The Effectiveness of Social Media Marketing Activities in Building Brand Equity and Patient Trust and its Influence on Visit Intention in Private Hospitals

Technological developments and increasingly fierce competition for private hospitals have forced private hospitals to innovate with each other to promote their services through social media. The research aims to measure how effective the implementation of social media marketing activities is in building brand awareness, brand image, brand equity, and trust from private hospital patients and their influence on visit intention. This study uses quantitative methods, and the data obtained will be processed using CB-SEM with the IBM AMOS application, analyzing 264 questionnaire responses. The study results show that social media marketing activities affect brand awareness, brand image, and trust but do not affect visit intention. Meanwhile, trust and brand equity have a significant impact on visit intentions. However, brand awareness does not affect brand image, yet both significantly impact brand equity. This study shows that collaboration between variables is needed to impact patient visit intentions positively. It is hoped that this research can help the management of private hospitals and other health facilities in forming marketing strategies through social media activities.


Introduction
The ease of disseminating information on social media and the internet, which cannot be separated from business people, has made them start to innovate their businesses using digital marketing of their products.Digital marketing requires a more complex strategy in its use because the aim of business people using digital marketing is not only so that a product or brand of a business product becomes known but also so that business people know the preferences of potential buyers online so that it is easier to develop strategies his business.
Tools that can be used in digital marketing include websites, search engines, social media marketing, e-mail marketing, and mobile marketing.Each digital marketing tool has unique characteristics that can be adapted to promote business products online.On the website, you can provide complete information for potential buyers, from pictures to prices and how to order goods.Search engines maximize business people by providing keywords appropriate to the products they sell through websites or blogs so that they can enter the search engine's main page.Social media marketing has several types that can help business people maximize their promotions through several types of social media according to their target buyers.E-mail marketing helps business people communicate with buyers continuously via e-mail and can provide interesting information.Mobile marketing helps business people spread their promotions through short messages or applications that suit their target consumers.
The creation of social media platforms has made it easier for various communities to gather and communicate.The increasing number of social media users can also be used as a media or this study were patients from the intended private hospital.The provisions of the intended hospital, as the object of research, is a hospital that has activity in providing content on its social media and actively interacting with followers of its social media.So that there are specific criteria for the research sample, namely: (1) Residents who live in Indonesia and are at least 18 years old; (2) Own and actively use social media; (3) Follow one or more private hospital social media accounts.
In determining the sample size for this study, the general principle is used where the sample size is five times the number of indicators or question items.The number of samples obtained through this method needs to meet the requirements for using the AMOS application, which exceeds 200 respondents.This study used 35 question items on the questionnaire, so the minimum number of respondents was 175 respondents, which was still insufficient for the minimum number of AMOS applications.Hence, the researcher determined the number of respondents to be at least 200, according to the minimum limit of the AMOS application.The data that has been collected is then analyzed statistically using the AMOS program.Based on the table above, of the eleven hypotheses, 4 relationships are not significant and 7 significant relationships.So the relationship between variables can be described as follows:

