Academica Turistica
Tourism & Innovation Journal – Revija za turizem in inovativnost
Year 16, No. 3, December 2023, issn 2335-4194
https://doi.org/10.26493/2335-4194.16_3
257 Does Better Physical Accessibility Lead to Higher Sales Revenues?
The Case of Slovenian Restaurant SMEs
Marko Kukanja and Saša Planinc
277 Understanding a Conceptual Framework of Spa Service Quality:
An Overview Approach
Aswin Sangpikul
291 Factors Influencing the Satisfaction and Revisit Intention of Jordanian
Medical Tourists
Malek Bader, Nirmeen Khasawneh, Ramzi Al Rousan, Sami Al Hasanat,
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313 Marketing Strategies in Cross-Border Tourist Destinations: A Literature Review
Alenka Pahor Žvanut and Ksenija Vodeb
329 Bibliometric Analysis of Online Collaboration in Travel Agencies
Jorge Raúl Avilas Hernández, Nolberto Cruz Aguilera, Félix Díaz Pompa,
and Maja Borlinič Gačnik
346 A Study of Thai Massage Service Quality Effect on International Tourist Confidence
Napaporn Janchai, Glenn Baxter, and Panarat Srisaeng
357 Abstracts in Slovene – Povzetki v slovenščini
361 Instructions for Authors
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256 | Academica Turistica, Year 16, No. 3, December 2023
Original Scientific Article
Does Better Physical Accessibility
Lead to Higher Sales Revenues?
The Case of Slovenian Restaurant SMEs
Marko Kukanja
University of Primorska, Slovenia
marko.kukanja@fts.upr.si
Saša Planinc
University of Primorska, Slovenia
sasa.planinc@fts.upr.si
Despite the significance of accessibility for sustainable tourism development, little
is known about the relationship between physical accessibility and restaurant sales
revenues. Previous studies also did not consider restaurantmanagers’ perceptions of
accessibility, although they are responsible for implementing an accessible offer. The
objectives of the present study are (1) to investigate ifmanagers of small andmedium-
sized restaurant enterprises (smes) perceive restaurants as physically accessible and
(2) to determine if better physical accessibility generates higher sales revenues. This
study was performed in two steps. First, research on accessibility and relevant leg-
islation was analysed. Second, primary data was collected using a self-administered
questionnaire in field research from 149 restaurant managers, and secondary finan-
cial data for each sme was obtained through publicly available financial reports. To
express the perspectives of people with disabilities (pwds), disability organisation
representatives were included in the questionnaire development process. Descrip-
tive statistics and correlation analyses were used to analyse the data. Findings reveal
that managers have low knowledge of accessibility, perceive restaurants as relatively
poorly accessible, and that physical accessibility is not correlated to sales revenues.
Concerning the different layout areas,managers identified toilet facilities as themost
inaccessible restaurant area. Besides the legislative responsibility, managers should
also be aware of the economic potential of the disability market in tourism and the
fact that an accessible offer facilitates the use of restaurants for society as a whole.
The article ends with providing recommendations for the restaurant industry, poli-
cymakers, and academia.
Keywords: restaurant smes, disability, managers, physical accessibility, sales
revenue
https://doi.org/10.26493/2335-4194.16.257-275
Introduction
Tourism, including the restaurant sector, is a global
economic driver. In 2019, the tourism industry con-
tributed 10.3 of the world’s gross domestic product
(gdp). Similarly, in the Republic of Slovenia, one of the
smallest European (eu) economies, the contribution
of tourism to gdp in 2019 was 10.6 (World Travel
and Tourism Council, n.d.). The tourism industry has
Academica Turistica, Year 16, No. 3, December 2023 | 257
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
also provided several opportunities for the growth of
micro, small, and medium-sized enterprises (smes),
which accounted for 99.8 of all business entities in
the eu in 2021 (Eurostat, 2021).
Despite its economic significance, tourism also has
an essential social perspective, addressing human-
related challenges in the global economic environ-
ment. Apart from being a labour-intensive industry, in
developed (western) societies, ‘holidaying’ is consid-
ered a social right (Cockburn-Wootten & McIntosh,
2020). However, for people with disabilities (pwds),
it can present a source of inequality and frustration.
As the right to tourism engagement is considered
a social norm, tourism should provide equal opportu-
nities for all members of society (Cockburn-Wootten
&McIntosh, 2020). From this point of view, accessible
tourism (also known as barrier-free tourism) refers to
activities in which anyone can freely engage regard-
less of their health conditions, psychological needs,
or functional disabilities. Namely, pwds also desire
social participation and expect the same tourism ex-
periences as non-disabled customers (Boxall et al.,
2018). From this perspective, a growing body of litera-
ture recognises the importance of tourism for sustain-
able development, which should harmonise economic
growth with social inclusion and environmental pro-
tection. Accordingly, fighting inequality in tourism
is one of the sustainable development objectives of
tourism in the 2030 Agenda since everyone should
have equal access to tourism activities (World Tourism
Organization, n.d.).
It is interesting to note that, globally, the issue of
accessibility did not enter the political debate until
the late 20th century. Only in 2008 did the United
Nations Convention on the Rights of Persons with
Disabilities (uncrpd) come into force (United Na-
tions, n.d.). In the eu, the uncrpd was ratified by
the eu only in December 2010. Interestingly, in the
United States of America (usa), the rights of pwds
were first protected in 1990 by the Americans with
Disabilities Act (ada). However, there are still many
obstacles in the life of pwds. First, there are obstacles
in the built environment (physical barriers), those re-
lating to the connection between supply and demand
(communicational and functional barriers), and ob-
stacles relating to how pwds are perceived in society
as a whole (barriers related to social integration) (Lim,
2020). For pwds to enjoy tourism equally, these re-
strictions must be removed.
As a result of growing awareness of the issue, an
increased number of tourism researchers have been
focusing on this topic recently, with the majority of
studies focusing on the hotel sector. Most of the stud-
ies (e.g. Ferri Sanz et al., 2019; Kuo&Kalargyrou, 2014;
Lim, 2020; Zhang & Cole, 2016) analysed the demand
side, while the service providers’ (managerial) per-
spective was examined to a much lesser extent (e.g.
Grady & Ohlin, 2009; Nicolaisen et al., 2012). Inter-
estingly, only a few studies were found on restaurant
physical accessibility (e.g. Dias de Faria et al., 2012;
McClain et al., 1993; Wan-Chen & Chi-Chuan, 2012).
Due to the socioeconomic issues that humanity
is currently facing, accessibility is a topic that de-
serves special attention. According to statistical data,
more than 1 billion people (approximately 15 of the
global population) live with a disability (Eurostat,
2021). pwds represent 87million Europeans (approx-
imately 25 of the eu population). Similarly, pwds
represent 13 of the population in Slovenia, although
this number excludes those who experience various
types of temporary disabilities (Ministrstvo za delo,
družino, socialne zadeve in enakemožnosti, n.d.; Sen-
di, 2019). Considering a known connection between
population ageing and multiple disabilities, this num-
ber is expected to increase considerably in the coming
years (Ferri Sanz et al., 2019).
In terms of the share pwds represent in society
(approx. 25 of the eu population), to our knowl-
edge, no study has empirically investigated restaurant
managers’ perceptions of physical accessibility. More-
over, no studies analysing the relationship between
physical accessibility and sales revenue were found.
Given the lack of research, this study sought to deter-
mine how restaurant managers evaluate physical ac-
cessibility and its compliance with legislative require-
ments and professional recommendations. According
to Cockburn-Wootten and McIntosh (2020), service
providers are generally unaware that their facility is
not accessible to everyone. As managers’ awareness of
the actual state of restaurants’ physical (in)accessibility
258 | Academica Turistica, Year 16, No. 3, December 2023
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
presents the first step in implementing an accessible
offer, we pose the first research question (rq1): How
do restaurant managers perceive the physical accessi-
bility of restaurants they manage?
Besides its social perspective, the accessible tour-
ism market has also been identified as a growing seg-
ment that could provide additional economic ben-
efits. Namely, the disability market in tourism in-
cludes pwds and their friends and family members
who are emotionally connected to pwds. Accord-
ing to Donovan (2020), the global disability market
has approximately a population of 5.15 billion peo-
ple and is estimated to control over 13 trillion us dol-
lars in disposable income. Accordingly, many studies
(Buhalis & Darcy, 2011; Cockburn-Wootten & McIn-
tosh, 2020; Domínguez et al., 2013) investigated the
accessible tourism market and its economic impor-
tance for tourism destinations. A Spanish study by
Domínguez et al. (2013) revealed that pwds spend
significantly more than abled travellers.
Interestingly, studies investigating accessibility and
profitability in hotels (Baghdadi et al., 2017; Calvo-
Mora et al., 2015; Capitaine, 2016) provided contra-
dictory and inconsistent research findings about the
economic importance of an accessible tourism of-
fer. Surprisingly, to our knowledge, no research has
investigated the importance of physical accessibility
for restaurant business performance. Based on this
background, we sought to answer the second research
question (rq2):What is the impact of restaurant phys-
ical accessibility on restaurant sales revenues?
In particular, this study has two specific objectives:
(1) to empirically explore restaurantmanagers’ percep-
tions of restaurant physical accessibility and its reg-
ulatory compliance in a small eu economy, and (2)
to establish whether better (higher-perceived) physi-
cal accessibility positively influences restaurant sales
revenues. Hopefully, this research will provide new
insights into restaurant physical accessibility and de-
termine its importance for restaurant smes’ financial
performance. The findings should make an important
contribution to restaurant accessibility and revenue
management.
This study applied a mixed methodological ap-
proach to achieve its objectives. After the literature
review, theoretical findings and the identified physical
accessibility indicators were pre-discussed by disabil-
ity experts. In the next step, data were collected in field
research from 149 restaurant managers. A correlation
analysis using Spearman’s rank and Pearson’s corre-
lational coefficient was performed to investigate the
correlations between the observed indicators. Next,
research results were presented and discussed. The
paper concludes with implications for practice and
policy, a presentation of research limitations, and rec-
ommendations for future research.
Literature Review
Key Disability and Accessibility Definitions:
An International Perspective
Disability has been interpreted differently over time
and across various cultures. As a result, disability is
viewed as a complex, multidimensional, and evolving
concept (Boxall et al., 2018). Accordingly, there are
several definitions of disability, mainly used for statis-
tical purposes (Buhalis & Darcy, 2011).
From a scientific standpoint, two paradigms of dis-
ability (the medical and the social model) dominate
disability research (Dominguez et al., 2013). The med-
ical model emphasises each person’s medical situation
(an individual pathology). In contrast, the social (or
the collective) model emphasises limitations imposed
by society (Nicolaisen et al., 2012). According to the
social model, a person’s handicap results from the in-
teraction with the external environment, which might
exacerbate any underlying health issues an individ-
ual might have by preventing them from participating
equally in society (Ameri et al., 2020). Based on both
models, theWorldHealthOrganization (who) has es-
tablished the International Classification of Function-
ing, Disability, and Health (icf). Based on the icf’s
multidimensionality approach, there are various ways
to quantify disability, such as accounting for various
impairments, functional restrictions, or social integra-
tion problems (Dominguez et al., 2013).
Based on the social model of disability, the un-
crpd declaration introduced the un definition of
pwds and set the minimum requirements for their
rights and protection. The uncrpd, in Article 1, de-
fines pwds as ‘those who have long-term physical,
Academica Turistica, Year 16, No. 3, December 2023 | 259
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
mental, intellectual or sensory impairments which in
interaction with various barriers may hinder their full
and effective participation in society on an equal basis
with others’ (United Nations, n.d.). According to this
definition disability is a long-term inability to engage
in ‘normal’ life activities due to psychological, men-
tal, or physical constraints (Cruz-Morato et al., 2021).
The fundamental principles of the uncrpd refer to
respecting a person’s dignity, autonomy and indepen-
dence, non-discrimination, participation and social
inclusion, equality of opportunity, and accessibility.
The concept of accessibility is, in terms of provid-
ing equal access to everyone, inextricably linked to
disability. Only with unhindered access to facilities
and services will pwds be included in society. In line
with Article 9 of the uncrpd, countries should iden-
tify and eliminate all obstacles and barriers to ensure
that pwds can assess their environment, transporta-
tion, public facilities, services, and it technologies
(United Nations, n.d.). Furthermore, to protect hu-
man rights, prevent inequalities, and build inclusive
societies, the un General Assembly, in 2015, adopted
a critical document entitled ‘Transforming our world:
the 2030 Agenda for Sustainable Development.’ The
document outlines 17 sustainable development goals
(sdg) the un member states should achieve. Among
them, the 11th goal is to ensure free access of pwds to
living space (United Nations, 2015).
Accordingly, physical accessibility can be defined
as a set of characteristics thatmake buildings, environ-
ments, and products generally accessible (Calvo-Mora
et al., 2015). Furthermore, besides being generally ac-
cessible, the physical environments should be safe and
healthy, practical, understandable and respectful of
diversity, and aesthetically pleasing (Watchorn et al.,
2021). Therefore, accessibility is not just about elimi-
nating physical barriers but also about designing and
involving solutions that make the offer generally ac-
cessible. This approach is also known as the Universal
Design Principle (Calvo-Mora et al., 2015; Watchorn
et al., 2021).
However,measuring accessibility is not that simple,
as the different legislative bodies and research associa-
tions use the concept of accessibility according to their
research intentions and traditions (Domínguez et al.,
2013). Applying different methodologies means that
research results are often difficult to compare among
the various sectors and countries (Nicolaisen et al.,
2012). For this study, based on the uncrpd defini-
tion of disability and by following the meaningful in-
terpretation of the eu Accessibility Act, we will con-
sider physical accessibility as an essential feature of the
built environment that allows access, use, and equiv-
alent experience in restaurant facilities (disability and
accessibility studies are presented in the following sec-
tion).
Disability and Accessibility Studies
in the Hospitality Industry
Hotel Studies
Studies on accessibility in the hospitality sector have
mainly focused on hotel guests. Nevertheless, only
some studies examined the service providers’ (the
managerial) perspective. For example, Grady and Oh-
lin (2009) examined hotels’ compliance with ada;
Darcy and Pegg (2011) examined managers’ percep-
tions of the availability of disability services; andCruz-
Morato et al. (2021) examined the labour inclusion of
pwds in hotels.
Concerning physical accessibility andfinancial per-
formance in hotels, we only came across a small num-
ber of articles, that provide inconsistent research find-
ings. For example, Calvo-Mora et al. (2015) found that
hotel managers in Seville (Spain) were highly aware
of accessibility potentials for hotel financial perfor-
mance. In contrast, Capitaine (2016) reported that ho-
tel managers in Quebec (Canada) were mainly scepti-
cal about the economic value of the disability market.
Similarly, Darcy and Pegg (2011) reported that hotel
managers in Australia needed to be more intelligent
and responsible in providing access to pwds and ex-
ploiting the economic potential of this market.
A negative view of the relationship between ho-
tel accessibility and feasibility was also identified in
the study of Lebanese hotels by Baghdadi et al. (2017).
Authors reported that hotel managers mostly believe
that pwd-friendly facilities negatively influence the
satisfaction of the abled customer population, con-
sequently negatively impacting hotel popularity and
profitability in the long term. Nevertheless, based on
260 | Academica Turistica, Year 16, No. 3, December 2023
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
calculating the different revenue scenarios, the authors
(ibid.) theoretically demonstrated the economic feasi-
bility of an accessible hotel offer.
Restaurant Studies
Only a few studies covering the various issues of dis-
ability in the restaurant industry could be found, such
as an analysis of Oklahomamanagers’ attitudes toward
hiring pwds (Chi & Qu, 2005); employment of peo-
ple with intellectual disabilities in the case of a casual
dining restaurant operating in Ohio (Feerasta, 2017);
utilisation of restaurants by pwds in Korea (Joo &
Cho, 2012); and the possibility of employing pwds
with dementia in Japanese restaurants (Jiang et al.,
2021). In a study on discrimination in the us restau-
rant industry, Riesch and Kleiner (2005) reported that
racial and disability-based discrimination are the two
most common forms.
Specifically, concerning restaurant physical acces-
sibility, we have found only a few studies. One of the
first studies dates to the nineties when McClain et al.
(1993) investigated restaurant wheelchair accessibil-
ity in the usa and found notable differences between
the different types of restaurants. Significant problems
with providing an appropriate dining environment for
blind people in Taiwanese restaurants were reported
by Wan-Chen and Chi-Chuan (2012). According to
Dias de Faria et al. (2012), the ideal restaurant for vi-
sually impaired customers would be one where the
waiter reads the menu, the staff is compassionate and
where careful, low-intensity lighting and sounds, and
round tables are used, and the server can be called
by pressing a button. Similarly, Sokolenko (2018) re-
ported significant problems with infrastructure de-
velopment for pwds in the case of Ukrainian restau-
rants. Finally, to our knowledge, no studies have inves-
tigated the relationship between physical accessibility
and restaurant smes’ financial performance. More-
over, we have not identified any studies analysingman-
agers’ perceptions of restaurant accessibility within the
eu.
Financial Performance Analysis
The primary data source for creating financial analy-
ses are financial statements, such as balance sheets and
the profit and loss account. Numerous data, which can
be seen from both reports, enable the calculating of a
wide range of financial performance indicators such as
revenue, assets, and profit analyses.
Nevertheless, a Uniform System of Accounts for
Restaurants (usar) has been developed (Niemeier &
Hayes, 2005) to facilitate the financial performance
evaluation of restaurants.However, usar is not bind-
ing in the eu (nor in Slovenia), making it more chal-
lenging to create comparative analyses. Since sev-
eral financial indicators are available from financial
statements, according to Ferreira and Otley (2009),
choosing the most appropriate indicators for the fi-
nancial performance evaluation is crucial. With this
in mind, Planinc (2022) conducted a comprehensive
review of financial indicators used in restaurant in-
dustry studies and found that researchers measure the
financial performance of restaurant smes using vari-
ous financial indicators. According to Planinc (2022),
several researchers (e.g. Bera, 2021; Lee & Ha, 2012;
Hua, 2014) used sales revenue to analyse the finan-
cial performance of restaurant smes, as sales revenue
presents the fundamental metric of any financial per-
formance analysis. Moreover, several other industry-
specific Key Performance Indicators (kpis) can be cal-
culated based on sales revenue, such as average spend-
ing per person (asp), sales per employee per hour,
restaurant profit margin and efficiency analyses (Har-
ris, 2013). Therefore, for answering rq2, we decided
to use sales revenue as the key financial performance
indicator.
Methodology
Disability and Accessibility Legislation
The EU Legislation
In Tables 1 and 2, the key eu initiatives (international
treaties, strategies, and conventions) and the eu di-
rectives (common rules) related to the field of the
study are summarised in chronological order. The eu
has no separate disability act (such as ada). The eu
member states’ main challenge is implementing the
2021–2030 eu Strategy for the Rights of pwds, which
the Commission supports (European Commission,
2021).
Concerning restaurant accessibility, the eu Acces-
Academica Turistica, Year 16, No. 3, December 2023 | 261
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
Table 1 The eu Disability Initiatives
Year Initiatives Relevance
 eu Convention on Human Rights (echr) The first document to protect human rights and political
freedoms.
 Treaty of Amsterdam (now Article  of the Treaty
on the Functioning of the eu)
Protection of human rights against any form of discrimina-
tion.
 eu Charter of Fundamental Rights (cfr) Set of human rights that must be protected in the eu.
 Ratification of the uncrpd at the eu level An international perspective of promoting and protecting
the human rights of persons with disabilities.
 Lisbon Treaty amendment to the Treaty on the eu The cfr became a legally binding document within the eu
 eu Disability Strategy – The main instrument of the eu Commission to implement
the uncrpd policy.
 eu Pillar of Social Rights This document highlights the right of pwds to assess
goods and services available to the public and enable them
to participate equally in society.
 Strategy for the Rights of pwds – The goal is to ensure that Europeans with disabilities no
longer experience any form of discrimination and to build
a Union of equality.
Table 2 The eu Disability Directives
Year Directives Relevance
 The Equality Framework Directive Employment and Occupation (eu directive
//ec)
The minimum accessibil-
ity standards for pwds
in the areas of guest ser-
vice, employment, built
environment, transporta-
tion, information, and
communications.

and

Regulations on the Rights of Passengers with Reduced Mobility in main modes of
Transport (e.g. Air – Regulation (ec) No. /; Sea andWaterways – Regula-
tion (eu) No. /)
 eu web accessibility directive (eu directive /)
 eu Accessibility Act (eu directive //ec)
sibility Act will enter into force in 2025 andwill not ap-
ply to sme restaurants (European Parliament and the
Council of the European Union, 2019). Nevertheless,
restaurants are considered businesses open to the pub-
lic. Therefore, according to uncrpd, pwds have the
right to access all aspects of society equally with oth-
ers. Specifically, according to paragraph b. of Article
9 of the uncrpd (United Nations, n.d.), private enti-
ties offering services to the public should consider all
aspects of accessibility for pwds.
The National Legislation
TheRepublic of Slovenia has brought its disability laws
into compliance with the eu’s. Specifically, the Act rat-
ifying the uncrpd and the Optional Protocol to the
uncrpd stepped into force in 2008, while the Pro-
tection Against Discrimination Act was introduced in
2016. The law mentioned above, in Article 2, strictly
prohibits any discrimination regarding access to goods
and services available to the public (Zakon o varstvu
pred diskriminacijo (zvard), 2016).
Regarding restaurant accessibility, several acts cover
the different aspects of disability and accessibility pro-
vision. This section focuses on legislation and rec-
ommendations relevant to public restaurants’ acces-
sibility. Table 3 presents the relevant legislation and
documentation (national guidelines and action pro-
grammes) chronologically.
262 | Academica Turistica, Year 16, No. 3, December 2023
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
Table 3 The National Legislation
Year Document Relevance
 National Guidelines to Improve the Built Environ-
ment, Information, and Communications Accessibil-
ity for pwds (Nacionalne usmeritve za izboljšanje
dostopnosti grajenega okolja, informacij in komu-
nikacij za invalide)
According to this document, non-discriminatory access to
public environments and services is considered a funda-
mental right of pwds.
 Act on the Equalisation of Opportunities for pwds
(Zakon o izenačevanju možnosti invalidov (zimi))
Based on this Act, discrimination due to disability in access
to goods and services available to the public is strictly pro-
hibited. Article  clearly defines the deadline for public fa-
cilities to eliminate all physical barriers by the end of .
 Rules on universal construction and the use of con-
struction works (Pravilnik o univerzalni graditvi in
uporabi objektov)
This rule specifies the essential requirements to ensure the
universal construction of facilities.
 Building Act (Gradbeni zakon (gz-)) This Act protects the public interest in the construction of
buildings by following the principle of equal opportunities.
 Spatial Management Act (Zakon o urejanju prostora
(zurep-))
This Act enables universal (non-discriminant) access to the
public infrastructure.
 Action Programme for pwds – (Akcijski
program za invalide)
The programme aims to promote, protect, and ensure the
full and equal enjoyment of the human rights of pwds
and to promote respect for their dignity.
 Consumer Protection Act (Zakon o varstvu
potrošnikov (zvpot-))
This Act demands accessibility, clarity, and unambiguous
provision of messages to all consumers.
Moreover, in the analysis of the national legisla-
tion, the following standards have also been consid-
ered: sist iso 21542:2022 (this document specifies a
range of requirements and recommendations related
to the design and constructional aspects of the usabil-
ity and accessibility of buildings); sist 1186:2016 (this
standard relates to the tactile surface indicators for the
blind and partially sighted); sist en 17210:2021, and
sist tp cen/tr 17621:2021 (these standards describe
minimum functional requirements for an accessible
built environment) (https://www.sist.si). In addition,
the different professional recommendations (manuals
and handbooks) were also taken into consideration,
such as the manual(s) for inclusive design and access
to information (Albreht, 2018), universal housing con-
struction (Albreht et al., 2017), accessibility of facili-
ties in public use (Sendi et al., 2015), and accessibility
of built environmental and informational technology
(Sendi, 2019).
Fromour research perspective, it is essential to em-
phasise that the Act on the Equalisation of Opportu-
nities for pwds (Zakon o izenačevanju možnosti in-
validov (zimi), 2010), in Article 38, determines the
deadline for all public facilities (including the exist-
ing restaurant providers) to eliminate all physical bar-
riers by the first reconstruction or at the longest byDe-
cember 2025. The Building Act (Gradbeni zakon (gz-
1), 2021) and the Rules on universal construction and
the use of construction works (Pravilnik o univerzalni
graditvi in uporabi objektov, 2018) prescribe construc-
tion following the universal accessibility guidelines for
new constructions.
Instrument Design
First, following the analysis of previous research and
legislation related to disability and legislative require-
ments presented in Table 3, indicators of physical
accessibility (44 indicators) were identified. In the
next step, the identified accessibility indicators were
prechecked by three pwd representatives (disability
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Table 4 Accessibility Indicators
Indicators Layout areas
 Five per cent of all parking spaces or at least one-are properly marked and no more than  m from
the entrance.
Parking
 There is an area for a car to stop safely for a short period if there are no available free parking spots.
 Parking space is unobstructed and allows wheelchair manoeuvring (min. length is . m and min.
width is . m).
 There is adequate lighting in the parking area.
 Between the parking area and the restaurant, there is a paved, non-slip surface. Access path
 The path is adequately marked with contrasting colours and informational signs.
 There are floor indicators.
 There are no physical obstacles.
 The width of the access path is adequate (min. . m).
 Good lighting is provided.
 Access from the nearest public transport station is safe and unobstructed.
 The entrance is visible and adequately marked. Entrance
 There is enough space for wheelchair manoeuvring.
 The entrance is unobstructed, the floor mats are at floor level, and the threshold is at most  cm high.
 The entrance has a canopy or windbreak.
 The bell can be easily accessed from the wheelchair.
 There is a custom side entrance for pwds.
 A sign at the entrance indicates that the restaurant is appropriate for pwds.
 The corridors are suitably wide and allow unhindered movement. Connec. spaces
 Signposts are visible, legible, and of appropriate height.
 Room markings are visible, legible, and of appropriate height.
 The arrangement of the tables allows unimpeded movement in a wheelchair. Dining room
 At least part of the tables allows dining from a wheelchair (the bottom edge and depth of the table is
min. . m).
 All inscriptions are of appropriate size.
Continued on the next page
experts) to ensure that they matched the scope of the
study and were appropriate for inclusion in the ques-
tionnaire. All disability experts are members of the
National Council of Disability Organisations of Slove-
nia (a convenience sampling method for selecting the
experts was used). This non-governmental organisa-
tion unites representatives and other disability organ-
isations operating at the state level in the Republic of
Slovenia.
The next phase included designing a self-admin-
istered questionnaire with mostly binary questions
related to accessibility requirements. Physical acces-
sibility indicators were split into six main layout areas
of the restaurant (attributes) following the customer
movement path (accessibility indicators and attributes
are presented in Table 4). Indicators ranging from i1
to i29 are area specific. Indicators ranking from i30 to
i40 are considered generic and simultaneously apply
to different layout areas (entrance, connecting spaces,
dining room, and toilets). In contrast, indicators rank-
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Table 4 Continued from the previous page
Indicators Layout areas
 The sanitary area is marked with an international sign for the disabled. Toilets
 The space size is min . m × . m, and there is enough space for unhindered movement.
 The equipment is at a suitable height and easily accessible.
 Appropriate hand holders and accessories are installed.
 An emergency call device is installed.
 Doors are visible. Entrance, con-
necting spaces,
dining room,
toilets
 The doors are suitably (min. . m) wide.
 Doors open with ease and do not obstruct anyone.
 Hooks are visible and easily accessible.
 The doors stand out in contrast to the surrounding walls.
 There is sufficient space for wheelchair manoeuvring.
 The flooring is flat and non-slip.
 The lighting is adequate.
 There are information labels for pwds.
 Colours that contrast are used.
 Floor markings are provided.
 Steps are marked, with handrails, and of the proper width (min. . m) and height (max.  cm). Access path,
entrance, con-
necting spaces,
dining room,
toilets
 The wheelchair ramp is marked, accessible, and of the proper width (min. . m), slope (max. ),
and length that enable wheelchair manoeuvring.
 The lift is marked and accessible, and its min. Size is . m × . m, and the door is min. . m wide.
 The wheelchair lift platform is marked, easily accessible, and has the proper size (min. . m × . m)
and slope (max. ).
ing from i41 to i44 refer to potential level differences
in five layout areas (access between the parking and the
restaurant, entrance, connecting spaces, dining room,
and toilets). In case of level differences, the man-
ager subsequently indicated the areas to which they
refer.
Following the disability experts’ recommendations,
managers were also asked to indicate their self-per-
ceived accessibility knowledge (three indicators), com-
petencies (two indicators), the difficulty of adjusting
the offer for pwds (two indicators), and the availabil-
ity of external support for adjusting the offer (two in-
dicators). For all questions, a five-point Likert-type
ordinal scale was used (see also Table 6). Finally, man-
agers provided their demographic characteristics (pre-
sented as categorical variables) and basic information
about the restaurant facility. Furthermore, managers
were asked to indicate whether they had any friends or
family members with a disability (Kuo & Kalargyrou,
2014) and the estimated percentage of pwds in their
restaurants. After the questionnaire was developed,
three restaurant managers pre-tested it to determine
whether it was simple to understand.
Data Collection Process
Given the study’s objectives, primary data was col-
lected from 200 restaurants across Slovenia between
May and August 2022 from pre-trained data collec-
tors using convenience sampling. In 2021, 8,410 restau-
rant businesses (nace code I.56 – Food and Beverage
(F&B) service activities) were recorded in the Slove-
nian business register (https://pxweb.stat.si/sistat/en).
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Since the Slovenian national classification system of
the different types of restaurant facilities does not fully
comply with the eu coding system (nace), the au-
thors had to focus on those restaurant facilities with
comparable operational characteristics. As a result,
the sample frame consisted of sit-down restaurants
registered as smes that are not located in shopping
malls, do not have several branches (restaurant units),
and are not under monumental protection. Exam-
ples of these restaurants include traditional à la carte
restaurants, inns, casual and fast food sit-down restau-
rants, and coffee and pastry shops. Hotel and fran-
chise restaurants and other businesses serving pre-
dominately beverages (such as pubs and bars) were
excluded from the research. The data collectors pre-
checked randomly chosen restaurants to ensure that
all restaurants met the specified requirements. If the
restaurant met the research criteria, the manager was
kindly requested to complete the questionnaire, either
in the presence of the data collector (questionnaires
were hand-delivered to managers) or the data collec-
tor agreed to collect the completed questionnaire. In
cases where managers needed additional explanation
about the research, the data collectors provided the
requested information.
Nevertheless, some managers refused to partic-
ipate in the study for various reasons (mainly lack
of time). If the manager refused to participate, the
data collector selected another restaurant sme, cor-
responding to the above-presented research criteria.
The final analysis is based on 149 valid questionnaires
(the response rate was 74.5), representing 1.77 of
the i56 population in Slovenia.
In the next step, secondary financial data for each
restaurant sme was obtained from official financial
reports (profit and loss accounts for the year 2021),
which in Slovenia are in the public domain (https://
www.ajpes.si/fipo/default.asp).
Data Analysis
Data analyses were done using the Statistical Package
for Social Sciences (spss 26.0). Descriptive statistics
were used to analyse managers’ responses about their
demographic and restaurants’ physical characteristics.
A correlation analysis using Spearman’s rank andPear-
Table 5 Managers’ Assessment of Restaurant Accessibility
Accessibility attributes () () () ()
Parking  . . .
Access. between the parking
area and the restaurant
 . . .
Entrance  . . .
Connecting spaces  . . .
Dining room  . . .
Toilets  . . .
Notes Column headings are as follows: (1) no. of possible
positive responses (indicators) to each attribute, (2) aver-
age no. of positive responses-indicators, (3) percentage, (4)
stdandard deviation.
son’s correlational coefficient was performed to inves-
tigate the correlations between the observed indica-
tors.
Research Findings
Characteristics of the Sample
Most respondents (37) were between 36 and 45 years
of age, and the sample was predominantly composed
of male managers (62). Most managers (42) had
finished a vocational or secondary school. The high-
est percentage (35) reported having 11 and 20 years of
working experience. Almost seventy per cent (68.9)
of all managers reported owning the restaurant they
manage. Notably, 87 of managers indicated they had
no relatives or friends with a disability.
In terms of restaurants’ characteristics, à la carte
restaurants composed 32 of the sample, followed by
coffee and pastry shops (26), inns (27), and casual
and fast food restaurants (15). On average, restau-
rants had 8.2 employees, 102 seats, and 27.5 years of
business activity. The average age of the restaurants
was 67 years (referring to the year of construction); on
average, they were last renovated in 2011. Finally, the
average yearly sales revenue per restaurant sme was €
364,620.93.
Accessibility Evaluation
To answer rq1, managers’ self-evaluations of acces-
sibility were analysed according to the six-attribute
level.
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Table 6 Managers’ Self-Perceived Knowledge and Perceptions of the Different Accessibility Issues
Indicators Statements () ()
Knowledge We know the eu accessibility policy . .
We know accessibility legislation . .
We know the economic potential of the disability market in tourism . .
Competence We have the competence to adjust the offer to the needs of pwds . .
The staff has the competencies to adjust the offer to the needs of pwds . .
Difficulty Adjustment of the offer and removal of physical obstacles is difficult . .
Adjustment of the offer represents a large financial burden for the restaurant . .
External
support
There is enough official information to help us adjust the offer . .
There is enough professional support to help us adjust the offer . .
Notes Column headings are as follows: (1) average, (2) standard deviation.
The findings are summarised in Table 5, where the
average number of indicators (managers’ positive re-
sponses) for each attribute is displayed. To better un-
derstand accessibility evaluation, the highest- and the
lowest-rated indicators were also presented (see text in
brackets below).
The two highest-rated attributes were the park-
ing area and entrance. The highest-rated indicators
were i3 (parking space is unobstructed), i12 (visible
and adequately marked entrance), and i14 (unob-
structed entrance). In contrast, the two lowest-rated
attributes were accessibility between the parking area
and the restaurant and toilets, with i7 (floor indica-
tors), i28 (hand holders and accessories), and i25 and
i29 (signs for disabled and emergency call devices in
toilets) as the lowest-rated indicators. Overall, these
results answered rq1 as they indicate that according
to managers’ perceptions, none of the six restaurant
accessibility attributes is perceived as fully accessible
for pwds. The next section of the survey evaluated
managers’ responses, indicating their self-perceived
knowledge and perceptions of the different accessibil-
ity issues. All indicators weremeasured on a five-point
Likert-type ordinal scale, ranging from 1 (very low or
do not agree) to 5 (very high or completely agree).
Results in Table 6 indicate that the highest-rated
indicators reveal managers’ perceptions about the fi-
nancial burden related to offering adjustment (m =
3.59) and their self-perceived competence to adjust
the offer to the needs of pwds (m = 3.50). In contrast,
the lowest-rated indicators show managers’ knowl-
edge of the eu policy on accessibility (m = 2.45) and
their knowledge of the economic potential of the dis-
ability market (m = 2.90).
