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Assessment Scale of Competitiveness of Wellness Destinations in Thailand

An assessment scale was developed to measure the competitiveness of wellness destinations in Thailand, particularly from the perspective of the wellness tourism firm. Several studies emphasized exploring the management of tourist attractions, the development of routes, and the promotion of products to wellness tourists. A number of studies concerning Thai spas and developing community wellness tourism explored quality development for businesses and communities and the types of wellness tourism in a particular area. However, there has been a lack of research regarding the development of a measurement scale for evaluating the competitiveness of wellness destinations, particularly among those that offer niche services, rather than a more general view; this would be especially useful for Thai destinations.

  • wellness destination
  • destination competitiveness
  • scale development

1. Competitiveness in Economics and Management

Competitiveness can be defined through three approaches: behavioral, structural, and functional approaches. According to the behavioral approach, competitiveness is the act of identifying unique strategies businesses employ in a rivalry situation in order to provide financial efficacy of demand. The structural approach describes competitiveness as a strategy whereby there is regulation in terms of production such that there is an interbranch movement of factors of production. The functional approach, on the other hand, describes competitiveness as a major determinant of economic growth which results from businesses introducing development and innovative strategies. This approach argues that in order for a business to achieve a competitive advantage, it should be able to produce at a low cost and produce new products which satisfy the demand [1].
In line with Boikova et al. [2], competitiveness is a factor of economic growth. It ensures that there is there is efficient allocation of resources by ensuring that the resources used to produce a product are of good quality and conform with what the customer prefers. The resources are also allocated efficiently, minimizing the costs of production. The firms are also able to come up with new products and better production techniques. With improvement in efficiency, there is increased productivity, which in turn leads increased economic growth as measured by GDP per capita. The consumer is also able to utilize the product.
Competitiveness increases profitability. With increased competitiveness, there is greater research and development. The firms invest in research and development in order to bring out the business aspects that may not be working and come up with better business ideas. Research and development bring about innovation and thus improved products [3]. Improved products result in a sales increase, which leads to increased profitability of the company and consequently increased GDP [4]. Moreover, competitiveness reduces the level of unemployment in an economy. Owing to the fact that competitiveness increases the efficiency of production, bringing about economic growth, the unemployment rate reduces. Increased economic growth leads to an increased investment rate. Existing businesses are also able to operate at a low cost and thus are able to employ more people. The unemployment rate is thus reduced as a result of competitiveness [5].
In addition, competitiveness reduces the inflation rate. The higher the competitiveness, the lower the price levels. High competitiveness results in better allocation of resources, which leads to reduction in prices, temporarily reducing the inflation rate. Competitiveness also informs a firms’ pricing behavior and consequently, the inflation rate. A firm’s decision to revise the price of a product due to a demand shock is more likely to be prompt in a competitive market compared to a non-competitive market. Therefore, the inflation rate is reduced as a result of competitiveness [6].
In conclusion, competitiveness is a major determinant of the direction the economy will take. Increased competitiveness brings about an improvement and efficiency in resource allocation. This in turn results in economic growth. Profitability of any firm is also increased due to competitiveness. The company increases the level of research and development, and thus information on how to better the products is revealed, leading to increased profitability. Competitiveness, on the other hand, reduces the unemployment and the inflation rate in any given economy.

