Medical Tourism of International Elderly Patients in Taiwan

Abstract

The main aim of this study was to explore on medical tourism of international elderly patients in Taiwan. The study focused on the tourism sector of Taiwan. The study explored various factors that motivated the international tourists to participate in medical tourism, in line with main objective. The study relied on primary data using structured questions to explain the main objective and the data was analysed using statistical tools like SPSS, and ANOVA analysis.

The study categorized the tourists into three groups with regard to the level of medical needs, for instance, high level medical needs, moderate level medical needs and low level medical needs. The results of the study revealed that the variables of the study varied significantly among the three groups, for instance, tourists who fell in the category of high level wellness preferred to take long vacations and had a greater urge for entertainment. All in all, medical tourism is regarded as a segment of health tourism and many tourists make the visits for health purposes.

The findings of this study are very relevant to tourists, tourist planners and tourist marketers. It is also adequate for the country to improve and protect the physical appearance of tourist destination sites to enable her to be in a competitive position as compared to the other countries. Moreover, the ease of accessibility to the tourist destination sites should be improved so as to give an easy time for the elderly tourists to move around. Accommodation facilities and other social amenities should be upgraded so that they can be up to standard and fit the specifications and the requirements of the tourists.

Introduction

Overview

This chapter covers the background to the study, problem statement, research objectives and hypotheses and the significance of the study.

Background to the study

Medical entails a particular notion of health (Müller & Lanz-Kaufmann, 2002, p. 12). Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of wellness is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Wellness can, therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in.

Medical needs direct the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, it involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or will to aid in his/her functionality. An individual will achieve a higher degree of wellness when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment (Ardell, 1977, p. 54).

The condition of being combined with a positive attitude in a continuous process entails the vibrant development of wellness (Travis, 1984, p. 33). The definition of wellness according to Müller and Lanz-Kaufmann is in line with the definition given by Ardell (1977). Wellness is a health condition whereby the individual’s body, intellect and spirit work in unison. The elements that define wellness include: self-conscientiousness, health and prettiness, food nutrition, recreation, mental education, social interaction and sensitivity to the environment (Travis, 1984, p. 33). In addition, Müller and Lanz-Kaufmann noted that the hospitality industry should strive to refurbish its market in order to provide products that promote wellness so that the tourists can enjoy their trips better.

Recent history in the field of wellness tourism point out to the fact that many individuals have resorted to seeking for treatments or other health related therapies to boost their personal health standard and the general appearance. Complementary medicines gave way to the introduction of conventional medicine with the aim of aiding the people to stay in good physical shape and to be energetic. Yoga and massage are some of the most popular methods of treatment that are being used in the present world. Medical tourism is widely regarded as a branch of health tourism as the tourists are motivated to better their health standards.

Many at times, medical tourism takes place in institutions that help to cure various illnesses; there is still a difference between wellness and cures from the health perspective. It is a belief that the urge for wellness is normally followed by healthy individuals, who have the prime objective of prevention rather than cure. The wellness tourists however seek for services which are similar to those of tourists seeking for curative services, but it is their enthusiasm of safeguarding and advancing their health that separates them from those tourists seeking for curative services.

Statement of the problem

Medical tourism is considered to be a branch of health tourism. Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Medical tourism involves the individuals visiting hotels or recreational centres that provide wellness services. Medical tourism, being a subset of healthcare tourism does not entail elective surgery.

It is required that wellness hotel should have an up-to-standard wellness infrastructure in order to provide the best services to the tourists. There exist various extents of wellness as there are various extents of illness. Wellness tourism, therefore, is in line with the individual’s intent to improve the class of his/her life, physical health, mental health and social interaction. The individuals stay in specific hotels that have the capability to make available the relevant professional expertise and professional care. The various service packages of the hotels include: physical training, dieting activities and mental training. The hotels that function in line with wellness tourism should therefore strive to safeguard the individual’s physical health, mental health, and social relations.

