Analysis of citizen satisfaction in municipal services

Romero-Subia, José Fernando; Jimber del Río, Juan Antonio; Ochoa-Rico, María Salomé; Vergara-Romero, Arnaldo Article Analysis of citizen satisfaction in municipal services Economies Provided in Cooperation with: MDPI – Multidisciplinary Digital Publishing Institute, Basel Suggested Citation: Romero-Subia, José Fernando; Jimber del Río, Juan Antonio; Ochoa-Rico, María Salomé; Vergara-Romero, Arnaldo (2022) : Analysis of citizen satisfaction in municipal services, Economies, ISSN 2227-7099, MDPI, Basel, Vol. 10, Iss. 9, pp. 1-24, https://doi.org/10.3390/economies10090225 This Version is available at: https://hdl.handle.net/10419/328525 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. 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Economies 10: 225. https://doi.org/10.3390/ economies10090225 Academic Editor: Ralf Fendel Received: 4 July 2022 Accepted: 8 September 2022 Published: 14 September 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 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 (https:// creativecommons.org/licenses/by/ 4.0/). economies Article Analysis of Citizen Satisfaction in Municipal Services JoséFernando Romero-Subia 1, Juan Antonio Jimber-del Rio 1,* , María SaloméOchoa-Rico 1,2 and Arnaldo Vergara-Romero 3 1 Department of Agricultural Economics, Finance and Accounting, Faculty of Economics and Business Sciences, Universidad de Córdoba, Plaza de Puerta Nueva s/n, 14002 Cordoba, Spain 2Faculty of Economic, Universidad Ecotec, Samborondón 092301, Ecuador 3Department of Research, Universidad Ecotec, Samborondón 092301, Ecuador *Correspondence: [email protected] Abstract: Citizen demand for quality public services is increasing, and improvements in the provision of public services affect citizen satisfaction and loyalty. This research is to evaluate citizens’ loyalty to municipal officials on the quality of public services provided by the municipality. The measurement is made through a household-level survey, with a sample of 428 valid questionnaires, in a rural parish of Tengel in Guayaquil, following the American Customer Satisfaction Index (ACSI). This study used the Warp-PLS 7.0 software with a structural equation model to evaluate the seven hypotheses raised. A new component is included in this research: the effect of perceived quality in the provision of municipal services in rural areas on the value ratio perceived by the citizen and overall satisfaction. The results obtained allowed us to observe that the loyalty of the citizen to the elected municipal officials depends on citizen satisfaction with the public services provided by the municipal administration in rural areas. In addition, the quality perceived by the citizen modulates at different levels the relationships between the perceived value and the citizen satisfaction. Areas of improvement in the provision of public services such as municipal police, firefighters, veterinary services, parking services and address information were identified. The findings would allow local public administrators to take action to improve the services provided in rural areas in order to maintain the loyalty of citizens. Keywords: citizen satisfaction; municipal services; rurality; SEM; ACSI 1. Introduction Rural territories are seen as good places to live. These assumptions are based on aspects such as community integration, low crime rate and beautiful natural landscapes, which shape the so-called “romantic rural life” (Lee and Lassey 1980;Hubatková2019). On the contrary, other authors indicate that cities can offer a better quality of life in terms of access to services (Bouckaert et al. 2005). The low availability of services is seen as a major setback in rural life (Scharf and Bartlam 2006;Giarchi 2006;Milbourne 2012). In other words, cities can be better places and have greater well-being (Morrison and Weckroth 2018;Okulicz-Kozaryn and Valente 2019). Lack of appropriate data and partial understanding of the term “rural” make it difficult to study (Hubatková2019), Rural areas are not homogeneous in their character but differ, maintaining particularities such as wealth, size, age structure, services, or proximity to urban center (Champion and Hugo 2004;Ballas et al. 2003;Manthorpe et al. 2008). Citizen contributions to democratic governance make governments pay attention to voters’ opinions (Song et al. 2020;Biswas and Roy 2020), while citizens expect politicians to guarantee their demands (Rönnerstrand and Oskarson 2020). Satisfaction plays a fundamental role in re-elections (Martin and Raffler 2020;Esaiasson et al. 2020). In recent decades, governance reforms have sought to improve the quality of public services (Zarychta 2020). Quality of service is considered a fundamental aspect of the Economies 2022,10, 225. https://doi.org/10.3390/economies10090225 https://www.mdpi.com/journal/economies Economies 2022,10, 225 2 of 24 measurement of performance in the public sector (Biswas and Roy 2020), resulting in national or local governments maintaining approaches based on the quality of the public services they provide (Filippetti 2020). For the measurement of service quality, citizen satisfaction is considered a main indicator (Kelly and Swindell 2002;Osborne 2010). Satisfaction is the pleasurable sensation you get when you receive something you want (Remoaldo et al. 2020). From the point of view of consumption, Oliver (1981) mentions that satisfaction is the collection of psychological states, the result of emotions comprising expectations combined with previous consumer feelings about the experience. Quality of service can be defined as a difference between expected (expectations) and perceived service (perceptions) (Parasuraman et al. 1985;Ni et al. 2020). The expectation is influenced by variables such as education level, income level, or social level (Bostancı and Erdem 2020). Consequently, satisfaction is attributed to different expectations between urban and rural populations (Scharf and Bartlam 2006;Sørensen 2014). Studies on expectations, perceived quality and satisfaction in rural areas are scarce, which justifies the analysis of the quality of public services in the Rural Canton of Tenguel (Scharf and Bartlam 2008). The study was conducted in Tenguel, a rural coastal parish in the province of Guayas, Guayaquil canton, Ecuador (Polo Almeida 2020). Tenguel has a population of 13.800 inhabitants, with an average age of 37 years; the male population corresponds to 53.12%, while the female population to 46.88% (Instituto Nacional de Estadísticas y Censos ( INEC ) 2021). Tenguel has been linked to agriculture, livestock, forestry and fishing, mining, and quarrying (Álvarez 2015). The method used in this research to evaluate the satisfaction of the citizens of Tenguel with municipal services was the Structural Equations Model (SEM), the study is based on the American Customer Satisfaction Index (ACSI) (Fornell et al. 1996) which allows us to carry out evaluations about customer satisfaction in the private and public sector (Ogikubo et al. 2009). ACSI is a proven model for use in research on the satisfaction of services such as transportation (Shen et al. 2016), customer service (Hult et al. 2019), economic conditions (Ogikubo et al. 2009), provision of services Ali and Kaur 2018), public trust (Li and Wang 2021), health (Yuliansari et al. 2017), or municipal services (Yuan-yuan et al. 2007). The model is based on the expectations that are created before using the public services provided by the municipality (expected quality). Citizens use public services and perceive the quality of service of the different causes that form the perceived quality, both constructs (expected quality and perceived quality) are related to the perceived value. Citizens compare the balances or imbalances between the perceived cost of local taxes and the value received from municipal public services. When the citizen has internalized the perceived value, he can evaluate satisfaction with the public services provided by the municipality, and the levels of satisfaction will motivate him to recommend or re-elect the municipal authorities (loyalty). The objective of this research is to assess the loyalty of citizens to municipal officials on the quality of public services provided by the municipality in a rural parish in the city of Guayaquil. The study expands the existing literature on citizen satisfaction and loyalty in rural territories. Although it is true that the ACSI method is a traditional and contrasted method, it has been little used in rural areas of Latin America. This research provides new results to the scarce literature on citizen satisfaction with municipal services in rural areas. The ACSI model is made up of indices that estimate causal models. This model is divided into three parts: on the left side are customer expectations, perceived quality and perceived value; in the center is satisfaction and on the right side as a consequence of satisfaction is customer loyalty. The American Customer Satisfaction Index is a tried and tested model that has been used in various studies in the literature (Ogikubo et al. 2009;Shen et al. 2016). The model has a solid foundation that can be successfully adapted to different areas in order to analyze Economies 2022,10, 225 3 of 24 the satisfaction and loyalty of users of a product or service. Customer satisfaction is measured on a scale of 1 to 10, with 1 meaning the customer is very dissatisfied and 10 very satisfied. Customer expectations are also measured on a scale of 1 to 10, with 1 meaning low expectations of the product or service and 10 meaning high expectations. Quality control associations, research groups and universities in countries such as India, Saudi Arabia, Singapore, Dubai, Kuwait, South Africa, Honduras, Puerto Rico and Colombia implement quality and satisfaction control systems. The literature includes similar user satisfaction measurement systems such as “Swedish