Variable Relationship Analysis (Path Analysis)
In the relationship between SMMA and BA, which has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 5.603.Apart from that, the path coefficient shows a (+) connotation of 0.513, where every increase in social media marketing activity will increase brand awareness by 0.513.So, it can be concluded that social media marketing activity significantly positively affects brand awareness.
In the relationship between SMMA and BI, it has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 5.135.Apart from that, the path coefficient shows a (+) connotation of 0.518, where every increase in social media marketing activity will increase the brand image by 0.518.So, it can be concluded that social media marketing activity significantly positively affects brand image.In the relationship between SMMA and T, which has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 6.566.Apart from that, the path coefficient shows a (+) connotation of 0.522, where every increase in social media marketing activity will increase the brand image by 0.522.So it can be concluded that social media marketing activity significantly positively affects trust.
The relationship between BA and BI has a p-value (0.074) or above 0.05 and a t-value ≤ (1.96), namely 1.784.Even though the path coefficient shows a (+) connotation of 0.232, because it has an incompatible p-value and t-value, the relationship between brand awareness and brand image does not significantly affect it.The relationship between BA and BE has a p-value (0.005) or below 0.05 and a t-value ≥ (1.96), namely 2.788.Apart from that, the path coefficient shows a (+) connotation of 0.362, where each increase in brand awareness will increase brand equity by 0.362.So it can be concluded that brand awareness significantly positively affects brand equity.
The relationship between BI and BE has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 4.410.Apart from that, the path coefficient shows a (+) connotation of 0.518, where each increase in brand image will increase brand equity by 0.518.So it can be concluded that brand image significantly positively affects brand equity.In the relationship between BA and VI, it has a p-value (0.314) or above 0.05 and a t-value ≤ (1.96), namely 1.006.Even though the path coefficient shows a (+) connotation of 0.193, because it has an incompatible p-value and t-value, the relationship between brand awareness and visit intention has no significant effect.
In the relationship between BI and VI, which has a p-value (0.023) or below 0.05 and a t-value ≤ (1.96), namely -2.281.Moreover, the path coefficient shows a (-) connotation of -0.665, so the relationship between brand image and visit intention has no significant effect.In the relationship between T and VI, which has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 4.101.Apart from that, the path coefficient shows a (+) connotation of 0.711, where each increase in trust will increase visit intention by 0.711.So, it can be concluded that trust has a significant positive effect on visit intention.
In the relationship between BE and VI, it has a p-value (0.000) or below 0.05 and a t-value ≥ (1.96), namely 4.953.Apart from that, the path coefficient shows a (+) connotation of 1.440, where each increase in brand equity will increase visit intention by 1.440.So, it can be concluded that brand equity significantly positively affects visit intention.In the relationship ISSN 2721-0960 (Print), ISSN 2721-0847 (online) Copyright © 2024, Journal La Sociale, Under the license CC BY-SA 4.0 between SMMA and VI, which has a p-value (0.111) or above 0.05 and a t-value ≤ (1.96), namely -1.594.Moreover, the path coefficient shows a (-) connotation of -0.252, so the relationship between social media marketing activity and visit intention has no significant effect.Based on the table above, of the eleven hypotheses, 4 were rejected, and 7 were accepted.So, the hypothesis that has been built can be explained as follows:

H1: Social Media Marketing Activity (SMMA) positively affects Brand Awareness
Based on the data processing results from the structural model, the results obtained are a tvalue of (5.603) greater than the value of 1.96 and a p-value of (0.000) smaller or below thse value of 0.05 for social relations.Media marketing activity and brand awareness.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H1 is accepted.This study's results are from research conducted by Guha et al. (2021), where social media marketing activity influences brand awareness.This research was also conducted by (Mahadewi et al., 2020) in a private hospital, which shows that when social media marketing activity decreases, the brand awareness the hospital provides through social media also decreases.
Previous research also conducted by Ardiansyah & Sarwoko (2020) states that there is a positive influence of Social Media Marketing on Brand Awareness.This shows, if Social Media Marketing increases, Brand Awareness will increase, and vice versa.So that with the role of social media, business people increasingly have the opportunity to compete competently in increasing Brand Awareness.
The use of social media by hospitals promises to help customers understand the Health services offered, which is the goal of social media marketing itself.Therefore, by creating a good impression, it is believed that a good brand image and brand awareness can be created for the hospital (Utami & Sugiat, 2023).Brand Awareness is the ability that occurs in the minds or minds of consumers in remembering a particular brand and then making a purchase.Brand Awareness is a dominant indicator for consumers in determining purchasing decisions.When consumers buy a product for the first time, it is possible that Brand Awareness has occurred in consumers as a cue to distinguish high quality and low quality from a brand (Amalia & Kurniawati, 2023).In relation to hospitals, marketing with social media will allow people to remember the name of the hospital and then do treatment at the hospital.
Social media marketing (SMM) activities can effectively increase brand awareness by providing novel value to customers from what has been provided by the media.Consumers identify social media as a more reliable source of information than traditional marketing communication tools (Wiebowo, 2023).The existence of brand awareness or brand awareness through memory or the ability to identify brands from individuals for a product can make consumers tend to put trust in their minds so that they can trigger a purchase intention for the product (Pranata & Pramudana, 2018).

