Factors affecting revisit intention for medical services at dental clinics

Sewon Park; Han-Kyoul Kim; Mankyu Choi; Munjae Lee

doi:10.1371/journal.pone.0250546

. 2021 May 4;16(5):e0250546. doi: 10.1371/journal.pone.0250546

Factors affecting revisit intention for medical services at dental clinics

Sewon Park ^1,^#, Han-Kyoul Kim ^2,^3,^#, Mankyu Choi ^4,^5,^‡,^*, Munjae Lee ^6,^7,^‡,^*

Editor: Andrej M Kielbassa⁸

PMCID: PMC8096099 PMID: 33945558

Abstract

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (β = 0.364, p < 0.001), expertise (β = 0.319, p < 0.001), communication by doctors (β = 0.224, p < 0.001), and tangibility (β = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (β = 0.258, p < 0.001), tangibility (β = 0.192, p < 0.001), communication by doctors (β = 0.163, p < 0.001), and expertise (β = 0.122, p < 0.01). Further, service value (β = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (β = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients’ intention to revisit through patient-oriented communication.

Introduction

Medical services are changing from a disease-centered model to a patient-centered model. In the existing disease-centered model, all decisions on patient care are made based on the expertise of doctors and other medical personnel. However, in the patient-centered model, patients actively participate in their treatment process and their needs and preferences are reflected in care-related decision making [1, 2]. These changes in the decision-making structure of medical services create competition among medical institutions, forcing them to take steps to survive financially. For instance, they are employing strategies to understand and satisfy patients’ needs, much like general commercial enterprises.

In general, to receive care in Korea, primary and secondary medical institutions must be visited first. Subsequently, patients with major ailments are issued with a medical referral form, and care can be received at a tertiary medical institution. Most dental clinics are categorized as primary and secondary medical institutions, and primary medical institutions can receive treatment at the tertiary medical institutions. In addition, most dental clinics tend to have outpatients and relatively few patients with severe diseases. Therefore, it is necessary to increase patients’ revisit intention through patient-centered communication so that they can choose the dental clinic in which they would want to receive their treatment [3].

Appropriate communication between doctors and patients provides the latter with information about their treatment based on empathy and understanding and goes beyond mere communication. It may also ensure effective healthcare by enabling joint decision making between physicians and patients [4]. Therefore, healthcare providers should offer their services in a patient-oriented manner. Further, patient-centered communication reduces medical expenditure by decreasing the possibility of unnecessary testing [5].

Healthcare service quality refers to medical services that maximize the welfare of patients while balancing the expected benefits and losses during the treatment process [6]. Healthcare service quality meets the needs of the patient based on the service outcome, service process, and physical environment. Patients tend to have difficulty in evaluating service quality before experiencing it in person. Indeed, even when a service is provided, it is difficult to assess its quality unless a specific problem occurs [7].

Patient satisfaction is a continuous value judgment based on the stimuli associated with the periods before and after consumers’ use of medical services. Patients assess medical services based on their own standards, judge the value of those services, and provide a certain response. The result of medical consumers’ evaluation can influence their revisit and positive word-of-mouth behavior, which affects the profitability of medical institutions markedly. Service value affects consumer satisfaction through the exchange of cost, time, and service quality. In particular, medical institutions must understand the value of the medical services offered to patients. Medical service value is a concept used to describe or predict the response of a medical consumer; service production itself does not refer to an inherent value but to several parts such as perceived service quality, which form the total service value [8]. Medical institutions should increase consumers’ revisit intention by improving the quality of medical services. As such, the importance of the quality of medical services as perceived by patients is emphasized through the provision of patient-centered medical services, which aim to raise patient satisfaction and the revisit intention for healthcare services.

Recently, the concepts of service quality, patient satisfaction, and the relationship between revisit intention and service value have been considered. Prior studies have mainly examined the extent to which service quality affects both satisfaction and revisit intention as well as how satisfaction affects revisit intention. However, most deal with medical service quality, patient satisfaction, and revisit intention individually, and few studies analyze the relationships among them [9–11].

This study analyzed the effect of health communication and service quality on service value, patient satisfaction, and revisit intention, focusing on dental clinics with a high number of patient interactions. To this end, the null hypothesis is that health communication and medical service quality do not affect the revisit intention of dental clinics through the mediating effects of service value and patient satisfaction. Dental services mainly comprise treatment for caries, implants, orthodontics, and oral care. Therefore, since patients require continuous management, they tend to continue to receive treatment in the clinics in which they were first treated. Therefore, for dental clinics, it is important to identify the factors affecting patients’ revisit intention. This may help improve the competitiveness of primary medical institutions in Korea by analyzing the correlations among health communication quality, medical service quality, patient satisfaction, service value, and revisit intention.

Materials and methods

Research model

Fig 1 shows the research model. This study analyzed the structural relationship between health communication quality and the intention to revisit medical institutions through patient satisfaction and service value. For this, health communication and medical service quality were used as independent variables and revisit intention was used as the dependent variable. Furthermore, patient satisfaction and service value were used as parameters. Communication by doctors and assistants were selected as sub-items of health communication quality and expertise, reliability, tangibility, and accessibility were selected as sub-items of medical service quality.

Data source and research participants

The study population consisted of outpatients at dental clinics in Seoul. Data were collected using questionnaires during dental clinic visits in Seoul from December 1 to December 30, 2016 (S1 Appendix). Since research measuring the quality of health communication and medical services for dental clinics is scarce, it is expected that these data will help formulate a plan to increase dental clinic revisit intention. First, we determined that there were 941 dental clinics in Seoul from the Korean Medical Practitioners Association. Next, we selected 15 dental clinics using stratified random sampling. Since cooperation with the clinic director was necessary for this research, the official research cooperation document was sent to the director one week before the study commenced using the contact information of dental clinics provided by the Korean Medical Practitioners Association. To confirm directors’ cooperation in advance, we recontacted them two days before the survey and informed them of the institution to which the researcher belonged, research purpose, and visit date. Through this process, we obtained cooperation from 10 dental clinics.

We focused on patients aged over 13 years waiting to make a payment or receive their prescription after receiving treatment as an outpatient in the dental clinic. Since oral care can lead to chronic diseases, regular checkups are required from adolescence. The quality of dental services received by patients during adolescence can become an obstacle to continuous visits to dental institutions in adulthood; therefore, adolescent patients were included in the study. The survey method involved researchers and trained investigators informing patients that they belonged to external research institutes, briefly explaining the purpose of the study and content of the questionnaire, and distributing the questionnaires. The self-administered questionnaire was collected immediately after the patient had completed it. A total of 600 questionnaires were distributed and collected, with 60 copies in each of the 10 dental clinics. However, there were 30 incomplete questionnaires because of the short waiting time for payment and receiving the prescription. Of the 600 collected copies, 570 valid copies were thus used for the analysis. The study did not include participants in vulnerable environments or collect or record personally identifiable information. We also did not collect or record sensitive information in accordance with Article 23 of the Privacy Act.

Research tool

Communication is not only the exchange of information or transmission of opinions, but also the conveyance and understanding of meanings and exchange of emotions. This study constructed a questionnaire based on the measurement items developed by Bowers et al. [12], Marley et al. [13], and Goleman [14]. The questionnaire items for communication by doctors and assistants were revised to reflect communication between doctors and patients; the measurement was conducted using five items each for doctors and assistants [15, 16].

Concerning medical service quality, the SERVOPERF measurement model of Cronin and Taylor was utilized [17, 18]. To measure service quality using the SERVPERF model, 17 questions were used: three items for expertise, four for reliability, six for tangibility, and four for accessibility [19–21].

Patient satisfaction was measured using the measurement items developed by Westbrook [22], Woodside et al. [23], and Dodd et al. [24]. Since higher patient satisfaction in dental clinics indicates high revisit intention more than in other medical institutions, some modifications were made to reflect the characteristics of dental clinics in Korea [25].

Service value is the physical and emotional value the patient experiences through the treatment process and results. Some modifications were made to consider the characteristics of Korean dental clinics based on the measurement items developed by Gooding and Cronin et al. [26–28].

Revisit intention refers to the intentions of healthcare users to maintain a continuing transaction with a healthcare provider after experiencing its services. The measurement items developed by Swan and Reidenbach and Sandifer-Smallwood were utilized. As the word-of-mouth effect of existing patients can significantly influence choosing a medical institution, especially a dental clinic, some modifications were made to reflect the characteristics of dental services [29–32].

Data analysis

Data analysis was conducted using SPSS 25.0 (IBM, Chicago, IL, USA) and Amos 18.0 (IBM, Chicago, IL, USA) software. The specific analysis method was as follows. First, a frequency analysis was conducted to determine the demographic characteristics of the participants. Second, a factor analysis was performed to verify the validity of the questions, while the reliability of the measurement questions was validated using Cronbach’s α. For the factor analysis, an exploratory factor analysis (EFA) of the Varimax mode orthogonal rotation was first performed to examine the factor structure of the questions to measure the variables. Next, a confirmatory factor analysis (CFA) was conducted to confirm whether the derived factor structure was consistent with the actual empirical data. Third, structural equation modeling was utilized to analyze the structural relationships influencing each factor. The structural equation models were analyzed using a two-step approach. First, a CFA was conducted on the individual measurement models or simultaneously on the factors and variables included in both the measurement model and the theoretical model. This process confirmed the reliability in a single dimension and the validity between concepts. Second, we linked and analyzed the factors that appeared in the research model and evaluated the structural relationships.

Results

Demographics

Participants’ age range showed an even distribution, with 171 people (30%) in their 20s being the largest age group. Concerning academic background, the largest percentage—361 people—had graduated from college (63.3%); for average income, 158 people had a monthly income of more than 5 million won (27.7%). Regarding the question of whether it was their first medical examination, 88.6% of respondents answered that it was not; on the reason for visiting the dental clinic question, cavity treatment accounted for the largest group (33.5%), followed by scaling (14%), and endodontic treatment (12.6%). For the time spent visiting the dental clinic, approximately 77.7% responded that it was less than 30 minutes, and for their reason for visiting, accessibility (32.3%) accounted for the largest group, followed by excellent medical staff (22.6%) and referral by acquaintances (15.6%). This may be because dental treatment often requires continuous treatment and people tend to use accessible dental clinics for an extended period since a large number of patients visit the clinic to receive regular checkups (Table 1).

Table 1. Participants’ demographic characteristics and medical utilization behavior.

Type		No.	%
Sex	Male	231	41.0
Sex	Female	339	59.0
Age	Under 20 years	23	4.0
	20 to 29 years	171	30.0
	30 to 39 years	114	20.0
	40 to 49 years	114	20.0
	50 to 59 years	86	15.1
	60 years or over	62	10.9
Education	Under middle school	44	7.7
	High school	165	29.0
	Junior college	312	54.7
	University and above	49	8.6
Income	Under 1 million won	13	2.3
	1–2 million won	48	8.4
	2–3 million won	93	16.3
	3–4 million won	125	21.9
	4–5 million won	133	23.3
	5 million won and over	158	27.7
First visit	First visit	65	11.4
First visit	Returning patients	505	88.6
Reason for visit	Cavity treatment	191	33.5
	Endodontic treatment	72	12.6
	Implant	59	10.4
	Scaling	80	14.0
	Ache	23	4.0
	Checkup	15	2.6
	Whitening	10	1.8
	Correction	53	9.3
	Prosthetic treatment	29	5.1
	Denture	11	1.9
	Gum treatment	21	3.7
	Other	6	1.1
Time required for visit	Within 15 minutes	306	53.7
	Within half an hour	137	24.0
	Within an hour	78	13.7
	Within an hour and a half	49	8.6
Reason for selection	Accessibility	184	32.3
	Referral by acquaintances	89	15.6
	Cheap medical expenses	29	5.1
	Excellent medical staff	129	22.6
	Convenient medical procedure	15	2.6
	Kindness	29	5.1
	Sanitary condition	10	1.8
	Convenient hospital facilities	11	1.9
	Hospital reputation	30	5.3
	Other	44	7.7
Selection method	Perimeter solicitation	319	56.0
	Internet	70	12.3
	Advertisement	36	6.3
	Hospital recommendation	9	1.6
	Sign	105	18.4
	Homepage	6	1.0
	Other	25	4.4

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Reliability and study model verification

An EFA was conducted based on the collected data to examine the factor structure of the 48 questions used to measure the variables. For exploratory factor analysis, the validity of the composition was verified using the principal components analysis (PCA) of the Varimax rotation, and Kaise-Meyer Olkin (KMO) and Barlett sphericity were verified. Variables were selected based on an eigenvalue of 1 or more and factor loading of 0.4 or more for each variable, and Cronbach’s Alpha was checked for reliability, and items that lowered reliability were removed through factor analysis and improved to an appropriate level. As a result, six items including the expertise of assistants and responsiveness of the office/clinic had commonality less than 0.4 and were deleted. Hence, 42 questions were finally selected. The EFA was again conducted to examine the factor structure of the final selected items. The Kaiser–Meyer–Olkin test value was 0.944, while Bartlett’s test of sphericity was also significant (χ₂ = 13748.522, p < 0.001). Therefore, the data used in the analysis were judged as suitable for the factor analysis. In addition, the total variance explained was 74% (Table 2).

Table 2. EFA results.

