This chapter covers the background to the study, problem statement, research objectives and hypotheses and the significance of the study.
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Background to the study
The wide spread of the H7N9 Virus and food contamination have impacted on tourism. Health tourism involves a particular conception of health (Müller & Lanz-Kaufmann, 2002, p. 12; Horneman et al., 2002). Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of health is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Health can therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in.
Health directs the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, health involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or will to aid in his/her functionality. An individual will achieve a higher degree of health when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment (Ardell, 1977, p. 54).
The condition of being combined with a positive attitude in a continuous process entails the vibrant development of health (Travis, 1984, p. 33). The neutral point in the health continuum shows that no apparent sickness exists yet a low intensity of health prevails. The individual is protected from premature death by returning them to the neutral point. The main aim of the health model is not only just to aid in the healing of the individual’s diseases, but also to elevate the individual to a higher rank of health.
The definition of health according to Müller and Lanz-Kaufmann is in line with the definition given by Ardell (1977). Health is a health condition whereby the individual’s body, intellect and spirit work in unison. The elements that define health include: self-conscientiousness, health and prettiness, food nutrition, recreation, mental education, social interaction and sensitivity to the environment (Travis, 1984, p. 33). In addition, Müller and Lanz-Kaufmann noted that the hospitality industry should strive to refurbish its market in order to provide products that promote health so that the tourists can enjoy their trips better.
Statement of the problem
Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Health tourism involves the individuals visiting hotels or recreational centres that provide health services.
It is required that health hotels should have an up-to-standard health infrastructure in order to provide the best services to the tourists. There are various extents of health as there are various extents of illness. Health tourism, therefore, is in line with the individual’s intent to improve the class of his/her life, physical health, mental health and social interaction. The individuals stay in specific hotels that have the capability to make available the relevant professional expertise and professional care. The various service packages of the hotels include: physical training, dieting activities and mental training. The hotels that function in line with health tourism should therefore strive to safeguard the individual’s physical health, mental health, and social relations.
Objectives of the study
The general objective of this study was to determine the impacts of H7N9 Virus and food contamination with Maleic Acid on inbound tourism for elderly to Taiwan. In line with the general objective, the study examined the following specific objectives:
- To determine the effectiveness of the H7N9 Virus of elderly participation in health tourism;
- To determine the influence of food non-contamination on elderly participation in health tourism;
- To determine the influence of the desire for entertainment on elderly participation in health tourism;
- To investigate the influence of the urge to take a vacation on elderly participation in health tourism;
Hypotheses of the study
In order to meet the above objectives, the following hypotheses were tested:
- Ho1: The H7N9 Virus motivate the elderly tourists to travel;
- Ho2: Food non-contamination motivate the elderly tourists to travel;
- Ho3: The urge for entertainment motivate the elderly tourists to travel;
- Ho4: The urge to take a vacation motivate the elderly tourists to travel;
Justification of the Study
The findings of this study are of great value to policy makers and regulatory authorities. It provides the policy makers with a wide exposure with regard to the assessment of the influence of health tourism’s participation for the elderly, thus enabling them to adopt the relevant strategies in line with the situation. The findings of this study also add to the body of knowledge of related studies.
Scope of the Study
The scope of this study was in line with the general objective, which was to explore on the influence of health tourism’s participation of the elderly. Using primary data and applying statistical techniques, the study explained the variables to meet the research objectives. The study used a cross-sectional research design to meet the objectives. The data of the survey were analysed using statistical techniques such as SPSS.
This chapter reviews the theories both empirical and theoretical that are closely linked to the influence of health tourism’s participation of the elderly.
Decisive models of tourists’ actions
The process of tourists’ behaviour is both complex and vigorous. In the context of tourism, the tourist behaviour process is considered to be complex due to the fact that tourism products are intangible and the purchasing power of the tourists is accumulated (Correia, 2002; Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Three sets of models have emerged as a result of the interdisciplinary status of health tourist behaviour. The models include: microeconomic models, structural models and processional models. In the case of microeconomic models, health tourists normally have the motive to increase their utility to the maximum subject to a combination of constraints such as: time, income and the level of technology (Morley, 1992; Moutinho, 2000, p. 13; Fridgen, 1996, p. 46; Hsu & Huang, 2008, p. 52; Huang & Tsai, 2003; Jang & Wu, 2006; Anderson & Langmeyer, 1982; Javalgi et al., 1992; Littrell, 2004). In the case of structural models, the connection between the input and output is scrutinized. Consequently, for the case of processional models, the tourist’s judgments are put in examination (Abelson & Levi, 1985; Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118).