H2: Social Media Marketing Activity (SMMA) positively affects Brand Image
Based on the data processing results from the structural model, the results obtained are a tvalue of (5.135) greater than the value of 1.96 and a p-value of (0.000) smaller or below the value of 0.05 for social relations.Media marketing activity and brand image.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H2 is accepted.The results are from research conducted by (Guha et al., 2021) and (Moslehpour et al., 2021), both of which provide results that social media marketing activity influences a brand's brand image.
It is important for companies to shape online business interactions and customer behavior.Social Media Marketing Activities (SMMA) is the activity of using social media as a marketing tool to create awareness, recognition, memory, and action on a brand, product, business, individual, or group, either directly or indirectly (Dahlan & Rivai, 2022).So marketers are required to understand the increasingly important role of technology in shaping the market to adjust the company's approach to communicating and interacting with customers in an ever-evolving marketing ecosystem (Hidayah, 2019).Technological acceleration encourages companies in the technology sector, especially intangible products, to start using SMMA in marketing their products to improve brand image (Ramadani & Kurniawati, 2023).Brand image is an image that is formed from individual thoughts in seeing and assessing a brand or brand (Karamang, 2022).Brand image is measured by indicators of brand association strength, brand association advantage and brand association uniqueness (Alverina & Achmadi, 2023).

H3: Social Media Marketing Activity (SMMA) positively affects Trust
Based on the data processing results from the structural model, the results obtained are a tvalue of (6.566) greater than the value of 1.96 and a p-value of (0.000) smaller or below the value of 0.05 for social relations.Media marketing activity and patient trust.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H3 is accepted.The results of this study are based on research conducted by (Moslehpour et al., 2021), which shows that social media marketing activity influences the trust of a brand's followers.The marketing activities provided by private hospitals through social media can not only increase the trust and engagement of private hospitals' social media followers.
Trust is the foundation of a business.Customer trust is part of the general expectation that someone has that someone else's words are reliable (Nasution & Simamora, 2021).Customer trust is measured through four indicators, namely: Dependability, honest, competence and likable (Razak et al., 2018).
Trust is considered an important factor and is one of the critical factors in stimulating online transactions.When trust is getting higher, of course it will be used as a measure to foster consumer buying interest in online transactions, so the higher the trust, the higher the buying interest.Positive trust certainly affects consumer interest in shopping online because they believe that sellers are able to carry out their business activities properly and can be trusted by sending products purchased to consumers (Rachmadhaniyati & Sanaji, 2021).
Fast response in serving consumers in a friendly, fast, detailed manner in explaining goods, skillful in communicating and clear so that buyers do not hesitate to ask questions.They use social media such as whatsapp, facebook, telegram and instagram as a medium to promote their products/services (Ningsih, 2020).

H4: Brand Awareness has a positive effect on Brand Image
Based on the data processing results from the structural model, the results obtained are a tvalue of (1.784) greater than the value of 1.96 and a p-value of (0.074) smaller or below the value of 0.05 for brand relationships.Awareness and brand image.This shows that there is no significance between the two variables.So, based on the values obtained, it can be concluded that H4 is rejected.The results of this study are not based on research conducted by (Guha et al., 2021), which shows that brand awareness can influence brand image.
The research results obtained are different from the results of previous research conducted by Andriano & Cahyaningratri (2022) which states that brand awareness has a positive effect on brand image.Brand awareness can be considered as a problem or issue related to whether the name used in a brand will be able to stick to the minds of consumers which occurs in conditions of consumers thinking about things related to a particular product (Cahya & Yulianthini, 2023).
Brand image is considered as a perspective or perception that arises from consumers related to a brand which is considered as a reflection of an association that consumers have thought about.Meanwhile, brand awareness is the ability of a buyer to recognize or remember that a brand is part of a certain product category (Rachmawati & Andjarwati, 2020).
Unlike in this study, what is meant by the brand is the name of the hospital.So it is concluded that a person's ability to do treatment at a hospital will not affect the hospital's image.

