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 [54].

In line with Boikova et al. [55], 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 [56]. Improved products result in a sales increase, which leads to increased profitability of the company and consequently increased GDP [57]. 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 [58].

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 [59].

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.

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 [60].

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 [61]. 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 [62]. The International Healthcare Research Center (IHRC) predicted a growth of health and wellness tourism in Thailand at 14% per annum [63]. 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 [64]. 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 [65].

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 [67] 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. [68] 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. [69] 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 [5] 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) [70] and ratings of The International Healthcare Research Center in 2020 [62] 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 [63].

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 [71]. 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 [72]. COVID-19 is a key variable that is holding back growth in the health and wellness tourism sector.

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. Moreover, several research articles addressing this topic were reviewed to understand how scale development adequately promotes reliability and validity.

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 [73] 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 [74] 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. [75] 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 [76] 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 [77] 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. [78] 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 [79] 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.