Public Version

Establishing client psychological comfort through
communication style in a professional services context
Rawi Roongruangsee
A thesis in fulfilment of the requirements for the degree of

Doctor of Philosophy in Marketing
School of Marketing
UNSW Business School
The University of New South Wales
Sydney, Australia
March 2018
THE UNIVERSITY OF NEW SOUTH WALES
Thesis/Dissertation Sheet
Surname or Family name: Roongruangsee
First name: Rawi Other name/s:
Abbreviation for degree as given in the University calendar: PhD
School: School of Marketing Faculty: UNSW Business School
Title: Establishing client psychological comfort through communication style in a professional services context
Abstract 350 words maximum:
Professional services are typically high in credence properties, information asymmetry, and associated with
client anxiety and uncertainty. To reduce client anxiety and ensure a positive service evaluation, creating client
psychological comfort through interpersonal communication is vital. Psychological comfort represents a person’s feelings
of security, reassurance, peace of mind, and reduction of anxiety. While its role is discerned among academics and
practitioners, client psychological comfort lacks rigorous investigation in professional services and its association with
interpersonal communication.
Using uncertainty reduction theory and the revised social interaction model as theoretical foundations, this thesis
provides empirical examinations of psychological comfort generated from client perceptions of professional service
providers’ (affiliative or dominant) communication style, as in choice of words and manner, in three interrelated studies.
Study 1 explores the impact of communication style on client psychological comfort and subsequent outcomes
(satisfaction, repurchase intention, WOM recommendation) in a medical services setting. It tests moderating effects of
cognitive social capital and cultural value orientation. The results reveal the different influences of affiliative and dominant
styles on psychological comfort and service outcomes, under conditions of high cognitive social capital and collectivist
value orientation.
Study 2 tests the internal validity of the communication style - psychological comfort relationship using an
experimental design and examines joint impacts of communication style. The findings verify the causal relationship
between the two variables. Combined effects of two styles create different levels of psychological comfort. Study 3
investigates, in the financial advisory services, the mediating role of attributional confidence on the communication style
psychological comfort linkage across clients' cultural value orientations. Attributional confidence partially mediates
affiliative style and psychological comfort. Although the impact of communication style on attributional confidence is not
significantly different across two cultural value orientations, attributional confidence stimulates higher psychological
comfort among clients with an individualist value orientation.
This thesis contributes to service literature by examining the influence of communication style on client
psychological comfort, the contingency conditions, and the underlying mechanism. It offers implications on client
psychological comfort-building strategies and client uncertainty reduction.
Declaration relating to disposition of project thesis/dissertation
I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or
dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the
provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in
future works (such as articles or books) all or part of this thesis or dissertation.
I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International
(this is applicable to doctoral theses only).
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ORIGINALITY STATEMENT
‘I hereby declare that this submission is my own work and to the best of my knowledge
it contains no materials previously published or written by another person, or
substantial proportions of material which have been accepted for the award of any
other degree or diploma at UNSW or any other educational institution, except where
due acknowledgement is made in this thesis. Any contribution made to the research by
others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged
in the thesis. I also declare that the intellectual content of this thesis is the product of
my own work, except to the extent that assistance from others in the project’s design
and conception or in style, presentation and linguistic expression is acknowledged.’
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i
COPYRIGHT STATEMENT
‘I hereby grant the University of New South Wales or its agents the right to archive
and to make available my thesis or dissertation in whole or part in the University
libraries in all forms of media, now or here after know, subject to the provisions of the
Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain
the right to use in future works (such as articles or books) all or part of this thesis or
dissertation.
I also authorise University Microfilms to use the 350 word abstract of my thesis in
Dissertation Abstract International (this is applicable to doctoral theses only).
I have either used no substantial portions of copyright material in my thesis or I have
obtained permission to use copyright material; where permission has not been granted
I have applied/will apply for a partial restriction of the digital copy of my thesis or
dissertation.’
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Date …………..……………………………….……………….………………………
AUTHENTICITY STATEMENT
‘I certify that the Library deposit digital copy is a direct equivalent of the final
officially approved version of my thesis. No emendation of content has occurred and
if there are any minor variations in formatting, they are the result of the conversation
to digital format.’
Signed ……………………………………………………………………………………………………………………
Date …………..……………………………….……………….………………………
ii
ABSTRACT
Professional services are typically high in credence properties, information

asymmetry, and associated with client anxiety and uncertainty. To reduce client
anxiety and ensure a positive service evaluation, creating client psychological comfort
through interpersonal communication is vital. Psychological comfort represents a
person’s feelings of security, reassurance, peace of mind, and reduction of anxiety.
While its role is discerned among academics and practitioners, client psychological
comfort lacks rigorous investigation in professional services and its association with
interpersonal communication.
Using uncertainty reduction theory and the revised social interaction model as
theoretical foundations, this thesis provides empirical examinations of psychological
comfort generated from client perceptions of professional service providers’
(affiliative or dominant) communication style, as in choice of words and manner, in
three interrelated studies. Study 1 explores the impact of communication style on client
psychological comfort and subsequent outcomes (satisfaction, repurchase intention,
WOM recommendation) in a medical services setting. It tests moderating effects of
cognitive social capital and cultural value orientation. The results reveal the different
influences of affiliative and dominant styles on psychological comfort and service
outcomes, under conditions of high cognitive social capital and collectivist value
orientation.
Study 2 tests the internal validity of the communication style - psychological

comfort relationship using an experimental design and examines joint impacts of
communication style. The findings verify the causal relationship between the two
variables. Combined effects of two styles create different levels of psychological
comfort. Study 3 investigates, in the financial advisory services, the mediating role of
attributional confidence on the communication style - psychological comfort linkage
across clients’ cultural value orientations. Attributional confidence partially mediates
affiliative style and psychological comfort. Although the impact of communication
style on attributional confidence is not significantly different across two cultural value
orientations, attributional confidence stimulates higher psychological comfort among
clients with an individualist value orientation.
This thesis contributes to service literature by examining the influence of

communication style on client psychological comfort, the contingency conditions, and
the underlying mechanism. It offers implications on client psychological comfort-
building strategies and client uncertainty reduction.
iii
ACKNOWLEGEMENTS
I would like to express my appreciation exclusively to my supervisor Professor

Paul Patterson who has provided me with excellent guidance, opportunities, and
understanding. I am truly blessed to learn from and work with him. I would also like
to thank Associate Professor Liem Ngo for his co-supervision and encouraging me
with his discipline in researching. Without effective and timely advice from both of
them, my research and a completion of thesis would not be achieved.
I would like to show my sincere gratitude to the following people at the School
of Marketing, UNSW Sydney: Professor Adrian Payne, Dr. Rita di Mascio, and
Associate Professor Jack Cadeaux for their constructive comments on my research
proposal, Professor John Roberts, Associate Professor Nitika Garg, Associate
professor Emeritus James Nelson, Associate Professor Peter Roebuck for their
consultations, and the school staffs for their supports. I would also like to thank the
people from Faculty of Business Administration, Chiang Mai University: Dean Siriwut
Buranapin, for giving me his trust and an opportunity to pursue my studies, and my
colleagues at Marketing Department for reinforcement and assistance on data
collection. Moreover, I would like to thank Chiang Mai University and the UNSW
Business School for granting me tuition supports throughout the years of study.
A special thanks to the persons and organisations associated with the data
collection: Melinda McMullan, Brett Saurine, Mattana Sornanan, Parin Kritsunthon,
Dr. Warat Winit, Maharaj Nakorn Chiang Mai Hospital, and the Marketing
Department, Chiang Mai University.
Furthermore, I would also like to extend my gratitude to my parents; Montathip

and Chaiwat Roongruangsee, for all of the unconditional love and supports that
they’ve given. This thesis is dedicated to them. I would like to thank all my friends in
Chiang Mai for their constant encouragement even through distance and time.
Additionally, I would like to thank my PhD associates: Kedsaraporn Panngam, Eileen
Chiew, David Sugianto Lie, Felix Septianto, Yutian Shen, Pei-Yu Chien, Jake An,
Obaid Gill, Nicole Lasky, Tony Lu, Luu Ngoc, and Chi Pham for their academic and
psychological supports. This PhD journey is filled with enjoyable and remarkable
moments because of their friendship.
iv
TABLE OF CONTENTS
ORIGINALITY STATEMENT.................................................................................i
COPYRIGHT STATEMENT...................................................................................ii
AUTHENTICITY STATEMENT.............................................................................ii
ABSTRACT...............................................................................................................iii
ACKNOWLEDGEMENTS......................................................................................iv
TABLE OF CONTENTS...........................................................................................v
LIST OF FIGURES AND TABLES......................................................................viii
About the thesis: A not from the author...................................................................1
CHAPTER 1: INTRODUCTION.............................................................................2
1.1 Overview........................................................................................................2
1.2 Client Evaluations of Professional Services...................................................4
1.3 Client Psychological Comfort........................................................................5
1.4 Interpersonal Communication........................................................................6
1.5 Recent Knowledge and the Research Gap......................................................8
1.6 Research Questions......................................................................................12
1.7 Theoretical Foundation.................................................................................13
1.8 Thesis Overview...........................................................................................17
1.9 Theoretical Contribution...............................................................................21
1.10 Thesis Structure...........................................................................................22
CHAPTER 2: BUILDING CLIENT PSYCHOLOGICAL COMFORT

THROUGH COMMUNICATION STYLE: EVIDENCE FROM A SOUTH-
EAST ASIAN COLLECTIVIST COUNTRY.................................................23
Abstract................................................................................................................23
2.1 Introduction...................................................................................................24
2.2 Conceptual Background & Research Hypotheses………............................28
2.2.1 Professional Services...........................................................................28
2.2.2 Psychological Comfort........................................................................29
2.2.3 Communication Style..........................................................................33
2.2.4 Moderating Role of Cognitive Social Capital.....................................38
2.2.5 Moderating Role of Cultural Value Orientation..................................40
2.2.6 Satisfaction..........................................................................................43
2.2.7 Repurchase Intention and WOM Recommendation............................43
2.3 Research Methodology.................................................................................44
i
2.3.1 Data Collection....................................................................................44
2.3.2 Measurements......................................................................................46
2.4 Analysis & Findings.....................................................................................48
2.4.1 Measurement Model............................................................................48
2.4.2 Common Method Bias.........................................................................51
2.4.3 Structural Model and Hypothesis Testing...........................................53
2.4.4 Competing Model................................................................................55
2.5 Discussion.....................................................................................................58
2.5.1 Theoretical Contributions....................................................................61
2.5.2 Managerial Implications......................................................................63
2.5.3 Limitations and Directions for Further Research................................66
CHAPER 3: BUILDING CLIENT PSYCHOLOGICAL COMFORT THROUGH

COMMUNICATION STYLE: A SUPPLEMENTARY STUDY…………....68
3.1 Introduction...................................................................................................68
3.2 Research Hypotheses....................................................................................69
3.2.1 Psychological Comfort........................................................................69
3.2.2 Influence of Joint Communication Style.............................................70
3.3 Research Methodology.................................................................................74
3.3.1 Design and Procedure..........................................................................74
3.3.2 Measurements......................................................................................75
3.4 Analysis & Findings.....................................................................................77
3.4.1 Manipulation Check............................................................................77
3.4.2 Validity and Reliability Assessment...................................................78
3.4.3 Hypothesis Testing..............................................................................79
3.5 Discussion.....................................................................................................81
3.5.1 Theoretical Contributions....................................................................81
3.5.2 Managerial Implications......................................................................83
3.5.3 Limitations and Directions for Further Research................................84
CHAPTER 4: MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE OF

THE RELATIONSHIP BETWEEN COMMUNICATION STYLE AND
PSYCHOLOGICAL COMFORT: A CROSS-CULTURAL ASSESSMENT...86
Abstract................................................................................................................86
4.1 Introduction..................................................................................................87
4.2 Conceptual Background & Research Hypotheses………............................91
4.2.1 Uncertainty Reduction in Professional Services.................................91
4.2.2 Direct Effects of Communication Style on Psychological Comfort....93
4.2.3 Indirect Effects through Attributional Confidence..............................95
4.2.4 Moderating Effects of Cultural Value Orientation..............................97
4.3 Research Methodology...............................................................................101
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4.3.1 Data Collection..................................................................................101
4.3.2 Test for Nonresponse Bias.................................................................104
4.3.3 Measurements....................................................................................105
4.4 Analysis & Findings...................................................................................107
4.4.1 Measurement Model..........................................................................107
4.4.2 Measurement Validation...................................................................108
4.4.3 Measurement Equivalence.................................................................110
4.4.4 Common Method Bias.......................................................................111
4.4.5 Structural Model and Hypothesis Testing.........................................112
4.5 Discussion...................................................................................................118
4.5.1 Theoretical Contributions..................................................................122
4.5.2 Managerial Implications....................................................................125
4.5.3 Limitations and Directions for Further Research..............................127
CHAPTER 5: CONCLUSION..............................................................................129
5.1 Synopsis......................................................................................................129
5.2 Summary of Key Findings and Theoretical Contributions.........................130
5.3 Managerial Implications.............................................................................134
5.4 Limitations and Directions for Further Research.......................................136
5.5 Conclusion..................................................................................................138
REFERENCES........................................................................................................140
APPENDICES.........................................................................................................156
Appendix 1: Questionnaire – Study 1 (Chapter 2)............................................156

Appendix 2: Scenarios and Questionnaire – Study 2 (Chapter 3)....................162
Appendix 3: Questionnaire – Study 3 (Chapter 4)............................................170
iii
LIST OF FIGURES AND TABLES
CHAPTER 1: INTRODUCTION
Table 1.1: Summary of three studies..............................................................18
CHAPTER 2: BUILDING CLIENT PSYCHOLOGICAL COMFORT

THROUGH COMMUNICATION STYLE: EVIDENCE FROM A
SOUTH-EAST ASIAN COLLECTIVIST COUNTRY
Table 2.1: Empirical studies of client psychological comfort in services
contexts...........................................................................................31
Figure 2.1: Conceptual model........................................................................35
Table 2.2: Measurement model results...........................................................49
Table 2.3: Descriptive statistics and correlations of study constructs............51
Table 2.4: Results from the structural model (baseline model)......................53
Table 2.5: Results from the structural model (full model).............................55
Table 2.6: Results from the competing model................................................57
Figure 2.2: Competing model.........................................................................57
Table 2.7: Model fit statistics.........................................................................58
CHAPER 3: BUILDING CLIENT PSYCHOLOGICAL COMFORT

THROUGH COMMUNICATION STYLE: A SUPPLEMENTARY
STUDY
Figure 3.1: Combinations of communication styles.......................................71
Table 3.1: Validity and reliability assessment................................................79
Figure 3.2: Effects of affiliative and dominant communication styles on client
psychological comfort..................................................................80
CHAPTER 4: MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE

OF THE RELATIONSHIP BETWEEN COMMUNICATION STYLE
AND PSYCHOLOGICAL COMFORT: A CROSS-CULTURAL
ASSESSMENT
Figure 4.1: Conceptual model......................................................................101
Table 4.1: Measurement model results.........................................................107
Table 4.2: Descriptive statistics and correlations of study constructs..........109
Table 4.3a: Results of mediation analysis.....................................................113
Table 4.3b: Results from a bootstrapping procedure....................................115
Table 4.4: Results of moderation analysis....................................................117
Table 4.5: Hypotheses results.......................................................................117
iv
ABOUT THE THESIS: A NOTE FROM THE AUTHOR
The thesis consists of three academic paper-styled manuscripts1, each of which
reports empirical evidence of client psychological comfort developed from perceived
communication style in the contexts of professional services. Sections of this thesis
have been accepted for presentation and appeared in international conference
proceedings as follows:
Roongruangsee, R. & Patterson, P. G. (2014). The impact of communication style on
psychological comfort in a professional consumer services context: An East ‒
West culture perspective. ANZMAC 2014 Conference, Brisbane, Australia.
Roongruangsee, R. & Patterson, P. G., & Ngo, L. (2016). Building client psychological
comfort through communication style in financial advisory services.
ANZMAC 2016 Conference, Christchurch, New Zealand.
Roongruangsee, R. & Patterson, P. G., & Ngo, L. (2017). Are you comfortable?
Building client psychological comfort through communication style in
financial advisory service. EMAC 2017 Conference Poster Session,
Groningen, The Netherlands.
Patterson, P. G. & Roongruangsee, R. (2018). The impact of communication style on
client psychological comfort in healthcare services. SERVSIG 2018
Conference, Paris, France.
1
This thesis use the plural “we” on occasion, as they are to be submitted for journal publication in co-
authorship with supervisor and co-supervisor.
1
CHAPTER 1
INTRODUCTION
The overall objective of this thesis is to empirically examine the influence of
client-perceived communication style on client psychological comfort in a
professional consumer services context. The two theoretical foundations of the thesis
are uncertainty reduction theory and the revised social interaction model. This first
chapter provides an overview of the topic, describes the knowledge gap, poses research
questions, outlines three studies conducted, and describes the theoretical contribution.
1.1 Overview
The professional services industry is one of the world’s fastest growing
economic sectors, forming a major part of both developed and developing economies
(Bello, Radulovich, Javalgi, Scherer, & Taylor, 2016; Dotzel, Shankar, & Berry, 2013;
Frey, Bayón, & Totzek, 2013). In 2015, the industry attained annual revenues of $1.6
trillion USD in the United States (The International Trade Administration, 2017) and
$130 billion AUD in Australia (Windle, 2017) and accounted for nearly 45% of the
gross domestic product of the emerging market of Thailand (Thailand Convention and
Exhibition Bureau, 2017). Around the world, many factors have contributed to the
evolution of professional services marketing, including information technology,
distance from clients, the economy, and globalisation (Reid, 2008). Extant literature
has placed emphasis on studying client relationships (Newholm, Laing, & Hogg, 2006;
Rosenbaum, Massiah, & Jackson, 2006; Seiders, Flynn, Berry, & Haws, 2015), service
interactions (Macintosh, 2009; Patterson, 2016; Sharma & Patterson, 1999; Weißhaar
2
& Huber, 2016), client co-creation (Greer, 2015; Mikolon, Kolberg, Haumann, &
Wieseke, 2015), service quality (Hausman, 2003; McNeilly & Feldman Barr, 2006),
and cross-cultural aspects (Chan, Yim, & Lam, 2010; Ueltschy, Laroche, Eggert, &
Bindl, 2007). As contemporary service industries encounter highly competitive
environments, it is of paramount importance that service providers establish positive
client experiences and lasting client relationships (Berry, Carbone, & Haeckel, 2002;
Gremler & Gwinner, 2000; Reinartz, Krafft, & Hoyer, 2004).
With regard to professional services targeted to the consumer market (e.g.,
healthcare, legal, financial, accounting, psychological counselling, and architectural
services), it is particularly important for firms to establish and leverage their client
relationships (Hausman, 2003; Reid, 2008; Sharma & Patterson, 1999, 2000). This
requirement stems from the consultative and problem-solving characteristics of
professional services. Such services are technically complex, highly customised, and
usually delivered by highly qualified personnel over continuous courses of
transactions and service encounters (McColl-Kennedy, Patterson, Brady, Cheung, &
Nguyen, 2015). They are often referred to as “pure” services—that is, almost
completely lacking in tangible elements (Gummesson, 1978; Mitra, Reiss, & Capella,
1999; Thakor & Kumar, 2000). Essentially, professional services are high in credence
properties, which means that clients find technical service quality to be vague and
difficult to evaluate, even after they have tried them, purchased them, and consumed
them (Darby & Karni, 1973; Ostrom & Iacobucci, 1995; Swartz & Brown, 1989).
There is asymmetry of information between service providers and clients, in which
clients possess less skill and technical knowledge (e.g., medical explanations, legal
understandings, financial investing strategies) than service providers; most clients
3
cannot define their needs, distinguish among diverse options, or evaluate the services
with confidence (Alford & Sherrell, 1996; Bennett & Smith, 2004). Moreover, clients
typically perceive professional services to have high uncertainty and risk, given that
technical service outcomes unfold over time and their value cannot be easily identified
following service delivery (Bennett & Smith, 2004; Bloom, 1983; Lian & Laing, 2004;
Mills & Moshavi, 1999; Mitra et al., 1999).
1.2 Client Evaluations of Professional Services
Because of the technical complexity of professional services—and the
difficulty that clients have in evaluating the services they receive—chances are high
that relationships between professional service providers and clients will be
problematic (Mikolon et al., 2015). With regard to interpersonal communication in
particular, service providers might fail to appreciate their clients’ apprehension and
reactions. One of the most common and critical mistakes that professional, high-
contact service providers make is failure to communicate effectively with clients
(McQueen, 2015). For instance, healthcare professionals may put patients at risk by
using verbal communication that causes clients to receive inadequate information,
misinterpret information, or be unclear about directions (Centre for Culture, Ethnicity,
and Health, 2015; O’Daniel & Rosenstein, 2008). During therapist-related service
encounters, patients may become anxious if therapists’ diagnoses and treatments sound
highly complicated (VFA Learning, 2017). Similarly, clients of financial advisory
services may feel insecure about advisors’ investment plan instructions because they
lack the technical “know-how”. Clients’ mental anguish during service encounters
could result in suspicion about service quality, obstruction of service delivery, or even
acute consequences such as physical, emotional, or legal damage (Spake, Beatty,
4
Brockman, & Crutchfield, 2003). At the very least, it could impede the development
and maintenance of client relationships with professional service providers.
1.3 Client Psychological Comfort
To minimise possible damages to client relationships and create positive
service experiences, it is vital that clients feel comfortable or gain psychological
comfort with professional service providers; comfort being a multidimensional
construct comprises physical comfort, physiological comfort, and psychological
comfort (Scitovsky, 1992; Slater, 1985). In psychological terms, it represents feelings
of security, reassurance, peace of mind (Scitovsky, 1992), ease, relief of mental
distress (Simmons, 2001), and reduction of anxiety (Daniels, 2000; Hill & Garner,
1991). Humans actively and constantly seek to enhance and maintain their feelings of
comfort about their surroundings (Simmons, 2001; Slater, 1986). Research has
investigated psychological comfort across a number of disciplines, including
sociology, psychology, humanities, medical studies, business, and marketing. Studies
in the field of services marketing suggest that psychological comfort develops during
interactions with service providers (Lloyd & Luk, 2011; Spake et al., 2003). Feelings
of comfort and safety about service providers shape clients’ assessments of perceived
service quality (Butcher, Sparks, & O'Callaghan, 2001; Dabholkar, Shepherd, &
Thorpe, 2000; Paswan & Ganesh, 2005) and lead to client satisfaction, trust,
commitment, and positive voice (Spake et al., 2003).
With regard to professional services encounters, both academics and
practitioners indicate that client psychological comfort plays an essential role in
developing and retaining relationships with providers. Mitra et al. (1999) advise
5
credence-based service providers to emphasise the reduction of client anxiety and
perceived risks during service encounters. To deliver positive service experiences, it
is as important to manage clients’ positive emotional components as it is to deliver
functional quality (Berry et al., 2002). Bloom (1983, p. 104) highlights the importance
of reducing clients’ perceived service uncertainty by quoting the executive director of
a major architectural professional service provider: “You’re selling a feeling of
comfort with you and an understanding of clients’ problem and anxieties”
Accordingly, investigation of the concept of psychological comfort in the context of
professional services—in which clients have high levels of anxiety or perceived
uncertainty—is warranted.
1.4 Interpersonal Communication
Interpersonal communication is crucial to creating client psychological
comfort with professional service providers (Caplan & Thomas, 1995; Spake et al.,
2003). Professional services entail ongoing, intense, and extensive interactions
between providers and clients to “produce” services (Brown & Swartz, 1989; Frey et
al., 2013; Mitra et al., 1999; Patterson, 2016). Successful communication conveys
technical and functional service quality and leads to trust and stronger relationship
commitment (Sharma & Patterson, 1999). It educates and informs clients, minimises
information asymmetry, lowers perceived risk, reduces uncertainty, and signals overall
professional quality (Caplan & Thomas, 1995; Patterson, 2016; Sharma & Patterson,
1999). Empathy, humour, and social bonding convey the “soft skills” of professional
service providers. Among the communication aspects, communication style of
professional service providers are the focal elements that drive positive client
evaluations and responses, as well as feelings such as satisfaction (Buller & Buller,
6
1987; Ring & Van de Ven, 1994; Webster & Sundaram, 2009), trust, confidence, and
strong connection with communicators (Albrecht & Adelman, 1987; Booms &
Nyquist, 1981).
Communication style is defined as “the way one verbally and paraverbally
interacts to signal how literal meaning should be taken, interpreted, filtered, or
understood” (Norton, 1978, p. 99). According to Ben-Sira (1976, 1980), a common
condition of professional–client relationships is that participants lack the ability to
judge whether the content of others’ responses achieves their goals. In this condition,
service providers’ modes of response (rather than the content of their responses) assist
and influence the stability of interactions and evaluations of providers’ behaviours.
Communication style is especially salient in medical sociology. Physicians’
appropriate communication style acts as bridges to patients’ perceived uncertainty and
influence their emotional responses and evaluations (Ben-Sira, 1980; Buller & Buller,
1987; Webster & Sundaram, 2009). Therefore, to monitor the abilities of professional
service providers to render client psychological comfort and provide successful
service, it is vital to observe their communication style.
7
1.5 Recent Knowledge and the Research Gap
1.5.1 Client Psychological Comfort
With its definition, psychological comfort is distinct from certain related
constructs. For example, confidence/psychological benefits (Gwinner, Gremler, &
Bitner, 1998), in forming a relationship with a service provider give a similar meaning:
Feelings of reduced anxiety, confidence, and trust. However, confidence in a person
occurs after he/she develops a level of comfort, trust, or security in a provider over
time and only after a relationship has been created (i.e., knowing what to expect in
service encounter) (Gwinner et al., 1998; Hennig-Thurau, Gwinner, & Gremler, 2002;
Spake et al., 2003). Psychological comfort thus appears as an antecedent of
confidence/psychological benefits rather than a similar construct (Spake et al., 2003).
Also, familiarity (Agarwal & Rao, 1996; Keller, 1993; Maio Mackay, 2001) is another
similar construct. Nevertheless, familiarity is a measure of brand awareness, including
service brand awareness (e.g., how much a client knows about a brand). Familiarity
characterises situations that might influence, instead of explain, psychological comfort
(Spake et al., 2003). Moreover, psychological comfort has been studied in terms of
self-comfort (Simmons, 2001) and employed interchangeably as social comfort
(Butcher, Sparks, & O’Callaghan, 2001), interaction comfort (Sharma, Tam, & Kim,
2015; Sharma & Wu, 2015), and relationship comfort (Gaur, Madan, & Xu, 2009)
when examining clients’ feeling from interaction with an individual service employee.
Despite the important role of psychological comfort in determining clients’
service evaluations, studies of client psychological comfort in services and indeed
broader management literature have been limited. Researchers mostly have examined
psychological comfort in the non-professional services context (e.g., fashion apparel
8
retailing, casual dining restaurants, cafes, hairdressing, and hospitality services); they
have found it to be an antecedent of service quality, value, and loyalty (Ainsworth &
Foster, 2017; Butcher et al., 2001; Dabholkar et al., 2000; Lloyd & Luk, 2011). The
concept of client psychological comfort adds to understanding of the traditional
paradigm of satisfaction, trust, and commitment by showing a positive and increasing
influence on satisfaction, trust, commitment, and active voice (Gaur, Madan, & Xu,
2009; Spake et al., 2003). The psychological comfort of clients using non-professional
services is influenced by service providers’ manner (e.g., polite, helpful, encouraging),
their efforts to identify client needs (e.g., understanding, asking for input, being
knowledgeable) (Lloyd & Luk, 2011), and clients’ perceived cultural distance (Sharma
& Wu, 2015; Sharma, Wu, & Su, 2016). Client psychological comfort in an online
shopping setting (as it relates to increased online purchasing) stems from Internet
usage comfort, Internet technical comfort, and comfort with providing personal
information online, (Akhter, 2015; Spake, Zachary Finney, & Joseph, 2011). These
findings suggest that service employees’ careful management of interpersonal
communication leverages client psychological comfort and leads to successful,
enduring client relationships. However, the notion of client psychological comfort in
professional services settings has received scant research attention. Most studies have
focused on its well-identified consequences, such as intentions to retain the service,
satisfaction, trust, and commitment to professionals in healthcare and banking services
(Gaur et al., 2009; Spake et al., 2003; Spake & Bishop, 2009). Moreover, empirical
investigations of the precursors of client psychological comfort remain scarce (Caplan
& Thomas, 1995). In the professional services context, in which credence properties
and technical complexity are high, and client contact is highly interactive, the
9
antecedents that establish client psychological comfort merit the attention of
academics and practitioners (Lloyd & Luk, 2011).
1.5.2 Communication Style
Communication style has been assessed by researchers in multiple disciplines,
including medicine, sociology, organisational management, sales management, and
services marketing. In the medical field, studies have examined the influence of
medical providers’ (physicians’ or dentists’) communication style on patients’
perceived service quality and emotional responses according to satisfaction,
commitment to prescribed treatments, and utilisation of service (Ben-Sira, 1980;
Buller & Buller, 1987; Cousin, Mast, Roter, & Hall, 2012; Kiesler & Auerbach, 2003;
Mast, Hall, & Roter, 2008; Street, 1989). In medical sociological studies, Kiesler
(1983, 1986) suggests that, in general, individuals express one of two communication
styles during interactions: affiliative or dominant (stemming from the
affiliativeness/horizontal dimension and dominance/vertical dimension of the
interpersonal circumplex). Affiliative communication style builds and maintains
positive communicator–listener relationships (e.g., friendly, warm, concerned,
encouraging, open, socially oriented). Dominant communication style involves
behaviours that develop and retain control of a speaker during interactions (e.g.,
direction- and guidance-giving, concise, hurried, contentious) (Ben-Sira, 1976, 1980;
Norton, 1978; Street, 1989; Webster & Sundaram, 2009; Wong & Tjosvold, 1995).
Communication style has recently gained attention among marketing studies
as a focal part of personal selling (Dion & Notarantonio, 1992; Notarantonio & Cohen,
1990; Williams & Spiro, 1985), professional and non-professional service delivery and
evaluation (Kang & Hyun, 2012; Kim, Jeon, & Hyun, 2011; Webster & Sundaram,
10
2009), which assert that it prominently shapes client satisfaction. Although the role of
communication style in providing cues to reduce clients’ perceived uncertainty and
anxiety has not been investigated, findings from the medical and marketing fields
about the effectiveness of communication style to generate positive client service
responses provide a valuable framework for examining the relationship between
communication style and client psychological comfort in professional services
contexts.
Moreover, from a managerial standpoint, it is essential for professional service
providers and administrators to understand which style of communication creates the
most effect on client psychological comfort and how those styles reduce clients’
perceived uncertainty and anxiety. Berger and Calabrese (1975) examine the effect of
interpersonal communication when people perceive uncertainty about other people and
their surroundings. To reduce uncertainty, people use communication to gain
attributional confidence (Clatterbuck, 1979) or their comprehension and predictability
about their behaviours and the behaviours of others. Because clients may use
attributional confidence as a mechanism to reduce uncertainty and anxiety related to
service outcomes and professionals’ performances, professionals’ communication
style may have both direct and indirect impacts on client psychological comfort.
There is also academic support for the notion that there is considerable client
heterogeneity in credence-based services contexts (Garry, 2008). Clients may have
distinct values and beliefs that produce varying service perceptions and assessments
and change the impacts of communication style on psychological comfort. Therefore,
it is necessary to use a contingency approach to examine the factors that moderate the
strength of the relationship between communication style and psychological comfort.
11
Communication literature suggests that clients’ national culture, their perceptions of
power, and degree of similarity of service providers and clients could affect their
perception of communication style and so its impact on psychological comfort they
feel toward service providers (Webster & Sundaram, 2009). Cross-cultural and
intercultural communication studies indicate that clients’ cultural variances affect their
uncertainty-reduction processes (Gudykunst & Nishida, 1986, 2001; Gudykunst,
Yang, & Nishida, 1985). Because psychological comfort has not been previously
investigated across cultures, it is insightful to incorporate the effect of clients’ cultural
value orientation on the reduction of client anxiety and uncertainty in the professional
services context.
1.6 Research Questions
Reflecting the present knowledge and limited understanding of client
psychological comfort and its associations with professional service providers’
communication style, this thesis examines five interrelated research questions.
1. In professional services encounters, to what extent do clients’ perceptions of
service providers’ communication style (affiliative and dominant) influence
psychological comfort?
2. Does client psychological comfort mediate the relationship between perceived
service providers’ communication style and subsequent behavioural outcomes
(client satisfaction, repurchase intention, word-of-mouth [WOM]
recommendation)?
3. How does the impact of communication style on client psychological comfort
vary among individual clients with different characteristics and backgrounds?
12
4. What is the underlying process by which clients attain psychological comfort
during professional service encounters?
5. Does clients’ cultural value orientation influence the mechanism of psychological
comfort development?
1.7 Theoretical Foundation
In answering the research questions, this thesis employs Ben-Sira’s (1976,
1980) revised social interaction model and Berger and Calabrese’s (1975) uncertainty
reduction theory. In view of professional services context comprising credence
properties, technical complexity, knowledge asymmetry, uncertainty of service
outcomes and interaction with professional service providers (who could be strangers
at initial visits), uncertainty reduction theory explains clients’ need to reduce perceived
uncertainty and anxiety (Berger & Calabrese, 1975; Mitra et al., 1999). Following the
theory’s axiom, this thesis proposes that clients depend on service providers’
communication to acquire information for reducing uncertainty and anxiety (Berger &
Calabrese, 1975; Knobloch, 2008; Lian & Laing, 2004). Moreover, the revised social
interaction model is used to explain clients’ observation and assessment on such
communication style as a service provider’s mode of response instead of technical
content. Since clients are incapable of judging the technical content of providers’
responses, the perceived communication style act as observable cues that serve as
bridges to clients’ perceived uncertainty and anxiety, and so assist them in evaluating
technical service outcomes (Ben-Sira, 1976, 1980). The feelings of reduced anxiety
and uncertainty explains client psychological comfort, which in turn influences overall
service evaluations and subsequent behaviour (e.g., satisfaction, repurchase intention,
and WOM recommendation).
13
1.7.1 Uncertainty Reduction Theory
Originated by Berger and Calabrese (1975), uncertainty reduction theory
explains communicative activities structured for reducing uncertainty in the initial
phases of interaction between strangers. A key concept of the theory is uncertainty
(i.e., individuals’ unsure feelings about interactions with other persons) that forms
communication behaviours. Uncertainty arises sharply at initial phase when
individuals lack information about the other party and immediate environment. It
develops from an awareness of ambiguity and increases when several consequences
are equally possible (Berger & Calabrese, 1975; Berger & Bradac, 1982; Bradac, 2001;
Knobloch, 2008). The theory postulates that individuals are motivated to reduce
uncertainty about their social environment and strive to predict and explain their
contexts. In such setting, it suggests interpersonal communication behaviour plays two
roles: (1) something which individuals attempt to predict and explain, and (2) a way
to formulate such predictions and explanations (Berger & Calabrese, 1975). Axiom 1
and 2 address that an increase in verbal and nonverbal affiliative communication
between strangers leads to a decrease in uncertainty levels in an initial interaction
situation, and vice-versa (Berger & Calabrese, 1975).
Uncertainty reduction theory has acted as a theoretical foundation in numerous
systematic studies of communication, mainly regarding how individuals communicate
when they are unsure about surroundings (Knobloch, 2008). Among the field of
interpersonal communication, uncertainty reduction theory has been categorised as
individually-centred (Bylund, Peterson, & Cameron, 2012; Knobloch, 2008) with a
focus on relationship-development (Miller, 2004). For over three decades, scholars
have adopted uncertainty reduction theory to studies in healthcare, intercultural
14
interaction, romantic relationship, and organisational context (Knobloch, 2008) to
explain initial interaction in general (e.g., Gudykunst & Nishida, 2001; Kellerman &
Reynolds, 1990) as well as initial interaction of established relationships (e.g.,
Knobloch, 2007).
In professional services marketing studies, uncertainty reduction theory has
been employed in the health communication literature in 1990s and the year 2000
(Beck et al., 2004). The theory explains the interactions between clients and service
providers (who are strangers in most encounters) in the setting where asymmetry of
information and knowledge ambiguity is present.
1.7.2 Revised Social Interaction Model
Ben-Sira (1976) offered a revised model of social interaction that focuses on a
relationship between professional service providers and clients. The conventional
social interaction model is concerned with individuals’ interaction process where actor
A gains satisfaction from a relationship with actor B once A perceives B’s response to
A’s activity as fostering A’s goal achievement. However, the traditional model is valid
only when A has an adequate understanding of the content of B’s response and the
skills to judge to what degree the response will advance A’s goal achievement. In
situation where B’s response does not provide an instant solution and A is incapable
of comprehending or judging B’s response, the traditional model is not viable. Ben-
Sira (1976) suggested that this latter condition is common in a professional-client
relationship. When there is uncertainty involving clients’ well-being (e.g., assessing
healthcare services), clients are unable to judge the content of the professionals’
response. They still require a solution and “esoteric” skills from a professional.
15
By emphasising the professional service provider-client interaction, a revised
social interaction is proposed to highlight that professional’s “mode of response”,
rather than the content, assists and influences the stability of an interaction. Ben-Sira’s
(1976) study showed that a general practitioner’s “affective behaviour” (acting toward
a patient as a person instead of a case) is a key aspect in building a layman’s
satisfaction and in evaluating an instrumental component of a general practitioner’s
behaviour. Ben-Sira’s (1980) study later revealed that a physician’s emotional support
bridges over a patient’s perceived uncertainty regarding the content and outcome of
medical treatment. Clients (patients) are emotionally involved in the problem that
requires a professional’s (physician’s) solution. They lack an ability to judge the
professional’s activities, and are unable to credit the goal achievement to the
professional’s activities.
With a grounding in medical services, Ben-Sira’s (1976, 1980) social
interaction model has been adopted and supported in healthcare contexts which
assessed patients’ satisfaction with professionals’ communication (Buller & Buller,
1987; Street, 1989). The model has been applied in other professional service
encounters to explain an impact of communication. Webster and Sundaram’s (2009)
findings support theoretical orientations of the model. Clients rely on professional
service provider’s communication style when evaluating the service received and in
reaching their satisfaction. Brown and Swartz (1989) addressed a congruent assertion
to a revised social interaction model that technical complexity and intangibility of
professional services can guide clients to search for and evaluate substitute indicators
of quality. Behaviour of professionals observed during a personal interaction is one of
the signs that clients assess during professional service encounters. Sharma and
16
Patterson (2000) also found that clients evaluate a firm’s performance based on the
way financial advisors behaved toward them during service encounters.
1.8 Thesis Overview
This thesis comprises three independent but related empirical research studies,
embedded in the context of consumer-focused professional services. The overall
objectives are to examine the role of client psychological comfort, its association with
communication style, the underlying process of psychological comfort development,
and related contingency conditions. The first study (cross-sectional survey) introduces
the notion of client psychological comfort in professional (medical) services and
explores communication style as its potential antecedent. The study incorporates
service outcomes (satisfaction, repurchase intention, WOM recommendation) and
contingency conditions that influence the strength of communication style on client
psychological comfort. The second study (experimental design) supplements the first.
It assesses the internal validity of communication style–psychological comfort
causality and expands the effects of communication style from sole to joint. That is,
professionals sometimes use a mix of communication styles, rather than a single style,
when engaging with clients. The third study (cross-sectional survey) investigates the
underlying mechanism of clients’ uncertainty reduction while using financial advisory
services. It assesses the effect of attributional confidence in mediating the impact of
communication style on client psychological comfort and examines the model across
clients’ cultural value orientations. Table 1.1 summarises the distinct inputs of the
three studies for answering the research questions.
17
Table 1.1 Summary of three studies
Study 1 Study 2 Study 3

