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Secondary but significant: secondary customers’ existence, vulnerability and needs in care services

Henna M. Leino (Department of Marketing and International Business, Turku School of Economics, University of Turku, Turku, Finland)

Journal of Services Marketing

ISSN: 0887-6045

Article publication date: 16 October 2017

Issue publication date: 22 November 2017




The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service customers’) loved ones.


The position and vulnerabilities of secondary customers of care services are studied and examples provided by reviewing empirical research reported in the care service literature. A conceptual discussion is developed on the “customer” concept in an extended sense, beyond the focal customers. The “primary customer” and “secondary customer” concepts are employed to supplement the extant discussion on customer units and ecosystems.


Secondary customers are exposed to secondary vulnerability and their well-being is affected by the services provided primarily to their loved ones. The most recurring needs of secondary customers concern psychosocial support, communication and information and cultural sensitivity.

Practical implications

New perspectives on understanding the “customer” concept in an extended sense. This assists in supporting the customers’ dynamic activities and processes within the customer ecosystems. To address care service customers’ loved ones’ vulnerabilities and needs and to support their well-being, they should also be recognised as customers – “secondary customers” – with patients being the “primary customers”.

Social implications

The results are especially relevant when considering services’ influences on vulnerable customers’ ecosystems and on individuals within them. It is important to recognise that beyond a vulnerable customer, several secondary customers may be exposed to secondary vulnerability, needing support.


The paper is apparently the first to connect the constructs “primary” and “secondary customer” and customer vulnerability to the customer ecosystem discussion. Also, essential future research questions are provided.



This work is supported by the Finnish Funding Agency for Technology and Innovation (Tekes) and Otto A. Malm Foundation.


Leino, H.M. (2017), "Secondary but significant: secondary customers’ existence, vulnerability and needs in care services", Journal of Services Marketing, Vol. 31 No. 7, pp. 760-770.



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Copyright © 2017, Emerald Publishing Limited

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