Customer Satisfaction Barometer” (SCSB) (Hult et al. 2019), “Norwegian Customer Satisfaction Barometer” (NCSB) (Ali and Kaur 2018), “European Customer Satisfaction Index” (ECSI) (Li and Wang 2021), “Hong Kong Customer Satisfaction Index” (HKCSI) (Yuliansari et al. 2017). The model has been used to measure customer loyalty in different fields, such as psychology (Yuan-yuan et al. 2007), satisfaction with university studies (Demirovi´c Bajrami et al. 2020) or rural development (Lenzi and Perucca 2020). It has also been widely used to study the tourism sector (Hoogerbrugge et al. 2021;Bouckaert et al. 2005). After the introduction, the research contains five sections: The second consists of a theoretical framework that includes a description of the results obtained by several authors with their applied methodologies and the constructs of the theoretical model. The third is the presentation of the methodology used. The fourth summarizes the presentation and analysis of results. Finally, we present the discussion and conclusions, followed by the bibliographic references. The improvement of the living conditions of rural areas can be expressed through economic, environmental, social, and cultural benefits (Demirovi´c Bajrami et al. 2020). Elements that are attributed to possible effects of dissatisfaction in rural areas are financial difficulty, poor public transport and few amenities (Scharf and Bartlam 2006). It is common for many of the basic public services such as medical services, communication routes, firefighting services and the police to be less promoted by the authorities in rural areas since the cost-benefit ratio (understood as voters) is not very beneficial. The rural development of a territory is a set of economic, social, technological, institutional, infrastructural, environmental and cultural resources that constitute its development potential (Hidalgo-Fernández et al. 2019) and that can be translated into socioeconomic well-being if it is managed from a territorial perspective, collaborative and respectful of local knowledge and values (Furmankiewicz et al. 2021). Therefore, knowing the quality that a rural citizen expects from municipal services based on their environment, the quality they perceive, the value perceived globally, satisfaction and loyalty are decisive for improving the well-being of citizens, promoting local entrepreneurship of the intrinsic values of the area. Rural development can be understood as the improvement of the economic, social and cultural conditions of a rural territory, with respect for the physical environment and in such a way that it has a positive impact on the quality of life of the resident population and integrates the territory into the whole of society (Boletín de La Asociación de Geógrafos Españoles 2016). The expectations of citizens when it comes to access to quality public services in rural areas differ according to how they tend to see their municipalities: they will have higher accessibility expectations if they see their territory as an urban center; on the contrary, if they see their settlement as eminently rural, they will have expectations of access to worse services, as they see this as a normal particularity of rural life (Hubatková2019). Studies such as that of Lenzi and Perucca (2020) examined the proximity to large cities, with the advantages of access to services that this implies associated with the satisfaction of citizens of smaller places. In their findings, Hoogerbrugge et al. (2021) mention that rural residents living in polycentric regions have greater satisfaction than urban residents. Governments from all over the world have paid attention to public opinion on the performance of their management (Bouckaert et al. 2005;Van Ryzin 2015). An assumption in citizen satisfaction is that the quality of public service is important (Van Ryzin 2015;Van Economies 2022,10, 225 4 of 24 Ryzin et al. 2008), so there is a relationship between citizen satisfaction and government performance. The growing intensity and complexity of public service has spurred policy reform ef-forts across the globe, many featuring attempts to promote more collaborative government. Collaboration in Public Service Delivery sheds light on these efforts, analyzing and reconceptualizing the major types of collaboration in public service delivery through a governance lens (Forrer et al. 2010). In accordance with Bovaird and Loeffler (2007) the quality of local governance in a town in the UK, demonstrating how the concept of local governance can be operationalized, presenting key findings on the quality of local governance in the case study and suggesting that more limited, service-oriented, performance assessment systems may be misleading. Citizen assessments and government performance are reflected in studies conducted in democratic and decentralized contexts, where citizens can reveal their satisfaction or loyalty to the government of their choice through the exercise of election (Brinkerhoff et al. 2018;Choi et al. 2004). Citizen opinion about their satisfaction with public services could provide government officials with feedback on their management and alert them of priorities, the clientele they serve, or how to reallocate resources (Song and Meier 2018). Consequently, citizen perception assessments are used to measure governments at the local or national level (Bouckaert et al. 2005). Perceived quality is considered one of the most studied topics in service marketing (Choi et al. 2004). It is a measured result of the recent consumer experience that has a direct or positive impact on the satisfactory overall customer quotient (Fornell 1992;Cronin et al. 2000). Studies have shown that perceived quality has an impact on customer satisfaction and that satisfaction is primarily determined by perceived quality (Fornell 1992;Martensen et al. 2000;Caruana 2002). Therefore, if perceived quality increases, satisfaction should increase (Johnson et al. 2001). For example, Wangpipatwong et al. (2009) using multiple regression analysis, found a correlation between the quality of service of e-government websites and citizen satisfaction in Thailand. Kelly and Swindell (2002) investigated the relationship between citizen satisfaction with municipal services and the measurement of administrative quality, demonstrating a correlation with citizen satisfaction. Rodrigues and Tavares (2020) investigated the impact of citizen satisfaction on the quality of a public policy of territorial reform implemented in Portugal. This territorial reform had prior economic motivations and its consequences were financial difficulties to citizens. Their findings demonstrated negative democratic effects on electoral participation, such as political protest to the reform. Expected quality is a measure of customer anticipation of the quality of a product or service, it is represented as a pre-purchase experience (Fornell et al. 1996). Oliver (1980) mentioned that a consumer’s satisfaction with a product or service is based on perceived quality and expected quality. Yilmaz et al. (2021) evaluate citizen satisfaction in light rail transit services, through the American Customer Satisfaction Index (ACSI). One of their findings was that the expected quality variable acts as a mediating variable between image and loyalty. It had previously been indicated that variables such as level of education, income level, or social level influence the expected quality (Bostancı and Erdem 2020). Therefore, satisfaction differs from the expected quality of urban and rural populations (Scharf and Bartlam 2006;Sørensen 2014). Bostancı and Erdem (2020) investigated citizens’ satisfaction with local services in Osmaniye, Turkey, using fuzzy FDEMATEL and FTOPSIS models. The study revealed that citizens’ satisfaction with the quality of local services ranged from low to high levels depending on location. Perceived value is considered a compromise between what they receive and what the customer sacrifices in exchange for quality (Johnson et al. 2001;Flint et al. 2002); or the Economies 2022,10, 225 5 of 24 relationship between quality and price paid (Parasuraman et al. 1985;Wangpipatwong et al. 2009). For Zeithaml (1988), it is the evaluation of the value before or after the use or consumption of goods or services. So, if perceived value increases, so will satisfaction (Fornell et al. 1996;Fornell 1992). Ali and Kaur (2018) conducted a detailed review of factors related to expected user quality to assess the perceived value in calculating satisfaction to customers who used the 3PL service using ACSI. Shen et al. (2016) evaluated rail passenger satisfaction using a model of structural equations that determined the influence of expected quality and perceived quality on perceived value and satisfaction. Customer satisfaction is the ability of a product to match its expected quality (Yilmaz et al. 2021;Flint et al. 2002), a post-consumer assessment of the quality of the product or its coincidence between the perceived quality and the perceived value. Consumer satisfaction is fundamental to the practice of consumer sovereignty (Choi et al. 2004), Therefore, customer satisfaction is recognized as influencing the formation of consumers’ future purchasing intentions (loyalty) (Taylor and Baker 1994). Through a trend analysis using structured interviews in South Africa O’Leary (2007) identified variables that have the greatest impact on the provision of municipal services. Among the variables mentioned were public services with a positive impact on the quality of life, spatial location of housing and citizen participation. Samkar and Alpu (2013) studied citizen satisfaction with the services provided by the Municipality of Eskisehir in Turkey. Through factor analysis, their findings allowed them to observe general satisfaction with the services provided by the Municipality, such as transport, transit, cultural and artistic activities, environmental cleaning, urbanism, organization