(Chapter 2) (Chapter 3) (Chapter 4)
Research  Explore impact of  Ensure internal  Investigate
Objectives communication style validity of attributional
on client communication confidence in
psychological style–client mediating
comfort and psychological communication
subsequent outcomes comfort style–client
(satisfaction, relationship psychological
repurchase intention,  Examine effects of comfort
WOM joint relationship
recommendation). communication  Assess clients’
 Examine contingency style on client heterogeneity
conditions that affect psychological across two cultural
the communication comfort value orientations
style–psychological at the individual
comfort association level
Answering 1, 2, 3 1 4, 5
Research
Question(s)
Methodology Survey data from Experimental study Survey data from

and Context medical services, from medical financial advisory
Thailand services, Thailand services, Australia
and Thailand
Theoretical Revised social interaction model and uncertainty reduction theory
Foundations
1.8.1 Study 1: Building Client Psychological Comfort through Communication Style:
Evidence from a South-East Asian Collectivist Country
In a high-credence, consumer-focused professional services setting, this study
introduces client psychological comfort as a focal construct that encourages positive
service evaluation. It examines perceptions of service providers’ communication style
(affiliative and dominant) as antecedents of client psychological comfort and
accompanying service outcomes. The study accounts for clients’ cognitive social
18
capital and cultural value orientation as potential moderators of the link between
communication style and psychological comfort.
A cross-sectional survey conducted in an Eastern, medical services context
reveals that client psychological comfort plays a role in professional services. Service
providers’ communication style significantly shapes client psychological comfort,
which in turn drives satisfaction, repurchase intention, and WOM recommendation.
Cognitive social capital and cultural value orientation have varying moderating effects
on the relationship between communication style and psychological comfort. This
study develops a competing model, which indicates that psychological comfort
partially mediates the communication style and client satisfaction association. The
study contributes to professional services literature by exploring, for the first time,
client psychological comfort and its relationship with communication style in a
professional services context. The study provides implications for strategies to boost
client psychological comfort, especially with regard to the use of appropriate
communication style.
A Supplementary Study
This study provides additional evidence of the association between
communication style and client psychological comfort. Its purpose is to confirm the
internal validity of the causal relationship between the two main constructs in a
controlled setting. Moreover, the study expands the examination of communication
style to include the effects of joint communication styles on client psychological
comfort.
19
To replicate the first study’s findings, this study employs an experimental
design in an Eastern, medical services setting. Manipulations include four scenarios
that feature conversations between a physician and a patient. The results confirm the
causal relationship between communication style and client psychological comfort:
Different combinations of service providers’ affiliative and dominant communication
styles drive client psychological comfort at varying levels. The study contributes to
professional services literature by testing the impacts of joint communication styles
and verifying their causal relationships with client psychological comfort.
Practitioners can use the insights of this deeper assessment of (joint) communication
style to achieve the highest degree of client psychological comfort.
1.8.3 Study 3: Mediating Role of Attributional Confidence on the Relationship Between
Communication Style and Psychological Comfort: A Cross-Cultural Assessment
Professional services encounters can generate considerable client uncertainty
about service outcomes, performance of professionals, and even interactions with
professionals. Using uncertainty reduction theory as the theoretical lens, this study
proposes that clients’ attributional confidence—that is, their perception of the
adequacy of information to understand and predict professionals’ behaviour—plays a
part in reducing uncertainty in professional services encounters. The study develops a
conceptual model to examine the role of attributional confidence in mediating the link
between communication style and client psychological comfort. It tests the model
across Hofstede’s (1980b, 1980c) cultural value orientations (i.e., collectivism/
individualism) at the individual, rather than national, level.
This research draws data from clients of major financial advisory firms in
Australia and Thailand. The results show that attributional confidence partially
20
mediates one of two communication styles and client psychological comfort, and that
the impact of communication style on attributional confidence is not substantially
different across two cultural value orientations. However, attributional confidence also
positively influences the psychological comfort of individualist (rather than
collectivist) value oriented clients. The findings underline the mediating role of
attributional confidence in the professional services context and provide external
validity with a cross-cultural examination of the relationship between communication
style and client psychological comfort. They imply that managers should pay close
attention to clients’ reduction of uncertainty through perceived adequacy of
information and clients’ distinct cultural value orientation.
1.9 Theoretical Contributions
In all, the studies offered in this thesis contribute to existing professional
services literature in three ways. First, they offer a bridge over a persistent knowledge
gap, by demonstrating the significance of client psychological comfort in the
professional services context, which features high credence attributes, complexity, and
knowledge asymmetry. They show that client psychological comfort is a precursor to
clients’ positive assessments of service and behavioural outcomes. This thesis
empirically identifies perceptions of professional service providers’ communication
style as antecedents of client psychological comfort during service encounters. The
three studies (conducted in professional services settings, such as medical and financial
advisory services) reveal that affiliative and dominant communication styles influence
client psychological comfort in different ways.
21
Second, this thesis illuminates the underlying mechanism of client
psychological comfort development by revealing the mediating role of attributional
confidence. Service providers’ communication style provides clients with observable
cues that influence those clients’ levels of uncertainty and abilities to understand and
predict service providers’ behaviours. Using uncertainty reduction theory as a
theoretical background, the research shows that attributional confidence provides a
link to the relationship between communication style and client psychological comfort
in professional services encounters.
Third, the thesis recognises the possibility that the impacts of communication
style on client psychological comfort get transmitted across clients’ characteristics and
cultural boundaries; it tests the conditions (cognitive social capital and cultural value
orientation) in which both the link between communication style and client
psychological comfort and the mediating relationship are stronger or weaker.
1.10 Thesis Structure
The three studies are presented in Chapters 2, 3, and 4. Each study comprises
the same structure: abstract, introduction, conceptual background and research
hypotheses, research methodology, analysis and findings, and discussion. The
conclusion chapter (Chapter 5) summarises key findings of the three studies and
discusses managerial implications, limitations, and directions for future research.
References for all studies are consolidated and shown at the end of the thesis.
22
CHAPTER 2: BUILDING CLIENT PSYCHOLOGICAL COMFORT THROUGH
COMMUNICATION STYLE: EVIDENCE FROM A SOUTH-EAST ASIAN COLLECTIVIST COUNTRY
CHAPTER 2
BUILDING CLIENT PSYCHOLOGICAL COMFORT THROUGH
COMMUNICATION STYLE: EVIDENCE FROM A SOUTH-EAST ASIAN
COLLECTIVIST COUNTRY
Abstract
As a form of high credence service, professional (e.g., medical, financial

advising, psychotherapy, legal) services typically feature high complexity and high
information asymmetry, resulting in client anxiety and uncertainty. This study
demonstrates that psychological comfort is key to ensuring positive client responses
to professional services. By drawing on a revised social interaction model and
uncertainty reduction theory, this study examines the impact of the service provider’s
communication style for establishing client psychological comfort and enhancing
client satisfaction. It also explores contingency conditions in which the impact of
communication style on psychological comfort varies, according to client
heterogeneity (cognitive social capital and cultural value orientation). The results of
survey data, collected in a hospital setting in Thailand, indicate that perceptions of
physicians’ affiliative and dominant communication styles significantly drive client
psychological comfort, which in turn influences satisfaction, repurchase intention, and
word-of-mouth recommendation. This study also advances a competing model,
focused on the role of psychological comfort in mediating communication style and
satisfaction. It offers the first examination of the importance of client psychological
comfort and its association with communication style in a professional services
context. The results have pertinent implications for the appropriate use of
communication style to engage clients of professional services firms.
Keywords professional services, psychological comfort, communication style,

cognitive social capital, cultural value orientation
23
2.1 Introduction
Contemporary service firms prioritise the building and retaining of client
relationships by delivering on core promises and providing positive service
experiences (Berry, Wall, & Carbone, 2006; Frow & Payne, 2007; Grace & O'Cass,
2004; Wu & Liang, 2009; Zhang & Bloemer, 2008). However, in professional, high-
contact settings such as medical, psychotherapy, and legal services, it is often
challenging for clients to assess whether or not they have received a quality outcome
and value. For example, patients may be distressed by physicians’ complicated
explanations of treatments; financial services clients may feel insecure when advisors
give them complex directions about investment plans. Such uneasy feelings during
service provision could lead clients to feel dissatisfaction and doubt with regard to
service quality.
These challenges stem from the credence properties associated with
professional services. Typically, clients lack the knowledge and/or skills to confidently
evaluate the technical outcomes (e.g., medical treatments, legal advice), even after
using them (Darby & Karni, 1973; Grace & O'Cass, 2004; Ostrom & Iacobucci, 1995).
Information asymmetry exists when clients possess less technical information than
qualified professionals (Alford & Sherrell, 1996; Bennett & Smith, 2004; Stiglitz,
2002). Technical complexity, customisation, personal contact, and criticality
associated with professional services (Chan, Yim, & Lam, 2010; Patterson, 2000) may
cause client uncertainty and anxiety (Bennett & Smith, 2004; Lian & Laing, 2004;
Mills & Moshavi, 1999). Therefore, to achieve positive attitudinal and behavioural
responses from clients, it is essential that service providers grant their clients
psychological comfort (Spake, Beatty, Brockman, & Crutchfield, 2003).
24
Scholars in numerous disciplines, including psychology, sociology, and
communications, have studied psychological comfort. In the fields of services
marketing in general and professional services in particular, academics and
administrators advise service providers to reduce client anxiety and perceived risk
during encounters (Mitra, Reiss, & Capella, 1999; Patterson, 2016). Bloom (1983, p.
104) quotes an architectural firm director, speaking to professional service providers:
“You’re selling a feeling of comfort with you and an understanding of client’s
problems and anxieties”. However, despite the importance of client psychological
comfort to successful professional services delivery, the concept has received little
research attention, especially with regard to identifying its antecedents.
To establish client psychological comfort and facilitate clients’ abilities to
confidently evaluate technical outcome, interpersonal communication between clients
and service providers takes on added significance (Bitner, 1990; Solomon, Surprenant,
Czepiel, & Gutman, 1985). Prior research suggests that for providers of professional
services, appropriate interpersonal communication is of paramount importance for
ensuring client comprehension and reaching desirable service outcomes (Seiders,
Flynn, Berry, & Haws, 2015). Interpersonal communication that is inappropriate,
ambiguous, or dishonest results in compensation costs, loss of credibility, and poor
client relationships (Mikolon, Kolberg, Haumann, & Wieseke, 2015; Yeates, 2015).
The communication style of service providers (Norton, 1978), in particular, plays a
major role in shaping clients’ emotional responses and affects client satisfaction, trust,
feelings of confidence, and sense of connectedness (Buller & Buller, 1987; Cousin et
al., 2012; Webster & Sundaram, 2009; Wong & Tjosvold, 1995). Despite the
development and operationalisation of communication style in professional services
25
contexts, extant literature has not addressed the extent to which perceptions of
professional service providers’ communication style reduce perceptions of risk and
uncertainty and leads to psychological comfort.
Using Berger and Calabrese’s (1975) uncertainty reduction theory and Ben-
Sira’s (1976, 1980) revised social interaction model, we investigate the role of client
psychological comfort—as stimulated by clients’ perceptions of the communication
style of professional service providers—in driving positive client feelings and
evaluations. Because clients’ perceptions of communication style may vary according
to their individual differences, we also posit a contingency model of the relationship
between communication style and psychological comfort, moderated by clients’
cognitive social capital and cultural value orientation. We use medical services as the
context for this research, because such services are high in credence properties (Darby
& Karni, 1973). As most medical outcomes only become manifest over time, patients
often evaluate medical services by observing aspects of physicians’ behaviours rather
than their technical skills (Berry & Bendapudi, 2007; Krishnan & Hartline, 2001). The
interpersonal skills of physicians and the psychological comfort of clients/patients are
key aspects of clients’ relationships with physicians (Berry & Bendapudi, 2007; Spake
et al., 2003).
The aim of this paper is to answer several research questions: First, does a
client’s perception of a service provider’s (i.e., physician’s) communication style
influence his or her degree of psychological comfort? Second, with regard to client
heterogeneity, in which conditions does communication style have stronger or weaker
effects on client psychological comfort? Third, does client psychological comfort lead
to positive service evaluations and behaviours, such as satisfaction, repurchase
26
intention, and recommendation? Fourth, does communication style directly lead to
positive client responses, in concert with its impact on psychological comfort? In
summary, we attempt to explain the significance of professional service providers’
communication style for reducing client anxiety and driving psychological comfort,
according to various contingency conditions.
This study contributes to professional services literature in several ways. First,
it introduces the role of client psychological comfort as a key antecedent of clients’
professional services evaluations. Using a medical services setting, we demonstrate
that psychological comfort is a precursor of client satisfaction and thus an influencer
of behavioural responses. Second, on the basis of uncertainty reduction theory and the
revised social interaction model, this study explains clients’ levels of anxiety and
uncertainty through their perceptions of service providers’ communication style; it is
the first to identify communication style as a determinant of client psychological
comfort in a professional services setting. Finally, it accounts for client heterogeneity
by examining contingency conditions in which the impact of communication style on
psychological comfort differs. Cognitive social capital and cultural value orientation
are the moderators examined.
We begin with a review of relevant literature. Then we describe the
development of our research hypotheses, our methodology, and the findings. Finally,
we present our conclusions and discuss the theoretical contributions, managerial
implications, and directions for research indicated by our results.
27
2.2 Conceptual Background & Research Hypotheses
2.2.1 Professional Services
The service characteristics of intangibility and inseparability specify that
services are highly associated with individual service providers’ performance and
interpersonal contacts with clients (Frey, Bayón, & Totzek, 2013; Iacobucci & Ostrom,
1996; Kunz & Hogreve, 2011; Parasuraman, Zeithaml, & Berry, 1985; Zeithaml,
Parasuraman, & Berry, 1985). In professional consumer services, however, achieving
effective interaction and engagement during service provision is complex (McColl-
Kennedy et al., 2015; Mills & Moshavi, 1999). Professional services are closely
associated with credence properties, in that clients lack product knowledge and find
technical outcomes difficult to evaluate, even after trial use, purchase, or consumption
(Darby & Karni, 1973; Macintosh, 2009; Ostrom & Iacobucci, 1995). Examples of
credence-related services include legal, psychotherapy, financial, medical, and other
professional services provided by highly trained, qualified providers (Frey, Bayón, &
Totzek, 2013; von Nordenflycht, 2010; Ostrom & Iacobucci, 1995). Professional
services are therefore known as “pure” services (i.e., almost completely lacking in
tangible elements); they are perceived as highly technical, customised, and often high
in criticality (Chan et al., 2010; Patterson, 2000; Stewart, Hope, & Muhlemann, 1998;
Thakor & Kumar, 2000).
In such a context, the amount of information available to clients before
consumption is small compared with the amount normally available from non-
professional services (Hill, 1988; Kotler, Hayes, & Bloom, 2002; Mitra et al., 1999;
von Nordenflycht, 2010). Clients cannot directly observe service quality and value
28
(Bloom, 1983). Only professional service providers have access to specialised
knowledge of services, such as understanding of legal matters, medical diagnoses, or
financial planning solutions. Thus, information asymmetry arises between the two
parties (Mills & Moshavi, 1999; Stiglitz, 2002; Sweeney, Soutar, & McColl-Kennedy,
2011), often resulting in client perceptions of uncertainty and risk (Hill, 1988; Lian &
Laing, 2004; Mills & Moshavi, 1999). Clients who have only limited knowledge of
services are uncertain about service outcomes and the provider’s performance, and the
high degree of perceived physical, financial, or functional risk associated with the
services tends to exacerbate their feelings. Such uncertainty influences clients’
physical well-being and reduces their financial and psychological comfort (e.g.,
medical and financial services contexts) (Gallan, Jarvis, Brown, & Bitner, 2013; Hill,
1988; Mitra et al., 1999).
2.2.2 Psychological Comfort
Psychological comfort describes feelings of security, reassurance, ease, relief
of mental distress, peace of mind, and reduction of anxiety (Lloyd & Luk, 2011;
Scitovsky, 1992; Simmons, 2001; Spake et al., 2003). In non-professional service
contexts (e.g., apparel retailing, hospitality, restaurants), interactions between service
providers and clients enhance client psychological comfort. During service encounters,
clients enter emotional states after observing and appraising service providers’
behavioural cues (e.g., language used, tone of voice, facial expressions, body gestures)
(Lloyd & Luk, 2011). Feelings of safety and comfort about service providers become
part of the criteria that clients use when evaluating their overall service quality,
satisfaction, and commitment (Dabholkar, Shepherd, & Thorpe, 2000; Lloyd & Luk,
2011; Paswan & Ganesh, 2005). For example, waiters who practise good
29
communication skills and manners create client psychological comfort that, when
combined with client evaluations of restaurant service outcomes, affects clients’
judgements of overall service quality.
Although it is relatively easy for clients to evaluate non-professional services,
it is more complex and difficult for them to judge professional service quality. In
professional service settings, psychological comfort can be the key factor in alleviating
anxiety resulting from information asymmetry and perceived uncertainty. Providers
can reduce client anxiety and perceived risk by offering feelings of comfort and
understanding client concerns (Bloom, 1983; Mitra et al., 1999). By extending
psychological comfort to clients, providers can ensure positive client evaluations of
technical quality and thereby improve overall service success. Despite this,
professional services studies devote little attention to client psychological comfort. As
Table 2.1 shows, services-related marketing studies mostly examine client
psychological comfort in non-professional service settings; professional service
studies (Gaur, Madan, & Xu, 2009; Spake et al., 2003; Spake & Bishop Jr, 2009) tend
to investigate the consequences of, rather than the antecedent(s) that induce, client
psychological comfort.
30
Table 2.1 Empirical studies of client psychological comfort in services contexts

Study Method of Analysis Service Context Antecedent Variable Outcome Variables
Dabholkar, Shepherd, Longitudinal study Religious service Reliability, personal attention, comfort, Service qualityb,
and Thorpe (2000) features satisfactionb, behavioural
consequencesb
Butcher, Sparks, and Survey data Hairdressing services, café Satisfaction, value for money, perceived Service loyaltya
O’Callaghan (2001) services, naturopathy core quality, relational outcomes (social
services comfort, social regard, friendship)
Spake, Beatty, In-depth interviews Retailers, restaurants, Consumer comfort

Brockman, and healthcare services,
Crutchfield (2003) hairdressing services,
financial services
Survey data Hairdressing services, Consumer comfort Satisfactiona, trusta
healthcare services commitmenta, active
voicea
Paswan and Ganesh Survey data Higher education services Social class Cross-cultural interaction
(2005) comforta, satisfactiona,
recommendationa
Gaur, Madan, and Xu Survey data Retail banking services Relationship comfort, relationship Satisfactiona, trusta,
(2009) proneness (moderator) commitmenta, loyaltya,
active voicea
Spake and Bishop Survey data Healthcare services Satisfaction, trust, commitment, Intention to remain in the
(2009) psychological comfort, perceived servicea
closeness (moderator)
Spake, Zachary Survey data Online shopping Experience, tech savvy, confidence, worry, Amount spent onlinea
Finney, and Joseph comfort with providing personal
(2011) information online, concern for privacy
31
Study Method of Analysis Service Context Antecedent Variable Outcome Variables