2. Dynamic Development of the Wellness Destination Market in Thailand

Health and wellness tourism, as a form of group tourism, is popular, with many regular visitors traveling to Thailand. This kind of tourism allows travelers to visit beautiful places along and engage in other activities, including medical treatment. Some travelers with no diseases visit Thailand for therapeutic activities to enhance their wellbeing. The health and wellness tourism market has recorded recent rapid growth in the Asia-Pacific region, especially in Thailand. This expansion of global wellness tourism is due to three factors: (1) the global middle-class population has increased, with higher incomes and an increased focus on tourism, (2) people now pay more attention to wellness, with increased knowledge about non-communicable diseases (NCDs), while muscle soreness is caused by stress due to the burden of responsibility, and (3) tourists now recognize a new experience that does not involve buying souvenirs to take back home [7].
From 2018 to 2022, tourist expansion in the Asia-Pacific region recorded a compound annual growth rate (CAGR) of 3.3% per annum, with strong economic and social development. Nowadays, the large variety of airlines and direct international flight schedules make travel faster and easier. Critical infrastructure development has also resulted in lower travel costs and the convenience of booking through online platforms.
In Thailand, health and wellness tourism had a CAGR of 11.45% per annum between 2014 and 2018. A total of 38,277,300 foreign tourists visited Thailand in 2018, with an increase of 8.19% in 2019. The latest report by GlobalData confirms Thailand as a key destination for health and wellness tourism, with numbers of health and wellness tourists forecasted to increase to 27.7 million by 2022, representing an increase in CAGR of 5.6% from 2019 [8]. The Ministry of Tourism and Sports identified health and wellness tourism as one of the top five revenue-generating industries. In 2020–2021, health and wellness tourism in Thailand was ranked 17th by Global MTI. Factors used in this ranking included destination environment, medical tourism industry, and quality of facilities and services. Moreover, Thailand was also ranked 15th in quality of facilities and services in terms of health and wellness tourism [9]. The International Healthcare Research Center (IHRC) predicted a growth of health and wellness tourism in Thailand at 14% per annum [10]. This information corresponds to the number of international tourists visiting Thailand, with an average increase of 12% per annum. Thai health and wellness tourists hail from Cambodia, Laos, Myanmar, and Vietnam (CLMV) and also from China and Japan. In 2018, two and half million international tourists visited Thailand for health and wellness tourism, accounting for 6 to 8% of the total number of tourists [11]. The growth of health and wellness tourism in Thailand may be partly due to Thailand’s focus on elderly tourists aged 60 years and over. Tourist numbers in this age group are increasing as a result of improved medical facilities. Many elderly people now spend their lives after retirement engaging in recreational activities or traveling to relax because they have more time than other generations. These people are financially stable, representing a new target market with higher purchasing power. Over the next 10 years, seven million elderly foreign tourists are forecasted to visit Thailand annually, with 31% coming from Japan. This increase in the elderly tourist population is an opportunity for Thailand to become the main target group of health and wellness tourists to further increase income from tourism [12].
Numbers of Thai health and wellness tourists are increasing, with Asians as the main group. However, despite Thailand’s high income from health and wellness tourism in the form of treatment, another group travels for health and wellness tourism in Thailand for health promotion, (disease prevention). Based on the foregoing information, the trend of health and wellness tourism in Thailand is increasing, especially when the main tourist groups are Asians. In Thailand, medicinal herbs are also used to treat various tourist ailments through foot massages, hermit exercise (Rusie Dutton) or spa treatment. UNESCO has recognized Thai massage as part of its Representative List of the Intangible Cultural Heritage of Humanity. Chantaburee [13] studied the opportunities and competitiveness in the Thai spa business, and concluded that there were great prospects for both Thai and foreign tourists, while Heesup et al. [14] found that spa tourism was becoming very popular among tourists from countries in Asia, such as Thailand, India, Singapore, and Malaysia. In the same vein, Kieanwatana et al. [15] reported that expectations of foreign health and wellness tourists in Thailand were high, with most wishing to relax their bodies and minds.