The classical economic theory is the main basis of the microeconomic model that analyses the behaviour of the health tourists. When taking into consideration the demand for manageable goods or services, classical economic theory is very instrumental. In addition, the classical economic theory brings into focus the limitations that relate to tourism analysis. Samuelson (1991) asserts that the notion that the tourists strive to maximize the utility that they derive from health tourism contributes to the process of tourism analysis. Moreover, the destination sites for tourists are not considered as objects that can directly be used, but rather products that have characteristics that facilitate the derivation of utility (Lancaster, 1966, p. 140; Pearce, 1982; Maslow, 1954; Cleaver et al., 1999; Zimmer et al., 1995; Koss, 1994); this utility is subject to various constraints. Morley (1992, p. 254) brings into focus the utilization of microeconomic theory to the field of tourism. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of health tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000; Bai et al., 2001; Britton, et al., 1999, p. 27; Kinni, 1994; Barcelo, 2000).
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Scholarly studies that relate to the analysis of the influence of health tourism’s participation of the elderly are founded on the basis of various models that are considered to be outstanding. These models stem from the perspective of the processional models. The first model is the Nicosia model (1966) which concentrates on the correspondence that occurs between the tourist and the firm, and how the firm convinces the tourist to acquire her products. Another model dubbed Howard and Sheth’s model (1969) integrated the input notion that describes the conduct of the tourists; in addition, the model states the ways by which the tourists incorporate these inputs in their decision making process. The Howard and Sheth’s model has continued to be regarded as the most important model for analysing tourist activities.
Health tourist performance can be assessed by paying regard to the analytic analysis of desire, anticipations, conception and satisfaction. Gallarza, Saura and Garcia (2002, p. 63) emphasized on the use of statistical tools (such as multivariate analysis that depend on other analyses like correlation matrix, sampling techniques and regression analyses) on tourism. Qualitative choice models are very efficient in assessing the health tourist behaviours; such models entirely depend on multinomial logit (Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118). In the recent past, many academic scholars have applied structural models on researches that relate to the influence of health tourism’s participation for the elderly (Baker & Compton, 1998, p. 800; Shoemaker, 1989; Romsa & Blenman, 1989).
Tourist decision making processes
There are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Before the tourist proceeds to make the purchase, the pre-decision stage usually precedes. This stage normally entails serious decision making by the tourist as he/she has to make the best choice out of the many alternatives. The kind of choices that the tourists have in this stage include: the travel destination, the activities to engage in during the travel and the level of expenditure that the tourist expects to commit. Very many tourists are motivated to travel because of the various activities that they intend to engage in or carry out (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466; McCabe, 2000, p. 1050; Fodness, 1994, p. 563; Robson, 2002).
The pre-decision stage gives way for the decision stage. At this point the tourists make decisions paying attention to the time they have available for the travel and the amount of income that they want to commit on the travel. The decision stage is mostly concerned with the purchase of products. The post-purchase stage stems from the factors that determine the process of making choices and checks whether the tourist has been satisfied with the decisions or the choices that he/she had opted for. This stage, therefore, plays an important role in assessing the likelihood of making the purchase again and also in recommending or opposing the choice or the decision (Abelson & Levi, 1985; Barros & Proença, 2005, p. 300; Barsky, 1992, p. 54; Hunt, 1977, p. 49).
Generally, motivation refers to a certain need that influences a person to assume a certain demeanour in order to satisfy that need. The motivation theories can be linked to the psychological factors like: wants, desires and goals, as the theories provide a description of the psychological factors (Fodness, 1994, p. 563; Woodside, Frey & Daly, 1989, p. 12). The psychological factors of needs, desires or goals induce an urgent urge in the person’s mind which leads him/her to purchase goods or services; thus, motivation directly influences the feelings of the individuals (Gartner, 1993, p. 200; Dann, 1996, p. 43; Baloglu, 1997, p. 226). Tourists who have divergent motives may assess a tourist destination in the same manner especially if they are of the opinion that the destination provides them with the maximum health utility.