Lloyd and Luk (2011) In-depth interviews Fashion apparel retailing,
casual dining restaurants
Survey data Fashion apparel retailing, Interaction behaviours, (service manner, Service qualitya,
Casual dining restaurants need identification), comfort (mediator) satisfactiona, word of
moutha
Akhter (2015) Survey data Online shopping Internet usage comfort, internet technical Online shoppinga, online
comfort, demographic variables bankinga
Khan, Ro, Gregory, Experimental design Hospitality services Customer and employee gender, employee Comforta, satisfactiona,
and Hara (2015) solicitation (moderator) feedback willingnessa
Sharma, Tam, and Experimental design Restaurant Perceived cultural distance, service roles Interaction comforta,
Kim (2015) (moderator), service outcomes perceived service qualitya,
(moderator) satisfactiona
Sharma and Wu Experimental design Restaurant Service outcome, perceived cultural Interaction comforta,
(2015) distance, consumer ethnocentrism perceived service qualitya,
(moderator), intercultural competence satisfactiona
(moderator)
Sharma, Wu, and Su Experimental design Restaurant Perceived cultural distance, service Interaction comforta, service
(2016) outcomes, personal cultural orientations qualitya, satisfactiona
(moderators)
Ainsworth and Foster Survey data In-store retail shopping Atmospheric elements, consumer comfort Perceived shopping valuea
(2017)
a
Self-reported variable. bObjective variable.
32
2.2.3 Communication Style
Clients assess the quality and value of professional and non-professional
services according to their perceptions of process/functional quality (i.e., how the
service is delivered) (Brown & Swartz, 1989; Grönroos, 1982; Hennig-Thurau, Groth,
Paul, & Gremler, 2006; Stewart et al., 1998; Sweeney, Soutar, & McColl-Kennedy,
2011). For professional services in particular, it is this quality—the manner in which
professionals interact and deliver core services—that clients can observe and use as a
proxy for evaluating technical service outcomes (Brown & Swartz, 1989; Hausman,
2003; Johnson & Zinkhan, 1991; Sharma & Patterson, 2000; Sweeney, Soutar, &
McColl-Kennedy, 2011). The communication of professional service providers is thus
a primary antecedent of service quality, reducing clients’ perceptions of associated
uncertainty and risk (Bennett & Smith, 2004; Carpenter, 2012; Hill, 1988; Lian &
Laing, 2004). It allows technical knowledge to be understood and appreciated by
clients, encourages co-production, and stimulates desirable service outcomes (Auh,
Bell, McLeod, & Shih, 2007; Carpenter, 2012; Payne, 1986; Webster & Sundaram,
2009). Among various communication elements, communication style is essential for
promoting the perceived quality of service encounters, by fostering feelings of trust,
satisfaction, and confidence (Webster & Sundaram, 2009). Norton (1978, p. 99)
defines communication style as “the way one verbally and paraverbally interacts to
signal how literal meaning should be taken, interpreted, filtered, or understood”. The
style or manner (i.e., tone of voice, facial expression, spatial distance from the listener,
eye gaze) that allows a person (service professional) to communicate his or her
meaning can influence the outcome of an interaction (Wong & Tjosvold, 1995).
33
Studies in medical sociology comprehensively document the influence of
communication style on patients’ emotional responses and perceptions of quality
(Ben-Sira, 1976; Buller & Buller, 1987; Cousin et al., 2012; Street, 1989). Marketing
researchers also have addressed communication style as a part of the service delivery
process and as a basis for service evaluation (Kang & Hyun, 2012; Kim, Jeon, & Hyun,
2011; Webster & Sundaram, 2009; Williams & Spiro, 1985; Wong & Tjosvold, 1995).
Figure 2.1 depicts our conceptual model. By using Berger and Calabrese’s
(1975) uncertainty reduction theory and Ben-Sira’s (1976, 1980) revised social
interaction model as underlying theories, we focus on the association between service
providers’ communication style (as perceived by clients) and client psychological
comfort, using a medical services context. Considering the credence properties of
medical services, information asymmetry, and the complexity of discussions with
physicians (who may be strangers at initial visits), uncertainty reduction theory
suggests the need to reduce clients’ perceived uncertainty and anxiety (Berger &
Calabrese, 1975; Mitra et al., 1999). We postulate that because of their lack of
technical knowledge, clients rely on professional service providers’ communications
(verbal and non-verbal) to acquire information and so reduce uncertainty and
accompanying risk (Berger & Calabrese, 1975; Knobloch, 2008; Lian & Laing, 2004).
According to the revised social interaction model, clients observe and process such
communication as a mode of response rather than a transmission of technical content.
Their observations serve as bridges to their perceived uncertainty and anxiety and help
them evaluate the technical outcomes of service provisions (Ben-Sira, 1976, 1980).
For clients, the communication style of professional service providers become
34
observable cues for reducing uncertainty, building psychological comfort, and shaping
overall service evaluations and future behaviour.
Figure 2.1 Conceptual model
Professional Service Provider Client
Communication Style Cognitive Social Repurchase

Capital Intention
Affiliative
H3b (-) H3a (+)
Communication Style H6 (+)
H1 (+)
Psychological H5 (+)
Satisfaction
Comfort
H2 (-)
Dominant
H4b (-) H4a (+) H7 (+)
Communication Style
Collectivist Value
Orientation Recommendation
Controls
Age, Gender, Service criticality
Global brand experience,
Focal brand experience
Norton (1978) categorises communication style as dominant, dramatic,
animated, open, contentious, relaxed, friendly, attentive, and impression leaving. The
aim of the communicator is to convey a communicator image. According to Kiesler
(1983, 1986), individuals generally express one of two communication styles in an
interaction: affiliative or dominant (resulting from the affiliativeness/horizontal
dimension or the dominance/vertical dimension of the interpersonal circumplex)
(Buller & Buller, 1987; Cousin & Mast, 2013; Kiesler & Auerbach, 2003).
Affiliative communication style involves behaviours that seek to develop and
maintain a positive relationship between the communicator and listener, such as
concern, friendliness, empathy, warmth, compassion, and social orientation (parallel
to Norton’s [1978] attentive, relaxed, open, and friendly styles). According to the
35
revised social interaction model, service providers’ affective behaviours are key
stimulants of provider–client relationships when clients are incapable of judging the
technical content of services (Ben-Sira, 1976, 1980). Medical and sociology studies
show the effect of affiliative communication style on clients’ perceptions of
professional services. Physicians who adopt affiliative communication style generate
positive impressions, ease patient anxiety arising from medical conditions and
discussions (particularly during initial visits), and assist service interactions (Buller &
Buller, 1987; Street, 1989). Affiliative expressions (e.g., paying attention, endorsing
clients’ concerns, displaying friendliness) elicit positive client responses, because they
offer a personal touch and are preferred by clients (Carpenter, 2012; Webster &
Sundaram, 2009; Wong & Tjosvold, 1995). These findings correspond to uncertainty
reduction theory (Berger & Calabrese, 1975), which suggests that affiliative behaviour
(e.g., positive verbal content, pleasantness of vocal expressions) decreases feelings of
uncertainty, especially in initial interactions. In complex professional service
situations, the transfer of technical information to clients in a relaxed and empathetic
manner helps decrease anxiety, tension, and perceived difficulty of the service process
and promotes client psychological comfort. Therefore, we hypothesise:
H1: A healthcare provider’s affiliative communication style has a positive impact
on client psychological comfort.
In contrast, dominant communication style establishes and sustains
communicator control in an interaction; it includes behaviours such as conciseness,
hurriedness, direction-giving, and guidance-giving (equivalent to Norton’s [1978]
dominance, contention, animation, and dramatic styles). A professional’s controlling
and dominant manner stems from a status and power differential with the client and
36
the client’s limited understanding of the services (Buller & Buller, 1987; von
Nordenflycht, 2010). In general, patients have less positive perceptions of highly
dominant and controlling forms of communication (Buller & Buller, 1987; Street,
1989). Studies of other types of professional services offer similar results: Clients of
financial services express less favourable responses to professionals who demonstrate
dominant and controlling communication style (Webster & Sundaram, 2009).
According to uncertainty reduction theory (Berger & Calabrese, 1975), asking
questions can reduce uncertainty during an interaction. However, when clients
perceive professionals to be excessively dominant, they also perceive they have limited
opportunities to express concerns, voice opinions, or ask questions about service
complexity and technical matters. In such contexts, where dominant communication
style is used, clients are less likely to have positive emotional responses (e.g., anxiety
reduction or psychological comfort) (Street, 1989). Accordingly, our next hypothesis
is:
H2: A healthcare provider’s dominant communication style has a negative impact
on client psychological comfort.
Consumers/clients’ personal values (i.e., individuals’ values from the
standpoint of attitudes and personal motives that influence evaluations and behaviours)
(Vinson, Scott, & Lamont, 1977) have been shown for decades in consumer behaviour
(e.g., Beatty, Kahle, & Homer, 1991; Carman, 1978; Vinson et al., 1977), social
psychology (e.g., Braithwaite & Scott; Pitts & Woodside, 1983; Williams & Rokeach,
1979) literature, and a wide range of context regarding their impacts on various aspects
of human behaviour. In this thesis, we focus on two types of personal values, cognitive
social capital and cultural value orientation, as moderators that could alter the strength
37
of communication style in impacting client psychological comfort. Cognitive social
capital (Jones & Taylor, 2012; Nahapiet & Ghoshal, 1998) explains clients’ perceived
shared values, beliefs, and interests with professional service providers. It thus
measures clients and professionals’ overlapping values in influencing the impact of
affiliative and dominant communication style on client psychological comfort.
Cultural value orientation (Hofstede, 1991) accounts for clients’ cultural values,
norms, and preferences that influence service encounter evaluations and client
relationships (Patterson, Cowley, & Prasongsukarn, 2006). Therefore, it assesses
individual clients’ differences in their cultural values (individualism – collectivism)
that might affect the association between affiliative and dominant communication style
on client psychological comfort. The two moderators add to our understanding of
clients’ heterogeneity and how communication style varies in its effect. The following
sections explain these moderating effects in details.
2.2.4 Moderating Role of Cognitive Social Capital
Social capital comprises “the features of a social organisation that facilitate
coordination and cooperation for mutual benefit” (Putnam, 1995, p. 67). According to
this concept, social networks hold value, and individual and group productivity derives
from social contact (Putnam, 1995). Social capital takes three forms: relational
(strength of relationships developed over a history of interactions), cognitive (shared
common representation, interpretation, and systems of meaning among network
members), and structural (total pattern of connections between network members)
(Jones & Taylor, 2012; Nahapiet & Ghoshal, 1998). In this study, we adopt social
capital theory (Jones & Taylor, 2012) to examine clients’ cognitive social capital with
38
professionals and determine its moderating effect on the relationship between service
provider’s communication style and client psychological comfort.
Cognitive social capital represents the degree to which members in a network
share similar beliefs, ideas, interests, values, languages, norms of behaviour, and
systems of meaning that assist group behaviour (Jones & Taylor, 2012; Nahapiet &
Ghoshal, 1998). For clients, having cognitive social capital with professionals
positively influences their senses of trust and effectiveness, particularly when the
clients have limited knowledge of the services provided; perceived similarity with
professional service providers indicates the providers’ abilities to provide the desired
service outcomes (Coulter & Coulter, 2002, 2003; Crosby et al., 1990). Given the
characteristics of professional services, we predict that clients who perceive high levels
of cognitive social capital with service providers (i.e., share common interests and
values) are likely to process the providers’ communications more favourably than if
they perceive low cognitive social capital. Specifically, we predict that affiliative
communication style will generate a stronger positive effect on psychological comfort
among clients who perceive high levels of social capital with providers. By interacting
with people who have shared networks and preferences, and using a friendly,
empathetic communication style, client anxiety can be further reduced. Moreover, we
predict that the positive effect of cognitive social capital will compensate for the
negative effect of dominant communication style: If clients perceive high levels of
social capital (i.e., shared attitudes and behaviours) with providers who use a
dominant, controlling style, the style will be less likely to reduce their psychological
comfort. We therefore hypothesise the following:
39
H3a: When a client perceives high cognitive social capital with a healthcare
provider, the positive impact of affiliative communication style on client
psychological comfort is strengthened.
H3b: When a client perceives high cognitive social capital with a healthcare
provider, the negative impact of dominant communication style on client
psychological comfort is weakened.
2.2.5 Moderating Role of Cultural Value Orientation
People from different cultural backgrounds possess different values and norms
that affect their assessments of provider–client communication (Mattila, 1999; Wang
& Mattila, 2010). Yuan, Bazarova, Fulk, and Zhang (2013, p. 481) note that “people
from different cultures develop different standards of appropriate communication
style”. In professional services, service providers are exposed to clients with diverse
cultural value orientation (Sharma, Tam, & Kim, 2009) and different perceptions of
providers’ communication style. Given that social interaction is first and foremost a
social exchange between people, it is reasonable to expect that cultural value
orientation affect perceptions of communication style in service encounters.
This research focuses on clients’ cultural value orientation at the individual
rather than the national level. It is an ecological fallacy to adopt country-level cultural
dimensions to explain individual behaviours, because ecological or national-level
relationships apply to individuals (Patterson, Cowley, & Prasongsukarn, 2006; Yoo &
Donthu, 2002). According to Donthu and Yoo (1998), it is more appropriate to use
Hofstede’s (1980b, 1980c) cultural typology at the individual level, because
individual-level values are classified into selected cultural dimensions. Applying
40
Hofstede’s (1980b, 1980c) cultural value orientation differences, we hypothesise that
client perceptions of how professionals’ communication style shape their
psychological comfort are affected by their cultural value orientation along the
individualism–collectivism dimension.
A collectivist (vs. individualist) value orientation is a restricted social
framework in which people are differentiated between in-groups and out-groups
(Hofstede, 1980c). People with a collectivist value orientation are closely linked and
relationship-rich; they prioritise collective goals and are concerned with high context
(Mattila, 1999; Triandis, 1995). They are characterised by high uncertainty avoidance
and high power (social) distance (Hofstede, 1980c; Triandis, Bontempo, Villareal,
Asai, & Lucca, 1988). People with an individualist value orientation instead have
stronger self-concepts and greater senses of autonomy; they emphasise personal
achievement (Hofstede, 1980b). They are typically lower in uncertainty avoidance and
power distance (Hofstede, 1980c). Thailand (the source of our data collection) is
generally considered a collectivist country; however, because of the influence of
international travel and education in international schools, not all Thai citizens exhibit
a collectivist value orientation. For these reasons, we examine the collectivist–
individualist value orientations of clients at the individual level.
People with a strong collectivist value orientation communicate in a manner
that avoids conflict and uncertainty and maintains harmonious relations (Claramita,
Nugraheni, van Dalen, & van der Vleuten, 2013). When using professional services,
collectivist value oriented people have a high need for harmony and personal
relationships. Because they perceive that professionals have higher social status, they
also tend to accept directions and guidance from the professionals. For instance,
41
Eastern medical-service interactions tend to be characterised by a “prevailing”
communication style that implies a superior role of physicians (Claramita et al., 2013).
Most general relationships among people with a collectivist orientation are vertical
(e.g., parent–child) and enlarged by frequent guidance, consultation, and penetration
into the lower-status person’s private life (Triandis et al., 1988). In complex
professional service encounters, clients with a stronger collectivist value orientation
likely prefer affiliative communication style, because they tend to avoid conflict and
acquiesce to those in higher power positions (e.g., physicians). They also are more
likely to follow the service provider’s directions (De Mooij & Hofstede, 2002) and
accept dominant communication style, such that the negative impact of dominant
communication style on client psychological comfort diminishes.
In contrast, clients with an individualist value orientation are more
independent, more detached, distant, and self-reliant (De Mooij & Hofstede, 2002;
Triandis, 1995; Triandis et al., 1988). For such clients, the strength of the impact of
professionals’ communication style (affiliative or dominant) on psychological comfort
is not likely to vary. Therefore, no prediction is advanced. With regard to these
moderating effects, we hypothesise:
H4a: For clients with a collectivist value orientation, the positive impact of
affiliative communication style on client psychological comfort is
strengthened.
H4b: For clients with a collectivist value orientation, the negative impact of
dominant communication style on client psychological comfort is weakened.
42
In the following section, we discuss the outcomes of our client psychological
comfort and replication hypotheses. The outcomes relate to both emotional (satisfaction)
and behavioural (repurchase intention and recommendation) consequences.
2.2.6 Satisfaction
Client satisfaction is a result of a client’s cognitive and affective reactions to a
service encounter (Crosby et al., 1990; Oliver, 1980). This study focuses on client
satisfaction with professional (medical) service providers. According to the revised
social interaction model, satisfaction is a consequence in professional services; it
explains clients’ evaluations of professional service providers’ responses (Ben-Sira,
1976, 1980). Studies show that satisfaction is produced by client psychological
comfort elicited in service encounters, such as retailing, restaurants (Lloyd & Luk,
2011), higher education (Paswan & Ganesh, 2005), and hairdressing settings. Feelings
of safety and comfort with regard to service providers are vital factors in clients’
assessments of service quality; they are precursors to perceptions of technical quality
that flow through to satisfaction (Dabholkar et al., 2000; Lloyd & Luk, 2011; Spake et
al., 2003). Thus, for the professional services context, we advance the following
replication hypothesis:
H5: Client psychological comfort is positively associated with satisfaction.
2.2.7 Repurchase Intention and WOM Recommendation
Professional service clients who are satisfied express intentions to repurchase
(Rosenbaum, Massiah, & Jackson Jr, 2006). In retail banking services, clients who
indicate positive behavioural intentions (e.g., continuing to use the services, holding
multiple accounts or service agreements) also are strongly, positively more satisfied
43
(Hallowell, 1996; Liu, Furrer, & Sudharshan, 2001). Moreover, many services
marketing studies that investigate the relationship between client satisfaction and
positive recommendation (i.e., positive WOM) find that satisfaction is a key driver of
positive recommendation and other beneficial post-purchase behaviours (Brown,
Barry, Dacin, & Gunst, 2005; Hennig-Thurau, Gwinner, Gremler, 2002; Johnson &
Zinkhan, 1991). Satisfied clients are more likely to provide recommendation to
potential clients, which helps ensure a firm’s financial returns (Hausman, 2003, 2004).
In a professional services context, clients who are satisfied with interpersonal
interactions with providers are highly likely to recommend the services to friends and
associates (Bontis et al., 2007; Hausman, 2004; Ladhari, Souiden, & Ladhari, 2011).
Accordingly, we posit the following replication hypotheses:
H6: Client satisfaction has a positive impact on repurchase intention.
H7: Client satisfaction has a positive impact on WOM recommendation.
2.3 Research Methodology
2.3.1 Data Collection
We conducted our research in a medical services setting in Thailand. Medical
services correspond to descriptions of professional services that are high in credence
properties (Darby & Karni, 1973; Ostrom & Iacobucci, 1995), in that they are
characterised by high complexity and high information asymmetry between physicians
and patients (Berry & Bendapudi, 2007; Hausman, 2004; Krishnan & Hartline, 2001).
Physicians diagnose patients’ symptoms and provide advice for treatment and healthy
behaviour. Because medical services often involve high degrees of patient anxiety and
stress, physicians are also responsible for patient/client psychological comfort (Berry
44
& Bendapudi, 2007; Spake et al., 2003). Clients find psychological comfort and
evaluate services received in service encounters by judging observable cues, such as
physician behaviours (e.g., interpersonal skills), rather than unobservable features such
as technical competence (Berry & Bendapudi, 2007; Hausman, 2004; Krishnan &
Hartline, 2001). Thus, it is reasonable to explore the communication style that
physicians use to transmit technical information, reduce patient stress, and generate
feelings of comfort.
We collected our data in Thailand, because of its potential for individual
culture variation. Thai people are increasingly being educated internationally and
exposed to Western culture through travel and tourism. For decades, Thai students
have been taking part in international higher, vocational, technical education and
English-language courses (predominantly in the United States, Australia, and the
United Kingdom). Since 2000, Thai students have enrolled mostly in Australian
institutions. In 2016, Thai students accounted for up to 30,451 enrolments in
Australian schools and universities (Australian Education International, 2006;
Department of Education and Training, 2016). With such expanded Western
educational training, it is reasonable to conclude that Thai people differ in their cultural
value orientation at the individual level, despite their country’s general collectivist
national profile (Hofstede, 1980b).
We used a pencil-and-paper survey to collect data from patients in public
hospitals and private medical clinics in three major cities in Thailand (Bangkok,
Chiang Mai, and Chiang Rai). Respondents were outpatients who had face-to-face
interaction(s) with physicians from various departments of hospitals/clinics. Their
range of medical issues included health check-ups, gastro-intestinal system diseases,
45
colds and flus, allergies, accidents, and cardiovascular diseases. Following patients’
consultations with physicians, we approached and invited the patients to participate in
the study. We presented them with a cover letter and information statement that
introduced the researchers, explained the general objective of the research, and
guaranteed the anonymity of responses. We completed the data collection in
approximately one month. Our final sample, after deleting incomplete questionnaires,
consisted of 355 responses. The majority of respondents were female (66.5%), ranging
in age from 35 to 64 years (42.3%); more than half reported having multiple meetings
with physicians (54.1%), and just over half had used the medical services of the
hospital/clinic exclusively in the preceding year (51%).
2.3.2 Measurements
To develop the questionnaire, we conducted a forward-translation (Hambleton,
1993). Two bilingual speakers whose mother tongue is Thai translated the questions.
Next, two bilingual speakers whose mother tongue is English back-translated them
(Brislin, Lonner, & Thorndike, 1973). We pre-tested the Thai-version questionnaire
with ten Thai respondents to ensure that the English meanings of the concepts, phrases,
and terms were equivalent to those in Thai. Because some words or phrases have no
precise comparable Thai translation, we made additional modifications (Brislin, 1980).
To assess face validity, we sent both the Thai and English questionnaires to marketing
academics to obtain their feedback on context and wording (Sharma & Patterson, 1999).
The measurements were adopted and modified from extant literature. We asked
respondents to think about the interactions they had just had with physicians from the
hospitals/clinics they were visiting on that day, using the interactions as their points of
46
reference throughout the questionnaire. We asked respondents for general information
(e.g., type, duration) about the medical services they received. We adopted Spake et
al.’s (2003) client psychological comfort scale. From a pre-test, we identified and
excluded two unrelated, redundant items. The reduced scale contained six word pairs
(e.g., uncomfortable/comfortable, very uneasy/very much at ease, very tense/very
relaxed), measured on 7-point semantic differential scales. We adapted a
communication style scale from Buller and Buller (1987), Norton (1978), Street
(1989), and Webster and Sundaram (2009). According to these authors’
categorisations of communication style, we formed a 22-item scale with 16 items that
assessed respondents’ perceptions of the affiliativeness of a physician’s
communication style—that is, the degree to which the professional showed attention,
friendliness, warmth, compassion, and social orientation and left an impression. Then
6 items measured respondents’ perceptions of the dominance of a physician’s
communication style—that is, the extent to which the professional established and
maintained control of conversations. Dominant behaviour included direction giving,
verbally exaggerating to emphasise a point, and a tendency to argue (e.g., “(the
physician I met today) tended to dominate the conversations”, “(the physician I met
today) verbally exaggerated to emphasise a point very frequently.”) (Buller & Buller,
1987; Norton, 1978; Street, 1989). Respondents indicated the extent to which they
agreed or disagreed with statements presented, on 7-point Likert scales in which 1 =
“strongly disagree” and 7 = “strongly agree”. From the results of the pre-test and face
validity test, the scale measuring dominant communication style is reduced and attuned
to represent an actual healthcare service setting in which physicians could be
somewhat, but not extremely, argumentative, dramatic, or physical and vocally act out
47
(Webster and Sundaram, 2009). Moreover, the face validity test suggests the dominant
scale to contain a smaller number of items in order to avoid redundancy of the
measurement. We drew 4 items that measured satisfaction from Oliver and Swan
(1989) and Patterson and Smith (2003). We measured repurchase (revisit) intention
using a 5-point scale (1 = “very unlikely” and 5 = “highly likely”), adopted from Yim,
Chan, and Lam (2012). We adopted the 10-point WOM recommendation scale from
Bontis et al. (2007). We made minor modifications to the scales to fit the research
setting. We adopted 4 cognitive social capital items from Jones and Taylor (2012), using
7-point Likert scales. For cultural value orientation, we used the CVSCALE (Yoo &
Donthu, 2002; Yoo, Donthu, & Lenartowicz, 2011), which captured client cultural value
orientation at the individual level. We applied 6 items of the collectivism–individualism
dimension, using 7-point Likert scales.
Control variables included respondents’ gender, age, focal brand experience
(experience with the hospital/medical clinic visited on that day), and global brand
experience (experience with other hospital/medical clinics in the past year for any type
of medical services). We also measured service criticality (perceived importance of
service) by asking about respondents’ perceived importance of their meetings with their
physicians, using a 5-point Likert scale. Their inclusion allows for a more robust test
of our hypotheses.
2.4 Analysis & Findings
2.4.1 Measurement Model
An exploratory factor analysis (EFA) confirmed two communication styles
(affiliative and dominant). We dropped two items (one from each style) because of
48
low factor loadings. We then performed a confirmatory factor analysis (CFA) using
Amos v22. After modifications, the results (Table 2.2) show that the model fit the data
relatively well: 2/df = 2.355, p < .001, comparative fit index (CFI) = .93, Tucker-
Lewis index (TLI) = .92, incremental fit index (IFI) = .93, goodness-of-fit index
(GFI) = .80, adjusted goodness-of-fit index (AGFI) = .77, root mean square error of
approximation (RMSEA) = .062, PCLOSE < .000, and standardised root mean square
residual (SRMR) = .06. The CFI, TLI, and IFI indicate that the model is parsimonious,
because each measure exceeds the recommended threshold of .90. Items yield
estimates of more than .50 (except one item in the dominant style scale, which is close
at .483) and are statistically significant (p < .001), indicating they share high variance
within the same construct. The average variance extracted (AVE) values are equal to or
above .50, suggesting convergent validity for all constructs. Reliability is satisfactory,
with Cronbach’s alphas ranging from .79–.97 and composite reliability above .70
(Bagozzi & Yi, 1988; Hair, Black, Babin, Anderson, & Tatham, 2010).
Table 2.2 Measurement model results

Items Loading
Affiliative communication style ( = .97; CR = .97; AVE = .70)
(This physician) listened to me very carefully. .779
Was extremely friendly. .818
Left an impression on me that he/she can explain things in an uncomplicated way. .821
Could repeat back to me exactly what I said. .823
Tended to be very encouraging most of the time. .859
Had knowledge of my illness, which I consider admirable. .805
Was extremely open and honest when talking to me. .791
Had a memorable smile and charm. .796
Deliberately reacted in a way that I know he/she was listening. .870
Was extremely attentive. .888
Was very relaxed during the discussion. .853
Expressed genuine concern for my welfare, which left an impression on me. .865
Acknowledged my input. .855
Always showed that he/she was very empathetic with me. .838
Gave me an impressive feeling about his/her manner of speaking to me as an .861
equal.
49
Dominant communication style ( = .79; CR = .79; AVE = .50)

Was somewhat confrontational during conversations. .594
Tended to dominate the conversations. .885
Verbally exaggerated to emphasise a point very frequently. .483
Tended to take control in discussions. .783
Psychological comfort ( = .94; CR = .94; AVE = .73)
Uncomfortable – Comfortable .834
Very uneasy – Very much at ease .867
Very tense – Very relaxed .902
Insecure – Secure .875
Worried – Worry free .834
Distressed - Calm .813
Satisfaction ( = .95; CR = .95; AVE = .83)
Following the meeting with this physician, I am happy with my decision to use .929
medical services from this hospital/clinic.
I am happy with the physician I met with. .929
I feel good about my decision to use medical services from this hospital/clinic. .936
Taking everything into consideration, I am very satisfied with physician’s medical .851
services.
Repurchase intention
In the future, how likely are you to engage in other medical services provided at .958
this hospital/clinic?
Recommendation
How likely would you be to recommend the physician to others (e.g., close friends, .978
colleagues, or family members) with a similar medical condition or service
needed?
Cognitive social capital ( = .94; CR = .92; AVE = .76)
(Judging from my meeting with this physician,) we share similar ideas and .911
interests.
We are similar in many ways. .934
We belong to some of the same groups. .812
We share the similar values. .812
Collectivist value orientation ( = .91; CR = .90; AVE = .62)
Welfare of a group (e.g., close friends, close colleagues, family members) is more .661
important than individual rewards.
Success of a group (e.g., close friends, close colleagues, family members) is more .741
important than individual success.
Individuals should sacrifice self-interest for the group. .863
Individuals should stick with the group even through difficulties. .866
Individuals should only pursue their goals after considering the welfare of the .864
group.
Group loyalty should be encouraged even if individual goals suffer. .704
Chi-square 1761.3
df 748
CFI .927
GFI .800
AGFI .770
RMSEA .062
SRMR .058
Notes:  = Cronbach’s alpha; CR = composite (construct) reliability; AVE = average variance extracted.
Loadings are standardised; all t-values are significant (p < .001)
50
Table 2.3 shows the correlations of the variables in the model. The square root
of the AVE for each construct is larger than its shared variance with any other
construct, indicating all constructs achieved discriminant validity (Fornell & Larcker,
1981).
Table 2.3 Descriptive statistics and correlations of study constructs
Mean S.D. 1 2 3 4 5 6 7 8
1. Affiliative communication
5.41 1.20 (.84)
style
2. Dominant communication
3.83 1.35 .077 (.71)
style
3. Psychological comfort 5.69 1.25 .698** -.027 (.85)
4. Satisfaction 3.85 1.09 .799** .056 .703** (.91)
5. Cognitive social capital 4.20 1.33 .509** .213** .417** .431** (.87)
6. Collectivist value
5.31 1.06 .455** .127* .363** .442** .286** (.79)
orientation
7. Repurchase intention 4.07 1.11 .352** .129* .236** .379** .307** .251** N/A
8. Recommendation 7.16 2.44 .526** .144** .448** .580** .351** .320** .390** N/A
Notes: S.D. = standard deviation, N/A = not applicable.
Values in parentheses on the diagonal are the square root of the AVE. Scales are 7-point Likert except
Satisfaction (4-point), Repurchase intention (5-point), and Recommendation (10-point).
*
Correlation is significant at the .05 level (two-tailed).
**
2.4.2 Common Method Bias
Because we measured all variables through a survey-based, cross-sectional
approach using single respondents’ data, common method variance could bias the
findings. Therefore, we employed both procedural controls (Podsakoff, MacKenzie,
Lee, & Podsakoff, 2003) and common method variance assessments (Malhotra, Kim,
& Patil, 2006). From a procedural remedies stance, we separated the measurements
using different response formats (semantic differential and Likert scales at various end
points). The cover page of the questionnaire ensured the strict anonymity and
confidentiality of participants. To prevent potential socially desirable responses, we
informed participants that their responses would be used only for academic research
51
purposes. Moreover, to minimise participants’ evaluation apprehension (Podsakoff et
al., 2003), our instructions clarified that there were no right or wrong answers to any
of the questions.
From a statistical remedies stance, we conducted multiple tests for common
method bias. First, we performed a Harman’s single-factor test (Harman, 1967) and a
CFA-based one-factor test. Results suggest that the single factor insufficiently
represents the items in the model; in EFA, the un-rotated single factor containing all
variables accounts for less than 50% of the variance (the first factor accounted for
45.46% of the explained variance), and in CFA, the single factor does not account for
all of the variance in the data. Second, we used a marker variable assessment technique
(Lindell & Whitney, 2001; Malhotra et al., 2006) in which we selected global brand
experience as a marker variable to control for common method variance (rM = .04,
p = .54). The mean change in correlations of the eight focal variables (rU – rA) when
we partialled out the effect of rM is .03, indicating no common method bias (Malhotra
et al., 2006). Third, we employed a single-method factor approach (Podsakoff et al.,
2003) by adding a directly measured latent methods factor to load on all items of the
measurement model. The fit indices of the measurement model with the method factor
show good fit to the data: 2/df = 2.220, p < .001, CFI = .93, TLI = .92, IFI = .93,
GFI = .80, AGFI = .77, RMSEA = .059, PCLOSE < .000, SRMR = .05. The
2 differences between the measurement model with and without a method factor are not
significant (2 = 81.1, df = 82, p < .90), suggesting an inability to reject the proposed
model and thus no significant issue with common method bias.
52
2.4.3 Structural Model and Hypothesis Testing
To test the hypotheses, we employed structural equation modeling (SEM)
using Amos v22. We first tested a baseline model (main effects). The model achieves
an acceptable fit; 2/df = 2.849, p < .001, CFI = .90, TLI = .89, IFI = .90, GFI = .79,
AGFI = .76; RMSEA = .072, PCLOSE < .000; SRMR = .12. As Table 2.4 shows,
affiliative communication style has a significant positive impact on psychological
comfort (β = .78, p < .001), and dominant communication style produces a significant
negative impact (β = -.12, p < .006). Psychological comfort also has a significant positive
effect on satisfaction (β = .77, p < .001), which subsequently yields positive effects on
repurchase intention (β = .41, p < .001) and recommendation (β = .61, p < .001).
Table 2.4 Results from the structural model (baseline model)

