Thailand as a Tourism Destination: Factors Influencing Wellness Tourism Intentions of Chinese Older Adults
Article Sidebar
Main Article Content
Abstract
Background. Thailand, with its rich natural resources, traditional healing therapies, and high-quality healthcare services, has become an attractive destination for Chinese senior tourists.
Aim. This study integrates the Health Belief Model (HBM) and Push-Pull Theory to examine the key determinants influencing older Chinese adults' intention to engage in wellness tourism in Thailand.
Methods. A quantitative approach was adopted, utilizing a structured questionnaire covering perceived susceptibility, perceived severity, perceived benefits, perceived barriers, push factors, pull factors, and wellness tourism intention. Data were collected through stratified random sampling across eastern, central, and western regions of China, using both online (WeChat, Wenjuanxing) and offline (senior activity centers, community health centers) methods. 462 valid responses were analyzed using structural equation modeling (SEM).
Result. The results indicate that perceived benefits positively influence wellness tourism intention, while perceived barriers significantly reduce it. Both push and pull factors enhance wellness tourism intention, with their interaction exerting an even more substantial effect. However, contrary to HBM’s conventional assumptions, perceived susceptibility and perceived severity negatively impact wellness tourism intention, suggesting that heightened health concerns may deter older adults from traveling.
Conclusion. This study extends the application of HBM and refines the Push-Pull Theory in the wellness tourism context. Practically, it offers insights for policymakers and industry stakeholders to develop targeted wellness tourism services. Furthermore, this study lays a theoretical foundation for future research by offering an integrative model that captures both health-related perceptions and tourism motivations.
Implementation. The findings deepen the understanding of how health perceptions and travel motivations interact to influence senior tourists’ wellness tourism decisions.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Ajzen, I. (1991). The Theory of planned behavior. Organizational Behavior and Human Decision Processes. https://doi.org/10.4135/9781446249215.n22
Bardukova, L. (2024). Health and Wellness Tourism: Current Trends and Strategies in the Bulgarian Tourism industry. Economics and computer science(2), 22-36. https://doi.org/RePEc:kab:journl:y:2024:i:2:p:22-36
Baydeniz, E., Çılgınoğlu, H., & Valeri, M. (2024). Impact of health tourism visitor experiences on behavioral intention. Journal of Organizational Change Management, 37(5), 1133-1153. https://doi.org/10.1108/JOCM-09-2023-0381
Boguszewicz-Kreft, M., Kuczamer-Kłopotowska, S., & Kozłowski, A. (2022). The role and importance of perceived risk in medical tourism. Applying the theory of planned behaviour. PLOS ONE, 17(1), e0262137. https://doi.org/10.1371/journal.pone.0262137
Champion, V. L., & Skinner, C. S. (2008). The health belief model. Health behavior and health education: Theory, research, and practice, 4, 45-65.
Chang, L., Moyle, B. D., Dupre, K., Filep, S., & Vada, S. (2022). Progress in research on seniors' well-being in tourism: A systematic review. Tourism Management Perspectives, 44, 101040. https://doi.org/10.1016/j.tmp.2022.101040
Chaulagain, S., Pizam, A., & Wang, Y. (2020). An Integrated Behavioral Model for Medical Tourism: An American Perspective. Journal of Travel Research, 60(4), 761-778. https://doi.org/10.1177/0047287520907681
Chen, K.-H., Huang, L., & Ye, Y. (2023). Research on the relationship between wellness tourism experiencescape and revisit intention: a chain mediation model. International Journal of Contemporary Hospitality Management, 35(3), 893-918. https://doi.org/10.1108/IJCHM-01-2022-0050