Correlations Between Restaurant Accessibility,
Managers’ Characteristics, and Sales Revenue
Following the study’s second goal (rq2), correlations
between sales revenues and accessibility attributes
were calculated. We tested the hypothesis that bet-
ter physical accessibility positively correlates to higher
sales revenues. For the correlation analysis, acces-
sibility indicators were first merged into accessibil-
ity attributes (new numerical variables showing the
number of positive responses (indicators) for each at-
tribute). Accordingly, correlations were calculated us-
ing the Pearson correlation coefficient (r). The corre-
lation analysis revealed that none of the six accessi-
bility attributes is statistically significantly correlated
(p > 0.05) to sales revenue, which answered rq2. As
this was a surprising and unexpected result, we in-
vestigated further. Accordingly, we hypothesised that
restaurant sales revenue positively correlates to man-
agers’ demographic characteristics, perceptions, and
knowledge about accessibility issues. Since all vari-
ables related to managers’ characteristics (used in cor-
relations) were ordinal categorical variables, correla-
tions between managers’ characteristics and sales rev-
enue were calculated using Spearman’s rank correla-
tion coefficient (rs). The same coefficient was also used
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Table 7 Correlations between Restaurant Sales Revenue, Physical Accessibility, Managers’ Responses about Accessibility,
and Their Demographic Characteristics
Category Indicators r/rs p
Accessibility
attributes (r)
Parking –. .
Accessibility between the parking area and the restaurant –. .
Entrance –. .
Connecting spaces . .
Dining room . .
Sanitary facilities . .
Managers’
knowledge/
perceptions of
accessibility
(rs)
Knowledge of the eu policy on accessibility . .
Knowledge of accessibility legislation . .
Knowledge of the economic potential of the disability market in tourism . .
Adjustment of the offer and removal of all physical obstacles is difficult .* .
Adjustment of the offer represents a large financial burden –. .
We have enough competence to adjust the offer to the needs of pwds .* .
Staff is competent in adjusting the offer to the needs of pwds . .
There is enough official information to help us adjust the offer –. .
There is enough professional support to help us adjust the offer –. .
Managers’
demographic
characteristics
(rs)
Age –. .
Education .* .
Years of experience –. .
Family members or friends with a disability . .
Notes *Correlations are significant at the p ≤ 0.05 level (2-tailed).
to calculate the correlations between sales revenue and
managers’ responses about accessibility (Likert-type
ordinal scales). The results of the correlation analyses
are presented in Table 7.
There are statistically significant (p≤ 0.05) positive
correlations only between sales revenues and man-
agers’ responses related to the difficulty of removing
the physical obstacles (rs = 0.19; p = 0.026), their per-
ceived competence to adjust the offer (rs = 0.193; p =
0.022), and the level of their formal education (rs =
0.168; p = 0.041).
Since the Act on the Equalisation of Opportuni-
ties for pwds (Zakon o izenačevanju možnosti in-
validov (zimi), 2010) demands that the existing ser-
vice providers eliminate all physical barriers during
the process of the first reconstruction (or by 2025),
we decided to additionally test if a correlation ex-
ists between the perceived overall level of restaurant
accessibility and the reported years of construction,
and the last renovation. Accordingly, we hypothesised
that newer and renovated restaurants are more acces-
sible. Interestingly, results indicate that only the year
of construction (newer buildings) positively correlates
to restaurant accessibility (r = 0.252; p= 0.006), while
there is no correlation between the year of the last
renovation and restaurant accessibility (r = 0.096; p =
0.299). The following section, therefore, moves on to
discuss the findings.
Discussion
The research approach applied for this study focuses
on the social model of disability, which emphasises
how society approaches pwds, rather than viewing
disability as an individual pathology. The literature on
ensuring restaurant accessibility and its significance
for restaurant sales revenues was surprisingly sparse,
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despite the importance of disability policy in the eu
political agenda.
Therefore, rq1 sought to determinewhetherman-
agers evaluate restaurants as fully accessible for pwds.
The questionnaire includes the legislative require-
ments and professional recommendations, indicators
identified in previous research, and indicators related
tomanagers’ self-perceived knowledge, competencies,
and perceptions about accessibility issues. Concerning
rq1, it was found that managers perceive restaurants
as relatively inaccessible. According to managers’ self-
evaluations, the most accessible are the following two
attributes – parking area and restaurant entrance. In
contrast, the lowest-rated attributes were the access
between parking and the restaurant and toilets. What
is surprising is that, in the middle of the eu, managers
perceive toilets as the most problematic accessibility
area in public restaurant facilities.
A more detailed review of accessibility indicators
reveals that the lowest scores relate to floor indica-
tors, availability of hand holders, and signs for pwds.
In contrast, the highest-rated indicators are unob-
structed parking availability and visible and unob-
structed restaurant entrance. It is difficult to explain
these results, but they might be related to the fact that
the lowest-rated indicators belong to the internal (in-
door) environment. In contrast, the highest-rated in-
dicators are publicly visible, which might influence
managers’ decisions to comply with the legislative re-
quirements. Overall, this self-evaluation study’s find-
ings align with earlier studies (Sokolenko, 2018; Wan-
Chen & Chi-Chuan, 2012), which also reported ac-
cessibility differences in the various restaurant layout
areas and were performed by external evaluators.
Another important findingwas thatmanagers rated
very low their knowledge of eu accessibility policy,
accessibility legislation, and the economic potential of
the disability market in tourism. A possible explana-
tion for relatively low accessibility evaluations (rq1)
might also be the consequence of managers’ low level
of accessibility knowledge (see Table 5). In this view, it
is surprising that managers believe adjusting the offer
presents a significant financial burden, though they re-
ported little knowledge about legislative requirements.
Paradoxically, managers also believe they have a high
level of competence to adjust the offer to the needs of
pwds. The inconsistency betweenmanagers’ low self-
perceived legislative knowledge and their high self-
perceived competence to adjust the offer may be be-
causemanagers generalise and simplify the complexity
of accessibility because they have little knowledge on
this matter. Another possible explanation for results
related to rq1 is thatmanagers are waiting till the very
last moment (till 2025) to adjust the offer.However, ac-
cording to their low self-perceived legislative knowl-
edge (see Table 5), we might wonder if they know the
deadline for adjusting the offer (although we did not
specifically check this in the research). As a result, we
may presume that the eu Commission’s dedication to
increasing disability awareness was not fully effective
(European Commission, 2021).
The second objective of this study was to investi-
gate the correlation between restaurant physical ac-
cessibility and sales revenue (rq2). The most promi-
nent finding from the analysis is that none of the six
accessibility attributes is statistically significantly cor-
related to sales revenue. It is difficult to explain this re-
sult due to the lack of research on the economic value
of accessibility in the restaurant industry. However,
these results agree with those obtained by Capitaine
(2016) and Darcy and Pegg (2011), who reported that
hotel managers are somewhat sceptical about the eco-
nomic value of the disabled market in tourism. Even
though this study has been unable to demonstrate
the economic benefit of physical accessibility for the
restaurant industry, these results might be partially
explained by the low percentage of pwds dining in
restaurants. Namely, managers reported that pwds,
especially those with a mobility impairment, present
4.8 of all customers, while blind people and the visu-
ally impaired constitute only 2.4 of their customer
base. At the same time, pwds might avoid public
restaurants or tend to be loyal to verified and acces-
sible restaurant providers. Another possible explana-
tion could be that restaurant managers do not take
into account the economic benefit of accessible offer-
ings as they do not have sufficient knowledge about
the economic potential of the disability market, which
according to Donovan (2020), is estimated to control
over 13 trillion us dollars globally.
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In the next step, managers’ self-perceived knowl-
edge, perceptions of accessibility issues, and demo-
graphic characteristics were correlated to sales rev-
enues. We especially wanted to check if the observed
correlations better explain results related to rq2. Re-
sults indicate positive correlations between sales rev-
enue and three indicators – managers’ beliefs about
the difficulty of removing the obstacles, their self-
perceived competencies, and the perceived financial
burden of adjusting the offer. This finding is interest-
ing, though it is somewhat contradictory to results
related to the correlation between sales revenue and
accessibility, where no statistically significant corre-
lations were found. A possible explanation for this
finding might be that managers are somehow aware
(or afraid) of the complexity and the financial bur-
den of adjusting the physical environment for pwds
because they have little knowledge about accessibil-
ity. Therefore, they relativise its importance and focus
on other (e.g. functional) aspects of accessibility, po-
tentially influencing restaurant sales revenues (rq2).
For example, managers may try to compensate for the
shortcomings of the physical environment by focus-
ing on service provision (e.g. helpfulness, kindness,
and support to pwds), which they afterwards corre-
late with their competence to adjust the offer to pwds.
Theoretically, thismight eliminate pwds’momentary
discomfort with the shortcoming of the physical envi-
ronment and result in higher sales revenue. However,
it is neither reflected in the actual improvement of the
physical environment nor its correlation to sales rev-
enues. Nevertheless, cautionmust be applied when in-
terpreting these results, as further studies, which take
these variables into account, will need to be under-
taken.
Concerning the correlations between managers’
demographic characteristics and sales revenues, it was
found that only the level of formal education is posi-
tively correlated to sales revenues. This result means
that restaurant managers with higher education gen-
erate higher sales revenues. This finding is consistent
with that of Lee and Hallak (2018), who confirmed
the importance of education for restaurant profitabil-
ity. Interestingly no correlations were found between
managers’ years of experience and sales revenues. Ac-
cordingly, we might assume that the business’s meth-
ods are more or less continuous (and potentially sub-
optimal). As both managers’ self-perceived accessi-
bility competence (assumingly gained through infor-
mal education) and the level of their formal education
proved essential for restaurant sales revenues, addi-
tional studies will be needed to develop a complete
picture of the importance of the self-perceived acces-
sibility competence for restaurant profitability.
Interestingly, no statistically significant correlation
was found between the accessibility level and the re-
ported year of restaurant renovation. On the contrary,
a positive correlation was found between the year of
construction of the restaurant facility and accessibility,
indicating that newly constructed restaurants are per-
ceived as more accessible. This finding suggests that
during the last renovation of the restaurant, no sig-
nificant improvements in physical accessibility were
made. According to the Building Act (Gradbeni za-
kon (gz-1), 2021, Article 7), a building permit is not
required for performing maintenance or minor re-
construction works on existing facilities, nor is a new
use permit issued. In contrast, for new buildings, a
professional commission performs a technical (on-
site) inspection (Gradbeni zakon (gz-1), 2021, Article
82). Therefore, a possible explanation for these results
might be related to managers’ relatively poor knowl-
edge of legislative requirements (see also previous ex-
planation) and the fact that the Act on the Equali-
sation of Opportunities for pwds (Zakon o izenače-
vanjumožnosti invalidov (zimi), 2010) does not spec-
ify sanctions for those who failed (or will fail) to ad-
just the offer on time. From this perspective, this study
supports evidence from previous observations, which
also emphasised the poor accessibility of facilities in
public use in the Republic of Slovenia, such as a re-
cent report issued by the Slovenian Ombudsman on
the inaccessibility of the Centres for Social Services
work (Komisija za socialno varstvo, delo, zdravstvo in
invalide, 2023).
Finally, the current findings are important in at
least two significant ways.
First, from the social perspective, results indicate
that managers perceive restaurants as insufficiently
accessible. Even though the universal design concept
270 | Academica Turistica, Year 16, No. 3, December 2023
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
has been actively introduced in the hospitality indus-
try (Gillovic & McIntosh, 2020; Watchorn et al., 2021)
and the eu has taken a serious approach towards the
protection of pwds, the results of our study reveal
that basic infrastructure is still not fully provided for
pwds, which limits them from equally integrating
into society. Following the eu’s anti-discrimination
policy, the environmental characteristics should not
obstruct pwds. Even though the Act on the Equali-
sation of Opportunities for pwds (Zakon o izenače-
vanju možnosti invalidov (zimi), 2010) enables the
adjustment of the offer up till 2025, it is somehow dif-
ficult to understand that in the 21st century, in an eu
member state, managers perceive restaurant toilet ac-
cessibility as a significant obstacle for pwds. This re-
sult is also important because physical inaccessibility
represents a deeper form of discrimination (Ameri et
al., 2020). Physical barriers negatively affect the hu-
man will and limit individual freedom (Cruz-Morato
et al., 2021). While customers without disabilities can
easily find alternative solutions to environmental bar-
riers (or other unsatisfactory elements of the offer) by
choosing a different service provider, pwds cannot
be in the same position as others.
Second, the discussion of accessibility is linked
with the marketing literature. Namely, based on the
restaurant marketing and quality management the-
ory (Kukanja et al., 2017), better physical accessibility
should not encourage customers to dine at specific
restaurants. In this view, Darcy and Pegg (2011) re-
ported that even where hotel rooms have been made
accessible, they may not always be attractive to pwds.
According to previous studies (Kukanja et al., 2017),
for customers without disabilities, the physical en-
vironment presents a necessary (fundamental) at-
tribute, while other marketing attributes (e.g. Peo-
ple and Product) influence the choice to (re)purchase.
Similarly, Zhang andCole (2016) reported that staff at-
titude critically determined pwds’ overall satisfaction
with lodging services. Therefore, in terms of making
the offer generally accessible to the public, eliminat-
ing the physical barriers is not the same as making the
product more marketing-attractive.
From the financial perspective, results indicate that
restaurant accessibility is not correlated to sales rev-
enue. In the eu alone, the disability population is es-
timated at 123.9 million, with a disposable income of
547.1 billion us dollars (Donovan, 2020). Moreover,
several trends in society imply positive relationships
with accessible restaurant offers, such as the increased
importance of pwds in the population, availability
of finances and time, awareness of environmental is-
sues, and the demand for a sustainable and socially re-
sponsible tourism offer (Gillovic & McIntosh, 2020).
Financial benefits should not present an argument
for investing in accessibility. However, a timely ad-
justment of restaurant facilities according to the leg-
islative requirements and professional recommenda-
tions on physical accessibility (see also Table 4) could
(potentially) boost sales revenues and increase busi-
ness opportunities and employment in the restaurant
industry. Nevertheless, an accessible environment is
also more comfortable for the abled population (Lim,
2020), meaning that the community benefits from ac-
cessible offerings.
Conclusion
The main goals of the current study were to analyse
managers’ self-assessment of restaurant physical ac-
cessibility (rq1) and to investigate if (in)accessibility
influences restaurant sales revenues (rq2).
This study’s results indicate a lack of literature on
disability in the restaurant sector. Furthermore, re-
sults revealed that despite the eu legislative frame-
work (see Tables 1 and 2), which should prevent dis-
crimination against pwds, and the Slovenian legis-
lation (see Table 3), which allows for the adjustment
of the physical environment for the existing service
providers up till 2025, managers evaluate the Slovene
restaurant industry as relatively poorly accessible. The
second significant finding was that physical accessi-
bility does not influence restaurant sales revenue, al-
though, theoretically, pwds could (potentially) gen-
erate substantial revenue for the restaurant industry.
This study is (to our knowledge) the first to em-
pirically investigatemanagers’ evaluation of restaurant
physical accessibility and its correlation to sales rev-
enue. Furthermore, the accessibility shortcomings that
we have identified in our study should contribute to
the improvement of restaurant accessibility in Slovenia
Academica Turistica, Year 16, No. 3, December 2023 | 271
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
and the implementation of the eu 2021–2030 Disabil-
ity Strategy in practice (European Commission, 2021).
This study should, in theory, provide an under-
standing of restaurant physical accessibility from the
managerial (the inner) perspective. However, since the
convenience sampling method was employed for this
study, the generalisability of results should be con-
sidered. Another limitation arises from the potential
geographical and cultural differences that could af-
fect the generalisability of research results since the
present study is focused on the Republic of Slovenia.
Third, accessibility evaluations might have been influ-
enced by managers’ subjective perceptions of restau-
rant accessibility. Fourth, this study focused on phys-
ical accessibility indicators and their correlation to
sales revenue using correlation analysis. Fifth, smes
often generate revenues from different business activ-
ities, even though they are primarily registered as f&b
service activities (i56). Accordingly, their financial re-
ports are aggregated, which might present a limitation
when taking sales revenue as a key financial indica-
tor. Finally, most respondents (restaurant managers)
reported owning the facility they manage. However,
in the case of tenants’ managers, investments in the
physical environment are often in the domain of the
facility’s owner.
Despite the presented limitations, this study sug-
gests several theoretical implications. The implement-
ed economic, social, and legislative norms are chang-
ing how our society is organised. Since physical inac-
cessibility in tourism is understood as a socially im-
posed restriction, society should strive to remove all
barriers that prevent pwds’ equal inclusion. Fighting
inequality is also one of the top priorities of tourism in
the 2030 Agenda (World Tourism Organization, n.d.).
Accordingly, more research on this topic is needed to
ensure that society is maturing regarding respecting
human rights.
Moreover, to better understand why restaurant
(in)accessibility does not influence sales revenue,more
investigations utilising controlled trials are required.
An eu cross-national study might offer more conclu-
sive evidence on this matter. A reasonable approach
to tackle this issue is to analyse pwds’ expectations
using the bottom-up approach, as Cockburn-Wootten
and McIntosh (2020) suggested. Accordingly, includ-
ing these indicators in future research could also help
us establish a greater accuracy on this matter. Finally,
testing a model that simultaneously considers the im-
portance of different internal and external variables
(e.g. by implementing structural equationmodelling –
sem) could also provide a deeper insight into the rela-
tionship between environmental andmanagerial char-
acteristics, managers’ and pwds accessibility percep-
tions, and restaurant business performance.
The findings of this study have several implications
for practice. Restaurant managers are responsible for
improving accessibility. According to the research re-
sults, much will have to be done quickly. Managers
should, therefore, understand the legislation well and
adjust their offer for pwds by removing all physical
barriers by 2025. Moreover, managers are also recom-
mended to introduce appropriate internal activities,
such as accessibility checklists and audits, to enable
constantmonitoring of restaurant accessibility. A sim-
ulation exercise for restaurant staff should also raise
awareness of the different problems pwds face. The
purpose of the accessible offer is not to provide care for
pwds but to facilitate their stay by providing freedom
of movement and easing the use of services provided.
In this view, unique campaigns, such as the promotion
of best practices, industry rewards for accessibility, and
the development of specialist platforms, could also
help to promote inclusion. Calvo-Mora et al. (2015) be-
lieve proper communication is crucial as pwds value
accurate accessibility information. Accordingly, on-
line platforms can benefit pwds, as they conduct ex-
tensive research to reduce uncertainties before dining
out (Cockburn-Wootten & McIntosh, 2020). Finally,
managers should go beyond the legal requirements of
providing physical accessibility by eliminating func-
tional and communicational barriers. Eliminating all
barriers would present a step towards an accessible
restaurant offer and an equal society.
Regarding recommendations for policymakers, it
is necessary to have adequate inspection controls. In
parallel, this intervention must be accompanied by
efficient, informative campaigns and educational sup-
port. In the long term, educational programmes about
social diversity, human rights, and inclusion should be
272 | Academica Turistica, Year 16, No. 3, December 2023
Marko Kukanja and Saša Planinc Does Better Physical Accessibility . . .
introduced at all educational levels. In support of the
2030 Agenda for SustainableDevelopment, favourable
financial loans could be provided for smes to adjust
the offer to pwds. Finally, collective empowerment
through active cooperation among the restaurant in-
dustry, disability organisations, academia, and the
public sector seems to be a way towards an equal soci-
ety. According to this perspective, in the restaurant in-
dustry, the distinction between pwds and customers
without disabilities should be considered a common
demographic characteristic, similar to how gender,
age, education level, and nationality are addressed in
accessibility. Finally, with this paper, we hope to fur-
ther contribute to the development of research in this
tourism sector and improve the accessibility of restau-
rant facilities.
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Academica Turistica, Year 16, No. 3, December 2023 | 275

Research Note
Understanding a Conceptual Framework of Spa
Service Quality: An Overview Approach
Aswin Sangpikul
Dhurakij Pundit University, Thailand
slu3522@yahoo.com
Due to the inadequate literature for fully understanding service quality in the spa
industry, this article has the objective to review the related literature to obtain a
conceptual understanding of a spa service quality framework. The method is based
on a systematic review of related literature by analysing service models/dimensions
from past studies and integrating them to obtain a comprehensive framework of spa
service quality. Based on the proposed framework, the four themes (dimensions)
of spa service quality are identified: (1) spa programmes and products, (2) physi-
cal environment, (3) customer-employee interaction, and (4) service outcome. The
overview suggests that using a single service model is insufficient to fully under-
stand the spa service quality framework because of its distinct characteristics. The
findings can help researchers and spa practitioners to thoroughly understand the
overall framework of spa service quality. In particular, the combination of physical
environment (technology-based equipment) and better customer-employee interac-
tion can contribute to service innovation for the spa industry. The overview helps
to extend the theoretical knowledge (framework) of the traditional servqual and
three-dimensionalmodels (physical, interaction and outcome quality) by adding the
product dimension as an additional component of the spa service quality framework.
Keywords: spa service quality, spa industry, spa services, wellness tourism
https://doi.org/10.26493/2335-4194.16.277-289
Introduction
The spa industry has been gaining in popularityworld-
wide over the past decades due to the increasing health-
awareness of people who seek a better quality of life,
the expansion of spa businesses, the growth of well-
ness tourism, and reasonable prices of services (Han
et al., 2017; Sangpikul, 2022a). Generally, spas offer
water-based facilities and a wide range of services for
health, relaxation and skin beauty (Hashemi et al.,
2015). As spas are related to people’s health and well-
being, many countries are promoting spas as one of
the wellness tourism sectors to respond to the global
trend as well as to attract more international tourists
to increase tourism revenue (Han et al., 2017; Sang-
pikul, 2022a). Many tourists may spend their free time
at destinations to visit spa establishments to experi-
ence spa services in a relaxing environment (Hashemi
et al., 2015; Tsai et al., 2012).
Being one of the service-oriented businesses, the
spa industry is heavily focused on employee perfor-
mance to provide customers with personalised ser-
vices and spa experiences (Lo et al., 2015; Tsai et al.,
2012). Customers generally perceive the quality of spa
services through employees’ abilities to provide the
services that meet their expectations (Lo et al., 2015;
Sangpikul, 2019). To deliver the services as customers
expect, this mainly concerns ‘service quality,’ which
is customers’ comparison of service expectations and
performances (Parasuraman et al., 1985). A company
providing a high level of service quality is likely to de-
Academica Turistica, Year 16, No. 3, December 2023 | 277
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
liver the services that meet customer needs and create
service satisfaction (Gonzalez & Brea, 2005; Lo et al.,
2015).
Given the importance of service quality to the suc-
cess of spa businesses, there is still inadequate litera-
ture to fully understand it within the spa industry, as
evidenced by the following arguments. First, many spa
studies have examined customer satisfaction and spa
service quality through the servqual model with
its five well-known dimensions, namely, reliability, re-
sponsiveness, assurance, empathy, and tangibles (e.g.
Bakirtzoglou et al., 2018; Lo et al., 2015; Loke et al.,
2018; Vryoni et al., 2017). However, servqual has
been criticised for some weaknesses which prevent it
from being fully applicable to a specific service sec-
tor as it seems to focus on service process rather than
the overall service quality assessment (Ali, 2015; Wu &
Ko, 2013). Several scholars argue that servqual is a
generic service quality instrument rather than a spe-
cific one for each business category due to its original
development within the finance and banking industry
(Kurtulmusoglu & Pakdil, 2017; Lo et al., 2015). Con-
sequently, the adoption of servqual to measure spa
service quality may be insufficient to thoroughly un-
derstand various distinct attributes of spa services due
to different settings (Choi et al., 2015; Lagrosen & La-
grosen, 2016). Thismay reflect someweaknesses in the
existing literature regarding spa service quality.
Second, given the weaknesses of servqual, there
have been several studies attempting to adopt several
models or approaches to measure spa service quality
in different contexts (e.g. Choi et al., 2015; Clemes et
al., 2020; Tsai et al., 2012). However, these past stud-
ies seem to provide an incomplete understanding of
overall spa service quality due to the lack of certain
important service dimensions. For example, in stud-
ies of Choi et al. (2015) and Tsai et al. (2012), respon-
siveness and employee courtesy were omitted, while
assurance and empathy were not included in Clemes
et al.’s (2020) study. Likewise, responsiveness and ser-
vice outcomes were omitted in Albayrak, Caber, and
Oz’s (2017) study. It is understandable that each study
may have its own purpose, scope, and research design
to examine spa service quality in different settingswith
well explained results. However, in terms of literature
overview and knowledge advancement, thismay affect
or limit spa practitioners’ opportunities to fully under-
stand their customers’ expectations and perceptions of
overall spa service quality. This may require further
study to fully understand the overall framework of spa
service quality.
Third, during the past decades, there have been
a number of spa-related studies providing different
views or methods regarding spa service quality based
on international perspectives (e.g. Albayrak et al.,
2017; Bakirtzoglou et al., 2018; Chieochankitkan &
Sukpatch, 2014; Choi et al., 2015; Clemes et al., 2020;
Gonzalez&Brea, 2005; Lagrosen&Lagrosen, 2016; Lo
et al., 2015; Loke et al., 2018; Sangpikul, 2019; Snoj &
Mumel, 2002; Tsai et al., 2012; Vryoni et al., 2017). An
overview of these studies may provide useful insights
or implications to better understand spa service qual-
ity within various contexts. Past studies conducting
systematic reviews in tourism and hospitality provide
useful implications for the tourism and hospitality lit-
erature such as the syntheses of knowledge, research
framework development, critical discussions, future
research directions, and the useful practical implica-
tions for hospitality and tourism businesses (Hardy
et al., 2002; Pahlevan-Sharifa et al., 2019; Shiwen et
al., 2022). In the same way, an overview of spa service
quality will provide such contributions.
In terms of spa practitioners, service quality is an
important instrument for them to better understand
how well a delivered service meets customer expecta-
tions (Parasuraman et al., 1988). A thorough under-
standing of service quality can assist spa practition-
ers in delivering better services to meet customer ex-
pectations, thereby contributing to customer satisfac-
tion, word-of-mouth communication, and repeat vis-
its (Lo et al., 2015; Sangpikul, 2022c). However, based
on the gaps in the literature as earliermentioned, there
is still a lack of integrated knowledge to assist spaman-
agers to thoroughly understand customers’ needs and
expectations for overall spa quality. In particular, re-
search discloses that spa customers generally have dif-
ferent health-related needs/concerns, various service
motivations and diverse service preferences (Tsai et al.,
2012; Sangpikul, 2022c). This suggests that spa man-
agers are required to have a well-rounded knowledge
278 | Academica Turistica, Year 16, No. 3, December 2023
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
about overall elements of spa service quality to bet-
ter deliver the services that meet a wide range of cus-
tomers’ needs, preferences and expectations in order
to maximise customer satisfaction.
In order to fill the gaps in the literature and en-
hance a thorough understanding of overall spa ser-
vice quality, this research note has the objective to
analyse and overview the related literature regarding
spa service quality within various contexts to provide
knowledge advancement and appropriate implemen-
tations in the spa industry. The overview approachwill
yield a greater picture and in-depth understanding of
the overall spa service quality framework, helping to
strengthen knowledge development in the field. In ad-
dition, the study will also assist spa managers to fully
understand what customers may expect from spa ser-
vices, and further develop the services to meet their
needs and expectations, thereby enhancing customer
satisfaction and repeat patronage (Sangpikul, 2019).
Literature Review
Service Quality
In the service literature, an early measurement of ser-
vice quality was proposed by Gronroos (1984), who
conceptualised service quality as a two-dimensional
construct: technical and functional quality. Techni-
cal quality refers to service outcome, or what cus-
tomers actually receive from the service, while func-
tional quality refers to the process of service delivery.
Expanding Gronroos’s model, the concept of service
quality based on customer expectations and percep-
tions was developed by Parasuraman et al. (1985), who
originally identified ten service dimensions, and later
reduced the overlapping dimensions to five dimen-
sions: reliability, assurance, responsiveness, empathy,
and tangibles. These five dimensions have been widely
known as servqual.
In addition to servqual, Brady andCronin (2001)
identified three structural dimensions of service qual-
ity: physical, interaction and outcome quality. Each
has its sub-dimension that defines the basis of service
quality perceptions. They argued that the combination
of all three dimensions (and sub-dimensions) consti-
tuted a customer’s overall perception of the quality of
service. Given the existing servicemodels, servqual
seems to have gained wide adoption in various service
sectors, including the hospitality and tourism indus-
try, due to its generic quality assessment tool with the
five different dimensions (Snoj & Mumel, 2002; Lo et
al., 2015; Sangpikul, 2019). However, it has often been
criticised for its weaknesses in several aspects, partic-
ularly the lack of specific coverage for service quality
assessment in a particular business category (Ali, 2015;
Kurtulmusoglu & Pakdil, 2017), including the spa in-
dustry. To fully understand the literature of spa service
quality, past studies are reviewed in the next section.
Studies of Spa Service Quality
This section aims to review and analyse the existing
models of spa service quality based on various set-
tings. Given a number of related studies, they may be
classified into two groups, as shown in Table 1. The
first group is the studies employing servqual (i.e.
Bakirtzoglou et al., 2018; Gonzalez & Brea, 2005; Lo et
al., 2015; Loke et al., 2018; Vryoni et al., 2017). Despite
the usefulness of servqual, scholars have criticised
certain weaknesses of it, as mentioned earlier. This ar-
gument is also true in the spa industry. For example,
certain attributes of spa service quality were not in-
cluded in past studies, such as product attribute (e.g.
Bakirtzoglou et al., 2018; Sangpikul, 2019; Vryoni et
al., 2017) and service outcome (e.g. Gonzalez & Brea,
2005; Lo et al. 2015; Loke et al., 2018). Product element
can be regarded as one of the important attributes in
spa service quality as customers can perceive it and be
exposed to different spa programme experiences (La-
grosen & Lagrosen, 2016; Tsai et al., 2012). Likewise,
service outcome is another important attribute of spa
service quality because it is what customers actually
expect to receive after the treatments (Choi et al., 2015;
Clemes et al., 2020).
Another set of studies (second group) employed
modified dimensions (different service models) to ex-
amine spa service quality (e.g. Albayrak et al., 2017;
Clemes et al., 2020; Choi et al., 2015; Lagrosen & La-
grosen, 2016; Tsai et al., 2012). Tsai et al. (2012), for
example, used five service dimensions to understand
male consumers’ perceived performance of Hong
Kong Hotel spas, namely: environment, service ex-
perience, augmented service quality, value, and relia-
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Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
Table 1 Literature Analysis and Overview of Research Gaps
Studies Authors Dimensions Country
of studies
Overview of
research gaps
Studies
employing
servqual
Bakirtzoglou et al.
(); Lo et al. ();
Loke et al. (); Snoj
& Mumel (); Sang-
pikul (); Vryoni
et al. ()
servqual dimensions: Reliability, assur-
ance, responsiveness, empathy, tangibles
China, Greece,
Slovenia, and
Thailand
All studies lack
certain attributes
of spa service
quality (e.g.
product and out-
come attributes).
Studies
employing
modified
models
Albayrak et al. ();
Choi et al. ();
Clemes et al. ();
Lagrosen and La-
grosen (); Tsai
et al. ()
Tangibility, competence & courtesy, credibil-
ity & safety.
Spa facility, spa programme, staff, uniqueness.
Interpersonal quality, environmental quality,
administrative quality, technical quality.
Process dimension, outcome dimension,
specific quality dimension.
Environment, service experience, augmented
services, value, reliability.
Turkey, Korea,
Thailand, Swe-
den, and China
(Hong Kong)
Most studies lack
certain impor-
tant attributes
(e.g. responsive-
ness, empathy, or
assurance).
bility. Choi et al. (2015) employed four quality dimen-
sions (spa facility, spa programmes, staff, and unique-
ness) to examine the relationships between spa ser-
vice quality, perceived value, satisfactions, and be-
havioural intentions. Assessing what attributes of spa
and wellness service quality affect customer satisfac-
tion in Antalya’s hotels (Turkey), Albayrak et al. (2017)
used tangibles, credibility and safety, and competence
and courtesy dimensions to understand the factors af-
fecting overall customer satisfaction.
For the second group, although there are various
service models being employed to examine spa ser-
vice quality, these studies still lack certain essential
components or dimensions, as earlier mentioned. For
instance, responsiveness and employee courtesy were
omitted in studies of Choi et al. (2015) and Tsai et
al. (2012), while assurance and empathy were not in-
cluded in Clemes et al.’s (2020) study, and responsive-
ness as well as service outcome were omitted in Al-
bayrak et al.’s (2017) study.
Following the above analysis, it is understandable
that researchersmay have different research objectives
and frameworks to examine spa service quality from
different perspectives. However, in terms of an aca-
demic overview, the existing literature seems to be in-
adequate andmay limit the capacity of researchers and
spa practitioners to fully understand spa service qual-
ity. Importantly, spa practitioners may lack the oppor-
tunities to deliver the better services to meet or satisfy
customer needs due to the incomplete service assess-
ment. Given the gaps in the literature, it is important
for scholars to seek for a better approach to fill them,
and to strengthen knowledge development in the field.
Method
In order to review the related literature regarding spa
service quality, Google Scholar was employed as a
main source of information. A number of studies used
Google Scholar for review studies (e.g. Chan & Hsu,
2016; Law et al., 2009). Google Scholar is the world’s
leading search engine, which indexes scholarly articles
from different databases (Law et al., 2009). A prelimi-
nary survey found that a number of spa-related stud-
ies were indexed in various databases, not limited to
only Scopus or a particular database. Google Scholar,
therefore, seems to be an appropriate source of infor-
mation as it has combined a lot of scholarly articles
from various databases.
In this study, a systematic review approach from
past studies was adopted and modified to provide re-
liable data collection and analysis, for example, set-
ting selection criteria, article search, screening data,
280 | Academica Turistica, Year 16, No. 3, December 2023
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
article eligibility, information record, and the analy-
sis/synthesis of the findings/reviews (Gomezelj, 2016;
Pahlevan-Sharifa et al., 2019).
This approach was adopted and modified as fol-
lows:
• Key words used to search for the data were deter-
mined, for example, ‘spa service quality,’ ‘spa ser-
vice,’ ‘day spa and service quality,’ ‘hotel spa and
service quality.’
• To search for the target articles, only English full-
text articles (from the year 2000 onwards) were
included in the analysis. A preliminary survey in-
dicated that studies related to spa services quality
have been documented from the year 2000 on-
wards. In particular, it may be noted that during
the years 2010–2020, studies in regard to spa ser-
vice quality received much attention from inter-
national scholars.
• The screening was conducted to search for the
studies related to spa service quality. An initial
survey found around 42 related studies; however,
the researcher had determined article eligibility
to choose only the relevant studies for final anal-
ysis.
• To determine article eligibility, a qualified article
had to contain the details of spa service quality,
including (1) service models (e.g. servqual or
other modified models), (2) service dimensions
(e.g. reliability, assurance, responsiveness), and
(3) measurement items being used. These criteria
help to fully understand spa service quality and
to further develop an appropriate overall frame-
work.