Model relationships Standardised Estimate t-Value
Affiliative communication style  Psychological comfort .78 16.25***
Dominant communication style  Psychological comfort -.12 -2.76**
Psychological comfort  Satisfaction .77 17.17***
Satisfaction  Repurchase intention .41 7.74***
Satisfaction  Recommendation .61 13.25***
Notes: Squared multiple correlations: Psychological comfort = .62, Satisfaction = .59,
Repurchase intention = .17, Recommendation = .37.
**
Significant at p < .01. ***Significant at p < .001.
In a test of the full model (i.e., with moderating effects), the results show that
the model acceptably fits the data: 2/df = 2.418, p < .001, CFI = .91, TLI = .91,
IFI = .91, GFI = .76, AGFI = .73; RMSEA = .063, PCLOSE < .000, and SRMR = .102.
The effects of both communication styles on psychological comfort provide support
for Hypotheses 1 and 2: Affiliative communication style has a significant positive
impact on psychological comfort (β = .61, p < .001), and dominant style produces a
small but significant negative impact (β = -.06, p < .030), as shown in Table 2.5.
Psychological comfort yields a significant positive impact on satisfaction (β = .77,
53
p < .001), which in turn has significant positive impacts on repurchase intention
(β = .41, p < .001) and recommendation (β = .61, p < .001), in support of Hypotheses
5, 6, and 7.
The positive association between affiliative communication style and
psychological comfort is moderated by high cognitive social capital (β = .10,
p < .001). That is, the strength of affiliative communication style for enhancing
psychological comfort is greater when patients perceive high similarity to their
physicians, as proposed by Hypothesis 3a. However, Hypothesis 3b is not supported;
the negative link between dominant communication style and psychological comfort
is not moderated by high cognitive social capital (β = -.043, p < .101).
The moderating effects of cultural value orientation (collectivism vs.
individualism) support Hypotheses 4a and 4b. The positive impact of affiliative
communication style on psychological comfort is moderated by collectivist value
orientation (β = .06, p < .001). Specifically, affiliative communication style is more
strongly associated with psychological comfort when a patient has a stronger
collectivist value orientation. Correspondingly, the negative influence of dominant
communication style on psychological comfort is moderated by a collectivist value
orientation (β = -.06, p < .012). Perceived dominant communication style has a
declining effect in terms of decreasing psychological comfort when patients are highly
collectivist value oriented. That is, dominant communication style has a weaker
negative influence on psychological comfort among patients with a collectivist value
orientation.
54
In addition, service criticality, one of the control variables, has a significant
(one-tailed) negative impact on psychological comfort (β = -.064, p < .068). This
finding supports the notion that an increase in patients’ perceived importance of the
service (criticality) lowers their psychological comfort. That is, the more critical the
medical consultation, the higher the level of client anxiety and stress and the lesser the
level of psychological comfort.
Table 2.5 Results from the structural model (full model)

Standardised Hypothesis
Hypothesised relationships t-Value
Estimate Supported
H1 Affiliative communication style  Psychological .61 10.66*** Yes
comfort
H2 Dominant communication style  Psychological -.06 -2.17* Yes
comfort
H3a Affiliative communication style × Cognitive social .10 5.11*** Yes
capital  Psychological comfort
H3b Dominant communication style × Cognitive social -.04 -1.64(ns) No
capital  Psychological comfort
H4a Affiliative communication style × Collectivist value .06 3.34*** Yes
orientation  Psychological comfort
H4b Dominant communication style × Collectivist value -.06 -2.50* Yes
orientation  Psychological comfort
H5 Psychological comfort  Satisfaction .77 17.17*** Yes
H6 Satisfaction  Repurchase intention .41 7.75*** Yes
H7 Satisfaction  Recommendation .61 13.26*** Yes
Repurchase intention = .17, Recommendation = .38.
*
Significant at p < .05. ***Significant at p < .001.
2.4.4 Competing Model
Both Hausman (2004) and Brown and Swartz (1989) indicate that effective
physician–patient communication results directly in patient satisfaction.
Communication style, in particular, is an affective component that has a strong direct
influence on patients’ service evaluations; it is an observable cue or proxy for
physicians’ technical skills as a basis of evaluating outcomes. Patients generally
55
display more satisfaction with their physicians when they perceive the physicians’
communications to be attentive and responsive to their expressions (Buller & Buller,
1987; Street, 1989). Conversely, patients are less satisfied when they perceive the
communication style to be dominant (Ben-Sira, 1980; Hausman, 2004; Street, 1989;
Wong & Tjosvold, 1995). These findings accord with Webster and Sundaram’s (2009)
finding that clients depend strongly on professionals’ communication style when
evaluating the professional services received. Affiliative communication style tends to
create higher client satisfaction; dominant/active style tends to generate lower
satisfaction. Accordingly, we test a competing model in which affiliative
communication style has a direct positive impact and dominant communication style
has a direct negative impact on satisfaction, in addition to the indirect impacts
mediated by psychological comfort.
The test of model fit shows satisfactory results and a superior fit:
2/df = 2.314, p < .001, CFI = .92, TLI = .91, IFI = .92, GFI = .76, AGFI = .74;
RMSEA = .061, PCLOSE < .000, and SRMR = .087. Affiliative style positively and
directly affects satisfaction (β = .583, p < .001) and psychological comfort (β = .584,
p < .001); dominant style has a non-significant direct effect on satisfaction (Table 2.6,
Figure 2.2). (Table 2.7 specifies that the competing model yields better results for 2,
GFI, CFI, RMSEA, and SRMR.) A chi-square test indicates a significant difference
(p < .001) between the hypothesised and competing models and shows that the
competing model fits the data better. Because the competing model indicates partial
mediation, we also applied Baron and Kenny’s (1986) test for mediation. The data
support the partial mediation of psychological comfort on the link between affiliative
style and satisfaction; we therefore conclude that the competing model offers a
56
marginally better fit than the hypothesised model. Client psychological comfort
partially mediates the impact of affiliative communication style on satisfaction.
Table 2.6 Results from the competing model
(Competing) model relationships Standardised Estimate t-Value

Affiliative communication style  Psychological comfort .58 9.89***
Dominant communication style  Psychological comfort -.06 -2.11*
Affiliative communication style × Cognitive social capital
 Psychological comfort .10 5.02***
Dominant communication style × Cognitive social capital
 Psychological comfort -.045 -1.63(ns)
Affiliative communication style × Collectivist value
orientation  Psychological comfort .06 -2.82**
Dominant communication style × Collectivist value
orientation  Psychological comfort -.06 -2.63**
Affiliative communication style  Satisfaction 0.58 10.83***
Dominant communication style  Satisfaction -.02 -1.06(ns)
Psychological comfort  Satisfaction .31 5.91***
Satisfaction  Repurchase intention .41 7.82***
Satisfaction  Recommendation .61 13.29***
Repurchase intention = .17, Recommendation = .38
*
Significant at p < .05. **Significant at p < .01. ***Significant at p < .001.
Figure 2.2 Competing model
Communication Style Cognitive Social Repurchase

Capital Intention
Affiliative
Communication Style
Psychological Satisfaction
Comfort
Dominant
Communication Style
Collectivist Value
Orientation Recommendation
Controls
Age, Gender, Service criticality
57
Table 2.7 Model fit statistics

Goodness of fit index Hypothesised model Competing model
2 2653.208 2536.091
df 1097 1096
p-value .000 .000
GFI .757 .763
AGFI .728 .736
NFI .862 .868
CFI .914 .920
IFI .914 .921
RFI .852 .858
RMSEA .063 .061
SRMR .102 .087
2.5 Discussion
This study aims to enrich services literature by examining the role of client
psychological comfort and its association with professional service provider
communication style, client satisfaction, client behavioural responses, and client
heterogeneity (cognitive social capital and cultural value orientation). We focus on
professional services because of their credence properties, information/knowledge
asymmetry, customisation, and complexity. Most clients experience considerable
uncertainty and uneasiness when evaluating service outcomes (Darby & Karni, 1973;
Stewart et al., 1998; Swartz & Brown, 1989; Zeithaml et al., 1985). Although
academics and practitioners have signified the need to create client psychological
comfort (Bloom, 1983; Mitra et al., 1999), they have paid scant attention to the
determinants of client psychological comfort. This study shows that in professional
consumer services contexts, service providers’ communication style influence client
psychological comfort and its consequences, including satisfaction, repurchase
intention, and WOM recommendation.
58
Most of our predictions are supported by the results. When professional service
providers use affiliative communication style—that is, express concern and
attentiveness to clients—they significantly stimulate client psychological comfort.
Conversely, when providers use dominant communication style—that is, display a
controlling and directing manner—they diminish psychological comfort. The findings
show that when clients encounter professional services that are complex and technical,
they use service providers’ communication style as observable indicators of the
services’ technical qualities. Clients who receive technical information provided in a
friendly, courteous manner and who have opportunities to express their concerns and
thoughts can assess the services they receive, find relief from perceived uncertainty
and anxiety, and experience psychological comfort. These results are consistent with
Ben-Sira’s (1976, 1980) revised social interaction model and Berger and Calabrese’s
(1975) uncertainty reduction theory, according to which clients modulate their feelings
of uncertainty and apprehension about service delivery by observing service providers’
communications. Affiliative communication style reduces uncertainty, but dominant
communication style, with its limited opportunities for raising concerns or asking
questions, does not: Although clients may still be able to assess the services, their
uncertainty and anxiety remains. In other words, they remain psychologically
uncomfortable.
The moderating effects of cognitive social capital offer contrasting but
interesting points. On the one hand, the positive effect of affiliative (i.e., warm and
friendly) communication style on client psychological comfort is even greater when
clients perceive that they have a high degree of similarity with their professional
service providers. Similarities in values, norms, and preferences inspire agreeability
59
and interaction between parties (Coulter & Coulter, 2002; Jones & Taylor, 2012).
Personal chemistry with a provider is vital in professional service relationships
(Stewart et al., 1998). On the other hand—and contrary to our prediction—high levels
of cognitive social capital do not moderate the relationship between dominant
communication style and psychological comfort. Although a high degree of client-
perceived similarity weakens the negative impact of dominant communication on
client psychological comfort (as we expected), its effect is not substantial. It appears
that shared attitudes are not sufficient to offset the negative effects (i.e., lower client
interaction, reduced psychological comfort) of dominant style of service provider
communication.
The moderator of cultural value orientation reveals noteworthy effects.
Affiliative communication style tends to promote higher client psychological comfort
when clients possess a collectivist (vs. individualist) value orientation. Because
collectivist value oriented people are group-oriented and relationship-rich, indications
of friendliness, sociability, and concern on the part of professional service providers
validates clients’ collectivist value characteristics, leading to further psychological
comfort during service encounters. A collectivist value orientation also lessens the
negative impact of dominant communication style on psychological comfort. Because
people with a collectivist value orientation are concerned with group harmony and
inclined to accept power distance from professionals (i.e., follow directions and accept
guidance from higher-power providers), providers’ use of dominant communication
style does not reduce collectivist value oriented clients’ psychological comfort.
As a consequence of client psychological comfort, we find that the more
comfortable clients feel, the more satisfied they are with their professional service
60
providers. This result confirms the link between psychological comfort and
satisfaction. Moreover, satisfaction stimulates clients’ intention to repurchase/revisit
hospitals or clinics for other medical services, as well as to recommend the service
providers to family members, close friends, and colleagues.
The competing model reveals additional, more comprehensive findings. With
similar moderating effects (cognitive social capital and cultural value orientation)
included, we find that affiliative communication style has a significant direct effect on
satisfaction, as well as an indirect effect through client psychological comfort. The
positive direct effect of affiliative style on client psychological comfort is slightly
lessened when its direct effect is present, resulting in a partial mediation of the link
between communication style and client psychological comfort. We conclude that both
types of communication style (affiliative/dominant) influence client psychological
comfort, which in turn shapes satisfaction and other consequences in professional
service settings. However, affiliative communication style has both a direct impact on
satisfaction and an indirect impact through client psychological comfort.
2.5.1 Theoretical Contributions
This study adds several aspects to professional services literature. First, it
shows that psychological comfort is a vital element in determining clients’ assessments
of professional services. Services marketing scholars such as Bloom (1983), Mitra et
al. (1999), and Spake et al. (2003) have addressed the need to gain clients’ trust and
reduce client anxiety; we introduce the additional mediator of client psychological
comfort to the professional services context. The role of client psychological comfort
that we describe in this study accords with Berger and Calabrese’s (1975) uncertainty
61
reduction theory. According to the theory, when clients lack technical information
about the services they are receiving and interact with professionals who are typically
strangers, they perceive high uncertainty and are motivated to ease their mental
distress. Therefore, it is crucial for professional service providers to establish client
psychological comfort during service interactions; such comfort is a precursor to
client-perceived service technical quality and determines success of the overall
service.
Second, this study is the first to highlight professional service providers’
communication style as an antecedent of client psychological comfort. Our findings
reinforce prior research (Brown & Swartz, 1989; Hausman, 2003; Johnson & Zinkhan,
1991; Sharma & Patterson, 1999, 2000) that suggests the success of professional
services rests on process/functional aspects, that is, the manner in which the services
are delivered. Specifically, we offer a model that explains the influence of service
providers’ affiliative and dominant communication styles, as perceived by clients, on
psychological comfort. We fill a research gap with regard to the drivers of client
psychological comfort in highly credence-based services settings, such as medical
services.
Third, we offer additional explanations of the relationship between
communication style and client psychological comfort by offering a competing model.
We show that affiliative communication style affects client satisfaction both directly
and indirectly through client psychological comfort. These results not only supplement
prior research (Ben-Sira, 1976; Street, 1989; Webster & Sundaram, 2009; Wong &
Tjosvold, 1995) regarding the positive effect of affiliative communication style on
professional service evaluation but also strengthen the association, by inserting the role
62
of client psychological comfort as a partial mediator. We find that dominant style,
however, yields no direct effect on satisfaction when psychological comfort is present.
These findings provide new insights to communication and services marketing
literature.
Fourth, this study empirically examines the moderating effects of cognitive
social capital and cultural value orientation; both moderators reflect heterogeneity
among clients and have crucial roles in human interactions. The two moderators
provide evidence of contingency conditions under which communication style
differently impacts psychological comfort. Cognitive social capital represents the
contingency conditions in which clients’ observations and perceptions influence the
effect of service providers’ affiliative communication style on psychological comfort.
This study also reveals a significant moderating role of collectivism–individualism
value orientations among individual clients. Dominant communication style does not
reduce psychological comfort when clients possess a highly collectivist value
orientation.
2.5.2 Managerial Implications
This research offers several empirical insights for healthcare professionals and
professional service providers and executives in general, especially those who deal
with highly technical information/skills, complexity, customisation, and personal
contacts (e.g., medical or legal services). Providers and executives should understand
that because most clients are not equipped with the professional knowledge needed to
evaluate the services they receive, they become uncertain and anxious when interacting
with professionals. In this context, it is essential to reduce client anxiety and maintain
63
client psychological comfort while delivering required core service outcomes. Service
providers and executives must know how to establish and retain psychological comfort
for clients before and during service provision.
Our findings support the notion that both client psychological comfort and
client satisfaction can be increased through the use of affiliative communication style.
By communicating with clients in an attentive, friendly manner, and allowing two-way
interactions, professional service providers can reduce client anxiety and foster
satisfaction. Professional service managers should note that such communication style
has a positive effect on client psychological comfort, regardless of clients’
demographics or prior service experiences. However, dominant communication style
reduces client psychological comfort and should be restrained during service
encounters. Accordingly, executives should train professionals in affiliative
techniques for conveying technical information and interacting with clients. For
example, regular role-playing practice could ensure that listeners correctly perceive
providers’ communications—both verbal and non-verbal—to be attentive, warm, and
sociable. Professionals also should have opportunities to share accounts of their client
service interactions and strategies with their colleagues.
Executives and managers need to be conscious of their clients’ cultural value
orientation. Professional service providers should recognise that collectivist clients
who show signs of compliance or maintaining agreement in conversations are even
more comfortable if the providers use affiliative communication style. Collectivist
clients tend to develop feelings of comfort, even when their providers use a more
dominant communication style (e.g., to deliver precise, strict directions). Both
communication styles increase psychological comfort for collectivist clients who are
64
drawn to harmony and group concerns. Furthermore, our results suggest that
professionals should observe whether clients perceive similarities with them in terms
of values, ideas, and social groups. The notion of cognitive social capital can be
included in role-play by identifying and emphasising similarities of interests (e.g.,
hobbies, sports teams) and networks (e.g., acquaintances, hometowns) while using
affiliative communication style. Such similarities generate greater client psychological
comfort. And, to maximise that comfort, professionals should not only transmit
information in a sociable, communicative style but also carefully listen to and observe
clients’ views and expressions.
Finally, executives and managers should keep in mind that communication can
be a double-edged sword. Most professional service providers (e.g., physicians) have
limited time to meet and serve clients (patients). Because they need to focus the
conversations on core services (Hausman, 2004), they are prone to using
dominant/controlling communication style. A U.S. physician, for example, may see up
to 40 patients a day in an outpatient clinic, between hospital rounds and while being
interrupted by phone calls and pagers at all times of the day and night (Berry &
Bendapudi, 2007). Using affiliative communication style, without placing a limit on
time spent (e.g., spending too much time on background information or small-talk),
might result in unmanageable schedules. Accordingly, providers should implement
attentive/social-oriented communication within reasonable time frames. Moreover,
affiliative communication style may not suit every professional service provider: Some
clients are able to detect “surface acting” in the emotional displays of providers (Groth,
Hennig-Thurau, & Walsh, 2009), so attempts at attentive communication could be
undermined by clients’ perceptions that the attentiveness is not genuine. Managers
65
should ensure that sincere expressions (e.g., constant eye contact, using a friendly tone
of voice) are included in providers’ communication training.
2.5.3 Limitations and Directions for Further Research
Some limitations of this study warrant attention. Our examination of client
psychological comfort occurs at a point at which clients have finished meeting with
their providers, and the measurements relate to only this one point in time. Although
psychological comfort is regarded as a stable state (Spake et al., 2003), several factors
might affect psychological comfort at other times during the service process. For
example, clients might become accustomed to the communication style of providers,
or providers might adjust their communication style to appeal to clients. Therefore, it
would be useful to capture the trend of client psychological comfort over time (e.g.,
several months or even years, depending on the type of service). However, when
capturing the dynamics of client psychological comfort, researchers should consider
other factors that may have confounding effects as the services progress. These factors
include the technical service results clients receive between meetings with their
providers, additional costs, terms and conditions of professional services received,
switching costs, and the attractiveness of alternatives.
Another limitation involves the data collected from clients as a single source
of information. Most professional services interactions comprise activities performed
by both providers and clients, so a sole focus on client perceptions may restrict the
insights that can be drawn from these interactions (Hausman, 2004). Future research
could collect dyadic data, from both clients and providers, about perceptions of
communication style (as listeners vs. speakers) and levels of psychological comfort
66
(as the person experiencing vs. the person delivering). Researchers also could enrich
professional services studies by performing a gap analysis of the perceptions of the
parties with regard to communication style and psychological comfort.
The study also has other restrictions related to the data collection. It focuses on
one professional services sector, namely, medical services. This setting is appropriate
for examining interpersonal communication in services that are highly credence-based
(i.e., characterised by complexity, uncertainty, and accompanying client anxiety);
future research could validate the current findings in other professional services
categories. For example, financial and legal services merit investigation, because their
clients tend to possess limited knowledge and skills to judge the services confidently
or feel comfortable that the service providers will deliver desirable service outcomes.
A final limitation is that the data comes from one (Eastern) country.
Researchers might gain a greater understanding of client cognition by collecting data
from other settings, in high individualist value oriented countries such as the United
States, Australia, and the Netherlands, to provide evidence to which the results might
be generalised.
67
COMMUNICATION STYLE: A SUPPLEMENTARY STUDY
CHAPTER 3
BUILDING CLIENT PSYCHOLOGICAL COMFORT THROUGH
3.1 Introduction
In our first study, we showed that dominant and affiliative communication
styles of professional service providers affect client psychological comfort, through
main as well as moderating effects. Although our theoretical model offers high
external validity, it needs to control for extraneous factors that might also influence
the relationship between communication style and client psychological comfort.
Accordingly, we conduct a supplementary study to enhance the internal validity and
validate the causal relationship in a controlled setting. We employ an experimental
design to assess the relationship between communication style and psychological
comfort. We omit the moderating effect of cultural value orientation from this study
since it is not the focal objective.
In practice, professional service providers use a mixture of communication
styles during extended service encounters. Accordingly, medical sociologists study the
joint effects of affiliative and dominant communication styles on patient responses
(e.g., Cousin & Mast, 2013; Mast, Hall, & Roter, 2007, 2008). Prior to conducting this
supplementary study, we test the joint effects of the two communication styles on
client psychological comfort from responses in the first study, using structural equation
modeling (SEM). The results show an interaction effect between dominant and
affiliative styles on psychological comfort (β = -.04, p < .06). The responses indicate
68
different degrees of client psychological comfort when the two communication styles
are classified into four groups: high-affiliative/low-dominant (M = 6.38, SD = .764),
high-affiliative/high-dominant (M = 6.30, SD = .864), low-affiliative/low-dominant
(M = 5.09, SD = 1.341), and low-affiliative/high-dominant (M = 5.02, SD = 1.233).
These findings allow us to investigate the effects of combined communication styles.
Using Berger and Calabrese’s (1975) uncertainty reduction theory, Ben-Sira’s
(1976, 1980) revised social interaction model, and a patient-centredness concept as
theoretical foundations, we conduct the study with two objectives. First, we seek to
confirm the causal relationship between professional service providers’
communication style and client psychological comfort in a controlled (medical
services) setting. Second, we seek to expand the examination of the effect of
communication style on psychological comfort to include joint effects. Specifically,
we propose that only specific combinations of affiliative and dominant communication
styles initiate higher client psychological comfort.
In the next section, we explain the development of three hypotheses. A review
of the literature is presented in the previous part (Chapter 2) and so will not be repeated
here. We then describe our methodology and findings and discuss the results.
3.2 Research Hypotheses
3.2.1 Psychological Comfort
Client psychological comfort (feelings of security, reassurance, being at ease,
and relieved from mental distress) (Lloyd & Luk, 2011; Spake et al., 2003) is an
emotional response that is shaped by observations of service providers’ behaviours
during service encounters (Lloyd & Luk, 2011). However, in the context of
69
professional services, client psychological comfort is associated with services high
customisation, complexity and information asymmetry between professionals and
clients (Darby & Karni, 1973; Hill, 1988; Lian & Laing, 2004; Ostrom & Iacobucci,
1995). According to uncertainty reduction theory (Berger & Calabrese, 1975), clients
are motivated to reduce their levels of perceived uncertainty and accompanying risk;
they seek to alleviate anxiety and distress and attain psychological comfort (Spake et
al., 2003). To reduce perceived uncertainty and anxiety, clients tend to seek
information by communicating with professional service providers (Knobloch, 2008).
However, according to Ben-Sira’s (1976, 1980) revised social interaction model,
insufficient understanding of the technical aspects of professional services leads
clients to observe and process service providers’ communication style as a mode of
response, rather than a transmission of technical content.
3.2.2 Influence of Joint Communication Style
Whereas some prior studies and our first study examine the impact of a
communication style independently of other styles (Buller & Buller, 1987; Street,
1989; Webster & Sundaram, 2009), the effects of a joint communication style also are
of interest to researchers. Medical studies investigate the effects of combined
affiliative/caring and dominant communication styles on patient satisfaction and
behavioural responses (Cousin et al., 2012; Mast, Hall, & Roter, 2007; Mast et al.,
2008). Marketing researchers focus on the influence of joint communication styles of
openness and dominance/preciseness on clients’ perceptions (of salespersons,
products, sales interactions) and probabilities of purchase (Dion & Notarantonio,
1992; Notarantonio & Cohen, 1990). Specifically, Notarantonio and Cohen (1990)
find that when communication styles interact, they influence clients’ perceptions
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differently than when they are used independently. Salespersons’ communication
style, for example, is “blended” rather than dichotomous. In professional services
settings, it is likely clients perceive combinations of a service provider’s
communication style. Such blends of affiliative and dominant communication styles
are relevant to the medical services context, in which extended service encounters are
the norm. In extended encounters, physicians may employ both communication styles
(affiliative and dominant), and patients may perceive a blend of styles.
Clients’ communication style perceptions (which vary according to providers’
choices of wording and expressions) assist in creating psychological comfort during
professional service encounters. For example, perceptions of affiliative style make
clients feel relaxed, attended to, empathised with, and encouraged during discussions,
whereas perceptions of dominant style are instrumental in receiving directions and
technical guidance during decision-making phases. Accordingly, we anticipate that
various combinations of affiliative and dominant communication styles (Figure 3.1)
result in varying degrees of client psychological comfort.
Figure 3.1 Combinations of communication styles
Affiliative Style
High Low
Dominant Style
Low
High
In medical services, both high-affiliative and low-dominant communication
styles, which produce more favourable patient responses, are recommended for
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physicians who wish to pursue “patient-centredness” or “patient-centred
communication” (Cousin & Mast, 2013; Cousin et al., 2012; Epstein et al., 2005;
Oates, Weston, & Jordan, 2000). Physicians’ expressions of high-affiliative (rather
than low-affiliative) communication style (i.e., conveying friendliness, concern, and
empathy to build and retain positive relationships) generate higher patient satisfaction
(Buller & Buller, 1987; Street, 1989) and encourage more client/patient emotional
statements and speech latency (Mast et al., 2008). High-dominant (i.e., expressing
directives and commands to establish and maintain control in interactions)
communication style (rather than low-dominant) instead exhibits a negative
relationship with client satisfaction (Buller & Buller, 1987; Street, 1989); it leads
patients to be less forthcoming (Mast et al., 2008). Moreover, in sales situations, clients
desire salespeople who express friendliness, reduce anxiety, and invite discussion
(Dion & Notarantonio, 1992; Notarantonio & Cohen, 1990).
Our first study shows that professional service providers’ use of high-affiliative
communication style has a strong positive effect on client psychological comfort.
Transmission of technical information in a warm, concerned manner generates client
relief from uncertainty and increases psychological comfort. In contrast, high-
dominant communication style has a negative effect on psychological comfort;
providers explain information in a way that fails to reduce perceived uncertainty and
anxiety. Clients are more psychologically comfortable when they receive technical
information in a less controlling manner, as well as when they can address concerns
and opinions and feel a sense of control. Professionals who adopt a combination of
high-affiliative and low-dominant communication styles—that is, are attentive and use
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fewer dominant expressions—could generate the highest levels of client psychological
comfort.
Thai medical services are the setting of this study. As a whole, Thailand is a
highly collectivist culture, scoring 20 on Hofstede’s (1980a) individualism–
collectivism scale. Thai clients therefore tend to desire high social interaction and
affiliation and limited confrontation during service encounters. We propose the
following hypothesis:
H1: A combination of a healthcare provider’s high-affiliative and low-dominant
communication styles produces the highest level of client psychological
comfort, among all conditions.
The first study also indicated that affiliative communication style (β = .58,
p < .001) has a much stronger effect on client psychological comfort than dominant
style (β = -.06, p < .035). It is plausible that the positive impact of affiliative style,
especially in the Thai cultural context, overshadows the smaller negative effect of
dominant style, such that the combination of high-affiliative and high-dominant
communication styles results in relatively moderate psychological comfort. In medical
studies, physicians’ high caring/affiliative and high-dominant communication styles
encourage more emotional expression by patients, though the combined effect is not
significant (Mast et al., 2007). Salespersons’ mixture of friendliness and precise
communication increases clients’ probability of purchasing, because it reduces clients’
intrinsic anxiety and makes the communication easier to understand (Dion &
Notarantonio, 1992). Thai clients generally desire social harmony and are inclined to
accept directions from professionals, whom they regard as having higher social status
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(Claramita, Nugraheni, van Dalen, & van der Vleuten, 2013; Hofstede, 1980a).
Therefore, we expect that when high-affiliative communication style is combined with
high-dominant style, the powerful positive impact of high-affiliative style overpowers
the negative impact of high-dominant style, resulting in higher client psychological
comfort. We hypothesise:
H2: A combination of a healthcare provider’s high-affiliative and high-dominant
communication styles produces a higher level of client psychological
comfort than a combination of the provider’s low-affiliative and high-
dominant communication styles.
As a corollary, and for the sake of completeness, we posit:
H3: A combination of a healthcare provider’s low-affiliative and high-dominant
communication styles produces the lowest level of client psychological
comfort, among all conditions.
3.3.1 Design and Procedure
We employed a 2 × 2 between-subjects experimental design (professional
service providers’ affiliative communication style: high vs. low) × (dominant
communication style: high vs. low) in a medical services setting. Participants were
undergraduate students taking a marketing course at a major university in northern
Thailand. The total number of participants was 323, after we deleted 22 incomplete
responses. Participants were mostly female (78.3%) with a median age of 21 years.
We chose Thai students and a medical services context for this study to validate the
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findings of our first study, which also examined a Thai medical services context. Our
purpose was to investigate the causal relationship between communication style and
client psychological comfort and to control for extraneous factors that may have
affected the results.
We randomly assigned participants to one of four conditions (high-
affiliative/low dominant, high-affiliative/high dominant, low-affiliative/low dominant,
and low-affiliative/high dominant) and arbitrarily allocated them to time slots. For all
conditions, we asked each participant to read a scenario (see Appendix 2 for scenarios)
describing a conversation between a physician and a patient, consulting to treat severe
recurrent headaches. We asked the participants to imagine themselves as the patient.
We informed them that the meeting was their second visit with the physician, and its
purpose was to discuss their symptoms and make decisions about treatments. We
selected recurrent headaches as the symptom for this study because headaches are
universal and relatable, with a psychosocial element that enables conversations
(Cousin et al., 2012; Mast et al., 2008). After reading the scenario, each participant
answered a pencil-and-paper questionnaire. The entire procedure lasted approximately
10 minutes.
3.3.2 Measurements
We adapted four scenarios from the experimental scripts of Mast et al. (2008)
and Cousin et al. (2012), to reflect the phases and functions of a medical services
interaction (i.e., greetings, information gathering, patient education and counselling,
decision making, and closing) while manipulating communication style as either
affiliative (high vs. low) or dominant (high vs. low). We held constant the patient’s
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symptoms, response, and dialogue structure across all conditions. We scripted the two
communication styles to differ according to the physician’s verbal (choice of wording)
and non-verbal (gesture and tone of voice) communications (Notarantonio & Cohen,
1990). Written scenarios are suitable for this study because they restrict the plausible
influences of the physician’s age (Buller & Buller, 1987), gender (Khan, Ro, Gregory,
& Hara, 2015; Mast et al., 2007) or the severity of the illness (Buller & Buller, 1987;
Webster & Sundaram, 2009).
A physician with high-affiliative communication style displays behaviours that
communicate friendliness, concern, empathy, and reassurance to clients, whereas low-
affiliative style represents a pattern in which these elements are not present. High-
dominant communication style entails expressions of control over the interaction, such
as asking close-ended questions and not seeking patients’ opinions or permission.
Low-dominant style reflects an absence of such a dominant manner or a situation in
which physicians show minimal or no control, such as asking open-ended questions,
asking for patients’ opinions or permission, and sharing decision making (Cousin et
al., 2012; Mast et al., 2008; Webster & Sundaram, 2009). For our study, we adjusted
the wording in several minor ways, to ensure a realistic presentation of medical service
interactions and the differences of communication style indicated by Norton (1978).
We pre-tested and confirmed the scenarios with Thai undergraduate students (n = 15).
We adapted key constructs of the questionnaire from prior literature. The client
psychological comfort scale came from Spake et al. (2003). It contains word pairs (e.g.,
uncomfortable/comfortable, very uneasy/very much at ease), measured on 7-point
sematic differential scales. We measured perceived communication style using a scale
adapted from Buller and Buller (1987), Norton (1978), Street (1989), and Webster and
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Sundaram (2009). For participants’ perceived affiliativeness of a physician’s
communication style, we used 16 items, then measured the perceived dominant
communication style using 6 items. Participants responded to statements on a 7-point
Likert scale (1 = “strongly disagree”, 7 = “strongly agree”).
Buller and Buller (1987) and Street (1989) suggest that the number of previous
visits to a physician shapes patients’ levels of satisfaction with affiliative and dominant
communication styles. We controlled for this effect by specifying that the scenario
portrayed participants’ second medical visits, across all four conditions. Finally,
participants provided demographic information.
3.4.1 Manipulation Check
We performed a manipulation check by running a 2 (affiliative style: high vs.
low) × 2 (dominant style: high vs. low) analysis of variance (ANOVA) on each
communication style. Respondents perceived the four conditions as significantly
different (p < .001), such that the scenarios that expressed high-affiliative style
appeared more affiliative than those that expressed low-affiliative style
(F(1,319) = 810.721, p < .001). They perceived the affiliativeness of the communication
style of Scenario 1 (M = 6.01, SD = .55) and Scenario 2 (M = 5.01, SD = .77) to be
significantly higher than those of Scenario 3 (M > 2.90, p < .001) and Scenario 4
(M > 3.29, p < .001). They also perceived that the scenarios that conveyed high-
dominant style were more dominant than those that conveyed low-dominant style
(F(1,319) = 352.172, p < .001). Specifically, the dominance of the communication
style in Scenario 2 (M = 5.49, SD = .85) and Scenario 4 (M = 6.00, SD = .72) appeared
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significantly higher than that of the style in Scenario 1 (M > 3.08, p < .001) and
Scenario 3 (M > 2.20, p < .001). Therefore, the results confirm the success of the
scenario manipulation.
3.4.2 Validity and Reliability Assessment
An EFA and a CFA confirm two communication styles and client
psychological comfort. The three factors explain 75.5% of the total variance, with item
loadings above .50 for all constructs (except one item in dominant communication
style, which was .41) (Table 3.1). As evidence of convergent validity for all constructs,
the AVE values are equal to or above .50. Cronbach’s alphas range from .88–.98, and
the range of composite reliability is above .70, suggesting the strong internal
consistency of the constructs (Hair, Black, Babin, Anderson, & Tatham, 2010). The
square root of the AVE for each construct is larger than its shared variance with other
constructs, in support of discriminant validity for all constructs (Fornell & Larcker,
1981).
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Table 3.1 Validity and reliability assessment