Crompton, J. (2024). Reflections on the Six Motives That Drive Tourists’ Pleasure Vacation Behavior. Journal of Travel Research, 64(1), 3-34. https://doi.org/10.1177/00472875241281520
Dann, G. M. S. (1977). Anomie, ego-enhancement and tourism. Annals of Tourism Research, 4(4), 184-194. https://doi.org/10.1016/0160-7383(77)90037-8
Devile, E. L., Eusébio, C., & Moura, A. (2024). Traveling with special needs: investigating constraints and negotiation strategies for engaging in tourism activities. Journal of Hospitality and Tourism Insights, 7(2), 820-843. https://doi.org/10.1108/JHTI-09-2022-0410
Esfandyari, H., Choobchian, S., Momenpour, Y., & Azadi, H. (2023). Sustainable rural development in Northwest Iran: proposing a wellness-based tourism pattern using a structural equation modeling approach. Humanities and Social Sciences Communications, 10(1), 499. https://doi.org/10.1057/s41599-023-01943-0
Feng, W., Liu, Y., & Li, D. (2022). Emotional or rational? The congruence effect of message appeals and country stereotype on tourists' international travel intentions. Annals of Tourism Research, 95, 103423. https://doi.org/10.1016/j.annals.2022.103423
Fu, H., & Sutunyarak, C. (2022). Knowledge Map of Chinese Tourists Travelling to Thailand: Based on the Bibliometric Method. Journal of Environmental Management & Tourism, 13(8), 2144-2160. https://doi.org/10.14505/jemt.v13.8(64).07
Gan, T., Zheng, J., Li, W., Li, J., & Shen, J. (2023). Health and wellness tourists’ motivation and behavior intention: The role of perceived value. International journal of environmental research and public health, 20(5), 4339. https://doi.org/10.3390/ijerph20054339
Gao, J., Zeng, X., Zhang, C., & Porananond, P. (2022). Understanding the young middle-class Chinese outbound tourism consumption: A social practice perspective. Tourism Management, 92, 104555. https://doi.org/10.1016/j.tourman.2022.104555
Gao, M., Jiang, F., Wang, J., & Wu, B. (2024). Population ageing and income inequality in rural China: an 18-year analysis. Humanities and Social Sciences Communications, 11(1), 1605. https://doi.org/10.1057/s41599-024-04110-1
Geng, W., Wan, Q., Wang, H., Dai, Y., Weng, L., Zhao, M., Lei, Y., & Duan, Y. (2023). Leisure involvement, leisure benefits, and subjective well-being of bicycle riders in an urban forest park: the moderation of age. Forests, 14(8), 1676. https://doi.org/10.3390/f14081676
Global Wellness Institute. (2024). Wellness Tourism. Global Wellness Institute. https://globalwellnessinstitute.org/what-is-wellness/what-is-wellness-tourism/
Godlewska, A., Mazurek-Kusiak, A., & Soroka, A. (2023). Push and pull factors influencing the choice of a health resort by Polish treatment-seekers. BMC Public Health, 23(1), 2192. https://doi.org/10.1186/s12889-023-17086-5
Guo, H., Jiang, J., Li, Y., Long, X., & Han, J. (2023). An aging giant at the center of global warming: Population dynamics and its effect on CO2 emissions in China. Journal of Environmental Management, 327, 116906. https://doi.org/10.1016/j.jenvman.2022.116906
Han, D.-I. D., Bergs, Y., & Moorhouse, N. (2022). Virtual reality consumer experience escapes: preparing for the metaverse. Virtual Reality, 26(4), 1443-1458. https://doi.org/10.1007/s10055-022-00641-7
Han, X., Wei, C., & Cao, G.-Y. (2022). Aging, generational shifts, and energy consumption in urban China. Proceedings of the National Academy of Sciences, 119(37), e2210853119. https://doi.org/10.1073/pnas.2210853119
He, M., Liu, B., & Li, Y. (2021). Tourist Inspiration: How the Wellness Tourism Experience Inspires Tourist Engagement. Journal of Hospitality & Tourism Research, 47(7), 1115-1135. https://doi.org/10.1177/10963480211026376
Hu, F., Wen, J., Phau, I., Ying, T., Aston, J., & Wang, W. (2023). The role of tourism in healthy aging: An interdisciplinary literature review and conceptual model. Journal of Hospitality and Tourism Management, 56, 356-366. https://doi.org/https://doi.org/10.1016/j.jhtm.2023.07.013
Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A Decade Later. Health education quarterly, 11(1), 1-47. https://doi.org/10.1177/109019818401100101
Jiang, L., Wu, H., & Song, Y. (2022). Diversified demand for health tourism matters: From a perspective of the intra-industry trade. Social Science & Medicine, 293, 114630. https://doi.org/10.1016/j.socscimed.2021.114630
Jo, H. (2024). Wellness and Wanderlust: How Social Wellness Impacts Travel Motivation. International Journal of Tourism Research, 26(5), e2745. https://doi.org/10.1002/jtr.2745
Kan, T., Ku, E. C., Sun, W. C., Lai, T.-C., Hsu, P.-Y., & Hsu, S. C. (2023). Wellness tourism enhances elderly life satisfaction. Journal of Quality Assurance in Hospitality & Tourism, 24(4), 402-428. https://doi.org/10.1080/1528008X.2022.2052394
Kim, S. i., Al-Ansi, A., Lee, J.-S., Chua, B.-L., Phucharoen, C., & Han, H. (2024). Wellness tourism experience and destination brand love. Journal of Travel & Tourism Marketing, 41(7), 988-1004. https://doi.org/10.1080/10548408.2024.2369752
Lee, K.-Y., & Jeong, J. Y. (2023). The effects of health beliefs upon nature-based tourism during COVID-19: Cases from the United States and South Korea. Journal of leisure research, 54(2), 203-226. https://doi.org/10.1080/00222216.2022.2158764
Leung, S. Y., & Ku, H. B. (2024). Cross-border healthcare-seeking and utilization behaviours among ethnic minorities: exploring the nexus of the perceived better option and public health concerns. BMC Public Health, 24(1), 1497. https://doi.org/10.1186/s12889-024-18981-1
Li, T. E., & Chan, E. T. H. (2021). “With a young spirit, we will be young forever”: Exploring the links between tourism and ageing well in contemporary China. Tourism Management, 86, 104345. https://doi.org/10.1016/j.tourman.2021.104345
Li, W., Yigitcanlar, T., Erol, I., & Liu, A. (2021). Motivations, barriers and risks of smart home adoption: From systematic literature review to conceptual framework. Energy Research & Social Science, 80, 102211. https://doi.org/10.1016/j.erss.2021.102211
Liao, C., Xiao, H., Li, Z., & Todo, Y. (2024). Beyond chronological age: exploring how different future time perspective influences the health tourism intention. BMC Psychology, 12(1), 689. https://doi.org/10.1186/s40359-024-02201-x
Lin, J., Cui, Q., Xu, H., & Guia, J. (2022). Health and local food consumption in cross-cultural tourism mobility: an assemblage approach. Tourism Geographies, 24(6-7), 1103-1122. https://doi.org/10.1080/14616688.2020.1867887
Liu-Lastres, B., Yang, Y., & Zhang, C. X. (2024). Optimal-fit model of risk perception and travel-related behaviors during a global pandemic. Journal of Destination Marketing & Management, 34, 100958. https://doi.org/10.1016/j.jdmm.2024.100958
Liu, B., Kralj, A., Moyle, B., He, M., & Li, Y. (2024). Perceived Destination Restorative Qualities in Wellness Tourism: The Role of Ontological Security and Psychological Resilience. Journal of Travel Research, 00472875241230019. https://doi.org/10.1177/00472875241230019
Liu, L., Zhou, Y., & Sun, X. (2023). The impact of the wellness tourism experience on tourist well-being: The mediating role of tourist satisfaction. Sustainability, 15(3), 1872. https://doi.org/10.3390/su15031872
Mai, X. T., & Nguyen, T. D. T. (2023). Push and pull factors for wellness tourism experience: framework development and implementations. International Journal of Tourism Policy, 13(1), 18-34. https://doi.org/10.1504/IJTP.2023.129165
Mathijsen, A., & Dziedzic, E. (2024). Diasporic Medical Tourism: examining tourists’ profiles, antecedents and behavioural intention. European Journal of Tourism Research, 37, 3702-3702. https://doi.org/10.54055/ejtr.v37i.3010