Variable		Commonality	Component
Variable		Commonality	1	2	3	4	5	6	7	8	9
Communication by doctor	Doctor1	0.698	0.295
	Doctor2	0.766	0.292
	Doctor3	0.750	0.251
	Doctor4	0.769	0.208
	Doctor5	0.794	0.184
	Doctor6	0.749	0.182
	Doctor7	0.766	0.136
Communication by assistant	Assistant1	0.755		0.818
	Assistant2	0.828		0.798
	Assistant3	0.814		0.791
	Assistant4	0.808		0.751
	Assistant5	0.823		0.732
Expertise	Expertise1	0.672			0.695
	Expertise2	0.754			0.661
	Expertise3	0.773			0.603
Expertise of assistant staff	Expertise of assistant1	0.312
	Expertise of assistant2	0.339
	Expertise of assistant3	0.392
Reliability	Reliability1	0.789				0.606
	Reliability2	0.785				0.571
	Reliability3	0.725				0.566
	Reliability4	0.719				0.525
responsiveness	Responsiveness1	0.234
	Responsiveness2	0.351
	Responsiveness3	0.256
Tangibility	Tangibility1	0.692					0.847
	Tangibility2	0.692					0.830
	Tangibility3	0.679					0.806
	Tangibility4	0.814					0.758
	Tangibility5	0.809					0.646
	Tangibility6	0.790					0.495
Accessibility	Accessibility1	0.804						0.817
	Accessibility2	0.814						0.786
	Accessibility3	0.721						0.775
	Accessibility4	0.757						0.673
Patient satisfaction	Patient satisfaction1	0.810							0.655
	Patient satisfaction2	0.825							0.640
	Patient satisfaction3	0.846							0.638
	Patient satisfaction4	0.798							0.568
Service value	Service value1	0.855								0.816
	Service value2	0.850								0.800
	Service value3	0.799								0.797
	Service value4	0.773								0.785
	Service value5	0.795								0.726
Revisit intention	Revisit intention1	0.882									0.685
	Revisit intention2	0.915									0.631
	Revisit intention3	0.906									0.626
	Revisit intention4	0.899									0.593
Eigenvalue			21.08	3.29	2.65	1.96	1.83	1.41	1.25	1.08	1.02
Explained variance (%)			16.2	11.13	9.83	9.75	9.53	6.15	5.03	3.49	2.89
Total explained variance (%)			16.26	27.39	37.21	46.96	56.54	62.69	67.71	71.21	74.10

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The Cronbach’s α values were 0.905 for communication by doctors, 0.932 for communication by assistants, 0.897 for expertise, 0.928 for reliability, 0.887 for tangibility, 0.820 for accessibility, 0.959 for patient satisfaction, 0.938 for service value, and 0.970 for revisit intention. The EFA was classified into the remaining nine factors. Hence, the Cronbach’s α values of the variables used in the study were very high (Table 3).

Table 3. Reliability verification.

Variable	No. of items	Construct reliability (Cronbach’s α)
Communication by doctors	7	0.905
Communication by assistants	5	0.932
Expertise	3	0.897
Reliability	4	0.928
Tangibility	6	0.887
Accessibility	4	0.820
Patient satisfaction	4	0.959
Service value	5	0.938
Revisit intention	4	0.970

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To verify the internal validity of the model, a CFA was conducted on the questions of the measurement model. To evaluate the appropriateness of the CFA, the χ₂ value, p-value for χ₂ value, Tucker–Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were used. The coefficient values were estimated as χ₂ = 1712.643 (df = 783, p < 0.001), TLI = 0.918, and CFI = 0.926, suggesting that the model fit was excellent overall. In addition, RMSEA = 0.063 was less than 0.08, making the factor analysis reasonable. In the CFA, two items for communication by doctors, one for tangibility, and one for accessibility did not exceed the 0.5 standardized factor loading criterion. Hence, of the 48 questions used to collect the data, six items with poor commonality were removed through the EFA and four items with poor validity were removed through the CFA. Therefore, 38 items were used for the analysis. Table 4 shows the results of the CFA for the model used in this study.

Table 4. CFA results.

Factor	Path	Estimate	S.E.	T	p-value	Standardized estimate	SMC
Health communication quality	Doctor1 ← Health communication	1.000				0.773	0.599
	Doctor2 ← Health communication	1.183	0.074	16.024	0.001	0.852	0.725
	Doctor3 ← Health communication	1.009	0.067	15.145	0.001	0.814	0.660
	Doctor4 ← Health communication	1.099	0.072	15.298	0.001	0.821	0.674
	Doctor5 ← Health communication	1.129	0.071	15.811	0.001	0.843	0.714
	Doctor6 ← Health communication	0.872	0.081	10.783	0.001	0.372	0.610
	Doctor7 ← Health communication	0.886	0.082	10.772	0.001	0.371	0.609
	Assistant1 ← Health communication	1.000				0.832	0.754
	Assistant2 ← Health communication	0.980	0.054	18.112	0.001	0.850	0.743
	Assistant3 ← Health communication	0.999	0.053	18.931	0.001	0.874	0.763
	Assistant4 ← Health communication	1.049	0.057	18.532	0.001	0.862	0.722
	Assistant5 ← Health communication	1.044	0.056	18.743	0.001	0.868	0.692
Expertise	Expertise1 ← Expertise	1.000				0.839	0.703
	Expertise2 ← Expertise	0.972	0.054	18.004	0.001	0.857	0.734
	Expertise3 ← Expertise	1.138	0.055	18.952	0.001	0.889	0.791
Reliability	Reliability1 ← Reliability	1.000				0.896	0.802
	Reliability2 ← Reliability	1.059	0.043	24.686	0.001	0.918	0.843
	Reliability3 ← Reliability	1.024	0.051	20.198	0.001	0.838	0.702
	Reliability4 ← Reliability	1.046	0.051	20.312	0.001	0.840	0.706
Tangibility	Tangibility1 ← Tangibility	1.000				0.754	0.568
	Tangibility2 ← Tangibility	1.153	0.085	13.611	0.001	0.765	0.585
	Tangibility3 ← Tangibility	1.227	0.077	15.998	0.001	0.882	0.778
	Tangibility4 ← Tangibility	1.239	0.078	15.955	0.001	0.880	0.774
	Tangibility5 ← Tangibility	1.306	0.086	15.130	0.001	0.839	0.705
	Tangibility6 ← Tangibility	0.979	0.110	8.924	0.001	0.271	0.520
Accessibility	Accessibility1 ← Accessibility	1.000				0.902	0.813
	Accessibility2 ← Accessibility	1.083	0.053	20.472	0.001	0.934	0.872
	Accessibility3 ← Accessibility	0.874	0.067	13.048	0.001	0.656	0.430
	Accessibility4 ← Accessibility	0.605	0.081	7.493	0.001	0.271	0.520
Service value	Service1 ← Service value	1.000				0.941	0.885
	Service2 ← Service value	1.014	0.034	30.273	0.001	0.927	0.859
	Service3 ← Service value	0.907	0.039	22.974	0.001	0.845	0.715
	Service4 ← Service value	0.801	0.045	17.679	0.001	0.751	0.564
	Service5 ← Service value	0.932	0.039	23.868	0.001	0.858	0.736
Patient satisfaction	Satisfaction1 ← Satisfaction	1.000				0.908	0.825
	Satisfaction2 ← Satisfaction	1.025	0.035	28.949	0.001	0.942	0.888
	Satisfaction3 ← Satisfaction	1.080	0.036	29.909	0.001	0.952	0.907
	Satisfaction4 ← Satisfaction	1.057	0.042	25.243	0.001	0.899	0.809
Revisit intention	Revisit1 ← Revisit intention	1.000				0.944	0.892
	Revisit2 ← Revisit intention	1.023	0.026	39.650	0.001	0.972	0.945
	Revisit3 ← Revisit intention	0.968	0.028	34.935	0.001	0.947	0.897
	Revisit4 ← Revisit intention	0.978	0.033	29.875	0.001	0.912	0.832

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***p<0.001, S.E. = Standard error, T = t-value, β = Standardized coefficient, SMC = Squared multiple correlation.

Structural equation model verification

The results of analyzing the model used in the study showed that χ₂ = 1653.662, TLI = 0.910, CFI = 0.917, and RMSEA = 0.072, indicating that the values of the indexes were generally excellent. Table 5 shows the goodness-of-fit of the research model.

Table 5. Research model verification (N = 570).

	χ^₂	DF	p-value	TLI	CFI	RMSEA
Research model	1653.662	644	0.001	0.910	0.917	0.072

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***p<0.001, X² = Chi-square statistic, DF = Degrees of freedom, TLI = Tucker–Lewis index, CFI = Comparative fit index, RMSEA = Root mean square error of approximation.

Table 6 shows the standardized path coefficient values and significance levels. First, the quality factors of dental services that affect service value included communication by doctors, expertise, reliability, and tangibility, all of which were found to have a positive impact. Investigating the influence of each factor separately, reliability (0.364) showed the highest influence on service value, followed by expertise (0.319) and communication by doctors (0.224). Conversely, communication by assistants and accessibility did not affect service value.

Table 6. Research model path coefficients.

Factor	Path	B	β	S.E.	T	p-value
Service value	Service ← Communication by doctors	0.215	0.224	0.060	3.600^**	0.001
	Service ← Communication by assistants	-0.038	-0.037	0.066	-0.580	0.562
	Service ← Expertise	0.321	0.319	0.086	3.748^***	0.001
	Service ← Reliability	0.365	0.364	0.089	4.113^***	0.001
	Service ← Tangibility	0.175	0.136	0.081	2.145^**	0.032
	Service ← Accessibility	0.014	0.014	0.052	0.259	0.795
Patient satisfaction	Satisfaction ← Communication by doctors	0.140	0.163	0.044	3.211^**	0.001
	Satisfaction ← Communication by assistants	0.046	0.050	0.046	0.997	0.319
	Satisfaction ← Expertise	0.110	0.122	0.062	1.778^*	0.075
	Satisfaction ← Reliability	0.231	0.258	0.064	3.585^***	0.001
	Satisfaction ← Tangibility	0.220	0.192	0.059	3.729^***	0.001
	Satisfaction ← Accessibility	-0.005	-0.005	0.037	-0.130	0.897
	Satisfaction ← Service value	0.397	0.444	0.050	7.941^***	0.001
Revisit intention	Revisit ← Patient satisfaction	0.491	0.383	0.087	5.616^***	0.001
Revisit intention	Revisit ← Service value	0.501	0.438	0.078	6.414^***	0.001

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*p<0.1,

**p<0.05,

***p<0.001, B = Unstandardized coefficient, β = Standardized coefficient, S.E. = Standard error, T = t-value

Next, the quality factors that affect patient satisfaction included communication by doctors, expertise, reliability, and tangibility, all of which were found to have a positive impact. Specifically, the influence of reliability (0.258) was the highest on patient satisfaction, followed by tangibility (0.192) and communication by doctors (0.163). Furthermore, similar to service value, communication by assistants and accessibility did not affect patient satisfaction. Additionally, service value (0.444)—the endogenous variable—also raised patient satisfaction. Fig 2 shows the influence of each factor.

Discussion

The present study analyzed the effect of the quality of health communication and medical services on service value, patient satisfaction, and revisit intention. We found that the quality of health communication and medical services influenced the revisit intention of dental clinics through the mediating effects of patient satisfaction and service value, thus rejecting the null hypothesis and accepting the alternative hypothesis. The detailed results are as follows.

First, reliability and communication by doctors raised patient satisfaction and service value. These results are similar to those of Chang et al. (2013), who found that the doctor’s communication attitude affects patient satisfaction, medical service quality, and reliability [33]. In addition, Rashid et al. (2014) reported that communication by doctors raises patients satisfaction more than clinical competency [34]. Further, it has been found that the empathy of hospital staff, a form of communication, affects patient satisfaction and revisit intention markedly [10, 35, 36]. Since outpatients—unlike inpatients—need to be provided with only the necessary medical services, factors such as convenient treatment, administrative procedures, and the kindness of medical staff may influence their satisfaction. In particular, dental clinics, which only see outpatients, can obtain accurate information on patients and provide the necessary medical services by utilizing doctors’ communication skills. This leads to a consistent increase in the reliability of healthcare services, resulting in improved service value and patient satisfaction.

Second, the results indicated that communication by assistants did not affect patient satisfaction or service value in contrast to previous research results. Ehsan et al. (2015) showed that smoother communication between doctors and assistants raises patient satisfaction [37]. In addition, Fellani Danasra et al. (2011) reported that most patients receiving dental treatment wish to communicate with assistants about their discomfort in treatment, which subsequently affects the patient’s intention to revisit dental clinics [38]. Because dental clinics have a longer period of medical treatment than general medical institutions, doctors’ communication with patients is more important than that by assistants. Therefore, to improve service value and patient satisfaction in dental clinics, patient-centered communication by doctors is required. In other words, doctors should understand and respect the position of patients and recognize the importance of communication skills, focusing on providing a sufficient explanation and conveying an expert knowledge of the treatment.

Third, patient satisfaction and service value influenced the intention to revisit dental clinics. According to Seema (2011), patient satisfaction improves compliance with the treatment process and helps to maintain treatment continuity, thereby influencing the revisit intention of a medical institution [39]. In addition, Anang et al. (2019) showed that service quality at a medical institution affects patient satisfaction [40]. Further, previous research has found significant correlations among outpatients satisfaction, service quality, and revisit intention [40–42]. Patients visit the medical institution that meets their selection criteria and continue to be provided with medical services from that medical institution. In particular, dental treatments such as caries, implants, and orthodontics usually take two to three years, rather than being one-off treatments; hence, patients have a strong tendency to maintain services in the long run. It is therefore important to retain existing patients by ensuring patient satisfaction and service value. Regarding satisfaction with dental services, the human factor also appears to be more important than in general medical treatment, meaning that the doctor’s active communication is again required. Accordingly, providing patient-oriented medical services and strengthening communication between doctors and patients may enhance revisit intention for dental clinics by improving service value and patient satisfaction.

Finally, the limitations of this study and future research directions should be noted. First, the questionnaires were distributed and collected from outpatients in selected dental clinics in Seoul. Because the distribution of dental clinics differs regionally, the results of this study cannot easily be generalized to all dental clinics. If the analysis was repeated by including dental clinics in different provinces, accessibility would also affect patient satisfaction and service value. Accordingly, follow-up studies should attempt to overcome this research’s regional limitations.