Items Loading
(This physician) Was extremely friendly. .961
Always showed that he/she was very empathetic with me. .946
Gave me friendly smiles. .952
Expressed genuine concern for my welfare, which left an impression on me. .878
Revealed personal things about himself. .901
Deliberately reacted in a way that I know he was listening. .806
Listened to me very carefully. .695
Left an impression on me that he can explain things in an uncomplicated way. .869
Was extremely open and honest when talking to me. .790
Could repeat back to me exactly what I said. .856
Had knowledge of my illness, which I consider admirable. .542
Gave me an impressive feeing about his/her manner of speaking to me as an equal. .813

(This physician) Mostly was the one speaking more frequently in conversations. .838
Came on strong in expressing his opinion. .735
3.4.3 Hypothesis Testing
In addition to the main effects of affiliative style (t(321) = 15.62, p < .001) and
dominant style (t(321) = -6.52, p < .001), a 2 × 2 ANOVA reveals a significant
interaction effect between dominant and affiliative communication styles on client
psychological comfort (F(1,319) = 4.05, p < .045). The results thus confirm the joint
impact of the two communication styles. The high-affiliative/low-dominant
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communication style condition (M = 5.20, SD = .89) produces more client
psychological comfort than any other condition (Figure 3.2), in support of Hypothesis 1.
The high-affiliative/high-dominant communication style condition (M = 3.77,
SD = 1.20) induces significantly higher client psychological comfort than low-
affiliative/low-dominant style (M = 2.91, SD = .96) or low-affiliative/high-dominant
style (M = 1.92, SD = .69), in line with Hypothesis 2. Although affiliative
communication style produces higher psychological comfort when combined with
low-dominant, rather than high-dominant, communication styles, this advantage is
greater in the high-affiliative style condition (5.20 vs. 3.77, t(319) = 9.20, p < .001)
compared with the low-affiliative style one (2.91 vs. 1.92, t(319) = 6.65, p < .001). The
low-affiliative/high-dominant communication style condition produces the lowest
level of client psychological, in support of Hypothesis 3.
Figure 3.2 Effects of affiliative and dominant communication styles on client

psychological comfort
6
5.20
Client Psychological Comfort
3.77
4
2.91
3
High Dominant
1.92 Low Dominant
2
0
High Affiliative Low Affiliative
Affiliative Communication Style
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3.5 Discussion
This study confirms the causal relationship between professional service
providers’ (affiliative and dominant) communication style and client psychological
comfort. The experimental study provides evidence of internal validity; it supports the
findings of our first study in a replicated research context (medical services setting in
Thailand). It also extends our examination of communication style, by investigating
the joint effects of affiliative and dominant communication styles. Particularly, we
demonstrate that client psychological comfort is highest when clients perceive
professional service providers’ communication style to be high-affiliative/low-
dominant. However, when they perceive providers’ communication style to be both
high-affiliative and high-dominant, the positive effect of affiliative style overpowers
the negative effect of dominant style and results in greater client psychological comfort
than when clients perceive low-affiliative/high-dominant communication styles. These
findings illustrate the power of affiliative communication style: Whether combined
with low- or high-dominant styles, it drives greater client psychological comfort during
professional service encounters. These findings are supported by a t-test, which reveals
that the difference between combining affiliative communication style with low- (vs.
high-) dominant communication style is greater for high- rather than low-affiliative
communication styles.
The findings of this supplementary study offer several theoretical
contributions, beyond the conclusions of our first study. First, this study introduces
communication style to professional services literature, identifying it as a vital
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antecedent of client psychological comfort. During service interactions, clients’
perceptions of professionals’ communication style (e.g., choice of wording, tone of
voice, physical expression) have crucial roles in producing feelings of comfort. This
causal relationship confirms the explanations of uncertainty reduction theory (Berger
& Calabrese, 1975) and the revised social interaction model (Ben-Sira, 1976, 1980).
Second, this study is the first to use a controlled research setting to demonstrate
that the joint use of affiliative and dominant communication styles also influences
client psychological comfort, with different combinations resulting in psychological
comfort at different levels. The study thus expands the examination of the impacts of
single communication styles (Buller & Buller, 1987; Street, 1989; Webster &
Sundaram, 2009) to consider the impacts of joint communication styles, as proposed
in medical sociology studies (Cousin et al., 2012; Mast et al., 2007, 2008).
Third, this study adds to professional services literature pertaining to the
influence and the power of Norton’s (1978) affiliative communication style. Not only
does affiliative communication style produce greater client psychological comfort than
dominant communication style, but it even overcomes the negative effect of dominant
style when the two styles are combined. Thus, affiliative communication style plays
an important buffering role and overpowers the impact of dominant communication
style when the joint styles are used.
Fourth, this study reinforces the concept of patient-centredness. It supports the
use of caring/sharing and high-affiliative/low-dominance styles as hallmarks of
professional service providers’ (e.g., physicians’) communication (Cousin & Mast,
2013; Cousin et al., 2012; Roter et al., 1997). A patient-centred (or client-centred)
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communication style not only makes clients more satisfied and produces better service
outcomes, but it also leads to significantly greater client psychological comfort.
The findings of this study offer several implications for professional service
managers and providers. First, it seems inevitable that professional service providers
will mix affiliative and dominant communication styles during their interactions with
clients in extended service encounters. Managers and professionals should recognise
that, during an interaction, the difference in the degrees of each communication style
impacts client psychological comfort in different ways.
Second, our findings show that to establish the greatest psychological comfort
among clients, professionals (e.g. healthcare providers) should use more affiliative and
less dominant communication styles. In particular, by being friendly (e.g., consoling
clients who suffer from anxiety, acknowledging clients’ concerns, providing
encouragement about receiving medical treatments) and allowing clients to share
decision making (e.g., permitting them to take over discussions, asking for their
opinions when deciding on medical treatments), professionals can produce the highest
level of client psychological comfort. When they practise such friendly, attentive
communication, professionals can maintain client psychological comfort, even if they
need to express dominance or control at some point of the service encounter. They can
lead discussions and be highly directive (e.g., decide on medical treatments) while
remaining friendly, empathetic, and concerned.
Third, professionals should be aware that when they use high-affiliative style
of communication, combining it with low-dominant style produces considerably
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greater client psychological comfort than that with high-dominant style. Managers
should therefore arrange regular training for implementing this desirable combination
of communication styles. They should ensure that the high-affiliative/low-dominant
communication style gets applied throughout all stages of service (i.e., greetings,
information gathering, educating/consulting, and decision making). However,
increasing demand for particular professional services (e.g., medical services,
banking/financial services) limits consulting time and pushes professionals to use low-
dominant/low-affiliative or high-dominant/low-affiliative styles. As client
psychological comfort leads to higher satisfaction and more WOM recommendation
and repurchase intention (as we established in our first study), professional services
firms must emphasise the importance of client psychological comfort. They should
encourage the consistent use of a high-affiliative component in all client engagements.
We acknowledge several limitations to our supplementary study. Our sample
is drawn from one collectivist value oriented country (Thailand). Although this sample
was essential for replicating our first study, future researchers could draw samples
from other highly collectivist oriented countries (e.g., China, Japan, Taiwan) and also
investigate whether the effects of the two communication styles on client
psychological comfort show similar results in other professional services settings (e.g.,
legal, financial services). The findings of our first study suggest that highly a
collectivist value orientation strengthens the positive impact of affiliative
communication style and weakens the negative impact of dominant communication
style on client psychological comfort. Tests of the causal relationship between
communication style and psychological comfort should yield the same findings in
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other collectivist value oriented countries, even if the professional services differ.
Also, researchers could explore the influence of combined communication styles,
using samples from highly individualist value oriented countries (e.g., the United
States, Canada, Australia, and the Netherlands). A different combination of
communication style (e.g., high-dominant/high-affiliate) may determine the degree of
psychological comfort of clients who are more independent and less inclined to
maintain group harmony. Additionally, researchers might examine the effects of the
combined communication styles on psychological comfort in a cross-cultural
perspective. Clients with different cultural value orientation (collectivism vs.
individualism) might prefer similar or different combination of affiliative and
dominant styles.
Another limitation relates to the service context. One of the most important
aspects of medical services is patient compliance (Dellande, Gilly, & Graham, 2004;
Seiders et al., 2015)—that is, getting patients to do what their physicians tell them,
such as take prescription medication, exercise, or change their diets. We do not focus
on patient compliance; researchers could conduct longitudinal studies to determine
which combination of communication style has the greatest impact on client (patient)
compliance.
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CHAPTER 4: MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE ON THE
RELATIONSHIP BETWEEN COMMUNICATION STYLE AND
PSYCHOLOGICAL COMFORT: A CROSS-CULTURAL ASSESSMENT
CHAPTER 4
MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE ON THE
Abstract
Psychological comfort is an essential precursor of clients’ favourable

evaluations of professional services encounters. Study 1 in this thesis reveals that
service providers’ communication style is an antecedent of psychological comfort.
However, there is a need to identify the mechanism that links client perception to
emotional responses. Using uncertainty reduction theory, this study proposes that
attributional confidence (i.e., reduction of uncertainty) mediates the association
between communication style and psychological comfort. It examines the mediation
model across two cultural value orientations—individualist and collectivist—at the
individual level, using survey data collected from clients of financial advisory firms in
Australia and Thailand. Results demonstrate that attributional confidence partially
mediates the link between affiliative communication style and client psychological
comfort. The strength of the impact of communication style on attributional confidence
is similar for both collectivist and individualist clients. However, attributional
confidence has a stronger influence on psychological comfort of individualist clients.
These results suggest that professional service managers should encourage the use of
communication style that provide sufficient information to reduce uncertainty and that
recognise the individual cultural value orientations of clients.
Keywords professional services, psychological comfort, communication style,

attributional confidence, cross-cultural
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4.1 Introduction
Client psychological comfort is vital to achieving positive service evaluations
and fruitful client relationships (Bloom, 1983; Spake et al., 2003; Spake & Bishop,
2009). Particularly among professional (e.g., financial advisory services, health
services, architecture, accounting, legal) services, establishing client psychological
comfort is of great importance in determining client satisfaction, trust, and
commitment (Gaur et al., 2009; Spake et al., 2003). However, attaining client
psychological comfort with professional service provider is challenging. Professional
services feature many credence properties; it is often difficult for clients to evaluate
the value or quality of the core/technical service outcomes confidently, even after they
have purchased and consumed them (Darby & Karni, 1973; Ostrom & Iacobucci, 1995;
Swartz & Brown, 1989). There is a high degree of knowledge asymmetry between
providers and most clients (Mills & Moshavi, 1999; Mitra et al., 1999), and interactions
involve high levels of customisation, complexity, perceived uncertainty, and risk (Hill,
1988; Lian & Laing, 2004).
In Study 1 of this thesis, we find that using appropriate communication style
with clients is an effective strategy for increasing psychological comfort. Because
professional services contain high levels of continuing interpersonal communication
between providers and clients (Brown & Swartz, 1989; Johnson & Zinkhan, 1991),
service providers’ communication style are the observable evidence that clients use to
evaluate technical service quality and achieve psychological comfort. Notwithstanding
the strong association between professional service providers’ communication style
and client psychological comfort, research has not yet fully explained the mechanism
by which clients reduce uncertainty. Clients of professional services perceive
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uncertainty in many forms, such as uncertainty of service outcomes, uncertainty of
service providers’ performance (which often unfold over time), and uncertainty of
communicating with service providers (Bloom, 1983).
We can enhance understanding of the association between communication
style and psychological comfort by examining clients’ levels of confidence about their
professional service provider. According to uncertainty reduction theory, people
reduce uncertainty by using interpersonal communication to develop attributional
confidence, that is, certainty about the behaviours of themselves and others (Berger &
Calabrese, 1975; Clatterbuck, 1979). Studies show that attributional confidence, in
turn, is negatively linked to anxiety (the inverse of psychological comfort) during
interactions (Gudykunst & Nishida, 2001; Gudykunst & Shapiro, 1996; Hubbert,
Gudykunst, & Guerrero, 1999), suggesting that communication style has the potential
to reduce clients’ perceived uncertainty and increase psychological comfort. That is,
attributional confidence may mediate the relationship between communication style
and client psychological comfort.
The notion of attributional confidence has also received substantial attention
from both cross-country, cross-cultural, and cross-relationship communication
researchers (Gudykunst & Nishida, 2001; Gudykunst, Nishida, & Schmidt, 1989;
Gudykunst et al., 1985) as well as intercultural communication authors (Neuliep,
2012). When interacting with strangers, people from different cultural contexts (e.g.,
high-context vs. low-context) increase their attributional confidence by drawing from
different sources (Gudykunst, 1983; Gudykunst & Nishida, 1986). Therefore, we
incorporate culture as a moderating variable when we examine the relationship
between communication style and attributional confidence. However, because
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members of one culture group might display diverse communication traits despite
sharing a common background (Littlejohn & Foss, 2008), our study investigates the
moderating influence of clients’ cultural value orientation, at the individual level, on
the associations between communication style, attributional confidence, and client
psychological comfort in a professional (financial) services context.
Our paper examines three interrelated research questions: First, can we
determine clients’ perceived adequacy of information (attributional confidence) about
professional service providers’ behaviour/performance according to their perceptions
of providers’ communication style? Second, does clients’ attributional confidence
mediate the impacts of communication style on their psychological comfort? Third,
does this mediation model vary across individual clients’ cultural value orientation?
Our overall objective is twofold: We aim to identify empirically the underlying
mechanism by which professional service providers’ communication style affect client
psychological comfort through clients’ degrees of attributional confidence. In addition,
we seek to identify the moderating effect of clients’ cultural value orientation (i.e.,
collectivism vs. individualism) at the individual level.
We select financial advisory services as the context of this study because such
services encompass high credence properties, customisation, asymmetry of
information, and uncertainty of core service outcomes (e.g., returns on investment,
financial security) that unfold over time (Christian Zinkhan & Zinkhan, 1990; Sharma
& Patterson, 1999, 2000). Most financial advisory services require extended
interactions between clients and advisors, and the functional service quality of the
advisors is vital (Bell, Auh, & Smalley, 2005). Moreover, advisors tend to be
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concerned about how their clients feel about their performance, that is, whether the
clients are experiencing feelings of certainty and psychological comfort.
This study makes several theoretical contributions to professional services
marketing and management literature. First, it adopts uncertainty reduction theory to
examine clients’ attributional confidence and so better understand clients’ relief of
anxiety in the professional services context. By testing the theory’s axioms using the
influence of perceived communication style, it enhances the theory’s implications for
professional services. Second, the study assesses the association of attributional
confidence and client psychological comfort. In the full model, it verifies the role of
clients’ perceived attributional confidence as an underlying mechanism of the link
between communication style and client psychological comfort. Third, it strengthens
cross-cultural communication literature by emphasising the effects of clients’ cultural
value orientation across the dimension of collectivism/individualism at the individual
level rather than the country level, and so avoiding an ecological fallacy (Donthu &
Yoo, 1998; Patterson, Cowley, & Prasongsukarn, 2006).
We organise the remainder of this study as follows: First, we present a literature
review and introduce our conceptual model and hypotheses. Next, we explain the
research methodology used to test the predicted relationships and report the results.
Finally, we discuss theoretical contributions and managerial implications and suggest
directions for further research.
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4.2 Conceptual Background & Research Hypotheses
4.2.1 Uncertainty Reduction in Professional Services
Professional services are manifestly involved with degrees of clients’ perceived
risk and uncertainty (Hill, 1988; Lian & Laing, 2004; Mills & Moshavi, 1999).
Professional services are high in credence properties, knowledge asymmetry, and
complexity (Darby & Karni, 1973; Mills & Moshavi, 1999; Stewart, Hope, &
Muhlemann, 1998), so clients rely principally on professional service providers’
performance to achieve desirable service outcomes (Patterson, 2016). For instance,
patients depend on physicians’ diagnoses and judgements with regard to cancer
treatments or count on financial advisors’ guidance to earn high returns on their
investments. Client uncertainty is particularly high during interactions with
professional service providers because, to most clients, communication with service
providers is comparable to meeting strangers. Because clients possess less technical
information than providers, they are unable to evaluate service outcomes pre-
consumption (or even post-consumption) confidently and are sometimes uncertain
about having fruitful discussions with service providers. Moreover, the core service
delivery (i.e., technical performance) of most professional services (e.g., curing a
critical illness, fighting a lawsuit, securing a good return on investments) unfolds over
time (Sharma & Patterson, 1999), resulting in even more perceived uncertainty.
Because of the presence of uncertainty, clients’ motivations to decrease
perceived insecurity can be explained by uncertainty reduction theory. The theory,
originated by Berger and Calabrese (1975), addresses communicative activities
structured to reduce uncertainty in initial interactions between unacquainted persons
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(Knobloch, 2008). Perceived uncertainty involves people’s unsure feelings about
interactions with others, their awareness of ambiguity (e.g., ambiguity in other
people’s messages), and the alternative ways that others might behave, as well as their
own range of responses to predict possible behaviours. Uncertainty reduction theory
postulates that people are motivated to reduce uncertainty about their social
environment and strive to predict and explain their contexts (Berger & Calabrese,
1975; Bradac, 2001; Knobloch, 2008). Over the decades, the theory has been applied
to healthcare and organisational contexts, intercultural interactions, romantic
relationships, and interpersonal communication in general (Bylund, Peterson, &
Cameron, 2012).
Berger and Calabrese’s (1975) theory also addresses the flow and acquisition
of information, whereby perceived adequacy of information to make retroactive and
proactive attributions creates degrees of certainty or attributional confidence
(Clatterbuck, 1979). When people interact with others who are unfamiliar, their
retroactive attribution (increased understanding of past actions) and proactive
attribution (increased predictability of possible responses) indicate sufficient
information to make decisions and reduce uncertainty. Various disciplines, including
communication in general, intercultural communication, cross-cultural
communication, and education, apply attributional confidence as a measurement of
uncertainty reduction. The process of understanding other people’s behaviour—and
the underlying reasons for it—is vital for reducing uncertainty and knowledge
ambiguity during interactions (Gelfand, Kuhn, & Radhakrishnan, 1996). Accordingly,
the concept of attributional confidence is highly relevant to the professional services
context.
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4.2.2 Direct Effects of Communication Style on Psychological Comfort
Psychological comfort represents a person’s peace of mind, reduction of
anxiety, feelings of security, reassurance, ease, and alleviation of mental distress
(Lloyd & Luk, 2011; Spake et al., 2003; Spake & Bishop, 2009). Client psychological
comfort develops during interactions with service providers and becomes clients’ most
important criterion for service evaluation of non-professional services (e.g.,
restaurants, hairdressers) (Dabholkar et al., 2000; Lloyd & Luk, 2011; Paswan &
Ganesh, 2005). In professional services with high credence properties, knowledge
asymmetry, and associated uncertainty and anxiety, client psychological comfort with
service providers is vital to client satisfaction, trust, and commitment (Bloom, 1983;
Lloyd & Luk, 2011; Spake et al., 2003). Extant literature indicates that clients gain
psychological comfort by observing service providers’ behavioural cues during
encounters (Lloyd & Luk, 2011; Spake et al., 2003). Particularly, Ben-Sira’s (1976,
1980) revised social interaction model indicates that clients depend on service
providers’ modes of response (rather than the content of their responses) to assess the
services they receive. Because most clients are incapable of evaluating technical
services, emotional support provided by professional service providers acts as a bridge
to clients’ perceived anxiety about service outcomes (e.g., outcomes of medical
treatments) (Buller & Buller, 1987; Street, 1989).
The communication style (Norton, 1978; Wong & Tjosvold, 1995) (manner of
communicating meaning, tone of voice, facial expression, spatial distance from the
listener, eye gaze) of professionals plays an important role in shaping clients’
perceptions of service quality, satisfaction, and trust, as well as their feelings of
confidence and senses of connectedness (Alford & Sherrell, 1996; Ben-Sira, 1976;
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Buller & Buller, 1987; Webster & Sundaram, 2009). Literature identifies two main
communication styles: affiliative and dominant (Kiesler, 1983, 1986). Affiliative
communication style involves expressions of attentiveness, friendliness, concern,
empathy, and compassion that develop and maintain positive communicator–listener
relationships. Corresponding to Ben-Sira’s (1976, 1980) revised social interaction
model, professional service providers’ affiliative communication style reflects
affective behaviours and drives clients’ positive service assessments, such as
satisfaction with physicians, dentists, and financial and legal services providers (Buller
& Buller, 1987; Street, 1989; Webster & Sundaram, 2009). Dominant communication
style refers to communicators’ giving of directions and guidance, domination, and
conciseness, to form and maintain control of interactions. When professional service
providers use a dominant style of communication, clients tend to evaluate the services
less positively, because they have limited opportunities to express concerns and
opinions (Buller & Buller, 1987; Street, 1989). In Study 1, conducted in a medical
services context, we find that by transferring technical service information to patients
using affiliative communication style, service providers can stimulate higher
psychological comfort. However, when patients perceive the communication style to
be dominant, their anxiety and concern persist, regardless of the technical service
information they receive. Therefore, we present the following replicating hypothesis:
H1: Professional service providers’ communication style affect client
psychological comfort such that (a) affiliative communication style positively
influences client psychological comfort, and (b) dominant communication
style negatively influences client psychological comfort.
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4.2.3 Indirect Effects through Attributional Confidence
When observing professional service providers’ communication style, clients
need a certain degree of confidence in the providers to gain psychological comfort.
According to Berger and Calabrese (1975), people attempt to predict and explain the
element of interpersonal communication. To reduce high degrees of perceived
uncertainty during interactions, verbal and nonverbal affiliative expressiveness (e.g.,
positive verbal content, pleasantness of vocal expressions, head nods) are essential. An
axiom of uncertainty reduction theory is that an increase in communication leads to a
decrease in uncertainty and subsequent positive relational outcomes, so we expect a
mediating effect of attributional confidence on the relationship between the two
communication styles (affiliative, dominant) and client psychological comfort.
Affiliative communication style of service providers, as perceived by clients,
relates specifically to attributional confidence. It is socially oriented and gives clients
opportunities to seek additional information (e.g., observing and interactively asking
questions) to reduce uncertainty. Affiliative behaviours decrease uncertainty levels
during interactions (Berger & Calabrese, 1975; Mehrabian, 1971). Responsive and
friendly communication characteristics facilitate uncertainty reduction (attributional
confidence) when people first meet. In turn, reduced uncertainty enhances positive
emotional and behavioural responses (Neuliep & Grohskopf, 2000). Moreover,
attributional confidence about unacquainted persons relates to reduced anxiety and
thus psychological comfort (Bradac, 2001; Gudykunst & Kim, 1997; Gudykunst &
Nishida, 2001; Hubbert et al., 1999; Neuliep & Ryan, 1998). Unpredictability results
in anxiety and a lack of trust (Turner, 1988). Thus, higher degrees of clients’
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attributional confidence likely lead to higher degrees of psychological comfort
(decreased anxiety). In addition to acknowledging the direct, positive effect of
affiliative communication style on client psychological comfort, this study examines
the indirect impact of service providers’ affiliative communication style on client
psychological comfort through attributional confidence. Formally,
H2a: Clients’ attributional confidence mediates the positive impact of affiliative
communication style on client psychological comfort.
Attributional confidence also may intervene in the association between
dominant communication style and client psychological comfort association. In Study
1, we show that dominant communication style negatively affects client psychological
comfort in a medical context. Communication behaviour that is dominant, assertive,
and competitive shows an adverse relationship with attributional confidence during
initial interactions (Neuliep & Grohskopf, 2000). According to uncertainty reduction
theory, having the opportunity to ask questions is essential to decreasing uncertainty
during initial encounters. Questioning and expressing opinions helps people gain the
information they need to make retroactive and proactive predictions and thereby
develop attributional confidence (Berger & Calabrese, 1975; Clatterbuck, 1979);
questioning leads to higher attributional confidence during early interactions
(Gudykunst, 1985; Gudykunst et al., 1985). Using interactive strategy to reduce
uncertainty signifies that a speaker is using a less-dominant communication style (e.g.,
providing the listener with opportunities to request, give opinions, or take parts in a
discussion). Accordingly, we expect that not only will dominant communication style
decrease client psychological comfort directly, but it also will affect it indirectly,
through attributional confidence. Although dominant communication style can transfer
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technical service content to clients, it prevents clients from having sufficient
information to make attribute retroactive and proactive attributions. Therefore:
H2b: Clients’ attributional confidence mediates the negative impact of dominant
communication style on client psychological comfort.
4.2.4 Moderating Effects of Cultural Value Orientation
The uncertainty reduction process varies by culture (Goldsmith, 2001;
Gudykunst, 1983, 1985; Gudykunst & Nishida, 1986, 2001; Gudykunst et al., 1989;
Neuliep, 2012). Perceptions of communication differ from one culture to another,
especially between high- and low-context cultures (Triandis, 1995). These differences
point to culture as a moderating variable in uncertainty reduction theory (Goldsmith,
2001; Neuliep & Grohskopf, 2000). Moreover, culture is salient in professional
services that require a medium to high level of contact between service providers and
clients (Mattila, 1999). Understanding the role of culture in clients’ process of
uncertainty reduction and psychological comfort development is a step toward
achieving successful professional services delivery.
This study centres on the differences in uncertainty reduction and
psychological comfort across clients’ cultural value orientations, along the
collectivism/individualism dimension (Hofstede, 1980b, 1980c). We measure clients’
cultural value orientation at the individual rather than the country level. This approach
avoids the ecological fallacy that assumes national-level cultural dimensions can
explain individual behaviours (Yoo & Donthu, 2002). By adopting Hofstede’s (1980b,
1980c) cultural typology at the individual level, we group the values of each person
into higher (vs. lower) collectivist/individualist orientations (Donthu & Yoo, 1998).
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In a collectivist culture, people operate in a social pattern that entails strong
connections among members. They are relationship focused and belong to only a few
in-groups that emphasise the goals, needs, and views of groups over individuals
(Hofstede, 1980c; Mattila, 1999; Triandis, 1995). Collectivist value oriented people
place high importance on group harmony; they avoid confrontation (Triandis, 1995)
and are threatened by ambiguous situations (Patterson & Smith, 2001). Conversely,
people with an individualist value orientation concentrate on goals, self-concepts, and
responsibility for themselves and their immediate families (Hofstede, 1980c).
Individualist value oriented people belong to many specific in-groups that have only
small influences on them (Triandis, Bontempo, Villareal, Asai, & Lucca, 1988).
Noting these distinctions between collectivist and individualist cultural value
orientations, we expect cultural differences will moderate the impacts of
communication style in (a) reducing uncertainty (attributional confidence) and (b)
gaining psychological comfort when clients encounter professional services.
The ability to predict others’ behaviour is more crucial to a collectivist value
orientation (Gudykunst et al., 1989). When reducing perceived uncertainty, people
who are collectivist value oriented concentrate on information that enhances accuracy
through indirect, nonverbal forms of communication (e.g., whether others understand
their feelings and make allowances for them during interactions, extent to which they
understand others) (Gudykunst & Nishida, 1986). Affiliative communication style,
with its emphasis on friendliness and socially oriented manners, verifies the values of
harmonious in-group relationships. Accordingly, attributional confidence is likely
higher among collectivist value oriented clients who perceive affiliative
communication style. Conversely, people possessing an individualist value orientation
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focus on information that increases accuracy through direct, explicit forms of
communication (e.g., another person’s attitudes and values) (Gudykunst & Nishida,
1986). They tend to be self-dependent and less emotional (De Mooij & Hofstede, 2002;
Triandis et al., 1988). Perceptions of affiliative communication style would show less
impact on attributional confidence for individualist value oriented people than the
content of information and intention of the speaking person. Accordingly, we predict
that the influence of affiliative communication style on attributional confidence differs
across cultures:
H3a: The positive impact of affiliative communication style on attributional
confidence is stronger for clients with a collectivist value orientation than for
The influence of dominant communication style on attributional confidence
also may differ across cultures. People with a collectivist value orientation pay
attention to information that offers accuracy through indirect communication, and they
are more likely to accept dominant communication style, due to their characteristics of
enduring high power (social) distance (Hofstede, 1980c; Triandis et al., 1988). Giving
directions and guidance and using a controlling manner may be perceived as
conventional if the speaker possesses higher social status. Dominant communication
style would have less of a negative effect on the attributional confidence of collectivist
value oriented people, because along with emphasising harmony and relationships,
they likely understand and predict higher-power behaviour by others. Individualist
value oriented people instead tend to develop attributional confidence interactively, by
asking questions (Gudykunst, 1985) and obtaining information from direct
communication (Gudykunst & Nishida, 1986). Dominant communication style, with
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its controlling manner and limits on questioning and raising concerns, would have a
more severe negative impact on the attributional confidence of individualist-oriented
people; with fewer chances to interrogate others, they also suffer reduced chances to
understand the information and predict others’ behaviours. Accordingly, we expect
that the effect of dominant communication style on attributional confidence differs:
H3b: The negative impact of dominant communication style on attributional
confidence is weaker for clients with a collectivist value orientation than for
The influence of attributional confidence on client psychological comfort could
differ according to differences in two cultural value orientations. Gudykunst and
Nishida (2001) find that in both acquainted and unacquainted relationships,
attributional confidence has a greater association with decreased anxiety (i.e.,
psychological comfort) among people with an individualist than a collectivist value
orientation. Having adequate information to make necessary decisions and reduce
uncertainty relates to an emphasis on independence and self-concept. Therefore,
attributional confidence will have a greater effect on the psychological comfort of
clients with an individualist value orientation. Although attributional confidence may
enhance the psychological comfort of people with a collectivist value orientation, that
influence can be surpassed by the prominence of nonverbal and social forms of
communication (Gudykunst & Nishida, 1986). Therefore, we hypothesise:
H4: The positive impact of attributional confidence on client psychological
comfort is stronger for clients with an individualist value orientation than for
clients with a collectivistic value orientation.
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Figure 4.1 illustrates the conceptual model.
Figure 4.1 Conceptual model
Communication Style Cultural Value

