Open AccessArticle Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh 1 Department of Business Administration, Faculty of Business and Entrepreneurship, Daffodil International University, Ras Al Khaimah Campus, Ras Al Khaimah P.O. Box 10021, United Arab Emirates 2 Department of Business Administration, Faculty of Business and Entrepreneurship, Daffodil International University, Dhaka P.O. Box 1216, Bangladesh 3 PSU Center for Global Health Research and Innovation (C-GHRi), Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand 4 Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand 5 Department of Philosophy, College of Arts and Sciences (CAAS), International University of Business, Agriculture and Technology, Dhaka 1230, Bangladesh 6 School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571, Australia 7 Department of Business Studies, State University of Bangladesh, Dhaka 1461, Bangladesh 8 Faculty of Business and Communications (FBC), INTI International University, Nila 71800, Malaysia * Author to whom correspondence should be addressed. Int. J. Environ. Res. Public Health 2026, 23(6), 769; https://doi.org/10.3390/ijerph23060769 (registering DOI) Submission received: 24 February 2026 / Revised: 24 May 2026 / Accepted: 5 June 2026 / Published: 7 June 2026 Highlights Public health relevance—How does this work relate to a public health issue? Chronic kidney disease is a growing burden in Bangladesh, with limited urban focused-dialysis services available. Understanding revisit intention among the patient’s attendance insight into continuity of care in urban health systems. Public health significance—Why is this work of significance to public health? The study identifies that the key determinants of revisit behavior are cost, perceived trust in healthcare providers, and patient satisfaction. Findings also highlight the mediating role of satisfaction in linking service quality, trust, and affordability to patient loyalty. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Improving affordability and strengthening perceived trust in healthcare providers can enhance patient retention in dialysis services. Providers and policymakers should prioritize patient-centered strategies to improve satisfaction and ensure sustainable dialysis care in urban Bangladesh. Chronic kidney disease (CKD) is a rising public health concern in low- and middle-income countries (LMICs), with urban populations disproportionately affected. In Bangladesh, particularly in Dhaka, dialysis services have become essential for CKD management. This study investigates the determinants of revisit intention among adult attendants of dialysis patients in Dhaka, using partial least squares structural equation modeling. A cross-sectional survey was conducted across four major dialysis centers totaling 399 valid responses. A purposive sampling technique was employed to ensure the inclusion of respondents with relevant experience and engagement in dialysis service utilization. Among respondents, over half were male, 43% had primary to higher secondary education, and one-third reported household incomes between BDT 40,001 and 60,000. The largest age group was 45–49 years (32.3%), and nearly 60% selected the facility due to nearness. Reliability and validity metrics met recommended thresholds, and multivariate normality was not assumed (Mardia’s test, p 0), indicating the predictive relevance of the model. Additionally, comparison between the prediction errors between PLS-SEM model and linear benchmark model (LM) showed largely comparable root mean squared error (RMSE) [ 30, 41], with half of the indicators that showed lower prediction errors under the PLS model and the rest that showed only marginal difference, indicating acceptable out-of-sample predictive performance. 3.7. Multi-Group Analysis Across Facility Types For the comparison of the structural relationship, multi-group analysis (MGA) was performed and presented in Table S5. The MGA result showed that most structural relationships did not significantly differ across facility types, while the effects of cost on perceived revisit intention ( p = 0.033), perceived patient satisfaction on perceived revisit intention ( p = 0.002), and perceived trust in healthcare providers on perceived patient satisfaction ( p = 0.007) significantly differed between public and private facilities, indicating that affordability, trust and satisfaction play a comparative roles in shaping the revisit intention among the public dialysis facilities. 