The important motivational elements that have been pointed out by different scholars in their studies include: the urge to get away from the daily programs or work; and the urge to seek for alternative enjoyable experiences (McCabe, 2000, p. 1050). The push-pull model was generated by Crompton (1979, p. 410). The model postulates that tourism is driven by two main forces; the first force, known as push, pushes the tourist out of his/her home driven by the desire to travel to an unspecified destination. In this context, the motivation of the push force depends on the satisfaction anticipated by the tourist, the urge for adventure, prestige, knowledge, and the desire to make new friendships.
The second force, known as pull, provides the tourist with the direction regarding the choice of the destination (Uysal, Mclellan & Syrakaya, 1996, p. 62). The motives of the pulling force influence the tourist’s choice of the place to visit; the forces are connected to the features of the destination and the infrastructures that define tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied (Mohsin & Ryan, 2003, p. 117; Beerli & Martin, 2004, p. 670; Uysal, Mclellan & Syrakaya, 1996, p. 62; Fodness, 1994, p. 563). When the tourist has already pointed out the need, he/she proceeds to identify the destination that grants him/her the maximum satisfaction; the next stage after this is the learning stage.
The tourist’s learning course
The learning process enables the tourist to gain the knowledge concerning a product and how the product will impact on the satisfaction of the tourist. Bettman and Park (1980) studied the learning process before developing another model that processes information about the behaviour of the tourists when they are making decisions concerning the destinations that they want to visit. Actually, the tourist has the ability to retain at most seven destination sites and at least two destination sites (Miller, 1956, p. 83; Miller, 1977; Arnould & Price, 1993, p. 26).
The learning process presents a number of destination sites to the tourist, who has a strain in remembering all of the destinations; thus, it is practical to choose a manageable number of destination sites that do not pose any hardship to the tourists. The analysis of the tourist learning can be viewed from the behavioural perspective or from the cognitive perspective. From the behavioural perspective, the tourist learning takes place in three parts, namely: gathering of information, making a choice and the learning experience. When the behaviour of the tourist is repetitive, then the benefits of the result are realized (Guy, Curtis and Crotts, 1990, p. 422)
Perception factors of the tourists
Perception refers to the way in which the travel tourists regard the value of the product (Sheth, Newman & Gross, 1991, p. 163; Correia & Crouch, 2004; Correia, Valle & Moço, 2005). The concept of perception stems from the cognitive point of view or from the behavioural point of view. Thus, it should be noted that perception occurs as a result of the process of tourist learning together with their motivations. Previous researches concerning tourist motivation reveal that the tourists’ selection and assessment of travel products are influenced mostly by affective factors (Fodness, 1994, p. 558).
Every tourist is driven by his/her personal motivational factors to travel; these motivational factors are both internal and external and they define the tourists’ insights regarding the destination (Baloglu & McCleary, 1999, p. 870; Gartner, 1993, p. 193; Correia, Valle & Moço, 2005). The internal motivational factors stem from the push motives while the external motivational factors stem from the pull motives. Perception is a dynamic process due to the fact that the tourists have the ability to select, to organize and to spell out the various stimuli into a useful and clear manner. The perception of the tourist, therefore, varies from the real characteristics of a product to the manner in which the tourist grasps and analyses information (Dann, 1981, p. 190; Pearce, 1982, p. 153). Perception can occur selectively if the tourist decides to be selective in his/her exposure, attention, perceptual blockage and perceptual defence. It is a common practice for the tourists to select only things they need and block out the things that they regard as unnecessary or unfavourable to them.
Satisfaction factors of the tourists
Each tourist has a different interpretation of the concept of satisfaction, thus, its definition is divergent among the various tourists. Many scholars in their research articles have linked the definition of satisfaction to the distinction between expectation and experience (Woodside, Frey & Daly, 1989, p. 12). Bultena and Klessig (1969, p. 349) gave a definition of satisfactory experience as a part of the level of the correspondence between the tourists’ desires and the experiences that they undergo. Satisfaction does not entirely stem from the pleasures that the tourists derive from the travelling experience, but rather it is the analysis that checks out whether the experience satisfied the tourist as it was expected to (Hunt, 1977, p. 459; Gnoth, 1997, p. 292; Dann, 1981, p. 190; Pearce, 1982, p. 153; Baloglu & McCleary, 1999, p. 870; Gartner, 1993, p. 193; Correia, Valle & Moço, 2005). Various researches have revealed that satisfaction and the brand’s attitude mean one and the same thing (LaTour & Peat, 1979, p. 433).