Orientation
H1a (+)
Affiliative
Communication H3a (+)
H2a (+) H4 (+)
Style
H3b (-) Attributional Psychological
H2b (-) Confidence Comfort
Dominant
Communication
H1b (-)
Style
Controls
Gender, Type of Service, Frequency
4.3.1 Data Collection
The context of this study is financial services. Financial advisory and financial
planning services conform with the description of professional services, in that they
are high in credence properties, technical complexity, customisation, and delivered by
highly qualified people (Darby & Karni, 1973; Sharma & Patterson, 1999, 2000). The
services focus on building and maintaining personalised investment strategies at a
level of security for clients; they consist of both core service elements (e.g., investment
advice, research, investment planning, security) and related supporting products (e.g.,
margin lending, cash accounts) (Bell et al., 2005). Financial advisory services contain
high product complexity with a wide service range and customisation for individual
clients’ needs. The technical complexity of the services requires financial advisors to
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possess high professional knowledge and skills (Greer, 2015). Accordingly, there is
information asymmetry between financial advisors and most clients, and outcomes of
the core services (e.g., investment returns) unfold over time, causing high uncertainty
(Auh, Bell, McLeod, & Shih, 2007; Christian Zinkhan & Zinkhan, 1990; Sharma &
Patterson, 1999). Due to these characteristics, there is a strong need for financial
advisors to address clients’ attributional confidence and psychological comfort. Most
clients possess less professional knowledge (e.g., determining superior investment
decisions in property, government bonds, and overseas equities; evaluating degrees of
risk). Typically, clients (especially new ones) are uncertain about service outcomes.
Therefore, it is reasonable to examine the communication style of financial advisors
as they transmit technical information, to determine how they can build clients’
attributional confidence, reduce uncertainty and anxiety, and generate psychological
comfort.
We collected client data from two very different cultures—Australia (with an
index of 90 on Hofstede’s (1980a) national score on the individualism/collectivism
dimension), and Thailand (score of 20)—to ensure high variance in cultural value
orientation. We avoided the use of a country-level cultural dimension to explain
individual behaviours, because it would create an ecological fallacy (i.e., ecological or
national-level relationships inferred to apply to individuals) (Yoo & Donthu, 2002).
Therefore, we capture clients’ cultural value orientation at the individual level by
measuring respondents’ cultural values irrespectively of whether they are Thai or
Australian. According to Donthu and Yoo (1998), using Hofstede’s (1980a; 1980b)
cultural typology at the individual level is equivalent because people’s values are
classified into selected cultural dimensions. Then, after assessing the psychometric
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equivalence of the Thai and Australian samples, we pooled the two samples. Individual
respondents were then assumed (irrespective of whether they were Thai or Australian)
as to where they lie on the collectivism/individualism scale.
Furthermore, there is growing cultural variation between the selected countries
at the individual level. Australians are being exposed to Eastern (highly collectivist
value oriented) culture as a result of an increasing number of visitors from Southeast
Asia, China, and the Middle East (Australian Bureau of Statistics, 2017a; Tourism
Australia, 2017a), increasing migration of foreign-born people (Australian Bureau of
Statistics, 2017b), greater investment from international corporations (Tourism
Australia, 2017b), and an increasing number of international students from Eastern
countries (e.g., China, India, Korea) (Department of Education and Training, 2017a).
At the same time, Thais are being influenced by an individualist value oriented culture
through tourism and international education. More Thai students are being educated at
schools and universities in Western countries such as the United States, Australia, and
the United Kingdom (Australian Education International, 2006; Department of
Education and Training, 2017b). Thailand welcomes a large number of foreign tourists
and expatriates each year (Bank of Thailand, 2017). With growing cultural diversity
in the two countries, it is reasonable to examine the impact of perceived
communication style on clients’ attributional confidence and psychological comfort at
the individual level, rather than the country level.
We employed a paper-based survey to collect data from clients of large
financial advisory firms located in major cities in Australia (Sydney, Brisbane, and
Canberra) and Thailand (Bangkok, Chiang Mai, and Nakhon Ratchasima).
Respondents were clients who had completed face-to-face consultations with financial
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advisors. The consultations spanned superannuation planning, investment planning,
wealth management, retirement planning, tax planning, and residential loans. We
instructed financial advisors about the objective of the study, the questionnaire
structure, and their task of inviting clients to participate. After the consultations, the
financial advisors introduced the study to clients and presented each of them with a
packet containing an information statement, a questionnaire, and a stamped return
envelope. Clients in Australia completed the questionnaire at their leisure and mailed
it back to researchers. Clients in Thailand completed the questionnaire after their
consultations, then sealed and left the packages for the researchers to collect. We sent
400 questionnaire packages to an Australian financial advisory firm and 200 packages
to Thai financial advisory firms. Clients in Australia mailed back 119 packages, and
clients in Thailand completed 140 packages, resulting in 30% and 70% response rates,
respectively.
The final number of responses after we removed incomplete questionnaires
was 243 (115 Australian clients and 128 Thai clients). The majority of respondents
were female (62.6%), 36.6% were 55 to 64 years of age, and 55.1% reported that their
consultation was their initial meeting with the advisor. The most common advice
received was related to investment planning (31.7%), and 56.4% had no preceding
experience with other financial advisory firms.
4.3.2 Test for Nonresponse Bias
We assessed nonresponse bias by comparing early and late respondents
(Armstrong & Overton, 1977) across five constructs: Affiliative communication style,
dominant communication style, attributional confidence, client psychological comfort,
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and cultural value orientation. We labelled the first 20% of those who completed and
returned the questionnaire as early respondents and the last 20% as late respondents.
In both respondent groups, the means for all constructs showed no significant
differences (p < .05). Therefore, nonresponse bias was not a concern.
4.3.3 Measurements
For the Thai sample, we adopted a forward-translation procedure (Hambleton,
1993) to develop the questionnaire. Two bilingual assistants whose mother tongue is
Thai translated the questionnaire, and then two other bilingual people whose mother
tongue is English performed a back-translation (Brislin, Lonner, & Thorndike, 1973).
We pre-tested both Thai and English versions of the questionnaires with 20
respondents (10 from each country). The respondents included practitioners,
marketing and accounting academics, and clients to ensure linguistic equivalence of
measurement and face validity with regard to instructions, constructs, phrases, and
wordings. We made additional modifications because several words and phrases had
no precise, similar translation (Brislin, 1980).
We asked respondents to reflect on the consultations/meetings they had just
had with financial advisors as the basis for completing the questionnaire. The first few
questions focused on general experiences with the financial advisory services received
from the current and past provider (i.e., type and length of services received). We
sourced the scales for the questionnaire from prior literature. We modified the
communication style scale from Buller and Buller (1987), Norton (1978), Street
(1989), and Webster and Sundaram (2009) using 7-point Likert scales in which 1 =
“strongly disagree” and 7 = “strongly agree.” Twelve items measured respondents’
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perceptions of the affiliativeness of a financial advisor’s communication style, that is,
the extent to which the financial advisor listened to the respondents’ requests; showed
attentiveness, friendliness, warmth, encouragement, and social orientation; and left
positive impressions. Five items measured respondents’ perceptions of dominance of
a financial advisor’s communication style, that is, the degree to which the financial
advisor built and maintained control of the meeting, dominated the conversation,
verbally exaggerated to emphasise a point, or tended to argue during a discussion. We
adopted Spake et al.’s (2003) client psychological comfort scale, excluding two of
eight items because they were unrelated to the context. The remaining six items
measured respondents’ levels of psychological comfort on 7-point semantic
differential scales with word pairs (e.g., uncomfortable/comfortable, very uneasy/very
much at ease, very tense/very relaxed). We sourced five items measuring attributional
confidence from Clatterbuck’s (1979) attributional confidence (CL7) scale. The items
examined respondents’ confidence in understanding and making predictions about
financial advisors’ attitudes, values, and behaviour in personal communications. We
scored the items from 0% = “not confident at all” to 100% = “very confident.” To
measure cultural value orientation, we used the CVSCALE from Yoo and Donthu
(2002) and Yoo, Donthu, and Lenartowicz (2011) to examine cultural value orientation
at the individual level. The measure contained six items pertaining to the
collectivism/individualism dimension on a 7-point Likert scale.
The questionnaire included measures of control variables that might have an
effect on respondents’ degrees of psychological comfort: gender, overall brand
experience (experiences with other financial advisory firm during the past five years),
type of client (first-time or repeat), and type of service being sought from the financial
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advisor. Clatterbuck (1979) suggests that the longer individuals associate, the higher
their degree of attributional confidence. The questionnaire thus controlled for
respondents’ focal brand experience (number of times they met with the financial
advisor).
4.4.1 Measurement Model
An exploratory factor analysis (EFA) confirmed the two communication styles
(affiliative and dominant), attributional confidence, client psychological comfort, and
cultural value orientation. We excluded one item from affiliative style because of a
low factor loading. We then carried out a confirmatory factor analysis (CFA) using
Amos v22. After modifications, the results (Table 4.1) indicates that the model fits the
data well: 2/df = 1.99, p < .001, comparative fit index (CFI) = .94, Tucker-Lewis
index (TLI) = .93, incremental fit index (IFI) = .94, goodness-of-fit index (GFI) = .82,
adjusted goodness of fit index (AGFI) = .79, root mean square error of approximation
(RMSEA) = .06, PCLOSE < .000, and standardised root mean square residual (SRMR)
= .06. The CFI, TLI, and IFI all exceed .90, so the measurement model is parsimonious
and fits the data.
Table 4.1 Measurement model results

Items Loading
(This financial advisor) listened to my requests very carefully. .809
Was extremely friendly. .795
Could repeat back to me exactly what was said. .817
Listened to my opinions. .796
Was being extremely open and honest when talking to me. .851
Deliberately reacted in a way that I know he/she was listening. .722
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Really left me with a positive impression. .883
Attributional confidence ( = .89; CR = .89; AVE = .74)
How confident were you of your general ability to predict how the advisor will .901
perform (e.g., developing your personal financial plan)?
How confident were you at predicting the value you will receive from the advisor? .888
How confident were you at predicting the advisor’s attitudes? .783
Cultural value orientation ( = .86; CR = .85; AVE = .53)
Success of a group (e.g., close friends, close colleagues, family members) is more .680
important than individual success.
Individuals should sacrifice self-interest for the group. .846
Individuals should stick with the group even through difficulties. .722
Individuals should only pursue their goals after considering the welfare of the group. .708
Group loyalty should be encouraged even if individual goals suffer. .658
Chi-square 720.8
df 361
CFI .941
GFI .822
AGFI .785
RMSEA .064
SRMR .056
Loadings are standardised; all t-values are significant (p < .001)
4.4.2 Measurement Validation
In Table 4.1, we evaluate convergent validity by examining both the
significance of the t-values and the average variance extracted (AVE). All items load
above .50, and all of the t-values are significant (p < .001), so the items share high
variance within the same construct. All AVE values are greater than .50, indicating
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convergent validity. Composite reliabilities for the five constructs are above .70, and
the Cronbach’s alphas range from .86 to .96, suggesting the reliability of the
measurement (Bagozzi & Yi, 1988; Hair et al., 2010). Table 4.2 shows that the model
achieves discriminant validity, as evidenced by the square root of the AVE for all
constructs, which is greater than any inter-factor correlation (Fornell & Larcker, 1981).
Cultural value orientation achieves the lowest AVE (.53) which might raise a
concern on convergent validity although the value is higher than the .50 threshold
(Bagozzi & Yi, 1988; Hair, Black, Babin, Anderson, & Tatham, 2010). The modest
AVE is a result of an item-deletion of the cultural value orientation variable in the
psychometric equivalence test of collectivist- and individualist value oriented
subsamples. By reducing one item, the model demonstrates good fit to the data,
supporting configural invariance and metric invariance test (which will be discussed
in the following section). Thus, the item-deletion reduces AVE of the construct but it
is counterbalanced by the measurement equivalence that is crucial for this study.
Table 4.2 Descriptive statistics and correlations of study constructs

Mean S.D. 1 2 3 4 5
1. Affiliative communication style 5.66 1.02 (.83)
2. Dominant communication style 2.87 1.39 -.595** (.81)
3. Attributional confidence 73.59 16.175 .603** -.438** (.86)
4. Psychological comfort 5.75 .98 .813** -.529** .667** (.84)
5. Cultural value orientation 4.89 .96 .153** .186* .150** .231** (.73)
Note: S.D. = standard deviation. Values in parentheses on the diagonal are the square root of the AVE.
Scales are 7-point Likert scales, except for attributional confidence (0%–100% score).
**
*
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4.4.3 Measurement Equivalence
Irrespective of whether the analysis is undertaken at the individual or national
level, it is essential to compare the metric equivalence of both subsamples so that they
may be either compared or combined (Horn, 1991; Steenkamp & Baumgartner, 1998).
The study examines clients’ cultural value orientation at the individual level.
Therefore, we divided the full sample into two subsamples using a median split on the
collectivist/individualist value orientation scale. We used measurement invariance to
assess whether the measures of the construct have similar meanings in different
conditions, such as different cultural value orientation groups. We then performed a
series of measurement invariance tests on the two groups (collectivist/individualist
value oriented respondents), including tests for configural and metric invariance via a
multiple-group CFA as prescribed by Steenkamp and Baumgartner (1998). The CFA
model supported configural invariance by the model, demonstrating good fit to the data
(2 = 1203.29/722 df, CFI = .917, RMSEA = .05) and significant estimates (p < .001) of
all parameters. In testing for metric invariance, we compared the model fit with a chi-
square difference test in which the factor loadings were fully constrained to be equal
to the fit of a freely estimated (unconstrained) model. We emphasised CFI because
it is robust to the limitations of goodness-of-fit 2 tests (Bryant & Satorra, 2012). A
CFI value of less than .01 supports invariance across models (Cheung & Rensvold,
2002; Patterson, Brady, & McColl-Kennedy, 2016). The results confirm the metric
invariance test (2 = 60.81/29 df, CFI = .005). Overall, collectivist and individualist
value oriented subsamples/models were invariant and thus the data was pooled.
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4.4.4 Common Method Bias
We measured the variables in this study via single-respondent data. Therefore,
there could be bias in the findings due to common method variance. To address this
concern, we undertook both procedural controls (Podsakoff, MacKenzie, Lee, &
Podsakoff, 2003) and common method variance assessments (Malhotra, Kim, & Patil,
2006). With regard to procedural remedies, we separated all measurements using
different response formats (semantic differential, percentage scoring, and Likert
scales). On the cover page of the questionnaire, we informed participants of the strict
anonymity and confidentiality of their responses. To prevent socially desirable
answers, we notified the participants that their responses would be used only for
academic research purposes. Also, to minimise participants’ evaluation-related
apprehension, our instructions stated that there were no right or wrong answers to any
questions (Podsakoff et al., 2003).
From a statistical standpoint, we performed several tests to examine common
method bias. First, we conducted a Harman’s single-factor test (Harman, 1967) and a
CFA-based one-factor test. Both revealed that a single factor did not adequately
represent the items. In an EFA, the un-rotated single factor including all variables
accounts for less than 50% of the variance (the first factor accounted for 43.3% of the
72.2% explained variance). In a CFA, the single factor was insufficient in explaining
all of the variance. Second, we performed a marker variable assessment technique
(Lindell & Whitney, 2001; Malhotra et al., 2006), with respondents’ frequency of
meeting a financial advisor as the marker variable (rM = .04, p = .54). The mean change
in correlations of the six variables of interest (rU – rA) when we pulled out the effect of
rM is .04, offering no evidence of common method bias. Third, we applied Podsakoff
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et al.’s (2003) single-method factor approach, by including a directly measured latent-
method factor to load on all items of the model. The single-method factor fit the data
well (2/df = 1.86, p < .001, CFI = .95, TLI = .94, IFI = .95, GFI = .82, AGFI = .78,
RMSEA= .06, PCLOSE < .007, and SRMR = .04). The fit of the measurement model
with a method factor did not differ from that of the model without a method factor
(2 = 60.72, df = 58, p < .38). Therefore, common method bias is not a concern.
4.4.5 Structural Model and Hypothesis Testing
We employed structural equation modeling (SEM) using Amos v22 to test the
hypotheses. A baseline model (main effects) fit the data reasonably well; 2/df = 2.18,
p < .001, CFI = .93, TLI = .92, IFI = .93, GFI = .83, AGFI = .79, RMSEA = .07,
PCLOSE < .000, SRMR = .07. All the proposed main effects of communication style
on client psychological comfort were significant. Affiliative communication style has
a significant positive impact (β = .73, p < .001) on client psychological comfort, and
dominant communication style yields a significant negative impact (β = -.13, p < .027).
The two communication styles explain 68% of the variance of client psychological
comfort. The results support both H1a and H1b.
In H2a and H2b we predicted that attributional confidence mediates the
relationship between communication style and client psychological comfort. We
conducted a three-step mediation analysis, following Baron and Kenny (1986),
MacKinnon and Dwyer (1993), and Kenny, Kashy, and Bolger (1998). The first step
illustrates that the independent variable (communication style) affects the mediator
(attributional confidence). The results in Table 4.3a for the overall model support this
step for one communication style. That is, Stage 1 in Model A indicates that affiliative
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communication style is a significant predictor of attributional confidence (β = .50, p <
.001) but dominant communication style fails to exert a significant impact on
attributional confidence (β = -.13, p < .095). The second step establishes that the
independent variable (communication style) affects the dependent variable (client
psychological comfort). In line with the findings for H1a and H1b (Table 4.3a, Model
B, Stage 1), affiliative style has a significant positive effect (β = .73, p < .001) on client
psychological comfort, and dominant style yields a significant negative impact
(β = -.13, p < .027).
Table 4.3a Results of mediation analysis
Model A: Model B:
DV = Attributional DV = Client psychological
confidence comfort
Variable  t  t
Stage 1
Affiliative communication style .50 6.27*** .73 10.43***
Dominant communication style -.13 -1.67 -.13 -2.21*
Stage 2
Affiliative communication style .61 8.80***
Dominant communication style -.09 -1.70
Attributional confidence .25 4.36***
Control variables
Gender .04 .69 .00 .08
Focal brand experience -.02 -.40 .07 1.75
Global brand experience .06 1.08 .11 2.80**
Type of client .21 3.49*** .00 .09
Type of service -.01 -.11 .01 .17
Squared multiple correlations .38 .72
***
Significant at p < .001.
**
*
Finally, the last step demonstrates that the mediator (attributional confidence) affects
the dependent variable (client psychological comfort) when we control for the
independent variable (communication style). If the effect of communication style is no
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longer significant when the mediator is included, full mediation is present. Table 4.3a
(Model B, Stage 2) shows that attributional confidence has a positive and significant
influence on client psychological comfort (β = .25, p < .001). When we add
attributional confidence in Stage 2, the positive effect of affiliative communication
style on client psychological comfort decreases from Stage 1 but remains significant
(β = .61, p < .001), suggesting a partial mediation and support for H2a. Dominant
communication style instead has a non-significant, negative impact on client
psychological comfort (β = -.09, p < .089), indicating no mediation through
attributional confidence in the link between dominant style and psychological comfort.
Therefore, H2b is not supported. Furthermore, one of the control variables, type of
client (whether first-time or repeat) has a significant effect on attributional confidence
in Model A. We expected this result, because uncertainty reduction theory suggests
that an increase in the length of contact and so experience leads to higher attributional
confidence.
We performed another test of the mediating effects of attributional confidence
on communication style and client psychological comfort by assessing the indirect
effects with a bootstrapping procedure conducted across 3,000 bootstrap samples,
following Hayes (2009, 2013) and MacKinnon, Fairchild, and Fritz (2007). The
structural model with attributional confidence as a mediator yields a satisfactory fit
(2/df = 2.06 p < .001, CFI = .93, TLI = .92, IFI = .93, GFI = .82, AGFI = .78,
RMSEA = .066, PCLOSE < .000, and SRMR = .068). The model explains substantial
variance in the ultimate dependent variable, client psychological comfort (72%), and
the mediating variable, attributional confidence (38%). Congruent with the first
mediation test, the results support H2a but not H2b. We find a significant positive
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indirect effect of affiliative communication style on client psychological comfort
through attributional confidence (β = .12, p < .001). However, the negative indirect
effect of dominant communication style on client psychological comfort through
attributional confidence is non-significant (β = -.03, p < .167). Moreover, global brand
experience (control variable) has a significant effect on psychological comfort
( = .11, p < .007), indicating that the greater clients’ experiences with other financial
advisory firms, the greater their psychological comfort as shown in Table 4.3b.
Table 4.3b Results from a bootstrapping procedure*

Mediated relationships Standardised Estimates p-Value
Affiliative communication style  Attributional
confidence  Psychological comfort .12 .001
Dominant communication style  Attributional
confidence  Psychological comfort -.03 .167
Notes: Squared multiple correlations: Attributional confidence = .38, Psychological comfort = .72
*
conducted across 3,000 bootstrap samples.
Next, we assessed the moderating effects of cultural value orientation
(collectivism/individualism) using SEM analysis. We divided the sample into two
groups using a median split of the cultural value orientation scale. In a baseline model,
we placed equality constraints on all beta and gamma parameters across collectivist-
and individualist value orientation groups. Next, we assessed a second model by
allowing only the path of interest to vary freely across groups. Then we ran a chi-
square difference test on both models (Patterson et al., 2016; Steenkamp, Batra, &
Alden, 2003; Voorhees & Brady, 2005). The results in Table 4.4 indicate that the
models differ significantly (p < .01) across two groups. When we examine individual
paths, we do not find support for the moderating effect of cultural value orientation on
associations between attributional confidence and affiliative communication style
(2 = 1.22, df = 1) or attributional confidence and dominant communication style
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(2 = 0.05, df = 1), even though the strength of the two styles across the two groups
accords with our predictions. Therefore, these results fail to support H3a and H3b, yet
they support a moderating effect of cultural value orientation on the association
between attributional confidence and client psychological comfort (2 = 4.62,
df = 1). Specifically, the estimate was .17 in the collectivist value oriented group and
.30 in the individualist value oriented group. Therefore, attributional confidence has a
stronger impact on psychological comfort among clients possessing individualist- than
collectivist value orientation, in support of H4.
Furthermore, there are noteworthy results about the direct effects of
communication style on client psychological comfort that we did not hypothesise. The
positive influence of affiliative communication style on client psychological comfort
when mediated by attributional confidence is not significantly different across the two
groups (2 = 1.26, df = 1) (Table 4.4). In contrast, we find a significant difference
of the negative effect of dominant communication style on client psychological
comfort across the two groups (2 = 5.55, df = 1). The negative impact of dominant
communication style on client psychological comfort is stronger for individualist
(-.22) than collectivist (-.08) value oriented clients. Table 4.5 summarises the results.
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Table 4.4 Results of moderation analysis