Health and wellness tourism in Thailand is regarded by foreign tourists as a form of medical tourism, with the purposes of managing disease and beauty enhancement. Thailand is recognized as the number one tourist destination in the world. Most medical tourists who travel to Thailand prefer to use health check-up services, including cosmetic surgery and dentistry. They also seek treatment for specific cardiovascular and bone diseases. The Global Wellness Institute [16] highlighted personal care and beauty as the service most needed by medical tourists. Plastic surgeons from Thailand are world-renowned, with similar levels of service as hospitals in the United States. Thailand can offer cutting-edge medical technology at prices far cheaper than in other countries. For example, rhinoplasty is two-fold cheaper than in the United States, while gender reassignment surgery is ten-fold cheaper than in the United States and other European countries. Furthermore, Thailand is recognized and trusted by medical tourists because Thai doctors specialize in surgery at more than 1000 private hospitals, while over 61 hospitals are Joint Commission International (JCI)-certified by the United States, higher than any other country in the region. The International Society of Aesthetic Plastic Surgery (ISAPS) [17] and ratings of The International Healthcare Research Center in 2020 [9] reveal that Thai medical tourism was ranked 17th in the world, accounting for 38% of cases in the Asian region. In addition, Oxford Economics data reveal that Chinese tourists flock to Thailand for medical services because China has a new policy that allows each family to have two children, resulting in fertility treatment services becoming more popular among Chinese people. The cost of accessing these services is THB 200,000 to 400,000 per visit. Chinese tourists also use antiaging and wellness services, generating around THB 23 billion in income for Thailand in 2017. An analysis of foreign tourists using antiaging services in 2018 revealed that 66,492 generated an income of THB 23,128,859,400. These tourists came from China, England, the United Arab Emirates, Singapore, India, and Germany. On average, they stayed 5 days in Thailand, spending THB 234,923 to 700,000 for medical services. For infertility treatment, most foreign tourists were from China, Vietnam, Myanmar, and India, spending an average of THB 200,000 to 400,000, while for drug or alcohol rehab, the most frequent foreign tourists were from Australia, the United Kingdom, the United States, and Hong Kong, spending an average of 28 days and receiving services at THB 230,000 to 440,000 per person. Tourists who came to relax and use massage services at health and wellness resorts were mainly from England, followed by Australia, Germany, the United States, and Russia. The average time spent on services was 3 to 10 days, at a cost of THB 160,000 to 370,000 per person [10].
Thailand gains a high income from health and wellness tourism that will increase in the future; however, weaknesses include security management, environmental sustainability, and comprehensive land transport connections. The Travel & Tourism Competitiveness Index 2019 rated Thailand as the second-lowest in ASEAN after the Philippines [18]. Since 2020, many countries have suffered from volatility in the global economy. On Friday 3 April 2020, the World Bank released data showing the rapid spread of coronavirus (COVID-19). This pandemic has caused a major global recession and is likely to have a strong financial impact on many countries. The sudden drop in global spending, cash flow for activities, and restrictions on travel have adversely affected tourism. Many restaurants and hotels have closed, with a sudden slowdown in cash flow in the tourism industry [19]. COVID-19 is a key variable that is holding back growth in the health and wellness tourism sector.

