When digitalisation meets fragmentation: evidence from the Italian public healthcare sector

Purpose – This study aims to investigate how fragmentation in digital public service delivery reshapes the mechanisms through which citizens translate service quality into institutional trust and satisfaction. Design/methodology/approach – A multi-group structural equation model based on the E-GovQual framework tests direct and mediated effects across two Italian regions with contrasting governance structures, namely Emilia-Romagna and Veneto. Findings – Service quality positively relates to satisfaction in both regions. However, the underlying mechanism differs. In the integrated system, trust significantly mediates this relationship. In the fragmented system, trust plays a negligible role. Thus, fragmentation does not weaken the effect of service quality per se but alters the evaluative pathway through which quality translates into satisfaction. Originality/value – This research advances existing views on regional disparities by theorising fragmentation as a condition that reshapes how citizens interpret and evaluate digital public services. Drawing on attribution theory, we argue that fragmentation disrupts the assignment of responsibility, thereby altering the mechanisms through which service quality translates into trust and satisfaction.