How Do Orders Impact Structural Equation Model? Empirical Evidence from Patient Satisfaction


There haven’t been enough empirical evidences of orders’ impact on structural equation model and satisfaction index results. This study is conducted to figure out the problem by making a comparison between the first-order and high-order structural equation models building with the same sample from healthcare. As expected, results showed that the path coefficients and goodness-of-fit indices of high-order structural equation model were basically the same with its counterpart, suggesting the structural equation model’s orders would not affect the index and play the role of simplifying the model. Besides, compared with the conventional first-order structural equation model in patient satisfaction, the high-order model tended to be an improvement, for providing the probability of analyzing intermediate latent variables and forming the theoretical basis of multi-level structural equation modeling study.

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Liu, Z. (2016) How Do Orders Impact Structural Equation Model? Empirical Evidence from Patient Satisfaction. Psychology, 7, 368-373. doi: 10.4236/psych.2016.73039.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Amin, M., & Zahora Nasharuddin, S. (2013). Hospital Service Quality and Its Effects on Patient Satisfaction and Behavioural Intention. Clinical Governance: An International Journal, 18, 238-254.
[2] Andaleeb, S. S., & Kara, A. (2014). The Structure and Measures of Service Quality Perceptions for Multiple-Encounter Services: A Study of Hospitals in Bangladesh. International Journal of Healthcare Management, 7, 92-102.
[3] Bagozzi, R. P., & Yi, Y. (1988). On the Evaluation of Structural Equation Models. Academic of Marketing Science, 16, 76-94.
[4] Bollen, K. A. (1989). Structural Equations with Latent Variables (p. 4). New York: John Wiley & Sons.
[5] Bollen, K. A., & Long, J. S. (1993). Testing Structural Equation Modeling. Newbury Park, CA: Sage.
[6] Breckler, S. J. (1990). Applications of Covariance Structure Modeling in Psychology: Cause for Concern? Psychological Bulletin, 107, 260-273.
[7] Cheng, E. W. L. (2001). SEM Being More Effective than Multiple Regression in Parsimonious Model Testing for Management Development Research. Journal of Management Development, 20, 650-667.
[8] Fornell, C., Johnson, M. D., Anderson, E. W., & Bryant, B. E. (1996). The American Customer Satisfaction Index: Nature, Purpose and Findings. Journal of Marketing, 60, 7-18.
[9] Hu, L., & Bentler, P. M. (1999) Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55.
[10] Huo, Y. (2004). CSI Model Building and the GME Comprehensive Estimation Research of Its Parameters. Doctoral Dissertation, Nanjing: Nanjing University of Science and Engineering. (In Chinese)
[11] J?reskog, K. G. (1970). A General Method for Analysis of Covariance Structures. Biometrika, 57, 239-251.
[12] Kazemi, N., Ehsani, P., Abdi, F., & Bighami, M. K. (2013). Measuring Hospital Service Quality and Its Influence on Patient Satisfaction: An Empirical Study Using Structural Equation Modeling. Management Science Letters, 3, 2125-2136.
[13] Lei, P., & Jolibert, A. (2012). A Three-Model Comparison of the Relationship between Quality, Satisfaction and Loyalty: An Empirical Study of the Chinese Healthcare System. BMC Health Services Research, 12, 436-447.
[14] Liu, Z. (2015). Literature Review of Domestic and International Research on Patient Satisfaction. Chinese Journal of Health Policy, 8, 60-66. (In Chinese)
[15] Oliver, R. L. (1980). A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions. Journal of Marketing Research, 17, 460-469.
[16] Ping Jr., R. A. (2015). A Note on Estimating Second-Order Interactions and Quadratics in Latent Variables (p. 304). New York: Springer.
[17] Qin, H., Prybutok, V. R., Peak, D. A., & Boakye, K. G. (2014). UCPERF: An Urgent Care Patient Satisfaction Instrument. The Quality Management Journal, 21, 11.
[18] Steiger, J. H. (1989). EzPATH: A Supplementary Module for SYSTAT and SYSGRAPH [Computer Program]. SYSTAT.
[19] Wu, M. (2011). Questionnaire Statistical Analysis and Practice—SPSS Operation and Application. Chongqing: Chongqing University Press. (In Chinese)

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