Second, since there are many free-of-charge items in dental treatment, it is necessary to examine their influence on revisit intention for medical services by considering the specificity of dental treatment and including price factors such as medical expenses. In particular, as implant procedures have recently been increasing, a future analysis could be conducted by dividing subjects into beneficiaries and non-beneficiaries of national health insurance to examine the impact of medical expenses on revisit intention. This would help understand the effect of transparent disclosure on medical expenses through communication between doctors and patients and its effect on patient satisfaction.

Third, this study focused on general dental clinics without classifying them into clinics and network hospitals and the structural model was applied to the quality of health communication and medical services, patient satisfaction, service value, and revisit intention. However, given that the number of network hospitals has recently increased rapidly and the co-branded opening of network hospitals targeting specific patients has become generalized, research should be conducted on image factors, which may have a direct effect on patient satisfaction and service value.

Conclusion

This study analyzed the factors influencing the intention to revisit medical services using data from patients visiting dental clinics in Seoul. The results showed that reliability and communication by doctors affected service value and patient satisfaction, which influenced revisit intention. The following measures are necessary to increase the satisfaction of patients who visit dental clinics and to increase the revisit intention. Dental clinics should provide appropriate medical services to outpatients based on smooth communication between doctors and patients. Additionally, encouraging doctors to show an attitude of respect toward the patient may affect patient satisfaction. Doctors providing medical treatment information to patients with a friendly and respectful attitude rather than an authoritarian one may be an effective strategy for dental clinics to build long-term relationships with patients.

Supporting information

S1 Appendix. Questionnaire for study participants.

(DOCX)

Click here for additional data file.^{(24.9KB, docx)}

Acknowledgments

We are grateful to the journal editors and three anonymous reviewers for taking the time to provide helpful comments to improve the paper.

Data Availability

All relevant data are within the manuscript and its Supporting Information files. S1 Appendix. Questionnaire for study participants https://doi.org/10.6084/m9.figshare.14418620.v1

Funding Statement

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2019S1A5A2A03040304).

References

1.Bolton RE, Bokhour BG, Hogan TP, Luger TM, Ruben M, Fix GM. Integrating personalized care planning into primary care: a multiple-case study of early adopting patient-centered medical homes. Journal of general internal medicine. 2020;35(2):428–36. 10.1007/s11606-019-05418-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Yujeong K, Eunmi L, Mee Kyung L, Mi Young K. Patient Characteristics That Influence the Experience of Patient Participation in Therapeutic Decision Making. Iranian Journal of Public Health. 2019;48(8):1537. [PMC free article] [PubMed] [Google Scholar]
3.Jung YS, Yang HY, Choi YH, Kim EK, Jeong SH, Cho MJ, et al. Factors affecting use of word‐of‐mouth by dental patients. International dental journal. 2018;68(5):314–9. 10.1111/idj.12387 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Kreps GL. The evolution and advancement of health communication inquiry. Annals of the International Communication Association. 2001;24(1):231–53. 10.1080/23808985.2001.11678988. [DOI] [Google Scholar]
5.Bertakis KD, Azari R. Determinants and outcomes of patient-centered care. Patient education and counseling. 2011;85(1):46–52. 10.1016/j.pec.2010.08.001 [DOI] [PubMed] [Google Scholar]
6.Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743–8. 10.1001/jama.260.12.1743 PubMed Central PMCID: PMC3045356. [DOI] [PubMed] [Google Scholar]
7.Zeithaml VA, Bitner MJ, Gremler D. Services Marketing:New York-McGrawHill. New York: McGrawHill; 1996. [Google Scholar]
8.Ettinger JW. Consumer-perceived value: the key to a successful business strategy in the healthcare marketplace. Journal of the American Geriatrics Society. 1998;46(1):111–3. 10.1111/j.1532-5415.1998.tb01024.x [DOI] [PubMed] [Google Scholar]
9.Kim CE, Shin J-S, Lee J, Lee YJ, Kim M-r, Choi A, et al. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals. BMC complementary and alternative medicine. 2017;17(1):174. 10.1186/s12906-017-1691-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
10.Meesala A, Paul J. Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future. Journal of Retailing and Consumer Services. 2018;40:261–9. [Google Scholar]
11.Batbaatar E, Dorjdagva J, Luvsannyam A, Savino MM, Amenta P. Determinants of patient satisfaction: a systematic review. Perspectives in public health. 2017;137(2):89–101. 10.1177/1757913916634136 [DOI] [PubMed] [Google Scholar]
12.Bowers MR, Swan JE, Koehler WF. What attributes determine quality and satisfaction with health care delivery? Health care management review. 1994;19(4):49–55. PubMed Central PMCID: PMC7896552. [PubMed] [Google Scholar]
13.Gider S, Runge B-U, Marley A, Parkin S. The magnetic stability of spin-dependent tunneling devices. Science. 1998;281(5378):797–9. 10.1126/science.281.5378.797 [DOI] [PubMed] [Google Scholar]
14.Goleman D. Emotional intelligence: Bantam; 2006. [Google Scholar]
15.Kyung-Il H, Bok-Dong K. The Effects of Medical Service Quality and Service Value by Relationship Quality on Customer Behaviour. Journal of Digital Convergence. 2010;8(4):137–50. [Google Scholar]
16.Byung-Ho L, Yu-Jin C. The Association between Medical Service Quality, Consumer Satisfaction, Service Value and Customer Loyalty of Dental Patients. The Korean Journal of Health Service Management. 2014;8(2):89–100. 10.12811/kshsm.2014.8.2.089. [DOI] [Google Scholar]
17.Cronin JJ Jr, Taylor SA. Measuring service quality: a reexamination and extension. Journal of marketing. 1992;56(3):55–68. 10.2307/1252296. [DOI] [Google Scholar]
18.Cronin JJ Jr, Taylor SA. SERVPERF versus SERVQUAL: reconciling performance-based and perceptions-minus-expectations measurement of service quality. Journal of marketing. 1994;58(1):125–31. 10.2307/1252256. [DOI] [Google Scholar]
19.Son S, Kwon Y, Choi I. Service quality of dental institutes measured by SERVQUAL model. J Korean Acad Dent Health. 2009;33(3):461–73. [Google Scholar]
20.Park S. Service Quality for the Disabled on the based SERVQUAL and Effect of Provider Characteristics on Service Quality: Focused on Daily Support Services for Severly Disabled Adults. Health and Social Welfare Review. 2014;34(3):477–504. 10.15709/hswr.2014.34.3.477 [DOI] [Google Scholar]
21.Choi C-J. Assessment of Service Quality in Hospital by using SERVPERF -Focused on Hospitals in Daejeon, South Chungchung Province. Journal of East and Central Asian Studies. 2005;16(1):138–56. [Google Scholar]
22.Westbrook RA. Product/consumption-based affective responses and postpurchase processes. Journal of marketing research. 1987;24(3):258–70. 10.1177/002224378702400302. [DOI] [Google Scholar]
23.Woodside AG, Frey LL, Daly RT. Linking sort/ice anlity, customer satisfaction, and behavioral intention. Journal of health care marketing. 1989;9(4):5–17. PubMed Central PMCID: PMC10304174. [PubMed] [Google Scholar]
24.Dodds WB. In search of value: how price and store name information influence buyers′ product perceptions. Journal of Consumer Marketing. 1991;8(2):15–24. 10.1108/07363769110034974. [DOI] [Google Scholar]
25.Min-Gyeong J. Convergence Analysis on The Determinants of Reuse Intention in Patients Visiting a Dentist. Journal of Convergence for Information Technology. 2017;7(4):1–9. 10.22156/CS4SMB.2017.7.4.001. [DOI] [Google Scholar]
26.Gooding S. An assessment of the relationship between service quality and customer satisfaction in the formation of consumers purchase intention. Journal of Retailing. 1995;70(2):163–78. 10.1016/0022-4359(94)90013-2. [DOI] [Google Scholar]
27.Cronin JJ, Brady MK, Brand RR, Hightower R Jr, Shemwell DJ. A cross-sectional test of the effect and conceptualization of service value. Journal of services Marketing. 1997;11(6):375–91. 10.1108/08876049710187482. [Google Scholar]
28.Lee S, Kim J, Kim S, Yang J. The causal relationship among hospital evaluation programme, internal service quality, service value, and managerial performance. Korean J Account Res. 2010;15(2):253–76. [Google Scholar]
29.Swan JE, Sawyer JC, Van Matre JG, McGee GW. Deepening the understanding of hospital patient satisfaction: fulfillment and equity effects. Journal of health care marketing. 1985;5(3). PubMed Central PMCID: PMC10274620. [PubMed] [Google Scholar]
30.Reidenbach RE, Sandifer-Smallwood B. Exploring perceptions of hospital operations by a modified SERVQUAL approach. Marketing Health Services. 1990;10(4):47. PubMed Central PMCID: PMC10108701. [PubMed] [Google Scholar]
31.Ahn S-s. The Effect of Service Authenticity on Customer Satisfaction and Word-of-Mouth and Reuse Intentions—Focused on Airline Services -. Aviation Management Society of Korea. 2018;16(1):91–105. 10.30529/amsok.2018.16.1.005. [DOI] [Google Scholar]
32.Lim C-K. A relationship among service quality, trust, customer satisfaction and reuse intention in real estate information web-sites. Journal of the Korea Industrial Information Systems Research. 2011;16(2):125–37. 10.9723/jksiis.2011.16.2.125. [DOI] [Google Scholar]
33.Chang C-S, Chen S-Y, Lan Y-T. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC health services research. 2013;13(1):22. 10.1186/1472-6963-13-22 PubMed Central PMCID: PMC3570322. [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman medical journal. 2014;29(1):3. 10.5001/omj.2014.02 PubMed Central PMCID: PMC24501659. [DOI] [PMC free article] [PubMed] [Google Scholar]
35.Johnson DM, Russell RS, White SW. Perceptions of care quality and the effect on patient satisfaction. International Journal of Quality & Reliability Management. 2016. 10.1108/IJQRM-08-2015-0121. [DOI] [Google Scholar]
36.Hesse C, Rauscher EA. The relationships between doctor-patient affectionate communication and patient perceptions and outcomes. Health communication. 2019;34(8):881–91. 10.1080/10410236.2018.1439269 [DOI] [PubMed] [Google Scholar]
37.Zarei E, Daneshkohan A, Pouragha B, Marzban S, Arab M. An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran. Global journal of health science. 2015;7(1):1. 10.5539/gjhs.v7n1p1 [DOI] [PMC free article] [PubMed] [Google Scholar]
38.Dewi FD, Sudjana G, Oesman YM. Patient satisfaction analysis on service quality of dental health care based on empathy and responsiveness. Dental research journal. 2011;8(4):172. 10.4103/1735-3327.86032 PubMed Central PMCID: PMC3221083. [DOI] [PMC free article] [PubMed] [Google Scholar]
39.Mehta S. Service quality as predicator of patient satisfaction: a study of the health care sector. Journal of Health Management. 2011;13(2):211–29. 10.1177/097206341101300206. [DOI] [Google Scholar]
40.Junaidi A, Siyoto S, Nurwijayanti N. Analysis of The Effect of Service Quality on The Level of Satisfaction, Trust and Interest In Revisiting Outpatients At The Hospital dr. Soepraoen Malang. Journal for Research in Public Health. 2019;1(1):53–9-–9. 10.30994/jrph.v1i1.7 [DOI] [Google Scholar]
41.Lee C. Patient loyalty to health services: The role of communication skills and cognitive trust. International Journal of Healthcare Management. 2020:1–11. 10.1080/20479700.2020.1756111. [DOI] [Google Scholar]
42.Kulsum U, Syah TYR. The Effect of Service Quality on Loyalty with Mediation of Patient Satisfaction. International Journal of Business and Management Invention. 2017;6(3):41–50. [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0250546.r001

Decision Letter 0

Andrej M Kielbassa

12 Jun 2020

PONE-D-19-29416

Factors affecting revisiting intention for medical services at dental clinics

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Reviewer #2: This paper describes the factors affecting revisiting intention of dental patients. The topic is very relevant and important. The paper could be enhanced by describing existing knowledge on this topic in the background section and making it more relevant to dentistry. Also there are inconsistencies in calling medical services versus dental clinics is confusing. It is better to stick with dental services and dental clinics if the study was conducted in these settings and to reduce ambiguity. Also, please describe briefly the types of dental care provided in the participating clinics. Finally, the current description the background has a lot of redundant material, which can be shortened.

The methods section again have way too much details and could be difficult for the reader to have a good grasp of the approach. Also, while the figure displaying the research model gives the impression of health communication as an independent variable, it appears health communication is a dependent variable.

The results section could also be improved by organizing results related to the research question and assessing the reliability of the survey questions separately. Also, clarity can be improved by being concise. The discussion section again can be enhanced by describing major findings concisely and clearly. It is also not clear what types of medical services dentists provide. Also, references need to be cited appropriately.

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PLoS One. 2021 May 4;16(5):e0250546. doi: 10.1371/journal.pone.0250546.r002

Author response to Decision Letter 0

13 Aug 2020

Response to Reviewer Comments

I wish to thank the reviewers for their constructive feedback. The reviewers point out some remaining elements requiring modifications or clarifications in order to validate my manuscript for publication. My manuscript was thoroughly reviewed and updated according to these pertinent remarks. I would like to illustrate these modifications and address those discussion points in my response below.

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Response 1: Has confirmed.

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Response 2:

Questionnaire (S1 Table) added.

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Response 3: Has confirmed.

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Response 4: Has confirmed.

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The study did not include subjects in vulnerable environments and did not collect or record personally identifiable information using information that is disclosed to individuals. We also did not collect or record sensitive information in accordance with Article 23 of the Privacy Act.

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Response 7: No financial support was provided to fund this manuscript.