H5: Brand Awareness has a positive effect on Brand Equity
Based on the data processing results from the structural model, the results obtained are a tvalue of (2.788) greater than the value of 1.96 and a p-value of (0.005) smaller or below the value of 0.05 for brand relationships.Awareness and brand equity.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H5 is accepted.The results of this study are from research conducted by (Guha et al., 2021), which shows that brand awareness can influence brand equity.These results also follow research conducted by (Kim et al., 2008), which shows that brand awareness can positively influence hospital brand equity.
These results are also supported by Harahap et al. (2022) which states that partially Brand Awareness has a significant effect on Brand Equity.Consumers can recognize the characteristics of a brand based on the information associated with the brand.The more consumers who can recognize or know a brand, the stronger the brand.
Brand equity is the added value provided by products and services.Building a brand's brand equity is an important thing to do because if a brand's brand equity is well established, it will have a positive effect on the brand (Lego & Widjaya, 2021).So that if the community has a high awareness of the hospital brand, the hospital's equity will also be high.

H6: Brand Image has a positive effect on Brand Equity
Based on the data processing results from the structural model, the results obtained are a tvalue of (4.410) greater than the value of 1.96 and a p-value of (0.000) smaller or below the value of 0.05 for brand relationships.Image and brand equity.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H6 is accepted.This study's results are from research conducted by (Guha et al., 2021) and (Moslehpour et al., 2021), which shows that brand image can influence brand equity.
Brand image is the consumer's perception of the brand, as reflected by the brand associations stored in the consumer's memory.One important aspect of a brand is its image, as reflected by the associations that consumers hold for it.It is useful for marketers to make a distinction between low-level considerations, which relate to consumer perceptions of specific performance and image attributes and benefits, and high-level considerations related to overall judgments, feelings, and relationships.
High equity is the dream of every brand because it means that these brands have closeness to the market and customers.The stronger the brand equity of a product, the stronger its appeal to consumers.So that the better the hospital image, it will also affect the hospital's equity which will also increase.

H7: Brand Awareness has a positive effect on Visit Intention
Based on the data processing results from the structural model, the results obtained are a tvalue of (1.006) greater than the value of 1.96 and a p-value of (0.314) smaller or below the value of 0.05 for brand relationships.Awareness and visit intention.This shows that there is no significance between the two variables.So, based on the values obtained, it can be concluded that H7 is rejected.The results of this study are in contrast to the results in the research of (Guha et al., 2021), which states that brand awareness can influence purchase intention, which ISSN 2721-0960 (Print), ISSN 2721-0847 (online) Copyright © 2024, Journal La Sociale, Under the license CC BY-SA 4.0 in this study is visit intention.The absence of influence between brand awareness and visit intention is also supported by (Abou-Shouk et al., 2021) research.
A high level of brand awareness, customers will pay more attention to the brand.When brand awareness is high, brand loyalty will also increase.In this study when brand awareness of the hospital does not affect visit intention.Although the main purpose of brand awareness is basically to strengthen the number of visitors to the selected destination and increase the probability.

H8: Brand Image has a positive effect on Visit Intention
Based on the data processing results from the structural model, the results obtained are a tvalue of (-2.281) greater than the value of 1.96 and a p-value of (0.023) smaller or below the value of 0.05 in the relationship.Brand image and visit intention.This shows that there is no significance between the two variables.So, based on the values obtained, it can be concluded that H8 is rejected.The results of this study are in contrast to research conducted by (Guha et al., 2021) and (Moslehpour et al., 2021), which shows that brand image can influence purchase intention, which in this study is visit intention.The absence of influence of brand image on visit intention is supported by research from (Abdul-Rahman et al., 2023), which found that the brand image of the community health center did not influence the patient's revisit intention because many patients were hesitant to visit health services since the Covid-19 pandemic.19 to prevent transmission.
In contrast to the results of research by Adiantari & Seminari (2022) which states that brand image has a positive and significant effect on repurchase intentions, in this case the intention to visit the hospital again.Visiting intentions are part of consumer behavior that occurs because there is a match between consumer desires and the performance of the services offered by the hospital, so that the desire to use them again in the future arises.

