollebeek, 2011; Sprott et al.,
2009).
As per Bowden (2009), customer-based engagement is a psychological process that results in an
increased loyalty, commitment and trust of the customer towards the brand. Thus the actual or active
brand engagement is defined as ‘the extent to which consumers are willing to invest their own personal
resources—time, energy, money—on the brand, beyond those resources expended during purchase or
consumption of the brand’ (Keller, 2013). A consumer is engaged only when he actively collects and
seeks information about the brand’s products and services, actively participates in marketing activities,
such as taking product demo, interacting with other product users, or joins an online community.
Brand engagement is expected to generate superior organizational performance outcomes, including
sales growth (Neff, 2007), differentiation from competition, competitive advantage and profitability
(Sedley & Perks, 2008; Voyles, 2007) and addressing consumers’ positive and negative emotions related
to the brand (Hollebeek & Chen, 2014).

Objectives and Conceptual Framework

The relationships among the above-discussed constructs of brand satisfaction, brand trust and brand
communities on brand engagement are developed into a conceptual framework in Figure 1.
6 Global Business Review

Figure 1. The Conceptual Framework

Source: The authors.

In this model, the associations are propositioned as developed through the literature. Both brand
satisfaction and brand trust are seen as antecedents of brand communities. The model reflects direct as
well as indirect effects that brand satisfaction has on brand community. Brand engagement is the outcome
variable driven by brand communities in this hypothesized model. SEM has been used to validate this
conceptual framework using data for high-value high-risk products.
The research objective, thus is one, to explore the constructs of brand satisfaction (BS), brand trust
(BT), brand community(BC), brand engagement(BE) and their associations with each other and two is
to propose a conceptual model to understand their inter-relationships and measure the impact of BS,
BT and BC on brand engagements. The four associations that the article expects to explore are the
specific associations of each of the constructs propositioned as (a) brand satisfaction is positively related
to brand trust; (b) brand trust is positively related to the brand community; (c) brand satisfaction is
positively related to the brand community; and (d) brand community impacts brand engagement.

Methodology

Sample and Data Collection

The sample frame constitutes 300 radiologists whose details were collected from a leading equipment
manufacturer in metro cities. From the list, the radiologist was selected randomly with the help of random
number table.
This study was conducted using a cross-sectional descriptive design. Quantitative data were collected
using simple random sampling from radiology practitioners across the metro cities of India from the
hospitals that had a size of more than 200 beds. A total of 152 valid responses were obtained from the
total of 300 self-reporting online questionnaires forms circulated among the users.
The demographic profile of the respondents is detailed in Table 1.

Research Instruments
Before the data collection process, the questionnaires were designed based on the measurement items
for the constructs of brand satisfaction, brand trust, brand community and brand engagement as
detailed in Table 2.
Dass et al. 7

Table 1. Demographic Profile of Respondents

Type of Classification Category Number of Respondents Percentage in Sample

Age Less than 40 years 25 16.44
40–50 years 120 78.94
More than 50 years 7 4.6
Education MBBS/MD 152 100
Gender Male 95 62.5
Female 57
Number of respondents 152
Source: The authors.

Table 2. Research Instruments

Construct No. of Items Scale Proposed By Reliability

Brand satisfaction 03 Bruhn et al. (2004) 0.817
Brand trust 03 Bruhn, Eichen, Hadwich, 0.843
and Tuzovic (2012)
Brand communities 04 Woisetschläger, Hartleb, 0.846
and Blut (2008)
Brand engagement 08 Sprott et al. (2009) 0.819
Source: The authors.
Note: All the items were measured on a five-point Likert scale of strongly agree to strongly disagree.

All the items were measured on a five-point Likert scale of strongly agree to strongly disagree.
Exploratory factor analysis (EFA) using SPSS 24 was conducted on all the attributes. The analysis
yielded four dominant factors with eigenvalue more than one, which include brand trust, brand
satisfaction, brand community and brand engagement.
We set a lower cut-off of factor loading at 0.5 in the EFA, and there was no item cross loading.
Confirmatory factor analysis is subsequently conducted to confirm the dimension structure, and the
confirmatory factor analysis model achieved a good fit. Regression analysis and SEM were conducted
for impact analysis for the dimensions.