• Given such eligibility, a total of 25 studies were in-
cluded in the final analysis. Key information of an
article was recorded accordingly (e.g. title, jour-
nal name, year of publication, methods, models
of service quality, service dimensions, measure-
ment items, and key findings).
• During data analysis, an individual study was
reviewed, and later it was combined with other
studies to form ideas/concepts regarding spa ser-
vice quality, and finally, all studies were inte-
grated and synthesised to develop a framework.
In addition to a systematic review approach, con-
tent analysis was employed to supplement data analy-
sis (e.g. reviewing past studies) and to group the find-
ings, as it is appropriate for a systematic coding and
categorising method used for analysing textual infor-
mation (Stemler, 2001). It was used to analyse and
group the data regarding spa service quality (including
service dimensions and items) frompast studies. Later,
similar concepts of spa service quality were grouped
into each construct and, finally, they were integrated
to form a framework of overall spa service quality. In
this study, a proposed frameworkwas reviewed by two
scholars and two spa managers to determine its ap-
propriateness and implementations. Some corrections
were made in regard to grouping of service items and
clarity of wording. Data were collected during June
2022.
Findings and Discussion
Identifying Themes and Framework
of Spa Service Quality
To present the findings, the studies related to spa ser-
vice quality have been reviewed, analysed and inte-
grated to obtain the comprehensive understanding of
the spa service quality framework as shown in Ta-
ble 2. Consequently, the four themes (dimensions)
of spa service quality are identified, namely, (1) spa
programmes and products, (2) tangibles and physi-
cal environment, (3) customer-employee interaction,
and (4) service outcome. Each theme is presented and
discussed as follows:
Dimension 1: Spa Programmes and Products
Spa programmes and products are established as the
first theme of the spa service quality framework. This
theme may be called ‘product dimension’ because it is
a starting point, or the first stage at which customers
expect to receive spa experiences. In an international
context, there are a variety of spa service providers
such as day spas, club spas, mineral spring spas, and
resort and hotel spas. These spa service providers may
offer different or a variety of spa programmes and
products to correspond to customer needs and prefer-
ences. According to Table 2, several past studies em-
ploy some product attributes in their studies to exam-
Academica Turistica, Year 16, No. 3, December 2023 | 281
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
Table 2 Identifying Themes and Framework of Spa Service Quality
Categories Literature Themes and framework
Dimension 
Product & service
attributes
Dimension 1
• Choices/varieties of spa programs (Choi et al., 2015; Clemes et
al., 2020).
• Quality of spa products (in-house and retail) (Choi et al., 2015;
Tsai et al., 2012).
• Availability of spa retail products (Sangpikul, 2019; Tsai et al.,
2012).
• Availability of augmented/complimentary services (Sangpikul,
2019; Tsai et al., 2012).
• Food & beverage services (Bakirtzoglou et al., 2018; Vryoni et
al., 2017).
• Product specialty/uniqueness (Choi et al., 2015).
Dimension 1
• Spa programs & products
• Choices/varieties of spa pro-
grams and facilities
• Quality of in-house and retail
products
• Availability of retail products
• Augmented or complimentary
services (including food & bev-
erage services)
• Product specialty
Dimension 
. Tangibles
. Physical
assurance
Dimension 2
• Decoration, atmosphere, and environment (Bakirtzoglou et al.,
2018; Clemes et al., 2020; Lo et al., 2015; Tsai et al., 2012; Vryoni
et al., 2017)
• Availability of facilities/equipment (Albayrak et al., 2017;
Bakirtzoglou et al., 2018; Lo et al., 2015)
• Employee appearance (Snoj & Mumel, 2002)
• Quality & maintenance of facilities/equipment (Bakirtzoglou et
al., 2018; Clemes et al., 2020; Lo et al., 2015; Tsai et al., 2012)
• Cleanliness & hygiene (venue, facilities) (Lo et al., 2015; Loke et
al., 2018)
• Customer security & safety (Albayrak et al., 2017; Sangpikul,
2019)
• Customer privacy (Lo et al., 2015; Sangpikul, 2019)
Dimension 2
• Tangibles & physical environ-
ment
• Decoration, atmosphere, and
environment
• Appearance of facili-
ties/equipment
• Employee appearance
• Quality & maintenance of facili-
ties/equipment
• Hygiene & cleanliness (physical
assurance)
• Customer security & safety
• Customer privacy
Continued on the next page
ine customer perceptions of spa service quality, for ex-
ample, product variety (Choi et al., 2015; Clemes et al.,
2020), quality of spa products (Choi et al., 2015; Tsai et
al., 2012), availability of spa retail products (Sangpikul,
2019; Tsai et al., 2012), augmented or complimentary
services (Sangpikul, 2019; Tsai et al., 2012), and prod-
uct specialty (Choi et al., 2015). However, the in-depth
analysis indicates that most studies merely measure
spa product attributes based on a few items, not the
dimension or construct. Measuring only a few items
may not reveal the complete picture in regard to spa
product attributes. Based on the existing literature,
there are several product attribute items associated
with this theme. These items are argued to be appro-
priate and sufficient to be established as the product
dimension with its relevant items. This suggests that
product dimension is important, and it should be in-
corporated as one of the spa service quality framework
themes. Future research may employ the items in the
product dimension to further understand customer
perceptions of spa programmes and products in or-
der to deliver the services that meet their needs and
expectations.
In addition, research indicates that a variety of spa
services available to customers can enhance their en-
joyment and satisfaction (Lagrosen&Lagrosen, 2016).
A thorough understanding of the product dimen-
sion may help spa practitioners to better understand
how customers perceive and evaluate their product at-
tributes. Researchers may employ the product dimen-
sion as a part of the spa service quality framework
to examine its relationships with other key variables
282 | Academica Turistica, Year 16, No. 3, December 2023
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
Table 2 Continued from the previous page
Categories Literature Themes and framework
Dimension 
. Reliability
. Empathy
. Responsiveness
. Assurance
. Courtesy &
friendliness
. Communication
Dimension 3
• Reliability (Albayrak et al., 2017; Clemes et
al., 2020; Lo et al., 2015)
• Empathy (Lo et al., 2015; Vryoni et al., 2017)
• Responsiveness (Clemes et al., 2020; Lo et
al., 2015; Vryoni et al., 2017)
• Customer service assurance
(Chieochankitkan & Sukpatch, 2014; Sang-
pikul, 2019)
• Courtesy & friendliness (Albayrak et al.,
2017; Clemes et al., 2020)
• Communication (Clemes et al., 2020; Sang-
pikul, 2019)
Dimension 3
• Customer & employee interaction
• Reliability (e.g. knowledge, expertise, perfor-
mance of promised services, services without
mistake)
• Empathy (e.g. caring services, personalized ser-
vices, understanding customers)
• Responsiveness (e.g. willingness to help cus-
tomers, provision of prompt services)
• Assurance (e.g. customer confidence/trust in
customer services)
• Courtesy & friendliness
• Communication
Dimension 
Outcome
Dimension 4
• Physical effect (Lagrosen & Lagrosen, 2016)
• Mental effect (Lagrosen & Lagrosen, 2016)
Dimension 4
• Service outcome
• Physical outcome
• Mental outcome
such as perceived value, satisfaction, and behavioural
intention.
Dimension 2: Tangibles and Physical Environment
Tangibles and physical environment are identified as
the second theme of the spa service quality frame-
work. Based on the literature, this dimension involves
two sub-themes: (1) tangibles, and (2) physical assur-
ance. Tangibles here refer to the servqual context.
According to Parasuraman et al. (1988), tangibles in-
volve the physical surroundings, facilities, and ameni-
ties provided in service venues. In the spa setting,
when customers are in spa venues, they will be ex-
posed to various aspects of spa tangibles/environment
(e.g. beautiful decoration, spa equipment, and treat-
ment rooms). Following Table 2, there are a number
of studies which include tangibles as a part of spa ser-
vice quality. They examined customer perceptions in
regard to, for example, spa decoration, atmosphere,
and environment (Bakirtzoglou et al., 2018; Clemes at
al., 2020; Lo et al., 2015), availability of facilities and
equipment (Albayrak et al., 2017; Bakirtzoglou et al.,
2018; Lo et al., 2015), and employee appearance (Snoj
& Mumel, 2002). Importantly, tangibles are argued to
be an important element of spa service quality as they
have an impact on customer satisfaction and emotions
in hotel spas (Lo et al., 2015; Sangpikul, 2022a). More
research may be needed to further examine the influ-
ences of tangibles on customer perceptions and satis-
faction in other spa categories to extend the literature.
In addition, physical assurance is also identified
and included in this dimension because it is associ-
ated with the physical environment, which can inspire
customer trust and confidence when using spa ser-
vices, based on Parasuraman et al. (1988). Physical as-
surances identified from the literature are, for exam-
ple, quality and maintenance of facilities/equipment
(Bakirtzoglou et al., 2018; Clemes et al., 2020), clean-
liness and hygiene (Lo et al., 2015; Loke et al., 2018),
customer security and safety (Albayrak et al., 2017;
Sangpikul, 2019), and customer privacy (Lo et al.,
2015; Sangpikul, 2019). According to the literature,
they are the service attributes that can enhance cus-
tomer confidence during service delivery. Past stud-
ies reveal that certain attributes of physical assurance
may have impacts on customer satisfaction and re-
peat consumption. For example, customers experi-
encing unclean spa venues, poor hygiene standards
or lack of service privacy may have negative expe-
riences of spa establishments and may not return to
Academica Turistica, Year 16, No. 3, December 2023 | 283
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
patronise them (Sangpikul, 2019). However, there are
still limited studies that specifically examine the role
of physical assurance in customer satisfaction, emo-
tions and loyalty in the spa industry. Understanding
these relationships may contribute to better service
improvement. Furthermore, a recent study (a qual-
itative method) indicates that perceived hygiene re-
lated to physical assurance (e.g. cleanliness and hy-
giene of spa venues, facilities, equipment) becomes an
important factor associated with customer satisfac-
tion and decision making in using spa services during
the covid-19 situation (Sangpikul, 2022b). Quantita-
tive approaches may be appropriate to further exam-
ine these relationships to better understand the role of
perceived hygiene in the spa industry.
Dimension 3: Customer-Employee Interaction
Customer-employee interaction is established as a
third element of the spa service quality framework.
This theme is important as it has been integrated based
on various servqual attributes (e.g. reliability, em-
pathy, responsiveness, assurance, courtesy and friend-
liness, and communication). These attributes are sim-
ilar to most of the 10 original dimensions as identified
by Parasuraman et al. (1985). This suggests that the
key elements of spa service quality are closely related
to servqual dimensions. This theme is thus called
customer-employee interaction because all service at-
tributes are mainly related to the interaction between
employees and customers. For example, when deliv-
ering spa services, customers expect to meet courte-
ous and friendly spa employees who provide them
with prompt services. They also expect professional
spa services from skilful therapists who provide them
with personalized services that meet customer ex-
pectations. During the delivery of services, employ-
ees and customers communicate with each other until
the completion of the services. All of these attributes
are inseparable characteristics of the hospitality indus-
try, including the spa industry, because employees and
customers cannot be separated during the delivery of
services (Sangpikul, 2022a). Consequently, all service
attributes under this theme play important roles dur-
ing service delivery because they involve interaction
between spa employees and customers. With a num-
ber of related studies in regard to customer-employee
interaction in the spa industry (e.g. Albayrak et al.,
2017; Bakirtzoglou et al., 2018; Clemes et al., 2020;
Gonzalez & Brea, 2005; Lo et al., 2015; Sangpikul, 2019;
Vryoni et al., 2017), the review of literature indicates
that knowledge about customer-employee interaction
in the spa industry is well documented.
However, there is still research room for this di-
mension, for example, spa service experiences and the
experience-based economy. As addressed, the spa in-
dustry is related to the experience-based economy be-
cause customers go to spas to experience the services
related to their health benefits. During the customer-
employee interaction, the delivery of spa services may
lead to the experience-based economy in terms of cus-
tomers’ service enjoyment, customers’ personal fulfil-
ment, and customer memory. Thus, there is still room
to explore further in this area, for example, the factors
of spa services contributing to customers’ service en-
joyment.
Dimension 4: Service Outcome
Service outcome is identified as the last theme. Ser-
vice outcome generally refers to what customers re-
ceive after their service consumption (Brady& Joseph,
2001; Gronroos, 1984). In the spa setting, this dimen-
sion relates to the outcome of spa services or what cus-
tomers feel after the completion of spa services, for ex-
ample, relaxation, stress-related relief or skin beauty.
Past studies indicate that customers go to spas for spe-
cific purposes, and expect to experience a spa service
outcome, either physical outcome (effect) or mental
outcome (effect) (Lagrosen & Lagrosen, 2016). They
may not go to spas if they do not receive the expected
service outcome. Service outcome, therefore, is an es-
sential part of spa service quality for a company to un-
derstand customer judgments about the overall spa ex-
periences and satisfaction. Service outcome as identi-
fied in the current study may have a similar concept
to functional quality as defined by Gronroos (1984).
According to Gronroos, functional quality is related
to what customers receive after the services, which is
usually perceived or interpreted in a subjective way. In
this regard, functional quality may support the nature
or characteristic of spa service outcome as customers
284 | Academica Turistica, Year 16, No. 3, December 2023
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
may interpret it differently and subjectively regarding
mental outcome (e.g. relaxation, stress relief) and/or
physical outcome (e.g. skin beauty).
Moreover, the review of literature indicates that
there is very limited knowledge about spa service out-
come in the international context. Among a few stud-
ies, Tsai et al. (2012), for example, employ only one
item of spa service outcome (relaxation) in their study
to measure customer perceptions of spa services in
Hong Kong’s hotels, whereas Clemes et al. (2020) em-
ploy a modified model with technical and functional
quality constructs (with the outcome dimension) in
their framework. However, their methods and find-
ings seem to provide very limited information to fully
understand spa service outcome due to the lack of at-
tribute items and its measurement.
In addition, the review of literature indicates that
service outcome, as defined by Gronroos (1984) and
Brady and Joseph (2001), has not been thoroughly ex-
amined in the spa industry due to the inadequate liter-
ature about it. This suggests that a complete picture in
regard to service outcome in the spa industry has not
yet been obtained.
Importantly, service outcome may be regarded as
a distinct variable as it can be employed either as an
independent or dependent variable in the quantita-
tive studies (like satisfaction variable). Past studies re-
veal that service outcome (as an independent variable)
can impact customer satisfaction and loyalty in cer-
tain service industries. For example, Hsieh and Hi-
ang (2004) find a positive effect of service outcome
on customer satisfaction across two types of service
businesses (i.e. banks and hospitals), while Choi and
Kim (2013) indicate similar findings in hospital ser-
vices. In addition, Murti, Deshpande, and Srivastava
(2013) find that other independent variables can affect
service outcome (as a dependent variable) in health-
care services. Based on the related literature, this sug-
gests that service outcome plays an important role in
health-related industries, and requires further studies
to specifically examine it in the spa industry to extend
the literature.
Table 3 has summarised and compared the current
findings with past literature to obtain a better under-
standing of overall spa service quality. The overview
approach helps to extend a better understanding of
spa service quality models as adopted from Parasur-
aman et al. (1988) (servqual) and from Brady and
Cronin (2001) (three-dimensional model) by adding
a product dimension (spa programmes and prod-
ucts) as a part of the spa service quality framework.
According to Table 3, following Parasuraman et al.
(1988), all service dimensions of servqual are asso-
ciatedwith 2 constructs (elements): (1) service process,
and (2) tangibles, but no product dimension. In con-
trast, Brady and Cronin (2001) have proposed a three-
dimensional model with 3 constructs: (1) interaction
quality element, (2) physical environment quality, and
(3) outcome quality, but no product dimension as well.
However, the current study has surveyed the existing
literature (including the two models), and has inte-
grated them into 4 constructs: (1) employee-customer
interaction, (2) tangibles and physical environment,
(3) service outcome, and (4) spa programmes and
products. In particular, spa programmes and products
have been additionally identified as a part of overall
spa service quality, given its relevance as earlier dis-
cussed. The four constructs being identified are ex-
pected to help spa practitioners to fully understand
customers’ expectations and perceptions of overall spa
service quality, and tomake appropriate service assess-
ment.
Conclusion and Implications
Conclusion
The overview of related literature has provided the
conceptual understanding of the spa service qual-
ity framework as shown in Table 3. All four dimen-
sions and their sub-dimensions are well supported by
the existing literature and were reviewed by schol-
ars and spa experts. Based on the analysis of litera-
ture, it seems that most international researchers are
likely to employ dimension 2 (physical environment)
and dimension 3 (customer-employee interaction) in
their studies (e.g. Bakirtzoglou et al., 2018; Lo et al.,
2015; Loke et al., 2018) to examine spa service quality
(see Table 1) because these dimensions are related to
servqual, the well-known service model in the hos-
pitality and tourism industry. However, servqual
has some weaknesses, as earlier discussed (focusing
Academica Turistica, Year 16, No. 3, December 2023 | 285
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
Table 3 Comparison of Major Service Models and Spa Service Quality Framework
servqual
Parasuraman et al. ()
Three-dimensional model
Brady and Cronin ()
Spa service quality framework
(current study: an overview approach)
Service process (i.e. reliability, empathy,
responsiveness, assurance)
Interaction quality (i.e. reliability, em-
pathy, responsiveness, assurance)
Employee-customer interaction (i.e.
reliability, empathy, responsiveness,
assurance)
Tangibles (i.e. tangibles) Physical environment quality (i.e. tan-
gibles)
Tangibles & physical environment (i.e.
tangibles, physical assurance)
– Outcome quality (i.e. service outcome) Service outcome (i.e. mental & physical
outcome)
– – Spa programmes & products (i.e. spa
treatments, product specialty)
on service process).Meanwhile, there are several stud-
ies employing other modified models, including the
three-dimensional model, which still lack certain ser-
vice dimensions (i.e. product and outcome dimen-
sions).
Theoretical Implications
First, due to the scarcity of research to fully under-
stand service quality in the spa industry, this article
has provided a conceptual understanding of the ser-
vice quality framework for the spa industry. Based on
the overview of related literature, the four themes (di-
mensions) of the spa service quality framework are
identified: (1) spa programmes, (2) physical environ-
ment, (3) customer-employee interaction, and (4) ser-
vice outcome. This conceptual framework helps to ex-
tend the theoretical knowledge and understanding of
the traditional three-dimensionalmodel (physical, in-
teraction and outcome quality) defined by Brady and
Cronin (2001) by proposing the product dimension
(spa programmes) as the additional component of the
spa service quality framework based on the current
literature. According to Brady and Cronin, customers
perceive the quality of services through three struc-
tural dimensions: physical, interaction and outcome
quality. However, their model lacks the product di-
mension due to the examination of different service
industries, not the wellness industry (health-related
services). Consequently, this article has extended the
service literature in regard to the product dimension,
specifically for the spa industry. Future quantitative
studies are suggested to verify this conceptual frame-
work.
Second, the findings from Table 2 may provide a
better approach to thoroughly understand the spa ser-
vice quality framework when compared to the serv-
qual model, which mainly focuses on customer-
employee interaction or service process but lacks prod-
uct and outcome dimensions as earlier discussed. In
this regard, the current findings help to explain why
servqual is not fully applicable to measure service
quality in the spa industry due to the lack of certain
service dimensions.
Third, regarding the product dimension (spa pro-
grammes), past studies merely measure them based
on individual items, not a dimension or a construct,
as addressed. However, this article has overviewed a
number of product attribute items from the existing
literature and has combined them in order to propose
the product dimension (spa programmes and prod-
ucts). Adding the product dimension in the spa service
quality framework may provide interesting or differ-
ent findings from what has been documented in the
literature due to the distinct characteristics of the spa
industry.
Fourth, in regard to service outcome, this dimen-
sion helps to better understand the term ‘service out-
come’ in the spa industry because there is limited lit-
erature to fully understand it. According to Gronroos
(1984) and Brady and Cronin (2001), service outcome
(technical quality/outcome quality) is generally de-
fined as what customers expect to receive after the
286 | Academica Turistica, Year 16, No. 3, December 2023
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
completion of the services. In this regard, the current
overview has further explained the characteristics of
service outcome in the spa industry in terms of men-
tal and physical outcome. In other words, what spa
customers expect to receive after the spa treatments
is mental and/or physical outcome (benefit). Research
indicates that service outcome is an important factor
associated with customer satisfaction (Lagrosen & La-
grosen, 2016; Sangpikul, 2022a). Thus, it is appropriate
to establish service outcome as an essential part of spa
service quality, thereby rounding out the limited lit-
erature about service outcome in the spa industry. In
addition, the service outcome dimension may help to
generate new findings in the quantitative studies as it
may be added or modified as an independent or a de-
pendent variable in the quantitative methods due to
its special features (such as satisfaction). Past studies
indicate that service outcome (independent variable)
can impact customer satisfaction and loyalty in certain
service industries, for example, banks and hospitals
(Choi & Kim, 2013; Hsieh & Hiang, 2004), whereas
Murti et al. (2013) find that other independent vari-
ables can affect service outcome (dependent variable)
in healthcare services. However, there is a lack of such
studies to further examine the impacts of service out-
come in the spa context. This is an important clue for
future studies to add or modify service outcome as the
dependent or independent variable (when appropri-
ate) in the quantitative studies to yield new findings
and extend the spa literature.
Finally, all elements of the proposed framework
may provide implications for future studies in re-
gard to service quality experience and the experience-
based economy in the spa industry. The spa indus-
try is argued to be one of the major experience-based
economy sectors in the tourism industry (Lo et al.
2015; Sangpikul, 2022b) because it sells ‘experiences’
in terms of a variety of spa programmes (1st element)
in a beautiful and relaxing environment (2nd element)
through professional customer services (3rd element)
in order to provide customers with the expected ser-
vice outcome (4th element). This suggests that all el-
ements of the proposed framework contribute to the
experience-based economy, and require further inves-
tigation about their relationships.
Managerial Implications
There are severalmanagerial implications for spa prac-
titioners to implement the proposed framework (di-
mensions and measurement items) to be applicable to
various spa categories and business strategies to better
understand their customer perceptions and expecta-
tions of overall spa services. The following recommen-
dations/implications aremade on each service dimen-
sion and are based on past literature in regard to the
implementation of spa service quality.
For product dimension, the product attributes be-
ing identified may help spa managers to fully un-
derstand how customers perceive/evaluate their ser-
vices/products as well as to obtain more information
from customer perspectives (Choi et al., 2015; Clemes
et al., 2020). The information obtained from the prod-
uct dimension may contribute to service development
as well as to develop a company’s marketing strategies
or competition purposes such as product specialty,
product positioning or product differentiation (Choi
et al., 2015; Ekinci, 2002).
In regard to the physical dimension, past research
indicates that the characteristics of the physical envi-
ronment of spa venues play an important role in en-
hancing customer experiences and satisfaction (Lo et
al., 2015; Tsai et al., 2012; Vryoni et al., 2017). Lo et al.
(2015), for example, reveal that the spa environment
has a positive impact on customer emotions. Similarly,
Tsai et al. (2012) indicate that the physical environment
contributes to the attractiveness of the spa venue and
customer satisfaction. Given the tangibles and physi-
cal environment dimension, spa managers may better
understandwhat customers expect concerning this di-
mension, and also learn what attributes should be as-
sessed to better satisfy customers, for example, spa at-
mosphere, venue decoration, quality of facilities, and
customer privacy (Bakirtzoglou et al., 2018; Clemes et
al., 2020; Lo et al., 2015).
For customer-employee interaction, this is themost
important element of spa service quality, as indicated
from past studies, because servqual belongs to this
dimension. Research shows that almost all servqual
dimensions, being examined in various settings, had
significant influence on customer satisfactions, emo-
tions and loyalty (Clemes et al., 2020; Lo et al., 2015).
Academica Turistica, Year 16, No. 3, December 2023 | 287
Aswin Sangpikul Understanding a Conceptual Framework of Spa Service Quality
Spa managers can obtain useful information by using
the items in the framework to better understand how
well their employees deliver the expected services. In
particular, the sub-dimensions like reliability, empa-
thy, and responsiveness are often found to be the im-
portant determinant factors contributing to customer
satisfaction and loyalty (Bakirtzoglou et al., 2018; Lo et
al., 2015). This suggests that spa managers need to pay
attention to the development of spa employees, who
are the crucial factor to deliver spa services to meet
customer expectations. Staff training and supervisory
monitoring can help to develop their employees in or-
der to provide better spa services and experiences for
customers (Lo et al., 2015).
As for outcome dimension, this is an important
element of spa service quality. Customers expect to
experience the service outcome either physically or
mentally (Lagrosen & Lagrosen, 2016). However, it
seems that many spa service providers may overlook
evaluating this element by focusing on service process
rather than the outcome results due to insufficient lit-
erature. The current findings may assist them to better
understand spa service outcome for future appropriate
implementations. As mentioned, research indicates
that service outcome is a significant factor influenc-
ing customer satisfaction, emotions, and subsequent
behaviour in the service industries (Choi & Kim, 2013;
Hsieh & Hiang, 2004). This suggests that the under-
standing of customer perceptions on service outcome
may help spa managers to do appropriate marketing
to target those who seek these outcome benefits (Choi
et al., 2015; Lagrosen & Lagrosen, 2016).
Finally, understanding of certain service dimen-
sions may help to generate service innovation in the
spa industry, particularly the combination of physical
environment (technology-based equipment) and bet-
ter customer-employee interaction (Sangpikul, 2022c).
For example, training professional employees by using
high-tech equipment or facilities may help to gener-
ate service differentiation or innovation as perceived
by customers since these services may lead to prod-
uct competitive advantages (strength of the business).
Skin beauty treatments may be a good example of
product differentiation/innovation in the spa indus-
try by delivering excellent customer service together
with a high-tech facility to provide customers with the
expected service outcome.
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Academica Turistica, Year 16, No. 3, December 2023 | 289

Original Scientific Article
Factors Influencing the Satisfaction and Revisit
Intention of Jordanian Medical Tourists
Malek Bader
Hashemite University, Jordan
malekbader@hotmail.com
Nirmeen Khasawneh
Hashemite University, Jordan
nermeenibra@yahoo.com
Ramzi Al Rousan
Hashemite University, Jordan
rousanramzi@yahoo.com
Sami Al Hasanat
Al Hussein Bin Talal University, Jordan
samihasanat@gmail.com
Kamakshya Prasad Nayak
Punjabi University, India
kn0733@gmail.com
The study aimed to analyse the factors that impact the satisfaction and revisiting
intention of medical tourists in Jordan. A theoretical model consisting of seven
variables, namely service quality, risk perception, value for money, destination at-
traction, tourist-friendly environment, satisfaction and revisit intention was framed
based on previous literatures. For testing of the model a methodological approach
was followed. First, the survey was conducted among medical tourists visiting the
top ten hospitals in Jordan, resulting in the collection of 395 responses. Then a struc-
tural equation model was employed to analyse the data. The study found that the
independent variables, including service quality, value for money, and destination
attraction had a significant impact on the satisfaction and revisit intention of med-
ical tourists. The analysis also revealed that the tourist-friendly environment had a
significant influence on satisfaction but did not significantly impact revisit intention.
However, the study did not provide evidence of any significant impact of risk per-
ception on satisfaction and revisit intention. Aligning with the findings, the govern-
ment and private entities of Jordan can prioritize maintaining the quality of services,
enhancing the attractiveness of the destination, and ensuring a tourist-friendly en-
vironment. They can also consider addressing and mitigating the risk perception of
medical tourists, as it was not found to impact the tourist’s satisfaction and revisit
intention.
Keywords:medical tourism, Jordan tourism, medical tourists, revisit intention,
tourist satisfaction, consumer behaviour
https://doi.org/10.26493/2335-4194.16.291-311
Introduction
The growth of medical tourism has experienced a sig-
nificant increase in recent decades due to globaliza-
tion (Mohd Isa et al., 2019). This expansion can be
attributed to various pull and push factors in mod-
ern times, which have contributed to the rising de-
mand formedical tourism and its robust growth (John
& Larke, 2016). The pull factor stems from the pres-
Academica Turistica, Year 16, No. 3, December 2023 | 291
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
ence of advanced and internationally accredited med-
ical care facilities, skilled doctors, high service qual-
ity in healthcare units, shorter waiting times, and rel-
atively lower costs of medical treatment in the host
destination. On the other hand, the push factor arises
from expensive medical treatments, long waiting lists
for treatment in home countries, affordable interna-
tional airfare, foreign economic exchange rates, the de-
sire for privacy and confidentiality in treatment, rec-
ommendations from friends and family, and inade-
quate insurance coverage (John & Larke, 2016). In re-
cent times, people are increasingly travelling to less ex-
pensive countries for medical procedures such as or-
gan transplantation, bypass surgery, cosmetic surgery,
and dental treatments (Mohd Isa et al., 2019). How-
ever, in the 1990s, there was a reverse trend, with peo-
ple from less advanced nations travelling to more ad-
vanced countries due to a lack of facilities and skilled
doctors in their home countries (Cham et al., 2021).
Medical tourism involves tourists travelling to and
staying in the host country for various medical and
non-medical activities, leading to increased tourism
revenue, gdp, and foreign exchange reserves (Khan et
al., 2020). Medical tourists often engage in leisure and
business activities during their stay (Khan et al., 2020).
According to published reports, medical tourism is
projected to grow at an annual rate of 25, reaching
usd 3 trillion by 2025 (as cited in Cham et al., 2021,
p. 2).
AmongMiddle Eastern countries, Jordan and Leb-
anon have become top-notch destinations for attract-
ing medical tourists (Al Adwan, 2020). Jordan has
also emerged as an attractive and safemedical tourism
destination, particularly for Lebanese, Syrian, Yemeni,
and Sudanese individuals in theMiddle East andNorth
Africa regions (Alsarayreh, Mahasneh et al., 2017; Al-
sarayreh, Nawaiseh et al., 2017).
Jordan’s success in medical tourism can be attri-
buted to factors such as internationally accredited hos-
pitals, a highly competent and qualifiedmedical work-
force, advanced medical technology and equipment, a
growing pharmaceutical industry, favourable climatic
conditions, social security, and convenient transporta-
tion facilities (Al-Azzam, 2016). Despite these reasons
for celebrating Jordan’s success as a medical destina-
tion, its full potential in the field ofmedical tourism re-
mains untapped (AlAdwan, 2020).Medical tourism in
the Jordanian region has received less attention from
researchers, and some studies have focused on explor-
ing the motivating factors for medical tourists who
choose Jordan as their preferred destination for sub-
sequent visits. It is crucial to understand the motivat-
ing factors that influencemedical tourists’ intention to
revisit (Al-Azzam, 2016).
The ultimate objective of any tourism-centric or-
ganization or tourism-promoting country lies in sat-
isfying the tourists and encouraging them to revisit
(Li, 2020; Cakici et al., 2019; Atikahambar et al., 2019).
These also apply to the promotion of medical tourism
(Jeaheng et al., 2020). Researchers explored the desire
ofmedical tourists to return frommany angles, explor-
ing several elements that impact their intention. They
have also explored various factors that impact trav-
ellers’ intention to revisit. Jordan, being a top-notch
destination for medical tourism among the Arabian
nations, has attracted many researchers to conduct
studies onmedical tourism (Anshasi &Alsyouf, 2020).
As per the report published by Amman Vision Invest-
ment and Development (an investment management
company in Jordan), a significant percentage of Jor-
dan’s gdp, around 8, comes from medical tourism.
Jordan has also been recognized as the best medical
tourism destination in 2014 (Alsarayreh, Nawaiseh et
al., 2017). Jordan was also found to be the most pop-
ular medical tourism destination in the Middle East
and North African countries (Alsarayreh, Mahasneh
et al., 2017).
Various studies on the promotion of Jordan as a
medical tourism destination have been undertaken
throughout the years. Significant research has been
conducted on destination promotionwith digitalmar-
keting (Alghizzawi et al., 2020), marketing mix (Al-
Azzam, 2016), the government’s role in promoting Jor-
dan as a medical tourist hub (Dalbooh, 2015), the con-
tribution ofmedical tourism to destination promotion
(Alsarayreh, Nawaiseh et al., 2017), and a framework
for promoting sustainablemedical tourism (Darwazeh
et al., 2021). Some studies have also looked into the be-
haviour of medical tourists in Jordan after they have
made their purchase.
292 | Academica Turistica, Year 16, No. 3, December 2023
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Alsarayreh,Mahasneh et al. (2017) studied 95 tour-
ists who visited Aqaba, Jordan, for medical reasons to
assess customer satisfaction based on medical-related
variables such as medical facilities, financial consid-
erations, and service quality. This study’s indepen-
dent variables were all related to medical services.
Al-Maaitah (2017) aimed to investigate the degree of
satisfaction of medical tourists by utilizing the psy-
chometric features of care instruments. Shriedeh et al.
(2017) evaluated the impact of service quality onmed-
ical service providers’ brand equity. Shriedeh (2019)
did a similar study to assess the cause-and-effect con-
nection between service quality and medical tourism
service provider brand equity. Previous studies, how-
ever, have not considered the success factors of med-
ical tourism in Jordan, nor have they examined the
number and scope of research publications that inves-
tigate how medical and non-medical factors influence
Jordanian medical tourists’ satisfaction levels and in-
tent to return.
This study aims to address this research gap and to
check the impact of various medical and non-medical
factors on the satisfaction and further revisit intention
of Jordanian medical tourists. The goal is to investi-
gate the post-purchase behaviour of medical tourists
rather than identifying the driving factors for choos-
ing Jordan as a medical tourism destination.
Literature Review and Hypothesis Development
Several researchers reviewed relevant literature to un-
derstand the interrelationship effects of various vari-
ables in the context of medical tourists’ revisit inten-
tion, such as medical service quality, destination at-
traction, tourist-friendly environment, perceived risk,
perceived cost, satisfaction, and revisit intention.
Medical Tourist’s Revisit Intention
Researchers have paid close attention to the revisit in-
tention ofmedical tourists, which indicates an individ-
ual’s readiness to return to a location after their initial
visit (Su et al., 2018). Marketers in the tourism busi-
ness are continually looking for strategies to increase
income by enticing customers to return to a place (Co-
hen et al., 2014). Repeat visits not only result in in-
creased tourist spending but also in recommendations
for others to visit (Correia et al., 2015). Repeat visits are
important for tourist locations for three reasons: lower
marketing expenses involved with acquiring new con-
sumers, an indication of customer satisfaction and the
likelihood of referrals via word-of-mouth (as cited in
Heydari Fard et al., 2021, p. 9).
In the case of medical tourism, revisiting intention
is important (Arici & Güçer, 2018). Host nations and
organizations in the medical tourism industry work
hard to nurture loyal tourists and encourage return
visits (Aljumah et al., 2020; Ahmed et al., 2017). This
is why studies focus on return intention, which origi-
nates from patient satisfaction and loyalty (Ahmed et
al., 2017). Ghosh and Mandal (2019) emphasized the
necessity of providing a pleasant customer experience
to please medical tourists and entice them to return.
As per Um et al. (2006), revisit intention is the exten-
sion of tourist satisfaction.Han andHwang (2018) em-
phasized the significance of organizations in the med-
ical tourism sector focusing on persuading first-time
tourists to return to their facilities.
h1 The satisfaction of medical tourists positively
impacts the tourist’s revisit intention.