4. Discussion The study revealed that adult attendants of dialysis patients in Dhaka expressed a strong intent to revisit the same dialysis facilities. Perceived revisit intention was significantly influenced by cost, perceived trust in healthcare providers, and perceived patient satisfaction. While dialysis service quality and word of mouth did not show direct effects on perceived revisit intention, both contributed indirectly by enhancing perceived patient satisfaction. Mediation analysis confirmed that perceived patient satisfaction plays a central role in linking service quality, trust, word of mouth, and cost to revisit behavior. These findings highlight the importance of trust, perceived value, and satisfaction in shaping loyalty among dialysis patient attendants in urban Bangladesh. This study included multiple dialysis centers in Dhaka, improving contextual relevance. Moreover, the sample characteristics were compared with the national dialysis statistics and show similar distribution, though generalizability remains limited [ 3]. The use of a localized, literature-informed tool and trained staff helped ensure data quality. PLS-SEM allows detailed analysis of complex relationships. However, several limitations should be acknowledged. The reliance on self-reported data may introduce social desirability bias. The purposive sampling of facilities limits generalizability and may introduce selection bias. Additionally, the exclusion of attendants of inpatients and those with severe medical conditions may have omitted perspectives from more vulnerable caregiving contexts. The data did not meet the assumption of multivariate normality, which, although permissible in PLS-SEM, may affect the generalizability of parametric interpretations. The study focused solely on attendants’ perspectives, which may differ from patients’ own experiences and decision-making processes. Additionally, when it comes to trust in facility and staff, which is built over time, or the word of mouth, our inclusion criteria did not account for the duration of the taking of the dialysis a specific facility, which influences the trust issues. Future studies should consider these issues. Finally, this is a cross-sectional study, and the findings should be interpreted as an association rather than a causal relationship. 5. Conclusions This study examined the factors influencing revisit intention among adult attendants of dialysis patients in Dhaka. The findings indicate that cost, trust in healthcare providers, and patient satisfaction significantly contribute to revisiting behavior, with patient satisfaction playing a central mediating role. While dialysis service quality and word of mouth did not show direct effects on revisit intention, both contributed indirectly through their influence on satisfaction. These results suggest that enhancing trust, perceived value, and satisfaction may be effective strategies for improving service retention in urban dialysis settings. Importantly, this study was conducted during the dialysis sessions; in the context of Bangladesh it is common to present a caregiver during the treatment session, but the perspective of the caregiver is also very important in the context of Bangladesh as suggested by the findings of our study. However, the interpretation of recommendation is framed cautiously, emphasizing affordability trust and satisfaction as empirically supported drivers of revisit intention rather than prescriptive causal determinants. The non-significant direct effects of service quality and word of mouth highlight the need for further investigation into how these constructs operate in caregiver decision-making contexts. Additionally, the government could consider subsidy models, trust-building programs, and targeted service quality improvements. Supplementary Materials The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph23060769/s1, Table S1: Survey Instrument; Table S2. Reliability Analysis; Table S3. Discriminate Validity; Table S4. Assessment of Out-Of-Sample Predictive Performance; Table S5. Multi-Group Analysis (MGA) Across Public and Private Dialysis Facilities. Author Contributions T.F.A., R.I., K.F.S., K.K., K.E.A., S.F.P. and K.S.A. jointly conceptualized the study and designed the analytical approach. T.F.A. and R.I. led data collection, monitoring and overall project management. T.F.A. and K.F.S. led analysis, interpretation, and wrote original draft. T.F.A., K.F.S., S.F.P. and K.S.A. contributed to responding to the reviewer comments, revising the manuscripts, and language editing. T.F.A., K.F.S., K.K., K.E.A., S.F.P. and K.S.A. provided critical input on the methodology and supported the interpretation of findings. All authors have read and agreed to the published version of the manuscript. Funding The authors did not receive any funding or financial support to conduct this study. Institutional Review Board Statement Ethical approval for the study was obtained from the institutional review boards of the Daffodil International University, Bangladesh, under the reference number DIU/DoR/EC/240103, 15 January 2024. Informed Consent Statement Written informed consent was obtained from all the individual participants included in the study prior to data collection. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to ethical considerations and participant confidentiality, the dataset is not publicly shared. Acknowledgments We acknowledge the research participants for their voluntary role and shared their valuable opinion. Conflicts of Interest There are no potential conflicts of interest to be disclosed. 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Socio-Demographic Characteristics of the Respondents. Table 1. Socio-Demographic Characteristics of the Respondents. Variable Items Frequency Percentage Gender Male 239 59.9% Female 160 40.1% Educational Primary/secondary/higher secondary 174 43.6% Diploma and equivalent 159 39.8% Bachelor/Master/decorated degree 46 11.5% Others 20 5.0% Household Income † Below 20,000 69 17.3% 20,001–40,000 23 5.8% 40,001–60,000 132 33.1% 60,001–80,000 56 14.0% 80,001–100,000 56 14.0% 100,001–Above 63 15.8% Patients Age Group 18–30 32 8.0% 31–44 56 14.0% 45–49 129 32.3% 50–59 42 10.6% 60–64 124 31.1% 65 and above 16 4.0% Residence Urban 337 84.5% Rural 62 15.5% Reason For Choosing the Dialysis Center Located Nearby 242 60.7% Doctor Referral 99 24.8% Others factor 58 14.5% Note. † Currency values are presented in Bangladeshi Taka (BDT). Table 2. Hypothesis Testing for Path Coefficient. Table 2. Hypothesis Testing for Path Coefficient. Hypothesis Coefficient t-Values 95% CI p-Value Decision Q 2R 2f 2CO -> PS 0.294 4.441 0.163, 0.409 PS 0.152 3.033 0.038, 0.238 0.003 Accepted 0.022 THP -> PS 0.229 4.317 0.126, 0.332 PS 0.103 2.128 0.013, 0.192 0.034 Accepted 0.024 CO -> RI 0.167 2.936 0.061, 0.281 0.003 Accepted 0.279 0.477 0.026 DDS -> RI 0.008 0.152 −0.099, 0.102 0.879 Rejected 0.000 PS -> RI 0.422 7.760 0.321, 0.523 RI 0.252 5.379 0.168, 0.344 RI −0.044 0.966 −0.136, 0.037 0.334 Rejected 0.003 Note. DDS = dialysis delivery service; THP = trust in healthcare providers; WOM = word of mouth; CO = cost; PS = patient satisfaction; RI = revisit intention; R 2 indicates the proportion of variance explained by the exogenous constructs. Q 2 reflects the model’s predictive relevance, and f 2 represents the effect size; CI = Confidence Interval. Table 3. Hypothesis Testing for Mediation Effect. Table 3. Hypothesis Testing for Mediation Effect. Hypothesis Coefficient t-Values 95% CI p-Value Mediation Type THP -> PS -> RI 0.097 4.386 0.055, 0.140 PS -> RI 0.044 2.103 0.005, 0.084 0.036 Complementary DDS -> PS -> RI 0.064 2.641 0.019, 0.114 0.009 Complementary CO -> PS -> RI 0.124 3.624 0.059, 0.195 <0.001 Complementary Note. DDS = dialysis delivery service; THP = trust in healthcare providers; WOM = word of mouth; CO = cost; PS = patient satisfaction; RI = revisit intention; CI = Confidence Interval. Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Share and Cite MDPI and ACS Style Abir, T.F.; Islam, R.; Salahin, K.F.; Kakon, K.; Agho, K.E.; Peris, S.F.; Ali, K.S. Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh. Int. J. Environ. Res. Public Health 2026, 23, 769. https://doi.org/10.3390/ijerph23060769 AMA Style Abir TF, Islam R, Salahin KF, Kakon K, Agho KE, Peris SF, Ali KS. Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh. International Journal of Environmental Research and Public Health. 2026; 23(6):769. https://doi.org/10.3390/ijerph23060769 Chicago/Turabian Style Abir, Tanvir Fittin, Rakibul Islam, Kazi Fayzus Salahin, Kaniz Kakon, Kingsley Emwinyore Agho, Sandy Francis Peris, and Khan Sarfaraz Ali. 2026. "Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh" International Journal of Environmental Research and Public Health 23, no. 6: 769. https://doi.org/10.3390/ijerph23060769 APA Style Abir, T. F., Islam, R., Salahin, K. F., Kakon, K., Agho, K. E., Peris, S. F., & Ali, K. S. (2026). Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh. 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Exploring Facility Revisit Intentions Among the Kidney Dialysis Patient’s Attendance: Evidence from a Cross-Sectional Study in Dhaka, Bangladesh