Analysis
A two-stage SEM was carried out to validate the hypothesized model (Hair, Ringle, & Sarstedt, 2013).
In the first stage, CFA was carried out to validate the proposed measurement model (MM), and in the
second stage, the structural model (SM) was developed to test the relationship among the variables as
hypothesized in the theoretical model.
EFA was used to see whether all proposed items (measured variables) load significantly on their
respective factor and, therefore, to identify the underlying relationship between measured variables and
their respective factor/construct.
8 Global Business Review

Exploratory Factor Analysis

Kaiser–Meyer–Oklin (KMO) and Bartlett’s sphericity tests were carried out to measure sample
adequacy for factor analysis and values were found to be satisfactory. The approximate of chi-square was
found to be 1,948.574 with a degree of freedom of 153, which is significant at 5 per cent level
of significance (refer to Table 3). The KMO statistic was found to be 0.914, greater than 0.50 (Hair
et al., 2013), which is considered appropriate for factor analysis. Factor analysis was performed using
SPSS 24.0.
In the pattern matrix, we got four factors with eigenvalue more than 1 as shown in Table 4.
All brand engagement items loaded in the first factor, the brand trust items loaded on second factor,
all brand satisfaction items loaded on third factor and all brand community items loaded on the fourth
factor. This way, a clear four-factor structure emerged without any cross loading. All loading value
was greater than 0.5.

Table 3. Result and Analysis

KMO and Bartlett’s Test

Kaiser–Meyer–Olkin measure of 0.914
sampling Adequacy
Bartlett’s test of Sphericity Approx. chi-square 1948.574
df 153
Sig. 0.000
Source: The authors.

Table 4. Pattern Matrix

Pattern Matrixa
Factor
1 2 3 4
BT1 –0.848
BT2 –0.800
BT3 –0.889
BS1 –0.864
BS2 –0.776
BS3 –0.582
BC1 –0.449
BC2 –0.934
BC3 –0.836
BC4 –0.764
BE1 0.657
BE2 0.427
BE3 0.736
BE4 0.757

(continued)
Dass et al. 9

Table 4. (continued)

Pattern Matrixa
Factor
1 2 3 4
BE5 0.771
BE6 0.848
BE7 0.654
BE8 0.644
Source: The authors.
Notes: Extraction method: principal axis factoring.
Rotation method: Oblimin with Kaiser normalization.
a
Rotation converged in 6 iterations.

Measurement Model: Confirmatory Factor Analysis (CFA)

In CFA, goodness-of-fit indices are estimated for each latent construct as a distinct model (Schreiber,
Nora, Stage, Barlow, & King, 2006).
With data of the 152 respondents, the four-construct CFA of brand satisfaction, brand trust, brand
communities and brand engagement was conducted to demonstrate reliability, convergent and
discriminant validity. The constructs are discriminant from each other as their squared inter correlations
(SIC) are found to be less than average variance extracted (AVE) in all cases. Based on several criteria,
the model is found to fit well. Overall Cronbach’s alpha value for brand satisfaction, brand trust, brand
communities and brand engagement were found to be 0.817, 0.843, 0.846 and 0.819, respectively.
The results show (Table 5) that the measurement model achieved very good fit (CMIN/df = 3.14, CFI =
0.85, NFI = 0.79, RMSEA = 0.08). The model adequacy was assessed by the fit indices suggested by
Hair, Anderson, Tatham and Black (2010), and Jöreskog and Sörbom (1989).

Structural Equation Modeling

The SEM was conducted using AMOS 19. The structural model achieved a very good fit (CMIN/df =
2.23, CFI = 0.915, NFI = 0.85, RMSEA = 0.09).
The structural model is as shown in Figure 2.

Table 5.

Model NPAR CMIN df P-value CMIN/df

Default model 39 415.376 132 0.000 3.147
Model NFI Delta1 RFI rho1 IFI Delta2 TLI rho2 CFI
Default model 0.798 0.766 0.853 0.828 0.851
Model RMSEA LO 90 HI 90 PCLOSE
Default model 0.08 0.115 0.143 0.000
Source: The authors.
10 Global Business Review

Figure 2. Structural Equation Modeling (SEM) Results

Source: The authors.

