Highlights

Abstract

Keywords

۱٫ Introduction

۲٫ Theoretical background

۳٫ Methodology

۴٫ Empirical evidence

۵٫ Results and discussion

۶٫ Conclusions

Acknowledgement

References

Vitae

Abstract
Purpose
This research aims to increase understanding on how multilevel trust is developed as well as how trust levels are interconnected and influence international marketing strategy for healthcare services.

Design/Methodology/Approach
A comparative case study approach was applied with Elekta, a Swedish firm, operating in Brazil, the Philippines, China, Russia, and Hong Kong.

Findings
The research culminated in a multilevel trust (MLT) model comprised of three levels relating to individuals, company performance, and context.

Research implications/limitations
This study offers a context-based multilevel trust model from a process perspective focusing on healthcare. This model can be tested in other service sectors.

Practical implications
Managers should consider multilevel trust to boost relationships and achieve local acceptance.

Originality/Value
This research contributes to trust theory by constructing a context-based multilevel trust model for international healthcare marketing.

۱٫ Introduction

This study deals with multilevel trust in healthcare services and how it affects international marketing strategy in emerging markets. Knowledge on multilevel trust is essential to understand how trust is built to facilitate development of long term relationships (Zaheer & Zaheer, 2006). Trust can be defined as the willingness to rely on an exchange partner one has confidence in (Bianchi & Saleh, 2010). Currall and Inkpen (2006) assert that trust needs to be discussed at different levels—person, group, and firm—to comprehend its role in organizational performance. They further claim that over time interpersonal trust can evolve to intergroup and then to interorganizational trust. Trust is thus dynamic, which makes multilevel trust a major issue in understanding interorganizational relationships.

Considering its importance and limited understanding on multilevel trust, a special issue in Journal of Trust Research was dedicated to this topic (Volume 8:2, 2018). Researchers have studied trust at micro levels (citizenship behavior, Mayer & Gavin, 2005; negotiation success, Lee, Yang, & Graham, 2006), and macro levels (strategic alliances, Fryxell, Dooley, & Vryza, 2002). Mouzas, Henneberg, and Naudé (۲۰۰۷) have discussed trust at personal and organizational levels, differentiating trust between individuals internally and representing different organizations. Lyu and Ferrin (2018) term personal trust as interpersonal trust; Zaheer, McEvily, and Perrone (1998) introduced interorganizational trust, which refers to the collective trust of members of one organization for another. Fregidou-Malama and Hyder (2015) add country-level trust to the other two levels to initiate trust discussion in international marketing.