Standardised Parameter R2
Chi-
Estimates
square
Collectivist Individualist Collectivist Individualist
difference Oriented Oriented Oriented Oriented
Model Relationships (2) Clients Clients Clients Clients
Affiliative communication style
 Attributional confidence 1.22 .501*** .407*** .439 .328
Dominant communication style
 Attributional confidence 0.05 -.195* -.130 .404 .366
Attributional confidence 
Psychological comfort 4.62 .166** .299*** .785 .707
Affiliative communication style
 Psychological comfort 1.26 .633*** .623*** .787 .683
Dominant communication style
 Psychological comfort 5.55 -.082 -.220** .781 .710
Note: Squared multiple correlations (overall model): Psychological comfort = .80 (collectivist) vs. .65
(individualist), Attributional confidence = .40 (collectivist) vs. .37 (individualist).
***
Significant at p < .001, **Significant at p < .01, *Significant at p < .05.
Table 4.5 Hypotheses results

Standardised Hypothesis
Hypothesised Relationships
Estimates Supported
H1a Affiliative communication style  Psychological comfort .73*** Yes
H1b Dominant communication style  Psychological comfort -.13 *
Yes
H2a Affiliative communication style  Attributional
confidence  Psychological comfort .13*** Yes
H2b Dominant communication style  Attributional
confidence  Psychological comfort -.03(ns) No
Standardised Estimates
Hypothesised Relationships Collectivist Individualist Hypothesis
Oriented Oriented Supported
Clients Clients
H3a Affiliative communication style × Cultural value orientation
 Attributional confidence .50 .41(ns) No
H3b Dominant communication style × Cultural value orientation
 Attributional confidence -.19 -.13(ns) No
H4 Attributional confidence × Cultural value orientation
 Psychological comfort .17 .30* Yes
***
**
*
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4.5 Discussion
The overall objective of this study has been to shed light on the mediating role
of attributional confidence on the link between communication style and client
psychological comfort. It also examines differences across clients’ cultural value
orientation at the individual level. It highlights client psychological comfort as a vital
construct in the consumer-focused professional services context and a consequence of
professional service providers’ communication style as perceived by clients. Grounded
in uncertainty reduction theory, this study identifies attributional confidence as the
means by which clients develop feelings of ease and calmness about professional
services provision. Clients’ perceptions of professional service providers’
communication style influence their feelings about the adequacy of information they
obtain to reduce their uncertainty about service outcomes, providers’ performance, and
their interactions with providers. This study confirms that reducing client uncertainty
drives psychological comfort. However, the impact of attributional confidence on
client psychological comfort varies across cultural value orientations.
The results from our study of Australian and Thai clients of financial advisory
services support most of our hypotheses. In line with prior research, we find that
clients’ perceptions of professional service providers’ communication style influences
their psychological comfort. Affiliative communication style, which conveys
friendliness and attentiveness, significantly and strongly inspires client psychological
comfort. In contrast, dominant communication style, which conveys control and
domination, diminishes it. By testing the proposed conceptual framework in a
professional (financial advisory services) setting, the study shows that professionals’
communication style provide clients with observable indicators to assess services’
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technical qualities. Affiliative communication style transfers technical service
information to clients in a concerned and friendly manner, thereby reducing client
anxiety about professional services about which they lack the knowledge to evaluate.
The results conform with the revised social interaction model (Ben-Sira, 1976, 1980).
Dominant communication style communicates technical service information to clients
by taking control of discussions and restricting clients’ opportunities to articulate
opinions and concerns. Although it provides observable indicators to help clients gain
technical information, it does not reduce client anxiety.
Clients’ attributional confidence partially mediates the relationship between
affiliative communication style and client psychological comfort; the strong positive
effect of affiliative communication style drives client psychological comfort both
directly and indirectly through attributional confidence. This finding is consistent with
Neuliep and Grohskopf’s (2000) finding that responsive (warm, sincere) component
of the interpersonal communication competence positively correlates with uncertainty
reduction. Service providers’ friendly, encouraging, and attentive communication style
not only transfers technical information to clients but also helps clients understand and
predict providers’ attitudes and performances. Reducing clients’ perceived uncertainty
drives the reduction of their anxiety and produces psychological comfort. However,
we do not find support for attributional confidence as a mediator of the relationship
between dominant communication style and client psychological comfort; dominant
communication style negatively affects attributional confidence as we expected, but
the effect is not significant. This result is similar to Neuliep and Grohskopf’s (2000)
finding that assertiveness (e.g., dominance, competitiveness) component of
interpersonal communication competence. Dominant style also has a negative but non-
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significant impact on client psychological comfort. Therefore, attributional confidence
does not serve as a mechanism of the link between dominant communication style and
client psychological comfort. Professionals’ uses of directing and controlling
behaviours keeps clients from gaining the additional information they need to
understand and predict professionals’ attitudes and performance. As a result, the
clients continue to feel uncertain, their levels of anxiety remain, and they are unable to
attain psychological comfort.
The moderating effect of clients’ cultural value orientation offers more insights
into the communication style/attributional confidence/psychological comfort model.
Primarily, the model yields different results depending on the value orientation
(individualist/collectivist) of clients recruited from two countries. Collectivist value
oriented clients show a higher variance in psychological comfort than clients
possessing an individualist value orientation indicating that the two communication
styles, along with attributional confidence, decrease concern and anxiety more for
clients with collectivist- than individualist value orientation. By assessing individual
paths, we show that the impacts of affiliative and dominant communication styles on
attributional confidence do not differ across the two groups of clients. These findings
can be explained by Gudykunst’s (1983) finding that in both collectivist and
individualist value oriented cultures, people increase their attributional confidence by
having background information about those with whom they interact. For this reason,
the effects of professional service providers’ communication styles on attributional
confidence are comparable across cultures. Nevertheless, the strengths and directions
of the effects accord with our predictions: The positive effect of affiliative style on
attributional confidence are stronger for clients possessing collectivist- than
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individualist value orientation and the negative influence of dominant style are weaker
for clients who are collectivist-oriented. Similarly, Gudykunst and Nishida (1986) find
that the type of information that people in high-context cultures use to understand and
predict others’ behaviours reflects the extent to which they understand others; others
understand their feelings and make allowances when they communicate. Their study
supports a stronger impact of affiliative style and a weaker effect of dominant style on
attributional confidence among collectivist value oriented clients. However, people in
an individualist value oriented culture rely more on direct communication (content) to
predict others’ behaviour. Therefore, both styles of communication have less impact
on attributional confidence.
Still, cultural value orientation moderates the link between attributional
confidence and client psychological comfort. The ability to have sufficient information
to predict others’ behaviour has more influence on psychological comfort for
individualist- than collectivist value oriented clients. This finding is in line with
Gudykunst and Nishida (2001) dual-culture finding that when respondents from the
United States interact with unfamiliar persons, they show a stronger negative
correlation between attributional confidence and anxiety than respondents from Japan.
In a high individualist value orientation culture, people’s perceptions of having
adequate information relate to a decrease in uncertainty (Sheer & Cline, 1995).
However, people in a collectivist value orientation culture value nonverbal symbols,
speech, and social status (Hall, 1989; Littlejohn & Foss, 2008); for them, predictability
and understanding of others is not as strong as a driver of psychological comfort as it
is for people in an individualist value oriented culture.
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When clients have attributional confidence, the direct effects of
communication style have varying effects on client psychological comfort. Affiliative
communication style enhances psychological comfort for both collectivist and
individualist value oriented clients. This finding confirms the strong influence of
friendly and attentive communication style on clients’ perceived service quality,
irrespective of cultural value orientation. For dominant communication style, the
presence of attributional confidence results in differences between the two groups of
clients. Its effect is more negative for the psychological comfort of clients with an
individualist value orientation because of their decreased power distance, strong self-
reliance, and distance and detachment from groups (i.e., professional service
providers) (De Mooij & Hofstede, 2002; Hofstede, 1980c; Patterson & Smith, 2003;
Triandis, 1995; Triandis et al., 1988). Receiving information in a dominant, directive
style contradicts the values of individualist oriented clients.
This study makes several contributions to services marketing literature. First,
it leverages Berger and Calabrese’s (1975) uncertainty reduction theory to understand
the uncertainty reduction process of clients in professional services contexts. To most
clients, professional service providers resemble strangers; the service provision often
requires extensive interpersonal communication. This study enhances implications of
the theory by demonstrating that service providers’ appropriate communication style
can decrease clients’ degrees of uncertainty about service providers’ performances and
interactions with service providers. It supports Berger’s (1986) assertion that
uncertainty reduction embraces the interpersonal communication process (professional
services encounters) of individuals. In particular, affiliative communication style
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reduces clients’ uncertainty, by increasing their attributional confidence in
professional service providers. Accordingly, for clients, acquiring adequate
information about service providers by observing their communication style is key to
understanding the situation and reducing uncertainty.
Second, this study is the first to verify empirically that attributional confidence
(i.e., reduction of uncertainty) drives client psychological comfort. Whereas a few
communication researchers have referred to Clatterbuck’s (1979) operationalisation of
attributional confidence as it relates to anxiety reduction (Gudykunst & Nishida,
2001), we contribute to services literature by using a professional (financial advisory)
services setting to propose a positive link between clients’ attributional confidence and
psychological comfort. In professional services settings that are high in credence
properties, knowledge asymmetry, and complexity, providing clients with adequate
information to predict and understand service providers reduces their worry and
anxiety.
Third, this study shows that attributional confidence is an underlying
mechanism of the relationship between affiliative communication style and client
psychological comfort. Affiliative communication style not only increases client
psychological comfort directly but also boosts it indirectly by promoting clients’
abilities to reduce perceived uncertainty. However, attributional confidence does not
play a significant mediating role in the relationship between dominant communication
style and client psychological comfort; dominant, controlling communication
behaviour discourages client psychological comfort in professional services situations,
but it does not create an indirect effect through attributional confidence.
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Fourth, this study validates the link between communication style and client
psychological comfort in a financial advisory services context. In accordance with
Ben-Sira’s (1976, 1980) revised social interaction model, it shows that clients observe
financial advisors’ communication style as a mode of response, rather than evaluating
the technical content of the services, to assess service provision. However,
supplemental findings indicate that service providers’ use of affiliative communication
style, prior to client psychological comfort and service evaluation, reduces client
uncertainty (i.e., generates attributional confidence).
Fifth, this study contributes to cross-cultural studies that build on uncertainty
reduction theory, by offering a model that links communication style, attributional
confidence, and client psychological comfort expressed by clients from two cultural
value orientations at the individual level. By studying clients from two countries with
different cultures (Australia and Thailand), this study ensures high variance in clients’
cultural value orientation, specifically on the collectivism/individualism dimension.
The findings reinforce the Gudykunst and Nishida (2001) finding that the impact of
attributional confidence on anxiety reduction is greater in individualist than collectivist
value oriented culture, particularly with regard to interactions of unacquainted persons.
Moreover, it shows that despite disparities in clients’ values and beliefs, the impacts
of professional service providers’ affiliative and dominant communication styles on
clients’ attributional confidence are similar. Notably however, when attributional
confidence is present, the negative direct influence of dominant communication style
on client psychological comfort is more powerful for clients who are individualist-
than collectivist value oriented.
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Professional service providers and managers can benefit from this study in
several ways. First, they can recognise that clients’ attributional confidence, or
perceived certainty about situations, plays a part in professional services provision.
Typical professional services (e.g., financial, medical, legal services) encompass
substantial degrees of uncertainty for clients, such as worry about receiving desirable
service outcomes or anxiety about engaging in successful communication with service
providers who possess more technical service knowledge or skills. This study shows
that the more clients perceive that they are acquiring adequate information to
understand and predict professional service providers, the greater their reduction of
uncertainty, and the greater their psychological comfort. Managers and professionals
should ensure that clients gain sufficient knowledge of service providers’ attitudes and
behaviours (e.g., by communicating information about their own personal opinions
about the services or their actions given specific circumstances) to reduce uncertainty
and stimulate feelings of comfort.
Second, to foster clients’ attributional confidence, professional service
providers should use affiliative communication style. Managers should encourage
service providers to practise communicating technical information to clients in
everyday language, giving reassurances, listening, and allowing clients to ask
questions. Professional services firms can promote the use of affiliative
communication style by training service providers to apply affiliative manners. They
also can ensure that during communications, clients understand providers’ personal
attitudes, ideas, and behaviours in ways that help them predict providers’
performances. For example, when planning for new investments, financial advisors
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can express their personal judgements and reasoning in a friendly, reassuring manner,
recognising that affiliative communication style stimulates client psychological
comfort directly as well as implicitly through their attributional confidence.
However, managers and professional service providers also should be aware
that the use of dominant communication style results in less of a boost to clients’
attributional confidence. Corporate training programs for service providers should
highlight how this dominant, directive style of communication prevents clients from
gaining information and impedes their abilities to predict service providers’
performance. We recommend that to increase clients’ attributional confidence and
psychological comfort, professional service providers should limit their use of
dominant communication style during service encounters.
Furthermore, it is worthwhile for professional service managers and providers
to pay attention to individual clients’ cultural value orientation (i.e., whether they tend
toward individualism or collectivism), rather than their nationalities. Attributional
confidence has more influence on the psychological comfort of individualist than
collectivist value oriented clients. Therefore, during service encounters, service
providers should transmit adequate information to clients who display high self-
reliance or strong personal judgement. Service providers should closely observe
clients’ values and beliefs during service encounters. Although affiliative and
dominant communication styles have the same influence on attributional confidence
for both individualist and collectivist value oriented clients, an excessive use of
dominant style is more likely to impair the psychological comfort of individualist
clients. In such cases, service providers should take extra care in their interactions with
clients.
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This study has certain limitations that might be addressed in future studies.
First, uncertainty reduction theory focuses on initial interpersonal communication
between strangers, such that reducing perceived uncertainty about the other person is
the main concern. Because our research context entails high credence properties,
technical complexity, and knowledge ambiguity, we take the view that uncertainty
encompasses aspects that go beyond the person in the interaction (in our context, the
professional service provider) and an initial meeting. Other potential uncertainty
includes service outcome and an extended service time frame. Accordingly, we
examine uncertainty reduction (i.e., attributional confidence) of clients at various
stages of service provision and with differing frequencies of meetings with
professional service providers. We incorporate these factors as control variables (type
of client and focal brand experience). Although the effect of the focal brand experience
on clients’ attributional confidence is not significant, the type of client has a significant
impact ( = .21, p < .003). Therefore, we call on researchers to examine the potential
moderating effect of clients’ length of patronage (first-time vs. repeat clients) on the
link between communication style and attributional confidence. Researchers also
should account for other possible factors associated with repeat clients that could alter
the strength of the link. For example, over time, professional service providers may
adapt their communication style to encourage preferable client responses, or service
outcomes that clients receive between meetings may influence their perception of
communication style, attributional confidence, and psychological comfort.
Second, we consider the final limitation that relates to the relationship between
attributional confidence and client psychological comfort. Although prior literature
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(Gudykunst & Nishida, 2001; Sheer & Cline, 1995) indicates the influence of
attributional confidence on the reduction of anxiety (i.e., psychological comfort), the
use of a survey approach in our study could rule out potential generalisations of cause
and effect. Continued research might include an experimental study to provide
evidence about the direction of causality between the two variables. Our findings show
a significant effect of overall brand experience (i.e., clients’ experiences with other
financial advisory firms) on client psychological comfort ( = .11, p < .007) when
attributional confidence is present. Researchers could examine the moderating role of
clients’ overall experiences. Investigations could also place on compare professional
and non-professional services settings (especially those with extensive, high-
involvement service provision, such as regularly or frequently visited retailers or
automobile dealers).
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CHAPTER 5: CONCLUSION
CHAPTER 5
CONCLUSION
5.1 Synopsis
Inevitably, in the delivery of consumer-based professional services that involve
high credence properties, knowledge asymmetry, complexity, and uncertainty, clients
will feel anxious or insecure. Patients who undergo therapeutic or other medical
treatments, for example, feel nervous; financial services clients feel worried about
asset management plans that are technically complex. To establish successful client
relationships, literature indicates the importance of client psychological comfort
during professional services provision. Studies reveal clients’ perceptions of
providers’ communication style shape their positive emotional responses. However,
researchers have not examined explicitly the association of communication style with
client psychological comfort, or with the process that leads to psychological comfort
and its contingency conditions. Such insights are crucial for managers who wish to
grasp fully the model of client psychological comfort development. To bridge these
knowledge gaps, this thesis advances the following research questions:
1. In professional services encounters, to what extent do clients’ perceptions of
service providers’ communication style (affiliative and dominant) influence
psychological comfort?
2. Does client psychological comfort mediate the relationship between perceived
service providers’ communication style and subsequent behavioural outcomes
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(client satisfaction, repurchase intention, word-of-mouth [WOM]
recommendation)?
3. How does the impact of communication style on client psychological comfort
vary among individual clients with different characteristics and backgrounds?
4. What is the underlying process by which clients attain psychological comfort
during professional service encounters?
5. Does clients’ cultural value orientation influence the mechanism of psychological
comfort development?
To answer these research questions, we completed three empirical studies, presented
in Chapters 2, 3, and 4. The following section summarises the overall findings and
theoretical contributions of each study.
5.2 Summary of Key Findings and Theoretical Contributions
Overall, the three studies consistently reveal several key findings. Firstly, client
psychological comfort plays a key role in a professional services context in
determining satisfaction, repurchase intention, and WOM recommendation. Secondly,
clients’ perceptions of professional service providers’ communication style act as
determinants of their psychological comfort. Specifically, affiliative communication
style has a strong impact in driving client psychological comfort while dominant
communication style has a negative impact. Thirdly, a number of contingency
conditions moderate the association between communication style and client
psychological comfort.
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Evidence from a South-East Asian Collectivist Country
In Chapter 2, this study answers Research Questions 1, 2, and 3. It introduces
client psychological comfort into a professional (medical) services setting. The study
examines the impact of professional service providers’ affiliative and dominant
communication styles on client psychological comfort and on the consequences of
psychological comfort (satisfaction, repurchase intention, WOM recommendation). It
explores client heterogeneity in cognitive social capital and cultural value orientation
as moderators, using the revised social interaction model and uncertainty reduction
theory.
The findings reveal that client psychological comfort conforms to the
professional services context and acts as a vital part of clients’ assessments of service.
The study adds to professional services literature by identifying the strong association
between client psychological comfort and two styles of communication. It shows that
affiliative communication style strongly inspires client psychological comfort,
whereas dominant communication style reduces psychological comfort. Furthermore,
client psychological comfort drives satisfaction, intention to repurchase, and WOM
recommendation.
The study shows that the impact of communication style on client
psychological comfort varies among individual clients with different characteristics
and backgrounds. Affiliative commination style drives greater client psychological
comfort among clients who perceive high cognitive social capital (i.e., high similarities
in values, norms, preferences) with their professional service providers. Also, the
association between affiliative communication style and client psychological comfort
131
is stronger among clients with a collectivist cultural value orientation (showing
concerns for group harmony, collective goals, and high context). Moreover, among
collectivist value oriented clients, the negative impact of dominant communication
style on client psychological comfort is weaker.
The study proposes a competing model that shows client psychological
comfort partially mediates the relationship between affiliative communication style
and satisfaction. Affiliative communication style affects satisfaction directly, as well
as indirectly through client psychological comfort. This finding enhances prior
research on the positive influence of affiliative communication style in professional
services evaluation and offers professional services marketing literature new insights
on the role of client psychological comfort.
A Supplementary Study
Study 2 responds to Research Question 1. As an extension of Study 1, it
examines the causal relationship of communication style and client psychological
comfort in a controlled professional (medical) services context. Using the concept of
patient-centeredness, as applied in medical sociology studies, this study extends the
investigation of communication style to examine the effects of joint styles.
An experimental study offers evidence of internal validity and supports the
findings of Study 1. First, it verifies the causal relationship in which professional
service providers’ communication style is an antecedent of client psychological
comfort. Second, it enhances studies on communication style by illustrating that a
combination of high-affiliative/low-dominant communication style produces the
132
highest client psychological comfort among all conditions. In particular, this study
highlights the superior impact of affiliative style overpowers the negative impacts of
dominant style on client psychological comfort. A combination of high-
affiliative/high-dominant styles produces higher client psychological comfort than
combinations that feature low-affiliative style. Finally, the findings strengthen the
patient-centeredness concept addressed in medical sociology studies, confirming that
high-affiliative/low-dominant communication not only yields more satisfaction but
also generates higher client psychological comfort.
5.2.3 Study 3: Mediating Role of Attributional Confidence on the Relationship Between
Communication Style and Psychological Comfort: A Cross-Cultural Assessment
This study addresses Research Questions 4 and 5. With uncertainty reduction
theory as the theoretical background, it examines attributional confidence as a
mediator of the association between communication style and client psychological
comfort. It explores the mediation model among clients from two countries, according
to their individual cultural value orientation (collectivism/individualism).
In a financial advisory services setting, the findings confirm that both affiliative
and dominant communication styles shape client psychological comfort. Importantly,
they reinforce the notion proposed by uncertainty reduction theory that interpersonal
communication decreases the uncertainty of professional services clients. Although
attributional confidence is a partial mediator of the relationship between affiliative
communication style and client psychological comfort, it does not mediate the negative
link between dominant communication style and client psychological comfort.
133
When we assess the mediation model across two cultural value orientations,
we find that both the positive impact of affiliative communication style on attributional
confidence and the negative impact of dominant communication style on attributional
confidence are stronger among clients possessing collectivist- than individualist value
orientation. However, the difference is not substantial. A more substantial difference
occurs in the link between attributional confidence and client psychological comfort:
The influence of attributional confidence on client psychological comfort is stronger
among individualist- than collectivist value oriented clients. These findings contribute
to cross-cultural studies that focus on uncertainty reduction theory and cultural value
orientation at the individual level.
5.3 Managerial Implications
With three empirical studies, this thesis offers several points of guidance to
practitioners. First, professional service providers and executives should be aware that
most clients are not equipped with the high technical knowledge or skills they need to
evaluate the services they receive confidently. Professional services feature high
complexity, information asymmetry, uncertainty, and risks that cause clients to be
anxious. It is therefore vital for professional service providers to establish client
psychological comfort with them during service encounters, to ensure favourable
service evaluations and positive behavioural responses.
Second, managers should be aware that clients’ perceptions of professional
service providers’ communication style are observable cues that determine client
psychological comfort. They should recognise that a friendly, attentive communication
style drives client psychological comfort and client satisfaction, irrespective of clients’
134
demographics and previous experiences with the services. They should also be mindful
that communication style that exhibits domination and control—though necessary to
some extent in professional services—significantly decreases client psychological
comfort. By acknowledging that communication style comprises a mixture of both
affiliativeness and dominance, professional service providers can be sure to maximise
their use of affiliative communication style and minimise their use of dominant
communication style. Executives should instigate communication training (e.g., role
playing, forums) for professional service providers to allow them to practice affiliative
communication while limiting dominant communication.
Third, in addition to using appropriate communication style, professional
service providers should carefully observe, or even formally assess via psychological
instruments, clients’ different cultural value orientation and cognitive social capital.
Clients who show signs of group harmony and compliance toward service providers
will not only be more psychologically comfortable with affiliative style but also more
tolerant of dominant style. Clients who perceive high similarities in values, ideas, and
social groups with service providers also will be more psychologically comfortable
with affiliative style. Accordingly, communication training should account for clients’
characteristics and beliefs.
Fourth, because professional services encompass degrees of uncertainty and
risk, providing clients with enough information to help them understand and predict
professional service providers’ behaviour (i.e., building attributional confidence) is
crucial to reducing uncertainty and developing psychological comfort. Attributional
confidence is the means by which clients’ perceptions of communication style foster
client psychological comfort. During service encounters, service providers should
135
voice their personal opinions and reasoning, to provide clients with sufficient
information to be certain of the providers and the services. To develop clients’
attributional confidence (and thus psychological comfort), providers should use
affiliative communication style to transmit technical information and allow clients to
ask questions. In particular, they should provide individualist value oriented clients
(i.e., those showing high self-reliance and strong personal beliefs) with enough
personal information to increase the client psychological comfort.
Fifth, relying on communication style to generate client psychological comfort
can be a double-edged sword if it is not implemented carefully. Most professional
services are constrained by limited time and high demand. To be effective, affiliative
communication style should be applied only for suitable durations—and with sincerity
(e.g., with inspiring tone of voice, eye contacts, friendly gestures). These guidelines
can be included in communication training.
5.4 Limitations and Directions for Further Research
Although this thesis enriches understanding of client psychological comfort
and communication style in the professional services context, it also has several
limitations. First, the arguments in this thesis emphasise the role that communication
style plays on impacting clients’ perception of technical quality (the core service or
“what” is delivered) of the professional service rather than functional and relational
quality (“how” the service is delivered) (Brown & Swartz, 1989; Sharma & Patterson,
1999; Sharma & Patterson, 1999; Sweeney, Soutar, & McColl‐Kennedy, 2011). Future
research might place more emphasis on the role that communication style and client
136
psychological comfort play in determining clients’ evaluation of functional and
relational quality.
Second, the examination of client psychological comfort in the three studies
relates only to clients’ feelings following recent interactions with professional service
providers. However, most professional services entail multiple and extended
encounters that could vary in their degrees of client psychological comfort over time.
Service providers might adapt their communication style to clients’ reactions, or
clients could become familiar with the communication style. Future research could
attempt to capture the dynamic of client psychological comfort over time, using
longitudinal studies. Researchers also should consider the impacts of factors such as
technical service outcomes (received between encounters), attached terms and
conditions, and switching costs.
Third, the use of self-reported data in the two survey-based studies might lead
to common method bias. Although our procedural remedies and statistical tests do not
reveal any significant issues, the problem may still exist. To preclude this issue,
objective measures could assess client psychological comfort (e.g., cameras recording
clients’ facial, physical, and verbal responses) and its consequences (e.g., repurchases,
referral data). In addition, research could benefit from dyadic studies (professional
service providers–clients). Researchers could also perform a gap analysis of
communication style and client psychological comfort from the perspectives of both
professional service providers and clients.
Fourth, the experimental study in Study 2 (Chapter 3) constrains the sample to
one collectivist cultural value oriented country (Thailand). Replications of this
137
research should include countries with an individualist cultural value orientation (e.g.,
the United States, Canada, the Netherlands) and other professional services (e.g.,
financial advisory services, psychiatric services). They may find that among different
cultures and types of professions, client psychological comfort derives from different
combinations of affiliative and dominant communication styles than in medical
services settings of an Eastern, collectivist value oriented culture.
Fifth, the final limitation relates to Study 3’s (Chapter 4) assessment of
attributional confidence. Uncertainty reduction theory indicates that in their initial
meetings, people are primarily concerned with reducing uncertainty about others.
However, Study 3 recognises that uncertainty presented in professional services entails
further aspects. It measures the attributional confidence of clients at various stages of
service provision. It includes the type of client (first-time vs. repeat client) in the
analysis as a control variable that shows a significant effect on attributional
confidence. Accordingly, researchers could examine clients’ length of
patronage/status as a potential moderator of the association between communication
style and attributional confidence. Furthermore, an experimental study could be
conducted to investigate the direction of causality in the linkage between attributional
confidence and client psychological comfort. Additional research would benefit from
an increased response rate too; online surveys could be employed to collect data from
professional services clients.
5.5 Conclusion
The establishment of client psychological comfort is essential for professional
services firms that aim to achieve successful client relationships. This thesis highlights
138
the impact of perceived communication style on client psychological comfort,
heterogeneity among clients, and the mediating role of attributional confidence. It
encourages professional service researchers and practitioners to expand the study of
the link between communication style and client psychological comfort to the broader
scope of marketing and management. In conclusion, this thesis should act as a catalyst
for future research (e.g., dyadic studies, longitudinal studies, studies using objective
data, studies using devices in measuring physical activity) and service managers, to
attach importance to the role of client psychological comfort and professional service
providers’ communication style to achieve fruitful client relationships.
139
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155
APPENDICES
Appendix 1: Questionnaire – Study 1 (Chapter 2)
Business School
School of Marketing
A STUDY OF CLIENT ATTITUDES

TOWARDS MEDICAL SERVICES
Participation Information Statement

What is the research study about?
This research is part of the doctoral dissertation of Ms. Rawi Roongruangsee, a PhD candidate in School of
Marketing, UNSW Sydney. This research aims to examine client attitudes towards medical services. You
are invited to take part in this research study because you have been using medical services. Participation
in this research is voluntary. Your decision will not affect your relationship with UNSW Sydney.
There are no right or wrong answers – we are interested in your personal views.
What will happen to information about me?