3. A Review of the Development and Validation of a Scale Studies

The validity and reliability of research data play a critical role in ensuring that the research goal has been accurately achieved. The various issues that tend to occur concerning reliability and the validity of measure within a research process majorly contribute to enormous challenges for the researchers during the interpretation process, which often leads to the research being regarded as invalid. However, scale development, which is described as establishing reliable and valid research measures to evaluate the attribute of interest successfully, was developed to ensure reliability and validity of research data are achieved to promote a successful interpretation process.
In most situations, researchers tend to face a significant challenge when they realize that the attained results from research are not conclusive and, as a result, lead to inadequate understanding of a particular research topic. Hinkin [20] argues that having an adequate measurement in research is crucial because it contributes to achieving the research objectives. In addition, experiencing issues with the measures tends to be quite challenging for the researcher to develop an effective conclusion despite implementing advanced research techniques. Worthington and Whittaker [21] also argue that conceptual interpretability is a definitive factor retention criterion, which means that the researchers need to retain a factor in situations where it may be interpreted more successfully. Both arguments agree that implementing scale development in a research process contributes to an actual coefficient among the variables being focused on, which depend on their ability to operationalize a reliable and accurate latent construct.
On the other hand, Li et al. [22] assert that implementing scale development in a research process promotes validity and reliability of research data, contributing to an efficient and practical approach to exploring a theoretical structure within a latent construct. Moreover, the exploratory factor analysis plays a crucial role in the scale development process. It focuses on exploring observed variables’ primary framework, hence laying a rigid platform for a straightforward interpretable factor solution within a latent construct. Furthermore, in support of this notion, Gerbing and Anderson [23] argue that with the exploratory factor analysis reducing numerous indicators to a more manageable data set, it defines the relationship between the variable and the respondent, hence allowing a compelling exploration of the primary theoretical structure of the situation.
In an attempt to effectively attain a critical understanding of the passenger experiences, Ittamalla and Srinivas Kumar [24] identified that through scale development, the ability to achieve personal experiences from respondents was more effective compared to other approaches. Thus, with its ability to capture various personal and professional perspectives, the scale development may contribute significantly to the evaluation and enhancement of different areas of the public sector, such as the transport system and healthcare system, among others. Moreover, concerning this argument, Simms et al. [25] assert that the effectiveness framework linked to the scale development approach mainly concentrates on gathering responses from the original item population and the statistical processes established to sharpen those items into comparable and distinguishable scales. In addition, McKinley and Hyde [26] also support the idea that achieving various perspectives through scale development tends to result in the development of a critical understanding of the latent construct.
In conclusion, the scale development procedures have been implemented in diverse fields due to their ability to offer reliable and valid research data, allowing the researchers to interpret their research findings more accurately.

4. Measurements of Wellness Destination Competitiveness

4.1. Destination Environment

“Destination environment” refers to the key environmental and cultural factors of a destination that impact its suitability for development, improvement, or adaptation, including its established appeal and tourist attractions. In empirical tourism studies, researchers found that the following factors impacted the potential of a destination environment: political stability; the number of university hospitals [27][28][29][30][31]; the perceived safety of the destination and the number of police stations [28][30][31][32][33][34][35]; the sanitation, hygiene, and cleanliness of the attractions [28][31][32][36][37][38]; human resources and the local labor market; the friendliness of local people; the responsiveness of the tourism/hospitality employees to visitor needs; the responsiveness of destination services and the ease of communication between residents and tourists [28][29][34][38][39][40][41]; and the readiness of information technology and communication infrastructures of the destination, including telecommunication systems and online tourist information [28][30][39][40].

4.2. Wellness Tourism Travel and Policy

Wellness tourism “travel and policy” refers to regulations, rules, and policies concerning transportation and tourism in an area or surrounding tourist attractions that support wellness tourism and the methods to attract wellness tourists. Empirical research has shown that wellness tourism travel and policy are affected by the following: management guidelines focusing on sustainable tourism policies and destination management as well as government and health authorities as strange attractors [36][42]; openness to international tourists with a focus on convenience in financial institutions and currency exchange facilities, attitudes of custom/immigration officials, the visa policy, and the ease and cost of obtaining an entry visa, if required [28][29][31][32][34][38][39][43]; price competitiveness of tourism services, hospitality services, accommodation services, restaurants, airport amenities, and destination tour packages, as well as the total cost relative to that of a competitor destination [28][31][34][35][37][38]; and the importance given to environmental sustainability, such as environmental commitment, sustainability, the residents’ quality of life, and waste disposal [27][28][30][31][33][39][41][44].

4.3. Wellness Tourism Infrastructure and Capacity

Wellness tourism “infrastructure and capacity” refers to the readiness of the existing infrastructure of a potential wellness destination that is being considered for development, improvement, or adaptation. In studies of wellness tourism competitiveness, key factors reported included the following: transportation systems that allowed convenient access to an area or tourist attraction by air, land, or water, the destination transport facilities, and the quality of local transport [27][28][31][32][34][35][37][38][39][40][41][45][46]; comprehensive tourism service infrastructures, such as tourism support services, easy access to tourist information both on-site and online, and tourist guidance information and signage [28][31][32][34][35][37][38]; accessibility and accommodation for special needs and disabilities at destination facilities according to current standards [30][33][35][37][40][42]; accommodation for dietary restrictions and preferences, including a variety of food and beverages available at local hospitality facilities and the availability of quality food and meals [29][32][35][38][40][42]; accessibility and accommodation for special needs and disabilities at recreational sites and activities, including a variety of entertainment, festivals, theaters, galleries, cinemas, sports facilities, special events, sports, and other recreational opportunities [28][31][34][35][37][38][42].