Point 8: State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

Response 8:

MC and ML conceptualization, operative project leader. SP and ML performed the statistical analysis, interpreted the data, and helped to draft the manuscript. SP participated in the design of the study and helped to draft the manuscript. ML participated in the data collection and revised manuscript. MC designed the study, was principal investigator, participated in the interpretation of the data and revised the manuscript. All authors have read and approved the final manuscript.

Point 9: If any authors received a salary from any of your funders, please state which authors and which funders. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Response 9: The authors received no specific funding for this work.

Point 10: Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure.

Response 10: It's corrected.

Point 11: Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

Response 11: It's corrected.

I hope that the considerable changes made to my research paper coupled with our above arguments will convince the reviewers in reconsidering our manuscript for publication in your journal. I thank you in advance for your kind and thorough attention in the review of my work.

Best regards,

Response to Reviewer Comments

Point 1: Please provide important information. Presently, this section does contain some self-explaining phrases only. Remember that this part is a stand-alone section, allowing future readers to switch to your main text.

Response 1: P.2

Introduction

Recent changes in the medical paradigm are highlighting the importance of patient-centered communication. However, due to the lack of awareness of medical institutions and of competence in medical personnel, the quality of medical services regarding communication between doctors and patients has not improved. This study analyzes the impact of health communication and medical service quality, service value, and patient satisfaction on revisiting intention for dental clinics.

Methods

The study subjects were outpatients who were treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire visited the dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed to 10 dental clinics, 60 copies each, and 570 valid questionnaires were used for analysis. n this study, the structural influence of factors was determined using structural equation modeling.

Results

The factors influencing service value were reliability (0.364), expertise (0.319), and communication by a doctor (0.224). In addition, the factors influencing patient satisfaction were in the order of reliability (0.258), tangibility (0.192), and communication by a doctor (0.163). On the other hand, service value had a positive effect on patient satisfaction, and patient satisfaction was found to influence dental clinics the reuse intention.

Conclusion

Providing accurate medical services to inpatients based on smooth communication between doctors and patients will have a positive effect on improving patient satisfaction. In addition, the doctor will be able to attract long-term customers by increasing the patients to revisiting through patient-oriented communication.

Point 2: Remember to elaborate both aims and objectives more clearly. There must be a deducable null hypothesis, reasonable and indisputable.

Response 2: P.4

Recently, the concept of service quality, patient satisfaction, and the relationship between reuse intention and service value has been added and considered. Existing prior studies mainly consisted of the relationship between service quality and satisfaction (service quality → satisfaction), service quality and reuse (service quality → reuse intention), service quality and satisfaction, and reuse intention (service quality → satisfaction → reuse intention). However, most of them deal with medical service quality, patient satisfaction, and reuse intention individually, and few studies analyze the relationship between them [6-8].

The purpose of this study is to analyze the structural relationship between the satisfaction of the quality of medical service of outpatients visiting the dental clinic and the reuse intention.

Point 3: Re your research model, this must be understandable for every reader. Just depicting some kind of chart would not seem appropriate. Please remember to guide the reader.

Response 3: P.5

The purpose of this study was to analyze the structural relationship between health communication and medical service quality, service value, patient satisfaction, and medical institution reuse intention. Therefore, health communication was divided into communication by doctor and communication by assistant, and medical service quality was classified into expertise, reliability, tangibility, and accessibility. In addition, the purpose of this study is to analyze whether health communication and medical service quality influence patient's reuse intention through mediating patient satisfaction and service value. The research model of this study is as follows (Fig 1).

Point 4: Collecting data from December 1 to December 30, 2016 would seem outdated, wouldn't it?

Response 4: P.5-6

Since research on measuring the quality of health communication and medical services for dental clinics has been insignificant, it is expected that this data will be able to derive a plan to increase dental clinic revisiting intention.

Point 5: This section must provide methodology. Do not give a literature review here.

Response 5:

It's corrected.

Point 6: As always, please provide general names with your text, followed by (brand names; manufacturer, city, country) in parentheses. Please provide full information with ALL materials and methodologies.

Response 6: P.7

SPSS 25.0 (SPSS Inc., Chicago, IL, USA) and Amos 18.0 (SPSS Inc., Chicago, IL, USA) software

Point 7: To test internal consistency among the measurement items, a reliability verification was conducted using the Cronbach's α value. To measure construct validity, a factor analysis was performed using the Varimax mode." This obviously refers to methodology. Please revise.

Response 7: P.7

Second, to test internal consistency among the measurement items, a reliability verification was conducted using the Cronbach's α value, and to measure construct validity, factor analysis was performed using the Varimax mode.

Point 8: Table 3 shows the results of the CFA for the model used in this study." Again, this would not seem sufficient. Do you expect the reader to analyze these data?

Response 8: P.10

To evaluate the appropriateness of CFA, χ₂ value, the p-value for χ₂ value, TLI(Tucker Lewis Index), CFI(Comparative Fit Index), and RMSEA(Root Mean Square Error of Approximation) were used. The model goodness of fit for the measurement model was that the coefficient values estimated as χ₂=1712.643 (df=783, P=0.001), TLI=0.918, CFI=0.926 were 0.9 or higher, and overall, the model fits were excellent. In addition, RMSEA=0.063 is less than 0.08, making the factor analysis reasonable.

Point 9: This would not seem well-elaborated. Please discuss outcome, provide insight thoughts on the methodology, and speculate on future research directions. As with the other sections, this part must be re-prganized.

Response 9: P.15-16

These results are the same as those of the previous studies that the reliability of the treatment results improves patient satisfaction and service value. In addition, it was found that communication through the empathy of hospital staff was consistent with the results of previous studies that had a great impact on patient satisfaction and reuse intention [7, 35, 36].

At this point, the limitations of this study and future research directions should be noted. First, questionnaires were distributed and collected from outpatients only in certain dental clinics located in Seoul. Because the distribution status of dental institutions differs from region to region, the results of this study cannot easily be generalized to all dental institutions. If the analysis were to be repeated including dental clinics located in the provinces, accessibility would also affect patient satisfaction and service value. Accordingly, any follow-up studies should attempt to overcome regional limitations.

Second, since there are many non-payment items in dental treatment, it is necessary to examine what effect these items have on the reuse intention for medical services by considering this specificity of dental treatment and including price factors like medical expenses. Particularly, as implant procedures have been increasing recently, an analysis could be conducted by dividing subjects into two categories: beneficiaries and non-beneficiaries of national health insurance. This method could then consider and analyze the impact of medical expenses on reuse intention. Based on this, the effect of transparent disclosure concerning medical expenses through communication between doctors and patients and its effect on patient satisfaction can be understood.

Third, this study focused on general dental clinics without classifying them into clinics and network hospitals, and the structural model was applied on communication, quality of medical service, patient satisfaction, service value, and reuse intention. However, given that the number of network hospitals have recently been rapidly increasing and the co-branded opening in the network type targeting specific patients has become generalized, research should be conducted on image factors, which may have a direct effect on patient satisfaction and service value.

Point 10: Do not simply repeat the results here. This section must provide a reasonable extension of your outcome. Strictly stick to your aims here.

Response 10: P.17

Therefore, it is considered that the following measures are necessary to increase the satisfaction of patients who have visiting dental clinics and to increase the reuse intention. First, it is necessary to increase the patient's reliability in the doctor by providing accurate information about the process to patients. The reliability of the patient's doctor affects the outpatients and affects patient satisfaction and reuse intention. Therefore, it is necessary for doctors and patients to exchange information on treatment plans to improve reliability and to increase patient satisfaction through smooth communication about the treatment process. Second, patient satisfaction and service value should be increased through active communication by doctors. In the case of dental clinics, patient-centered communication is important because there are many mild diseases and many outpatients. In other words, when choosing a dental clinic, it appears that more consideration is given to the kindness of doctors and nurses. Therefore, it is necessary to strengthen communication with patients and increase service value through an in-depth explanation of diseases. Third, reuse intention should be increased through patient-centered communication. The patient is important to recognize not only the quality of the medical service but also the process in which the medical service is delivered. Therefore, not only the professional medical service provided by the medical staff but also the interaction or communication with the medical staff while the medical service is being provided can be more satisfied and the service value can be increased. Therefore, doctors will be able to enhance communication and increase service value to increase patient satisfaction. This will ultimately increase the patient's reuse intention and attract long-term customers.

Point 11: Please revise for uniform formatting. Stick to the Guidelines.

Response 11:

It's corrected.

Best regards,

Response to Reviewer Comments

Point 1: The paper could be enhanced by describing existing knowledge on this topic in the background section and making it more relevant to dentistry. Also there are inconsistencies in calling medical services versus dental clinics is confusing. It is better to stick with dental services and dental clinics if the study was conducted in these settings and to reduce ambiguity.

Response 1: P.3

A dental clinic is a subject where patients can receive insurance benefits regardless of the referral form, so lighter patients tend to use higher-level hospitals more easily than other subjects. It is necessary to attract them through patient-centered communication.

Point 2: Also, please describe briefly the types of dental care provided in the participating clinics.

Response 2: P.4

Dental medical services are mainly provided of dental caries, implants, orthodontics, and oral care, and since they require continuous management, they tend to continue to receive treatment in clinics treated initially. Therefore, in the case of dental clinics, it is important to identify factors affecting the patient's reuse intention.

Point 3: Finally, the current description the background has a lot of redundant material, which can be shortened.

Response 3:

It's corrected.

Point 4: The methods section again have way too much details and could be difficult for the reader to have a good grasp of the approach. Also, while the figure displaying the research model gives the impression of health communication as an independent variable, it appears health communication is a dependent variable.

Response 4: P.5

addition, the purpose of this study is to analyze whether health communication and medical service quality influence patient's reuse intention through mediating patient satisfaction and service value. The research model of this study is as follows (Fig 1).

Point 5: The results section could also be improved by organizing results related to the research question and assessing the reliability of the survey questions separately. Also, clarity can be improved by being concise.

Response 5: P.10-12

Table 3. Confirmatory factor analysis.

Factor Path Estimate S.E T p-value Standardized Estimate SMC

Health communication Doctor1 ← Health communication 1.000 0.773 0.599

Doctor2 ← Health communication 1.183 0.074 16.024 *** 0.852 0.725

Doctor3 ← Health communication 1.009 0.067 15.145 *** 0.814 0.660

Doctor4 ← Health communication 1.099 0.072 15.298 *** 0.821 0.674

Doctor5 ← Health communication 1.129 0.071 15.811 *** 0.843 0.714

Doctor6 ← Health communication 0.872 0.081 10.783 *** 0.372 0.610

Doctor7 ← Health communication 0.886 0.082 10.772 *** 0.371 0.609

Assistant1 ← Health communication 1.000 0.832 0.754

Assistant2 ← Health communication 0.980 0.054 18.112 *** 0.850 0.743

Assistant3 ← Health communication 0.999 0.053 18.931 *** 0.874 0.763

Assistant4 ← Health communication 1.049 0.057 18.532 *** 0.862 0.722

Assistant5 ← Health communication 1.044 0.056 18.743 *** 0.868 0.692

Expertise Expertise1 ← Expertise 1.000 0.839 0.703

Expertise2 ← Expertise 0.972 0.054 18.004 *** 0.857 0.734

Expertise3 ← Expertise 1.138 0.055 18.952 *** 0.889 0.791

Reliability Reliability1 ← Reliability 1.000 0.896 0.802

Reliability2 ← Reliability 1.059 0.043 24.686 *** 0.918 0.843

Reliability3 ← Reliability 1.024 0.051 20.198 *** 0.838 0.702

Reliability4 ← Reliability 1.046 0.051 20.312 *** 0.840 0.706

Tangibility Tangibility1 ← Tangibility 1.000 0.754 0.568

Tangibility2 ← Tangibility 1.153 0.085 13.611 *** 0.765 0.585

Tangibility3 ← Tangibility 1.227 0.077 15.998 *** 0.882 0.778

Tangibility4 ← Tangibility 1.239 0.078 15.955 *** 0.880 0.774

Tangibility5 ← Tangibility 1.306 0.086 15.130 *** 0.839 0.705

Tangibility6 ← Tangibility 0.979 0.110 8.924 *** 0.271 0.520

Accessibility Accessibility1 ← Accessibility 1.000 0.902 0.813

Accessibility2 ← Accessibility 1.083 0.053 20.472 *** 0.934 0.872

Accessibility3 ← Accessibility 0.874 0.067 13.048 *** 0.656 0.430

Accessibility4 ← Accessibility 0.605 0.081 7.493 *** 0.271 0.520

Service value Service1 ← Service value 1.000 0.941 0.885

Service2 ← Service value 1.014 0.034 30.273 *** 0.927 0.859

Service3 ← Service value 0.907 0.039 22.974 *** 0.845 0.715

Service4 ← Service value 0.801 0.045 17.679 *** 0.751 0.564

Service5 ← Service value 0.932 0.039 23.868 *** 0.858 0.736

Patient

satisfaction Satisfaction1 ← Satisfaction 1.000 0.908 0.825

Satisfaction2 ← Satisfaction 1.025 0.035 28.949 *** 0.942 0.888

Satisfaction3 ← Satisfaction 1.080 0.036 29.909 *** 0.952 0.907

Satisfaction4 ← Satisfaction 1.057 0.042 25.243 *** 0.899 0.809

Reuse intention Reuse1 ← Reuse intention 1.000 0.944 0.892

Reuse2 ← Reuse intention 1.023 0.026 39.650 *** 0.972 0.945

Reuse3 ← Reuse intention 0.968 0.028 34.935 *** 0.947 0.897

Reuse4 ← Reuse intention 0.978 0.033 29.875 *** 0.912 0.832

Sample Size, n=570, χ₂=1197.727, df=532, χ₂/df=2.25, TLI=.931, CFI=.938, RMSEA=.065

χ₂=Chi-square statistic, DF=Degrees of freedom, TLI=Tucker Lewis index, CFI= Comparative fit index, RMSEA=Root mean square error of approximation.