By completing this questionnaire you consent to the research team collecting and using information about
you for the research study. Your information will only be used for the purpose of this research study and it
will only be disclosed with your permission. You will not be individually identifiable in any results published
from this research. All information you provide will be treated CONFIDENTIALLY and only reported in the
aggregate. We do not expect that there will be any risks or costs associated with taking part in this study.
We expect a completion of questionnaire to take up to 10 – 15 minutes.
What should I do if I have further questions about my involvement in the research study?
You can contact Ms. Rawi Roongruangsee
Mobile: 0627544901 (Thai), Email: r.roongruangsee@student.unsw.edu.au
Your participation is greatly appreciated.
156
Participation selection and purpose of the study
You are invited to take part in a study on client attitudes towards medical services. We aim to examine
client psychological comfort generated from professional service provider’s (i.e., physician’s)
communication style in a medical services context. You have been invited because you have been
using medical services from Maharaj Nakorn Chiang Mai Hospital, are aged 18 years or over, and
have experienced medical services through a face-to-face interaction with a physician.
Participation and risks of the study

If you decide to take part in the research study, you will be asked to complete a questionnaire by
answering a series of questions, which will ask you questions about your experience with medical
services, your opinion of physician’s communication, your overall satisfaction/dissatisfaction with the
physician. Aside from giving up your time, we do not expect that there will be any risks or costs
associated with taking part in this study. We expect this activity to take up to 10-15 minutes.
There are no costs associated with participating in this study, nor will you be paid. We hope to use
information we get from this research study to form part of Ms. Roongruangsee’s doctoral dissertation.
Findings of this research study will be used by Maharaj Nakorn Chiang Mai Hospital to enhance the
clients’ service experience.
Confidentiality and disclosure of information

By completing the questionnaire you consent to the research team collecting and using information
about you for the research study. Your information will be anonymous and will only be used for the
purpose of this research study. It will only be disclosed with your permission. It is anticipated that the
results of this study will be published and/or presented in a variety of forums, but you will not be
identifiable in these publications.
You have the right to request access to the information about you that is collected and stored by the
research team. You also have the right to request that any information with which you disagree be
corrected. You can do this by contacting a member of the research team at
r.roongruangsee@student.unsw.edu.au.
Withdraw from the study

If you do consent to participate, you may withdraw at any time. If you want to withdraw, you can stop
doing the questionnaire anytime. Once you have submitted it, your responses cannot be withdrawn
because they are anonymous and therefore we will not be able to tell which one is yours. If you decide
to leave the research study, the researchers will not collect additional information from you.
Research Team contact

Name Ms. Rawi Roongruangsee (student investigator)
Telephone +66 0627544901
Email r.roongruangsee@student.unsw.edu.au
Complaints/concerns
You may contact:
Position Research Administration Section,
Human Research Ethics Coordinator
Faculty of Medicine, Chiang Mai
UNSW Sydney, Australia
University
Telephone + 61 2 9385 6222 +66 053 935 149
Email humanethics@unsw.edu.au researchmed@cmu.ac.th
157
Please read the following important definitions before commencing this questionnaire
“Physician” refers to a medical practitioner you interacted with today for a medical treatment or
service. Please use only this physician as your point of reference through this questionnaire.
SECTION 1: Your experience with medical services
Q1 Please think about an interaction you had with the physician you met today. What type of
medical condition/services did you experience?
Write here: …………………………………………………………………………………..
Q2 Is this the first time you met this physician for the medical condition/services in Q1?
Yes if yes, go to Q4 No
Q3 Until now, how many times have you met this physician?
Write here: …………… times
Q4 How many times, during the past 1 year, have you visited other clinic/hospital for any
types of medical services? (If there is no clinic/hospital other than the one where you met
this physician in Q1, please write “0”)
Q5 Please circle ONE number to reflect your opinion for the following questions
How important was the meeting with this physician to you?
Not Somewhat Very Extremely

important important Important important important
1 2 3 4 5
Next page
158
SECTION 2: Your opinion of the physician’s communication
Q6 (a) We would like your opinion of the communication style of the physician you met with
for medical treatment or service in Q1. Please circle ONE number for each statement to
reflect your opinion. If you strongly agree with the statement, circle a 7. If you strongly
disagree circle a 1. If your feelings are not strong, circle one of the numbers in the middle.
There are no right or wrong answers.
Strongly Strongly
This physician:
Disagree Agree
Listened to me very carefully. 1 2 3 4 5 6 7
Was extremely friendly. 1 2 3 4 5 6 7

Left an impression on me that he/she can explain
1 2 3 4 5 6 7
things in an uncomplicated way.
Could repeat back to me exactly what I said. 1 2 3 4 5 6 7
Tended to be very encouraging most of the time. 1 2 3 4 5 6 7

Had knowledge of my illness which I consider
1 2 3 4 5 6 7
admirable.
Was extremely open and honest when talking to
1 2 3 4 5 6 7
me.
Revealed personal things about himself/herself. 1 2 3 4 5 6 7
Had memorable smile and charm. 1 2 3 4 5 6 7

Deliberately reacted in a way that I know he/she
1 2 3 4 5 6 7
was listening.
Was extremely attentive. 1 2 3 4 5 6 7
Was very relaxed during the discussion. 1 2 3 4 5 6 7

Expressed genuine concern for my welfare,
1 2 3 4 5 6 7
which left an impression on me.
Acknowledged my input. 1 2 3 4 5 6 7
Always showed that he/she was very empathetic
1 2 3 4 5 6 7
with me.
Gave me an impressive feeing about his/her
1 2 3 4 5 6 7
manner of speaking to me as an equal.
(b) Again, please circle ONE number for each statement to reflect your opinion of the
communication style of this physician.
Strongly Strongly
This physician:
Disagree Agree
Mostly was the one speaking more frequently in
1 2 3 4 5 6 7
conversations.
Came on strong in expressing his/her opinion. 1 2 3 4 5 6 7
Was somewhat confrontational during
1 2 3 4 5 6 7
conversations.
Tended to dominate the conversations. 1 2 3 4 5 6 7
Verbally exaggerated to emphasise a point very
1 2 3 4 5 6 7
frequently.
Tended to take control in discussions. 1 2 3 4 5 6 7
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159
SECTION 3: Your relationship with the physician
Q7 From the interaction you had with this physician. What were your feelings?
Please circle ONE number corresponding to your feeling in each statement
Uncomfortable 1 2 3 4 5 6 7 Comfortable
Very uneasy 1 2 3 4 5 6 7 Very much at ease
Very tense 1 2 3 4 5 6 7 Very relaxed
Insecure 1 2 3 4 5 6 7 Secure
Worried 1 2 3 4 5 6 7 Worry free
Distressed 1 2 3 4 5 6 7 Calm
SECTION 4: Overall satisfaction/dissatisfaction
Q8 (a) Now we would like your overall opinion about this physician. Please circle ONE number
corresponding to each statement which reflects your opinion.
Strongly Strongly
Disagree Agree
Following the meeting with this physician, I am happy with
1 2 3 4 5 6 7
my decision to use medical services from this hospital/clinic.
I am happy with the physician I met with. 1 2 3 4 5 6 7
I feel good about my decision to use medical services from 1 2 3 4 5 6 7

this hospital/clinic.
(b) Taking everything into consideration, how satisfied are you with the physician’s medical
services so far?
Somewhat Dissatisfied 1 2 3 4 5 6 7 Very Satisfied
Q9 Please read the following statements and circle ONE number for each statement to reflect your
opinion.
Strongly Neither Agree Strongly
Judging from my meeting with this physician:
Disagree Nor Disagree Agree
We share similar ideas and interests. 1 2 3 4 5 6 7
We are similar in many ways. 1 2 3 4 5 6 7
We belong to some of the same groups. 1 2 3 4 5 6 7
We share the similar values. 1 2 3 4 5 6 7
Q10 In the future, how likely are you to engage in other medical services provided at this
hospital/clinic? (If not likely to engage at all, circle a 1. If very likely, circle a 5, and so on).
Very unlikely 1 2 3 4 5 Highly likely
Next page
160
Q11 How likely would you be to recommend the physician to others (e.g., close friends,
colleagues, or family members) with a similar medical condition or service needed?
Please circle ONE number.
Very Unlikely 0 1 2 3 4 5 6 7 8 9 10 Very Likely
SECTION 5: Respondent Profile
Finally, in this last section, we would like to ask some questions about yourself .
Q12 Please read the following statements and circle ONE number for each statement to reflect your
opinion.
Strongly Strongly
Disagree Agree
Welfare of a group (e.g., close friends, close
colleagues, family members) is more important than 1 2 3 4 5 6 7
individual rewards.
Success of a group (e.g., close friends, close
individual success.
Individuals should sacrifice self-interest for the group. 1 2 3 4 5 6 7
Individuals should stick with the group even through 1 2 3 4 5 6 7

difficulties.
Individuals should only pursue their goals after 1 2 3 4 5 6 7
considering the welfare of the group.
Group loyalty should be encouraged even if individual 1 2 3 4 5 6 7
goals suffer.
Q13 Are you: Please put an X next to your answer.
Male Female
Q14 To which of the following age categories do you belong?

18 – 24 years 45 – 54 years
25 – 34 years 55 – 64 years
35 – 44 years Over 65 years
THANK YOU FOR YOUR COOPERATION
161
Appendix 2: Scenarios and questionnaire – Study 2 (Chapter 3)
No………
School of Marketing
The Impact of Communication Style on Psychological Comfort

in a Professional Services Context
INSTRUCTION
This questionnaire has 4 pages:
Page 1 Instructions
Page 2 A written scenario
Page 3, 4 Questions
The following scenario presents a conversation between a physician and a patient.

Please read the scenario in Page 2 and listen carefully.
Please imagine yourself as a patient who is consulting a physician for recurrent headaches.
This is your second time seeing the physician to discuss the symptoms
and make a decision about the treatment.
As you enter the room, here is the conversation:
Important survey information
What is the research study about?

This research is part of the doctoral dissertation of Ms. Rawi Roongruangsee, a PhD candidate in School of
Marketing, UNSW Sydney. This research aims to examine client psychological comfort from physician’s
communication style in medical services.
There are no right or wrong answers to questions in this research – we are interested in your views.
What will happen to information about me?

By completing this questionnaire you consent to the research team collecting and using your information for
the study. Your information will only be used for the research purpose and it will only be disclosed with your
permission. You will not be identifiable in any results published from this research. All your information will
be treated confidentially and only reported in the aggregate. We do not expect that there will be any
risks/costs associated with your participation. We expect a completion of questionnaire to take 8 minutes.
What should I do if I have further questions about my involvement in the research study?
You can contact Ms. Rawi Roongruangsee
Mobile: 0627544901 (Thai), (+61) 41 0263564 (Australian), Email: r.roongruangsee@student.unsw.edu.au
162
You are invited to take part in this research study. We aim to examine client psychological comfort
generated from joint impacts of professional service provider’s (i.e., physician’s) communication style
in a medical services context. You have been invited because you are a student of Faculty of Business
Administration, Chiang Mai University, and are aged 18 years or over.

If you decide to take part in the research study, you will be asked to listen to an audio clip and
answer a series of questions in a questionnaire, which will ask you questions about your opinion of
physician’s communication from the audio clip, your feelings, and your overall satisfaction or
dissatisfaction with the physician. Aside from giving up your time, we do not expect that there will be
any risks or costs associated with taking part in this study. We expect this activity to take 8 minutes.
Findings of this research study will be used by professional service firms (e.g., hospitals, clinics) to
enhance the clients’ service experience.



Telephone +66 0627544901
Complaints/concerns
You may contact:
Position Marketing Department, Faculty of
Human Research Ethics Coordinator
Business Administration, Chiang Mai
University
Telephone + 61 2 9385 6222 +66 053 942 134
Email humanethics@unsw.edu.au accba@cmu.ac.th
163
Scenario 1 (High affiliative – Low dominant)
Physician: Hi. What can I do for you today? <Physician smiles>

You: Hi… It’s the headaches. They have become more frequent during the past two weeks.
Physician: <Physician nods and carefully listens> I am sorry to hear that they have gotten worse...
You: I am worried about it. A friend of my family is just diagnosed with brain tumour. And, her first
symptoms were bad headaches, for several weeks.
Physician: <Physician nods and carefully listens> I can see how unpleasant it is to you...Before we talk more
about it, is there anything else you would like to talk about today?
You: No, thank you. I just want to talk about the headaches.
Physician: Ok, so, what can you tell me about the headaches?
You: They happen 2 to 3 times a week.
Physician: That is a lot! Anyone would be worried. How would you describe the pain?
You: They are quite intensive. They start behind my right eye…They’re really disturbing when I’m trying to
work. Especially when I use a computer, I couldn’t focus what was showing on the screen.
Physician: <Physician nods and carefully listens> Hmm…behind the right eye…That sounds like they’re really
severe. However, they are quite common. I myself have experienced it before. We can do something
about it…Very often the pain you described is associated with bad posture or eyestrain like, for
example, working for long periods of time at the computer. Stress is often a trigger too. Do you know
what I mean?
You: Yes…But…I can’t really specify which one is the cause.
Physician: Sometimes it is simply a mystery because you cannot pinpoint a specific cause. We can work together
to get to the bottom of it.
You: Yes, that’ll be great. I really want to find out.
Physician: <Physician smiles> I can see how frustrating it is for you…There are several treatment options. First,
you can wait and see if the symptoms resolve on their own, to save you from unnecessary treatment. If
the headaches do not resolve, however, important time could be lost. Only you can make this type of
choice. What do you think?
You: I’d like to try something to cure them. But, I’m not sure what should I go for…
Physician: There are two options. First, you could ask for a CAT scan to check that there is no any bleeding in the
brain...But, the sort of headache you describe is very rarely related to this case…Second, you could
take medication to help with the pain. It may take us some time to work together to get the right
dosage. I hope you will not become too discouraged if the headaches continue during this period. What
do you think you would like to do?
You: Um...
Physician: I know making these decisions is not easy. Let’s consider the options that make the best sense for
you...
You: I think…I’ll go for the medication.
Physician: Ok, let’s do that. I’ll pass the prescription to pharmacy department. I hope you will feel better soon. Is
there any other question?
You: No, that is all. Thank you.
Physician: Ok, let’s see what happens in 2 weeks <Physician smiles>. Goodbye.
You: Goodbye.
164
Scenario 2 (High affiliative – High dominant)
Physician: Hi. How have your headaches been since I saw you last? <Physician smiles>
You: Hi…The headaches have become more frequent during the past two weeks.
Physician: <Physician nods and carefully listens> I am sorry to hear that they have gotten worse.
Physician: <Physician nods and carefully listens> I can see how unpleasant it is to you...Ok, I want to talk about
your headaches so I can make a decision about treatment.
You: Ok.
Physician: How often do you have the headaches?
Physician: That is a lot! Anyone would be worried. Where does it hurt? Is it always in the same place?
You: They are quite intensive. They start behind my right eye and only here…They’re really disturbing
when I’m trying to work. Especially when I use a computer, I couldn’t focus what was showing on the
screen.
Physician: <Physician nods and carefully listens> Hmm…behind the right eye…That sounds like they’re really
severe. However, they are quite common. I myself have experienced it before. We can do something
about it... Very often the pain you described is associated with bad posture or eyestrain like, for
example, working for long periods of time at the computer. Stress is often a trigger too. Any questions?
You: No question... But…I can’t really specify which one is the cause.
Physician: Sometimes it is simply a mystery because you cannot pinpoint a specific cause. But I am sure I can get
to the bottom of it.
Physician: <Physician smiles> I can see how frustrating it is for you...There are several treatment options I have in
mind. First, I want to wait and see if the symptoms resolve on their own, to save you from unnecessary
treatment. If the headaches do not resolve, however, important time could be lost. I generally prefer to
do something more than just wait. Ok?
You: Ok. But, I’m not sure what should I go for…
Physician: I’m going to order more extensive tests. A CAT scan can rule out a cerebral haemorrhage. The sort of
headache you describe is very rarely related to this case…Nevertheless, I want you to have more tests.
You: Ok.
Physician: I’m going to prescribe medication to help with the pain. It may take some time for me to work out just
the right dosage. I hope you will not become too discouraged if the headaches continue during this
period.
You: Ok.
Physician: I know making these decisions is not easy. And considering how each treatment would affect your life,
I will have you take the medication...I will write the prescription for Imitrex and I want you to begin
taking it right away.
You: Ok.
Physician: That should do it for today. I hope you will feel better soon. You will need to come back in 2 weeks.
You: Sure. Thank you.
Physician: <Physician smiles> Goodbye.
You: Goodbye.
165
Scenario 3 (Low affiliative – Low dominant)
Physician: Hi, please come in. What can I do for you today? <Physician looks at you and reads a file>
You: Hi…It’s the headaches. They have become more frequent during the past two weeks.
Physician: Ok. <Physician still reads the file>
Physician: Before we talk more about the headache, is there anything else you would like to talk about
today?
You: No, thank you. I just want to talk about the headaches.
Physician: Ok, yes. So, what can you tell me about the headaches?
Physician: Ok. How would you describe the pain?
You: They are quite intensive. They start behind my right eye and only here. They’re really disturbing
when I’m trying to work. Especially when I use a computer, I couldn’t focus what was showing
on the screen.
Physician: So, the headaches are frequent enough to disrupt your daily activities and the pain is typically behind
your right eye. Very often the pain you described is associated with bad posture or eyestrain like,
for example, working for long periods of time at the computer.
Do you know what I mean?
You: Yes. But…I can’t really specify which one is the cause.
Physician: We can work together to get to the bottom of it.
Physician: There are several treatment options. First, you can decide to wait and see if the symptoms resolve
on their own. Waiting may save you from unnecessary treatment. If the headaches do not resolve,
however, important time could be. Only you can make this type of choice. What do you think
makes sense for you? <Physician reads a file>
You: I’d like to try something to cure them. But, I’m not sure what should I go for…
Physician: There are two options. First, you could ask for a CAT scan to check that there is no any bleeding in
the brain...So far, what you describe sounds pretty common….Second, you could take medication to
help with the pain. It may take us some time to work together to get the right dosage. What do you
think you would like to do?
You: Um…
Physician: Let’s consider with of the options we discussed makes the best sense for you.
You: Um... I think I’ll go for the medication.
Physician: Ok, let’s do that. I’ll pass the prescription to the pharmacy department. Is there anything else I can
do for you today?
You: No, that is all. Thank you.
Physician: Ok, let’s see what happens in 2 weeks. Goodbye.
You: Goodbye.
166
Scenario 4 (Low affiliative – High dominant)
Physician: Hi, please come in. How have your headaches been since I saw you last? <Physician looks at you
and reads a file>
You: Hi… The headaches have become more frequent during the past two weeks.
Physician: Ok. <Physician still reads the file>
Physician: Ok, I’ll talk about your headaches so I can make a decision about treatment.
You: Ok.
Physician: How often do you have the headaches?
Physician: Ok. Where does it hurt? Is it always in the same place?
You: They are quite intensive. They start behind my right eye and only here….They’re really
disturbing when I’m trying to work. Especially when I use a computer, I couldn’t focus what
was showing on the screen.
Physician: So, the headaches are frequent enough to disrupt many of your daily activities and the pain is typically
behind your right eye. Very often the pain you described is associated with bad posture or eyestrain
like, for example, working for long periods of time at the computer.
Any questions?
You: No. But, I can’t really specify which one is the cause.
Physician: I am sure I can get to the bottom of it.
Physician: There are several treatment options I have in mind. First, I want to wait and see if the symptoms
resolve on their own. Waiting may save you from unnecessary treatment. If the headaches do not
resolve, however, important time could be lost. I generally prefer to do something more than just
wait. <Physician reads a file>
Ok?
You: Ok. But, I’m not sure what should I go for…
Physician: I’m going to order more extensive tests. A CAT scan can rule out a cerebral haemorrhage. So far,
what you describe sounds pretty common. Nevertheless, I want you to have more tests.
You: Ok.
Physician: I’m going to prescribe medication to help with the pain. It may take some time for me to work out
just the right dosage.
You: Ok.
Physician: I want you to take the medication. I will write the prescription for Imitrex and I want you to begin
taking it right away.
You: Ok.
Physician: That should do it for today. You will need to come back in 2 weeks.
You: Sure. Thank you.
Physician: Goodbye.
You: Goodbye.
167
Q1 As you were the patient in the scenario, what are your feelings after speaking with the
physician? Please circle ONE number corresponding to each statement.
Q2 Please circle ONE number corresponding to each statement to indicate your opinion
about the physician’s communication. There is NO right or wrong answer.
Strongly Strongly
This physician… Disagree Agree

Tended to be very encouraging most of the
1 2 3 4 5 6 7
time.
Always showed that he/she was very
1 2 3 4 5 6 7
empathetic with me.
Gave me friendly smiles. 1 2 3 4 5 6 7
Expressed genuine concern for my welfare,
1 2 3 4 5 6 7
which left an impression on me.
Revealed personal things about himself. 1 2 3 4 5 6 7
Deliberately reacted in a way that I know he
1 2 3 4 5 6 7
was listening.
Listened to me very carefully. 1 2 3 4 5 6 7
Left an impression on me that he can explain
1 2 3 4 5 6 7
things in an uncomplicated way.
Was extremely open and honest when talking to
1 2 3 4 5 6 7
me.
Could repeat back to me exactly what I said. 1 2 3 4 5 6 7
Had knowledge of my illness, which I consider
1 2 3 4 5 6 7
admirable.
Gave me an impressive feeing about his/her
1 2 3 4 5 6 7
manner of speaking to me as an equal.
Strongly Strongly
This physician… Disagree Agree
Mostly was the one speaking more frequently in 1 2 3 4 5 6 7
conversations.
Came on strong in expressing his opinion. 1 2 3 4 5 6 7
Was somewhat confrontational during 1 2 3 4 5 6 7
conversations.
1 2 3 4 5 6 7
frequently.
Next page
168
In this last section, please tell us about yourself.
Gender male female
Age (years old)
18 19 20 21 22 other
(please specify)………….….
169
Appendix 3: Questionnaire – Study 3 (Chapter 4)
No…….
Business School
School of Marketing
A STUDY OF CLIENT ATTITUDES

TOWARDS FINANCIAL ADVISORY SERVICES
Important survey information

In the first section, you will be asked to answer a series of questions about your experience with
financial advisory services. Then, you will be asked about your opinion of a financial adviser’s
communication, your intention to maintain a relationship with the adviser, and your overall
satisfaction or dissatisfaction. There are no right or wrong answers – we are interested in your
personal views. In the last section, you will be asked to answer questions about yourself that will
be used only for classification purposes.
All information you provide will be treated CONFIDENTIALLY and only reported in the aggregate.
If you have any questions, please contact Ms. Rawi Roongruangsee

Australia: 0410263564, 029385 3384
Thailand: 0627544901
Email: r.roongruangsee@student.unsw.edu.au
170
You are invited to take part in a study on client attitudes towards financial advisory services. We aim
to examine client psychological comfort generated from professional service provider’s (i.e., financial
advisor’s) communication style in a financial advisory services context. You have been invited because
you have been using financial advisory services from UniSuper or Thai retail banking services, through
a face-to-face interaction with a financial advisor.

If you decide to take part in the research study, you will be asked to complete a questionnaire by
answering a series of questions, which will ask you questions about your experience with financial
advisory services, your opinion of financial advisor’s communication, your overall
satisfaction/dissatisfaction with the advisor. Aside from giving up your time, we do not expect that
there will be any risks or costs associated with taking part in this study. We expect this activity to take
up to 10-15 minutes.
Findings of this research study will benefit others who research on the influence of professional service
provider’s communication style in creating client psychological comfort.



Telephone +66 0627544901 (Thailand), +61 0410263564 (Australia)
Complaints/concerns
You may contact:
Position Human Research Ethics Coordinator
Telephone + 61 2 9385 6222
Email humanethics@unsw.edu.au
171
Please read the following important definitions
before commencing this questionnaire
“Financial adviser” as defined in this questionnaire refers to a financial advising/planning

professional you just interacted with for any type of financial services or advice. Please use this financial
adviser as your point of reference throughout this questionnaire.
SECTION 1: Your experience with financial advisory services
Q1 What type of financial advisory services were you seeking from your appointment today?
Write here: ……………………………………………………………………………………..
Q2 Was this the first time you have met this financial advisor?
Yes if yes, go to Q4 No
Q3 Now please think about this financial advisory firm.

(a) How long have you been using this firm to provide you with financial advice?
Write here: …………… years
(b) During this period, how many times have you met a financial advisor(s)?
Q4 How many times, during the past five years, have you visited other financial advisory
firms? (If there is no firm other than this firm, please write “0”)
Write here: …………….….. times
Next page
172
SECTION 2: Your opinion of a financial adviser’s communication
Q5 (a) We would like your opinion of the communication style of the financial advisor you met
with today. Please circle ONE number for each statement to reflect your opinion. If you
strongly agree with the statement, circle a 7. If you strongly disagree then circle a 1. If your
feelings are not strong, circle one of the numbers in the middle. There are no right or wrong
answers.
Strongly Strongly
This financial adviser:
Disagree Agree
Listened to my requests very carefully. 1 2 3 4 5 6 7
Could repeat back to me exactly what was said. 1 2 3 4 5 6 7
Listened to my opinions. 1 2 3 4 5 6 7
Tended to be very encouraging most of the time. 1 2 3 4 5 6 7
Was being extremely open and honest when

1 2 3 4 5 6 7
talking to me.
Revealed personal things about himself/herself. 1 2 3 4 5 6 7
Deliberately reacted in a way that I know he/she

1 2 3 4 5 6 7
was listening.
Really left me with a positive impression. 1 2 3 4 5 6 7
(b) Again, please circle ONE number for each statement to reflect your opinion of the
communication style of the financial advisor you met with today.
Strongly Strongly
This financial adviser:
Disagree Agree
Came on strong in expressing his/her opinion. 1 2 3 4 5 6 7
Was somewhat confrontational during

1 2 3 4 5 6 7
conversations.

1 2 3 4 5 6 7
frequently.
Next page
173
SECTION 3: Your relationship with a financial adviser
Q6 Now think about the interaction you had with this financial advisor. Please answer each
question using a scale from zero (0)% to one hundred (100)%.
By talking to this financial adviser:

How confident were you of your general ability to predict how the advisor will perform
(e.g., developing your personal financial plan)? …….….%
How confident were you at predicting the value you will receive from the advisor? …….….%
How confident were you at predicting the advisor’s value of money? ….…….%
How confident were you at predicting the advisor’s attitudes? .……….%
How well did you feel you know the advisor? ….…….%
Q7 From the interaction you had with this financial advisor. What were your feelings?
Please circle ONE number corresponding to each statement
SECTION 4: Respondent Profile
Finally, in this last section, we would like to ask some questions about yourself.
Q8 Please read the following statements and circle ONE number corresponding to each statement.
Strongly Strongly
Disagree Agree
Welfare of a group (e.g., close friends, close
individual rewards.
Success of a group (e.g., close friends, close
individual success.
Individuals should sacrifice self-interest for the 1 2 3 4 5 6 7
group.
Individuals should stick with the group even through 1 2 3 4 5 6 7
difficulties.
Individuals should only pursue their goals after 1 2 3 4 5 6 7
considering the welfare of the group.
Group loyalty should be encouraged even if 1 2 3 4 5 6 7
individual goals suffer.
Next page
174
Q9 Are you: Please put an X next to your answer.
Male Female
Q10 To which of the following age categories do you belong?

18 – 24 years 45 – 54 years
25 – 34 years 55 – 64 years
35 – 44 years Over 65 years
175

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Establishing client psychological comfort through

communication style in a professional services context

A thesis in fulfilment of the requirements for the degree of

Surname or Family name: Roongruangsee

First name: Rawi Other name/s:

Abbreviation for degree as given in the University calendar: PhD

School: School of Marketing Faculty: UNSW Business School

Abstract 350 words maximum:

Declaration relating to disposition of project thesis/dissertation

……………………………………………… ……………………………………..……… ……….……………………...…….

FOR OFFICE USE ONLY Date of completion of requirements for Award:

Professional services are typically high in credence properties, information

Study 2 tests the internal validity of the communication style - psychological

This thesis contributes to service literature by examining the influence of

I would like to express my appreciation exclusively to my supervisor Professor

Furthermore, I would also like to extend my gratitude to my parents; Montathip

LIST OF FIGURES AND TABLES......................................................................viii

About the thesis: A not from the author...................................................................1

CHAPTER 2: BUILDING CLIENT PSYCHOLOGICAL COMFORT

CHAPER 3: BUILDING CLIENT PSYCHOLOGICAL COMFORT THROUGH

CHAPTER 4: MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE OF

Appendix 1: Questionnaire – Study 1 (Chapter 2)............................................156

CHAPTER 2: BUILDING CLIENT PSYCHOLOGICAL COMFORT

CHAPER 3: BUILDING CLIENT PSYCHOLOGICAL COMFORT

CHAPTER 4: MEDIATING ROLE OF ATTRIBUTIONAL CONFIDENCE

The thesis consists of three academic paper-styled manuscripts1, each of which

reports empirical evidence of client psychological comfort developed from perceived

communication style in the contexts of professional services. Sections of this thesis

have been accepted for presentation and appeared in international conference

Roongruangsee, R. & Patterson, P. G. (2014). The impact of communication style on

psychological comfort in a professional consumer services context: An East ‒

West culture perspective. ANZMAC 2014 Conference, Brisbane, Australia.

comfort through communication style in financial advisory services.

ANZMAC 2016 Conference, Christchurch, New Zealand.

Building client psychological comfort through communication style in

financial advisory service. EMAC 2017 Conference Poster Session,

Groningen, The Netherlands.

Patterson, P. G. & Roongruangsee, R. (2018). The impact of communication style on

client psychological comfort in healthcare services. SERVSIG 2018

Conference, Paris, France.

The overall objective of this thesis is to empirically examine the influence of

client-perceived communication style on client psychological comfort in a

The professional services industry is one of the world’s fastest growing

evolution of professional services marketing, including information technology,

Bindl, 2007). As contemporary service industries encounter highly competitive

environments, it is of paramount importance that service providers establish positive

Gremler & Gwinner, 2000; Reinartz, Krafft, & Hoyer, 2004).

With regard to professional services targeted to the consumer market (e.g.,

healthcare, legal, financial, accounting, psychological counselling, and architectural

requirement stems from the consultative and problem-solving characteristics of

usually delivered by highly qualified personnel over continuous courses of

transactions and service encounters (McColl-Kennedy, Patterson, Brady, Cheung, &

There is asymmetry of information between service providers and clients, in which

understandings, financial investing strategies) than service providers; most clients

Mills & Moshavi, 1999; Mitra et al., 1999).

1.2 Client Evaluations of Professional Services

Because of the technical complexity of professional services—and the

that relationships between professional service providers and clients will be

problematic (Mikolon et al., 2015). With regard to interpersonal communication in

contact service providers make is failure to communicate effectively with clients

using verbal communication that causes clients to receive inadequate information,

misinterpret information, or be unclear about directions (Centre for Culture, Ethnicity,

highly complicated (VFA Learning, 2017). Similarly, clients of financial advisory