4.4. Wellness Tourism Man-Made and Cultural Resources

“Man-made and cultural resources” refers to the readiness of semi-natural and man-made resources as well as the cultural traditions and knowledge of an area and tourist attractions that are suitable for developing new tourist attractions, routes, and activities that will attract wellness tourists. These include the appeal of the local area and how that can be used to promote the destination for wellness tourists. Previous research found that factors that promoted and supported wellness tourism included natural attractions, natural wonders, scenery and landscape, and man-made attractions [31][32][34][35][37][40][47][48]; cultural and local knowledge that pertained to unique archaeological and cultural attractions, historical attractions, cultural festivals, handicrafts/souvenirs, iconic attractions, traditional arts, and cultural richness [27][29][30][31][32][34][35][38][40][42][44][48][49]; resources that were suitable for planning and organizing wellness activities, such as adventure activities and creative tourism resources [30][31][34][37][40]; the availability of modern medical facilities, technology, and resources [29][31][32][39][41]; and the readiness of wellness and other related business resources, such as the availability of spas and hot springs, the variety of existing tourist attractions for recovering patients, and tourism amenities, such as cafeterias, public phones, hotels, restaurants, banks, and emergency services [29][50].

4.5. Wellness Tourism Strategy and Structure

Wellness tourism “strategy and structure” refers to the strategic planning needed to develop and improve wellness tourism in an area with tourist attractions and the presentation of activities for restorative health treatments. Previous research found factors that impact the strategy and structure included the quality of professional services and treatments that met the performance standards of tourism/hospitality companies as well as the development of training programs to enhance the quality of the available services [28][31][32][37][40][41][47]; awards for reputation and wellness tourism, such as internationally recognized medical services and highly regarded healthcare institutions [32][50]; quality certificates and international standard accreditation of medical and health services, including those of international hospital accreditation and credentials [29][32][51]; reported customer satisfaction regarding the availability of communication through a patient’s native language and the quality of the experience as well as protocols for visitor satisfaction management, and tourism companies with programs to ensure/monitor visitors’ satisfaction [30][32][38][39][41][42]; the connectedness and ease of access to products, services, activities, and other components of wellness tourism provided for tourists [45]; health-related spa and wellness activities that offer nutrition therapy [47]; exercise for health [29]; meditation [29]; hydrotherapy such as water-based and sweat-bathing treatments [47]; mind rejuvenation activities, including the availability of cooking classes [29]; and body and aesthetic care activities [47].

4.6. Wellness Tourism Innovation Potential

Wellness tourism “innovation potential” refers to a region or tourist attraction’s potential to create and offer unique, innovative products and services to attract wellness tourists. Previous research found that factors indicating innovation potential included knowledge exploitation for upscale, rapid medical services [32][52]; human capital to develop new products and services, such as knowledgeable staff who are experts in wellness tourism, have creative abilities, and passion in developing new products and services [43][51]; openness to service innovation, such as exploiting market opportunities, utilizing technology, and digitizing the tourist experience [36][46][50][51]; adaptive, rapid solutions to improve current systems, such as knowledge transformation and organizational changes to optimize the management of sustainability, programs to monitor and ensure visitor satisfaction hosted the tourism firm, and awareness of tourism employees regarding the quality of services as well as their technical competency [4][41][51][52]; the application of outstanding community resources, knowledge, and local identity as selling points and adding value to products and tourism services to maximize local economic development [42]; continuous improvement and development of new working processes regarding management capabilities of health tourism firms and organizations, the establishment of training programs to improve service quality, well-defined performance criteria in tourism/hospitality enterprises, and quality assessment and enforcement [29][39][50].