Objectives of the study

The general objective of this study was to explore on medical tourism of international elderly patients in Taiwan. In line with the general objective, the study examined the following specific objectives:

1. To determine the effectiveness of sun and sea on elderly participation in medical tourism;
2. To determine the influence of cultural heritage and events on elderly participation in medical tourism;
3. To determine the influence of the desire for entertainment on elderly participation in medical tourism;
4. To investigate the influence of the urge to take a vacation on elderly participation in medical tourism;

Hypotheses of the study

In order to meet the above objectives, the following hypotheses were tested:

1. Ho₁: Sun and sea motivate the elderly tourists to travel;
2. Ho₂: Cultural heritage and events motivate the elderly tourists to travel;
3. Ho₃: The urge for entertainment motivate the elderly tourists to travel;
4. Ho₄: The urge to take a vacation motivate the elderly tourists to travel;

Justification of the Study

The findings of this study are of great value to policy makers and regulatory authorities. It provides the policy makers with a wide exposure with regard to the assessment of medical tourism of international elderly patients. The findings of this study also add to the body of knowledge of related studies.

Scope of the Study

The scope of this study was in line with the general objective, which was to explore on medical tourism of international elderly patients in Taiwan. Using primary data and applying statistical techniques, the study explained the variables to meet the research objectives. The study used a cross-sectional research design to meet the objectives. The data of the survey were analysed using statistical techniques such as SPSS and ANOVA analysis.

Literature Review

Introduction

This chapter reviews the theories both empirical and theoretical that are closely linked to the influence of wellness tourism’s participation of the elderly.

Decisive models of tourists’ actions

The process of tourists’ behaviour is both complex and vigorous. In the context of tourism., the tourist behaviour process is considered to be complex due to the fact that tourism products are intangible and the purchasing power of the tourists is accumulated (Correia, 2002). Three sets of models have emerged as a result of the interdisciplinary status of wellness tourist behaviour. The models include: microeconomic models, structural models and processional models. In the case of microeconomic models, medical tourists normally have the motive to increase their utility to the maximum subject to a combination of constraints such as: time, income and the level of technology (Morley, 1992). In the case of structural models, the connection between the input and output is scrutinized. Consequently, for the case of processional models, the tourist’s judgments are put in examination (Abelson & Levi, 1985).

Samuelson (1991) asserts that the notion that the tourists strive to maximize the utility that they derive from wellness tourism contributes to the process of tourism analysis. Moreover, the destination sites for tourists are not considered as objects that can directly be used, but rather products that have characteristics that facilitate the derivation of utility (Lancaster, 1966, p. 140); this utility is subject to various constraints. Morley (1992, p. 254) brings into focus the utilization of microeconomic theory to the field of tourism. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of wellness tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000; Lancaster, 1966, p. 140).

Scholarly studies that relate to the analysis of the influence of wellness tourism’s participation of the elderly are founded on the basis of various models that are considered to be outstanding. These models stem from the perspective of the processional models. The first model is the Nicosia model (1966) which concentrates on the correspondence that occurs between the tourist and the firm, and how the firm convinces the tourist to acquire her products. Another model dubbed Howard and Sheth’s model (1969) integrated the input notion that describes the conduct of the tourists; in addition, the model states the ways by which the tourists incorporate these inputs in their decision making process. The Howard and Sheth’s model has continued to be regarded as the most important model for analysing tourist activities.

Medical tourist performance can be assessed by paying regard to the analytic analysis of desire, anticipations, conception and satisfaction. Gallarza, Saura and Garcia (2002, p. 63) emphasized on the use of statistical tools (such as multivariate analysis that depend on other analyses like correlation matrix, sampling techniques and regression analyses) on tourism. Qualitative choice models are very efficient in assessing the wellness tourist behaviours; such models entirely depend on multinomial logit (Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118). In the recent past, many academic scholars have applied structural models on researches that relate to the influence of medical tourism’s participation of the elderly (Baker & Compton, 1998, p. 800).