Satisfaction
Satisfaction is the post-purchase behaviour of con-
sumers, reflecting their likes and dislikes after expe-
riencing a service (Wijaya, 2015). It is accomplished
by the use of certain procedures that bridge the gap
between customer expectations and the services of-
fered (Al-Mhasnah et al., 2018). Healthcare service
providers prioritize patient satisfaction, as it contrib-
utes to their reputation (Lim et al., 2018). Their ul-
timate objective is to please patients and keep them
for future services by providing high-quality, efficient
treatment at a fair cost (Suhail & Srinivasulu, 2021). In
the healthcare industry, ‘patient satisfaction’ is a reg-
ularly used phrase to evaluate service quality (Ahmed
et al., 2017). It measures healthcare professionals’ per-
ceived service quality and acts as a performancemetric
(Shabbir et al., 2016).
Service Quality
The term ‘service quality’ has been defined in a vari-
ety of ways by various scholars (Khan F. et al., 2017).
Academica Turistica, Year 16, No. 3, December 2023 | 293
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
However, the core definition of service quality mea-
surement is the ‘assessment of a person’s happiness
by comparing their post-service perception with their
initial expectations’ (Grönroos, 1984; Parasuraman et
al., 1988; Webster, 1989; Lee et al., 2006). To evalu-
ate the effectiveness of service-centric organizations,
service quality is used as a criterion (Suhail & Sriniva-
sulu, 2021). The service quality evaluation tool should
be verified to ensure that it accurately assesses the ser-
vice quality of the specific service (Papadomichelaki
& Mentzas, 2012).
Parasuraman et al. (1988) developed the servqu-
al scale which is widely used for the evaluation of
service quality. Researchers such as Lam (1997), Al-
Mhasnah et al. (2018), Meesala and Paul (2018), Qoli-
pour et al. (2018), Amankwah et al. (2019), S. Lee and
Kim (2017), andAhmed et al. (2017) have also used the
servqual scale to evaluate healthcare services.How-
ever, the servqual instrument has come under fire
since it exclusively focuses on the process of providing
services while ignoring the results of such interactions
(de Keyser & Lariviere, 2014). In his research, Abbas
(2020) referenced several studies that strongly criti-
cized the generalizability of the servqual scale for
evaluating service quality. Cronin and Taylor (1992)
developed the servperf model by replacing the ex-
pectation component with the performance measure-
ment component from the servqual model. Akdere
et al. (2020) used the servperf model to assess the
service quality in the healthcare industry. In her re-
view article, Endeshaw (2021) cited several studies
that assessed the quality of healthcare services, includ-
ing ‘servqual,’ ‘servperf,’ ‘healthqual,’ ‘Pub-
HosQual,’ and ‘HospitalQual’ and highlighted that
the previous studies were limited, as they primarily
emphasized the functional aspect of healthcare ser-
vices while giving minimal attention to the technical
components and relying heavily on the experience of
healthcare service providers. The studies performed
by Brown et al. (1993) and Babakus and Mangold
(1992), much before the study performed by Ende-
shaw (2021), also emphasised both the functional and
technical aspects of service while evaluating service
quality for the health care sector. Technical quality is
concerned with the technical outputs of the services,
whereas functional quality is concerned with how the
technical quality is communicated to the customer, re-
sulting in the recipient’s happiness with their service
experience (Arora & Stoner, 1996). Technical quality
is concerned with the technical outcomes of the ser-
vices. According to Doyle et al. (2013), patients fre-
quently place a higher priority on the technical and
clinical components of the services than on practi-
cal factors like the accessibility of the doctors or the
doctor-patient interactions. Caruana (2002) referred
to the technical component as the ‘what’ aspect, which
considers the outcome of the service process and fo-
cuses on output quality. Conversely, the functional
component, referred to as the ‘how’ aspect, consid-
ers the process quality and pertains to the method by
which the service is provided.
Numerous research has emphasized how crucial
service quality is to medical visitors’ happiness. Ac-
cording to Silvestri et al. (2017), continuous quality
improvement in hospital services is essential for en-
suring customer satisfaction. According to Padma et
al. (2010), the quality of hospital personnel has a signif-
icant influence on patient satisfaction. The study also
found that the patients are satisfied with the quality of
clinical care, the hospital’s reputation, and trustwor-
thiness, while attendants of the patients are influenced
by the administration and infrastructure of the hos-
pitals. Similarly, Thawornwiriyatrakul and Meeprom
(2020) revealed that the travel motives of health and
wellness tourists are strongly influenced by perceived
service quality and satisfaction. There is a close asso-
ciation between perceived service quality dimensions
and patient satisfaction (Ali et al., 2021). The level of
patient satisfaction is influenced by various factors, in-
cluding the functional, auxiliary, and special adminis-
trative features that patients experience.
Lee andKim (2017) investigated the factors impact-
ing hospital revisit intention and discovered positive
correlations between the quality of the medical ser-
vice, travellers’ satisfaction and their subsequent in-
tention to revisit. Additionally, healthcare customers’
perceptions of service quality have a major influence
on their satisfaction, albeit to varying degrees depend-
ing on their socioeconomic attributes (Suhail & Srini-
vasulu, 2021). Similarly, Li (2020) focused on service
294 | Academica Turistica, Year 16, No. 3, December 2023
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
quality, corporate image, and self-service technology
(sst) as indicators of customer satisfaction and re-
visit intention, recommending that marketers contin-
uously enhance service quality to improve overall cus-
tomer satisfaction.
h2 The service quality dimensions of medical ser-
vice providers have a positive impact onmedical
tourists’ satisfaction.
h3 The service quality dimensions of medical ser-
vice providers have a positive impact on medi-
cal tourists’ revisit intention with the mediating
effect of their satisfaction.
Destination Attractiveness
The attractiveness of a destination encompasses vari-
ous non-home elements which attract travellers, such
as landscapes, activities, experiences, transportation,
accommodation, and other services (Lew, 1987). This
includes the natural attractions at the destination such
as flora, fauna, waterfalls, beaches, and landscapes, as
well as artificial attractions at the destination including
heritage, structure, and other tourism services. In ad-
dition to medical services, people who travel abroad
for medical reasons look for tourist-oriented ameni-
ties such as lodging, leisure activities, and shopping
(Sultana et al., 2014). The frequency of travel to a cer-
tain location reflects the location’s ability to attract vis-
itors (Bianchi et al., 2014). Instead of only drawing vis-
itors for their first visit, a locationmust be able to draw
them again to be successful over the long term (Cohen
et al., 2014). Positive perceptions of on-site experiences
at tourist attractions contribute to tourist satisfaction
(Navratil et al., 2012).
Um et al. (2006) performed research inHongKong
on the factors that influence visitors’ intentions to re-
turn and their levels of satisfaction while on vacation.
They highlighted the significance of perceived desti-
nation attraction as a primary factor influencing the
revisit intention of travellers, with satisfaction medi-
ating this relationship. In a study by Seetanah et al.
(2020), the quality of tourist attractions was identi-
fied as a significant attribute affecting destination sat-
isfaction and influencing the revisit intention of trav-
ellers. Similarly, research conducted by Sukarno et al.
(2019) on Yogyakarta Heritage Tourism in Indone-
sia indicated that tourism attractions significantly and
favourably affect visitors’ pleasure and desire to return.
h4 The medical tourist destination attraction posi-
tively impacts tourist satisfaction.
h5 The medical tourist destination attraction posi-
tively impacts tourists’ revisit intention with the
mediating effect of their satisfaction.
Tourist-Friendly Environment
Jordan receives approximately 90 of itsmedical tour-
ists from Middle Eastern countries, while only 10
come from European nations, America, and Asia to-
gether (Al Adwan, 2020). Due to religious consider-
ations, travellers from Middle Eastern countries fre-
quently choose to stay in a destination that offers a
Muslim-friendly environment such as having halal-
friendly restaurants and offering halal-friendly foods
(Battour et al., 2011).
Making a destinationwarm and hospitable to tour-
ists not only improves visitor satisfaction but also
draws in more travellers (Nedelea, 2017). The satisfac-
tion of travellers is also increased by having tourist-
friendly amenities at the airport, such as duty-free
shopping options. This in turn has a favourable effect
on their intention to go back to the place (Chuchu,
2020). Furthermore, Kim et al. (2021) conducted a
study that identified unethical business practices, reg-
ulations, customs, and visitor management as attri-
butes of a destination that can contribute to a negative
guest experience. Tourist dissatisfaction is eventually
caused by these attributes. However, Lunt et al. (2011)
discovered that having cross-border insurance cover-
age for travellers seeking medical care in another na-
tion increases their satisfaction. Furthermore, accord-
ing to Salehzadeh et al. (2016), medical tourists who
are exposed to the host country’s familiar culture, lan-
guage, and religion report feeling more content and
are more likely to return. According to Esiyok et al.
(2017), patient satisfaction is significantly influenced
by the cultural similarities between the host nation and
the patients. A ‘medical tourism experience’ scale was
also suggested by Ghosh and Mandal (2019) to assess
the effect of this on visitor satisfaction. The treatment,
Academica Turistica, Year 16, No. 3, December 2023 | 295
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
service quality, costs, medical infrastructure, attrac-
tion, culture, and ease of access to destinations are just
a few of the seven factors covered by this measure.
h6 The tourist-friendly environment of a destina-
tion has a positive impact on tourist satisfaction.
h7 The tourist-friendly environment of a destina-
tion has a positive impact on tourists’ revisit in-
tention with the mediating effect of their satis-
faction.
Perceived Risk
Bauer (1960) introduced the theory of perceived risk.
The perceived risk refers to the customer’s percep-
tion and anticipation of potential adversities and un-
certainties related to their probable future (Pathak &
Pathak, 2017). According to Zhu and Deng (2020, p.
3), the perception of tourism risk includes several ele-
ments, such as operational risk, crisis risk, and cul-
tural conflict risk. Tourists are now seriously con-
cerned about the possibility of lockdowns caused by
the covid-19 pandemic, especially in light of the
virus’s first spread and future waves (Gössling et al.,
2020). Another dangerous element that discourages
travellers is terrorism, particularly in places like the
Middle East that are vulnerable to such attacks (Hun-
ter-Jones et al., 2008; Seabra et al., 2020). Natural
disasters also discourage tourists from visiting cer-
tain destinations (Albu, 2016). The political instability,
along with the potential for terrorist attacks negatively
affects tourists’ intentions (Artuğer, 2015). Travellers
are subject to a variety of dangers, such as robbery,
bad weather, political upheaval, terrorism, disasters,
infections, strikes, and food poisoning. These risks
can arise from individual events such as illness, envi-
ronmental conditions, weather, conflicts, and cultural
differences (Cianconi et al., 2020).
Sohn et al. (2016) found that risk perceptions lead
to negative satisfaction. The researchers also discov-
ered a cause-and-effect relationship between percep-
tion and satisfaction which lead to future visit inten-
tion. Travellers with higher perceived risk are more
likely to make changes to their trip arrangements
(Kozak et al., 2007). According to Tasci and Boylu
(2010), the perceived risk for foreign travellers in-
cludes safety concerns, cultural conflicts, sanitation is-
sues, language barriers, and transportation challenges.
These factors contribute to decreased satisfaction lev-
els among tourists (Tasci & Boylu, 2010).
h8 The perceived risk of medical tourists has a neg-
ative effect on tourist satisfaction.
h9 The perceived risk of medical tourists has a neg-
ative effect on tourists’ revisit intention with the
mediating effect of their satisfaction.
Value for Money
The trade-off between the price consumers pay and
the goods or service they receive may be viewed from
the standpoint of the customer as ‘Value for Money’
(Nasution&Mavondo, 2008). It depicts the customer’s
evaluation of a product or service’s general qualities in
monetary terms (Lee et al., 2019). Travellers give care-
ful consideration to financial aspects whilemaking va-
cation plans (Chang & Wildt, 1994). Customers are
more concerned with the advantages they gain than
the costs they pay (Hanif et al., 2010).
The capacity of marketingmanagers to forecast the
degree of consumer satisfaction depends heavily on
value for money (Ahmed et al., 2021). According to
several sources, including Rajaguru (2016), Kusuma-
wardani and Aruan (2019), Williams and Soutar
(2009), Gault (1986), Ahmed et al. (2021), and Na-
sution and Mavondo (2008), it is regarded as a cru-
cial element of customer satisfaction in a variety of
businesses. Customers evaluate the advantages gained
against the disadvantages incurred (Zeithaml, 1988).
A country can attract wellness tourists from other
countries by offering competitive prices (Kiatkawsin&
Han, 2017). Value formoney has been investigated and
shown to have a favourable impact on customer sat-
isfaction by several researchers (Chen & Chen, 2010;
Gallarza et al., 2013). Customer satisfaction, in turn,
leads to intentions to revisit and recommend the prod-
ucts or services (Heydari Fard et al., 2021; Kim& Park,
2017). Additionally, tourists are more satisfied when
a place is reasonably priced, which increases their in-
tentions to return and recommend (Mai et al., 2019).
h10The value formoney ofmedical tourismdestina-
tions has a positive effect on tourist satisfaction.
296 | Academica Turistica, Year 16, No. 3, December 2023
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
PSQ – Functional
PSQ – Technical
Destination
Attractiveness
Tourist
Friendliness
Service Quality
Risk
Value for Money
Satisfaction Revisit intention
H2 (H3)
H4 (H5)
H6
(H7
)
H
8
(H
9)
H
10
(H
11
)
H1
Figure 1 Tentative Model Based on Hypotheses
h11 The value for money of medical tourism desti-
nations has a positive effect on tourists’ revisit
intention with the mediating effect of their sat-
isfaction.
Based on the above theory-driven hypotheses, the
following tentativemodel can be depicted for research
(Figure 1).
Methodology
Study Site
Jordan, situated in the Eastern Mediterranean region,
holds significance by being geographically close to
three continents: Asia, Africa, and Europe (Al-Tam-
memi, 2020). This Middle Eastern country shares its
border with Iraq, Israel, Palestine, Saudi Arabia, and
Syria (Al-Tammemi, 2020). In 2014, Jordan gained
recognition as an appealing destination for medical
tourists when it was awarded the title ‘medical tourism
destination of the year’ (Anshasi & Alsyouf, 2020).
Since then, the country has attracted medical tourists
from numerous countries and has become one of the
most sought-after destinations for medical purposes
(Anshasi & Alsyouf, 2020).
Research Instrument
The research instrument for this study was framed in
the form of a questionnaire, which consisted of seven
major factors used to measure the revisit intention of
foreign tourists visiting Jordan for medical purposes.
These factors included revisiting intention, medical
tourist satisfaction, service quality, tourist-friendly en-
vironment, destination attraction, value for money,
and perceived risk.
The revisit intention was measured with a four-
item scale adopted byMohd Isa et al. (2019),M. J. Khan
et al. (2017) and Cham et al. (2021). Similarly, the sat-
isfaction of the medical tourists was measured with a
five-item (Before Content Validity) scale adopted by
Cham et al. (2021) and Zailani et al. (2016).
For measuring service quality in terms of func-
tional and technical dimensions, a scale with four
items for ‘functional service quality’ and three items
for ‘technical service quality’ was adopted from de
Keyser and Lariviere (2014). The tourist-friendly envi-
ronment was measured using four items (Before Con-
tent Validity) and was adopted from various studies,
including Ghosh and Mandal (2019) and Zarei et al.
(2018). The destination attraction scale included four
items taken fromMahmud et al. (2021), andM. J. Khan
et al. (2017). The value for money (vfm) scale con-
sisted of four items taken from Kusumawardani and
Aruan (2019) and the perceived risk scale included
four items fromM. J. Khan et al. (2017).
These adopted itemsweremodified to suit the con-
text of this study onmedical tourism. A five-point Lik-
ert scale ranging from strongly disagree to strongly
agree was used for data collection. The questionnaire
was reviewed by five industry experts, four officers of
the top cadre from the medical council of Jordan, and
ten researchers to ensure its relevance, representative-
ness and precision. After the review, the questionnaire
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Table 1 Scale
Category No. Item Source Action
Revisit
Intention
rvst I will consider this hospital as my first choice in the future when I
need healthcare services.
Mohd Isa et al.
()
Adopt
rvst I will visit this hospital in the future if I need healthcare services. Mohd Isa et al.
()
Adopt
rvst If I need medical services in the future outside my country of
residence, I would consider this hospital as my first choice.
Cham et al. () Adopt
rvst I am likely to visit Jordan again for medical purposes. Khan et al. () Adapt
Satisfaction sat I am satisfied with my decision to use the service at this hospital. Cham et al. () Adopt
sat My choice to come to Jordan for a medical facility is a wise decision. Cham et al. () Adapt
sat I am satisfied with the healthcare practices in this hospital. Zailani et al. () Adapt
sat I am not disappointed to use this hospital’s service. Cham et al. () Adopt
Functional
Service
Quality
psqfu1 The overall reliability of the hospital is satisfactory. de Keyser and
Lariviere ()
Adapt
psqfu2 The services offered by the hospital are optimally managed. de Keyser and
Lariviere ()
Adapt
psqfu3 I am satisfied with the speed of delivery at the hospital. de Keyser and
Lariviere ()
Adapt
psqfu4 The customer service of the hospital demonstrates good speed and
friendliness.
de Keyser and
Lariviere ()
Adapt
Technical
Service
Quality
psqtch1 The overall quality of the medical service is good. de Keyser and
Lariviere ()
Adapt
psqtch2 The health information provided by the hospital is perceived to be
of high quality.
de Keyser and
Lariviere ()
Adapt
psqtch3 The hospital offers a range of medical services. de Keyser and
Lariviere ()
Adapt
Tourist-
friendly
Environ-
ment
trfd The rules and regulations of Jordan are very friendly to me as a
medical tourist.
Zarei () Adapt
trfd I am feeling secure in Jordan. Zarei () Adapt
trfd The local people are open to welcoming people from other cultures. Ghosh and Mandal
()
Adopt
Continued on the next page
was refined, resulting in elimination of two items (1
each from satisfaction and tourist-friendly environ-
ment).
Pilot Testing
Following that, a pilot test was conducted onfiftymed-
ical tourists from two prestigious hospitals in the Am-
man region to establish face validity. This region in
Jordan boasts exceptional medical infrastructures and
makes a significant contribution to the field of med-
ical tourism. The statements were properly read and
understood. The final version of the questionnaire for
data collection consisted of thirty items, which can be
found in Table 1.
The target population for this study comprises for-
eign tourists who have either visited or are currently
visiting Jordan for medical purposes. In 2019, Jordan
received approximately 220,000 medical tourists, a
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Table 1 Continued from the previous page
Category No. Item Source Action
Destination
Attraction
datr The medical tourism destination has many exciting events and
activities and an attractive landscape for spending quality time.
Mahmud et al.
()
Adopt
datr Jordan offers appealing local food. Khan et al. () Adapt
datr Jordan has beautiful scenery and natural attractions. Khan et al. () Adapt
datr Jordan has good standard of hygiene and cleanliness. Khan et al. () Adapt
Value for
Money
vfm The service of hospital is good for the price paid. Kusumawardani
and Aruan ()
Adapt
vfm I see value for the money I paid. Kusumawardani
and Aruan ()
Adapt
fvm The price I pay for various facilities and services in Jordan is very
reasonable.
Kusumawardani
and Aruan ()
Adapt
vfm The facilities and services I got is worth what I paid. Kusumawardani
and Aruan ()
Adapt
Perceived
Risk
rsk A medical tour to Jordan involves unexpected extra expenses (such
as changes in exchange rates, extra costs in hotels).
Khan et al. () Adapt
rsk A medical trip to Jordan is more expensive than other international
trips.
Khan et al. () Adapt
rsk There is a possibility of a strike on (airport, railway station, buses) in
Jordan.
Khan et al. () Adapt
rsk Travelling to Jordan involves too much risk. Khan et al. () Adapt
figure close to the annual average, as reported by Al
Nawas (2020) in The Jordan Times. Prior to 2016, the
Kingdom consistently welcomed more than 250,000
patients annually, according to the Private Hospitals
Association (pha). Due to the difficulties encountered
in gathering data from departing medical tourists in
Jordan, the data collection process focused on tourists
who were currently undergoing treatment.
Sample Selection
The sample size for the study was determined us-
ing the confidence interval method recommended by
Burns and Bush (2010). According to this method, the
minimum sample size required for an infinite popu-
lation is 384. To achieve an effective sample, a judge-
mental sampling method was adopted.
Judgemental sampling was employed in the first
stage. This approach was first chosen because the top
hospitals in Amman, followed by Ibrid, receive the
highest number ofmedical tourists from foreign coun-
tries. Therefore, the top ten reputable hospitals based
on world rank were selected for data collection. The
list of hospitals was obtained from thewebsite (https://
hospitals.webometrics.info/en/aw/jordan). Permission
was sought from themanagement of these hospitals to
conduct the study.
Data Collection
Six hospitals allowed collecting of data. The hospi-
tals that permitted data collection are King Hussein
Cancer Centre, Specialty Hospital Amman, Islamic
Hospital, King Abdullah University Hospital, Alkha-
lidi Medical Centre, and Jordan Hospital. The med-
ical tourists from each hospital that had permitted
data collection were approached randomly. A total of
625 medical tourists from different countries were ap-
proached, out of which 395 were available and showed
interest in filling in the questionnaire with a rate of
63. Two researchers collected the data from Decem-
ber 2021 to April 2022.
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Data Analysis
The researchers involved in the data collection en-
sured the avoidance of missing values, which subse-
quently helped in the data-cleaning process. In the
subsequent step, data analysis was performed using
spss 23.0 and smartpls 3.3.4. The demographic data
were analysed using spss 23.0. The structural equa-
tion modelling (sem) was performed with smartpls
software. The analysis of the structural equationmodel
involves a two-step approach which includes the anal-
ysis of the measurement model and structural model.
The measurement model assesses the relationship be-
tween the observed items and their latent constructs.
This study analysed themeasurementmodel using the
confirmatory factor analysis (cfa) method. The ap-
plication of cfa helped in assessing the fitness of the
measurementmodel, its composite reliability (cr) and
construct validity (test of both Convergent and Dis-
criminate validity). Next, the structuralmodel analysis
was performed, which helped in testing the hypothe-
ses. The mediating effects were checked using the
bootstrapping method with sem-pls. pls enables a
researcher to assess latent constructs using small and
medium sample sizes and non-normality distributed
data (Ali et al., 2018). sem-pls is a recommended
technique to analyse serial mediation and path co-
efficients in structural models (Hair et al., 2017).
Theory-driven modelling without exploratory fac-
tor analysis (efa) can be justified based on several
compelling arguments put forth by prominent re-
searchers in the field of psychometrics and structural
equation modelling. Henson and Roberts (2016) em-
phasize that efa is primarily used for theory gen-
eration, whereas confirmatory factor analysis (cfa)
is employed for theory testing. This distinction un-
derscores the notion that when a solid theoretical
foundation already exists, there may be little need for
efa. Green et al. (2016) support this by highlight-
ing that efa is applied when there is limited prior
knowledge regarding factor structure and the num-
ber of factors, whereas cfa is preferred when there
is well-established theoretical knowledge and a de-
sire to confirm the model’s fit with the data. Hulland
et al. (2018) argue that using both efa and cfa on
the same dataset can be unnecessary and potentially
misleading, further reinforcing the idea that theory-
driven modelling can be conducted without efa.
Results
CommonMethod Bias
Harman’s single-factor test was applied in this study to
check the issue of common method bias (cmb). Ac-
cording to the rule of Harman’s single-factor test, the
issue of common method bias would occur if one fac-
tor accounts for more than 50 of the total variance.
The commonmethod bias is absent in this study as the
total variance explained by one component was found
to be less than the threshold limit of 50 at just 38.21.
Demographic Profile of Respondents
The demographic data have been depicted in Table 2.
The collected data showed that a total of 205 (52)
male and 190 (48) female respondents filled in the
questionnaire, indicating that the respondents were
equally distributed by gender. The respondents in
the age group of 26 to 35 were the highest with 220
(56) respondents, followed by the age group 36 to
45 with 102 (26) respondents, 46 to 55 with 43 (11)
respondents, above 55 with 20 (5) respondents, and
below 25 with 10 (3) respondents. The majority of
respondents were married, comprising 292 (74) re-
spondents, while fewer were unmarried, accounting
for 103 (26) respondents. Respondents with different
levels of educational qualification were found with a
higher number being those who had completed post-
graduate level (pg) with 186 (47) respondents fol-
lowed by undergraduate level with 96 (24) respon-
dents, M.Phil./Ph.D. with 63 (16) respondents, and
others with 15 (4) respondents. Out of the respon-
dents, 190 (48) were employed, 153 (39) had their
own business, 40 (10) were self-employed, 5 (1)
were students, and 7 (2) were unemployed.
Due to the differences in currency valuation of the
countries the medical tourists belong to, their income
level was measured in usd. It was found that respon-
dents with an income group of 1500 to 2500 usd ac-
counted for 145 (37) respondents, followed by the in-
come group of 2500 usd to 3500 usd with 130 (33)
respondents, more than 3500 usd with 64 (16) re-
spondents, and less than 1500 usd with 56 (14) re-
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Table 2 Demographic Profile
Category Item f 
Gender Male  
Female  
Total  
Age Below   
From  to   
From  to   
From  to   
Above   
Total  
Marital Status Married  
Unmarried  
Total  
Educational
Qualification
Up to th  
ug  
pg/Masters  
M.Phil./Ph.D.  
Other  
Total  
Occupation Student  
Employee  
Businessperson  
Self Employed  
Unemployed  
Total  
Monthly
Income
More than  usd  
 to  usd  
 to  usd  
Less than  usd  
Total  
Native
Country
me other than Jordan  
North America  
Europe  
Asian other than me  
Africa  
spondents. The majority of respondents, 315 (80),
were fromMiddle East countries, followed by 30 (8)
Table 3 Measurement Model Summary
Items Loadings ave cr rho_A α
() datr . . . . .
datr .
datr .
datr .
() psqfu1 . . . . .
psqfu2 .
psqfu3 .
psqfu4 .
() psqtch1 . . . . .
psqtch2 .
psqtch3 .
() vfm . . . . .
vfm .
vfm .
vfm .
() rsk . . . . .
rsk .
rsk .
rsk .
() rvst . . . . .
rvst .
rvst .
rvst .
() sat . . . . .
sat .
sat .
sat .
() trfd . . . . .
trfd .
trfd .
Notes Row headings are as follows: (1) Destination Attrac-
tiveness, (2) Perceived Service Quality – Functional Aspect,
(3) Perceived Service Quality – Technical Aspect, (4) Revisit
Intention, (5) Perceived Risk, (6) Satisfaction, (7) Tourist
Friendliness, (8) Value for Money.
from Europe, 23 (6) fromAfrica, 15 (4) fromNorth
America, and 12 (3) from Asian countries.
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Table 4 Discriminant Validity (Fornell and Larker
Criterion)
() () () () () () () ()
() .
() . .
() . . .
() . . . .
() . . . . .
() . . . . . .
() . . . . . . .
() . . . . . . . .
Notes Column/rowheadings are as follows: (1) Destination
Attractiveness, (2) Perceived Service Quality – Functional
Aspect, (3) Perceived Service Quality – Technical Aspect,
(4) Revisit Intention, (5) Perceived Risk, (6) Satisfaction, (7)
Tourist Friendliness, (8) Value for Money. The diagonal is
the square root of the ave of the latent variables and indi-
cates the highest in any column or row.
Measurement Model Analysis
Several criteria were employed to assess the measure-
ment model in our study. Firstly, confirmatory factor
analysis was conducted using a factor loading cut-off
value of 0.50 (Hulland, 1999; Kline, 2015). This analysis
helps establish the relationship between the observed
variables and their underlying constructs, ensuring
the validity of the measurement model. Secondly, the
internal consistency was evaluated using Cronbach’s
alpha, rho_A and composite reliability (cr) with a
cut-off value of 0.70. The Cronbach’s alpha provides
a lower bound estimate of internal consistency relia-
bility, while composite reliability (cr) provides an up-
per bound estimate. Rho_A, on the other hand, typ-
ically falls between these bounds and can be a good
representation of a construct’s internal consistency re-
liability. All the measures of reliability (i.e. Cronbach’s
alpha, rho_A, and cr) values were found to be above
the cut-off value, hence satisfactory (Table 3). Third,
to evaluate construct validity, two measures were em-
ployed. The first measure was the average variance
extracted (ave), which should exceed 0.5 (Table 3).
ave indicates the proportion of variance captured by
the construct and serves as evidence of convergent va-
Table 5 Collinearity Issues and Explanatory Power of the
Model
Construct vif R2
Destination Attractiveness . .
Perceived Service Quality – Functional . .
Perceived Service Quality – Technical . .
Risk . .
Satisfaction . .
Tourist Friendliness . .
Value for Money . .
lidity. The second measure of construct validity was
based on Fornell-Larcker criterion (Fornell & Larcker,
1981), which assesses discriminant validity (Table 4).
According to this criterion, the square root of the ave
for each latent variable should be greater than the cor-
relation among the latent variables. By satisfying this
criterion, the variables in our study demonstrate dis-
tinctiveness and provide evidence of discriminant va-
lidity. Overall, the measurement model demonstrated
satisfactory reliability, convergent validity, and dis-
criminant validity. These results support the robust-
ness of our research and validate the accuracy of the
selectedmeasurement items in capturing the intended
constructs.
Structural Model Analysis and Hypotheses Testing
The findings of this study, obtained through the pls-
sem method and the bootstrap technique in Smart
pls, included both direct effects and specific indi-
rect effects. Following the satisfactory findings of the
measurement model, the structural model was eval-
uated using pls-sem. The collinearity of constructs
was evaluated beforemodel evaluation. The vif value
of variables was found to be less than 2.0 (Table 5), in-
dicating that there is no issue of multicollinearity by
retaining the threshold of 5.0. (Ringle et al., 2015).
Following the test for multicollinearity, the path
coefficients were assessed with a bootstrapping pro-
cess of 2000 iterations. The investigation utilised the
Normed Fit Index (nfi) and the Standardised Root-
Mean-Square Residual (srmr) to assess the fit of the
model. The findings indicate that the srmr value is
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
Table 6 Path Coefficients with Direct Effects
h Relationships β T P Remarks
h Satisfaction→ Revisit Intention . . . Accepted
h Service Quality→ Satisfaction . . . Accepted
h Destination Attractiveness→ Satisfaction . . . Accepted
h Tourist Friendliness→ Satisfaction . . . Accepted
h Risk→ Satisfaction . . . Not accepted
h Value for Money→ Satisfaction . . . Accepted
Table 7 Specific Indirect Effects
h Relationships β T P Remarks
h Service Quality→ Satisfaction→ Revisit Intention . . . Accepted
h Destination Attractiveness→ Satisfaction→ Revisit Intention . . . Accepted
h Tourist Friendliness→ Satisfaction→ Revisit Intention . . . Not Accepted
h Risk→ Satisfaction→ Revisit Intention . . . Not Accepted
h Value for Money→ Satisfaction→ Revisit Intention . . . Accepted
0.061 (srmr < 0.08) and the nfi value is 0.918 (nfi
> 0.9), indicating a good model fit (Hair et al. 2017).
Furthermore, the model’s explanatory ability was in-
vestigated using the coefficient of determination (R2).
All R2 values exceeded the proposed cut-off value of
0.10 (Table 5) (Falk & Miller, 1992).
The path coefficientswere then evaluated to test the
stated hypotheses. Table 6 shows path coefficients with
direct impacts of variables with all t-statistics values
greater than 1.96 and statistically significant, suggest-
ing the acceptance of hypotheses predicting the direct
influence of independent variables on dependent vari-
ables. Based on Table 6, hypotheses h1, h2, h4, h6,
and h10 were accepted since the p-values were be-
low the significant level of 0.05. The t statistics for h1,
h2, h4, h6, and h10 were found to be 4.34, 3.15, 2.81,
2.15, and 2.45, respectively. The satisfaction of medical
tourist significantly influenced their revisit intention
(h1: β = 0.189, t = 4.344, p < 0.005). Similarly, the ser-
vice quality of medical facilities (h2: β = 0.273, t =
3.156, p < 0.005), tourist destination attractions (h4: β
= 0.245, t = 2.811, p < 0.005) and tourist friendliness
(h6: β = 0.171, t = 2.155, p < 0.005) significantly im-
pacted medical tourists’ satisfaction. Satisfaction was
also influenced by value for money (h10: β = 0.238, t
= 2.459, p < 0.005) significantly. The p-value for h8,
which examined the effect of risk on satisfaction (h8:
β = 0.021, t = 0.565, p > 0.005), exceeded 0.05, indi-
cating insignificance. Hence, hypothesis h8 was not
accepted (Figure 2). Service Quality (β = 0.273) was
found to have the highest impact on satisfaction, fol-
lowed by Destination Attraction (β = 0.245), Value
for Money (β = 0.238), and Tourist Friendliness (β =
0.171).
Table 7 represents the specific indirect effects of
the independent variables on the dependent variable
revisit intention with the mediating effect of satisfac-
tion. The mediating effect of Satisfaction in the rela-
tionship between Service Quality and Revisit Inten-
tion (h3) was found to be significant (h3: β = 0.052, t =
2.43, p < 0.05) with the highest beta coefficient among
the other independent variables. Similarly, the medi-
ating effect of Satisfaction in the relationship between
Destination Attraction and Revisit Intention (h5) was
significant (h5: β = 0.046, t = 2.23, p < 0.05). Addition-
ally h11 was accepted, indicating the significant me-
diation of Satisfaction between Value for Money and
Revisit Intention (h11: β = 0.045, t = 1.97, p < 0.05).
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Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
PSQ – Functional
PSQ – Technical
Destination
Attractiveness
Tourist
Friendliness
Service Quality
Risk
Value for Money
Satisfaction Revisit intention
177.067
190.93
0
3.156
2.811
2.15
5
0.
56
5
2.
45
9
4.344
Figure 2 Path Analysis
Service Quality, Destination Attraction, and Value for
Money were all found to have a positive impact on
tourists’ revisit intention, with a mediating effect on
their satisfaction. However, these effects were of lower
intensity, as indicated by their lower beta coefficient.
Conversely, hypotheses h7 and h9 were rejected, in-
dicating insignificant mediation effects of satisfaction
between the relationship of Tourist Friendliness (h7:
β = 0.032, t = 1.84, p > 0.05) and Risk (h9: β = 0.004, t
= 0.51, p > 0.05) with Revisit Intention.
Discussion and Conclusion
While previous studies in the Jordanian region have
focussed on analysing factors influencing the selec-
tion of Jordan as a tourist destination, this study ex-
amines the influential factors of tourist satisfaction
that drive revisit intentions. The study underscores
the experiential dimensions as well-established factors
that serve as travel motivators. It aligns with a similar
study conducted by Ghosh and Mandal (2019), which
developed the mtex construct to measure the ser-
vice experience. The mtex construct utilized in this
study incorporates and emphasizes three major cate-
gories of measures that capture various dimensions of
the tourism experience. These categories encompass
medical-related, travel-related, and holiday-related as-
pects. Consideration of these dimensions is crucial
for promoting or upgrading the standard of facilities
and services, as well as regulating the rules and reg-
ulations for medical tourists. According to Nasab et
al. (2011), price followed by medical services and the
destination-related dimensions are the major factors
that contribute to a country’s competitiveness in at-
tracting medical tourists.