Point 6: The discussion section again can be enhanced by describing major findings concisely and clearly. It is also not clear what types of medical services dentists provide. Also, references need to be cited appropriately.

Response 6: P.14-15

It's corrected. (Reference added).

Particularly, dental treatments such as dental caries, implants, and orthodontics are usually provided treatments for 2 to 3 years—rather than one-off treatments—they have a strong tendency to maintain services.

Best regards,

Response to Reviewer Comments

Point 1: The discussion section: lacks referencing as the authors stated several times (previous studies) without giving reference to which study?

Response 1:

It's corrected. (Reference added)

Point 2: For the conclusion section: the limitations should be stated within the discussion section and the conclusion should summarise only the key result and future studies if required.

Response 2: P.17

Best regards,

Attachment

Submitted filename: Response to reviewers1.docx

Click here for additional data file.^{(21KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0250546.r003

Decision Letter 1

Andrej M Kielbassa

3 Sep 2020

PONE-D-19-29416R1

Factors affecting revisiting intention for medical services at dental clinics

PLOS ONE

Dear Dr. lee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but still does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Having intensively reviewed your draft, your revised and re-submitted draft still would not seem satisfying. I have double checked your submitted draft, and, in particular, you should follow the R #1 comments, to finalize your paper convincingly, and to meet both PLOS ONE's quality standards and our readership's expectations. Please note that a further non-convincing revision (not considered acceptable with regard to language, reviewers' constructive criticism, content, generalizable outcome, and/or Authors' Guidelines) will lead to outright reject.

Please submit your revised manuscript by Oct 18 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Andrej M Kielbassa

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: No

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

Reviewer #3: Yes

**********

6. Review Comments to the Author

Reviewer #1: General remark

- This submission has improved to some extent, no doubt. However, the authors have failed to follow all the reviewers' recommendations, and this would seem astonishing. Please note that a reviewer invests much time in your submission, to improve understanding and perception. Ignoring those recommendations generally is not appreciated.

Abstract

- Please add EXACT results, and provide P values.

Intro

- Please note that each statement of facts must be accompanied by a reference. See, for example, "The importance of communication in medical services has been highlighted before". Revise thoroughly.

- "Therefore, this study analyzes (...)." You have done this already, right? Please switch to past tense. Revise thoroughly throughout your draft.

- Again, , as recommended previously, please provide a null hypothesis. Remember that H0 must be reasonable and deducible from the foregoing thoughts.

Meths

- "The research model of this study is as follows:" Again, as recommended previously, you should guide the readers. This means that each figure must be accompanied by text, thus explaining the authors' intention.

- "However, there were many incomplete questionnaires." What does this mean? How many is "many"?

- Again, please note that this section is not supposed to provide a literature review. This ha been recommended previously, and the authors obviously do not want to follow this aspect. See "In 1985, a study by Parasuraman et al. on the quality of medical services provided five categories of quality. These quality categories include (...)."

- Same with "In 1992, Cronin and Taylor attempted to measure service quality based on (...)." Please revise thoroughly, and do not mix section contents.

- Please provide manufacturers of the software used.

Results

- Please double check legends of both tables and figures, and revise for readability.

- Instead of indicating ***, please provide exact P values.

Disc

- "This differs from the findings of previous studies that state (...)." What studies do you refer to here? Again, please note that each such statement must be accompanied by a reference.

- Same with "Furthermore, the results also differed from previous study results stating that (...)." Please note that a reviewer's task is not considered to co-author your manuscript.

- Same with "This is consistent with the findings of previous studies (...)." Again, this revised and re-submitted draft would not seem convincingly elaborated.

Concl

- Do not repeat methodology or results here. Instead, provide a reasonable extension of your outcome which must stick to the aims of your study.

- Note that aspects like "limitations" must be given with the Discussion section.

Refs

- Still the references would not seem to follow the Journal's Guidelines for Authors. No doubt, it would seem hard to understand why the authors do not want to follow those guidelines.

In total, this revised version would not seem ready to proceed.

Reviewer #3: Thank you for addressing the comments fully, which made the manuscript sound technically and scientifically.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #3: No

PLoS One. 2021 May 4;16(5):e0250546. doi: 10.1371/journal.pone.0250546.r004

Author response to Decision Letter 1

19 Oct 2020

Response to Reviewer Comments

Point 1: Abstract - Please add EXACT results, and provide P values.

Response 1: P.2

The factors influencing service value were reliability (β=0.364, p=0.000), expertise (β=0.319, p=0.000), communication by a doctor (β=0.224, p=0.000) and tangibles (β=0.136, p=0.032). In addition, the factors influencing patient satisfaction were in the order of reliability (β=0.258, p=0.000), tangibility (β=0.192, p=0.000), communication by a doctor (β=0.163, p=0.001) and Expertise (β=0.122, p=0.075). On the other hand, service value (β=0.438, p=0.000) had a positive effect on patient satisfaction, and patient satisfaction (β=0.383, p=0.000) was found to influence dental clinics the reuse intention.

Point 2: Intro - Please note that each statement of facts must be accompanied by a reference. See, for example, "The importance of communication in medical services has been highlighted before". Revise thoroughly.

Response 2:

This part was removed under reviewer advice from a previous revision. Thank you for reviewing my paper so that it can be published.

Point 3: Intro - "Therefore, this study analyzes (...)." You have done this already, right? Please switch to past tense. Revise thoroughly throughout your draft.

Response 3: P.4

This study analyzes the effect of health communication and service quality on service value, patient satisfaction, and reuse intention, focusing on dental clinics with high patient interaction.

Point 4: Intro - Again, , as recommended previously, please provide a null hypothesis. Remember that H0 must be reasonable and deducible from the foregoing thoughts.

Response 4: P.4

To this end, in this study, the null hypothesis is that communication by doctors and assistant staff affects the reuse intention medical institutions with service value and patient satisfaction as parameters. In addition, this study aims to analyze by setting the null hypothesis that the medical services quality affects the reuse intention medical institutions by mediating service value and patient satisfaction.

Point 5: Meths - "The research model of this study is as follows:" Again, as recommended previously, you should guide the readers. This means that each figure must be accompanied by text, thus explaining the authors' intention.

Response 5: P.5

The research model of this study is as follows (Fig 1). This study attempted to analyze the structural impact relationship between health communication and the intention to reuse medical institutions through patient satisfaction and service value. For this, health communication and medical service quality were used as independent variables, and the reuse intention was used as the dependent variable. In addition, patient satisfaction and service value were used as parameters. Communication by doctors and by assistants was selected as sub-items of health communication, which is an independent variable, and expertise, reliability, tangibility, and accessibility were selected and measured as sub-items of medical service quality.

Point 6: Meths - "However, there were many incomplete questionnaires." What does this mean? How many is "many"?

Response 6: P.6

However, there were 30 incomplete questionnaires

Point 7: Meths - Again, please note that this section is not supposed to provide a literature review. This ha been recommended previously, and the authors obviously do not want to follow this aspect. See "In 1985, a study by Parasuraman et al. on the quality of medical services provided five categories of quality. These quality categories include (...)."

Response 7:

This part was removed under reviewer advice from a previous revision. Thank you for reviewing my paper so that it can be published.

Point 8: Meths - Same with "In 1992, Cronin and Taylor attempted to measure service quality based on (...)." Please revise thoroughly, and do not mix section contents.

Response 8:

This part was removed under reviewer advice from a previous revision. Thank you for reviewing my paper so that it can be published.

Point 9: Meths - Please provide manufacturers of the software used.

Response 9: P.8

The data analysis was conducted using SPSS 25.0 (SPSS Inc., IBM, Chicago, IL, USA) and Amos 18.0 (SPSS Inc., IBM, Chicago, IL, USA) software.

Point 10: Results - Please double check legends of both tables and figures, and revise for readability.

Response 10: P.13-14

Table 3.

***p<0.001, S.E=Standard error, T=t-value, β=Standardized coefficients, SMC=Squared Multiple Correlation.

Table4.

***p<0.001, X2=Chi-square statistic, DF=Degrees of freedom, TLI=Tucker Lewis index, CFI= Comparative fit index, RMSEA=Root mean square error of approximation.

Table5.

*p<0.1, **p<0.05, ***p<0.001, B=Unstandardized coefficients, β=Standardized coefficients, S.E=Standard error, T=t-value

Point 11: Results - Instead of indicating ***, please provide exact P values.

Response 11: P.13

Factor Path Estimate S.E T p-value β SMC

Health communication Doctor1 ← Health communication 1.000 0.773 0.599

Doctor2 ← Health communication 1.183 0.074 16.024 0.001 0.852 0.725

Doctor3 ← Health communication 1.009 0.067 15.145 0.001 0.814 0.660

Doctor4 ← Health communication 1.099 0.072 15.298 0.001 0.821 0.674

Doctor5 ← Health communication 1.129 0.071 15.811 0.001 0.843 0.714

Doctor6 ← Health communication 0.872 0.081 10.783 0.001 0.372 0.610

Doctor7 ← Health communication 0.886 0.082 10.772 0.001 0.371 0.609

Assistant1 ← Health communication 1.000 0.832 0.754

Assistant2 ← Health communication 0.980 0.054 18.112 0.001 0.850 0.743

Assistant3 ← Health communication 0.999 0.053 18.931 0.001 0.874 0.763

Assistant4 ← Health communication 1.049 0.057 18.532 0.001 0.862 0.722

Assistant5 ← Health communication 1.044 0.056 18.743 0.001 0.868 0.692

Expertise Expertise1 ← Expertise 1.000 0.839 0.703

Expertise2 ← Expertise 0.972 0.054 18.004 0.001 0.857 0.734

Expertise3 ← Expertise 1.138 0.055 18.952 0.001 0.889 0.791

Reliability Reliability1 ← Reliability 1.000 0.896 0.802

Reliability2 ← Reliability 1.059 0.043 24.686 0.001 0.918 0.843

Reliability3 ← Reliability 1.024 0.051 20.198 0.001 0.838 0.702

Reliability4 ← Reliability 1.046 0.051 20.312 0.001 0.840 0.706

Tangibility Tangibility1 ← Tangibility 1.000 0.754 0.568

Tangibility2 ← Tangibility 1.153 0.085 13.611 0.001 0.765 0.585

Tangibility3 ← Tangibility 1.227 0.077 15.998 0.001 0.882 0.778

Tangibility4 ← Tangibility 1.239 0.078 15.955 0.001 0.880 0.774

Tangibility5 ← Tangibility 1.306 0.086 15.130 0.001 0.839 0.705

Tangibility6 ← Tangibility 0.979 0.110 8.924 0.001 0.271 0.520

Accessibility Accessibility1 ← Accessibility 1.000 0.902 0.813

Accessibility2 ← Accessibility 1.083 0.053 20.472 0.001 0.934 0.872

Accessibility3 ← Accessibility 0.874 0.067 13.048 0.001 0.656 0.430

Accessibility4 ← Accessibility 0.605 0.081 7.493 0.001 0.271 0.520

Service value Service1 ← Service value 1.000 0.941 0.885

Service2 ← Service value 1.014 0.034 30.273 0.001 0.927 0.859

Service3 ← Service value 0.907 0.039 22.974 0.001 0.845 0.715

Service4 ← Service value 0.801 0.045 17.679 0.001 0.751 0.564

Service5 ← Service value 0.932 0.039 23.868 0.001 0.858 0.736

Patient

satisfaction Satisfaction1 ← Satisfaction 1.000 0.908 0.825

Satisfaction2 ← Satisfaction 1.025 0.035 28.949 0.001 0.942 0.888

Satisfaction3 ← Satisfaction 1.080 0.036 29.909 0.001 0.952 0.907

Satisfaction4 ← Satisfaction 1.057 0.042 25.243 0.001 0.899 0.809

Reuse intention Reuse1 ← Reuse intention 1.000 0.944 0.892

Reuse2 ← Reuse intention 1.023 0.026 39.650 0.001 0.972 0.945

Reuse3 ← Reuse intention 0.968 0.028 34.935 0.001 0.947 0.897

Reuse4 ← Reuse intention 0.978 0.033 29.875 0.001 0.912 0.832

***p<0.001, S.E=Standard error, T=t-value, β=Standardized coefficients, SMC=Squared Multiple Correlation.

Point 12: Disc - "This differs from the findings of previous studies that state (...)." What studies do you refer to here? Again, please note that each such statement must be accompanied by a reference. - Same with "Furthermore, the results also differed from previous study results stating that (...)." Please note that a reviewer's task is not considered to co-author your manuscript.

Response 12: P.16

These results are shown in Chang et al. (2013), the doctor's communication attitude affects the overall medical satisfaction of patients, and the medical service quality and the patient's reliability are similar to the results of a study that affects patient satisfaction. Also, Rashid et al. The health communication of doctors in (2014) were similar to the results of a study that showed greater satisfaction to patients than clinical competence [31, 32].

This is, Ehsan et al. (2015) The interaction between the medical staff and the patient affects the overall satisfaction of medical services, and it is different from the research results that the more the communication by doctors and assistant staff with the patients more smoothly, the patient satisfaction is improved [35]. In addition, Fellani Danasra et al. In (2011), most of the patients receiving dental treatment want to talk to the assistant staff about their discomfort, which is different from the research results that have an effect on the patient's reuse intention of dental institutions [36].

Point 13: Disc - Same with "This is consistent with the findings of previous studies (...)." Again, this revised and re-submitted draft would not seem convincingly elaborated.

Response 13: P.16-17

In Seema (2011), patient satisfaction is similar to the results of a study that observes the treatment process and maintains the continuity of treatment, and that patient satisfaction closely affects the reuse intention a medical institution [37]. Also, Anang et al. In (2019), research results show that the quality of service at a medical institution affects patient satisfaction [38]. Quality of service has a significant effect on the reuse intention and is similar to previous research results that show a significant correlation between satisfaction of outpatients, quality of service, and reuse intention [38-40].