4.7. Wellness Tourism Collaborative and Proactive Marketing

Wellness tourism “collaborative and proactive marketing” refers to the capability of an area or tourist attraction to collaborate with other destinations and attractions and proactively market to their targeted customer groups. In previous studies, researchers found that that factors indicating collaborative and proactive marketing included the formation of collaborative clusters as well as the number of partnerships and collaborative projects [43][53][54]; the application of business networks and alliances to communicate with all stakeholders, including the establishment of strategic alliances in destination competitiveness [36][53]; opportunities and support of local communities in taking part in planning wellness tourism [53][55]; collaboration with wellness and health tourism agencies [51]; collaboration between public and private agencies by determining firm tourism strategies through joint public–private policymaking, commitment of the public sector to tourism and hospitality education, and commitment of the private sector to tourism and hospitality education [29][53][56]; collaboration with public and private agencies to advertise wellness tourism products and services including wellness tourism marketing, promoting networking, and strategic planning, and public–private partnerships (PPPs) in healthcare financing [45][51][53][54][57]; a focus on offering targeted brand stories that support community and environmental development [39][58]; targeted brand building to attract tourists with on-trend slogans, logos, and health promotion services of tourism destinations [32][36][51][54][59][60]; the organization of wellness tourism programs and activities in which local communities could participate that also create local employment opportunities [54]; building a more impactful brand identity than the competitors’, [42][59][60]; linking advertising and marketing through health-related social media and sporting connections as well as business ties and trade links in key tourist origin markets [39][41]; environmental simulations presented at popular venues so that target groups, customers, and potential customers could experience and visualize wellness destinations [61][62][63]; local, national, and international promotional events and campaigns [50]; and surveys that score collaborative values, such as tourists’ content creation, online reviews, and online satisfaction [64][65].