Meeprom, S., & Chancharat, S. (2022). Building health and wellness service experience extension: a case study of Bangkok, Thailand. Sustainability, 14(18), 11691. https://doi.org/10.3390/su141811691
Mikulić, J., Krešić, D., & Šerić, M. (2021). The factor structure of medical tourist satisfaction: exploring key drivers of choice, delight, and frustration. Journal of Hospitality & Tourism Research, 45(8), 1489-1512. https://doi.org/10.11771096348020987273
National Bureau of Statistics of China. (2024). National Data. https://data.stats.gov.cn/english/easyquery.htm?cn=C01
Nguyen, N. X., Tran, K., & Nguyen, T. A. (2021). Impact of service quality on in-patients’ satisfaction, perceived value, and customer loyalty: A mixed-methods study from a developing country. Patient preference and adherence, 2523-2538. https://doi.org/10.2147/PPA.S333586
Nicolau, J. L., Rodríguez-Sánchez, C., & Ruiz-Moreno, F. (2024). A motivation-based study to explain accommodation choice of senior tourists: Hotel or Airbnb. International Journal of Hospitality Management, 123, 103911. https://doi.org/10.1016/j.ijhm.2024.103911
Niu, F. (2022). A push-pull model for inter-city migration simulation. Cities, 131, 104005. https://doi.org/10.1016/j.cities.2022.104005
Pan, C., Qiu, H., Zhang, L., Zhou, A., & Gu, S. An Investigation into Tourists' Intentions to Participate in Traditional Chinese Medicine (TCM) Wellness and Rehabilitation Tourism: Insights from In-Depth Interviews at the Luofu Mountain Tourist Area. https://doi.org/10.54097/5ekt5j36
Patterson, I., & Balderas-Cejudo, A. (2023). Tourism towards healthy lives and well-being for older adults and senior citizens: Tourism Agenda 2030. Tourism Review, 78(2), 427-442. https://doi.org/10.1108/TR-06-2022-0269
Pekovic, S. (2021). Green pull motives and overall tourist satisfaction: a macro- and micro-levels analysis. International Journal of Contemporary Hospitality Management, 33(4), 1368-1390. https://doi.org/10.1108/IJCHM-06-2020-0609
Peng, J., Yang, X., Fu, S., & Huan, T.-C. (2023). Exploring the influence of tourists’ happiness on revisit intention in the context of Traditional Chinese Medicine cultural tourism. Tourism Management, 94, 104647. https://doi.org/10.1016/j.tourman.2022.104647
Piyaphanee, W., Stoney, R. J., Asgeirsson, H., Appiah, G. D., Díaz-Menéndez, M., Barnett, E. D., Gautret, P., Libman, M., Schlagenhauf, P., Leder, K., Plewes, K., Grobusch, M. P., Huits, R., Mavunda, K., Hamer, D. H., & Chen, L. H. (2023). Healthcare seeking during travel: an analysis by the GeoSentinel surveillance network of travel medicine providers. Journal of Travel Medicine, 30(3), taad002. https://doi.org/10.1093/jtm/taad002
Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education Monographs, 2(4), 328-335. http://www.jstor.org/stable/45240621
Seow, A. N., Choong, Y. O., Choong, C. K., & Moorthy, K. (2022). Health tourism: behavioural intention and protection motivation theory. Tourism Review, 77(2), 376-393. https://doi.org/10.1108/TR-11-2020-0546
Sher, C.-H., & Sung, T.-J. (2024). Designing a Community-Based Health Promotion Program for Older Adults Based on Perceived Usefulness, Service Experience, Perceived Value, and Behavioral Intention. Journal of Gerontological Social Work, 67(4), 515-540. https://doi.org/10.1080/01634372.2024.2338081
Sien Leong, L., Hussin, S. R., & Abdullah, N. H. (2023). Why Not Travel to Malaysia? Perspectives of Future Senior Tourists toward Senior-Friendly Destination Attributes. Journal of Quality Assurance in Hospitality & Tourism, 24(1), 75-100. https://doi.org/10.1080/1528008X.2021.2024108
Soldatenko, D., Zentveld, E., & Morgan, D. (2023). An examination of tourists’ pre-trip motivational model using push–pull theory: Melbourne as a case study. International Journal of Tourism Cities, 9(3), 572-597. https://doi.org/10.1108/IJTC-03-2023-0036