of parks, sports areas and agricultural activities. Customer loyalty is seen as an ingrained commitment to buy back or re-favor a product or service, consistently in the future (Oliver 1999). Disgruntled customers are unwilling to show loyalty to services or products they do not like (Olever 1997;Amin et al. 2013). The relationship between satisfaction and loyalty has gained attention in the literature, there is the certainty that high levels of satisfaction lead to greater purchase intention (Verhoef et al. 2001; J. Y. Kim and Im 2017). In addition, satisfied customers are likely to tell others about their favorable experience and engage in positive advertising of the product or service (Varma and Srikrishna 2016). In an empirical analysis of more than 400 data from Saudi citizens using transactional e-government services, Chatfield and AlAnazi (2013) found that quality of service and citizen satisfaction describe citizens’ loyalty to e-government facilities. A study by Vetrivel Sezhian et al. (2014) showed that the indirect effect of service quality on loyalty through satisfaction is greater than the proportion of satisfaction that directly affects loyalty, in a study of bus transport service users in India. The provision of municipal public services can cover areas such as road maintenance, waste management, security, parking, and traffic control (Ghodousi et al. 2016). However, they differ in each country. For example: In Turkey, a municipality provided cheaper bread with additional vitamins due to the high cost of living (Samkar and Alpu 2013). Likewise, a municipality in Portugal offers a physical activity program to older people (e Sáand Fernandes 2020). This study evaluates the public services provided by the Municipality of Guayaquil to the Rural Parish of Tenguel, in services where Ecuadorian municipal governments have competencies according to the Constitution of the Republic of Ecuador (Asamblea Nacional Constituyente 2008) and the functions established by the Decentralized Autonomous Governments of Ecuador according to the Organic Code of Territorial Organization, Autonomy and Decentralization (COOTAD) (Asamblea Nacional del Ecuador 2010). The variables used to assess the loyalty of citizens to municipal officials on the quality of public services provided by the municipality in the rural parish of Guayaquil were (1) Quality of public services expected in Tenguel parish; (2) perceived quality of public services Economies 2022,10, 225 6 of 24 provided in Tenguel parish; (3) by comparing the expected quality and the perceived quality we can estimate the perceived value; (4) satisfaction, as an emotional or cognitive response of the citizen who uses public services and; (5) loyalty that the citizen has as a result of the experience with municipal public services. The hypotheses used in this study were formulated according to the theoretical framework and previous research in this area (Figure 1). Economies 2022, 10, x FOR PEER REVIEW 6 of 26 This study evaluates the public services provided by the Municipality of Guayaquil to the Rural Parish of Tenguel, in services where Ecuadorian municipal governments have competencies according to the Constitution of the Republic of Ecuador (Asamblea Nacional Constituyente 2008) and the functions established by the Decentralized Autonomous Governments of Ecuador according to the Organic Code of Territorial Organization, Autonomy and Decentralization (COOTAD) (Asamblea Nacional del Ecuador 2010). The variables used to assess the loyalty of citizens to municipal officials on the quality of public services provided by the municipality in the rural parish of Guayaquil were (1) Quality of public services expected in Tenguel parish; (2) perceived quality of public services provided in Tenguel parish; (3) by comparing the expected quality and the perceived quality we can estimate the perceived value; (4) satisfaction, as an emotional or cognitive response of the citizen who uses public services and; (5) loyalty that the citizen has as a result of the experience with municipal public services. The hypotheses used in this study were formulated according to the theoretical framework and previous research in this area (Figure 1). Figure 1. Theoretical research model. Hypothesis 1 (H1). The quality of public services expected by the citizen has a positive and significant influence on the perceived quality of public services (Shabbir et al. 2017; Atombo and Wemegah 2021). Hypothesis 2 (H2). The quality of public services that the citizen expects has a positive and significant influence on the perceived value of public services (Amin et al. 2013; Sun 2018). Hypothesis 3 (H3). The quality of public services perceived by citizens has a positive and significant influence on the perceived value of these public services (Ercsey and Józsa 2016; Peña et al. 2012). Hypothesis 4 (H4). The quality of public services perceived by the citizen has a positive and significant influence on citizen satisfaction with the public service (Nuviala et al. 2012; Dettori et al. 2020). Hypothesis 5 (H5). The value of public services perceived by the citizen has a positive and significant influence on citizen satisfaction (Havas et al. 2016; K. H. Kim and Park 2017). Hypothesis 6 (H6). The quality of public services that a citizen perceives positively and significantly influences his loyalty (Chi et al. 2020; Goyal and Chanda 2017). Hypothesis 7 (H7). A citizen’s satisfaction with public services has a positive and significant influence on citizen loyalty (Castillo Canalejo and Río 2018; Xue and Chen 2019). Figure 1. Theoretical research model. Hypothesis 1 (H1). The quality of public services expected by the citizen has a positive and significant influence on the perceived quality of public services (Shabbir et al. 2017;Atombo and Wemegah 2021). Hypothesis 2 (H2). The quality of public services that the citizen expects has a positive and significant influence on the perceived value of public services (Amin et al. 2013;Sun 2018). Hypothesis 3 (H3). The quality of public services perceived by citizens has a positive and significant influence on the perceived value of these public services (Ercsey and Józsa 2016;Peña et al. 2012). Hypothesis 4 (H4). The quality of public services perceived by the citizen has a positive and significant influence on citizen satisfaction with the public service (Nuviala et al. 2012;Dettori et al. 2020). Hypothesis 5 (H5). The value of public services perceived by the citizen has a positive and significant influence on citizen satisfaction (Havas et al. 2016;K.H.Kim and Park 2017). Hypothesis 6 (H6). The quality of public services that a citizen perceives positively and significantly influences his loyalty (Chi et al. 2020;Goyal and Chanda 2017). Hypothesis 7 (H7). A citizen’s satisfaction with public services has a positive and significant influence on citizen loyalty (Castillo Canalejo and Jimber del Rio 2018;Xue and Chen 2019). 2. Materials and Methods The study was conducted in the rural parish of Tenguel (Figure 2), located in the province of Guayas canton Guayaquil, Ecuador (Polo Almeida 2020). Most of Tenguel’s population has little assembly power when it comes to making public demands to Municipal authorities, except when it comes to social programs and other aspects related to them (Álvarez 2015). The government is a Decentralized Autonomous Municipality, with a mayor and 15 council members who are elected by popular vote for a 4-year term (Muy Ilustre Municipalidad de Guayaquil 2021). Economies 2022,10, 225 7 of 24 Economies 2022, 10, x FOR PEER REVIEW 7 of 26 2. Materials and Methods The study was conducted in the rural parish of Tenguel (Figure 2), located in the province of Guayas canton Guayaquil, Ecuador (Polo Almeida 2020). Most of Tenguel’s population has little assembly power when it comes to making public demands to Municipal authorities, except when it comes to social programs and other aspects related to them (Álvarez 2015). The government is a Decentralized Autonomous Municipality, with a mayor and 15 council members who are elected by popular vote for a 4-year term (Muy Ilustre Municipalidad de Guayaquil 2021). Figure 2. Location of Tenguel in Guayaquil. Source: (Sageo 2021). The data were collected with a questionnaire, which was given to citizens of Tenguel. In order to guarantee the validity of the questionnaire, the questions were based on previous studies (Álvarez 2015; Vetrivel Sezhian et al. 2014; Ghodousi et al. 2016). Several items were based on studies with similar measurement objectives and needs (Samkar and Alpu 2013; Yazdanpanah et al. 2013; Bostancı and Erdem 2020). The information was collected through a questionnaire. The survey was carried out to households located in Tenguel parish, which consists of 67 items grouped into three sections: (1) Questions about expected quality, perceived quality, and perceived value of public services provided in Tenguel, in security, transport, and provision of public services in general. (2) Questions related to satisfaction and loyalty with the public municipal administration based on citizens’ experience with the services provided by the municipality and (3) Questions about the citizen’s sociodemographic profile. Citizens were informed of the academic purposes and anonymity of the study before completing the questionnaire and the verbal consent of the citizen was requested before completing the questionnaire; anonymity was guaranteed at each stage of the data collection process. In the first two sections, a seven-point Likert scale was used, in which 1 was the lowest rating and 7 was the highest. Participation in the study was voluntary and individual, sample data was collected through a questionnaire at different times of the day during March 2021. The survey could only be completed with citizens residing in the rural parish of Tenguel; the study area consisted of 2458 households. Figure 2. Location of Tenguel in Guayaquil. Source: (Sageo 