The findings of the current study reveal the influ-
ence of satisfaction on medical tourists’ intention to
revisit. This is consistent with the findings of Ahmed
et al. (2017), Kim et al. (2009), Ghosh and Mandal
(2019), and Um et al. (2006), who found satisfaction
to be a precursor to a traveller’s repurchase intention.
According to Ghosh and Mandal (2019), meeting all
the essential dimensions outlined in the mtex scale,
including quality medical treatment, accommodation,
and local travel experiences, not only leads to the sat-
isfaction of medical tourists but also influences their
intention to recommend the destination. Um et al.
(2006) found that in the context of international travel,
tourist satisfaction plays a crucial role in shaping their
intention to revisit a destination, particularly when the
destination offers novel experiences or entails lower
opportunity costs for the tourists.
Service quality should consider both the functional
and technical aspects of medical services provided by
hospitals in Jordan (Caruana, 2002). The functional
aspects encompass tangibility, reliability, responsive-
ness, assurance, and empathy, while the technical as-
pects are about how medical services are delivered.
The study found that service quality has a positive in-
fluence on tourist satisfaction, which is supported by
the findings of Lee andKim (2017), Padma et al. (2010),
Thawornwiriyatrakul andMeeprom (2020), and Ali et
al. (2021). Ahmed et al. (2017) conducted a study on
304 | Academica Turistica, Year 16, No. 3, December 2023
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
patients from healthcare units in Bangladesh, which
revealed that patients perceive the service quality of
private hospitals to be higher than that of public hospi-
tals, mainly due to their focus on technical and func-
tional aspects. Satisfaction achieved from the quality
of service also influences medical tourists’ revisit in-
tention, as supported by Lee and Kim (2017) and Tha-
wornwiriyatrakul and Meeprom (2020). According to
Padma et al. (2010), the patients and attendants pri-
oritize the interpersonal aspect of care as they have a
limited understanding of the technical part of medi-
cal services. Hence, to satisfy them, their service needs
must be understood properly.
The value for money was found to significantly in-
fluence tourist satisfaction, indicating that the satis-
faction of medical tourists in Jordan is positively in-
fluenced by the value they receive for their money.
Furthermore, value for money was found to posi-
tively influencemedical tourists’ revisit intention post-
satisfaction. This aligns with the findings of Mai et al.
(2019), which reveals that affordable price of services
at the destination contribute to visitor satisfaction and
their revisit intention. The findings of this study are
also supported by Um et al. (2006), which highlights
the influence of value for money on satisfaction and
revisit intention. The researchers aim to unravel the
specificways inwhich each of these factors contributes
to the overall perception of value for money. For in-
stance, service duration becomes a critical factor as
it directly impacts the customer experience, influenc-
ing their level of satisfaction. Additionally, the conve-
nience, cost of service, and search cost are explored
to shed light on their individual roles in shaping cus-
tomer perceptions. By explicating how each element
intertwines with the concept of value for money, the
researchers provide a comprehensive understanding
of the factors influencing satisfaction in the context of
the services under examination.
In this study, the tourist-friendly environment of
Jordan was found to positively influence the satis-
faction of the medical tourists with statistical signifi-
cance. This finding is consistent with the study con-
ducted by Darwazeh et al. (2021), which indicates
that not-so-stringent government regulations, trav-
eller friendly business practices and relaxed custom
charges are influential factors for the success of Jordan
as a medical tourist destination. Ghosh and Mandal
(2019) also support the cultural acceptance of the local
people as a precursor to medical tourists’ satisfaction.
However, the influence of a tourist-friendly environ-
ment on revisit intention, with the mediating effect
of satisfaction, was not found to be significant in our
study. This suggests that a revisit intention triggered
solely by a tourist-friendly environment is not deemed
sufficient based on our research findings.
The current study was not found to be aligned with
the outcomes of the previous studies conducted by
Tasci and Boylu (2010) and Sohn et al. (2016), which
highlight the influence of negative risk perception on
tourist satisfaction and revisit intention. However, it
does not imply the perception of medical tourists re-
garding Jordan as a riskier destination. The significant
effect of perceived risk on satisfaction and revisit in-
tention cannot determine the perception of risk asso-
ciated with Jordan as a medical tourism destination.
The findings reveal that tourist destination attrac-
tion significantly influences the satisfaction of Jorda-
nian medical tourists. This finding is supported by
Navratil et al. (2012), who found a significant and pos-
itive influence of tourist destination attraction in Jor-
dan on medical tourist satisfaction. The tourist desti-
nation attraction of Jordan was also found to signif-
icantly influence medical tourists’ revisit intentions,
with satisfaction mediating the effect. This aligns with
the studies conducted by Um et al. (2006), Seetanah
et al. (2020), and Sukarno et al. (2019), which found
that attractive destinations satisfy the tourists and in-
fluence their revisit intentions. Um et al. (2006) em-
phasize the importance of destination attraction over
traveller satisfaction in stimulating revisit intention.
Seetanah et al. (2020), and Sukarno et al. (2019) re-
veal the quality of the destination’s attraction results
in tourist satisfaction and revisit intention. In the cur-
rent study, themedical tourists are found to be satisfied
by the destination attraction of Jordan and consider a
second visit.
The suggestedmodel holds significant value for the
global scientific community. First, it has the potential
to inform and support researchers working in the area
of medical tourists in suggesting important drivers of
Academica Turistica, Year 16, No. 3, December 2023 | 305
Malek Bader et al. Factors Influencing the Satisfaction and Revisit Intention
medical tourists’ satisfaction and revisit intention. Sec-
ond, this research offers a foundation for the other re-
searchers in this area in understanding the role of trav-
eller’s risk perception in influencing their satisfaction
and revisit intention. Third, this study can help future
researchers in conceptualizing various elements of ser-
vice offerings that have the potential to influence their
satisfaction and revisit intention.
This study also has managerial implications for
hospitals and destination management companies.
First, taking insights from the current study, hospitals
can consider maintaining good quality medical ser-
vices by focusing on both technical and clinical excel-
lence and by ensuring a sound service delivery process
which can address the functional aspects. Second, hos-
pitalsmay consider prioritizingmodern and advanced
clinical standards and state-of-the-art facilities based
on the current findings. Third, the government can
consider implementing favourable policies for creat-
ing a tourist-friendly environment thatmay align with
the findings of the current study. This study also sug-
gests the destination management companies should
consider working on the destination’s attractiveness.
Fourth, whilemanaging and delivering services, atten-
tion can be paid to the monetary aspects for ensuring
the services to be perceived as valuable and not overly
costly. Fifth, work can be done to reduce the magni-
tude of risk perception of the tourists by empathizing
with the medical tourists. Seventh, the stakeholders
like hospitals and destinationmanagement companies
can consider the findings of this study while making
long- and short-term strategies.
This study has some limitations. First, this study
was conducted in the top ten hospitals in Jordan,
which may limit the generalizability of the findings.
Future research could include medical tourists from
other hospitals to provide a broader perspective. Sec-
ondly, the current study did not differentiate between
medical tourists visiting government and private hos-
pitals. Future research can consider conducting a cross-
sectional study to examine differences in outcomes be-
tween tourists utilizing government and private med-
ical facilities. Third, this study focuses on five external
factors, namely tourist destination attraction, service
quality, value for money, perceived risk, and tourist
friendliness of the destination. Future studies could
explore additional factors that may influence the sat-
isfaction and revisit intentions of medical tourists.
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Academica Turistica, Year 16, No. 3, December 2023 | 311

Original Scientific Article
Marketing Strategies in Cross-Border
Tourist Destinations: A Literature Review
Alenka Pahor Žvanut
PhD Student at the University of Primorska, Slovenia
62203001@student.upr.si
Ksenija Vodeb
University of Primorska, Slovenia
ksenija.vodeb@fts.upr.si
The basic principle of the operation of a tourist destination as a system of connected
stakeholders is the creation of new value that is reflected in the creation of added
value for participants in the business process. To create added value, stakeholders
need to strategically plan and manage their marketing function. A systematic quali-
tative review of the latest current literature (last ten years) is carried out in the field of
introducing marketing strategies into the wider strategy of developing cross-border
tourist destinations. The selected databases were Web of Science and Scopus. We
found that cross-border tourist destinations do not take systematic approaches to
introduce marketing strategies, but rather identify themselves as a part of broader
development strategies of cross-border areas. In rare cases, stand-alone brands are
formed to help destinations consolidate their market position and exploit the poten-
tial of two or more cross-border destinations at the same time. Despite identifying
different synergistic effects and understanding the importance and benefits of in-
tegration and coopetition, marketing strategies in cross-border tourist destinations
are not yet standardized business practice. The review article contributes to show-
casing the important role of cross-border marketing strategies in tourism and paves
the way for more detailed research on the topic in the future.
Keywords: tourism, cross-border, tourist destination, strategy, marketing strategy
https://doi.org/10.26493/2335-4194.16.313-328
Introduction
A tourist destination is perceived by the tourist as a
composite set of services, which is marketed in a uni-
form way. They expect to receive all the necessary in-
formation and organized elements of the offer within
the tourist destination system in one place (Vodeb,
2010), regardless of where the tourist destination is
geographically located. How the tourist destination
work is organized is not relevant to the tourist – only
the expected experience as a result of the expressed
need or interest during their visit. Cross-border des-
tinations, even in those areas where administrative
borders are no longer there, such as in the European
Union, face many challenges concerning the uncoor-
dinated operation of two or more different tourist sys-
tems in one tourist area, which is marketed as a cross-
border tourist area or destination (Kozak & Buhalis,
2019). In general, border destinations face poorer eco-
nomic efficiency and thus also lower competitive ad-
vantages than other inland destinations (Vodeb, 2012).
Therefore, cross-border integration is an appropriate
systemic development approach (Timothy & Tosun,
Academica Turistica, Year 16, No. 3, December 2023 | 313
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
2003), including for those destinations that are con-
nected across borders for various other interests. To
make it easier for companies to overcome modern
economic challenges, including economic volatility
due to various unforeseen events, such as the recent
major health crisis of the Covid epidemic (Šerić et
al., 2021), wars, environmental disasters caused by cli-
mate change, etc., tourist destinations should develop
marketing strategies (Tosun et al., 2005) with targeted
branding.
Marketing strategies are all the more important for
regions in cross-border areas, as they face many ge-
ographical, administrative and socio-cultural differ-
ences. These, in turn, raise specific challenges that can
be managed with a variety of tools and approaches.
Strategic planning in marketing helps regional devel-
opment planners, management and decision-making
bodies and other regional managers to facilitate mar-
keting, management and promotion of economic ac-
tivity (Gerlitz et al., 2021; Kozak & Buhalis, 2019).
Research and study of cross-border cooperation in
tourism are largely subordinated to actual implemen-
tation practices and cross-border cooperation projects,
as their occurrence is mainly the result of the activa-
tion of natural resources or infrastructure in an area
that combines or links destinations into mutual part-
nership cooperation. Cross-border cooperation can
be defined within at least four different scopes (Tim-
othy & Saarinen, 2013): at the global level, at the re-
gional level, in bilateral networks, and through coop-
eration at the local level. Each scope of cross-border
(partner) networks has implications for tourist desti-
nations. Different scopes of partnership cooperation
require different intensities of integration depending
on the level of influence of an individual institution in
a certain cross-border tourist destination. This raises
the question of how these organizations approach and
conduct common marketing strategies and within
what scope. Partnership cooperation brings a variety
of experience and knowledge to stakeholders that can
be revealed in a long period of monitoring the phe-
nomenon in the formation of a pattern or trend that
indicates the direction of development in the future.
The purpose of this paper is to examine whether
cross-border tourist destinations plan and implement
marketing strategies and at what geographical scale.
The authors performed a systematic analysis of rel-
evant current literature examining approaches to the
design and implementation of marketing strategies in
cross-border tourist destinations. The research ques-
tions for the purpose of the review article are:
1. At what scope of cross-border cooperation desti-
nations use marketing strategies as a part of the
management and development of cross-border
tourist destinations?
2. What are the opportunities and obstacles in build-
ing joint marketing strategies for cross-border
tourist destinations?
The objectives of the paper are to identify the char-
acteristics of strategic marketing approaches of cross-
border tourist destinations and to gain insight into the
importance and prevalence of the topic in academic
research of the tourism industry.
Scopes of Cross-Border Tourist Destinations
The basic principle of cross-border cooperation is the
establishment of cross-border connections and con-
tractual relations in border areas to find common solu-
tions to common problems (Vodeb, 2007, p. 37). How-
ever, cross-border tourist destinations do not neces-
sarily cover only border areas, but also build cooper-
ation through cross-border partnerships in different
geographical and institutional scopes (Wang & Fes-
enmaier, 2007) or historical scopes (Saarinen & Kask,
2008).
For this review article, we selected Timothy and
Saarinen’s (2013) concept of four main scopes of cross-
border cooperation from a geographical and implicitly
organizational perspective:
• global partnerships (e.g. almost all countries in
Europe are involved in theUnitedNations, or un-
der the authority of the World Tourism Organi-
zation and unesco, global partner chains);
• regional cross-border cooperation is implement-
ed within the European Union through several
different programmes and partnerships (e.g. Eu-
roregio, Interreg, European Tourism Organiza-
tion);
314 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Global
partnership
Regional cross-
border cooperation
Bilateral cross-
border cooperation
Local
cooperation
Cross-border
destination
Figure 1 Presentation of the Scope of Cross-Border
Cooperation in Relation to a Cross-Border
Destination by the Intensity of Integration and
Direct Power of the Cross-Border Partnership’s
Influence on the Destination’s Tourism Activity
(adapted from Timothy & Saarinen, 2013)
• bilateral cross-border cooperation between two
or three countries, not necessarily with countries
sharing the same border. These have their own
national tourism organizations but can perform
together in the market (e.g. Elbe/Labe region);
• local cooperation between countries that share an
administrative border, but the area is intertwined
with cultural and natural resources. In this case,
the border areas form a cross-border tourist des-
tination.
The development of tourism in cross-border desti-
nations is encouraged by various forces, interests and
needs (Wang & Fesenmaier, 2007), such as political,
socio-cultural, economic, technological, competitive
and safety (Timothy & Tosun, 2003; Saarinen & Kask,
2008; Wang & He, 2016). Therefore, how marketing
relationships are established, and their intensity, can
be aggravated by the fact that local tourism organiza-
tions operating in cross-border destinations carry out
marketing activities with other stakeholders at differ-
ent levels and dimensions, and not necessarily with
uniform and homogeneous objectives.
Figure 1 shows the extent of cross-border cooper-
ation in relation to a cross-border destination, geo-
graphically. The integration of a cross-border desti-
nation within an individual scope depends on the in-
tensity of cooperation and integration and the direct
power of the cross-border partnership’s influence on
the destination’s tourism activity. Although the supply
at the destination strongly depends on local integra-
tion, it cannot avoid integration at the global level (To-
sun et al., 2005). Concerning stakeholders at the global
level, given the influence of the local tourist destina-
tion outside the destination area, it can be concluded
that its influence is less powerful within the global
partnership than at the local level (intensity of arrows
in Figure 1). The importance of local authorities in for-
mulating a marketing strategy is crucial as it also rep-
resents a starting point for the establishment of new
economic initiatives in the field of tourism (Kozak &
Buhalis, 2019). Relationships between individual part-
ners can be business or non-business, spontaneous or
organized (Vodeb, 2007), which determines the het-
erogeneous partnership activities in between tourist
destinations.
Marketing Strategies of Tourist Destinations
In a traditional market economy, new value is created
through a company’s business process with two key
parts of process planning: manufacturing and sales. In
developed economies, value delivery is becoming im-
portant, bringing added value to different participants
in the process, and is strongly influenced by consumer
preferences and choices that dictate market demand
(Kotler&Levy, 1969). Creating a strategicmarket pres-
ence is important for both businesses and other stake-
holders operating at the country or regional level; it
allows them to use new, tailored processes to achieve
their objectives more effectively.
Strategic management models differ when applied
to destinations as a collection of organizations from
public, private, and civil sectors.Marketing of a tourist
destination is one of the key development policies or
sub-strategies of a comprehensive tourism strategy, on
the basis of which it is possible to achieve the desired
development of a tourist destination. But it needs to
be planned, too. Strategic planning is one of the key
aspects affecting the development and success of the
tourist destination. Strategic planning in tourism con-
ceptualizes a certain number of steps in the process,
Academica Turistica, Year 16, No. 3, December 2023 | 315
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
where the output of the previous step becomes the in-
put of the next, to the overall final concept of the strat-
egy (Uran Maravić & Juvan, 2009). It is also impor-
tant that tourist destinations developmarketing strate-
gies with targeted branding. Brandmanagement is the
most important distinguishing feature of tourist desti-
nations, as a result of aggressivemarketing in compet-
itive markets and information deluge (Šerić & Vitner
Marković, 2011). In developing a common brand, it is
therefore important to examine the various aspects of
market positioning (Brezovec & Nemec Rudež, 2009;
Kodrin, 2021), related to cross-border tourist destina-
tions:
• geographical positioning, administrative bound-
aries and certain territorial diversity and speci-
ficities;
• social perception, exchange of information, shar-
ing of experiences, norms in building and estab-
lishing relationships, marketing skills;
• understanding cultural characteristics which re-
duce social and organizational differences;
• creativity and receptivity towards open innova-
tion.
Among other strategic prerequisites, political sup-
port, organization of local tourism organizations and
tourism associations, management structure and mu-
tual interests are important for successful cross-border
tourism cooperation in the field of institutional co-
operation, whereas branding, cooperation in the co-
design of tourist products, access to the market and
combined sales efforts are also important for strategic
marketing (Kozak & Buhalis, 2019).
The marketing process is an important part of a
company’s business process that allows it to trade. Ex-
change as a part of trade, however, is a fundamen-
tal condition and purpose of the operation of com-
panies, which, in basic economic theory, pursues the
goal of making a profit (Foxall, 2020). To enter mar-
kets with created value, it is necessary that product
supply transforms the marketing strategy into a mar-
keting mix. In this case, we must consider also mar-
keting expenditures for the implementation of the se-
lectedmarketingmix. There are severalmarketingmix
models. The most prevalent is the McCarthy model. It
divides themarketingmix into four elements, which it
calls 4p: product, price, place and promotion. It later
upgraded to 7ps, which additionally includes people,
process and physical evidence of the marketing mix
(van Waterschoot & van den Bulte, 1992). The model
can also be used at tourist destinations.
Methodology
The methodological approach chosen is based on the
appropriate selection of methodology and dataset in
the chosen databases of scientific publications, based
on keyword selection.
We used Cooper’s Taxonomy (Cooper, 1988) of lit-
erature reviewwhich focuses on practices and applica-
tions. With a systematic literature review, we strive to
synthesize researched evidence, identify main charac-
teristics and issues relevant to the research topic and
point out conclusions in a generalized manner. The
perspective of the article is based on a qualitative re-
view.
A four-step model (Babbie, 2016) was selected in
the methodology selection for preparing the literature
review:
1. selection of an appropriate literature base offer-
ing the largest set of academic articles and other
literature in the field of study,
2. obtaining data based on selected keywords in the
field of study,
3. an arrangement of data based on selected assess-
ment criteria and analysis,
4. discussion and conclusion with findings.
The review of the databases covered the period
from 1 January 2012 to 20 April 2022.
In the first phase, the methodological approach re-
quired an overview of the literature of academic arti-
cles and other scientificworkswithin online databases.
The dataset of selected keywords was collected in two
of the world’s most widely used web databases:Web of
Science and Scopus.Validity and reliability of datawere
assured with several techniques: combining compara-
tive tests of search strings to make a final selection of
keywords, finding comprehensive literature to select
relevant articles and using predefined inclusion and
exclusion criteria tomake a reliable data analysis (Paré
316 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 1 Search Results of Literature by Selected Keywords
in Selected Databases
Item Web of Science Scopus
Keywords Tourism, cross-
border, market-
ing, strategy
Tourism, cross-
border, market-
ing, strategy
Search Constraints Topic (title, ab-
stract, keywords)
Topic (title, ab-
stract, keywords)
Type of Publication All All
Publication Period ..–
..
..–
..
Language English English
Research Area All All
Results  
et al., 2015), with a double review approach in the data
analysis stage. The first comparative test of choosing
several combinations of keywords in both databases
was done, as follows. The first selection of keywords
was based on generic terms that best describe the field
studied: tourism, cross-border, coopetition, marketing
strategy, travel, cooperation. Since the number of hits
was low, the first selection of keywords was refined to
the selected keywords: tourism, cross-border, market-
ing, strategy.
When obtaining data from databases of scientific
literature, the goal was to obtain all relevant scientific
literature, regardless of the type of publication (publi-
cations in conference proceedings and other scientific
meetings, research articles and book chapters).
For the Web of Science and Scopus databases, we
searched for selected keywords in titles, abstracts,
and groups of keywords. In addition, a search of the
Google Scholar database was performed, but due to
a disproportionately large number of results (17,300
hits) compared to the other two databases, the Google
Scholar database was subsequently excluded. After the
first search string, themost relevant results were found
in the Web of Science as shown in Table 1. After re-
viewing all the search results according to the selected
keywords, 8 articles were duplicated in both databases.
The final set for further review (processing) of data
was reduced to 50 articles.
The results of the selected keywords were studied
from several aspects and particular findings have been
revealed:
• by number of publications by year (Table 2): a sig-
nificant increase in interest in the topic studied is
evident from 2016 onwards;
• by type of publications (Table 3): both databases
show a variety of publication types;
• by number of citations of the publications (Ta-
ble 4): modus of numbers of citations in both
databases is in a range of numbers of citations
between 21 and 50.
In regard to the source of publications, we note that
articles have been published in different publications
and journals, that their number is diverse, and there
are no cases when at least two or more articles were
published in the same journal, indicating diverse treat-
ment of the research field, despite the inclusion of the
keyword ‘tourism.’
Among all publications, there are only four jour-
nals from the tourism research field, of which only two
have an impact factor in the first quartile, namely:
• Deturope: The Central European Journal of Re-
gional Development and Tourism (impact factor:
q3),
• International Journal of TourismResearch (impact
factor: q1),
• Journal of Hospitality and Tourism Insights (not
included in the Scimago Journal&Country Rank
database),
• Scandinavian Journal of Hospitality and Tourism
(impact factor: q1).
The weak representation of the topic in research
journals in the field of tourism indicates a lower pres-
ence of the research topic among researchers in tour-
ism. In the analysis of selected articles, special atten-
tion is paid to those that record higher citations, as
shown in Table 4.
In the third step, a selection of articles was per-
formed based on the arrangement of data according
to selected assessment criteria and in order to iden-
tify those articles crucial for our research questions to
achieve the goal of this paper.
Academica Turistica, Year 16, No. 3, December 2023 | 317
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 2 Number of Published Articles from 2012 to 2022, in Web of Science and Scopus
Database           
Scopus           
Web of Science           
Table 3 Type of Research Publications, in Web of Science
and Scopus
Type of publication Web of Science Scopus
Note  
Conference review  
Conference paper  
Book chapter  
Article  
Notes In percent.
Table 4 Demonstration of the Importance of Articles
by Citation, in Web of Science and Scopus
Number of citations Web of Science Scopus
() () () ()
>    
–    
–    
–    
–    
–    
    
Notes Column headings are as follows: (1) number of arti-
cles, (2) share among all articles ().
After refining the broad set of literature, abstracts
of 50 selected articles were read. Subsequently, 17 arti-
cles were selected for a literature review, based on the
method of eliminating irrelevant articles, according to
the following criteria (Arksey & O’Malley, 2005):
• the content of the article deals with cross-border
cooperation, but the field of research is general,
e.g. economically oriented and does not address
a specific area of tourism,
• the content of the article deals with the field of
tourism, but the content does not coincide with
the content of research questions and addresses
other topics irrelevant to this literature review.
Of the 17 articles, 3 were not freely available, so the
authors were asked for direct access via an application
in the Research Gate database. Access to those arti-
cleswas not confirmed by the authors and articles were
subsequently excluded from further analysis. One ar-
ticle was published only in Chinese and was excluded
due to ignorance of the language. Out of 13 articles,
a detailed reading of the entire content of the articles
was done. Three articles were subsequently excluded
due to inadequate content that did not reflect our re-
search questions. In the final selection of the litera-
ture review, 10 articles were discussed 7 of them deal-
ing with cross-border regions or destinations within
or along the external borders of the European Union.
Most of the articles (7 of them) were published in the
last four years, which indicated a greater presence of
the research topic in recent years.
Table 5 contains all the articles discussed by au-
thor, year of publication, key concepts used, research
methods/samples, scientific contribution and scope of
cross-border cooperation.
Results and Analysis
Cross-Border Cooperation Scopes and Marketing
The studied articles provide a more detailed insight
into the issue of planning and implementing cross-
border destination, management and related under-
standing and approaches in their marketing. The au-
thors largely recognize the importance of the com-
petitive advantages of cross-border cooperation and
the relevance of designing and implementing mar-
keting strategies within the institutional organization,
mainly as tourist destinations. The implementation of
marketing strategies in cross-border destinations is in
most cases difficult due to various administrative, po-
litical, infrastructural and logistical factors and limited
318 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 5 Overview of Selected Articles
Author Key concepts Methods/samples Scientific contribution Scope
Qi, L., &
Xiaoyan, Z.
()
Overview of cross-border
mergers and acquisitions,
brand strategies, and recom-
mendations for China hotel
industry, considering bc and
bb perspectives.
Single case study – a
worldwide hotel chain.
Article contributes in its comprehen-
sive analysis of conceptualization of
cross-border tourism cooperation and
its significance in promoting economic
development, international coopera-
tion, and safety issues among border
countries. Better understanding of im-
pact on the brand image and using
brand equity of the acquired brand
to avoid customer loyalty loss, as an
essential part of the marketing strategy.
Global
Makkonen,
T. ()
Article explores economic im-
pact of cross-border shop-
ping on local tourism industry
and destination marketing,
analysing tourist demand and
future cross-border coopera-
tion potential.
Qualitative method. Case
study: semi-structured
interviews with  ltos
and  enterprises. Trian-
gulation of data sources
was done (webpage con-
tent, official tourism
guides, personal inter-
views with managers).
Article builds upon earlier studies
and validates existing models of By-
grå () and Timothy and Butler
() of promoting and managing
cross-border tourism destinations. The
research confirmed that tourist visits
are in positive correlation with low-
price shopping at the border. Lack of
a strategic marketing approach by in-
dividual border regions leads to weak
cross-border collaboration.
Bilateral
Wang, W.,
& He,Y.
()
Establishing new cross-
border cooperation in the
Xishuangbanna-North Laos
regions as a tourist destina-
tion considering opportunities
and obstacles, and exploring
spatial patterns (modes) like
‘core-edge’ or ‘point-axis’ de-
velopment mode and network
mode and their derivatives.
Case study,
Xishuangbanna-North
Laos Crossborder
Tourism Cooperation
Zone.
Conceptualization of cross-border
tourism cooperation and its signifi-
cance in promoting economic devel-
opment, international cooperation,
and safety issues among border coun-
tries. Highlights main attributes of
strategic management: research, skilled
teams, infrastructure, transport, com-
munication (marketing strategy), and
information networks.
Bilateral
Continued on the next page
resources (human, financial, etc.). Following a bet-
ter understanding of cross-border marketing, differ-
ent scales of cooperation have been identified through
reviewed articles, using the concept of the scope of
cross-border cooperation in a tourist destination (in
geographical and organizational terms). Most of the
articles (7 of them) dealt with bilateral cross-border
cooperation, of which 5 addressed cross-border coop-
eration within the Euroregion or Eurocities. The other
three articles were equivalent in terms of the scope of
cross-border cooperation: global (1), regional (1), and
local (1). All three dealt with bothmarketing strategies
and branding. Only three articles of bilateral scope of
cross-border cooperation addressed both marketing
and the need for branding of cross-border destina-
tions.
Through the authors’ research work, they identify
several opportunities as well as obstacles to further de-
velopment of a cross-border tourist destination as a
comprehensive tourist system, and in variousways, in-
clude the consideration ofmarketing strategies inmar-
ketplace strategies.
Academica Turistica, Year 16, No. 3, December 2023 | 319
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 5 Continued from the previous page
Author Key concepts Methods/samples Scientific contribution Scope
Liberato,
D., Alén,
E., Liber-
ato P., &
Domínguez,
T. ()
Enhanced conceptualization
of tourism in border territo-
ries beyond the transnational
level, by analysing regional
demarcation, geographical, le-
gal, economic scope, and local
identity.
Qualitative method.
Case study,  semi-
structured interviews
in , with expert
stakeholders from var-
ious economic fields
(including tourism).
Includes the concept of
data saturation.
Understanding of various dimensions of
cross-border tourism, revealing complex
relationships between tourists and local
communities, capturing individual expe-
riences, and contributing to sustainable
tourism growth strategies. Study re-
veals that creating promotional channels
with materialized, organized and imple-
mented tourism marketing strategies in
the context of promotion of Euroregions
is a pre-condition for success.
Bilateral
Woyo E., &
Slabbert, E.
()
Analysing Victoria Falls’ cross-
border marketing opportuni-
ties and examining motivations
for cross-border partnerships,
considering demand side of
socio-demographic character-
istics and supply-side factors.
Quantitative method,
using a demand and
supply-based survey
questionnaire. The data
were analysed using
descriptive statistics,
factor analyses and one-
way analysis of variance.
The article’s findings contribute to the
existing literature and results on four di-
mensions: experiences of tourists visiting
shared border attractions, and poten-
tial growth opportunities, challenges
and tourist motivations. It proposes a
new destination marketing framework
which employs all four dimensions from
both demand and supply aspect of cross-
border marketing.
Bilateral
Hrynokh,
N. V.,
Dmytruk,
V. I., Di-
achenko,
A., & Kni-
azevych, A.
O. ()
Article explores tourism devel-
opment in Carpathian Eurore-
gion, focusing on marketing
strategy, cross-border coop-
eration, and key indicators of
tourism flow, administrative
and territorial distribution.
Desktop research based
on existing strategic
documents of both re-
gions and official statis-
tics. Data from 
to  were studied.
Empirical research was
excluded.
A contribution of this article lies in the
identification and analysis of socio-
economic aspects of cross-border
tourism destination. Article’s key find-
ings are that greater activation in strate-
gic development is needed and an up-
dated marketing strategy for manag-
ing domestic, inbound, and outbound
tourism in Ukraine.
Bilateral
Continued on the next page
Opportunities for Cross-Border Cooperation
Cross-border cooperation can contribute tomany new
opportunities that need to be identified first. Cross-
border tourist destinations tend to face poorer eco-
nomic efficiency and have fewer competitive advan-
tages (Novotny, 2020; Liberato et al., 2018). Woyo
and Slabbert (2019) consider that the performance
of tourist destinations is in most cases measured in
terms of competitive advantages rather than coopera-
tion, especially in the context of cross-border cooper-
ation. Šerić et al. (2021), on the other hand, see cross-
border cooperation as a basis for brand management
and consider cross-border cooperation as valorisation
of existing tourism resources that contribute to greater
destination competitiveness.Wang and He (2016) em-
phasize that building cross-border tourism coopera-
tion strengthens relations and cooperation between
cross-border regions, stimulates the development of
tourism products, and encourages consumption in
the cross-border area by visitors and further devel-
opment of the tourism industry. They see tourism as a
bridge and, at the same time, as a carrier for multilat-
eral exchange and cooperation that strengthens trust
and creates benefits for all participants.
320 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 5 Continued from the previous page
Author Key concepts Methods/samples Scientific contribution Scope
Jurado-
Almonte, J.
M., Pazos-
Garcia, F.
J., & Cas-
tanho R. A.
()
Research of geographical
and institutional framework
of regions at the Spanish-
Portuguese border, Eurocities’
strengths, cross-border cooper-
ation, marketing strategies, and
future trends.
Qualitative method.
Survey with  ques-
tions, desktop research
(statistics, cartography),
by phone and in-person
interviews, in  and
.
The empirical study outlines the
strengths and weaknesses of six Iberian
Eurocities, identified by using several
critical factors for cross border coop-
eration from a perspective of being au-
tonomous cross-border cooperation
entities, fostering common public ser-
vices in cross-border areas (common
equipment and services within existing
infrastructure), and acting as territorial
lobbies for obtaining funding for projects
(promotion of a strong territorial strat-
egy). Concerning infrastructure and
management of cross-border regions a
coordinated marketing plan and adver-
tising are an important success factors.
Bilateral
Novotny, L.
()
The article discusses the im-
portance of communication in
cross-border cultural tourism
supply, focusing on media, ad-
vertising, and social media,
identifying deficiencies and
barriers to visitors. It focuses
on strategic marketing and
concepts of destination com-
petitiveness.
Quantitative method.
A questionnaire
among students on the
Czech-German border
(Labe/Elbe Euroregion).
Study synthesizes theories and principles
for strategic marketing and manage-
ment of tourist destinations in Czech-
German Borderland. Article provides
a deeper understanding of the various
dimensions of cross-border tourism
(motives, aspirations, beliefs, values, at-
titudes), explores complex relationships
(tourist-local communities), captures
the subjective experiences of individu-
als, and contributes to the development
of contextually relevant strategies for
sustainable tourism growth.
Bilateral
Continued on the next page
Promotional activities as an essential part of mar-
keting strategies are implemented in cross-border tour-
ism destinations or cross-border tourism products in
the form of building a single visibility that combines
two or more destinations in one promotional message
(Tosun et al., 2005). This way of cooperation brings
many advantages:
• the costs of promotion per country or tourist or-
ganization are reduced due to the sharing of costs
of mutual marketing activities (Liberato et al.,
2018),
• the promotional effects multiply as each country
further promotes the tourismproduct through its
own digital channels in its own country or abroad
(Woyo & Slabbert, 2019),
• increasing business opportunities, including op-
portunities for additional investment, additional
employment and innovation (Woyo & Slabbert,
2019),
• the possibility of joint financing of projects and
joint search for sources of project financing by
several cross-border destinations, for the same
project (Jurado-Almonte et al., 2020),
• greater and more efficient exchange of informa-
tion between countries, exchange of good prac-
tices and greater networking of other providers
Academica Turistica, Year 16, No. 3, December 2023 | 321
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Table 5 Continued from the previous page
Author Key concepts Methods/samples Scientific contribution Scope
Gerlitz, L.,
Meyer, C.,
& Prause
G. ()
The South Baltic Sea region
is experiencing a need for a
sustainable transition. The
article is seeking improve-
ments, focusing on a tailored
regional marketing and brand-
ing strategy connecting social
paradigms with environmental
ones and based on sociological
theoretical starting points.
Qualitative method. A
survey among  sme
companies in Denmark,
Germany, Lithuania,
Poland and Sweden.
Additional interviews
and field research were
undertaken. The re-
search was conducted
from July  to De-
cember .
