Influence of Promotional Strategies, Brand Image, Quality of Service and Price Against Community Trust (Study on TK II Hospital dr. Soepraoen)

Community trust in a health institution is fundamental. Trust is a number of specific beliefs about integrity (trustworthy party honesty and ability to keep promises), behevolence (trustworthy attention and motivation to act in accordance with interests that trust them), competency (the ability of trusted parties to carry out trusting needs) and predictability (consistency in the behavior of trusted parties). The purpose of this study is to influence the promotion strategies, brand image, service quality, and price on public trust (Studies in Soepraoen Hospital Malang). The research design used is quantitative research. The research method used is quantitative research method causal research. The sampling technique used proportional sampling with a sample of 100 respondents. Data analysis techniques using multiple linear regression tests. The results showed that the descriptive results of promotion strategy variables showed an overall average value of 4.15 with a percentage of 26% and a good category, descriptive Brand Image variables had an overall average value of 4.05 with a percentage of 41% with good categories, in the descriptive variable Price Performance had a value the overall average of 4.10 in the good category with a percentage of 30%, in the Service Quality variable has a mean overall score of 4.07 in the good category of 36%, and the variable patient trust during treatment has an overall average value of 3.99 in the good category with percentage 68%. Of the 100 respondents studied in the promotion strategy have a significant influence on trust, in brand image has a significant influence on trust, at prices having a significant influence on trust, on service quality has a significant influence on trust, and simultaneously for each each promotion strategy variable, brand image, price, and service quality have a significant influence on trust. The trust variable is more influenced by the service quality variable than the promotion strategy, brand image, and price variable.


ABSTRAK
Community trust in a health institution is fundamental. Trust is a number of specific beliefs about integrity (trustworthy party honesty and ability to keep promises), behevolence (trustworthy attention and motivation to act in accordance with interests that trust them), competency (the ability of trusted parties to carry out trusting needs) and predictability (consistency in the behavior of trusted parties). The purpose of this study is to influence the promotion strategies, brand image, service quality, and price on public trust (Studies in Soepraoen Hospital Malang). The research design used is quantitative research. The research method used is quantitative research method causal research. The sampling technique used proportional sampling with a sample of 100 respondents. Data analysis techniques using multiple linear regression tests. The results showed that the descriptive results of promotion strategy variables showed an overall average value of 4.15 with a percentage of 26% and a good category, descriptive Brand Image variables had an overall average value of 4.05 with a percentage of 41% with good categories, in the descriptive variable Price Performance had a value the overall average of 4.10 in the good category with a percentage of 30%, in the Service Quality variable has a mean overall score of 4.07 in the good category of 36%, and the variable patient trust during treatment has an overall average value of 3.99 in the good category with percentage 68%. Of the 100 respondents studied in the promotion strategy have a significant influence on trust, in brand image has a significant influence on trust, at prices having a significant influence on trust, on service quality has a significant influence on trust, and simultaneously for each each promotion strategy variable, brand image, price, and service quality have a significant influence on trust. The trust variable is more influenced by the service quality variable than the promotion strategy, brand image, and price variable.

INTRODUCTION
The level of public trust in returning to hospital is influenced by how well the hospital is doing promotions, brand image, service quality and price to patients undergoing treatment at the hospital. Promotion strategies can be carried out internally (improving health services, mobilizing doctors, nurses and all hospital employees) and externally (providing information about hospital services that do not violate the code of ethics, using mass media, providing tarif information clearly, etc.) (Sudjana , 2009).
In addition to promotional strategies, brand image is something that must be considered because according to Setiadi (2012), consumers who have a positive image of a brand will be more likely to make purchases. Brand image can be seen from three dimensions: functional image, affective image, and reputation. Service quality greatly influences the patient's level of trust to return to the hospital because the product that satisfies one's preferences is the highest quality product (Garvin in Tjiptono, 2012: 143). The price is the balance of patients returning to the hospital because patients are very calculating the ability to fulfill the dependents provided by the hospital. According to Stanton in Rosvita (2010) price indicators include: affordability of prices, conformity of prices with product quality, price competitiveness and price compatibility with benefits. Therefore, to find out the factors of influence of the four variables on public trust the researchers chose the title "Effect of Promotion Strategy, Brand Image, Service Quality and Price on Public Trust (Study of Dr. Soepraoen's Second Hospital)"