Affective reactions have a major influence on the experiences of the tourists’ consumption process with regard to their judgments on post-purchase satisfaction (Madrgal, 1995, p. 212; Spreng, MacKenzie & Olshavsky, 1996, p. 17; Barsky, 1992, p. 54; Oliver, 1993, p. 422). In this case, it is assumed that the satisfaction of the tourists is dependent on the performance of the product (health), the perceptions of the tourist in relation to the product, and the motivations that the tourists have. The ratio between the performance and the perception rises as the level of the tourist’s satisfaction also rises (Barsky, 1992, p. 54; Fodness, 1994, p. 558; Jamrozy, Backman & Backman, 1996, p. 912; Fodness & Murray, 1997, p. 506); the ratio depends on the nature of the experiences that the tourists have in relation to the experience they had envisaged or desired. The dissatisfaction of the tourists comes about when there is a major disparity between what the tourists had expected and what they actually experience in terms of the performance of the products (Money & Crotts, 2003, p. 195; Guy, Curtis & Crotts, 1990; Uysal, Mclellan & Syrakaya, 1996, p. 62).
Behavioural objective factors of the tourist
The intention by the tourist to make a purchase depends on their motives relating to both the behavioural and social norms. The motives of the tourists depend on the level of expectations that they have concerning the probability of assuming a certain behaviour and the assessment of how they regard it (Fishbein & Ajzen, 1980; Uysal & Hagan, 1993; Crompton, 1979). Lam and Hsu (2006) in their study used the theory of reasoned action to show that the intention of the tourists to choose a destination site depends on the recognized behaviour and the past behaviour (Fishbein & Ajzen, 1980; Crompton, 1990, p. 53; Correia, 2002; Truong, 2005, p. 229). The image that the travelling tourist portrays depends on the quality of the destination site, the anticipated satisfaction, the eagerness of the tourists to return and their enthusiasm to propose the destination to their friends. When the destination site is of a high quality, the tourists will be persuaded to return to the site because of the high level of satisfaction he/she experiences; the level of satisfaction will further influence whether the tourists will recommend the destination site to their friends. Further, studies show that the more a tourist visits a site, the more he/she is motivated to return, especially with regard to mature destinations (Kozak, 2001, p. 792; Woodside & Lyosnski, 1989; Holbrook, 1978, p. 550; Gartner, 1993, p. 200).
Theory and Hypotheses Development
The tourists rely on information sources for travel awareness
Studies by Baloglu and McCleary (1999) confirm that tourists utilize the various sources of information so as to be familiar with the destined site. The sources of information include: the media (i.e. newspapers, televisions, internet, or travel magazines), information from friends or relatives through word of mouth, among others (Um & Crompton, 1990, p. 436; Fakeye & Crompton, 1991, p. 12; Dann, 1977, p. 186). The information is very beneficial to the tourists in their decision making process. There are four basic types of sources of information, they include: neutral information sources (tourism firms), commercial information sources (travel agencies), social information sources (relatives or friends) and promotional information sources (internet, magazines, radios or television) (Bargeman & Poel, 2006, p. 711; Crotts, 1999; Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000).
Various information sources motivate the tourists to visit
In their study, Um and Crompton (1990) established that travel tourists use the various sources of information to bring about a cognitive perception or an affective perception. Tourism is like any other product, thus, the tourist should seek for all the relevant information that relate to the product before deciding to purchase it. Woodside and Lyosnski (1989) in their study revealed the influence of the information sources on how they trigger the needs of the tourist. Tourists who are uncertain always resort to use travel agencies rather than media sources to get information relating to a destination site (Money & Crotts, 2003, p. 195; Dann, 1977, p. 186; Song & Witt, 2000; Lancaster, 1966, p. 140). Health tourists are motivated by the promotional campaigns or publicity of the destination site (Crompton, 1979, p. 412; Kotler, Haider & Rein, 1993).
The sources of information initiate pull motivations in the tourist’s mind
The sources of information act as forces that affect pull motivations on the minds of travel tourists (Woodside & Lyosnski, 1989; Holbrook, 1978, p. 550; Gartner, 1993, p. 200).