Tourist decision making processes

There are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Before the tourist proceeds to make the purchase, the pre-decision stage usually precedes. This stage normally entails serious decision making by the tourist as he/she has to make the best choice out of the many alternatives. The kind of choices that the tourists have in this stage include: the travel destination, the activities to engage in during the travel and the level of expenditure that the tourist expects to commit. Very many tourists are motivated to travel because of the various activities that they intend to engage in or carry out (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466).

The pre-decision stage gives way for the decision stage. At this point the tourists make decisions paying attention to the time they have available for the travel and the amount of income that they want to commit on the travel. The decision stage is mostly concerned with the purchase of products. The post-purchase stage stems from the factors that determine the process of making choices and checks whether the tourist has been satisfied with the decisions or the choices that he/she had opted for. This stage, therefore, plays an important role in assessing the likelihood of making the purchase again and also in recommending or opposing the choice or the decision (Abelson & Levi, 1985; Barros & Proença, 2005, p. 300).

Uncertain factors

Impulsive factors

Generally, impulsion or motivation refers to a certain need that influences a person to assume a certain demeanour in order to satisfy that need. The motivation theories can be linked to the psychological factors like: wants, desires and goals, as the theories provide a description of the psychological factors (Fodness, 1994, p. 563). The psychological factors of needs, desires or goals induce an urgent urge in the person’s mind which leads him/her to purchase goods or services; thus, motivation directly influences the feelings of the individuals (Gartner, 1993, p. 200; Dann, 1996, p. 43; Baloglu, 1997, p. 226). Tourists who have divergent motives may assess a tourist destination in the same manner especially if they are of the opinion that the destination provides them with the maximum wellness utility.

The important motivational elements that have been pointed out by different scholars in their studies include: the urge to get away from the daily programs or work; and the urge to seek for alternative enjoyable experiences (McCabe, 2000, p. 1050). The push-pull model was generated by Crompton (1979, p. 410). The model postulates that tourism is driven by two main forces; the first force, known as push, pushes the tourist out of his/her home driven by the desire to travel to an unspecified destination. In this context, the motivation of the push force depends on the satisfaction anticipated by the tourist, the urge for adventure, prestige, knowledge, and the desire to make new friendships. The second force, known as pull, provides the tourist with the direction regarding the choice of the destination (Uysal, Mclellan & Syrakaya, 1996, p. 62).

The motives of the pull force influence the tourist’s choice of the place to visit; the forces are connected to the features of the destination and the infrastructures that define tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied (Mohsin & Ryan, 2003, p. 117; Beerli & Martin, 2004, p. 670; Uysal, Mclellan & Syrakaya, 1996, p. 62; Fodness, 1994, p. 563). When the tourist has already pointed out the need, he/she proceeds to identify the destination that grants him/her the maximum satisfaction; the next stage after this is the learning stage.

The tourist’s learning course

The learning process enables the tourist to gain the knowledge concerning a product and how the product will impact on the satisfaction of the tourist. Bettman and Park (1980) studied the learning process before developing another model that processes information about the behaviour of the tourists when they are making decisions concerning the destinations that they want to visit. Actually, the tourist has the ability to retain at most seven destination sites and at least two destination sites (Miller, 1956, p. 83).

A study conducted by Guy, Curtis and Crotts (1990) confirm that the tourists’ learning about a destination is determined by their previous experiences or by the kind of information that they receive either directly or indirectly concerning the destination (Money & Crotts, 2003, p. 195). The search for information relating to the destined visit site by the tourists is motivated by the various contingencies in the marketplace and the nature of the visits (Fodness & Murray, 1997, p. 506). Tourists who travel on a regular basis have a more affinity to receive information that relate to the travel product or the travel destination; with this regard they are more enthusiastic to spread the information to other interested travellers (Jamrozy, Backman & Backman, 1996, p. 912). The learning process by the consumes give way to the perception

Insight/perception factors of the tourists

Perception refers to the way in which the travel tourists regard the value of the product (Sheth, Newman & Gross, 1991, p. 163; Correia & Crouch, 2004; Correia, Valle & Moço, 2005). The concept of perception stems from the cognitive point of view or from the behavioural point of view. Thus, it should be noted that perception occurs as a result of the process of tourist learning together with their motivations. Previous researches concerning tourist motivation reveal that the tourists’ selection and assessment of travel products are influenced mostly by affective factors (Fodness, 1994, p. 558).