2021). The data were collected with a questionnaire, which was given to citizens of Tenguel. In order to guarantee the validity of the questionnaire, the questions were based on previous studies (Álvarez 2015;Vetrivel Sezhian et al. 2014;Ghodousi et al. 2016). Several items were based on studies with similar measurement objectives and needs (Samkar and Alpu 2013; Yazdanpanah et al. 2013;Bostancı and Erdem 2020). The information was collected through a questionnaire. The survey was carried out to households located in Tenguel parish, which consists of 67 items grouped into three sections: (1) Questions about expected quality, perceived quality, and perceived value of public services provided in Tenguel, in security, transport, and provision of public services in general. (2) Questions related to satisfaction and loyalty with the public municipal administration based on citizens’ experience with the services provided by the municipality and (3) Questions about the citizen’s sociodemographic profile. Citizens were informed of the academic purposes and anonymity of the study before completing the questionnaire and the verbal consent of the citizen was requested before completing the questionnaire; anonymity was guaranteed at each stage of the data collection process. In the first two sections, a seven-point Likert scale was used, in which 1 was the lowest rating and 7 was the highest. Participation in the study was voluntary and individual, sample data was collected through a questionnaire at different times of the day during March 2021. The survey could only be completed with citizens residing in the rural parish of Tenguel; the study area consisted of 2458 households. The survey was applied to a total of 576 households selected with simple random sampling, obtaining 428 valid questionnaires; therefore, the participation rate of the universe is 17.41% and the sample had a confidence level of 96% and a margin of error of 4.52%. The questions in the third section related to the socio-demographic profile were completed with closed questions. Data from this research were tabulated and analyzed using structural equation modeling (PLS-SEM), using Warp-PLS 7.0 software (ScriptWarp Systems, P.O. Box 452428, Laredo, Economies 2022,10, 225 8 of 24 TX, USA). The method is recognized as an appropriate analytical technique for testing as well as for the theoretical model (Hair et al. 2011). The model was designed (see Figure 1above) using the American Customer Satisfaction Index (ACSI). Table 1shows the constructs of the model and the latent and observed variables. Table 1. Scales used. Authors Variable Indicators (Bostancı and Erdem 2020; Ogikubo et al. 2009;Shen et al. 2016;Hidalgo-Fernández et al. 2019;Yilmaz et al. 2021) Expected Quality (EXPEQUAL) Expected Quality: (EQ1) Town planning and zoning, (EQ2) Roads and pavements, (EQ3) Organization of traffic and crossing, (EC4) Public Transport System, (EQ5) Car parking service, (EQ6) Address information, (EQ7) Transport Services, (EQ8) Drinking water quality, (EQ9) Wastewater and drains, (EQ10) Garbage collection and town cleaning, (EQ11) Parks and gardens, (EQ12) Public road and street lighting, (EQ13) Preservation of historical and cultural heritage, (EQ14) Cultural activities, (EQ15) Social and cultural facilities, (EQ16) Funeral services, (EQ17) Social activities, (EQ18) Firefighting service, (EQ19) Local police service, (EQ18_2) Sports services, (EQ19_2) Veterinary services, (EQ20) Noise reduction, (EQ21) Air pollution, (EQ22) Green areas, (EQ23) Social services. (Wangpipatwong et al. 2009; O’Leary 2007;e Sáand Fernandes 2020;Rico et al. 2022) Satisfaction (SATISFAC) Satisfaction: (S1) Satisfaction with the town and road planning, (S2) Satisfaction with the provision of municipal services, (S3) Global satisfaction with the user experience. (Ni et al. 2020;Rodrigues and Tavares 2020;Yilmaz et al. 2021;Chatfield and AlAnazi 2013;Vetrivel Sezhian et al. 2014) Loyalty (LOYALTY) Loyalty: (L1) I would recommend my friends or family to vote for the mayor of Guayaquil, (L2) I would vote for the mayor of Guayaquil again, (L3) I would recommend the services provided by the Municipality of Guayaquil, (L4) I would recommend family or friends living out of town to live in Guayaquil, (L5) I would recommend family or friends living out of town to visit Guayaquil. (Kelly and Swindell 2002; Wangpipatwong et al. 2009; Rodrigues and Tavares 2020) Perceived Quality (PERQUAL) Perceived Quality: (PQ1) Urban planning and zoning, (PQ2) Roads and pavements, (PQ3) Organization of traffic and crossing, (PC4) Public Transport System, (PQ5) Car parking service, (PQ6) Address Information, (PQ7) Transport services, (PQ8) Drinking water quality, (PQ9) Wastewater and drains, (PQ10) Garbage collection and town cleaning, (PQ11) Parks and gardens, (PQ12) Public road and street lighting, (PQ13) Preservation of historical and cultural heritage, (PQ14) Cultural activities, (PQ15) Social and cultural facilities, (PQ16) Funeral services, (PQ17) Social activities, (PQ18) Firefighting services, (PQ19) Local police service, (PQ18_2) Sports service, (PQ19_2) Veterinary services, (PQ20) Noise reduction, (PQ21) Air pollution, (PQ22) Green areas, (PQ23) Social services. (Shen et al. 2016;Ali and Kaur 2018;Hidalgo-Fernández et al. 2019) Perceived Value (PERVALU) Perceived Value: (PV4) Public Transport System, (PV5) Car parking service, (PV7) Transport services, (PV8) Drinking water quality, (PV9) Wastewater and drains, (PV10) Garbage collection and town cleaning, (PV11) Parks and gardens, (PV12) Public road and street lighting, (PV13) Preservation of historical and cultural heritage, (PV14) Cultural activities, (PV15) Social and cultural facilities, (PV16) Funeral services, (PV17) Social activities, (PV18) Firefighting services, (PV19) Local police service, (PV18_2) Sports service, (PV19_2) Veterinary services Source: Author. 3. Results This section provides the results obtained after applying the structural equation models. First, an extract of the sociodemographic profile is presented and later the reliability Economies 2022,10, 225 15 of 24 Table 8. Model fit and quality indices. Measures of Fit Value p-Value Average path coefficient (APC) 0.222 <0.001 Average R-squared (ARS) 0.2000 <0.001 Average adjusted R-squared (AARS) 0.197 <0.001 Index of Quality Value Ranges Average block VIF (AVIF) 1.308 acceptable if ≤5, ideally ≤3.3 Average full collinearity VIF (AFVIF) 1.705 Tenenhaus GoF (GoF) 0.283 Small ≥ 0.1, medium ≥ 0.25, large ≥ 0.36 Sympson’s paradox ratio (SPR) 1.000 acceptable if ≥0.7, ideally = 1 R-squared contribution ratio (RSCR) 1.000 acceptable if ≥0.9, ideally = 1 Statistical suppression ratio (SSR) 1.000 acceptable if ≥0.7 Nonlinear bivariate causality direction ratio (NLBCDR) 0.786 Source: Author. Next, we calculated the significance of the Structural coefficient for each of the hypotheses raised, the values of the calculations are shown in (Table 9) and we verified the hypotheses H3, H4, H5, H6, and H7. This means that there is a positive and unifying relationship between perceived quality and perceived value, between perceived quality and satisfaction, perceived value and satisfaction, between perceived quality and loyalty, and there is a positive and meaningful relationship between satisfaction and loyalty of citizens to municipal officials. Table 9. Hypotheses analysis. Hypothesis Effect Path Coefficient p-Value Supported? H1: Expectative Quality—Perceived Quality + 0.067 0.082 NO H2: Expectative Quality—Perceived Value + −0.057 0.117 NO H3: Perceived Quality—Perceived Value + 0.795 <0.001 *** YES H4: Perceived Quality—Satisfaction + 0.173 <0.001 *** YES H5: Perceived Values—Satisfaction + 0.154 <0.001 *** YES H6: Perceived Quality—Loyalty + 0.220 <0.001 *** YES H7: Satisfaction—Loyalty + 0.085 0.037 ** YES a = 0.001 (***); a = 0.01 (**). Source: Author. Figure 3shows the hypotheses and the relationships between them. (R) refers to the number of questions that were asked about each of them, and the values of R2 and the p-value for each hypothesis are also shown. Economies 2022,10, 225 16 of 24 Economies 2022, 10, x FOR PEER REVIEW 16 of 26 Tenenhaus GoF (GoF) 0.283 Small ≥ 0.1, medium ≥ 0.25, large ≥ 0.36 Sympson’s paradox ratio (SPR) 1.000 acceptable if ≥0.7, ideally = 1 R-squared contribution ratio (RSCR) 1.000 acceptable if ≥0.9, ideally = 1 Statistical suppression ratio (SSR) 1.000 acceptable if ≥0.7 Nonlinear bivariate causality direction ratio (NLBCDR) 0.786 Source: Author. Next, we calculated the significance of the Structural coefficient for each of the hypotheses raised, the values of the calculations are shown in (Table 9) and we verified the hypotheses H3, H4, H5, H6, and H7. This means that there is a positive and unifying relationship between perceived quality and perceived value, between perceived quality and satisfaction, perceived value and satisfaction, between perceived quality and loyalty, and there is a positive and meaningful relationship between satisfaction and loyalty of citizens to municipal officials. Table 9. Hypotheses analysis. Hypothesis Effect Path Coefficient p-Value Supported? H1: Expectative Quality—Perceived Quality + 0.067 0.082 NO H2: Expectative Quality—Perceived Value + −0.057 0.117 NO H3: Perceived Quality—Perceived Value + 0.795 <0.001 *** YES H4: Perceived Quality—Satisfaction + 0.173 <0.001 *** YES H5: Perceived Values—Satisfaction + 0.154 <0.001 *** YES H6: Perceived Quality—Loyalty + 0.220 <0.001 *** YES H7: Satisfaction—Loyalty + 0.085 0.037 ** YES a = 0.001 (***); a = 0.01 (**). Source: Author Figure 3 shows the hypotheses and the relationships between them. (R) refers to the number of questions that were asked about each of them, and the values of R2 and the pvalue for each hypothesis are also shown. Figure 3. Causal relationships of the model and p-Values. 4. Discussion and Conclusions Figure 3. Causal relationships of the model and p-Values. 