Push motivations are instigated by internal motives of the tourists
Push motivations that are instrumental in influencing the tourist’s trip are classified as internal factors (Dann, 1977, p. 186). These internal factors that influence the push motivations include: the feeling of loneliness by the tourist, the urge of the tourist to travel, and the desire of the tourist to gain social recognition. In addition, Crompton (1990) regards internal factors as the factors that trigger the urge to travel in order to relax, socialize, earn prestige and get away from the daily routine.
Pull motivations are instigated by external motives of the tourists
In their study, Uysal and Hagan (1993) confirm that the characteristics of the tourist’s travel destination are connected to the pull factors. The tourist’s choice of the travel location is mostly influenced by the pull motives (Crompton, 1990, p. 53). Examples of pull motivation factors include: the available hospitality, accommodation, cost of the trip, type of food, nightlife, among others.
Methodology is the process of instructing the ways to do the research. It is, therefore, convenient for conducting the research and for analysing the research questions (Snell & Dean, 1992, p. 480). The process of methodology insists that much care should be given to the kinds and nature of procedures to be adhered to in accomplishing a given set of procedures or an objective. Methodology gives a description of distinct methods or procedures that are to be used in analysing the data. These methods or procedures stand for a creative generic structure; thus, their order may be rearranged, or they may be combined or broken down into sub-processes.
With this regard, research methodology can entail elaboration of the generic processes and procedures; as well, research methodology can be elaborated through figurative means and can be adjusted to eliminate obscurity in the school of thought with tenacious conceptions or doctrines as they associate to a specific field or discipline of inquiry especially if the philosophical and/or principal of the presumptions that signify a specific methodology or a specific study is known as reasoning methodology. A section on the methodology in academic research of the researchers will always be generally de rigueur.
The research strategy
First, with regard to the qualitative research, areas of study were chosen with determination, paying attention to whether the areas of study are in line with the features that have been predetermined (Creech, 1995, p. 33). Next, the part played by the researchers was to obtain a higher critical care (Creech, 1995, p. 33). This is mainly done in qualitative research due to the fact that there is every chance of the researcher assuming a transcendental or a ‘neutral’ position. Thus, this appears to be more elusive both in philosophical and/or practical terms. It is for this reason that the qualitative researchers are frequently pressed to mirror on their part in the research procedures and make things obvious in their research analyses.
In the research process, the choices of the two processes: deductive and inductive processes can be used for carrying out the research. A deductive approach is described as a study in which the theory is tested by the empirical observation, and is referred as moving from the general to the specific. Deductive research establishes a theory and then checks on the data; it uses quantitative data and it is a very structured approach. On the other hand, inductive approach is a study in which the theory is developed from observation of reality and is the opposite of deductive research; it moves from the specific observations to the general statements.
Inductive approach does not start with the theory, and is very flexible using qualitative data. This study mainly used the inductive process in the case of exploring the influence of health tourism’s participation for the elderly because the theory is developed from the observations of the reality, and during the process, there are qualitative data that are used for data analysis (Snell & Dean, 1992, p. 480; Skinner, 1953, p. 306; Creech, 1995; Bryman & Bell, 2003, p. 214).
Quantitative and Qualitative Approach
Quantitative research approach refers to the use of statistical techniques, mathematical techniques and calculation techniques to empirically analyse data (Bryman & Bell, 2003, p. 217). Quantitative methodology aims at utilizing mathematical and statistical theories and models to analyse the data. Quantitative methodology validates the hypotheses and conclusions that have been drawn from qualitative methodology (Carter, 2009, p. 239). The scientific procedures and processes that are utilized in quantitative methodology encompass: deriving models and theories; designing instruments for data gathering; controlling the variables empirically; and analysing data through the use of models (Robson, 2002, p. 212).
Qualitative approach is mostly concerned with the human motives and the reasons behind such motives (Snell & Dean, 1992, p. 482). The main questions that come with qualitative approach are ‘why?’ and ‘how?’, in addition to ‘what?’, ‘where?’ and ‘when?’. With regard to this, a researcher utilizing the qualitative approach will tend to use smaller samples rather than larger samples (Carter, 2009, p. 239). Qualitative approach strictly generates only the information that applies to the designated case study; any additional information is treated as guesses. Once hypotheses are drawn through qualitative approach, they are tested through quantitative approach (Robson, 2002, p. 212).