The study focuses on research adopting
a holistic and processual perspective
and innovation-driven transformation
perceived from an ecosystem of cross-
border stakeholders, contributing to
regional development and Blue Growth
discourse in the South Baltic Sea Region.
Research of marketing and branding
strategies using existing resources and
innovation opportunities in three pillars:
resources, opportunities, and sustainable
ecosystem.
Regional
Šerić, N.,
Bagarić, L.,
Jakšić Sto-
janović, A.,
& Keković,
N. ()
Post-Covid, tourist behaviour
changes, specialized products,
and cross-border cooperation
are influencing marketing and
branding strategies. A new
model of expanded content
on supply aims to create new
specialized tourism products,
focusing on cross-border coop-
eration.
Qualitative method. In-
ternal and external anal-
ysis of tourist provider,
using swot, tows,
Pestec, Mof and Recoil
analysis models. Find-
ings were tested through
a survey of a sample of
representatives of travel
agencies.
A new model for creating specialized
tourism products post-Covid by linking
core, additional, and expanded content
with brand creation using marketing
strategy. It contributes also on what to
rely on the marketing strategies in the
post-Covid time: identifying characteris-
tics of the micro-location, infrastructure
upgrades (roads, recreational zone),
partnerships with supply entities and
resource concessionaires, including sus-
tainable environmental standards, eco
gastronomic offer, implementation of
digital user platforms.
Local
indirectly involved in the cross-border tourism
infrastructure (Makkonen, 2016; Woyo & Slab-
bert, 2019).
Gerlitz et al. (2021) believe that combining diver-
sity is a potential for development that can be realized
if a conceptual framework, financial resources and ad-
ministrative support are present. Šerić et al. (2021)
argue that it is possible to maintain competitiveness
by diversifying products, expanding content and im-
proving quality. These also need to be implemented
in marketing strategies and communicated through
brands, which will contribute to strengthening the
global brand awareness of a specialized tourism prod-
uct. The expanded contents of a specialized tourism
product open up opportunities for new outbound
tourist markets and attract new segments of tourists.
After cross-border mergers and acquisitions, the
brand or tourist brand is more effective as part of the
marketing plan because cultural barriers are also over-
come (Qi & Xiaoyan, 2014). Connecting companies to
clusters and networking creates better business visi-
bility and more marketing opportunities. The prin-
ciple of cooperation in cross-border regions, based
on such integration, is important not only from the
point of view of marketing but also from joint brand
management. It enables the integration of different in-
stitutions into a single framework, including different
stakeholders, setting common goals and highlighting
key values and initiatives to develop common strate-
gies. Sharing common goals and synchronizing them
is key to shared marketing success and branding as a
single cluster of interrelated stakeholders (Gerlitz et
al., 2021).
322 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
The marketing and brand strategy should be based
on three pillars and should be seen from the per-
spective of the ecosystem and processes, considering
the following strategic measures (Gerlitz et al., 2021;
Hrynokh et al., 2019):
1. the creation of tools for pooling, allocating and
(re)combining resources that lead to knowledge
excellence and, consequently, to the development
of innovation, thus achieving a sustainable orga-
nizational (regional) ecosystem;
2. providing key tools related to entrepreneurship
and creative discovery;
3. transforming cross-border regions into a brand
with a common vision for the future and a com-
mon strategic positioning.
Obstacles to Cross-Border Cooperation
Novotny (2020) and JuradoAlmonte et al. (2020) con-
sider that the main barriers to effective cross-border
marketing are inadequate infrastructure, organiza-
tional and information barriers, financial barriers re-
lated to visitor costs and logistical barriers. Woyo
and Slabbert (2019) perceive the greatest challenges
of cross-border cooperation in single marketing. The
biggest obstacles are the fear of losing a unique na-
tional identity, greater seasonality, budgetary con-
straints, difficulties in measuring a country’s perfor-
mance, uneven development between destinations,
different tourism policies and thus different market-
ing approaches, and a lack of economic links.
Wang and He (2016) point out that cross-border
tourism also faces obstacles that hinder the develop-
ment of tourism in these areas, such as:
• sensitivity to political influences along the bor-
der, from a geopolitical point of view, from inter-
national relations, and an economic point of view.
It is a question of the free movement of labour,
products and finance;
• infrastructure and support resources are usu-
ally weaker at the border than further inside the
country;
• the problem of the flow of investment and profits
across borders inhibits entrepreneurial activity;
• lack of uniform approaches and orientations in
the implementation and control of standards in
tourism;
• linguistic and cultural differences.
At the same time, stakeholders of tourist destina-
tions involved in the marketing activities of a cross-
border destination or tourist product face the chal-
lenge of finding a balance between competitiveness
and partnership. Beritteli (in Liberato et al., 2018) con-
siders that a principle of collaboration in the commu-
nities of tourist destinations is a prerequisite for their
planning and development. This makes it easier and
also more efficient to market destinations as single lo-
cales.
It is necessary to take advantage of both destina-
tions, especially in the case of cross-border cooper-
ation of a wider economic spectrum (Liberato et al.,
2018).
Some authors (Woyo & Slabbert, 2019; Makkonen,
2016) find that research into marketing opportunities
and challenges related to cross-border attractions is
limited due to a number of administrative barriers. As
a result, the topic is less researched, which is noted by
this literature review. The authors (Jurado-Almonte et
al., 2020) point out the following elements as critical
factors for the success of cross-border destinations:
• themost critical (marketing and advertising, com-
mon equipment and services, access to European
funds),
• mediumcritical (promotion of a strong territorial
strategy, development of consolidated strategies,
activation of the public),
• less critical (improved urban connectivity, pro-
motional strategies against the flight of young
and talented people).
Discussion
The marketing of a cross-border destination differs in
comparison to other inland tourist destinations in sev-
eral factors and restrictions that are conditioned by
the administrative border or other economic, social,
security, or institutional obstacles. Consequently, the
unifiedmanagement of a cross-border tourist destina-
tion is required as an optimal strategy. This marketing
Academica Turistica, Year 16, No. 3, December 2023 | 323
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
approach demands several mutual coordination, legal,
administrative and institutional adjustments of vari-
ous stakeholders involved in the planning, develop-
ment and implementation of marketing activities. The
number of stakeholders involved in the development
of a cross-border tourist destination and its products
depends at least on the geographical and institutional
scope, as shown in the model of Timothy and Saari-
nen (2013). Global partnerships in cross-border desti-
nations are less likely, and in tourism mostly present
as a part of global (hotel) chains. The results of the re-
view article indicate that most partnerships of cross-
border destinations are bilateral where two destina-
tions merge at a common frontier. Most cases in the
review were located in the European Union.
There is an evident lack of cited references in re-
viewed articles that would give a clear overview of
knowledge maturation on cross-border marketing
strategies of tourist destinations. Instead, we tried
to uncover some incipient reasons and events that
brought a few insights into the genesis of marketing
strategies in cross-border tourist destinations:
• Woyo and Slabbert (2019) detailed the first be-
ginnings of cross-border cooperation in tourism
back to the second half of the 20th century,main-
ly due to the overcoming of political barriers in
Europe and trends in growingmass tourism. The
development of marketing in cross-border desti-
nations emerged at the turn of the millennium;
• Makkonnen (2016) affirmed cross-border shop-
ping as an important advantage in developing
tourist destinations, already present in the 1990s
in North America (e.g. between the United States
and Canada). In several cases, they built a pro-
posal for a detailed action plan at a destination
marketing organization including a joint mar-
keting strategy with other nearby destinations.
He highlighted a model for cross-border shop-
ping from Timothy and Buttler (in Makkonen,
2016);
• Jurado-Almonte et al. (2020) substantiate the de-
velopment of cross-border cooperation between
Spain and Portugal around 1986 with the integra-
tion of both countries into the European Union
and later on with inclusion into the so-called
Schengen Area and the abolition of customs in
1995.
The review article confirmed that research interest
in the topic studied increased in the last decade.
The main focus of the review article above all aims
to contribute to a better understanding of scope, op-
portunities and barriers of collaboration in cross-
border destinations and within its usage of market-
ing strategies. Liberato et al. (2018, p. 1355) show that
border regions should move towards mixed ‘new gov-
ernance,’ considering that cross-border, as well as in-
terregional and transnational, cooperation only work
if administrative levels with different structures and
competencies cooperate across borders. They
should develop common cultural proximity, mutual
relationships and easy communication channels. They
think that the identity of a cross-border destination is
a key element when it comes to cross-border tourism.
Identity is strongly dependent on governance struc-
tures and how it is incorporated into cross-border des-
tinations. In such a manner it is an important part
of branding. Several authors (Novotny, 2020; Qi &
Xiaoyan, 2014; Šerić et al., 2021; Woyo & Slabbert,
2019) believe that the additional and expanded content
which is usually promoted in a cross-border tourist
destination, whilemerging individual tourist supply as
one unified product (Makkonen, 2016), should have a
greater significance inmarketing strategy and brand as
well. Marketing strategies are closely linked to brand-
ing. Brand integration should fully consider local cul-
tural factors and should be in line with the company’s
other strategies, adjusted to new entering markets (Qi
& Xiaoyan, 2014).
Gerlitz et al. (2021) confirm that better recognition
of cross-border destination abroad could be achieved
by addressing tourism-related and place branding or
regional identity-building issues. Strategic positioning
ismore successful if it is underpinned by the European
Union’s programmes. Qi and Xiaoyan (2014) connect
brand awareness as an image that should be spread
through a series of marketing activities, which result
not only in a positive product image but also in a qual-
ity awareness of the product and customer loyalty.
324 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Some authors (Gerlitz et al., 2021) argue that for
successful marketing strategies for cross-border proj-
ects aimed at greater market competitiveness, inno-
vative approaches are crucial, which include key ele-
ments of the so-called 7ps. Through the innovation
process, individual development stages are formed in
which stakeholders and beneficiaries combine differ-
ent processes of innovation approaches and simulta-
neously design and place the marketing elements. In
this way, an innovation ecosystem is created, from the
inside out. Thus, innovation competencies and man-
agement skills are built for further growth, business
transformation, competitiveness and differentiation,
where marketing strategies play an important role. All
reviewed articles highlight the significance of promo-
tion and product as the main two elements of mar-
keting mix; only a few give importance to the element
‘place’ as an important international and global inte-
gration of products (Qi & Xiaoyan, 2014) and as an
important channel of communications to customers
with suitable advertising to leverage a destination’s at-
tractions (Makkonen, 2016).
In addition to the 4ps marketing approach, an
extended 7ps marketing strategy considers also peo-
ple, process and physical evidence. Woyo and Slabbert
(2019) consider the process as a big challenge since
cross-border destinations often have different institu-
tional structures, policies andmarketing strategies and
thus reflect that a tight management process will be
needed.Makkonen (2016, p. 41) argues that the process
of marketing is not without difficulties and depends
on a large number of stakeholders involved in tourism
destination marketing. Consequently, this distortion
of process potentially leads to incoherence in the des-
tinationmarketingmaterials produced by different ac-
tors, and it is difficult to quantitatively measure the re-
sults and return on investment. An additional element
in marketing strategy, ‘people’ involved in the service,
distribution, and selling of product are also essential
(Kotler & Levy, 1969), providing as high a service qual-
ity as possible while achieving strategic organizational
goals. Cross-border cooperation is also beneficial in
solving challenges such as poor service quality (Woyo
& Slabbert, 2019). Some cross-border destinations im-
plement process integration through different Euro-
pean Union programmes and initiatives, such as Eu-
rocities or Euro Regions (Gerlitz et al., 2021; Hrynokh
et al., 2019; Jurado-Almonte et al., 2020; Liberato et al.,
2018; Wang & He, 2016), with all the benefits of sus-
tainable development and spatial cohesion. Tourism
is emerging as an important part of this integration
(Liberato et al., 2018). These integrations are followed
with several positive outcomes: stimulation of the de-
velopment of tourism products and improving the lo-
cal economy (Liberato et al., 2018; Wang & He, 2016),
increasing the competitiveness of the destination and
creating new market opportunities (Šerić et al., 2021),
including with regions beyond cross-border frontiers
(Hrynokh et al., 2019), which are usually implemented
gradually (Wang & He, 2016).
Conclusions and Implications
Although there are several opportunities for cross-
border cooperation found in the literature review re-
sults, still the disruptive site of cross-border destina-
tions is evident compared to inland destinations. The
study confirms that marketing strategies are imple-
mented sporadically and gradually and are mainly de-
pendent on additional (in Europe mainly the Euro-
pean Commission’s) co-financing.
As marketing strategies are only successful in the
medium or long term (Uran Maravić & Juvan, 2009),
there is a perceived lack of longer-term strategic part-
nerships between stakeholders in cross-border areas,
which consolidate the marketing position and pro-
vide a basis for designing and implementing market-
ing strategies.
Conceptualization of cross-border tourist collab-
oration and their importance in advancing economic
growth, global cooperation, and safety concerns among
bordering countries is crucial. It draws attention to the
key characteristics of strategicmanagement, including
research, upskilled teams, infrastructure, transporta-
tion, communication (marketing strategy), and infor-
mation networks. Understanding the diverse aspects
of cross-border travel helps destinations develop plans
for sustainable tourism growth. According to this re-
view research, a prerequisite for success in the context
of promoting cross-border tourist destinations is the
development of promotional channels with material-
Academica Turistica, Year 16, No. 3, December 2023 | 325
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
ized, structured, and implemented tourismmarketing
plans.
Through this literature review, it was found that
cross-border tourist destinations do not use systematic
approaches to the introduction of marketing strate-
gies; these are identified in the context of broader de-
velopment strategies of cross-border areas.
In rare cases, stand-alone brands are created to
consolidate destinations in the market and exploit the
marketing potential of two or more cross-border des-
tinations at the same time.
The literature review reveals interpretable patterns
of weak development of joint marketing strategies or
their complete lack, and only a gradual understand-
ing of the need for strategic marketing approaches in
cross-border tourist destinations and calls for addi-
tional (financial) stimulation.
The theoretical value of the article is identification
of different perspectives on cross-border tourist desti-
nation marketing strategies with additional character-
izations in terms of defining the scope of cross-border
cooperation, using a model adapted from Timothy
and Saarinen (2013). One major insight of this review
is also a need for theorization in cross-border tourist
destination marketing, since some of the articles re-
viewed did not utilize theories, frameworks or models
(e.g. Qi & Xiaoyan, 2014; Wang & He, 2016; Hrynokh
et al., 2019). They were mostly used in articles of the
latest dates of publishing, but with modest research of
theoretical backgrounds.
Synthesis of reviewed articles could help research-
ers identify the research areas and methodologies in
the future and compare them with past experiences
and findings to address the research gaps and unan-
swered or new questions.
The research showed also a need for further re-
search of the topic with additional keywords in differ-
ent combinations, such as brand(ing), destination mar-
keting and place (as a synonym for destination).
All of the articles discussed faced similar limita-
tions. Research in review articles mostly focused on
only one cross-border area, so it is not possible to
compare opportunities and obstacles between two dif-
ferent cross-border areas, to identify differences or
the causes of these differences. The articles also ad-
dressed the concepts of marketing strategies weakly.
These were mainly part of larger strategies or just one
of many elements within the research concept.
Therefore, in general, further research should fo-
cus on efforts observing and addressing more cross-
border regions in parallel with longer-term observa-
tion, and includemore detailed concepts of addressing
marketing strategies. Furthermore, this paper shows
several directions of additional development and re-
search ofmarketing strategies in cross-border destina-
tions. First, from a geographical perspective, at local,
bilateral, or regional and/or global levels, within or
in comparison between them and their benchmark.
The research focus could be on the perspective of re-
lationship networks, the scope and intensity of ties
between partners and their influence on the destina-
tion’s tourism activities. Second, from a strategic per-
spective, themanagerial aspect of implementing inno-
vation processes and their adoption in the marketing
of cross-border destinations, comparison of success-
ful models of strategic management in tourist desti-
nations, and feasibility of implementing those models
in cross-border destinations. Third, from a marketing
perspective, opportunities and barriers to implement-
ing marketing strategies at cross-border destinations
with deeper insight into possible usage of marketing
mix elements that influence promotion and commu-
nication of cross-border destinations.
However, features and opportunities of marketing
strategies in cross-border destinations should be dis-
cussed in parallel. In the context of research on mar-
keting strategies, it would be useful to pay special at-
tention to modern communication channels such as
different social media networks, which bring different
approaches to communication from traditional forms
and thus significantly influence the design of market-
ing strategies. Namely, marketing in the last, especially
post-Covid period is experiencing radical changes. It
is mainly focused on digital communication channels
and is successfully transmitted to social media chan-
nels.
Overall, this paper contributes to showcasing the
important role of cross-border marketing strategies
and paves the way for more detailed research into the
topic in the future.
326 | Academica Turistica, Year 16, No. 3, December 2023
Alenka Pahor Žvanut and Ksenija Vodeb Marketing Strategies
Notes
In this research article terms ‘tourist destination’ and
‘tourism destination’ are used depending on the con-
text of the content of articles and according to scien-
tific terminology. The term ‘tourist destination’ refers to
delineated geographical tourist areas, whereas ‘tourism
destination’ reflects also the management of the tourist
destination.
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328 | Academica Turistica, Year 16, No. 3, December 2023
Original Scientific Article
Bibliometric Analysis of Online Collaboration
in Travel Agencies
Jorge Raúl Avilas Hernández
University of Holguin, Cuba
jorgeraulavilahdez@gmail.com
Nolberto Cruz Aguilera
University of Holguin, Cuba
nca790913@gmail.com
Félix Díaz Pompa
University of Holguin, Cuba
felixdp1978@gmail.com
Maja Borlinič Gačnik
University of Maribor, Slovenia
maja.borlinic@um.si
With the integration of ict in the distribution channels, the client is increasingly in-
dependent and autonomous in obtaining tourist services and products. The covid-
19 pandemic and global physical distancing policies reinforced this, detrimentally
for traditional travel agents, who have been forced to migrate totally or partially to
an online business model. However, working online is not enough since it is nec-
essary to have online collaboration strategies that facilitate the positioning of each
participant in a hostile competitive environment. The research is developed through
a bibliometric study, using the information obtained in the Scopus database to es-
tablish the state of knowledge about online collaboration in travel agencies. Various
Excel, Bibexcel, EndNote x20, Pajeck, SciMath, and vosviewer software were used
to analyse indicators and map bibliometric networks. The results show that the state
of cooperation between travel agencies as a factor of advantage in the new tourist en-
vironments is characterized by fierce competition and the strong impact of the digital
age, which constitute the main innovative contribution of the study. It is also deter-
mined that the research topic has not had high productivity in the database. Among
the main research gaps identified are online collaboration in traditional travel agen-
cies and the impacts of cooperation on customer perception and cybersecurity. The
study identifies the field’smost influential authors, journals, publications, key themes
and trends that have emerged over time. By identifying the critical success factors
and challenges of online collaboration in the travel industry, this study can help or-
ganizations to improve their collaboration practices.
Keywords: bibliometric analysis, online collaboration, Scopus, travel agency
https://doi.org/10.26493/2335-4194.16.329-344
Introduction
The tourism sector is generally immersed in a very
complex and dynamic operating environment due to
technological innovations, increased consumer de-
mand, intense competition, and distribution systems
changes attributable to technology development (Agu-
iar-Quintana et al., 2016; Ambrož & Omerzel, 2018).
For this reason, in the tourism sector, it is necessary
that all the actors constantly participate and, at the
same time, receive both primary and complementary
training to face the challenges imposed by the devel-
opment of new technologies (Mekinc et al., 2022).
The main reason behind this is that the tourism in-
dustry supports Internet-based distribution channels
Academica Turistica, Year 16, No. 3, December 2023 | 329
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
more, mainly due to the characteristics of the services
it generates: exhaustible and non-storable (Castillo-
Manzano & López-Valpuesta, 2010). With the ad-
vent of new technologies, consumer behaviour, travel
planning, and purchasing products and services have
also changed radically (Chang et al., 2018). With the
widespread use ofmediawith increasingly intuitive in-
terfaces, users generate and receive information in real
time. Each experience, fundamentally those associ-
atedwith tourism, leisure, and recreation, generates an
incredible volume of multimedia information, which
most users use as a pre-purchase evaluation criterion.
Considering the above and according to the profiles
and demand segments, we could speak of intelligent
tourists to the extent that they have more knowledge,
are more demanding, are connected, and share data
(Ivars Baidal et al., 2016).
Information and communication technologies have
indisputably been integrated into the tourism indus-
try. Traditional business models have changed sub-
stantially. As defined (Liang & Wang, 2011), ‘in terms
of its characteristics and models of services and con-
tent, the tourism industry is much more adaptable for
the online process.’ The development of these models
and their premature integration into tourist activity
led to entry into the era of electronic commerce (Guo
et al., 2014).
However, this development has undergone a lot of
modifications and has acquired actual shape in the
last 20 years (Liang & Wang, 2011), although it con-
stantly undergoes changes through the introduction
of new technologies such as the development of arti-
ficial intelligence (ai) in the so-called industrial revo-
lution 4.0 (Fedorko et al., 2022) and the introduction
of crypto-assets as a means of exchange (Aydoğan &
Aydemir, 2022).
Considering the above, it is easy to understand that
positioning itself in the online environment is a prior-
ity task for any tourism company. In this sense, it can
be said that for traditional intermediaries, it has been
quite tricky. The competition among these tourist ac-
tors is at a higher level. Technology has posed an enor-
mous challenge for the traditional forms of intermedi-
ation and promotion because its main strength lies in
the main weaknesses of these activities: the distance
to complete the acts of buying and selling, the greater
reach of the public and the reduction of costs for bro-
kerage concepts, which translates into more competi-
tive prices (Chang et al., 2018). New technology, there-
fore, constitutes one of the variables in the mandatory
care environment needed to attain the competitiveness
of any company in the environment in which it oper-
ates. In addition, ‘its future will depend on its correct
application in any business model’ (Aguiar-Quintana
et al., 2016; García & García, 2017).
Being such an essential link in the travel industry
has served well for travel agencies for more than 80
years. Initially, travel agencies were just brokers, paid
by airlines and other travel players to distribute their
products. The role of travel agencies in the tourism
industry has been influenced by the consolidation of
the sector and the advent of new technologies (Aguiar-
Quintana et al., 2016; Kutty & Melwin Joy, 2020).
Technology integration has generated new com-
petitors for travel agencies (Capriello & Riboldazzi,
2021), such as the classic integrated tour operators
that dominate their distribution channels. Tour op-
erators restructure their positioning strategies using
the Internet’s broad spectrum of tools. In this way,
they reach more customers who, through the online
medium, have access to millions of Internet possibili-
ties. The modern consumer has little free time to plan
all the details and review all possible offers, which is a
critical factor for companies. Among the main com-
petitors, we can mention the well-known web pages
selling tourist products and services, such as Expedia,
E-Dreams, Travelocity, and other online travel agen-
cies (otas). All these competitors have forced tradi-
tional intermediaries to move part of their business to
a virtual environment to remain competitive. In doing
this, new clients are not limited to making a simple
reservation by phone. Instead, they can use extensive
resources and e-tools to opt for services and products
with a level of personalization which cannot be found
otherwise: consult user opinions, compare prices, and
find more information regarding the selected destina-
tion (Mendoza García, 2018).
According to Slusarczyk et al. (2016), it is not eno-
ugh for intermediaries to develop the marketing of
their offers online since, in this environment, compe-
330 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
tition is even fiercer. At this point, these actors must
adopt online collaboration strategies to form multi-
ple market networks (Liang & Wang, 2011), which al-
lows them to take full advantage of the Internet phe-
nomenon. This will give each of the actors in the col-
laboration competitive advantages in the face of envi-
ronmental changes.
Most travel agents around the globe understand the
importance of cooperation, which is why they develop
competitive and cooperative relationships with their
counterparts in search of improving the development
performance of their products (Ku et al., 2013). With
this in mind, they need to know their positions and
roles in the industrial network.
Analogous competitors may share the market and
temporarily group customers to organize tour groups
(Chang, 2020). There is no doubt that this horizontal
collaboration is vital for the competitiveness of travel
agencies since the changing market of the travel in-
dustry requires strategic formulation based on feed-
back where collective knowledge is the central repos-
itory in which all beneficiaries of the alliance sup-
port themselves. However, collaboration with other
tourism players is vital for the correct functionality
of the travel agency, its existence, and online business
model, whose heart is the website. Regarding the first
criterion, Aguiar-Quintana et al. (2016) note that: ‘the
intermediary role of a travel agent requires a high de-
gree of communication and cooperation between con-
sumer and provider;’ this element can be observed in
the fundamental participation of dissimilar actors in
the creation of tourist packages.
The collaboration and formation of strategic al-
liances have been concepts widely studied, and from
different points of view. According to researchers such
as Marisol (2019), it is the process of combining ef-
forts, resources, and talents in the achievement of
a joint project, which among other benefits, allows
the achievement of competitive advantages (Ramírez
Orozco & Valencia, 2019; Išoraitė, 2009) from the
balance of collective objectives over individual ones
(Kazakova et al., 2018). Among the aforementioned
competitive advantages is the establishment of a bet-
ter preparedness to face the insecurities of the environ-
ment in the business sector imposed by globalization
(Išoraitė, 2009). It is also essential for solving prob-
lems for small and medium-sized companies (Mora
Castellanos et al., 2019), investment sharing, resources
(Hernández Leal et al., 2019), risks, knowledge, and
the possibility of entering new markets and reducing
costs.
Themain differentiating element of this traditional
type of collaboration is the use of technological tools
applied to these forms of cooperation. These tools are
presented to tourism businesses as platforms to join
efforts in the marketing process in the online environ-
ment (Abou-Shouk, 2022).
The advantages offered by this type of collabora-
tion, specifically in the network in which the travel
agency operates, are: reduction of costs for online op-
erations; integrated digital marketing actions, access
to new market segments offered by the integration of
technologies; improvements in knowledge manage-
ment applicable to the measurement of consumer be-
haviour; the creation of onlinemanagement platforms
that standardize operational communication between
each of the actors in the collaboration network; as well
as the advantages stated above of traditional forms of
collaboration.
Virtual collaboration relationships in travel agen-
cies can be summarized in two fundamental aspects,
‘Business-Business’ (b2b) and ‘Business-Consumer’
(b2c) relationships. In the b2b e-commerce of the
travel market, the wholesaler can develop virtual dy-
namic transaction platforms where buyers and sup-
pliers are brought together. From the point of view of
value chains, to be more efficient, a b2b collaboration
model enables travel agencies to improve performance
with the offer of electronic services (Huang, 2006).
As in traditional forms of collaboration, the rela-
tionships that can be established horizontally and ver-
tically are considered; however, this new medium has
generated a unique factor to consider, which is vital
for a travel agency and any online business – the con-
sumer. A satisfied customer acts as a powerful ally who
will unwittingly serve as a promoter because of the
mass feedback they generate about everything they
experience. For this reason, a second collaboration
model, b2c, focused on the consumer, is necessary
(Anas &Wee, 2020).
Academica Turistica, Year 16, No. 3, December 2023 | 331
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
The integration of Information and Communica-
tion Technologies in the collaboration networks of the
tourism system, specifically those with which tourism
intermediaries interact, has not been deeply studied.
This is because it constitutes an emerging topic in the
scientific literature closely linked to the development
of Information andCommunicationTechnologies and
its integration into the tourism industry, specifically
the travel industry.
The paper uses bibliometrics (Kresic & Gjurasic,
2023; Demir & Zečević, 2022), an analytical tool for
identifying the established online cooperation of travel
agencies as a factor of advantage in newer tourism en-
vironments characterized by modern ict tools. The
scientific questions that will focus the research process
toward the achievement of its general objective are as
follows:
• Has the topic investigated been productive?
• Howupdated is the bibliography available in Sco-
pus?
• Are there authors and impact scientific journals
that have systematized research to date?
• Who/which are the authors, journals, and docu-
ments with the greatest impact?
• How has authorial collaboration behaved?
• What are the main thematic lines the research
topic has moved through?
• What are the main research gaps?
Methodology
A methodology composed of logical steps that con-
stitute the common thread for developing the biblio-
metric analysis was used. It starts with selecting the
terms to build the search equation for publications
on online collaboration in travel agencies. The equa-
tion is defined as follows: ‘travel agency’ and (Col-
laboration or Coopetition or Alliance) and (On-
line or e-commerce or electronic commerce). The
articles indexed in the Elsevier Scopus database were
selected, coinciding with the criteria of Codina et
al. (2020), considering that it constitutes one of the
databases with the most significant impact on the so-
cial sciences (in 2020, this database had a represen-
tative coverage with 38,589 scientific journals in all
Figure 1 Methodology System for the Development
of the Bibliometric Study
research areas). The data is exported in ris and csv
files. Subsequently, these outputs are normalized using
the EndNote x20 software. 0 positives and duplicates
are recorded, so a total of 25 articles obtained from
the Scopus database that meet the search criteria are
documented. Bibliometrics has a quantitative charac-
ter based on the analysis of productivity and citations,
and qualitative based on the state-of-the-art mapping
and the study of social networks. Figure 1 shows the
aforementionedmethodological framework of our re-
search.
A set of three bibliometrics was detected (Table 1),
whose objective is to know the behaviour of the scien-
tific literature on collaboration in the tourism sector
(Ávila-Hernández et al., 2022; Chim-Miki & Batista-
332 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Table 1 A Set of Three Bibliometrics
Category Chim-Miki and Batista-
Canino ()
Cruz Aguilera et al.
()
Ávila Hernández et al.
()
Procedure for development of bibliometrics Yes Yes Yes
Database Scopus and wos wos Dimensions
Study period – – –
Systematic Literature Review (slr) Yes Yes Yes
Methodology for slr No No No
Bibliometric
indicators
Productivity Per Time × × ×
Per Author × × ×
Per Country ×
Per Affiliation ×
Per Journal × ×
Citations Per Authors × ×
Per Institutions ×
Per Journals ×
Per Documents × ×
Per Countries × ×
Thematic Index
Scientific Index
Recency Price ×
References usefulness ×
Half-life ×
Age of references ×
Impact Authors H-index
Journals H-index
G Index
Bradford Law
Network Co-authorship ×
Co-citation
Co-occurrence
Citation ×
Maps Time
Word Clouds
Strategic map
Tree map
Dendrogram
Canino, 2017; Cruz Aguilera et al., 2018). For this rea-
son, even though their field of research is broader, they
are taken as a precedent.
As previously mentioned, the indicators and other
elements of analysis are declared based on the scien-
tific questions (Table 2). This corresponds to the final
phase of the procedure and is fundamentally aligned
with the general research strategy.
Further, a literature review is developed to deter-
mine trends and future research gaps to complement
the analysis of the strategic framework. This is guided
by the prisma (Preferred Reporting Items for Sys-
tematics Reviews andMeta-analysis) protocol (Moher
et al., 2009). This analysis has four phases:
1. Identification
Academica Turistica, Year 16, No. 3, December 2023 | 333
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Table 2 A Set of Scientific Questions
Scientific questions Analysis unit Software
Has the subject been extensively studied? Productivity per year Bibexcel and Excel
Are there authors and impact scientific journals that have
systematized research to date?
Productivity per author
Most frequent magazines
Bibexcel and Excel
How up-to-date is the bibliography available in Scopus? Price Index Bibexcel and Excel
Who/which are the authors, journals and documents
with the greatest impact?
Price Index
Citations per authors
Citations per documents
H Index per author
Bibexcel and excel
How has authorial collaboration behaved? Collaboration between
authors (map)
Collaboration between
countries (map)
Bibexcel, Excel, ucinet , Net-
Graph, Pajeck, Vos Viewer
What are the main thematic lines through which the
research topic has moved?
Strategic chart SciMat
What are the main research gaps? Strategic chart
Systematic Literature review
SciMat
2. Presentation
3. Eligibility
4. Inclusion
The method proposes the consecutive and gradual
application of exclusion criteria in each phase. In the
first instance, during identification, articles are usu-
ally excluded through false positive and duplicate cri-
teria. In the second phase, quality exclusion criteria
are introduced, such as detailed information on the
methods used or the results obtained. The appropri-
ate design of the study and the quality of the jour-
nals in which they are housed is the third phase. In
its last phase, the articles whose content will be com-
pletely analysed are defined, resulting from the exclu-
sion in the eligibility phase. The exclusion criteria of
this phase consist of the total review of the content and
the elimination of articles whose basic focus is not the
analysis of online collaboration in travel agencies.
The bibliographic review details the selection pro-
cess of clinical articles to be analysed and theworkflow.
prisma is used to determine trends and future
research gaps, as defined in the materials and meth-
ods section. The workflow is detailed in Figure 2. The
first phase of this procedure coincides with the search
process and filtering of search results carried out in
the bibliometric analysis, so the number of articles re-
mains unchanged (n = 25).
Results
Bibliometric Indicators
Productivity per Year
Although collaboration between competitors is awide-
ly studied topic in industry areas, it has not had the
same follow-up in the travel and leisure industry
(Chim-Miki & Batista-Canino, 2017). For this rea-
son, it can be stated that online collaboration between
travel agents to achieve common objectives regarding
the management of electronic commerce is a novel
subject, as the first article was only published in 2001.
It is also necessary to consider that the development
of this theme is conditioned by technological innova-
tions and the degree of integration of these into tradi-
tional tourism distribution channels.
Figure 3 shows an increasing trend from the date
of the first publication. It is observed that until the
year 2022, only 25 publications related to the research
topic have been registered in the database. The anal-
334 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Records identi-
fied through data-
base search: Scopus
(n= 25)
Records removed:
duplicates (n=0),
false records (n=0)
Records screened
(n= . . .)
Records excluded
after quality
assessment (n= . . .)
Full text assessed for
eligibility (n= . . .)
Excluded irrelevant
articles based on full
texts (n= . . .)
Studies included in
review (n= . . .)
Id
en
ti
fic
at
io
n
Sc
re
en
in
g
El
ig
ib
ili
ty
In
cl
ud
ed
Figure 2 prisma protocol
0
1
2
3
4
5
6
2001 2004 2007 2010 2013 2016 2019 2022
y = 0.09664x + 0.8952, R2 = 0.1502
Figure 3 Analysis of Productivity per Year
ysis of Figure 3 shows that despite the importance of
the research topic, it did not have the development that
would be expected if it were compared with other re-
search topics, at least in this database.
Almost half of the investigations have been pub-
lished in the last five years. Eleven of the 25 are grouped
within the period 2017–2022, meaning that the bibli-
ography available to continue with this line of research
has a topicality rate of 44.
Authorship Analysis
Table 3 shows compliancewith the generalization dem-
onstrated by Lotka’s law in that at least 60 of the au-
thors of a research field make a single contribution in
Table 3 Analysis of Productivity and Systematicity of the
Authors
Authors () () ()
Guo, X.; Ling, L.   .
Rose, A. N. M.; Ozdemir, O.; Neysen,
N.; Pastor-Ruiz, R.; Rivera-García,
J.; Hsu, L.; Ozturk, A. B.; Leung, R.;
Kizildag, M.; Knudsen, D.-R.; Huang,
C.-C.; Kot, S.; Beldona, S.; Lan, Y.-
C.; Belleflamme, P.; Barnett, M.; Ji, J.;
Bourmistrov, A.; Ghanem, W. A. H.