4. Discussion and Conclusions Citizens’ satisfaction with the public services in a rural territory is the determining factor for loyalty to municipal government officials. Citizens who decided to re-elect municipal officials also recommend and share their experiences with family and friends (Semple 2019). The local public administration aims to improve and be efficient in the provision of public services and elements where it has competence, in the territory it manages. Economic, social, or environmental improvements should aim to improve living conditions in rural areas (Giarchi 2006). The study carried out an estimation of direct causal relationships, where latent variables of the main factors that make up the dimensions of the perception of satisfaction, the loyalty of the citizen to the municipal manager on the quality of public services provided by the municipality in rural areas. Most of the hypotheses raised in the theoretical model were confirmed so that local administrations that manage rural areas can use the study to improve the satisfaction of their citizens. It is clear from the results obtained how the perception of the perceived quality of municipal services has a positive and significant influence on the perceived value, the perceived satisfaction and on the loyalty to the managers who apply public policies. Hypothesis 1: It has not been possible to confirm, that is, the perception of the quality expected by citizens in rural areas of public services does not significantly influence the perceived quality of public services (Figure 4) (Navajas-Romero et al. 2020;Rico et al. 2022; Jimber Del Rio et al. 2020;Hidalgo-Fernández et al. 2019). According to Rust et al. (1999) their study, the results suggest that the most important moment for a product or service to establish the perceived quality in the minds of users is at the moment when consumers have little previous experience in the category, that is, if the respondents are younger, their experience in public services is scarce and their expectations have little influence on the perceived quality. Economies 2022,10, 225 17 of 24 Economies 2022, 10, x FOR PEER REVIEW 17 of 26 Citizens’ satisfaction with the public services in a rural territory is the determining factor for loyalty to municipal government officials. Citizens who decided to re-elect municipal officials also recommend and share their experiences with family and friends (Semple 2019). The local public administration aims to improve and be efficient in the provision of public services and elements where it has competence, in the territory it manages. Economic, social, or environmental improvements should aim to improve living conditions in rural areas (Giarchi 2006). The study carried out an estimation of direct causal relationships, where latent variables of the main factors that make up the dimensions of the perception of satisfaction, the loyalty of the citizen to the municipal manager on the quality of public services provided by the municipality in rural areas. Most of the hypotheses raised in the theoretical model were confirmed so that local administrations that manage rural areas can use the study to improve the satisfaction of their citizens. It is clear from the results obtained how the perception of the perceived quality of municipal services has a positive and significant influence on the perceived value, the perceived satisfaction and on the loyalty to the managers who apply public policies. Hypothesis 1: It has not been possible to confirm, that is, the perception of the quality expected by citizens in rural areas of public services does not significantly influence the perceived quality of public services (Figure 4) (Navajas-Romero et al. 2020; Rico et al. 2022; Río et al. 2020; Hidalgo-Fernández et al. 2019). According to Rust et al. (1999) their study, the results suggest that the most important moment for a product or service to establish the perceived quality in the minds of users is at the moment when consumers have little previous experience in the category, that is, if the respondents are younger, their experience in public services is scarce and their expectations have little influence on the perceived quality. Figure 4. H1, EXPQUAL−PERQUAL. Hypothesis 2 is not confirmed and is not significant (Figure 5) (Navajas-Romero et al. 2020; Rico et al. 2022; Hidalgo-Fernández et al. 2019), so we cannot say that the quality of public services expected by the citizen significantly influences the perceived value of public services. That the hypothesis has not been confirmed does not mean that it has no influence, only that it is not statistically significant enough. Figure 4. H1, EXPQUAL−PERQUAL. Hypothesis 2 is not confirmed and is not significant (Figure 5) (Navajas-Romero et al. 2020;Rico et al. 2022;Hidalgo-Fernández et al. 2019), so we cannot say that the quality of public services expected by the citizen significantly influences the perceived value of public services. That the hypothesis has not been confirmed does not mean that it has no influence, only that it is not statistically significant enough. Economies 2022, 10, x FOR PEER REVIEW 18 of 26 Figure 5. H2, EXPQUAL−PERVALU. Hypothesis 3: The quality of public services perceived by the citizen significantly influences the perceived value of these public services. Figure 6 shows the sinusoidal behavior of the variable; in addition, we can observe that high values of the perceived quality of public services have no direct influence on the perceived value. These findings coincide with studies such as Ali and Kaur (2018) and Shen et al. (2016). Figure 6. H3, PERQUAL−PERVALU. Municipal administrators must make improvements in territorial planning, general municipal services and the environment in rural areas. These developments would increase perceived quality and perceived value; citizens indicated that these improvements would increase their perception of satisfaction with public services. Citizens who perceive Figure 5. H2, EXPQUAL−PERVALU. Hypothesis 3: The quality of public services perceived by the citizen significantly influences the perceived value of these public services. Figure 6shows the sinusoidal behavior of the variable; in addition, we can observe that high values of the perceived quality of public services have no direct influence on the perceived value. These findings coincide with studies such as Ali and Kaur (2018) and Shen et al. (2016). Economies 2022,10, 225 18 of 24 Economies 2022, 10, x FOR PEER REVIEW 18 of 26 Figure 5. H2, EXPQUAL−PERVALU. Hypothesis 3: The quality of public services perceived by the citizen significantly influences the perceived value of these public services. Figure 6 shows the sinusoidal behavior of the variable; in addition, we can observe that high values of the perceived quality of public services have no direct influence on the perceived value. These findings coincide with studies such as Ali and Kaur (2018) and Shen et al. (2016). Figure 6. H3, PERQUAL−PERVALU. Municipal administrators must make improvements in territorial planning, general municipal services and the environment in rural areas. These developments would increase perceived quality and perceived value; citizens indicated that these improvements would increase their perception of satisfaction with public services. Citizens who perceive Figure 6. H3, PERQUAL−PERVALU. Municipal administrators must make improvements in territorial planning, general municipal services and the environment in rural areas. These developments would increase perceived quality and perceived value; citizens indicated that these improvements would increase their perception of satisfaction with public services. Citizens who perceive quality in municipal services are loyal to their municipality and re-elect the public managers who provide this perception. Hypothesis 4: The quality of public services perceived by the citizen significantly influences the citizen’s satisfaction with the public service. Figure 7shows an exponential form, in which perceived quality has a linear and direct influence on the satisfaction of the citizen residing in rural areas. The results coincide with studies by Wangpipatwong et al. (2009) and Rodrigues and Tavares (2020). The confirmation of this hypothesis means that increasing the quality of experience with public services for citizens living in rural areas influences satisfaction. Economies 2022, 10, x FOR PEER REVIEW 19 of 26 quality in municipal services are loyal to their municipality and re-elect the public managers who provide this perception. Hypothesis 4: The quality of public services perceived by the citizen significantly influences the citizen’s satisfaction with the public service. Figure 7 shows an exponential form, in which perceived quality has a linear and direct influence on the satisfaction of the citizen residing in rural areas. The results coincide with studies by Wangpipatwong et al. (2009) and Rodrigues and Tavares (2020). The confirmation of this hypothesis means that increasing the quality of experience with public services for citizens living in rural areas influences satisfaction. Figure 7. H4, PERQUAL−SATISFAC. Hypothesis 5: Is confirmed, so that the value of public services perceived by the citizen significantly influences the satisfaction perceived by citizens. Figure 8 shows that low values of the perceived value of public services do not significantly influence citizen satisfaction for high values, it is observed how it influences exponentially. This result has also been observed by other authors such as O’Leary (2007), Samkar and Alpu (2013) and Shen et al. (2016). Figure 8. H5, PERVALU−SATISFAC. Figure 7. H4, PERQUAL−SATISFAC. Hypothesis 5: Is confirmed, so that the value of public services perceived by the citizen significantly influences the satisfaction perceived by citizens. Figure 8shows that Economies 2022,10, 225 19 of 24 low values of the perceived value of public services do not significantly influence citizen satisfaction for high values, it is