Point 14: Concl - Do not repeat methodology or results here. Instead, provide a reasonable extension of your outcome which must stick to the aims of your study.

Response 14:

The revision was made according to the reviewer's opinion in the previous revision. Thank you for reviewing my paper so that it can be published.

Point 15: Concl - Note that aspects like "limitations" must be given with the Discussion section.

Response 15:

The revision was made according to the reviewer's opinion in the previous revision. Thank you for reviewing my paper so that it can be published.

Point 16: Refs - Still the references would not seem to follow the Journal's Guidelines for Authors. No doubt, it would seem hard to understand why the authors do not want to follow those guidelines.

Response 16: P.19

Modified according to reviewer's advice. Thank you for reviewing my paper so that it can be published.

Best regards,

Response to Reviewer Comments

Point 1: Thank you for addressing the comments fully, which made the manuscript sound technically and scientifically.

Response 1:

Thank you for reviewing my paper so that it can be published.

Best regards,

Attachment

Submitted filename: Response to reviewers1.docx

Click here for additional data file.^{(34.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0250546.r005

Decision Letter 2

Andrej M Kielbassa

2 Dec 2020

PONE-D-19-29416R2

Factors affecting revisiting intention for medical services at dental clinics

PLOS ONE

Dear Dr. Lee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Having intensively reviewed your draft, our reviewer has indicated that your submitted draft would not seem satisfying. I have double checked your submitted draft, to come to a more balanced decision. Indeed, you should follow the reviewer's comments, to finalize your paper convincingly, and to meet both PLOS ONE's quality standards and our readership's expectations. Please note that a non-convincing revision (not considered acceptable with regard to language, reviewers' constructive criticism, content, generalizable outcome, and/or Authors' Guidelines) will lead to outright reject.

Please submit your revised manuscript by Jan 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Andrej M Kielbassa

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #4: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #4: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Reviewer #1: Abstract

- "n this study, the structural (...)." meaning remains unclear, please revise.

- Please note that "p=0.000" would seem hardly possible. Must read p=0.001 (if this is the exact value), or p<0.001 (if exact result would be p=0.0009, for example), or p<0.0001 (if exact result would be p=0.000006, for example). Please revise thoroughly.

Intro

- "(...) model—where (...)" must read "(...) model — where (...)". Re-edit, and make use of your spacebar.

- Same with "(...) personnel — to a (...)". See also the same formatting shortcoming later on.

- "(...) so lighter patients tend to use higher-level hospitals (...)." Meaning of "lighter" patient remains unclear. Please clarify.

- Do not use unclear symbols with your text, see "(service quality → satisfaction)". Meaning of " → " remains unclear. With your full text, please provide full sentences. In this case, " → " could mean "service quality leads to higher satisfaction". Revise thoroughly.

- Authors have stated a false null hypothesis ("To this end, in this study, the null hypothesis is that communication by doctors and assistant staff affects the reuse intention medical institutions with service value and patient satisfaction as parameters."). Please remember that H0 proposes that there is NO difference between certain characteristics of a population (or data-generating process). Please see definitions on the web, and revise carefully.

- Same with "In addition, this study aims to analyze by setting the null hypothesis that the medical services quality affects the reuse (...)."

- "This study constructed a questionnaire based on the measurement items developed by Bowers et al., Marley et al., and Goleman." Please provide reference numbers after each author name/group.

- "Concerning medical service quality, (...)", and "Patient satisfaction is the cognitive response (...)". With your methods section, do not provide a literature review, and do not provide explanations or definitions. Stick exclusively to your methodology, and re-edit subheadings. Aspects considered necessary for the readership must be provided either with the Intro, or with the Disc section. Revise thoroughly.

- Same with "Service value refers to (...)", and "Reuse intention refers to (...)."

- Do not use legal terms like Inc., and so on. Please delete.

Results

- Again, please revise for minor typos. "(Table1)" must read "(Table 1)", you surely will agree.

- Same with TLI(Tucker Lewis Index), and so on. make use of your spacebar to separate acronyms and full text. Revise thoroughly.

- Again, revise for uniform formatting. Compare "TLI=0.918" and "TLI = 0.910". This clearly is considered the authors task. Always use X = Y, and make use of your spacebar. Revise thoroughly throughout your text.

Disc

- What about H0? Was it rejected or not rejected?

- Again, to facilitate reading, please revise your text for typos. See, for example, "Also, Rashid et al. The health communication (...)". Please note that all (co-)authors must read AND approve your submission before re-submitting your paper. This includes revision of typos. With 4 (!) authors/contributors, the number of minor and major shortcomings should be reducible, don't you agree?

- Same with "This is, Ehsan et al. (2015) The interaction between (...)". This text would seem perfectible.

- Again, same with "In addition, Fellani Danasra et al. In (2011), most of the patients (...)". Revise thoroughly throughout your text, and search some help of a native speaker.

Concl

- Revise to facilitate reading. Do not double terms like "therefore".

Refs

- Authors have failed to uniformly format this section.

- Again, stick to Guidelines for Authors, and consult some recently published papers. See the following example:

Cheng L, Weir MD, Xu HH, Antonucci JM, Lin NJ, Lin-Gibson S, et al. Effect of amorphous calcium phosphate and silver nanocomposites on dental plaque microcosm biofilms. J Biomed Mater Res B Appl Biomater. 2012; 100(5): 1378–1386. https://doi.org/10.1002/jbm.b.32709 PMID: 22566464 Revise thoroughly, and remember that proceeding will not be possible without a complete revision of your draft.

In total, this draft would seem worth following, but clearly is not considered ready to proceed.

Reviewer #4: The manuscript presents extremely relevant data for the organization of health actions; however, some aspects need to be better described.

The title of the manuscript leads us to the understanding of the services offered in dental clinics, however, when reading the text there is little focus specifically on this service, since the text is more centered on doctor and medical services. The suggestion is that the text be described about health services in general, and specifically about dental clinics and the dentist.

The research was carried out on dental clinics and dentists, however, there is little presence of these terms throughout the text, which allows for a confused reading of the text by over-mentioning the terms doctor and medical services.

Abstract

The abstract needs to present the context of dental clinics and not medical services, it is important to highlight the object of the study. It is necessary to review the verbs and present them in the past. The last sentence of the methods is incomplete. Replace p=0.000 with p<0.001, considering that there is no statistical significance equal to zero. In the statistical packages, when checking the output, it is possible to verify the exact significance.

Introduction

The first paragraph has no reference. Review throughout the text to prioritize the use of the terms: dentists and dental clinics. It is necessary to review the null hypothesis presented since this hypothesis generally states that there is no relationship between the studied phenomena. The objectives need to be better described, as there is duplication in the presentation.

Methods

The text does not make it clear what the inclusion criteria were. Were people under 18 included?

The data analysis section needs to be reviewed carefully. It is necessary to describe in detail the analyzes carried out, as well as the criteria used for each type of analysis. What were the criteria and procedures adopted for the factor analysis? What were the post-tests used to assess the adequacy of the model? What criteria are used?

Results

The results related to factor analysis were not presented. What were the communalities, the sample adequacy measures, the variance explained by each factor?

In the instrument used, there are more dimensions than those shown in Table 2. The dimensions “Expertise of assistant staff” and “Responsiveness of the office or clinic” are not listed in the table. The number of items in the Communication by assistant dimension is different on the table and on the instrument.

The instrument contains 48 items; however, it was presented that the analysis was performed with only 38 items, it is necessary to present the reasons that led to the exclusion of 10 items.

In table 5, it is necessary to review the presentation of the p-values (p=0.000). If the p-value was presented, it is not necessary to use symbols to describe the statistical significance.

In figure 2, the expertise dimension has repeated values, it is necessary to correct it. As this is the figure that presents the final model, I suggest that only the relations that were significant for the composition of the final model be presented.

Discussion

In view of the notes made, it is suggested that all dimensions of the final model be addressed in the discussion. It is necessary to review the use of the terms doctor and medical services.

Conclusion

It is highly recommended that the title, objectives and conclusion are related and that the conclusion responds directly to the proposed objectives.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #4: Yes: Arthur de Almeida Medeiros

PLoS One. 2021 May 4;16(5):e0250546. doi: 10.1371/journal.pone.0250546.r006

Author response to Decision Letter 2

16 Jan 2021

Response to Reviewer 1 Comments

Point 1: "n this study, the structural (...)." meaning remains unclear, please revise.

Response 1: P.2

In this study, the structural influence of factors was determined using structural equation modeling.

Point 2: Please note that "p=0.000" would seem hardly possible. Must read p=0.001 (if this is the exact value), or p<0.001 (if exact result would be p=0.0009, for example), or p<0.0001 (if exact result would be p=0.000006, for example). Please revise thoroughly.

Response 2: P.2

Results

The factors influencing service value were reliability (β = 0.364, p < 0.001), expertise (β = 0.319, p < 0.001), communication by a doctor (β = 0.224, p < 0.001) and tangibles (β = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were in the order of reliability (β = 0.258, p < 0.001), tangibility (β = 0.192, p < 0.001), communication by a doctor (β = 0.163, p < 0.001) and Expertise (β = 0.122, p < 0.01). On the other hand, service value (β = 0.438, p < 0.001) had a positive effect on patient satisfaction, and patient satisfaction (β = 0.383, p < 0.001) was found to influence dental clinics the reuse intention.

Point 3: "(...) model—where (...)" must read "(...) model — where (...)". Re-edit, and make use of your spacebar.

Response 3: P.3

Medical services are changing from a disease-centered model to a patient-centered model. In the existing disease-centered model, all the decision-making concerning patient care was conducted based on the expertise of doctors and other medical personnel, but in the patient-centered model, the patient actively participates in their treatment process and their needs and preferences are reflected in care-related decision making [1, 2].

Point 4: Same with "(...) personnel — to a (...)". See also the same formatting shortcoming later on.

Response 4: P.3

Point 5: "(...) so lighter patients tend to use higher-level hospitals (...)." Meaning of "lighter" patient remains unclear. Please clarify.

Response 5: P.3

In general, in order to receive care in Korea, primary and secondary medical institutions must be visited first, and in case of major ailment patients, a medical referral form is issued and care can be received at tertiary medical institutions. However, most dental clinics are composed of primary and secondary medical institutions, and primary medical institutions can receive treatment at the level of tertiary medical institutions. In addition, most of the dental clinics tend to have outpatients and relatively few patients with severe diseases. Therefore, it is necessary to increase the patient's reuse intention through patient-centered communication because the patient can choose a dental clinics to receive treatment [3].

Point 6: Do not use unclear symbols with your text, see "(service quality → satisfaction)". Meaning of " → " remains unclear. With your full text, please provide full sentences. In this case, " → " could mean "service quality leads to higher satisfaction". Revise thoroughly.

Response 6: P.4

Existing prior studies mainly consisted of the relationship between service quality affects satisfaction, or service quality affects reuse intention. In addition, it is focused on research that service quality affects satisfaction, and satisfaction affects reuse intention.

Point 7:

- Same with "In addition, this study aims to analyze by setting the null hypothesis that the medical services quality affects the reuse (...)."

Response 7: P.4

To this end, the null hypothesis was established that health communication and medical service quality do not affect the reuse intention of dental clinics by mediating service value and patient satisfaction.

Point 8: "This study constructed a questionnaire based on the measurement items developed by Bowers et al., Marley et al., and Goleman." Please provide reference numbers after each author name/group.

Response 8: P.6

This study constructed a questionnaire based on the measurement items developed by Bowers et al. [12], Marley et al. [13], and Goleman [14].

Point 9: "Concerning medical service quality, (...)", and "Patient satisfaction is the cognitive response (...)". With your methods section, do not provide a literature review, and do not provide explanations or definitions. Stick exclusively to your methodology, and re-edit subheadings. Aspects considered necessary for the readership must be provided either with the Intro, or with the Disc section. Revise thoroughly.

Response 9: P.6

Patient satisfaction was measured by using the measurement items developed by Westbrook [22], Woodside et al. [23], and Dodd et al. [24].

Point 10: Same with "Service value refers to (...)", and "Reuse intention refers to (...)."

Response 10: P.6

Service value is the physical and emotional value the patient feels through the treatment process and results.

Point 11: Do not use legal terms like Inc., and so on. Please delete.

Response 11: P.8

It's corrected.

IBM, Chicago, IL, USA

Point 12: Again, please revise for minor typos. "(Table1)" must read "(Table 1)", you surely will agree.

Response 12: P.9-10

It's corrected.

Point 13: Same with TLI(Tucker Lewis Index), and so on. make use of your spacebar to separate acronyms and full text. Revise thoroughly.

Response 13: P.11

It's corrected.

Tucker Lewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA)

Point 14: Again, revise for uniform formatting. Compare "TLI=0.918" and "TLI = 0.910". This clearly is considered the authors task. Always use X = Y, and make use of your spacebar. Revise thoroughly throughout your text.

Response 14: P.11, P.14

The model goodness of fit for the measurement model was that the coefficient values estimated as χ₂ = 1712.643 (df = 783, P < 0.001), TLI = 0.918, CFI = 0.926 were 0.9 or higher, and overall, the model fits were excellent. In addition, RMSEA = 0.063 is less than 0.08, making the factor analysis reasonable.

The result of analyzing the model used in the study showed that χ₂ = 1653.662, TLI = 0.910, CFI = 0.917, and RMSEA = 0.072, indicating that the values of the indexes are generally excellent and satisfactory. The goodness-of-fit of the research model is shown in Table 4.

Point 15: What about H0? Was it rejected or not rejected?

Response 15: P.16

As a result of the study, health communication and quality of medical service influenced the reuse intention of dental clinics by mediating patient satisfaction and service value, thus rejecting the null hypothesis and adopting the alternative hypothesis. The detailed study results are as follows.

Point 16:

- Same with "This is, Ehsan et al. (2015) The interaction between (...)". This text would seem perfectible.

"This is, Ehsan et al. (2015) The interaction between (...)"

