The moderating role of e-health literacy in the effect of digital relationship marketing components on relationship quality in health services

This study aims to examine the effect of digital relational marketing in healthcare services on relationship quality and to assess how each component of digital relational marketing—credibility, bonding, communication, and conflict management—impacts the trust, commitment, and satisfaction dimensions of relationship quality. It also investigates whether e-health literacy plays a moderating role in these effects. Although digitalization is rapidly spreading in the healthcare sector, studies that evaluate the impact of digital relational marketing on relationship quality—especially in a holistic manner— remain limited. Moreover, research on the moderating role of e-health literacy, defined as individuals' ability to understand and use digital health information, is lacking. In this context, the study is expected to contribute to the literature. An online survey was administered to 397 participants aged 18 and over who received healthcare services within the past two years at private hospitals in Ankara. The findings indicate that digital relational marketing significantly influences overall relationship quality and that each relational marketing component significantly affects specific dimensions of relationship quality. Among the components—credibility, bonding, communication, and conflict management—credibility, communication, and conflict management exert the strongest effects on trust, while bonding has the strongest effect on commitment. Finally, e-health literacy was found to have a significant moderating effect on the relationship between digital relational marketing and relationship quality. These results show that, for human-centered healthcare organizations, digital relational marketing is a critical success factor in patient relationship management. The strong impact of credibility, communication, and conflict management on trust underscores patients' primary expectations in digital interactions: transparency, consistency, and proactive problem-solving capability. The strong effect of bonding on commitment confirms the vital role of personalized service delivery (e.g., appointment reminders, mobile-app notifications, tailored video-based treatment education) in strengthening patient loyalty. The study's most important and novel contribution is demonstrating that e-health literacy plays a significant and positive strengthening (moderating) role in the link between digital relational marketing and relationship quality. As individuals' ability to obtain, understand, and use digital health information increases, the capacity of healthcare organizations' digital marketing efforts to enhance relationship quality also rises to a statistically significant degree. The study further shows that, in an increasingly digital healthcare environment, effective digital relational marketing practices positively influence relationship quality within customer relationship management (CRM) processes, and that sustaining these gains requires improving the target audience's e- health literacy. In light of these findings, digital relational marketing strategies are shown to be effective in enhancing relationship quality. However, to achieve more impactful and sustainable outcomes, digital relational marketing initiatives should proceed in tandem with interventions that improve e-health literacy—such as education, support, and user- friendly interface design. This holistic approach increases individuals' competence in using and understanding digital health tools and maximizes the positive impact of digital relational marketing on relationship quality. Ultimately, this integrated and personalized strategy forms the foundation—and the key—for healthcare organizations to build long- term, trust-based, and loyal patient relationships in the digital age.