observed how it influences exponentially. This result has also been observed by other authors such as O’Leary (2007), Samkar and Alpu (2013) and Shen et al. (2016). Economies 2022, 10, x FOR PEER REVIEW 19 of 26 quality in municipal services are loyal to their municipality and re-elect the public managers who provide this perception. Hypothesis 4: The quality of public services perceived by the citizen significantly influences the citizen’s satisfaction with the public service. Figure 7 shows an exponential form, in which perceived quality has a linear and direct influence on the satisfaction of the citizen residing in rural areas. The results coincide with studies by Wangpipatwong et al. (2009) and Rodrigues and Tavares (2020). The confirmation of this hypothesis means that increasing the quality of experience with public services for citizens living in rural areas influences satisfaction. Figure 7. H4, PERQUAL−SATISFAC. Hypothesis 5: Is confirmed, so that the value of public services perceived by the citizen significantly influences the satisfaction perceived by citizens. Figure 8 shows that low values of the perceived value of public services do not significantly influence citizen satisfaction for high values, it is observed how it influences exponentially. This result has also been observed by other authors such as O’Leary (2007), Samkar and Alpu (2013) and Shen et al. (2016). Figure 8. H5, PERVALU−SATISFAC. Figure 8. H5, PERVALU−SATISFAC. Hypothesis 6: It is also confirmed, therefore, the perceived quality of the public services that a citizen receives significantly influences their loyalty. Figure 9shows the sinusoidal behavior of this relationship, in which increases in perceived quality positively and significantly increase the perceived loyalty of citizens in rural areas. This coincided with the results of other studies by Kelly and Swindell (2002) and Chatfield and AlAnazi (2013). Economies 2022, 10, x FOR PEER REVIEW 20 of 26 Hypothesis 6: It is also confirmed, therefore, the perceived quality of the public services that a citizen receives significantly influences their loyalty. Figure 9 shows the sinusoidal behavior of this relationship, in which increases in perceived quality positively and significantly increase the perceived loyalty of citizens in rural areas. This coincided with the results of other studies by Kelly and Swindell (2002) and Chatfield and AlAnazi (2013). Figure 9. H6, PERQUAL−LOYALTY. Finally, hypothesis 7 is confirmed, so that the perceived satisfaction of a citizen with public services significantly influences the citizen’s loyalty. Figure 10 shows a flattened exponential behavior at the right end of this relationship. Very high satisfaction values do not directly influence loyalty, that is, there comes a time when the perception of quality is sufficient for the citizen and when satisfaction increases, loyalty no longer increases in rural areas. Figure 10. H7, SATISFAC−LOYALTY. Figure 9. H6, PERQUAL−LOYALTY. Finally, hypothesis 7 is confirmed, so that the perceived satisfaction of a citizen with public services significantly influences the citizen’s loyalty. Figure 10 shows a flattened exponential behavior at the right end of this relationship. Very high satisfaction values do not directly influence loyalty, that is, there comes a time when the perception of quality is sufficient for the citizen and when satisfaction increases, loyalty no longer increases in rural areas. Economies 2022,10, 225 20 of 24 Economies 2022, 10, x FOR PEER REVIEW 20 of 26 Hypothesis 6: It is also confirmed, therefore, the perceived quality of the public services that a citizen receives significantly influences their loyalty. Figure 9 shows the sinusoidal behavior of this relationship, in which increases in perceived quality positively and significantly increase the perceived loyalty of citizens in rural areas. This coincided with the results of other studies by Kelly and Swindell (2002) and Chatfield and AlAnazi (2013). Figure 9. H6, PERQUAL−LOYALTY. Finally, hypothesis 7 is confirmed, so that the perceived satisfaction of a citizen with public services significantly influences the citizen’s loyalty. Figure 10 shows a flattened exponential behavior at the right end of this relationship. Very high satisfaction values do not directly influence loyalty, that is, there comes a time when the perception of quality is sufficient for the citizen and when satisfaction increases, loyalty no longer increases in rural areas. Figure 10. H7, SATISFAC−LOYALTY. Figure 10. H7, SATISFAC−LOYALTY. The results showed that satisfaction and quality are positive factors that influence a citizen’s decision to choose or suggest a municipal official, as well as to recommend it as a residential or tourist destination. The findings coincide with other studies such as Chatfield and AlAnazi (2013); Samkar and Alpu (2013); Vetrivel Sezhian et al. (2014). The study confirmed the significance of citizens’ satisfaction with the public services provided in Tenguel by their local government and the intention of citizens to vote for civil servants, as well as its recommendation. That is, the loyalty of citizens depends on factors such as roads, water quality, waste management, parks and green areas, public transport, and maintenance of these services. However, some areas could be improved, such as citizen perception of firefighters, municipal police, veterinary services, parking, and address information, all of which do not meet citizens’ expectations. Public managers in rural areas must pause to evaluate each of the public services they offer their citizens. The study analyzes dimensions such as territorial planning (which includes, among other things, urban planning, state of the roads and pavements, transport service, and urban signage), municipal services (quality of drinking water, sanitation and sewage, public lighting, cemetery, activities and parks and gardens), and finally, the environmental dimension (noise pollution, air pollution, quality of green areas and recycling points). Knowing how the causal relationships of this study influence the final perception of satisfaction and loyalty of citizens in rural areas, they can apply policies that correct poor services in order to improve them and therefore improve the perception of citizens towards municipal services and towards the public managers who apply them. Therefore, this study has practical results that can be used by the Municipality of Guayaquil, as well as to determine important aspects to improve the loyalty of citizens that can be applied in other towns and cities with similar socioeconomic and cultural characteristics. Local public services vary according to the diversity and conditions of the country. Research that analyzes the satisfaction of citizens with the services provided in different areas and countries can be useful for municipalities to improve the quality of services provided, and therefore, the satisfaction of citizens. The limitation of this study lies in the sample since the data were obtained from surveys delivered to households in a rural parish (Tenguel) of the five that exist in Guayaquil, and this means that the data collected is only relevant for this socioeconomic profile. Together with information from other parishes, this study can solve this problem, with a more heterogeneous sample. A second limitation is that this type of study yields results that are expected to be true in all situations. However, more research is needed to see the evolution of citizen perceptions over time. Economies 2022,10, 225 21 of 24 Author Contributions: The author J.F.R.-S. conceived the idea for the article, wrote, and conducted data analysis. The co-authors (J.A.J.-d.R., M.S.O.-R. and A.V.-R.) read it and contributed to the discussion of the article. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: The data sets generated and/or analyzed during the current study will be provided with the delivery of the manuscript and are at reasonable request. Conflicts of Interest: The authors declare no conflict of interest. References Ali, Sadia Samar, and Rajbir Kaur. 2018. An Analysis of Satisfaction Level of 3PL Service Users with the Help of ACSI. Benchmarking: An International Journal 25: 24–46. [CrossRef] Álvarez, César Ariosto. 2015. Actualización Del Plan de Desarrollo y Ordenamiento Territorial de La Parroquia Tenguel. Available online: http://app.sni.gob.ec/sni-link/sni/PORTAL_SNI/data_sigad_plus/sigadplusdiagnostico/0968541880001_ COMPONENTESDIAGNOSTICOPDYOT-TENGUELMEJORADO_24-06-2015_19-00-30.pdf (accessed on 15 August 2020). Amin, Muslim, Zaidi Isa, and Rodrigue Fontaine. 2013. Islamic Banks: Contrasting the Drivers of Customer Satisfaction on Image, Trust, and Loyalty of Muslim and Non-Muslim Customers in Malaysia. International Journal of Bank Marketing 31: 79–97. [CrossRef] Asamblea Nacional Constituyente. 2008. Constitución de La República Del Ecuador. Available online: https://educacion.gob.ec/wpcontent/uploads/downloads/2012/08/Constitucion.pdf (accessed on 15 August 2020). Asamblea Nacional del Ecuador. 2010. Código Orgánico de Organización Territorial, Autonomía y Descentralización. Available online: www.finanzas.gob.ec (accessed on 15 August 2020). Atombo, Charles, and Tina Dzigbordi Wemegah. 2021. Indicators for Commuter’s Satisfaction and Usage of High Occupancy Public Bus Transport Service in Ghana. Transportation Research Interdisciplinary Perspectives 11: 100458. [CrossRef] Ballas, Dimitris, Thanasis Kalogeresis, and Lois Labrianidis. 2003. A Comparative Study of Typologies for Rural Areas in Europe. Paper presented at 43rd Congress of the European Regional Science Association: “Peripheries, Centres, and Spatial Development in the New Europe”, Jyväskylä, Finland, August 27–30. Biswas, Bikram, and Sajib Kumar Roy. 2020. Service Quality, Satisfaction and Intention to Use Union Digital Center in Bangladesh: The Moderating Effect of Citizen Participation. PLoS ONE 15: e244609. [CrossRef] [PubMed] Boletín de La Asociación de Geógrafos Españoles. 