- Again, same with "In addition, Fellani Danasra et al. In (2011), most of the patients (...)". Revise thoroughly throughout your text, and search some help of a native speaker.

Response 16: P.16

Also, Rashid et al. (2014), the health communication of doctors in were similar to the results of a study that showed greater satisfaction to patients than clinical competence [34].

This is, Ehsan et al. (2015), showed that the smoother communication between doctors and the assistant staff was found to be different from the research results that are linked to patient satisfaction [37]. In addition, Fellani Danasra et al. (2011), most of the patients receiving dental treatment want to talk to the assistant staff about their discomfort in treatment, which is different from the research results that it affects the patient's reuse intention of dental clinics [38].

Point 17: Revise to facilitate reading. Do not double terms like "therefore".

Response 17: P.18

This study aimed to analyze the influencing factors of the reuse of medical services, employing data from patients visiting dental clinics located in Seoul. The results showed that reliability and communication by doctors affected service value and patient satisfaction, which had an effect on reuse intention. It is considered that the following measures are necessary to increase the satisfaction of patients who have visiting dental clinics and to increase the reuse intention. Dental clinics should provide appropriate medical services to outpatients, which is based on smooth communication between doctors and patients. Additionally, doctors having an attitude of respect toward the patient may affect patient satisfaction. Doctors providing medical treatment information to patients with a friendly and respectful attitude rather than an authoritarian attitude may be an effective strategy for dental medical institutions to attract long-term customers.

Point 18: Refs

- Authors have failed to uniformly format this section.

- Again, stick to Guidelines for Authors, and consult some recently published papers. See the following example:

Response 18:

It's corrected.

Point 19: In total, this draft would seem worth following, but clearly is not considered ready to proceed.

Response 19:

Thank you for reviewing my paper so that it can be published.

Best regards,

Response to Reviewer 2 Comments

Point 1: The manuscript presents extremely relevant data for the organization of health actions; however, some aspects need to be better described. The title of the manuscript leads us to the understanding of the services offered in dental clinics, however, when reading the text there is little focus specifically on this service, since the text is more centered on doctor and medical services. The suggestion is that the text be described about health services in general, and specifically about dental clinics and the dentist. The research was carried out on dental clinics and dentists, however, there is little presence of these terms throughout the text, which allows for a confused reading of the text by over-mentioning the terms doctor and medical services.

Response 1: P.3

Point 2: The abstract needs to present the context of dental clinics and not medical services, it is important to highlight the object of the study. It is necessary to review the verbs and present them in the past. The last sentence of the methods is incomplete. Replace p=0.000 with p<0.001, considering that there is no statistical significance equal to zero. In the statistical packages, when checking the output, it is possible to verify the exact significance.

Response 2: P.2

Abstract

Introduction

Recent changes in the medical paradigm are highlighting the importance of patient-centered communication. However, due to the lack of awareness of dental clinics and of competence in medical personnel, the quality of medical services regarding communication between doctors and patients has not improved. This study analyzes the impact of health communication and medical service quality, service value, and patient satisfaction on revisiting intention for dental clinics.

Methods

The study subjects were outpatients who were treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire visited the dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed to 10 dental clinics, 60 copies each, and 570 valid questionnaires were used for analysis. In this study, the structural influence of factors was determined using structural equation modeling.

Results

Point 3: Introduction

Response 3: P.3

Point 4: Methods

The text does not make it clear what the inclusion criteria were. Were people under 18 included?

The data analysis section needs to be reviewed carefully. It is necessary to describe in detail the analyzes carried out, as well as the criteria used for each type of analysis.

Response 4: P.6

We focused on patients waiting to make a payment or to receive their prescription after receiving treatment as an outpatient over 13 years old in the dental clinic. Since oral care can lead to chronic diseases, regular checkups, and prevention are required from adolescence. The quality of dental services felt by patients during their adolescence can lead to adults, which can be an obstacle to continuous visits to dental institutions, so adolescent patients were included in the study.

Point 5: What were the criteria and procedures adopted for the factor analysis? What were the post-tests used to assess the adequacy of the model? What criteria are used?

Response 5: P.7

Second, factor analysis was performed to verify the validity of the questions, while the reliability of the measurement questions was validated using Cronbach's alpha (α). In the case of factor analysis, first, an Exploratory Factor Analysis (EFA) of the Varimax mode orthogonal rotation was performed to examine the factor structure of the questions for measuring variables. Next, a Confirmatory Factor Analysis (CFA) was conducted to confirm whether the derived factor structure was consistent with actual empirical data.

Point 6: The results related to factor analysis were not presented. What were the communalities, the sample adequacy measures, the variance explained by each factor?

Response 6: P.10

An EFA was conducted based on the collected data to examine the factor structure of Forty-eight questions used to measure variables. Factor analysis was carried out by removing the items that hinder the validity and deleting the questions with the lowest commonality. After that, the question with the lowest commonality was deleted and the work of factor analysis was repeated. As a result, the items of expertise of assistant staff, responsiveness of the office or clinic had low commonality and were deleted, and finally, forty-two questions were selected. EFA was again conducted to examine the factor structure of the final selected items. The Karser Meyer Olkin (KMO) = 0.944, Bartlett's test of sphericity test was also significant (χ₂ = 13748.522, P < 0.001), and the data used in the analysis were judged to be suitable for factor analysis. In addition, the Total Variance Explained was 74%.

Point 7: In the instrument used, there are more dimensions than those shown in Table 2. The dimensions “Expertise of assistant staff” and “Responsiveness of the office or clinic” are not listed in the table. The number of items in the Communication by assistant dimension is different on the table and on the instrument.

Response 7: P.10

Point 8: The instrument contains 48 items; however, it was presented that the analysis was performed with only 38 items, it is necessary to present the reasons that led to the exclusion of 10 items.

Response 8: P.11

In the CFA, two items on communication by doctors, one on tangibility, and one on accessibility did not exceed the 0.5 standard factor loading criterion. That is, out of the Forty-eight questions used for data collection, six items with poor commonality were removed through EFA, and four items with poor validity were removed through CFA. Therefore, 38 items—excluding ten items—were used for the analysis. Table 3 shows the results of the CFA for the model used in this study.

Point 9: In table 5, it is necessary to review the presentation of the p-values (p=0.000). If the p-value was presented, it is not necessary to use symbols to describe the statistical significance.

Response 9: P.14

Table 5. Research model path coefficients.

Factor Path B β S.E. T p-value

Service value Service ← Communication by doctor 0.215 0.224 0.060 3.600** 0.001

Service ← Communication by assistant -0.038 -0.037 0.066 -0.580 0.562

Service ← Expertise 0.321 0.319 0.086 3.748*** 0.001

Service ← Reliability 0.365 0.364 0.089 4.113*** 0.001

Service ← Tangibility 0.175 0.136 0.081 2.145** 0.032

Service ← Accessibility 0.014 0.014 0.052 0.259 0.795

Patient satisfaction Satisfaction ← Communication by doctor 0.140 0.163 0.044 3.211** 0.001

Satisfaction ← Communication by assistant 0.046 0.050 0.046 0.997 0.319

Satisfaction ← Expertise 0.110 0.122 0.062 1.778* 0.075

Satisfaction ← Reliability 0.231 0.258 0.064 3.585*** 0.001

Satisfaction ← Tangibility 0.220 0.192 0.059 3.729*** 0.001

Satisfaction ← Accessibility -0.005 -0.005 0.037 -0.130 0.897

Satisfaction ← Service value 0.397 0.444 0.050 7.941*** 0.001

Reuse intention Reuse ← Patient satisfaction 0.491 0.383 0.087 5.616*** 0.001

Reuse ← Service value 0.501 0.438 0.078 6.414*** 0.001

*p<0.1, **p<0.05, ***p<0.001, B=Unstandardized coefficients, β=Standardized coefficients, S.E=Standard error, T=t-value

Point 10: In figure 2, the expertise dimension has repeated values, it is necessary to correct it. As this is the figure that presents the final model, I suggest that only the relations that were significant for the composition of the final model be presented.

Response 10: P.15

Fig 2. Final path model.

Point 11: In view of the notes made, it is suggested that all dimensions of the final model be addressed in the discussion. It is necessary to review the use of the terms doctor and medical services.

Response 11: P.15-16

Point 12: It is highly recommended that the title, objectives and conclusion are related and that the conclusion responds directly to the proposed objectives.

Response 12: P.18

Best regards,

Attachment

Submitted filename: Reviewer4.docx

Click here for additional data file.^{(261.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0250546.r007

Decision Letter 3

Andrej M Kielbassa

5 Feb 2021

PONE-D-19-29416R3

Factors affecting revisiting intention for medical services at dental clinics

PLOS ONE

Dear Dr. Lee,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but still does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to re-submit a revised version of the manuscript that addresses the points raised during the review process.

Having intensively reviewed your draft, our reviewers again have indicated that your re-submitted draft might be perfectible. All in all, the indicated shortcomings would seem reasonable, and your current version would not seem satisfying. Please note that a final proceeding will be possible with faultless manuscripts only. Moreover, one of our reviewers has asked for more complete statistical explanations. Remember that reproducibility is the cornerstone of scientific advancement, so please ensure to re-submit replicable information and descriptions with your convincingly revised draft.

Indeed, you should follow the reviewers' comments, to finalize your paper, and to meet both PLOS ONE's quality standards and our readership's expectations. Please note that a non-convincing revision (not considered acceptable with regard to language, reviewers' constructive criticism, content, generalizable outcome, and/or Authors' Guidelines) will lead to outright reject.

Please submit your revised manuscript by Mar 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Andrej M Kielbassa

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #4: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #4: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #4: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #4: No

**********

6. Review Comments to the Author

Reviewer #1: Still, some minor typos are evident with the Reference section, and the latter would seem lacking uniformity. These aspects will be revised with the proofs, so please pay special attention to the proof reading. This revised and re-submitted manuscript would seem ready to proceed.

Reviewer #4: The authors accepted most of the suggestions made and adapted the manuscript accordingly. However, there is still a need for a better description of the statistical analysis plan and presentation of results related to exploratory factor analysis.

In the statistical analysis plan, the criteria used to include the variables in the exploratory factor analysis model were not described. What were the correlation coefficients considered for inclusion in this model? What were the commonality values considered to exclude variables from the model?

In the results, it is strongly recommended that the exploratory factor analysis results be presented in a table with the value of each variable's factor loads in each factor, with the value of the sample adequacy measure, commonality, and percentage of explained variance. All the factors generated must be presented, with their respective identifications and variables included. From these results, it is possible to understand why the factors were created and to know which variables were excluded from the final analysis.

Although I am not a native English speaker, it is strongly suggested to revise the entire text.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #4: No

PLoS One. 2021 May 4;16(5):e0250546. doi: 10.1371/journal.pone.0250546.r008

Author response to Decision Letter 3

24 Mar 2021

Response to Reviewer Comments

Point 1: Still, some minor typos are evident with the Reference section, and the latter would seem lacking uniformity. These aspects will be revised with the proofs, so please pay special attention to the proof reading. This revised and re-submitted manuscript would seem ready to proceed.

Response 1:

Modified it according to the reviewer's advice. Thank you for reviewing my paper so that it can be published.

Best regards,

Response to Reviewer Comments

Point 1: In the statistical analysis plan, the criteria used to include the variables in the exploratory factor analysis model were not described. What were the correlation coefficients considered for inclusion in this model? What were the commonality values considered to exclude variables from the model?

Response 1: P.13 (Line 211-218).

For exploratory factor analysis, the validity of the composition was verified using the principal components analysis (PCA) of the Varimax rotation, and Kaise-Meyer Olkin (KMO) and Barlett sphericity were verified. Variables were selected based on an eigenvalue of 1 or more and factor loading of 0.4 or more for each variable, and Cronbach's Alpha was checked for reliability, and items that lowered reliability were removed through factor analysis and improved to an appropriate level. As a result, six items including the expertise of assistants and responsiveness of the office/clinic had commonality less than 0.4 and were deleted.

Point 2: In the results, it is strongly recommended that the exploratory factor analysis results be presented in a table with the value of each variable's factor loads in each factor, with the value of the sample adequacy measure, commonality, and percentage of explained variance. All the factors generated must be presented, with their respective identifications and variables included. From these results, it is possible to understand why the factors were created and to know which variables were excluded from the final analysis.

Response 2: P.15-16(Line 223-224).

Table 2. EFA Results

Variable Commonality Component

1 2 3 4 5 6 7 8 9

Communication by doctor Doctor1 0.698 0.295

Doctor2 0.766 0.292

Doctor3 0.750 0.251

Doctor4 0.769 0.208

Doctor5 0.794 0.184

Doctor6 0.749 0.182

Doctor7 0.766 0.136

Communication by assistant Assistant1 0.755 0.818

Assistant2 0.828 0.798

Assistant3 0.814 0.791

Assistant4 0.808 0.751

Assistant5 0.823 0.732

Expertise Expertise1 0.672 0.695

Expertise2 0.754 0.661

Expertise3 0.773 0.603

Expertise of assistant staff Expertise of assistant1 0.312

Expertise of assistant2 0.339

Expertise of assistant3 0.392

Reliability Reliability1 0.789 0.606

Reliability2 0.785 0.571

Reliability3 0.725 0.566

Reliability4 0.719 0.525

responsiveness Responsiveness1 0.234

Responsiveness2 0.351

Responsiveness3 0.256

Tangibility Tangibility1 0.692 0.847

Tangibility2 0.692 0.830

Tangibility3 0.679 0.806

Tangibility4 0.814 0.758

Tangibility5 0.809 0.646

Tangibility6 0.790 0.495

Accessibility Accessibility1 0.804 0.817

Accessibility2 0.814 0.786

Accessibility3 0.721 0.775

Accessibility4 0.757 0.673

Patient satisfaction Patient satisfaction1 0.810 0.655

Patient satisfaction2 0.825 0.640

Patient satisfaction3 0.846 0.638

Patient satisfaction4 0.798 0.568

Service value Service value1 0.855 0.816

Service value2 0.850 0.800

Service value3 0.799 0.797

Service value4 0.773 0.785

Service value5 0.795 0.726

Revisit intention Revisit intention1 0.882 0.685

Revisit intention2 0.915 0.631

Revisit intention3 0.906 0.626

Revisit intention4 0.899 0.593

Eigenvalue 21.08 3.29 2.65 1.96 1.83 1.41 1.25 1.08 1.02

Explained variance (%) 16.2 11.13 9.83 9.75 9.53 6.15 5.03 3.49 2.89

Total explained variance (%) 16.26 27.39 37.21 46.96 56.54 62.69 67.71 71.21 74.10

Point 3: Although I am not a native English speaker, it is strongly suggested to revise the entire text.