M.; Fan, Y. W.; Kaarbøe, K.; Lan, Y.-
C.; Fernandez-Villaran, A.; Kurth, B.
L.; Liang, Z.; Nayar, A.; Mody, M. A.;
Huang, L.; Lin, C.-N.; Adi, S.; Saany,
S. I. A.; Yang, L.; Yan, H.-L.; Yeh, C.-
C.; Zheng, X.; Zhang, T.; Yusoff, M. H.;
Xiong, H.; Smolag, K.; Slusarczyk, B.;
Shen, C.-C.; Standing, C.; Wang, S.;
Tekin Bilbil, E.; Gao, Z.; Abou-Shouk,
M. A.; Starosta, K. D.; Ku, E. C. S.;
Ching, R. K. H.; Chen, K.; Chen, J.-S.;
Chen, J.-S.; Compart, A.; Dogru, T.;
Dogru, T.; Delgado-Ballester, E.; Budz,
S.; Altin, M.; Hui, A. C.; Hernández-
Espallardo, M.
  .
Notes Column headings are as follows: (1) number of sig-
natures, (2) number of authors, (3) productivity index.
the period. At the same time, as the number of contri-
butions from a single author increases, the number of
authors with that number of publications decreases. It
can be calculated using the formula:
xnyx = c, (1)
where yx is the number of accredited authors with x
number of publications, n and c are the constants that
need to be estimated (Antoinette Askew, 2008).
Based on the previous analysis focused on the
number of authors, the equation that follows the pre-
cepts of Lotka’s Law is related, but that focuses on the
classification of productivity. From the analysis it is
obtained that only 3.22 of the authors have a produc-
tivity index of 0.33, and the remaining 96.78 have
only one publication, so their productivity index is
zero. Therefore, no author can be considered prolific,
Academica Turistica, Year 16, No. 3, December 2023 | 335
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Table 4 Most Cited Authors
Authors References Authors References
Huang, L.  Kizildag, M. 
Delgado-Ballester, E.  Mody, M. A. 
Hernández-Espal., M.  Ozdemir, O. 
Guo, X.  Ozturk, A. B. 
Ling, L.  Zhang, T. 
Yang, C.  Kot, S. 
Zheng, X.  Slusarczyk, B. 
Barnett, M.  Smolag, K. 
Standing, C.  Fan, Y. W. 
Altin, M.  Ku, E. C. S. 
Dogru, T. 
not equalling or exceeding ten publications (Table 3).
The Lotka productivity index is calculated through the
relationship: Ip = log 10n (Cruz Aguilera et al., 2018).
The low productivity values may be due to the
high-quality standards required by the journals in-
dexed in the database. Only two authors exceed a sin-
gle publication: Guo, X. and Ling, L.
TheMost Cited Authors and h-Index
Once themost prolific authors have been analysed, lo-
cal authors (authors appearing in the research refer-
ences and in the list of researchers who have published
on the subject) are analysed.
As shown in Table 4, Guo, X., and Ling, L. are
among themost cited authors, with 51 references each,
divided between their two publications on the subject.
Although having only a single publication, Huang,
L., receives 54 citations for a single work; Delgado-
Ballester (50), Hernández-Espallardo,M. (50); Zheng,
X. (43); Yang C. (43); Barnett, M. (40) and Standing,
C. (40) also equal or exceed the 40 citations received.
Table 5 shows the relationship between the h-index
and the number of citations. Local authors with 40 or
more received quotations are selected. The h-index is a
quality indicator that relates the number of sources to
the author’s productivity. Guo, X. and Ling, L. are es-
sential authors on the quality of scientific production
regarding the research topic.
Table 5 H-Index
H-index/authors Citations H-index/authors Citations
 Huang, L.   Yang, C. 
 Guo, X.   Zheng, X. 
 Ling, L.   Standing, C. 
 Delgado-Ballester, E.   Barnett, M. 
 Hernández-Espal., M.    authors >
Collaboration Between Authors
This indicator makes it possible to measure the extent
of the collaboration between the actors in developing
research topics. The collaboration index, which results
from the ratio between apparent signatures and the
number of articles (Cruz Aguilera et al., 2018), is 2.51,
which is equivalent to an average of almost three au-
thors per article. Decomposing this result, it is deter-
mined that collaborative investigations predominate
since they represent 80 of all studies and over 20
of inquiries done by one author. Figure 4 presents the
collaboration network between authors.
Productivity by Country, International Authorial
Collaboration
The analysis of this indicator (productivity by coun-
try, international authorial collaboration) determines
that more than 50 of the research comes from Asian
universities, which is presented in Figure 5.
Taiwan has the highest number of contributions in
this regard (see Figure 6), with six studies on the re-
search topic. This is due to the environmental condi-
tions that are better for establishing strategic alliances,
the growing number of small business travel agencies,
and the pressure that e-commerce imposes in such a
competitive industry, as expressed by Huang (2006).
Next is China with five studies, the United States with
three, Spain andAustralia with two, and the remaining
countries with only one study.
When analysing collaborations between authors, it
can be seen that relationships between authors from
the same country predominate. Only Taiwan registers
international associations with the United States and
Australia.
336 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Figure 4
Collaboration Network
between Authors
Taiwan () .
China () .
usa () .
Australia () .
Norway () .
Belgium () .
Poland () .
Romania () .
Turkey () .
Malaysia () .
Indonesia () .
Figure 5 Representation Map of the Distribution
of Investigations
Figure 6 Collaboration Network by Country
TheMost Cited Documents
The most important document regarding the level of
citations they have received (over 50 sources) are the
articles by Huang (2006) with the title: ‘Building up
a b2b e-commerce strategic alliance model under an
uncertain environment for Taiwan’s travel agencies,’
Delgado-Ballester and Hernández-Espallardo (2008):
‘Building online brands through brand alliances in the
internet,’ and Guo et al. (2014): ‘Online coopetition
between hotels and online travel agencies: From the
perspective of cash back after stay.’
The first investigation starts from the decomposi-
tion of the theory of strategic alliances in four dimen-
sions with a specific order:
1. the environmental conditions for the establish-
ment of partnerships,
2. the inter-organizational motivation,
3. the selection of the collaborators, and
4. the evaluation of the performance of the strategic
alliances.
Subsequently, Guo et al. (2014) determine the vari-
ables that fall within the dimensions previously de-
fined in the context of Taiwan, based on a set of surveys
focused on general travel agencies, tour operators, and
Internet Service Providers (isps). These variableswere
used to establish the b2b model in the travel agencies
of the destination.
The research byDelgado-Ballester andHernández-
Espallardo (2008) focuses on brand alliances. Specif-
ically, it addresses the effect that the online purchase
of a product from a new agency that has developed a
Academica Turistica, Year 16, No. 3, December 2023 | 337
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
Table 6 Most Cited Documents
Authors Citations
Huang () 
Delgado-Ballester et al. () 
Guo et al. () 
Barnett and Standing () 
Kizildag et al. () 
Slusarczyk et al. () 
Ku and Wen Fan () 
collaboration with another well-known agency with
a brand reputation has on the consumer’s perception.
The novelty of the research is that this topic had tradi-
tionally been studied in the online context.
The study conducted by Guo et al. (2014) values
the collaboration established between hotels and on-
line travel agencies to distribute rooms in the same
hotel. The pricing policies of both actors are analysed,
with the result that, as part of the alliance, online dis-
tribution was agreed upon through both channels at
the same price. However, due to the guarantee of ob-
taining rooms, clients prefer to purchase directly with
the hotel. For this reason, the otas have defined a
new pricing strategy: paying a percentage (cash back
after stay) to customers who buy through the post-use
platform, intending to attract consumers. The research
objective is to evaluate consumer behaviour through
an economic game analysis. Within Table 6 we can
check seven of the most cited documents according to
research in the area of online collaboration in travel
agencies.
TheMost Productive Journals
A total of 24 journals have indexed the 25 publications
on the research topic, which are presented in Table
7. Among the related journals, only the International
Journal of Contemporary Hospitality Management sur-
passes a single article.
The Thematic Structure of Online Collaboration Between
Travel Agencies and Research Opportunities
Figure 7 shows a strategic diagram resulting from pro-
cessing the authors’ keywords and the words defined
Table 7 The Most Productive Journals
Journal Articles
International Journal of Contemporary Hospitality
Management

Journal of Revenue and Pricing Management 
Journal of the Operations Research Society of China 
International Journal of Multimedia and Ubiquitous
Engineering

Total Quality Management and Business Excellence 
Tourism Management 
Tourism Management Perspectives 
Journal of Travel and Tourism Marketing 
Journal of Vacation Marketing 
Technological Forecasting and Social Change 
Actual Problems of Economics 
Advances in Tourism Economics: New Developments 
Figure 7
Strategic
Chart
by the sources (index keywords) through SciMat. The
strategic framework distributes the different thematic
groups into four quadrants that delimit the axes of cen-
trality (x) and density (y). Each labelled globe consti-
tutes the central node of particular networks in which
other thematic axes are related, in this case, based on
conglomeration algorithms. The distribution is de-
fined as follows:
• First quartile (>x/2; <y/2): Specialized topics
• Second quartile (<x/2; <y/2): Motor themes
• Third quartile (<x/2; >y/2): Basic issues
338 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
• Fourth quartile (>x/2; >y/2): Emerging or disap-
pearing themes
In quadrant ii we can detect the motor themes
within the thematic line of study, which are much
more easily related to other fields of knowledge (Díaz-
Pompa et al., 2022). Within this quadrant are ‘Book-
ing.com,’ air transport, business information technol-
ogy, complementary products, demand model, net-
work analysis, and business processes.
The essential underdeveloped topics in the third
quadrant constitute research opportunities. Delimited
by this quadrant are traditional travel agencies, com-
petition, social networks, competitive advantages, and
competitiveness.
Other elements such as environmental changes,
economic and social effects, demandmodels, business
models, brand equity, and digitization constitute the
peripheral issues since they present trivial importance
for the research field. These are in the first quadrant.
Finally, there are electronic commerce, online trav-
el agencies, relationship management, distribution
channels, blockchain technology, online booking, and
collaborative marketing. These are emerging or disap-
pearing topics, which, if classified as the first group,
constitute a potential study gap.
In Figure 7, it can be seen that the transversal
themes located in the third quadrant, more than ba-
sic themes, are evidenced as the original themes of
the selected field of research and constitute the trigger
for the need for their study. The reason is that tradi-
tional travel agencies with their respective distribu-
tion channels are entering an increasingly competitive
market heavily dependent on technology. Therefore,
they need to focus their strategies on using the nu-
merous and changing tools provided by the Internet
to achieve competitive advantages in commercializ-
ing the services and products they offer, compared to
millions of competitors in the networks, through col-
laborative ties, but in the online medium.
Online collaboration relationships are studied be-
tween the same traditional travel agencies (Barnett
& Standing, 2001; Delgado-Ballester & Hernández-
Espallardo, 2008; Huang, 2006), and between travel
agencies and other actors within the tourism system
(Abou-Shouk, 2022). Barnett and Standing (2001) see
online collaboration as a massive opportunity in the
face of the growing disintermediation trends faced by
traditional travel agencies. It also reports other advan-
tages of this type of collaboration.We should consider
that it is necessary to adopt online media and chan-
nels to carry out marketing. It turns out that the in-
vestment for developing web pages in travel agencies
is not high when compared to traditional ways of revi-
talizing their products and services. The authors note,
among other things, that online collaboration between
traditional travel agencies can improve competitive-
ness in the market, can increase customer satisfaction
and loyalty and efficiency, and reduce costs, leading to
increased competition and reduced profitability.
Electronic commerce gives even more dynamism
to the environment of tourist activity; therefore, ignor-
ing or underusing the new tools places any tourism
company at a clear competitive disadvantage. That is
why the competitive space of the tourism industry,
specifically the travel industry, is undeniably condi-
tioned by the development of icts. For the year 2011,
according to Liang and Wang (2011), there was an in-
crease in the number of small andmedium-sized travel
agencies, which were characterized by the develop-
ment of their e-commerce model, the lag in the use of
online marketing, and underdevelopment of informa-
tion and lack of understanding of the connection at
the enterprise level.
This lag and the underutilization of the competitive
advantages offered by the online medium took its toll
on many tourist intermediaries. However, it should
be noted that travel agencies with a particular market
niche have not been so affected (Rodríguez Cid et al.,
2015).
External factors such as the development of the
covid-19 pandemic, economic crisis, and inflation at
a global level further increased the instability of the
environment in which the tourism system develops in
travel agencies and further accelerated the paradigm
imposed by the new technologies (Hernández Flores
et al., 2021).
The truth is that all these external factors are a re-
minder that the integration of technology in each of
the areas of the business models of tourism companies
Academica Turistica, Year 16, No. 3, December 2023 | 339
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
is not just a trend but rather a necessity, as defined by
Hosteltur (2022), and clarifies the undeniable need for
digitization for travel agencies through e-commerce
platforms such as Traveltool that allow, among other
things, omnichannel, visibility and presence on the in-
ternet, crm for customer management and portfolio
control, and improved knowledge management.
Sadly, the mere involvement of travel agencies in
the online environment does not guarantee their suc-
cess at all; it is necessary to go further based on for-
ward-looking strategies that take into account new
forms of closer cooperationwith service providers and
competing agencies in search of reduced costs for op-
erations, combine efforts in co-marketing campaigns
that expand potential markets, and build strong in-
formation channels that also make it possible to im-
prove knowledge management, among other benefits.
As Barnett and Standing (2001, p. 143) state in their ar-
ticle ‘Repositioning travel agencies on the Internet:’ ‘A
rapidly changing business environment, driven largely
by the Internet, requires companies to rapidly develop
new affiliations and alliances.’
Another of the models analysed by the authors is
that of co-alliance. It focuses on collaborative design,
engineering, or providing electronic support between
companies. This type of cooperation shows the advan-
tages and opportunities that the web offers. A group
of agencies can form consortiums and generate more
effective transactions for the network. Alliance mem-
bers would otherwise remain independent. However,
they share costs, web development, maintenance, and
promotion. Other models are analysed, such as star
alliances, value alliances, marketing partnerships, and
virtual corridors.
Huang (2006) not only shows the opportunities of
strategic alliances between travel agencies to improve
tourism competitiveness considering the changing en-
vironment; rather, he shows the value of the relation-
ship established between intermediaries and differ-
ent service providers to grant reciprocal added value
to their goods and services through the b2b online
business approach. An online b2b transaction mech-
anism is built on a platform capable of finding themost
like-minded partners, establishing ties upstream with
suppliers and downstream with distributors and retail
agencies to reduce costs. Among the benefits of this
type of alliance that the author shows are:
1. Transaction costs decrease for both parties when
they are automated or partially online;
2. The convenience of consumers is increased thro-
ugh the decrease in the insufficiencies of tourist
products and the reduction of search costs;
3. Sales expenses, marketing, and consumer service
costs go down;
4. The efficiency of internal operations is greatly
improved through electronic commerce infor-
mation transfers;
5. The response of the market information is faster,
and the feedback on the service received is ac-
celerated through Efficient Consumer Response
(ecr).
Professor Leo Huang’s study (2006) suggests that
it is essential for travel agencies to consider a set of
elements to develop the strategic alliance of b2b elec-
tronic commerce. In conditions of environmental in-
security, travel agencies venture into strategic partner-
ships with other organizations to ensure the acqui-
sition of rare market resources. In addition, to seize
new resources through alliances, they must incorpo-
rate electronic distribution channels in real time to
reduce costs per distribution and take control of per-
formance. This can only be achieved through this type
of collaboration.
The b2b alliance makes it possible to create a net-
work in which each of its parts responds simultane-
ously to the most specific needs of the consumer and,
therefore, improves their competitiveness.
Finally, control is essential in all processes, and the
measurement of the performance of collaboration net-
works is no exception. Therefore the ‘culture of collab-
oration is a fundamental factor’ (Huang, 2006, p. 1319).
The central research gap that the professor leaves is
that this analysis starts with the travel agencies in Tai-
wan and ends with these agencies. Hence, it is neces-
sary to know to what level the dimensions, variables,
and results can be generalized and shown in this re-
search.
As stated above, collaboration helps improve the
competitiveness of entities and networks of entities.
340 | Academica Turistica, Year 16, No. 3, December 2023
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
However, in virtualization, the question arises of per-
suading the client to turn to the agency managed
over the competition. In this sense, Delgado-Ballester
and Hernández-Espallardo (2008) analyse one of the
aspects of the theory of alliances: the effect of co-
branding to persuade the consumer. Specifically, it
evaluates the impact of this collaboration in the client’s
mind between agencies of prestigious brands and un-
known e-brands.
One of the primary factors for a particular con-
sumer to opt for a specific online business is largely
loyalty; therefore, the attitudes that materialize be-
haviour toward online brands can be analysed through
this point. For this reason, the brand alliance between
a travel agency whose brand is not recognized with
another who has a reputation constitutes a market-
ing opportunity for the former (Delgado-Ballester
& Hernández-Espallardo, 2008). An efficient brand-
building strategy consists of both brand-building fac-
tors, such as the website, and external third-party fac-
tors, such as alliances with well-known brand agen-
cies, since both factors act positively on brand trust
and consequently on fairness and on the consumer’s
willingness to behave favourably.
Up to the time of this study, brand alliances were
only analysed from the offline perspective of busi-
nesses. Therefore, unlike this type of alliance outside
the networks, web pages are the fundamental factor in
the online environment. They generate positive per-
ceptions of brands and help the online brand to dif-
ferentiate itself from competitors and provide added
value to consumers.
Regardingwhat is behind the collaboration, Delga-
do-Ballester and Hernández-Espallardo (2008) con-
sider a set of implications at the management level.
The brand’s reputation must be considered while cho-
osing the partners, and the final product’s coherence
results from integrating the offerings. In addition,
due to the benefits these relationships can provide,
it is understandable that they want to place the well-
positioned brand in a prominent location on web
pages to make the connections between their brands
and other reputable ones visible. Theoretical results
of that research suggest that relationships with parties
outside the organization’s boundaries may become a
perfect way to access critical resources of small and
new intercompany unions, especially in internet or-
ganizations, where they act as ratifiers that influence
the perception of the quality of young organizations
when quality measures are ambiguous or do not exist.
Delgado-Ballester and Hernández-Espallardo (2008)
pave the way for future research that stems from the
limitation of the analysis of a single web page. For this
reason, they propose replicating these results under
different conditions. They also urge the study of other
types of co-brand alliances.
Discussions
The study contributes to the existing literature by ex-
amining the integration of ict in the distribution
channels of travel agencies. It sheds light on how this
integration affects the independence and autonomy
of customers in obtaining tourism services and prod-
ucts. This theoretical contribution helps to improve
the understanding of the changing dynamics between
travel agencies and customers in the digital age. The
study explores the state of online collaboration in
travel agencies and highlights its importance in a hos-
tile competitive environment. Researching the topic
through a bibliometric study contributes to theoretical
knowledge about the role and impact of cooperation
in the travel industry. This analysis provides insight
into the current state of travel agency collaboration
and provides a basis for further research and theoreti-
cal development.
The investigations into travel agency alliances have
developed a coherent methodological evolution with
certain similarities that can be grouped into thematic
axes. One thematic axis, the base thematic axis (Bar-
nett & Standing, 2001; Huang, 2006), starts from dis-
intermediation trends and the consequent search for
competitiveness by travel agencies and the insecurities
of the environment to establish alliances, respectively.
Another thematic axis focuses on the consumer (Kua
& Wen Fan, 2009; Delgado-Ballester & Hernández-
Espallardo, 2008) and is generated by the need to anal-
yse the motivation of the parties to share information
between the parties of the alliance to obtain a better
relationship with the client and to measure the im-
pact of co-branding-type collaboration between agen-
Academica Turistica, Year 16, No. 3, December 2023 | 341
Jorge Raúl Avilas Hernández et al. Bibliometric Analysis of Online Collaboration
cies, respectively. A third thematic axis focuses on the
value chain (product) (Guo et al., 2014; Slusarczyk et
al., 2016), specifically on the product, and is gener-
ated by the behaviour of the parties involved within
the value chain and the changes in its precepts due to
the advent of new technologies.
Finally, there is a thematic axis focused on security
(Kizildag et al., 2019), which is based on the need for
the new distribution channels to have the same trans-
parency as the previous ones. This is where the issue
of the security protocol provided by the blockchain
arises from eliminating intermediaries for the devel-
opment of transactions. This last element is an emerg-
ing topic with enormous potential in the new online
value chains and their players.
According to the research findings, the study has
practical implications, especially for travel agencies
that want to succeed in the digital age. By revealing
competition and the powerful impact of the digital
age on collaboration within the industry, the research
helps agencies understand the challenges they face
and the need for effective online collaboration strate-
gies. This practical input can guide agencies in devel-
oping and implementing collaborative practices that
strengthen their market position.
The scope of the Scopus database limits this study,
as it may not cover all relevant publications in the
field. Furthermore, bibliometric analysis may over-
look some qualitative aspects of online collaboration
that could provide deeper insights.
Conclusions
The development of this research allows us to con-
clude that online collaboration in travel agencies is an
emerging topic in the scientific literature conditioned
by the development of information technologies. Only
25 articles were totally or partially related to the topic
analysed. Despite the few investigations, there is a
growing trend, especially between 2020 and 2021, due
to the outbreak of the covid-19 pandemic, raising the
need for research on its, crisis, and tourism.
The most critical authors, Guo et al. (2014), only
present twopublications on the subject; however, these
investigations have had an impact, with 51 local refer-
ences for a quality index (h-index) of 2. Within the
subject of study, these two authors have dedicated
themselves to a pretty specific topic: ‘Coopetition be-
tween hotels and online travel agencies when they de-
velop cash back.’ On the other hand, only the Inter-
national Journal of Contemporary Hospitality Manage-
ment presents more than one publication.
The systematic review of the literature showed that
the four levels of integration of the most research-
developed literature regarding online collaboration in
travel agencies are the meta-level associated with des-
tinations. Themost critical issue in this approach is the
creation of online collaborationmodels at the destina-
tion level, such as web services for the standardization
of information from the various systems of tourism
actors.
The main research gaps and also opportunities
for future research revealed by the strategic frame-
work are consumer perception regarding forms of co-
branding between travel agencies, changes in the value
chain towards the purely online environment, security
within the online value chain, online collaboration be-
tween traditional travel agencies, cybersecurity, and
blockchain.
Future studies in the area of bibliometric analysis
of collaboration in travel agencies could explore tra-
ditional travel agencies’ strategies to adapt to the dig-
ital environment and encourage online engagement.
Furthermore, investigating the impacts of collabora-
tion on customer perceptions and cyber security can
contribute to a more comprehensive understanding of
the benefits and challenges associated with online col-
laboration in the travel industry.
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344 | Academica Turistica, Year 16, No. 3, December 2023
Original Scientific Article
A Study of Thai Massage Service Quality Effect
on International Tourist Confidence
Napaporn Janchai
Suranaree University of Technology, Thailand
napaporn_jan@sut.ac.th
Glenn Baxter
Suan Dusit University, Thailand
g_glennbax@dusit.ac.th
Panarat Srisaeng
Suan Dusit University, Thailand
panarat_sri@dusit.ac.th
Wellness tourism is one of the world’s fastest growing industries (Global Wellness
Institute, 2018). Wellness tourism has developed into a very important tourismmar-
ket segment around the world over the past two decades or so. This is especially so
for Thailand, where wellness tourism has become one of country’s most important
tourismmarkets. In addition to attracting high-end tourists from developed and de-
veloping countries, wellness tourism also increases the economy of small or devel-
oping countries (Jagyasi, 2022). Thai massage has a strong link to wellness tourism
as it is a key service for wellness tourism. In terms of the massage business, tourist
confidence is the perception of service quality that influences a purchase decision.
Service quality and tourist confidence are intertwined, which then leads to income
and economic development. Therefore, examining service quality within Thai mas-
sage in relation to tourist confidence is important for exploring the crucial factors
influencing international tourist confidence in Thai massage. The results of this re-
search may lead to service quality development to encourage confidence among in-
ternational tourists who are a significant source of foreign revenue. This research
aims to examine the effect of Thai massage service quality on international tourist
confidence. A survey of 400 international tourists was conducted in Bangkok, Thai-
land between March and May 2019, using a structured research questionnaire to
collect all necessary data, which was then used to test the research hypotheses using
multiple regression analysis. The study concluded that three out of five elements of
service quality affect international tourist confidence. These elements include ‘Em-
pathy,’ ‘Tangibility,’ and ‘Responsiveness,’ while ‘Assurance’ and ‘Reliability’ did not
have a significant effect on tourist confidence. The findings of this research establish
an empirical relationship between empathy, tangibility and responsiveness of Thai
massage businesses and international tourists’ confidence. This insight of the study
may help the massage business to have a better understanding about the elements of
service quality that influence international tourist confidence.
Keywords: service quality, tourist confidence, wellness tourism, massage, Thailand
https://doi.org/10.26493/2335-4194.16.345-355
Academica Turistica, Year 16, No. 3, December 2023 | 345
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
Introduction
Wellness tourism has a strong link to the economic
system and is a significant source of revenue for many
countries, including Thailand. The $4.5 trillion well-
ness industry and the $2.6 trillion travel and tourism
sectors are powerfully intersected by wellness tourism
(2017 figures). People today demand to maintain their
healthy lifestyles and wellness practices even while
they are away from home, with holistic health and
prevention at the forefront of consumer decision-
making (Global Wellness Institute, 2020). Wellness
tourism has experienced rapid growth over the last
two decades or so (Huang & Xu, 2014; Lu et al., 2018).
Indeed,wellness tourismhas developed into an emerg-
ing tourism market segment that is not only directed
towards those who pursue solely thermal treatments
but also for those seeking illness prevention, physical
improvement, and spiritual balance, or even for those
clients who are eager to experience cultural and relax-
ation programmes (Costa et al., 2015). Wellness and
spa tourismhas become an importantmarketing strat-
egy that is increasingly being used to attract tourists.
Wellness and spa tourism now plays a very impor-
tant role in hotel industry, resorts, and tourist destina-
tions. Local and international tourists are the primary
consumers of wellness and spa services (Hashemi et
al., 2015). Furthermore, wellness tourism is a form of
tourismwhich can enhance the competitive advantage
of a destination (Magdalini & Paris, 2009).
Massage is a major service in the wellness tourism
sector, especially in Thailand. Thai massage is diverse,
outstanding, unique and has been acceptedworldwide
since people pay more attention to healthcare and
wellness today. The uniqueness of Thai massage is a
result of the wisdom and science of traditional health-
care, including service staff who provide friendly and
caring service for customers. As a result, the massage
business can generate significant revenue for the coun-
try. According to Bangkok Biz News (2020), in Thai-
land, wellness tourism services are a high-value mar-
ket with continuous growth. From 2017–2019, Thai-
land recorded 12.5 million wellness-related tourists.
Income from wellness tourism was 409,200 million
baht and Thailand’s wellness tourism sector employs
more than 530,000 people. The key mechanism for
creating a competitive advantage is service, which is
a distinctive feature of Thailand. According to the
Department of Health Service Support, Thailand had
1,609 accredited health establishments in 2015, which
comprised 509 spas, 1,070 health massage centres, and
30 beauty massage centres. There were 1,265 locations
in the regions and 344 in Bangkok (Leelawatananan,
2016).
Service quality plays a crucial role in business re-
lated to tourism, and this is especially so for the well-
ness and massage business sector (Venetis & Ghauri,
2004). The attainment of positive emotions and tourist
satisfaction can be enhanced by the quality of service
(Wu & Tsai, 2015). According to Unidha (2017), ser-
vice quality has a strong link to customer confidence
and customer loyalty. A study by Tahish andMaftuhah
(2015) indicated that service quality has a positive ef-
fect on tourist loyalty, and tourist confidence is the
most important factor that affects loyalty. Service qual-
ity development is fundamental to encouraging tourist
satisfaction and confidence, which can then lead to
tourist loyalty. Many studies have revealed that good
service quality encourages the customer to buy again,
to buymore, to buy other services, to become less sen-
sitive, and to make suggestions to other customers
about the service (Akbar & Parvez, 2009; Kheng et
al., 2010; Parasuraman et al., 1985; Unidha, 2017).
Confidence or trust is significant in the service
business because customers tend to buy the service
before actually receiving the service. Therefore, confi-
dence is a crucial factor in the purchase decision. Con-
fidence is one of the characteristics of customers’ trust,
alongside consistency, honesty, fairness, responsibility,
helpfulness, and benevolence. Service providers have
the opportunity to gain the confidence of clients. Be-
sides giving customers confidence, service providers
must have the potential to demonstrate good service
and the ability to respond to customers’ needs with
politeness and clarity to reassure customers that they
will receive the best quality service (Parasuraman et
al., 1985). Confidence will be assessed once the client
has received the service. Then the service will be com-
pared by the client with the agreement before using the
service specified by the service provider. If the client
receives the service as expected, the client’s confidence
346 | Academica Turistica, Year 16, No. 3, December 2023
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
will increase (Morgan & Hunt, 1994). Building confi-
dence with customers is an important factor that leads
to customer loyalty. Loyalty is buying or using a ser-
vice repeatedly, suggesting the service to others, and
building a good relationship that will benefit the busi-
ness in the long run (Akbar & Parvez, 2009; Han &
Hyun, 2015; Rasheed & Abadi, 2014).
This research focuses on the contribution of per-
ceived service quality of international tourists and
tourist confidence in massage businesses in Thailand.
This study extends the existing knowledge by taking
a relationship perspective to study the effect of per-
ceived service quality on tourist confidence. This study
may contribute to a better understanding of the rela-
tionship between service quality elements and tourist
confidence, which is a critical factor in the buying de-
cisions of customers.
Literature Review
Service Quality
Service quality is an action that an organization, busi-
ness, or individual presents so that service recipients
achieve both their goals and satisfaction. The nature
of service is intangible. Therefore, the client cannot be
the owner. The outcomes of the service may or may
not be associated with the product. For this reason,
businesses need to find a position that shows the ef-
fectiveness and benefits of the service, including lo-
cation, service staff, advertising, equipment, branding,
and price (Kotler, 1994).
The characteristics of the service are intangible,
time- and place-dependent, and beneficial to the cus-
tomers; they cannot be stored or moved, and the ser-
vice provider is part of the service. The consumer and
other people may also be part of the service, which
may affect the satisfaction that a customer receives
from the service (Masterson & Pickton, 2014). The
quality of the service is more diverse than the qual-
ity of the product because the employees who provide
the service are human and they are different (Koter
& Keller, 2006; Peter & Donnelly, 2011). Good service
is a service that meets the needs of customers with-
out errors, causing customers to be satisfied (Koter &
Keller, 2006; Lovelock &Wirtz, 2004; Parasuraman et
al., 1988).
From the customer perspective, the quality of ser-
vice is the satisfaction that has been fulfilled as needed.
Each person’s satisfaction is different, which means
that the quality of service in each person’s perspec-
tive is different (Parasuraman et al., 1985; Lovelock &
Wirtz, 2004). The factors that customers use when
evaluating service quality include credibility, security,
accessibility, communication, understanding the cus-
tomer, tangibility, responsiveness, competence, and
courtesy (Parasuraman et al., 1988; Lovelock &Wirtz,
2004).
According to Indeed Editorial Team (2022), Para-
suraman et. al. (1988) and Lovelock andWirtz (2004),
the factors that customers use whenmeasuring service
quality are credibility, security, accessibility, commu-
nication, understanding the customer, tangibility, re-
sponsiveness, competence, and courtesy. These factors
can be grouped into 5 categories whichmay be applied
in massage and spa businesses as follows.
1. Tangibility includes massage and spa service
shops, location, decoration, facilities, equipment,
ventilation, smell, light, sound, advertising me-
dia, and staff dress.
2. Reliability includes the ability to provide the right
service as agreed with customers.
3. Responsiveness: responding to customers in terms
of hospitality, information, answering questions,
helping customers solve problems, enthusiasm
and willingness to serve.
4. Assurance: the staff is knowledgeable in provid-
ing services, reliable, polite, and attentive to the
problems and needs of customers, and the service
is safe.
5. Empathy: the staff have to understand the needs
of different customers, be attentive, be able to
serve customers with different needs, and value
the customer.
Tourist Confidence
Confidence is one of the characteristics of customers’
trust, together with consistency, honesty, fairness, re-
sponsibility, helpfulness, and benevolence. The study
by Unidha (2017) found that the quality of service has
Academica Turistica, Year 16, No. 3, December 2023 | 347
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
a direct effect on confidence, and the confidence di-
rectly affects the loyalty of customers. This means that
the better the quality of the service, the more confi-
dence on the part of users. The more confident users
are, the more they will be loyal customers.
Confidence comes when customers consider ser-
vice in two ways: (1) credibility and honesty; (2) com-
mitment that is established to maintain customer re-
lationships and customer retention (Moorman et al.,
1992). Also, the relationship between the service pro-
viders and the clients who use the services provided by
a firm continuously results in value to the customers in
three ways: it creates more confidence in the service,
develops good friendships, and users receive a ser-
vice at a special price or special service (Gwinner et.
al., 1998, in Lovelock & Wirtz, 2004). The confidence
measure consists of 4 components, which are busi-
ness credibility, good quality of products and services,
getting customers interested, and keeping promises or
one’s word as agreedwith customers (Morgan&Hunt,
1994).
Building confidence or trust in businesses, prod-
ucts, and services to customers is an important factor
that helps businesses achieve higher profits and long-
term success. In addition, creating customer confi-
dence gives businesses the ability to charge properly
for products and services without needing to reduce
the price to compete, and although competitors can
reduce the price or offer promotions, customers who
have confidence in products, services, and the busi-
ness will not change their minds (Khera, 2018; Sang-
prasert, 2015). Building confidence requires time, and
customer confidence may only last for a short period
of time and quite possibly will not last forever. There-
fore, trust-building with customers should be consis-
tent for long-term continuous confidence (DeMers,
2017; Khera, 2018).
Research Framework
The service quality of Thai massage was identified
based on previous studies. We identified five indepen-
dent variables, which are tangibility, reliability, respon-
siveness, assurance, and empathy, which were consid-
ered to affect tourist confidence. The research frame-
work is shown in Figure 1.
Tangibility
Reliability
Responsiveness
Assurance
Empathy
Turist confidence
Figure 1 Proposed Research Framework
Hypothesis Development
Based on the preceding theoretical knowledge, the
present study examined perceived service quality in
the aspects of tangibility, reliability, responsiveness,
assurance, and empathy offered by massage and spa
services in Bangkok to determine how these attributes
affect a tourist’s confidence inmassage and spa service.
The following hypotheses were empirically tested in
this study:
h1 The perceived service quality in the aspect of
tangibility affects tourist confidence.
h2 The perceived service quality in the aspect of re-
liability affects tourist confidence.
h3 The perceived service quality in the aspect of re-
sponsiveness affects tourist confidence.
h4 The perceived service quality in the aspect of as-
surance affects tourist confidence.
h5 The perceived service quality in the aspect of em-
pathy affects tourist confidence.