H9: Trust has a positive effect on Visit Intention
Based on the data processing results from the structural model, the results obtained are a tvalue of (4.101) greater than the value of 1.96 and a p-value of (0.000) smaller or below the value of 0.05 in trust relationships.Patients and visit intention.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H9 is accepted.The results of this study are based on research conducted by (Moslehpour et al., 2021), which shows that trust can influence purchase intention, which in this study is visit intention.In health services, both hospitals and other health service settings such as health centers or clinics, the trust given by employees to patients can provide mutual benefits to both (Kim et al., 2008).
Service at the beginning of coming is one of the things that must be considered by the hospital because the experience given to visitors will be remembered and can make an assessment to come back (Tamahela & Nugroho, 2020).The trust that is present during the initial visit will make you want to return (intention to visit) to the hospital if you are sick.

H10: Brand Equity has a positive effect on Visit Intention
Based on the data processing results from the structural model, the results obtained are a tvalue of (4.953) greater than the value of 1.96 and a p-value of (0.000) smaller or below the value of 0.05 for brand relationships.Equity and visit intention.This shows that the two variables are significant.So, based on the values obtained, it can be concluded that H10 is accepted.The results of this study are based on research conducted by Guha et al. (2021), which shows that brand equity can influence purchase intention, which in this study is visit intention.
In hospitals in Penang, Malaysia, patients deliberately choose private hospitals with high brand equity so that private hospitals with high brand equity have a strong attraction for patients.
Brands can have positive or negative consumer-based brand equity (CBBE).This can occur when consumers respond less or more positively to exposure to marketing strategies on one brand than another.Building brand equity is a strategic step that can provide competitive value for the company (Trifiyanto et al., 2021).In this case, it is important to increase the hospital's brand equity because it will affect the hospital itself, especially on visiting intentions.

H11: Social Media Marketing Activity (SMMA) positively affects Visit Intention
Based on the results of data processing from the structural model, the results obtained are a tvalue of (-1.594), which is greater than the value of 1.96, and a p-value of (0.111), which is smaller or below the value of 0.05 in the relationship social media marketing activity and visit intention.This shows that there is no significance between the two variables.So, based on the values obtained, it can be concluded that H11 is rejected.The results of this study are in contrast to research conducted by (Moslehpour et al., 2021), which shows that social media marketing activity can influence purchase intention, which in this study is visit intention.Unfortunately, there are still very few journal articles that support the results of this research.However, several research articles examine each social media marketing activity dimension with purchase or visit intention.

Conclusion
The results obtained from the study show that social media marketing activity positively affects brand awareness, brand image, and patient trust.However, the results show that brand awareness does not affect the hospital's brand image, but both positively affect brand equity owned by private hospitals.Brand equity owned by the hospital positively affects patients' visit intentions.Moreover, the higher trust that patients have in the activities carried out by the hospital through social media marketing also has a positive effect on patients' intention to visit.So, based on the data obtained, the variables that have the most influence on patients' visit intention are the brand equity of the hospital and the trust given by private hospitals through social media marketing activities.Both variables are important in increasing patient visit intention in private hospitals.This study still has limitations and obstacles in the research process, and the limitations and shortcomings that exist in this study are expected to be suggestions for further research.These include: (1) The majority of respondents in this study live on the island of Java, so the information obtained is less diverse and only done by distributing questionnaires through social media.Suggestions for future research can further disseminate questionnaires so that they can find out the conditions of social media followers of private hospitals on other islands and outside Indonesia; (2) The selection of research respondents is less specific, whether the respondent is an inpatient or outpatient, with what kind of disease.So, for further research, it can further narrow down the intended respondents so that managerial implications input can be more specific.