Validity and Reliability
Validity refers to whether an instrument actually measures what it is supposed to measure, given the context in which it is applied. Reliability is concerned with consistence of measures. The level of an instruments’ reliability is dependent on its ability to produce the same results when used repeatedly. To achieve validity and reliability, the data was checked for coding errors and omissions while coding into excel sheets. The database was also verified for accuracy and completeness of all the entries to ensure reliability of data is achieved.
Data can be classified into two and they are secondary data and primary data. Primary data refer to the new data (observation, survey, interview, experiment, etc.) that the researcher needs to collect for the research while secondary data refers to the existing data that are available in various sources including books, journals, internet, etc. (Easterby, Thorp & Lowe, 2008, p. 216). For primary data collection, the issue is to focus on sampling. As far as the researcher is considered, the sampling technique is significant. For example, the sample size that is determined should not be too small as this will make it difficult to generalize the data. It is to be noted that reliable results can be originated from larger sample sizes (Bryman & Bell, 2003, p. 309).
The primary data sources comprise observation and participant observation, questionnaires and interviews, texts and documents, focused group, case study, etc. Questionnaires are practical approaches of collecting data. Respondents were also given the analogue questions that were supplemented by in depth interviews. The outstanding advantages of using questionnaires are that the data are accurate, anonymous, and they can cover a broad location without any geographical limitation. The disadvantages of using questionnaires are that they could be expensive, impersonal, delay in getting results, and the response rate can be very low (Easterby, Thorp & Lowe, 2008, p. 216). In this study, questionnaires were issued in 17 hotels in Taiwan. The hotels were selected with regard to their location and size.
Respondents and Unit of Analysis
In this study the questionnaires were issued to tourists visiting hotels in Taiwan. The study chose a target of 1,249 respondents and received feedback from 1,130 respondents. This is equivalent to a 90.5% response rate which is very good. In this research, data from the survey were entered into the Excel spreadsheet program for future analysis. The data was analysed using SPSS, regression and correlation analysis.
Findings, Data Analysis and Interpretation
This section covers the analysis of the data, presentation and interpretation. The results were analysed using SPPS, ANOVA, regression and correlation analysis.
The tourist sites were visited by at least 50% of all the tourists coming to Taiwan. In this study 1,249 questionnaires were issued to respondents; only 1,130 were successfully filled out. The results revealed that the female respondents were 53% as compared to the male respondents who were 47%. All the respondents had an average age of 45.39 years with a standard deviation of 14. Actually, the majority of the respondents were aged between 34 and 58 years. In addition, a major number of the respondents had obtained a higher level of education. The respondents had varied backgrounds with regard to their occupations; for instance, 70% were employees, managers were 17% and 13% were hotel owners.
With regard to the country of origin, 30% of the respondents came from Germany, followed by Austria (18%), Italy and the UK (12%), Russia (10%), and the rest were classified as other countries. In addition, a big number of the respondents (53%) had visited Taiwan initially. First time visits were more than repeat visits. Many of the respondents were travelling together with their spouses, and 33% were travelling with their spouses together with not less than one child. The respondents were grouped into three categories; the first category was, high level health, the second category was moderate level health, and the third category was low level health. Using a Chi-square test and ANOVA, the important differences among the three categories of the respondents were noted. The results are summarised in Table 4.1 and Table 4.2.
Table 4.1 Relationship between tourists’ characteristics and health groups
|Size of settlement |
Visiting with children
Visiting with spouse
Rely on brochures for information
Rely on TVs for information
Motivation by the H7N9 Virus
Motivation by food non-contamination
Willing to stay in another part of Taiwan
Food and drinks prices
Tour of Spain
Tour of Greece
First visit or repeat visit
Country of origin
Country of origin had the largest size effect, hence indicating an average strength. The size effect for the other variables was comparatively low. The important differences among the three groups were confirmed for size of settlement, visiting with children, visiting with spouse, relying on brochures for information, relying on TVs for information, motivation by the H7N9 Virus, motivation by food non-contamination, willing to stay in another part of Taiwan, food and drinks prices, tour of Spain, tour of Greece, sex/gender, occupation, first visit or repeat visit, country of origin, and education level. High level health tourists did not prefer to: stay in villages (28%), and to travel together with the children (44%) as compared to the two remaining groups. In addition, high level health tourists had a higher likelihood of relying on brochures to obtain information about the destination site (53%) and also to tour Spain (51%).