2016. No. 71—Dialnet. Available online: https://dialnet.unirioja.es/ejemplar/433471 (accessed on 5 August 2020). Bostancı, Bülent, and Nuri Erdem. 2020. Investigating the Satisfaction of Citizens in Municipality Services Using Fuzzy Modelling. Socio-Economic Planning Sciences 69: 100754. [CrossRef] Bouckaert, Geert, Steven Van de Walle, and Jarl K. Kampen. 2005. Potential for Comparative Public Opinion Research in Public Administration. International Review of Administrative Sciences 71: 229–40. [CrossRef] Bovaird, Tony, and Elke Loeffler. 2007. Assessing the Quality of Local Governance: A Case Study of Public Services. Public Money and Management 27: 293–300. [CrossRef] Brinkerhoff, Derick W., Anna Wetterberg, and Erik Wibbels. 2018. Distance, Services, and Citizen Perceptions of the State in Rural Africa. Governance 31: 103–24. [CrossRef] Caruana, Albert. 2002. Service Loyalty: The Effects of Service Quality and the Mediating Role of Customer Satisfaction. European Journal of Marketing 36: 811–28. [CrossRef] Castillo Canalejo, Ana Ma, and Juan Antonio Jimber del Rio. 2018. Quality, Satisfaction and Loyalty Indices. Journal of Place Management and Development 11: 428–46. [CrossRef] Champion, T., and Graeme Hugo, eds. 2004. New Forms of Urbanization: Beyond the UrbanRural Dichotomy. London: Routledge. [CrossRef] Chatfield, Akemi, and Jazem AlAnazi. 2013. Service Quality, Citizen Satisfaction, and Loyalty with Self-Service Delivery Options to Transforming e-Government Services. Paper presented at 24th Australasian Conference on Information Systems, Melbourne, Australia, December 4–6. Chi, Xiaoting, Seul Ki Lee, Young joo Ahn, and Kiattipoom Kiatkawsin. 2020. Tourist-Perceived Quality and Loyalty Intentions towards Rural Tourism in China. Sustainability 12: 3614. [CrossRef] Choi, Kui-Son, Woo-Hyun Cho, Sunhee Lee, Hanjoon Lee, and Chankon Kim. 2004. The Relationships among Quality, Value, Satisfaction and Behavioral Intention in Health Care Provider Choice: A South Korean Study. Journal of Business Research 57: 913–21. [CrossRef] Cronin, J. Joseph, Michael K. Brady, and G. Tomas M. Hult. 2000. Assessing the Effects of Quality, Value, and Customer Satisfaction on Consumer Behavioral Intentions in Service Environments. Journal of Retail 76: 193–218. [CrossRef] Demirovi´c Bajrami, Dunja, Adriana Radosavac, Marija Cimbaljevi´c, Tatiana N. Tretiakova, and Yulia A. Syromiatnikova. 2020. Determinants of Residents’ Support for Sustainable Tourism Development: Implications for Rural Communities. Sustainability 12: 94. [CrossRef] Economies 2022,10, 225 22 of 24 Dettori, Angela, Michela Floris, and Cinzia Dessì. 2020. Customer-Perceived Quality, Innovation and Tradition: Some Empirical Evidence. TQM Journal 32: 1467–86. [CrossRef] e Sá, Patrícia Moura, and Carolina Fernandes. 2020. An Assessment of a Municipal Physical Activity Programme for Seniors Based on the EFQM Model: Integrating the Views of Internal and External Stakeholders. Evaluation and Program Planning 80: 101796. [CrossRef] Ercsey, Ida, and LászlóJózsa. 2016. The Effect of the Perceived Value of Cultural Services on the Quality of Life. International Review on Public and Nonprofit Marketing 13: 15–36. [CrossRef] Esaiasson, Peter, Stefan Dahlberg, and Andrej Kokkonen. 2020. In Pursuit of Happiness: Life Satisfaction Drives Political Support. European Journal of Political Research 59: 25–44. [CrossRef] Filippetti, Andrea. 2020. Does Diversity Undermine the Welfare State? Evidence from the Provision of Local Public Services in European Regions. Kyklos 73: 68–95. [CrossRef] Flint, Daniel J., Robert B. Woodruff, and Sarah Fisher Gardial. 2002. Exploring the Phenomenon of Customers’ Desired Value Change in a Business-to-Business Context. Journal of Marketing 66: 102–17. [CrossRef] Fornell, Claes, and David F. Larcker. 1981. Structural Equation Models with Unobservable Variables and Measurement Error: Algebra and Statistics. Journal of Marketing Research 18: 382–88. [CrossRef] Fornell, Claes, Michael D. Johnson, Eugene W. Anderson, Jaesung Cha, and Barbara Everitt Bryant. 1996. The American Customer Satisfaction Index: Nature, Purpose, and Findings. Journal of Marketing 60: 7–18. [CrossRef] Fornell, Claes. 1992. A National Customer Satisfaction Barometer: The Swedish Experience. Journal of Marketing 56: 6–21. [CrossRef] Forrer, John, James Edwin Kee, Kathryn E. Newcomer, and Eric Boyer. 2010. Public–Private Partnerships and the Public Accountability Question. Public Administration Review 70: 475–84. [CrossRef] Furmankiewicz, Marek, Krzysztof Janc, and Áine Macken-Walsh. 2021. Implementation of the EU LEADER Programme at MemberState Level: Written and Unwritten Rules of Local Project Selection in Rural Poland. Journal of Rural Studies 86: 357–65. [CrossRef] Ghodousi, Mostafa, Ali Asghar Alesheikh, and Bahram Saeidian. 2016. Analyzing Public Participant Data to Evaluate Citizen Satisfaction and to Prioritize Their Needs via K-Means, FCM and ICA. Cities 55: 70–81. [CrossRef] Giarchi, George Giacinto. 2006. Older People ‘on the Edge’ in the Countrysides of Europe. Social Policy and Administration 40: 705–21. [CrossRef] Goyal, Praveen, and Udayan Chanda. 2017. A Bayesian Network Model on the Association between CSR, Perceived Service Quality and Customer Loyalty in Indian Banking Industry. Sustainable Production and Consumption 10: 50–65. [CrossRef] Hair, Joe F., Christian M. Ringle, and Marko Sarstedt. 2011. PLS-SEM: Indeed a Silver Bullet. Journal of Marketing Theory and Practice 19: 139–52. [CrossRef] Hair, Joseph F., Christian M. Ringle, and Marko Sarstedt. 2012. Partial Least Squares: The Better Approach to Structural Equation Modeling? Long Range Planning 45: 312–19. [CrossRef] Havas, Jarkko, Osamu Saito, Keisuke Hanaki, and Toshinori Tanaka. 2016. Perceived Landscape Values in the Ogasawara Islands. Ecosystem Services 18: 130–40. [CrossRef] Henseler, Jörg, and Wynne W. Chin. 2010. A Comparison of Approaches for the Analysis of Interaction Effects between Latent Variables Using Partial Least Squares Path Modeling. Structural Equation Modeling 17: 82–109. [CrossRef] Hidalgo-Fernández, Amalia, Ricardo Hernández-Rojas, Juan Antonio Jimber del Rio, and JoséCarlos Casas-Rosal. 2019. Tourist Motivations and Satisfaction in the Archaeological Ensemble of Madinat Al-Zahra. Sustainability 11: 1380. [CrossRef] Hirmer, Stephanie, and Peter Guthrie. 2016. Identifying the Needs of Communities in Rural Uganda: A Method for Determining the ‘User-Perceived Value’ of Rural Electrification Initiatives. Renewable and Sustainable Energy Reviews 66: 476–86. [CrossRef] Hoogerbrugge, Marloes M., Martijn J. Burger, and Frank G. Van Oort. 2021. Spatial Structure and Subjective Well-Being in North-West Europe. Regional Studies 56: 75–86. [CrossRef] Hubatková, Barbora. 2019. Older Adults’ Well-Being by the Type of Residential Setting: The Case of Small Municipalities in the Czech Republic. Journal of Rural Studies 72: 196–204. [CrossRef] Hult, G. Tomas M., Pratyush Nidhi Sharma, Forrest V. Morgeson, and Yufei Zhang. 2019. Antecedents and Consequences of Customer Satisfaction: Do They Differ Across Online and Offline Purchases? Journal of Retailing 95: 10–23. [CrossRef] Instituto Nacional de Estadísticas y Censos (INEC). 2021. Población por Sexo, Según Provincia, Parroquia y Cantón de Empadronamiento. Available online: https://www.ecuadorencifras.gob.ec/search/POBLACI%C3%93N+POR+SEXO,+SEG%C3%9AN+ PROVINCIA,+PARROQUIA+Y+CANT%C3%93N+DE+EMPADRONAMIENTO/ (accessed on 7 August 2021). Jimber Del Rio, Juan Antonio, Ricardo D. Hernández-Rojas, Arnaldo Vergara-Romero, and Ma Genoveva Dancausa Dancausa Millán. 2020. Loyalty in Heritage Tourism: The Case of Córdoba and Its Four World Heritage Sites. International Journal of Environmental Research and Public Health 17: 8950. [CrossRef] Johnson, Michael D., Anders Gustafsson, Tor Wallin Andreassen, Line Lervik, and Jaesung Cha. 2001. The Evolution and Future of National Customer Satisfaction Index Models. Journal of Economic Psychology 22: 217–45. [CrossRef] Kelly, Janet M., and David Swindell. 2002. A Multiple–Indicator Approach to Municipal Service Evaluation: Correlating Performance Measurement and Citizen Satisfaction across Jurisdictions. Public Administration Review 62: 610–21. [CrossRef] Kim, Jae Yeong, and Sang Hyun Im. 2017. Effect of Price Image on Post-Purchase Satisfaction and Repatronage Intention: Mediating Role of Price Fairness. Journal of Distribution Science 15: 71–81. [CrossRef] Economies 2022,10, 225 23 of 24 Kim, Kyung Hee, and Duk Byeong Park. 2017. Relationships Among Perceived Value, Satisfaction, and Loyalty: Community-Based Ecotourism in Korea. Journal of Travel and Tourism Marketing 34: 171–91. [CrossRef] Lee, Gary R., and Marie L. Lassey. 1980. Rural-Urban Differences Among the Elderly: Economic, Social, and Subjective Factors. Journal of Social Issues 36: 62–74. [CrossRef] Lenzi, Camilla, and Giovanni Perucca. 2020. Not Too Close, Not Too Far: Urbanisation and Life Satisfaction along the Urban Hierarchy. Urban Studies 58: 2742–57. [CrossRef] Li, Tuochen, and Siran Wang. 2021. How to Improve the Public Trust of the Intelligent Aging Community: An Empirical Study Based on the ACSI Model. International Journal of Environmental Research and Public Health 18: 197. [CrossRef] Manthorpe, Jill, Steve Iliffe, Roger Clough, Michelle Cornes, Les Bright, Jo Moriarty, and Older People Researching Social Issues. 2008. Elderly People’s Perspectives on Health and Well-being in Rural Communities in England: Findings from the Evaluation of the National Service Framework for Older People. Health and Social Care in the Community 16: 460–68. [CrossRef] [PubMed] Martensen, Anne, Lars Grønholdt, and Kai Kristensen. 2000. The Drivers of Customer Satisfaction and Loyalty: Cross-Industry Findings from Denmark. Total Quality Management 11: 544–53. [CrossRef] Martin, Lucy, and Pia J. Raffler. 