Response 3:

Modified it according to the reviewer's advice. Thank you for reviewing my paper so that it can be published.

Best regards,

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PLoS One. doi: 10.1371/journal.pone.0250546.r009

Decision Letter 4

Andrej M Kielbassa

12 Apr 2021

Factors affecting revisit intention for medical services at dental clinics

PONE-D-19-29416R4

Dear Dr. Lee,

congratulations and compliments, we’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Again, please accept our congratulations, kind regards, and stay healthy,

Prof. Dr. med. dent. Dr. h. c. Andrej M Kielbassa

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #4: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #4: (No Response)

**********

6. Review Comments to the Author

Reviewer #1: Revisions would seem satisfying, and paper is ready to proceed. Congrats and compliments, and stay healthy!

Reviewer #4: The authors present themes of extreme relevance to the organization of health services.

The manuscript has clarity and objectivity.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #4: No

PLoS One. doi: 10.1371/journal.pone.0250546.r010

Acceptance letter

Andrej M Kielbassa

23 Apr 2021

PONE-D-19-29416R4

Factors affecting revisit intention for medical services at dental clinics

Dear Dr. Lee:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Prof. Dr. med. dent. Dr. h. c. Andrej M Kielbassa

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Appendix. Questionnaire for study participants.

(DOCX)

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Data Availability Statement

All relevant data are within the manuscript and its Supporting Information files. S1 Appendix. Questionnaire for study participants https://doi.org/10.6084/m9.figshare.14418620.v1

[pone.0250546.ref001] 1.Bolton RE, Bokhour BG, Hogan TP, Luger TM, Ruben M, Fix GM. Integrating personalized care planning into primary care: a multiple-case study of early adopting patient-centered medical homes. Journal of general internal medicine. 2020;35(2):428–36. 10.1007/s11606-019-05418-4 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref002] 2.Yujeong K, Eunmi L, Mee Kyung L, Mi Young K. Patient Characteristics That Influence the Experience of Patient Participation in Therapeutic Decision Making. Iranian Journal of Public Health. 2019;48(8):1537. [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref003] 3.Jung YS, Yang HY, Choi YH, Kim EK, Jeong SH, Cho MJ, et al. Factors affecting use of word‐of‐mouth by dental patients. International dental journal. 2018;68(5):314–9. 10.1111/idj.12387 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref004] 4.Kreps GL. The evolution and advancement of health communication inquiry. Annals of the International Communication Association. 2001;24(1):231–53. 10.1080/23808985.2001.11678988. [DOI] [Google Scholar]

[pone.0250546.ref005] 5.Bertakis KD, Azari R. Determinants and outcomes of patient-centered care. Patient education and counseling. 2011;85(1):46–52. 10.1016/j.pec.2010.08.001 [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref006] 6.Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743–8. 10.1001/jama.260.12.1743 PubMed Central PMCID: PMC3045356. [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref007] 7.Zeithaml VA, Bitner MJ, Gremler D. Services Marketing:New York-McGrawHill. New York: McGrawHill; 1996. [Google Scholar]

[pone.0250546.ref008] 8.Ettinger JW. Consumer-perceived value: the key to a successful business strategy in the healthcare marketplace. Journal of the American Geriatrics Society. 1998;46(1):111–3. 10.1111/j.1532-5415.1998.tb01024.x [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref009] 9.Kim CE, Shin J-S, Lee J, Lee YJ, Kim M-r, Choi A, et al. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals. BMC complementary and alternative medicine. 2017;17(1):174. 10.1186/s12906-017-1691-6 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref010] 10.Meesala A, Paul J. Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future. Journal of Retailing and Consumer Services. 2018;40:261–9. [Google Scholar]

[pone.0250546.ref011] 11.Batbaatar E, Dorjdagva J, Luvsannyam A, Savino MM, Amenta P. Determinants of patient satisfaction: a systematic review. Perspectives in public health. 2017;137(2):89–101. 10.1177/1757913916634136 [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref012] 12.Bowers MR, Swan JE, Koehler WF. What attributes determine quality and satisfaction with health care delivery? Health care management review. 1994;19(4):49–55. PubMed Central PMCID: PMC7896552. [PubMed] [Google Scholar]

[pone.0250546.ref013] 13.Gider S, Runge B-U, Marley A, Parkin S. The magnetic stability of spin-dependent tunneling devices. Science. 1998;281(5378):797–9. 10.1126/science.281.5378.797 [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref014] 14.Goleman D. Emotional intelligence: Bantam; 2006. [Google Scholar]

[pone.0250546.ref015] 15.Kyung-Il H, Bok-Dong K. The Effects of Medical Service Quality and Service Value by Relationship Quality on Customer Behaviour. Journal of Digital Convergence. 2010;8(4):137–50. [Google Scholar]

[pone.0250546.ref016] 16.Byung-Ho L, Yu-Jin C. The Association between Medical Service Quality, Consumer Satisfaction, Service Value and Customer Loyalty of Dental Patients. The Korean Journal of Health Service Management. 2014;8(2):89–100. 10.12811/kshsm.2014.8.2.089. [DOI] [Google Scholar]

[pone.0250546.ref017] 17.Cronin JJ Jr, Taylor SA. Measuring service quality: a reexamination and extension. Journal of marketing. 1992;56(3):55–68. 10.2307/1252296. [DOI] [Google Scholar]

[pone.0250546.ref018] 18.Cronin JJ Jr, Taylor SA. SERVPERF versus SERVQUAL: reconciling performance-based and perceptions-minus-expectations measurement of service quality. Journal of marketing. 1994;58(1):125–31. 10.2307/1252256. [DOI] [Google Scholar]

[pone.0250546.ref019] 19.Son S, Kwon Y, Choi I. Service quality of dental institutes measured by SERVQUAL model. J Korean Acad Dent Health. 2009;33(3):461–73. [Google Scholar]

[pone.0250546.ref020] 20.Park S. Service Quality for the Disabled on the based SERVQUAL and Effect of Provider Characteristics on Service Quality: Focused on Daily Support Services for Severly Disabled Adults. Health and Social Welfare Review. 2014;34(3):477–504. 10.15709/hswr.2014.34.3.477 [DOI] [Google Scholar]

[pone.0250546.ref021] 21.Choi C-J. Assessment of Service Quality in Hospital by using SERVPERF -Focused on Hospitals in Daejeon, South Chungchung Province. Journal of East and Central Asian Studies. 2005;16(1):138–56. [Google Scholar]

[pone.0250546.ref022] 22.Westbrook RA. Product/consumption-based affective responses and postpurchase processes. Journal of marketing research. 1987;24(3):258–70. 10.1177/002224378702400302. [DOI] [Google Scholar]

[pone.0250546.ref023] 23.Woodside AG, Frey LL, Daly RT. Linking sort/ice anlity, customer satisfaction, and behavioral intention. Journal of health care marketing. 1989;9(4):5–17. PubMed Central PMCID: PMC10304174. [PubMed] [Google Scholar]

[pone.0250546.ref024] 24.Dodds WB. In search of value: how price and store name information influence buyers′ product perceptions. Journal of Consumer Marketing. 1991;8(2):15–24. 10.1108/07363769110034974. [DOI] [Google Scholar]

[pone.0250546.ref025] 25.Min-Gyeong J. Convergence Analysis on The Determinants of Reuse Intention in Patients Visiting a Dentist. Journal of Convergence for Information Technology. 2017;7(4):1–9. 10.22156/CS4SMB.2017.7.4.001. [DOI] [Google Scholar]

[pone.0250546.ref026] 26.Gooding S. An assessment of the relationship between service quality and customer satisfaction in the formation of consumers purchase intention. Journal of Retailing. 1995;70(2):163–78. 10.1016/0022-4359(94)90013-2. [DOI] [Google Scholar]

[pone.0250546.ref027] 27.Cronin JJ, Brady MK, Brand RR, Hightower R Jr, Shemwell DJ. A cross-sectional test of the effect and conceptualization of service value. Journal of services Marketing. 1997;11(6):375–91. 10.1108/08876049710187482. [Google Scholar]

[pone.0250546.ref028] 28.Lee S, Kim J, Kim S, Yang J. The causal relationship among hospital evaluation programme, internal service quality, service value, and managerial performance. Korean J Account Res. 2010;15(2):253–76. [Google Scholar]

[pone.0250546.ref029] 29.Swan JE, Sawyer JC, Van Matre JG, McGee GW. Deepening the understanding of hospital patient satisfaction: fulfillment and equity effects. Journal of health care marketing. 1985;5(3). PubMed Central PMCID: PMC10274620. [PubMed] [Google Scholar]

[pone.0250546.ref030] 30.Reidenbach RE, Sandifer-Smallwood B. Exploring perceptions of hospital operations by a modified SERVQUAL approach. Marketing Health Services. 1990;10(4):47. PubMed Central PMCID: PMC10108701. [PubMed] [Google Scholar]

[pone.0250546.ref031] 31.Ahn S-s. The Effect of Service Authenticity on Customer Satisfaction and Word-of-Mouth and Reuse Intentions—Focused on Airline Services -. Aviation Management Society of Korea. 2018;16(1):91–105. 10.30529/amsok.2018.16.1.005. [DOI] [Google Scholar]

[pone.0250546.ref032] 32.Lim C-K. A relationship among service quality, trust, customer satisfaction and reuse intention in real estate information web-sites. Journal of the Korea Industrial Information Systems Research. 2011;16(2):125–37. 10.9723/jksiis.2011.16.2.125. [DOI] [Google Scholar]

[pone.0250546.ref033] 33.Chang C-S, Chen S-Y, Lan Y-T. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC health services research. 2013;13(1):22. 10.1186/1472-6963-13-22 PubMed Central PMCID: PMC3570322. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref034] 34.Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman medical journal. 2014;29(1):3. 10.5001/omj.2014.02 PubMed Central PMCID: PMC24501659. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref035] 35.Johnson DM, Russell RS, White SW. Perceptions of care quality and the effect on patient satisfaction. International Journal of Quality & Reliability Management. 2016. 10.1108/IJQRM-08-2015-0121. [DOI] [Google Scholar]

[pone.0250546.ref036] 36.Hesse C, Rauscher EA. The relationships between doctor-patient affectionate communication and patient perceptions and outcomes. Health communication. 2019;34(8):881–91. 10.1080/10410236.2018.1439269 [DOI] [PubMed] [Google Scholar]

[pone.0250546.ref037] 37.Zarei E, Daneshkohan A, Pouragha B, Marzban S, Arab M. An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran. Global journal of health science. 2015;7(1):1. 10.5539/gjhs.v7n1p1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref038] 38.Dewi FD, Sudjana G, Oesman YM. Patient satisfaction analysis on service quality of dental health care based on empathy and responsiveness. Dental research journal. 2011;8(4):172. 10.4103/1735-3327.86032 PubMed Central PMCID: PMC3221083. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0250546.ref039] 39.Mehta S. Service quality as predicator of patient satisfaction: a study of the health care sector. Journal of Health Management. 2011;13(2):211–29. 10.1177/097206341101300206. [DOI] [Google Scholar]

[pone.0250546.ref040] 40.Junaidi A, Siyoto S, Nurwijayanti N. Analysis of The Effect of Service Quality on The Level of Satisfaction, Trust and Interest In Revisiting Outpatients At The Hospital dr. Soepraoen Malang. Journal for Research in Public Health. 2019;1(1):53–9-–9. 10.30994/jrph.v1i1.7 [DOI] [Google Scholar]

[pone.0250546.ref041] 41.Lee C. Patient loyalty to health services: The role of communication skills and cognitive trust. International Journal of Healthcare Management. 2020:1–11. 10.1080/20479700.2020.1756111. [DOI] [Google Scholar]

[pone.0250546.ref042] 42.Kulsum U, Syah TYR. The Effect of Service Quality on Loyalty with Mediation of Patient Satisfaction. International Journal of Business and Management Invention. 2017;6(3):41–50. [Google Scholar]

PERMALINK

Factors affecting revisit intention for medical services at dental clinics

Sewon Park

Han-Kyoul Kim

Mankyu Choi

Munjae Lee

Roles

Abstract

Introduction

Materials and methods

Research model

Fig 1. Research model.

Data source and research participants

Research tool

Data analysis

Results

Demographics

Table 1. Participants’ demographic characteristics and medical utilization behavior.

Reliability and study model verification

Table 2. EFA results.

Table 3. Reliability verification.

Table 4. CFA results.

Structural equation model verification

Table 5. Research model verification (N = 570).

Table 6. Research model path coefficients.

Fig 2. Final path model.

Discussion

Conclusion

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Andrej M Kielbassa

Roles

Author response to Decision Letter 0

Decision Letter 1

Andrej M Kielbassa

Roles

Author response to Decision Letter 1

Decision Letter 2

Andrej M Kielbassa

Roles

Author response to Decision Letter 2

Decision Letter 3

Andrej M Kielbassa

Roles

Author response to Decision Letter 3

Decision Letter 4

Andrej M Kielbassa

Roles

Acceptance letter

Andrej M Kielbassa

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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