METHODS
The design of this study is a quantitative approach. The sample used in this study were 100 patients who stayed at the TK Hospital. II dr. Soepraoen, Malang by using a proportional sampling technique. The analytical method used is the validity test, and the reliability test with = 5%. In other words, the variable will be valid and reliable if it has a value greater than. Sources of data in this study are primary data from the results of questionnaires and secondary data from research-related documents. In other words, the method of collecting data in this study is to use questionnaires or questionnaires and documentation. Descriptive analysis was carried out to analyze the results of the collected data after testing the hypothesis test on each variable using multiple linear regression tests. The level of significance of variables can be seen using the t test and f test. Furthermore, the determination test (R2) is used to measure how far the regression ability in explaining the variation of the dependent variable. The coefficient of determination is 0 (zero) and 1 (one).  (2018) Based on table 2, from 100 respondents it can be concluded that the results of respondents based on the age of the most are patients with ages between 31-40 years as many as 47 people (31%).  (2018) Based on table 3, from 100 respondents it can be concluded that the results of respondents based on the highest level of education are patients with Diploma level education as many as 40 people (40%).  (2018) Based on table 4, from 100 respondents it can be concluded that the results of respondents based on the economic status of the most are patients with income of 4.1 million -5 million as many as 36 people (36%).  (2018) Based on the results of table 5, the highest mean value is 4.21-5.00 at 60% with the Very High / Good category. This means that Dr. Soepraoen already has a very high / good promotion strategy that is supported by the implementation of the indicators mentioned above. So that it can be proven from the results of research that show 60% of the promotion strategy carried out by the hospital Dr. Soepraoen is in a very good category.  (2018) Based on table 6, the highest mean value is 4.21-5.00 by 50% with the Very High / Good category. This means that Dr. Soepraoen already has a very high brand image that is supported by the implementation of the indicators mentioned above. So that it can be proven from the results of research that shows 50% Brand Image conducted by the hospital Dr. Soepraoen is in a very good category.  (2018) Based on table 7, the highest mean value is 4.21-5.00 at 60% with the Very High / Good category. This means that Dr. Soepraoen already has very high / good prices supported by the implementation of the indicators mentioned above. So that it can be proven from the results of research that shows 60% of the price made by the hospital Dr. Soepraoen is in a very good category.  (2018) Based on table 8, the highest mean value is 4.21-5.00 at 52% with the Very High / Good category. This means that Dr. Soepraoen already has very high / good service quality which is supported by the implementation of the indicators mentioned above. So that it can be proven from the results of research that shows 52% of the quality of services carried out by the hospital Dr. Soepraoen is in a very good category.  (2018) Based on table 9, the highest mean value is 4.21-5.00 at 68% in the High / Good category. This means that Dr. Soepraoen already has high / good trust which is supported by the implementation of the indicators mentioned above but needs to be improved again. So that it can be proven from the results of research that show 68% of the trust carried out by the hospital Dr. Soepraoen in the High / Good category.

Effect of Nurse Behavior on Patient Comfort During Receiving Care at TK II Hospital Dr. Soepraoen
Nursing plays a key role in patient satisfaction because it affects every dimension of service quality. Providing satisfying service to patients is a priority and helps nurses to develop therapies and approaches that aim to improve health status and help undergo treatment. If explained in more detail, the knowledge, attitudes, beliefs, and values in question are hospital employees who are able to understand work procedures well in handling patients in the field of health services, applying knowledge, analyzing the patient's condition first, accepting suggestions and input well in patient care, can respect patient complaints by responding quickly and precisely, have responsibility in serving patients, have high trust in dealing with an illness, high self-confidence and diligent in caring for patients, have good behavior in caring for patients, and having good moral care in line with the explanation from Purwanto (2009) and Green (2010).
Behavioral variables with the highest mean value are 4.47 with the statement of indicators, namely hospital employees are able to apply knowledge in carrying out services in the health sector. These results can be intended that the behavior of a hospital nurse is directly proportional to the comfort of the patient produced. This is in accordance with the statement from Sunaryo (2014) which explains that behavior based on knowledge is generally lasting. Based on the data analysis that has been done in the study, it can be seen that nurse behavior has a significant positive effect on patient comfort. That is, the better and higher level of behavior possessed by nurses will be followed by the higher comfort of these patients. Courteous nurse behavior and in accordance with the implementation protocol are clearly seen as long as the nurses care for the patient.
Thus, nurses have high competence and sufficient knowledge so as to create comfort for patients because patients express their satisfaction regarding the care they get.

The Effect of Spatial Planning on Patient Comfort During Receiving Care at TK II Hospital Dr. Soepraoen
Behavior of nurses, a hospital must also have spatial standards for patients. Spatial indicators that must be considered include eye views on the shape of the building; The layout of the building is made multilevel or wide; Temperature controlled in the room; The area of the room which is on average not too dense; Information aspects; and Supply of drinking water and bath water. Based on data analysis that has been done in the study, it can be seen that spatial planning has a significant positive effect on patient comfort. That is, the better and higher the level of layout that the hospital has, the more comfortable the patient will be. the spatial variable with the highest mean value is 4.27 with the statement of the indicator namely the supply of water for the room cleanliness system is fulfilled. These results can be intended that the behavior of a hospital nurse is directly proportional to the comfort of the patient produced. This is supported by the theory expressed by Wasisto (2014) that the quality of health services is supported by many factors that exist in hospitals as a system. The layout in this hospital is very strategic because the location has a large and neatly arranged building. The neat arrangement facilitates the mobilization system in the hospital, so that it is easily accessible for both patients and families. In addition, a room that is designed to maintain a stable temperature, ventilation and lighting is sufficiently very supportive of the patient's care process so that it can create comfort for patients. Thus, it can be said that the layout of the Hospital is TK. II dr. Soepraoen has met the comfort criteria that support the patient care process during treatment.