Table 6 summarizes the path details obtained after testing the relationship between the latent
constructs. It is also clear from Table 6 that all the path coefficients are positive and significant in the
proposed model. Therefore, our proposed model cannot be rejected and, hence, supported. That is, there
is a positive association between brand trust, brand satisfaction, brand community and brand engagement.
All standardized path values were significant at 5 per cent levels, which are given in the tables.
Hypothesized paths are shown in Table 6. All item-wise paths are shown in Table 7.
The path value of BS to BT is strong. But the path values of BS to BC and BS to BT are low, though
the values came significant at the 5 per cent level.
In Indian context, there is no established online/offline brand community for radiologists. Most of the
buying happens through word-of-mouth or rapport building between the vendor and the organization.
Dass et al. 11

Table 6. Hypothesized Paths

Hypothesized Paths Standardized Values

BT ! BS 0.86
BC ! BS 0.326
BC ! BT 0.39
BE ! BC 0.761
Source: The authors.

Table 7. Standardized Weights

Standardized Regression Weights

Estimate
BT ! BS 0.860
BC ! BS 0.326
BC ! BT 0.390
BE ! BC 0.761
BS1 ! BS 0.933
BS2 ! BS 0.909
BS3 ! BS 0.728
BT1 ! BT 0.848
BT2 ! BT 0.879
BT3 ! BT 0.934
BC1 ! BC 0.714
BC2 ! BC 0.897
BC3 ! BC 0.896
BC4 ! BC 0.828
BE1 ! BC 0.838
BE2 ! BC 0.664
BE3 ! BC 0.873
BE4 ! BC 0.714
BE5 ! BC 0.830
BE6 ! BC 0.725
BE7 ! BC 0.739
BE8 ! BC 0.704
Source: The authors.

That might be the reason behind getting a lower path value between BS and BC; BT and BC. In this
medical healthcare industry, especially among the radiologists, there is no brand community feeling,
rather it is largely driven by utilitarian buying behaviour, which calls for future research scope, on how
to strengthen brand community in this industry by identifying more driving factors.
The theoretical model/framework hypothesized has been validated by the findings of the study. The
model has statistically demonstrated that brand trust, brand satisfaction and brand community have a
significantly positive impact on brand engagement. The overall prediction of the model is quite acceptable
(Cohen, 1988; Falk & Miller, 1992).
12 Global Business Review

Conclusion
As a contribution to the theory, this research helps in identifying those constructs (brand satisfaction,
brand trust, brand community and brand engagement) and their inter-relationships that help in building
greater brand engagement with all its stakeholders. The article brings into perspective how brand
communities through engagement can increase not only loyalty and innovation but also authenticity by
continually acclimating to the mutable needs, benefits and values of the brand tribes that give them
deeper meaning.
This is perhaps a first of its kind research in high-value, high-involvement technology product
category. It has established the validity of the conceptual framework that can be taken up for further
studies in the domain.

Managerial Implications
The go-to-market strategy for this kind of high value and high technology items is always a challenging
one for the marketers. The insights gained from the study can be used to develop a strong brand
community and thereby harness a strong brand engagement to advance the adoption of high-end,
high-resolution medical display equipment among radiologists and other medical equipment users in
India. Brand trust and brand satisfaction emerge as significant variables that affect brand communities
and thereby brand engagement. The findings of this work can help in effective value engineering of the
product and value creation for customers. Also, it may help optimally design marketing campaigns to
promote communities for the specific target audience and ensure the best value from the investment.

Limitations and Future Research

The findings of the study are limited to healthcare product users of one of the large companies, therefore
may lack generalization. Future studies can extend the scope to cover users of competing brands and
other high-risk high-value products as well. Second, the data were gathered through a quantitative survey
using structured questions, a follow-up qualitative study may provide useful insights, a mixed-methods
approach may be considered for future studies. The respondents in this research were mainly drawn from
the metro cities and hospitals having more than 200 beds at least. Therefore, to arrive at a more general
conclusion to make the research findings applicable across multiple segments, further research can look
to cover hospitals in semi-urban and rural cities. Other moderating variables such as the regulatory
environment, public versus private hospitals, public spending on health, government healthcare schemes
can be considered for further research.

Acknowledgements
The authors are grateful to the anonymous referees of the journal for their extremely useful suggestions to improve
the quality of the article. Usual disclaimers apply.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of
this article.
Dass et al. 13

Funding
The authors received no financial support for the research, authorship and/or publication of this article.

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