Every tourist is driven by his/her personal motivational factors to travel; these motivational factors are both internal and external and they define the tourists’ insights regarding the destination (Baloglu & McCleary, 1999, p. 870; Gartner, 1993, p. 193; Correia, Valle & Moço, 2005; Dann, 1981, p. 190; Pearce, 1982, p. 153). Perception can occur selectively if the tourist decides to be selective in his/her exposure, attention, perceptual blockage and perceptual defence. It is a common practice for the tourists to select only things they need and block out the things that they regard as unnecessary or unfavourable to them (Gnoth, 1997, p. 292)

Satisfaction factors of the tourists

Each tourist has a different interpretation of the concept of satisfaction, thus, its definition is divergent among the various tourists. Many scholars in their research articles have linked the definition of satisfaction to the distinction between expectation and experience (Woodside, Frey & Daly, 1989, p. 12). Bultena and Klessig (1969, p. 349) gave a definition of satisfactory experience as a part of the level of the correspondence between the tourists’ desires and the experiences that they undergo. Satisfaction does not entirely stem from the pleasures that the tourists derive from the travelling experience, but rather it is the analysis that checks out whether the experience satisfied the tourist as it was expected to (Hunt, 1977, p. 459). Various researches have revealed that satisfaction and the brand’s attitude mean one and the same thing (LaTour & Peat, 1979, p. 433).

Affective reactions have a major influence on the experiences of the tourists’ consumption process with regard to their judgments on post-purchase satisfaction (Madrgal, 1995, p. 212; Spreng, MacKenzie & Olshavsky, 1996, p. 17; Barsky, 1992, p. 54; Oliver, 1993, p. 422). In this case, it is assumed that the satisfaction of the tourists is dependent on the performance of the product (wellness), the perceptions of the tourist in relation to the product, and the motivations that the tourists have. The ratio between the performance and the perception rises as the level of the tourist’s satisfaction also rises (Barsky, 1992, p. 54); the ratio depends on the nature of the experiences that the tourists have in relation to the experience they had envisaged or desired. The dissatisfaction of the tourists comes about when there is a major disparity between what the tourists had expected and what they actually experience in terms of the performance of the products (Arnould & Price, 1993, p. 26). Miller (1977) concluded that tourist satisfaction can occur in various forms; for instance, desirable satisfaction, ideal satisfaction, and tolerable satisfaction (Truong, 2005, p. 229).

Behavioural objective factors of the tourist

The intention by the tourist to make a purchase depends on their motives relating to both the behavioural and social norms. The motives of the tourists depend on the level of expectations that they have concerning the probability of assuming a certain behaviour and the assessment of how they regard it (Fishbein & Ajzen, 1980). Lam and Hsu (2006) in their study used the theory of reasoned action to show that the intention of the tourists to choose a destination site depends on the recognized behaviour and the past behaviour (Fishbein & Ajzen, 1980; Kozak, 2001, p. 792).

Exploration of the study hypotheses

The tourists rely on information sources for travel awareness

Studies by Baloglu and McCleary (1999) confirm that tourists utilize the various sources of information so as to be familiar with the destined site. The sources of information include: the media (i.e. newspapers, televisions, internet, or travel magazines), information from friends or relatives through word of mouth, among others (Um & Crompton, 1990, p. 436; Fakeye & Crompton, 1991, p. 12; Dann, 1977, p. 186). The information is very beneficial to the tourists in their decision making process. There are four basic types of sources of information, they include: neutral information sources (tourism firms), commercial information sources (travel agencies), social information sources (relatives or friends) and promotional information sources (internet, magazines, radios or television) (Bargeman & Poel, 2006, p. 711; Crotts, 1999).