Sreen, N., Tandon, A., Jabeen, F., Srivastava, S., & Dhir, A. (2023). The interplay of personality traits and motivation in leisure travel decision-making during the pandemic. Tourism Management Perspectives, 46, 101095. https://doi.org/10.1016/j.tmp.2023.101095
Suess, C., Maddock, J. E., Dogru, T., Mody, M., & Lee, S. (2022). Using the Health Belief Model to examine travelers’ willingness to vaccinate and support for vaccination requirements prior to travel. Tourism Management, 88, 104405. https://doi.org/10.1016/j.tourman.2021.104405
Taflinger, S., & Sattler, S. (2024). A situational test of the health belief model: How perceived susceptibility mediates the effects of the environment on behavioral intentions. Social Science & Medicine, 346, 116715. https://doi.org/10.1016/j.socscimed.2024.116715
Takagi, S., Numazawa, Y., Katsube, K., Omukai, W., Saijo, M., & Ohashi, T. (2024). Theorizing the socio-cultural dynamics of consumer decision-making for participation in community-supported agriculture. Agricultural and Food Economics, 12(1), 22. https://doi.org/10.1186/s40100-024-00318-6
Uysal, M., & Jurowski, C. (1994). Testing the push and pull factors. Annals of Tourism Research, 21(4), 844-846. https://doi.org/10.1016/0160-7383(94)90091-4
Wallace-Williams, D. M., Tiu Wright, L., & Dandis, A. O. (2023). Social norms, cues and improved communication to influence behaviour change of smokers. Journal of Marketing Communications, 29(3), 288-313. https://doi.org/10.1080/13527266.2021.2018621
Wang, Q., Hung, K., & Liu, C. (2023). Tourist experience and well-being of Chinese elderly tourists through intergenerational interaction with their adult children. Journal of Hospitality and Tourism Management, 57, 18-28. https://doi.org/10.1016/j.jhtm.2023.08.016
Wang, X., Wong, Y. D., Liu, F., & Yuen, K. F. (2021). A push–pull–mooring view on technology-dependent shopping under social distancing: When technology needs meet health concerns. Technological Forecasting and Social Change, 173, 121109. https://doi.org/10.1016/j.techfore.2021.121109
Warner, L. M., & Schwarzer, R. (2025). Self-Efficacy and Health. In P. Liamputtong (Ed.), Handbook of Concepts in Health, Health Behavior and Environmental Health (pp. 1-26). Springer Nature Singapore. https://doi.org/10.1007/978-981-97-0821-5_15-1
Wright, D. W. M., & Zascerinska, S. (2023). Becoming immortal: future wellness and medical tourism markets. Journal of Tourism Futures, 9(2), 168-195. https://doi.org/10.1108/JTF-05-2021-0119
Xia, L., Lee, T. J., & Kim, D. K. (2024). Relationships between motivation, service quality, tourist satisfaction, quality of life, and spa and wellness tourism. International Journal of Tourism Research, 26(1), e2624. https://doi.org/10.1002/jtr.2624
Xiong, W., Huang, M., Leung, X. Y., & Li, Y. (2025). The healing impact of travel on the mental health of breast cancer patients. Tourism Management, 106, 104997. https://doi.org/10.1016/j.tourman.2024.104997
Xu, D., Shang, Y., Yang, Q., & Chen, H. (2023). Population aging and eco-tourism efficiency: Ways to promote green recovery. Economic Analysis and Policy, 79, 1-9. https://doi.org/10.1016/j.eap.2023.05.021
Xu, Q., Purushothaman, V., Cuomo, R. E., & Mackey, T. K. (2021). A bilingual systematic review of South Korean medical tourism: a need to rethink policy and priorities for public health? BMC Public Health, 21(1), 658. https://doi.org/10.1186/s12889-021-10642-x
Yin, J. D.-C., & Lui, J. N.-M. (2024). Factors influencing risk perception during Public Health Emergencies of International Concern (PHEIC): a scoping review. BMC Public Health, 24(1), 1372. https://doi.org/10.1186/s12889-024-18832-z
Zhao, Y., Yang, J., Song, J., & Lu, Y. (2025). The Effects of Tourism Motivation and Perceived Value on Tourists’ Behavioral Intention Toward Forest Health Tourism: The Moderating Role of Attitude. Sustainability, 17(2), 713. https://doi.org/10.3390/su17020713