5. Discussion on the Final Model of the Wellness Destination Competitiveness Assessment Dimensions

Despite many studies on wellness destination competition, empirical research on the factors affecting wellness destination competitiveness has been scarce. Therefore, to establish an assessment scale, researchers used qualitative and quantitative methods based on Churchill’s methodology. Seven wellness destination competitiveness assessment dimensions, including destination environment, travel and policy, infrastructure and capacity, man-made and cultural resources, strategy and structure, innovation potential, and collaborative and proactive marketing, were identified based on triangulated results, in-depth interviews, and expert panel discussions.
The first component was the destination environment. The safety and security of the destination was the indicator that had the highest factor-loading score. Tourism enterprises placed importance on effective administration and management of safety and security for tourists. This indicator directly affected tourists’ perception of the security of the destination. The findings are in line with Neto et al. [28]; Queiroz Neto et al. [31]; Woyo and Slabbert [38]; and Mustafa et al. [40], who suggested that political stability as well as safety and security were important conditions impacting tourist interest in a tourist destination.
The second component was travel and tourism policies. Openness to international tourists to specifically promote wellness tourism had the highest factor-loading score. Importance should also be placed on planning and transportation as well as traveling policies that support international services. These are in line with previous research that highlighted the level of internationalization [43], the efficiency of customs and immigration as well as attitudes of customs and immigration officials [34], visa policies, and the ease and cost of obtaining an entry visa [28][31][32][39] as key factors that influenced tourist interest in a tourist destination.
The third component was wellness infrastructure and capacity. Infrastructure supporting services and tourism was the indicator with the highest factor-loading score. This reflected that from the perspective of tourism enterprises, wellness tourism destinations should have guidelines and prepared suggestions available for tourists that are easily accessible at tourist information centers and online. This is in line with previous research findings that tourism support services [38][39][41], tourist guidance information and tourist services [34][35], and easy access to tourist information both online and on-site [31][32] were key factors that influenced tourist interest in a tourist destination.
The fourth component was man-made and cultural resources. The availability of semi-natural tourist attractions was the indicator with the highest factor-loading score. From the perspective of tourism enterprises, the unique and abundant natural resources of a wellness tourism destination were crucial to attract wellness tourists and could be used to promote health-related products and services. In addition, the man-made tourist attractions should blend in with the natural environment of the area. The results are in line with studies conducted by Junio et al. [32]; Neto et al. [28]; Queiroz Neto et al. [31]; Akin et al. [34]; Armis and Kanegae [35]; Milićević et al. [37]; Mustafa et al. [40]; Lee and Li [47]; and Wardana et al. [48], all of whom indicated that the natural environment, the natural wonders, and the scenery were all key factors that influenced tourist interest in a tourist destination.
The fifth component was wellness strategy and structure. The highest factor-loading scores were found in the link between diverse products, services, activities, and the components of wellness tourism and the visitors who visited the destination. From the perspective of tourism enterprises, business plans that effectively deliver wellness products and services to visiting tourists could increase competitiveness. Good business management requires integrated management and collaboration as well as the continuation among activities and stakeholders in the supply chain, including managing the balance between the supply and demand of wellness tourism. This was in line with research by Dias et al. [45], who found that facilitating access to suppliers was a key factor that influenced tourist interest in a tourist destination.
The sixth component was innovation potential. Human capital to develop new products or services had the highest factor-loading score. This reflected the perspective of tourism enterprises that the development of innovative products and services by those living and working at the wellness tourist destination were important factors to improve the wellness tourist’s overall experience. The findings were in line with research by Ganguli and Ebrahim [51] and Dias et al. [43], who found that the importance of creative and innovative development of new products and services for health and wellness was a key factor that influenced tourist interest in a tourist destination and their desire to return.
The seventh component was collaborative and proactive marketing. The formation of clusters, whose purpose was collaborative working and communication with all stakeholders, was the indicator with the highest factor-loading score. From the perspective of tourism enterprises, relationships among different agencies at different levels of wellness travel and tourism would result in the further development of the destination’s competitive potential. These findings are in line with research by Altinay and Kozak [36] and Dias et al. [43], who found that cluster creation, collaborative projects, and strategic alliances were key factors that improved the impact of marketing and brand awareness and influenced tourist interest in a tourist destination.

6. Discussion on the Important of the Wellness Destination Competitiveness Dimensions and Each Factor of the Wellness Destination Competitiveness Measurement Scale

Due to its association to collaborative strategic management, the collaborative and proactive marketing factor was determined to be critical. Supporting factors were destination environment, travel and policy, infrastructure and capacity, and man-made and cultural resources; these were used for proactive marketing to define clear positions and target groups of customers. Innovation potential was important, as it provided a guideline for developing and improving abilities to create or offer new health promotion products and services to increase the competitive potential with supporting factors, such as destination environment, travel and policy, infrastructure and capacity, and man-made and cultural resources. These work together to promote the wellness destination and increase its appeal to wellness tourist.
The least important component was the destination environment, along with the following items: a business environment that promotes wellness tourism business, human resources of staff in the area who welcome wellness tourists, and human resources in wellness tourism enterprises or businesses whose duty is to deliver products and services to tourists. In addition, the second least important factor was man-made and cultural resources, including the readiness of cultural and knowledge tourist attractions and the readiness of semi-natural tourist attractions. This indicates that tourism firms did not feel these were as important as improving a destination’s competitiveness and increasing the destination’s capacity to do so. Formation of cluster groups for wellness tourism management, aggressive marketing with business partners, stimulation of business enterprises and stakeholders to increasingly create and develop new products and services to respond to the needs of wellness tourists, policy setting with regard to tourism and traveling to attract wellness tourists, and especially the openness to international tourists caused tourism enterprises to view the components of destination environment and man-made and cultural resources as less important than the components of collaborative and proactive marketing, innovation potential, and travel and policy.

This entry is adapted from 10.3390/su14074152

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