Research Methodologies
Research Instrument
Closed-end questions (Mayo, 2014; Smith, 2017) ap-
plied to collect data on the predictors and criterions
variables, as well as on specific demographic charac-
teristics, underpinned the research undertaken in this
study. Generally, closed-end questions are often used
in confirmatory research, when the researchers want
to empirically examine specific hypotheses (Johnson
& Christensen, 2008).
348 | Academica Turistica, Year 16, No. 3, December 2023
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
The questionnaire was developed based on pre-
vious research emphasizing service quality (Crosby,
1979; Kotler & Keller, 2006; Lovelock & Wirtz, 2004;
Metters et. al., 2006; Parasuraman et al., 1988) and
tourist confidence (Akbar & Parvez, 2009; Parasur-
aman et al., 1985; Rasheed & Abadi, 2014). The self-
administered questionnaire was used to assess inter-
national tourists’ perceived service quality and confi-
dence in massage and spa services in Bangkok, Thai-
land.
The questionnaire consisted of threemain sections:
demographic characteristics, perceived service qual-
ity, and the tourists’ confidence in massage and spa
services. Service quality consisted of five factors: tangi-
bility with 12 items, reliability with 4 items, responsive-
ness with 5 items, assurance with 4 items, and empathy
with 5 items. In terms of tourist confidence, there were
4 questions: Creditability of the massage and spa ser-
vice business, Quality of massage/spa, Massage/spa as
agreed with the customer, and Provided information
about massage/spa is interesting.
The respondents were asked to indicate their level
of perceived service quality on a 5-point Likert scale,
ranked from (1) strongly disagree to (5) strongly agree,
and indicate their level of confidence ranked from low
(1), moderately low (2), average (3) to moderately high
(4), and high (5). The demographic characteristics of
the respondentsweremeasured using nominal and or-
dinal scales.
Data Collection and Study Sampling
The research population were international tourists
who had experience using a massage service in Bang-
kok. The questionnaire survey was carried out be-
tween March and May 2019. The target areas of col-
lecting data were popular destinations for interna-
tional tourists. These areas included Patpong, Silom,
Sathorn, Khao-Sarn Road, Sanam Luang, Pratu Nam,
and SiamSquare. The purposive samplingmethodwas
used to collect data. The key advantage of purposive
sampling is that it actively aims to enrich the study’s
data by including participants who have a particular
type of experience, characteristic or understanding to
share (Macnee & McCabe, 2008).
The questionnaires were collected mainly by the
researchers and four research assistants. In addition,
questionnaires were left at four massage shops and
picked up later. Field editing was also conducted at
the survey areas to check for the completeness of the
questionnaire (Gunturo & Hui, 2013).
The sample in this study were 400 international
tourists who used amassage/spa service in Bangkok. It
is generally accepted that 400 is an ideal sample size for
a survey (Anjum & Kazmi, 2019; Ghosh, 2018; Naseri
et al., 2021).
Data Analysis
To analyse the relationship between independent vari-
able (perceived service quality: tangibility, reliability,
responsiveness, assurance, and empathy) and depen-
dent variable (tourist confidence in massage services
in Bangkok, Thailand), both descriptive and inferen-
tial statistics were applied for this research using spss
Statistics version 26 and amos version 24 computer
programs. The demographic variables were analysed
using frequency and percentage. The mean score and
standard deviation were analysed for each indepen-
dent and dependent variable.
Confirmatory Factor Analysis (cfa) was employed
to analyse the components of each factor of the per-
ceived service quality (independent variable) and the
relationship between the perceived service quality (in-
dependent variables) and tourist confidence (depen-
dent variable).
Results
The research findings can be grouped into the demo-
graphic profile of the respondents, the five aspects of
perceived service quality, level of tourist confidence in
massage and spa service quality, and hypothesis test-
ing.
Demographic Profile of the Respondents
Table 1 presents the demographic profile of the respon-
dents. The majority of respondents were males. Most
of the respondents were in the age range of 21–30 years
and single. The majority were from Europe, held a
Bachelor’s degree, worked as office and sales workers,
and had an average annual income of $20,000 usd or
lower.
Academica Turistica, Year 16, No. 3, December 2023 | 349
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
Table 1 Demographic Characteristics of the Research’s
Respondents
Category Item Frequency 
Gender Male  .
Female  .
Age group Less than   .
–  .
–  .
–  .
–  .
>  .
Marital
status
Single  .
Married  .
Continent
of residence
East Asia  .
Europe  .
America  .
South Asia  .
Oceania  .
Middle East  .
Africa  .
Others  .
Education High school or lower  .
Bachelor degree  .
Postgraduate or higher  .
Occupation Unemployed/not working  .
Skilled/semi-skilled worker  .
Farmer  .
Office and sales worker  .
Professional  .
Entrepreneur or manager  .
Retired  .
Continued in the next column
Perceived Service Quality Regarding Massage
and Spa Service
According to Tables 2–6, international tourists strong-
ly agreed with the overall perceived service quality
regarding massage services. The highest mean score
is assurance, followed by reliability, empathy, respon-
siveness, and tangibility, consecutively. In terms of re-
Table 1 Continued from the previous column
Category Item Frequency 
Average
annual
income
, usd or lower  .
,–, usd  .
,–, usd  .
,–, usd  .
More than , usd  .
Table 2 Perceived Service Quality in the Aspect
of Tangibility
Item Mean sd
The massage/spa is in the right place and
location.
. .
Surrounding areas have proper sanitation. . .
The physical decoration has a clear concept,
is appropriate and visually appealing.
. .
The space within the massage/spa is well-
organized, clean and tidy.
. .
Provided faculties in the service place are
appropriate and clean (e.g. seat, restroom,
lavatory, dressing room).
. .
Spa/massage equipment and products are
appropriate and available.
. .
The service place has good ventilation. . .
The service place has a nice smell and helps
me to relax.
. .
The lighting in the service place is adequate
and appropriate.
. .
The service place has nice music and helps
me to relax.
. .
Advertising media (e.g. shop sign, printing
ad, online ad) is interesting and communi-
cates well with customers.
. .
The staff dresses properly. . .
Overall . .
liability and assurance, the tourists strongly agreed to
every variable of them. In the aspects of tangibility, re-
sponsiveness and empathy, the tourists strongly agree
with almost all of the variables, except one or two vari-
ables of each that the tourists agreed with.
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Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
Table 3 Perceived Service Quality in the Aspect
of Reliability
Item Mean sd
The staff can massage/spa according to
agreement.
. .
There are proper and reliable massage/spa
procedures, this includes before, during and
after massage/spa.
. .
Staff is skilled in massage/spa. . .
Staff massage/spa completes treatments
within the agreed time.
. .
Overall . .
Table 4 Perceived Service Quality in the Aspect
of Responsiveness
Item Mean sd
Staff is enthusiastic to welcome and serve
customers.
. .
Staff can provide information and answer
questions clearly.
. .
Staff is willing to massage/spa. . .
Staff can provide services and/or solve prob-
lems to make customer satisfied.
. .
Staff is available at all times of opening
hours.
. .
Overall . .
Level of Tourists’ Confidence in Massage
and Spa Service
International tourists were also required to rate their
confidence in massage and spa services in Bangkok. It
was found that the overall level of tourist confidence is
high. When considering each factor, the tourists had
high confidence regarding three factors and moder-
ately high one factor according to Table 7.
Hypothesis Testing
Confirmatory Factor Analysis was performed to test
the research hypotheses and to quantify the effects of
the perceived service quality, including the five factors
(tangibility, reliability, responsiveness, assurance, and
empathy), on tourist confidence. The five factors, or
the independent variables and the dependent variable,
Table 5 Perceived Service Quality in the Aspect
of Assurance
Item Mean sd
The healthcare service shows a business
license.
. .
The staff is polite and courteous. . .
The staff takes care of the problems and
needs of the customers.
. .
Staff shows sufficient knowledge and skill in
massage/spa.
. .
Customers feel safe in massage/spa treat-
ments.
. .
Overall . .
Table 6 Perceived Service Quality in the Aspect
of Empathy
Item Mean sd
A variety of massage/spa treatments are
available to serve different customer needs.
. .
Staff suggests customized massage/spa treat-
ments.
. .
Operating hours of the healthcare service are
convenient for customers.
. .
There is a variety of massage/spa products
to choose from (e.g. massage/spa cream, oil,
aromatherapy).
. .
A variety of herbal drinks after massage/spa
to choose from (e.g. ginger, lemongrass, bael,
chrysanthemum).
. .
There are customer inquiries to improve the
service to meet the needs of customers.
. .
Overall . .
tourist confidence, were assessed for the consistency of
the model and empirical data. The results of first or-
der confirmatory factor analysis are shown in Table 8.
According to the first order confirmatory factor anal-
ysis, factor loading of 13 indicators of the five factors of
perceived service quality have a value of 0.7 or higher,
which is acceptable (Brown, 2015). Four indicators of
Tangibility have a loading factor of 0.756–0.789. Two
indicators of Reliability have a loading factor of 0.744–
0.840. Two indicators of Responsibility have a loading
Academica Turistica, Year 16, No. 3, December 2023 | 351
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
Table 7 Level of Tourist Confidence in Massage
and Spa Service Quality
Item Mean sd
Creditability of the massage and spa service
business.
. .
Quality of massage/spa. . .
Massage/spa as agreed with the customer. . .
Providing information about massage/spa is
interesting.
. .
Overall . .
factor of 0.683–0.765. Three indicators of Assurance
have a loading factor of 0.765–0.798, and two indica-
tors of Empathy have a loading factor of 0.696–0.793.
According to the second order confirmatory anal-
ysis (Table 9), factor loading of the five factors of per-
ceived service quality were Tangibility 0.891, Reliabil-
ity 0.890, Responsibility 0.892, Assurance 0.885, and
Empathy 0.902. All of these factors have a value of
loading factor 0.7 or higher. This indicates that the five
factors of perceived service quality influence tourist
confidence. Therefore, hypotheses 1–5 are accepted.
According to Table 9, the model of five compo-
nents of perceived service quality and tourist confi-
dence was consistent with the empirical data, with p =
0.079 (p > 0.05), cmin/df = 1.245 (cmin/df ≤ 2.00),
gfi = 0.968 (gfi ≥ 0.90), tli = 0.993 (tli ≥ 0.90),
cfi = 0.994 (cfi ≥ 0.90), nfi = 0.968 (nfi ≥ 0.90)
and rmsea = 0.025 (rmsea ≤ 0.08). When consid-
ering the factor loading of each component, it was
found that the most important component of service
quality was Empathy, which influences the confidence
of tourists 81. The least important component of ser-
vice quality is Assurance, which influences the confi-
dence of tourists 78. The effect of the perceived ser-
vice quality ofmassage and spa businesses in Bangkok,
Thailand on tourist confidence is presented in Fig-
ure 2.
Conclusion and Implications
According to a study of Thai massage service quality
effect on international tourist confidence, five aspects
of perceived service quality were identified, which in-
cluded tangibility, reliability, responsiveness, assur-
Figure 2 The Effect of Perceived Service Quality
of Massage and Spa Businesses in Bangkok,
Thailand on Tourist Confidence
ance, and empathy. This research has illustrated that
all of the aspects of the service quality are linked to
tourist confidence. It also confirms that service quality
in the aspects of empathy is themost important factor,
contributing to 81 of tourist confidence and assur-
ance was the least important factor, affecting tourist
confidence 78. Understanding the effects of per-
ceived service quality on tourist confidence may lead
to the development of service quality in accordance
with tourist confidence, and this can lead to the use of
service quality and customer loyalty. From a manage-
rial perspective, it is crucial for thosewho are in charge
ofmanagingmassage/spa services to invest in the right
elements of service quality in terms of empathy: there
should be a variety of massage/spa products to choose
from (e.g. massage/spa cream, oil, aromatherapy) and
customers should be questioned to improve the ser-
vice to meet their needs. In terms of responsiveness,
352 | Academica Turistica, Year 16, No. 3, December 2023
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
Table 8 Statistics for Evaluating the Consistency of the Model with Empirical Data: The Results of First Order
Confirmatory Factor Analysis
Category Item Factor loading se T R2
Tangibility tb The physical decoration has a clear concept, appropriate and visually
appealing.
. . *** .
tb The space within the massage/spa is well-organized, clean and tidy. . . . .
tb Provided faculties in the service place are appropriate and clean (e.g.
seat, restroom, lavatory, dressing room).
. . . .
tb Spa/massage equipment and products are appropriate and available. . . .
Reliability rb There are proper and reliable massage/spa procedures, this includes
before, during and after massage/spa.
. . *** .
rb Staff is skilled in massage/spa. . . .
Respon-
siveness
rs Staff is enthusiastic to welcome and serve customers. . . *** .
rs Staff can provide information and answer questions clearly. . . .
Assurance as The staff is polite and courteous. . . *** .
as The staff takes care of the problems and needs of the customers. . . . .
as Staff shows sufficient knowledge and skill in massage/spa. . . .
Empathy em There is a variety of massage/spa products to choose from (e.g. mas-
sage/spa cream, oil, aromatherapy)
. . *** .
em There are customer inquiries to improve the service to meet the needs
of customers.
. . .
Table 9 Statistics for Evaluating the Consistency
of the Model with Empirical Data: The Results
of Second Order Confirmatory Analysis
Category Factor loading se T R2
Tangibility . *** .
Reliability . . . .
Responsiveness . . . .
Assurance . . . .
Empathy . . . .
staff should be skilled in massage/spa and enthusi-
astic to welcome and serve customers. In the aspect
of tangibility, the physical decoration should have
a clear concept, be appropriate and visually appeal-
ing, the space within the massage/spa should be well-
organized, clean and tidy, provided facilities in the ser-
vice place should be appropriate and clean (e.g. seat,
restroom, lavatory, dressing room), and spa/massage
equipment and products should be appropriate and
available. In terms of reliability, there should be proper
and reliable massage/spa procedures and staff should
be skilled in massage/spa. In terms of assurance, the
staff should be polite, take care of the problems and
needs of the customers and show sufficient knowl-
edge and skill in massage/spa. These should be a pri-
ority for wellness tourism because they have a strong
link to tourist confidence and this positively affects a
purchase decision, which then contributes to increas-
ing revenue from international tourists and wellness
tourism. Moreover, tourist confidence also positively
affects tourist loyalty to buy or use the service repeat-
edly, suggest the service to others, and engender a
good relationship, and this can benefit the business
and the country in the long run.
Limitation and Suggestion for Further Research
The current study provides the model of the influen-
tial factors that affect the perceived service quality and
tourist confidence of internal tourists in massage and
spa businesses in Bangkok, Thailand. It may be neces-
Academica Turistica, Year 16, No. 3, December 2023 | 353
Napaporn Janchai et al. A Study of Thai Massage Service Quality Effect
sary to test themodel of massage and spa businesses in
different countries. This should be undertaken to test
and modify the causal relationship model of the influ-
ential factors in tourist confidence.
Future research may also test the model with in-
ternational and domestic tourists to check the model’s
invariance. Moreover, other variables such as hygiene
and covid-19 or other epidemic prevention stan-
dards may be included to better explain influential
factors on tourist confidence in massage and spa ser-
vices.
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Academica Turistica, Year 16, No. 3, December 2023 | 355

Abstracts in Slovene Povzetki v slovenšini
Ali boljša fizična dostopnost vodi k večjim prihodkom od prodaje?
Primer slovenskih restavracij MSP
Marko Kukanja in Saša Planinc
Kljub pomenu dostopnosti za razvoj trajnostnega turizma je malo znanega o raz-
merju med fizično dostopnostjo in prihodki od prodaje v prehrambnih gostinskih
obratih (pgo). Predhodne raziskave prav tako niso upoštevale dojemanja dostopno-
sti z vidika menedžerjev pgo, čeprav so ti odgovorni za oblikovanje dostopne po-
nudbe. Cilja te raziskave sta (1) raziskati, ali menedžerji mikro, malih in srednje ve-
likih pgo obrate dojemajo kot fizično dostopne, in (2) ugotoviti, ali je boljša fizična
dostopnost povezana z višjimi prihodki od prodaje. Raziskava je bila izvedena v dveh
korakih – analizi relevantne literature in zakonodaje je sledila terenska raziskava.
Primarni podatki so bili zbrani s pomočjo vprašalnika, ki so ga so izpolnili mene-
džerji pgo (n = 149). Sekundarni finančni podatki so bili pridobljeni preko javno
dostopnih finančnih poročil. V postopek izdelave vprašalnika so bili vključeni pred-
stavniki invalidskih organizacij. Za analizo podatkov je bila uporabljena opisna in
korelacijska analiza. Ugotovitve kažejo, da menedžerji slabo poznajo zakonodajo s
področja dostopnosti, da pgo dojemajo kot relativno slabo dostopne ter da fizična
dostopnost ni povezana s prihodki od prodaje. Menedžerji so kot najnedostopnejše
ocenili sanitarije. Fizična dostopnost ni zgolj trženjska odločitev, temveč tudi zakon-
ska obveznost. Poleg tega bi se menedžerji morali zavedati ekonomskega potenciala
dostopnosti ter dejstva, da fizično dostopna ponudba olajša uporabo pgo za družbo
kot celoto. Prispevek se zaključi s priporočili zamenedžerje pgo, snovalce razvojnih
politik in raziskovalce.
Ključne besede: prehrambno gostinstvo, invalidi, menedžerji, fizična dostopnost,
prihodki od prodaje
Academica Turistica, 16(3), 257–275
Razumevanje konceptualnega okvira kakovosti zdraviliških storitev:
pregledni pristop
Aswin Sangpikul
Zaradi pomanjkljive literature za popolno razumevanje kakovosti storitev v zdravi-
liški industriji je cilj te raziskave pregledati sorodno literaturo, da bi pridobili kon-
ceptualno razumevanje okvira kakovosti storitev v zdraviliščih. Metoda temelji na
sistematičnem pregledu sorodne literature z analizo modelov/razsežnosti storitev iz
preteklih raziskav in njihovim povezovanjem, da bi dobili celovit okvir kakovosti
zdraviliških storitev. Na podlagi predlaganega okvira so opredeljene štiri teme (raz-
sežnosti) kakovosti zdraviliških storitev: (1) zdraviliški programi in izdelki, (2) fi-
zično okolje, (3) interakcija med strankami in zaposlenimi ter (4) (rezultati storitev.
Pregled pokaže, da uporaba enega samega modela storitev ne zadostuje za popolno
razumevanje okvira kakovosti zdraviliških storitev zaradi njihovih različnih značil-
nosti. Ugotovitve lahko raziskovalcem in zdraviliškim delavcem pomagajo pri teme-
ljitem razumevanju celotnega okvira kakovosti teh storitev. Zlasti kombinacija fizič-
nega okolja (tehnološka oprema) in boljše interakcijemed strankami ter zaposlenimi
Academica Turistica, Year 16, No. 3, December 2023 | 357
Abstracts in Slovene Povzetki v slovenšini
lahko prispeva k inovativnim storitvam v zdraviliški industriji. Pregled pripomore k
razširitvi teoretičnega znanja (okvira) tradicionalnega serqvual- in tridimenzio-
nalnegamodela (fizična kakovost ter kakovost interakcije in rezultata) z dodajanjem
razsežnosti izdelka kot dodatne sestavine okvira kakovosti zdraviliških storitev.
Ključne besede: kakovost zdraviliških storitev, zdraviliška industrija, zdraviliške
storitve, turizem wellnessa
Academica Turistica, 16(3), 277–289
Dejavniki, ki vplivajo na zadovoljstvo in namero ponovnega obiska
jordanskih zdravstvenih turistov
Malek Bader, Nirmeen Khasawneh, Ramzi Al Rousan, Sami Al Hasanat
in Kamakshya Prasad Nayak
Namen raziskave je bil analizirati dejavnike, ki vplivajo na zadovoljstvo in namero
ponovnega obiska s strani zdravstvenih turistov v Jordaniji. Teoretični model, sesta-
vljen iz sedmih spremenljivk, in sicer kakovosti storitev, zaznavanja tveganja, vre-
dnosti za denar, privlačnosti destinacije, turistom prijaznega okolja, zadovoljstva in
namere ponovnega obiska, je bil oblikovan na podlagi predhodne literature. Za testi-
ranje modela je bil uporabljen metodološki pristop. Najprej je bila izvedena anketa
med zdravstvenimi turisti, ki so obiskali deset najpomembnejših bolnišnic v Jorda-
niji, na podlagi katere je bilo zbranih 395 odgovorov. Nato je bil za analizo podatkov
uporabljen model strukturnih enačb. Raziskava je pokazala, da so neodvisne spre-
menljivke, vključno s kakovostjo storitev, razmerjem med ceno in kakovostjo ter
privlačnostjo destinacije, pomembno vplivale na zadovoljstvo zdravstvenih turistov
in njihovo namero za ponovni obisk. Analiza je pokazala tudi, da je turistom pri-
jazno okolje pomembno vplivalo na zadovoljstvo, ni pa pomembno vplivalo na na-
mero ponovnega obiska. Vendar pa raziskava ni zagotovila dokazov o pomembnem
vplivu zaznavanja tveganja na zadovoljstvo in namero ponovnega obiska. V skladu
z ugotovitvami lahko vlada in zasebni subjekti v Jordaniji dajo prednost ohranjanju
kakovosti storitev, povečanju privlačnosti destinacije in zagotavljanju turistom pri-
jaznega okolja. Razmislijo lahko tudi o obravnavi in zmanjšanju zaznavanja tveganja
zdravstvenih turistov, saj ni bilo ugotovljeno, da bi slednje vplivalo na zadovoljstvo
turistov in njihovo namero ponovnega obiska.
Ključne besede: zdravstveni turizem, jordanski turizem, zdravstveni turisti, namera
ponovnega obiska, zadovoljstvo turistov, vedenje potrošnikov
Academica Turistica, 16(3), 291–311
Tržne strategije v čezmejnih turističnih destinacijah: pregled literature
Alenka Pahor Žvanut in Ksenija Vodeb
Osnovno načelo delovanja turistične destinacije kot sistema povezanih deležnikov
je ustvarjanje nove vrednosti, ki se odraža v ustvarjanju dodane vrednosti za udele-
žence poslovnega procesa. Za ustvarjanje dodane vrednosti morajo deležniki strate-
ško načrtovati in upravljati svojo trženjsko funkcijo. Opravili smo jpregled aktualne
literature (zadnjih deset let) s področja uvajanja trženjskih strategij v širše strategije
358 | Academica Turistica, Year 16, No. 3, December 2023
Abstracts in Slovene Povzetki v slovenšini
razvoja čezmejnih turističnih destinacij. Izbrani bazi podatkov sta bili Web of Sci-
ence in Scopus. Ugotovili smo, da se čezmejne turistične destinacije ne poslužujejo
sistematičnih pristopov uvajanja trženjskih strategij, temveč se slednje identificirajo
v sklopu širših razvojnih strategij čezmejnih območij. V redkih primerih se obliku-
jejo samostojne blagovne znamke, s katerimi bi lahko destinacije utrdile svoj polo-
žaj na trgu in izkoristile potenciale dveh ali več čezmejnih destinacij hkrati. Kljub
prepoznavanju različnih sinergijskih učinkov in razumevanju pomena ter prednosti
povezovanja in sodelovalnega tekmovanja trženjske strategije v čezmejnih turistič-
nih destinacijah še niso standardizirana poslovna praksa. Pregledni članek prispeva
k predstavitvi pomena čezmejnih marketinških strategij v turizmu in utira pot za
podrobnejše raziskave na tem področju v prihodnje.
Ključne besede: turizem, čezmejno, turistična destinacija, strategija, trženjska
strategija
Academica Turistica, 16(3), 313–328
Bibliometrična analiza spletnega sodelovanja v potovalnih agencijah
Jorge Raúl Avilas Hernández, Nolberto Cruz Aguilera, Félix Díaz Pompa
in Maja Borlinič Gačnik
Zaradi integracije ikt v distribucijskih kanalih je naročnik pri pridobivanju turi-
stičnih storitev in produktov vse samostojnejši ter avtonomnejši. Pandemija covida-
19 in globalna politika t. i. fizične oddaljenosti sta še dodatno okrepili to, kar je ško-
dovalo tradicionalnim potovalnim agencijam. Te so morale za preživetje v celoti ali
delno vpeljati spletni poslovnimodel. Vendar pa delo v spletnemokolju samo po sebi
še ne pomeni zagotovljenega uspeha, saj je treba načrtovati strategije spletnega so-
delovanja, ki olajšajo pozicioniranje vsakega udeleženca v konkurenčnem spletnem
okolju. S pomočjo podatkov, pridobljenih v bazi Scopus, je bila opravljena bibliome-
trična analiza, ki je ugotavljala stanje povezovanja spletnega sodelovanja potovalnih
agencij. Za analizo indikatorjev in kartiranje bibliometričnih omrežij so bile upo-
rabljene različne programske opreme, kot so Excel, Bibexcel, EndNote x20, Pajeck,
SciMath in vosviewer. O stanju sodelovanja med posameznimi turističnimi agen-
cijami največ povesta dva faktorja: prepoznali smo ju v ostri konkurenci ter v moč-
nemvplivu digitalizacije. Prav ta ugotovitev predstavljata glavni inovativni prispevek
raziskave. Po drugi strani pa je bilo ugotovljeno, da se z raziskovanjem tematike ne
ukvarja veliko znanstvenikov, saj vsebina v bazah podatkov ni bila prepoznana kot
predmet raziskav. Med glavnimi vrzelmi, ugotovljenimi v raziskavi, sta spletno so-
delovanje v tradicionalnih potovalnih agencijah in učinki sodelovanja na dojemanje
naročnikov ter kibernetsko varnost. Raziskava identificira najvplivnejše avtorje, re-
vije, publikacije na tem področju ter ključne teme in trende, ki so se pojavljali skozi
čas. Z opredelitvijo ključnih dejavnikov uspeha in izzivov spletnega sodelovanja v
potovalni industriji lahko ta raziskava organizacijam pomaga izboljšati njihove pra-
kse sodelovanja.
Ključne besede: bibliometrična analiza, spletno sodelovanje, Scopus, potovalna
agencija
Academica Turistica, 16(3), 329–344
Academica Turistica, Year 16, No. 3, December 2023 | 359
Abstracts in Slovene Povzetki v slovenšini
Raziskava učinka kakovosti storitev tajske masaže z vidika zaupanja
mednarodnih turistov
Napaporn Janchai, Glenn Baxter in Panarat Srisaeng
Turizem wellnessa je ena najhitreje rastočih panog na svetu (Global Wellness Insti-
tute, 2018). V zadnjih dveh desetletjih se je razvil v zelo pomemben segment turi-
stičnega trga po vsem svetu. To velja še posebej za Tajsko, kjer je postal eden najpo-
membnejših turističnih trgov. Poleg privabljanja turistov iz višjih razredov iz razvi-
jajočih se ter razvitih držav turizem wellnessa pripomore tudi k povečanju gospo-
darske rasti majhnih ali razvijajočih se držav, ki imajo bogato ponudbo tradicional-
nih metod ohranjanja zdravja in dobrega počutja (Jagyasi, 2022). Tajska masaža je
tesno povezana turizmom wellnessa, saj predstavlja ključno storitev za to vrsto tu-
rizma. Kar zadeva dejavnost masaž, zaupanje turistov temelji na dojemanju kakovo-
sti storitve, ki vpliva na odločitev za nakup. Kakovost storitve in zaupanje turistov
sta medsebojno povezana in prispevata k donosu ter gospodarskemu razvoju. Zato
je pomembno preučiti kakovost tajske masaže v povezavi z zaupanjem turistov, da
bi raziskali ključne dejavnike, ki vplivajo na mednarodno zaupanje turistov v taj-
skomasažo. Rezultati te raziskave lahko vodijo v razvoj kakovosti storitev, da bi tako
spodbudili zaupanjemednarodnih turistov, ki predstavljajo pomemben vir tujih pri-
hodkov. Cilj raziskave je tako preučiti vpliv kakovosti storitev tajske masaže na zau-
panje mednarodnih turistov. V Bangkoku na Tajskem je bila medmarcem in majem
2019 izvedena raziskava, ki je zajela 400 mednarodnih turistov. Uporabili so struk-
turiran raziskovalni vprašalnik in zbrane podatke nato uporabili za testiranje pred-
postavk raziskave z metodo večkratne regresijske analize. Raziskava je ugotovila, da
trije od petih elementov kakovosti storitve vplivajo na zaupanje mednarodnih tu-
ristov. Ti elementi vključujejo »sočutje«, »oprijemljivost« in »odzivnost«, medtem
ko »zagotovilo« in »zanesljivost« nimata pomembnega vpliva na zaupanje turistov.
Ugotovitve te raziskave vzpostavljajo empirično razmerje med sočutjem, oprijemlji-
vostjo in odzivnostjo v poslovnemmodelu tajske masaže ter zaupanja mednarodnih
turistov. Ta vpogled lahko pomaga masažnim dejavnostim bolje razumeti elemente
kakovosti storitve, ki vplivajo na zaupanje mednarodnih turistov.
Ključne besede: kakovost storitve, zaupanje turistov, turizem wellnessa, masaža,
Tajska
Academica Turistica, 16(3), 346–355
360 | Academica Turistica, Year 16, No. 3, December 2023
Academica Turistica Instructions for Authors
Instructions for Authors
Aim and Scope of the Journal
Academica Turistica – Tourism and Innovation Journal
(at-tij) is a peer-reviewed journal that provides a fo-
rum for the dissemination of knowledge on tourism
and innovation from a social sciences perspective. It
especially welcomes contributions focusing on inno-
vation in tourism and adaptation of innovations from
other fields in tourism settings.
The journal welcomes both theoretical and appli-
cative contributions and encourages authors to use va-
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As a result of this your paper will be either accepted
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Manuscript Preparation
Manuscripts should be prepared according to the style
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Text formatting. Please, use the automatic page num-
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Academica Turistica, Year 16, No. 3, December 2023 | 361
Academica Turistica Instructions for Authors
the equation editor or MathType for equations. Whe-
never possible, use the si units (Système international
d’unités).
Thetitlepage should include the title of the article (no
more than 85 characters, including spaces), full name
of the author(s), affiliation (institution name and ad-
dress) of each author clearly identified; linked to each
author by use of superscript numbers, corresponding
author’s full name, telephone, and e-mail address.
Abstract. The authors are obliged to prepare two ab-
stracts – one in English and one (translated) in Slo-
vene language. For foreign authors translation of the
abstract into Slovene will be provided.
The content of the abstract should include the pur-
pose, methods, results, and contribution of the rese-
arch. It should only contain the information that appe-
ars in the text as well. It should contain no reference to
figures, tables and citations published in themain text,
and should not exceed 250 words.
Beneath the abstract, the authors should supply
appropriate keywords (3–6) in English and in Slovene.
For foreign authors the translation of the abstract into
Slovene will be provided.
The main text should contain a coherent and logi-
cal structure preferably following the imrad format
(Introduction, Methods, Research [and] Discussion).
However, other structures are also welcome (e.g. In-
troduction, Development and Conclusions) as long as
the text maintains its logical structure and focus. Ac-
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The length of the articles should not exceed 9,000
words (including tables, figures, and references), dou-
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Tables. Each table should be submitted on a sepa-
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Figures. Captions are required for all Figures and shall
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References
References should be formatted according to the Pu-
blication Manual of the American Psychological Associ-
ation (American Psychological Association, 2019).
The list of references should only include works
that are cited in the text. Personal communications
and unpublished works should only be mentioned in
the text. References should be complete and contain all
the authors that have been listed in the title of the ori-
ginal publication. If the author is unknown, start with
the title of the work. If you are citing a work that is in
print but has not yet been published, state all the data
and instead of the publication year write ‘in print.’
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362 | Academica Turistica, Year 16, No. 3, December 2023
Academica Turistica Instructions for Authors
Citing References in Text
One author. Tourism innovation specific is mentioned
(Brooks, 2010). Thomas (1992) had concluded . . .
Two authors. This result was later contradicted (Swar-
brooke &Horner, 2007). Price andMurphy (2000)
pointed out . . .
Three or more authors.Wolchik et al. (1999) or (Wol-
chik et al., 1999).
If two references with three or more authors shor-
ten to the same form, cite the surnames of the first
author and of as many of the subsequent authors as
necessary to distinguish the two references, followed
by a coma and et al.
List several authors for the same thought or idea
with separation by using a semicolon: (Kalthof et al.,
1999; Biegern & Roberts, 2005).
Examples of Reference List
Books
American Psychological Association. (2019). Publica-
tion manual of the American Psychological Associ-
ation (7th ed.).
Swarbrooke, J., &Horner, S. (2007).Consumer behavi-
our in tourism. Butterworth-Heinemann.
Journals
Laroche,M., Bergeron, J., & Barbaro-Forleo, G. (2001).
Targeting consumers who are willing to pay more
for environmentally friendly products. Journal of
Consumer Marketing, 18(6), 503–520.
Wolchik, S. A., West, S. G., Sandler, I. N., Tein, J.-
Y., Coatsworth, D., Lengua, L., . . . Griffin, W. A.
(2000). An experimental evaluation of theory-
basedmother andmother-child programs for chil-
dren of divorce. Journal of Consulting and Clinical
Psychology, 68, 843–856.
Newspapers
Brooks, A. (2010, 7 July). Building craze threatens
to end Lanzarote’s biosphere status. Independent.
http://www.independent.co.uk/environment/
nature/building-craze-threatens-to-end
-lanzarotes-biosphere-status-2020064.html
Chapters in Books
Poirier, R. A. (2001). A dynamic tourism develop-
ment model in Tunisia: Policies and prospects. In
Y. Aposotolopoulos, P. Loukissas, & L. Leontidou
(Eds.),Mediterranean tourism (pp. 197–210). Rou-
tledge.
Conference Proceedings
Price, G., & Murphy, P. (2000). The relationship be-
tween ecotourism and sustainable development: A
critical examination. In M. Ewen (Ed.), cauthe
2000: Peak performance in tourism and hospitality
research; Proceedings of the Tenth Australian Tou-
rism and Hospitality Research Conference (pp. 189–
202). La Trobe University.
Paper Presentation
Thomas, J. (1992, July). Tourism and the environment:
An exploration of the willingness to pay of the ave-
rage visitor [Paper presentation.] Tourism in Eu-
rope, Durham, England.
Theses andDissertations
Sedmak, G. (2006). Pomen avtentičnosti turističnega
proizvoda: primer destinacije Piran [Unpublished
doctoral dissertation]. University of Ljubljana.
Working Papers
Salamon, L. M., Sokolowski, S. W., Haddock, M. A., &
Tice, H. S. (2013). The state of global civil society vo-
lunteering: Latest findings from the implementation
of the un nonprofitt handbook (ComparativeNon-
profit Sector Working Paper No. 49). Johns Hop-
kins University.
Web Pages
Croatian Bureau of Statistics. (2001). Census of popu-
lation, households and dwellings. http://www.dzs
.hr/Eng/censuses/Census2001/census.htm
Manuscript Submission
The main manuscript document should be in Micro-
soft Word document format and the article should be
submitted to http://academica.turistica.si/index.php
/AT-TIJ/about/submissions
Academica Turistica, Year 16, No. 3, December 2023 | 363