On the other hand, 21% of the tourists in the category of low level health visited with their partners or spouses. This percentage was the least as compared with the other categories. 13% of low level health category of tourists relied on TVs for information regarding the destination site. 17% of the tourists in the category of moderate level health considered the H7N9 Virus as their main motivational factors to visit as opposed to 59% of the tourists in the category of high level health who did not consider the H7N9 Virus as the main motivational factors.
38% of the German tourists and 40% of the Italian tourists regarded health to be very essential to their lifestyle. In addition, 54% of Russian tourists and 71% of the UK’s tourists confirmed that health was very essential to their lifestyle. 33% of the respondents in the category of low level health had elementary or high school level of education. 28% of the tourists in the category of high level health complained about the high prices of food and drinks in the hotels.
The Chi-square test confirmed the overall significance of the variables, but the post hoc test did not reveal any considerable relationship between the three categories of health and motivation by food non-contamination, motivation to travel, willingness to stay in another part of Taiwan, and tour of Greece. With regard to these variables, it was noted that 49% of the tourists in the category of high level health were highly willing to stay in another side of Taiwan as compared to the other groups, 46% of the same tourists were motivated by food non-contamination, while 52% were willing to tour Greece and 50% were visiting for the first time.
Table 4.2 ANOVA analysis of tourists’ characteristics by health category
|Variable||High level||Moderate level||Low level||F (df1, df2)|
|Having a house |
Having a car
Clothes and shoes
Length of stay
Perception of the trip
|36.221(2, 1063)* |
- NOTE: * = Significant at 0.01
Mean with subscripts vary at p<0.05.
The three categories of tourists varied with regard to having a house, having a car, clothes and shoes, vacation, entertainment, stay period, insight of the vacation, and the age as shown in Table 4.2 above.
The respondents who had the view that health was not essential to their lifestyle regarded having a house, car, clothes and shoes as the least significant. The relevance of having a vacation and entertainment varied significantly among the three categories of tourists. The two variables were the most significant to high level health tourists and were less significant to low level health tourists. Also the period of stay during the trip varied significantly among the three categories of tourists. The high level health tourists preferred to stay for long as opposed to the low level health tourists who preferred to stay for a shorter period. The high level health group had the perception that lack of money influenced their vacation; the opposite was true for the low level health group. In terms of age, the high level health group was the oldest among the three groups.
Conclusions and Recommendations
Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Health tourism involves the individuals visiting hotels or recreational centres that provide health services (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466; Kozak, 2001, p. 792).
- Even though health tourism has been in existence in Taiwan, health tourism emerged as a subdivision of health tourism. Many tourists are motivated by the H7N9 Virus which are mainly income created. Health tourism, therefore, emerged as a segment of the market that took into consideration the two constituents (the H7N9 Virus). The packages of health tourism are presented in all the tourist destination sites.
- Health of the tourists are always accompanied by tranquillity, calmness and privacy, therefore, the consumers of health tourism always have a different mode of lifestyle as compared to other tourism consumers who do not seek for health services. Health tourism is mostly based on the socio-demographic attributes of the tourists. These attributes were the basis of categorising the health tourists into three groups.
- The period of stay during the trip varied significantly among the three categories of tourists. The high level health tourists preferred to stay for long as opposed to the low level health tourists who preferred to stay for a shorter period. The high level health group had the perception that lack of money influenced their vacation; the opposite was true for the low level health group. In terms of age, the high level health group was the oldest among the three groups.
A good number of tourists regarded health tourism to be very significant to their lifestyles, thus, Taiwan should make health tourism to be an activity on its own. This will ensure that the tourists are satisfied with every aspect, thus, making the holidays enjoyable.
In addition, the tourism season should be expanded so that the tourists can have a longer time to stay during their vacation. Relevant marketing strategies should be used to market the tourist destination sites.
The findings of this study are very relevant to the elderly tourists, tourist planners and tourist marketers. It is also adequate for the country to improve and protect the physical appearance of tourist destination sites to enable her to be in a competitive position as compared to the other countries. Moreover, the ease of accessibility to the tourist destination sites should be improved so as to give an easy time for the elderly tourists to move around. Accommodation facilities and other social amenities should be upgraded so that they can be up to standard and fit the specifications and the requirements of the elderly tourists.
Contributions and impacts
Health entails a particular notion of health. Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of health is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Health can, therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994).
Health directs the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, health involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or the will to aid in his/her functionality. An individual will achieve a higher degree of health when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment.
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