Effect of Hospital Environment on Patient Comfort During Receiving Care at TK II Hospital Dr. Soepraoen
From the results of observations and questionnaires that have been filled by respondents, Hospital Tk. II dr. Soepraoent has fulfilled several prescribed indicators or parameters. Based on the explanation described above, it can be concluded that patient satisfaction can be influenced by the high and low environment of a hospital as determined by the Indonesian Ministry of Health (2006). Based on the data analysis that has been done in the study, it can be seen that the environment has a significant positive effect on patient comfort. That is, the better and higher level of the environment that the hospital has, it will be followed by the higher comfort of these patients. Environmental variables with the highest mean value are 4.33 with a statement of indicators, namely the room in the hospital is protected from disturbing noise. This means that the hospital is directly proportional to the patient's comfort. Environmental variables produce an average of 4.06, which means the environment at the Hospital. II dr. Soeprao is in a good category. While the highest average of the 22 indicators of environmental variables is in the high / good category with an average value of 4.21-5.00 and a percentage of 52%.
Neighborhood Hospital II dr. Soepraoen strongly supports patient comfort while receiving care. This hospital has given its efforts in creating patient comfort. Room support facilities such as communication facilities, fire extinguishers, and the availability of sufficient quantities of bathrooms are also preventive measures that support patient comfort during treatment.

Effect of Health Service Quality on Patient Comfort During Receiving Care at TK II Hospital Dr. Soepraoen
Based on data analysis that has been done in the study, it can be seen that the quality of health services has a positive and significant influence on comfort. This means that the better and higher level of service quality that is owned by the hospital then, will be followed by the increasing comfort of patients during treatment. The quality of health services refers to the level of perfection of health services, which on the one hand can lead to satisfaction in each patient according to the level of satisfaction of the average population, and on the other hand the procedure of implementation is in accordance with established standards and professional codes (Azwar, 2000).
During the observation at the Tk Hospital. II dr. Soepraoen, all patients, both mild, middle, and patients with severe categories, received treatment in accordance with the procedure. All patients will be treated until completed according to the procedures set by the hospital. The level of excellent service is very helpful for patients during treatment. in the hospital.

Effect of Health Service Quality on Patient Comfort During Receiving Care at TK II Hospital Dr. Soepraoen
Based on the data analysis that has been carried out in the study, it can be seen that simultaneously for the four variables including behavior, spatial planning, environment, and service quality have a positive and significant effect on patient comfort, meaning if the behavior, spatial layout, environment, and service quality if have a high value, the patient's comfort level will also increase. This is in accordance with the research of Muhith and Nurwidji (2014) the work ability of nurses at RSU Dr. Wahidin Sudiro Husodo and Rekso Waluyo Hospital in Mojokerto have a significant influence on service quality, this means that the higher the work ability of nurses at RSU Dr. Wahidin Sudiro Husodo and Rekso Waluyo Hospital Mojokerto (based on dimensions or indicators of identification of work, significance of work, autonomy, and feedback), the level of quality of inpatient services in hospitals based on nurses' assessment is getting better as well.
Nurses' behavior in accordance with good work procedures, excellent spatial and environmental conditions and services that do not differentiate greatly affect the comfort of patients while undergoing treatment at the Tk Hospital. II dr. Soepraoen. In line with the previous explanation, all patient comfort criteria have been fulfilled by the hospital so that almost all patients stated comfort during treatment at the Hospital. II dr. Soepraoen, Malang.

CONCLUSION
The results of the study on data analysis: Behavioral variable shows the overall average value of 4.16 with a percentage of 38% and good category, Spatial variables have an overall average value of 4.07 with a percentage of 45% in the good category, Environmental variables have an overall average value of 4.06 in the good category with a percentage of 36%, Variable quality of health care has a value of average overall 4.19 in the good category percentage 61%, Variable patient comfort during treatment has an overall average value of 4.00 in the good category with a percentage of 68%., Based on the value of the determination coefficient obtained by the number 94.7%, it means that the contribution percentage of the effect of the independent variable of compensation consisting of behavior, spatial planning, environment, and service quality on the dependent variable of comfort is 94.7%.

SUGGESTION
Making input to the management of inpatient health services at Dr. IIepraoen TK II Hospital regarding patient response to the quality of care as long as patients receive care Provide input to the hospital management about the influence of the environment, spatial planning, care and quality of service on the quality of comfort as long as the patient receives treatment at the hospital.
For researchers to develop knowledge in the field of hospital administration and as a basis for the development of research on the quality of health services in hospitals and can find out the basis of data processing in research.