2020. Fault Lines: The Effects of Bureaucratic Power on Electoral Accountability. American Journal of Political Science 65: 210–24. [CrossRef] Milbourne, Paul. 2012. Growing Old in Rural Places. Journal of Rural Studies 4: 315–17. [CrossRef] Ministerio Del Trabajo. 2021. Available online: https://www.trabajo.gob.ec/el-salario-basico-unificado-sbu-para-el-2021-sera-de-usd400/ (accessed on 31 August 2021). Morrison, Philip S., and Mikko Weckroth. 2018. Human Values, Subjective Well-Being and the Metropolitan Region. Regional Studies 52: 325–37. [CrossRef] Muy Ilustre Municipalidad de Guayaquil. 2021. Available online: https://www.guayaquilesmidestino.com/apps/#/es/content/ historia (accessed on 15 August 2021). Navajas-Romero, Virginia, Ricardo David Hernández-Rojas, Amalia Hidalgo-Fernández, and Juan Antonio Jimber del Rio. 2020. Tourist Loyalty and Mosque Tourism: The Case of the Mosque-Cathedral in Córdoba (Spain). PLoS ONE 15: e0242866. [CrossRef] Ni, Anning, Chunqin Zhang, Yuting Hu, Weite Lu, and Hongwei Li. 2020. Influence Mechanism of the Corporate Image on Passenger Satisfaction with Public Transport in China. Transport Policy 94: 54–65. [CrossRef] Nunnally, J. C., and I. H. Bernstein. 1978. The Role of University in the Development of Entrepreneurial Vocations: A Spanish Study. New York: Psychometric Theory McGraw-Hill, pp. 387–405. Nuviala, Alberto Nuviala, Raquel Pérez-Ordás, Miguel Boceta Osuna, Alberto Grao-Cruces, Román Nuviala Nuviala, and JoséAntonio González Jurado. 2012. Calidad, Satisfacción y Valor Percibido de Lós Usuarios de Un Servicio Deportivo Público TT—Uality, Satisfaction and Perceived Value of Users of Public Service Sports. Movimento (Porto Alegre) 18: 11–32. [CrossRef] O’Leary, Brian. 2007. Changes in the Quality of Life of Durban’s People. Social Indicators Research 81: 357–73. [CrossRef] Ogikubo, Mizuho, Shane J. Schvaneveldt, and Takao Enkawa. 2009. An Empirical Study on Antecedents of Aggregate Customer Satisfaction: Cross-Country Findings. Total Quality Management and Business Excellence 20: 23–37. [CrossRef] Okulicz-Kozaryn, Adam, and Rubia R. Valente. 2019. No Urban Malaise for Millennials. Regional Studies 53: 195–205. [CrossRef] Olever, Richard L. 1997. Satisfaction: A Behavioral Perspective on the Customer. New York: Irwin McGraw Hill. Oliver, Richard L. 1980. A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions. Journal of Marketing Research 17: 460–69. [CrossRef] Oliver, Richard L. 1981. Measurement and Evaluation of Satisfaction Processes in Retail Settings. Journal of Retailing 57: 25–48. Oliver, Richard L. 1999. Whence Consumer Loyalty? The Journal of Marketing 63: 33–44. [CrossRef] Osborne, Stephen P. 2010. Delivering Public Services: Time for a New Theory? Public Management Review 12: 1–10. [CrossRef] Parasuraman, Anantharanthan, Valarie A. Zeithaml, and Leonard L. Berry. 1985. A Conceptual Model of Service Quality and Its Implications for Future Research. Journal of Marketing 49: 41. [CrossRef] Peña, Ana Isabel Polo, Dolores María Frías Jamilena, and Miguel Ángel Rodríguez Molina. 2012. The Perceived Value of the Rural Tourism Stay and Its Effect on Rural Tourist Behaviour. Journal of Sustainable Tourism 20: 1045–65. [CrossRef] Polo Almeida, Patricia. 2020. Determinación Social de La Salud En El Territorio: Miradas de Los Trabajadores Bananeros En Tenguel (Ecuador). Revista Ciencias de La Salud 18: 152–73. [CrossRef] Remoaldo, Paula, Mansour Ghanian, and Juliana Alves. 2020. Exploring the Experience of Creative Tourism in the Northern Region of Portugal—A Gender Perspective. Sustainability 12: 10408. [CrossRef] Rico, María SaloméOchoa, Arnaldo Vergara-Romero, JoséFernando Romero Subia, and Juan Antonio Jimber del Rio. 2022. Study of citizen satisfaction and loyalty in the urban 765 area of Guayaquil: Perspective of the quality of public services applying structural equations. PLoS ONE 17: e0263331. [CrossRef] [PubMed] Rodrigues, Miguel, and António F. Tavares. 2020. The Effects of Amalgamations on Voter Turnout: Evidence from Sub-Municipal Governments in Portugal. Cities 101: 102685. [CrossRef] Rönnerstrand, Björn, and Maria Oskarson. 2020. Standing in Line When Queues Are on the Decline: Services Satisfaction Following the Swedish Health Care Waiting Time Guarantee. Policy Studies Journal 48: 469–93. [CrossRef] Rust, Roland T., J. Jeffrey Inman, Jianmin Jia, and Anthony Zahorik. 1999. What You Don’t Know about Customer-Perceived Quality: The Role of Customer Expectation Distributions. Marketing Science 18: 77–92. [CrossRef] Economies 2022,10, 225 24 of 24 Sageo. 2021. Guayaquil—Mapa Sageo—Parroquia Tenguel. Available online: https://satellites.pro/plano/mapa_de_Sageo (accessed on 25 August 2021). Samkar, Hatice, and Ozlem Alpu. 2013. M Regression Approach for Satisfaction of Municipality Services: The Case of Eskisehir. Quality & Quantity 47: 1629–37. Sarstedt, Marko, Joseph F. Hair, Jun Hwa Cheah, Jan Michael Becker, and Christian M. Ringle. 2019. “How to Specify, Estimate, and Validate Higher-Order Constructs in PLS-SEM”. Australasian Marketing Journal 27: 197–211. [CrossRef] Scharf, Thomas, and Bernadette Bartlam. 2006. Rural Disadvantage: Quality of Life and Disadvantage amongst Older People–a Pilot Study. London: Commission for Rural Communities. Scharf, Thomas, and Bernadette Bartlam. 2008. Rural Ageing. A Good Place to Grow Old? Bristol: The Policy Press, pp. 97–108. Semple, Noel. 2019. Good Enough for Government Work? Life-Evaluation and Public Policy. Journal of Happiness Studies 22: 1119–40. [CrossRef] Shabbir, Asma, Shahab Alam Malik, and Saquib Yusaf Janjua. 2017. Equating the Expected and Perceived Service Quality: A Comparison between Public and Private Healthcare Service Providers. International Journal of Quality and Reliability Management 34: 1295–317. [CrossRef] Shen, Weiwei, Weizhou Xiao, and Xin Wang. 2016. Passenger Satisfaction Evaluation Model for Urban Rail Transit: A Structural Equation Modeling Based on Partial Least Squares. Transport Policy 46: 20–31. [CrossRef] Song, Miyeon, and Kenneth J. Meier. 2018. Citizen Satisfaction and the Kaleidoscope of Government Performance: How Multiple Stakeholders See Government Performance. Journal of Public Administration Research and Theory 28: 489–505. [CrossRef] Song, Miyeon, Seung-Ho An, and Kenneth J. Meier. 2020. Quality Standards, Implementation Autonomy, and Citizen Satisfaction with Public Services: Cross-National Evidence. Public Management Review 23: 906–28. [CrossRef] Sørensen, Jens F. 2014. Rural–Urban Differences in Life Satisfaction: Evidence from the European Union. Regional Studies 48: 1451–66. [CrossRef] Sun, Shi Chao. 2018. Public Transit Loyalty Modeling Considering the Effect of Passengers’ Emotional Value: A Case Study in Xiamen, China. Journal of Advanced Transportation 2018: 4682591. [CrossRef] Taylor, Steven A., and Thomas L. Baker. 1994. An Assessment of the Relationship between Service Quality and Customer Satisfaction in the Formation of Consumers’ Purchase Intentions. Journal of Retailing 70: 163–78. [CrossRef] Van Ryzin, Gregg G., Stephen Immerwahr, and Stan Altman. 2008. Measuring Street Cleanliness: A Comparison of New York City’s Scorecard and Results from a Citizen Survey. Public Administration Review 68: 295–303. [CrossRef] Van Ryzin, Gregg G. 2015. Service Quality, Administrative Process, and Citizens’ Evaluation of Local Government in the US. Public Management Review 17: 425–42. [CrossRef] Varma, Pawan Kumar, and G. Srikrishna. 2016. A Study On Consumer Buying Behavior Towards Organized Retail Outlets in Warangal. International Journal of Management Research & Review 1: 22–27. Verhoef, Peter C., Philip Hans Franses, and Janny C. Hoekstra. 2001. The Impact of Satisfaction and Payment Equity on Cross-Buying: A Dynamic Model for a Multi-Service Provider. Journal of Retailing 77: 359–78. [CrossRef] Vetrivel Sezhian, M., C. Muralidharan, T. Nambirajan, and S. G. Deshmukh. 2014. Attribute-based Perceptual Mapping Using Discriminant Analysis in a Public Sector Passenger Bus Transport Company: A Case Study. Journal of Advanced Transportation 48: 32–47. [CrossRef] Wangpipatwong, Sivaporn, Wichian Chutimaskul, and Borworn Papasratorn. 2009. Quality Enhancing the Continued Use of EGovernment Web Sites: Evidence from e-Citizens of Thailand. International Journal of Electronic Government Research 5: 19–35. [CrossRef] Xue, Yigui, and Jihkuang Chen. 2019. Research on the Influence of Service Quality, Passenger Satisfaction and Passenger Loyalty on Fuzhou Metro Line 1. International Journal of New Developments in Engineering and Society 3: 117–25. [CrossRef] Yazdanpanah, Masoud, Gholam Hossein Zamani, Stefan Hochrainer-Stigler, Nozar Monfared, and Jafar Yaghoubi. 2013. Measuring Satisfaction of Crop Insurance a Modified American Customer Satisfaction Model Approach Applied to Iranian Farmers. International Journal of Disaster Risk Reduction 5: 19–27. [CrossRef] Yilmaz, Veysel, Erkan Ari, and Yasin Emre O˘guz. 2021. Measuring Service Quality of the Light Rail Public Transportation: A Case Study on Eskisehir in Turkey. Case Studies on Transport Policy 9: 974–82. [CrossRef] Yuan-yuan, Hao, Li Yi-jun, Qi Wei, and Ye Qiang. 2007. A Study on Citizen Satisfaction Evaluation Model of Chinese Municipal Government Online Services. Paper presented at 14th International Conference on Management Science and Engineering, Harbin, China, August 20–22; pp. 186–91. Yuliansari, Pratiwi, Nursalam Nursalam, and Ahsan Ahsan. 2017. Service Quality Is Related to Loyalty of Nursing Care Services Based on SERVQUAL Theory and the American Customer Satisfaction Index (ACSI). Advances in Health Sciences Research 3: 59–62. Zarychta, Alan. 2020. Making Social Services Work Better for the Poor: Evidence from a Natural Experiment with Health Sector Decentralization in Honduras. World Development 133: 104996. [CrossRef] Zeithaml, Valarie A. 1988. Consumer Perceptions of Price, Quality, and Value: A Means-End Model and Synthesis of Evidence. Journal of Marketing 52: 2–22. [CrossRef]