Various information sources motivate the tourists to visit

In their study, Um and Crompton (1990) established that travel tourists use the various sources of information to bring about a cognitive perception or an affective perception. Tourism is like any other product, thus, the tourist should seek for all the relevant information that relate to the product before deciding to purchase it. Woodside and Lyosnski (1989) in their study revealed the influence of the information sources on how they trigger the needs of the tourist. Tourists who are always uncertain resort to using travel agencies rather than media sources to get information relating to a destination site (Money & Crotts, 2003, p. 195). Wellness tourists are motivated by the promotional campaigns or publicity of the destination site (Crompton, 1979, p. 412; Kotler, Haider & Rein, 1993).

The sources of information initiate pull motivations in the tourist’s mind

The sources of information act as forces that affect pull motivations on the minds of travel tourists (Woodside & Lyosnski, 1989; Holbrook, 1978, p. 550; Gartner, 1993, p. 200).

Push motivations are instigated by internal motives of the tourists

Push motivations that are instrumental in influencing the tourist’s trip are classified as internal factors (Dann, 1977, p. 186). These internal factors that influence the push motivations include: the feeling of loneliness by the tourist, the urge of the tourist to travel, and the desire of the tourist to gain social recognition. In addition, Crompton (1990) regards internal factors as the factors that trigger the urge to travel in order to relax, socialize, earn prestige and get away from the daily routine.

Pull motivations are instigated by external motives of the tourists

In their study, Uysal and Hagan (1993) confirm that the characteristics of the tourist’s travel destination are connected to the pull factors. The tourist’s choice of the travel location is mostly influenced by the pull motives (Crompton, 1990, p. 53). Examples of pull motivation factors include: the available hospitality, accommodation, cost of the trip, type of food, nightlife, among others.

The process of tourist participation in wellness tourism is both complex and vigorous. In the context of tourism, the tourist behaviour process is considered to be complex due to the fact that tourism products are intangible and the purchasing power of the tourists is accumulated (Correia, 2002). Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of travel tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000). There are various factors that influence the decision making process of the tourists; the main outstanding factor is actually the decision process. Tourism products, just like other normal products have several attributes which play the role of distinguishing them from the possible substitute products (Song & Witt, 2000; Lancaster, 1966, p. 140).

Qualitative choice models are very efficient in assessing the participation of medical tourists; such models entirely depend on multinomial logit (Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118). There are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994).

Factors motivating the elderly tourists to participate

Motivation refers to the category of a need or a plight that urges a person to engage in a certain action that is expected to offer his/her satisfaction (Moutinho, 2000, p. 13). In other instances, motivation has been taken to mean the drive that exists within a person that compels him/her to do a certain thing so as to meet a psychological need or a biological need (Fridgen, 1996, p. 46). Travel motivation is the kind of motivation that is connected to the reason why people decide to travel (Hsu & Huang, 2008, p. 52). The motivation that is connected to the tourists’ travel encompasses a wide spectrum of the tourists’ behaviours and their previous travel experiences. People trave as a result of various reasons, namely the need to loosen up, the need to socialise, and the need to escape from the daily burdens. The sense of adventure also drives the urge of people to travel. Pearce (1982) connected tourists’ motivation and behaviour to the Maslow’s (1954) hierarchy of human needs; he was of the opinion that “the main reason that made the tourists to be attracted to the destined place of visit was their desire to attain self-actualization, the feeling of love or belongingness, and also to attain the physiological needs” (p. 42).

There exist various available literatures that explain the various factors that motivate tourists to travel. In their study, Cleaver et al. (1999) revealed that “the market for the elderly is not uniform, and they pointed out seven segments that relate to the motivation for the elderly tourists. The segments include: thinkers, nostalgic, physicals, learners, status seekers, friendly and escapists” (p. 8). In addition, Backman et al. (1999) pointed out the similarities and contrasts that exist between the younger elders (55 to 64 years) and the other elders (65 years and above). In their study, they revealed that “the main motivation factors that drove the younger elders to travel was the need to relax or to engage in leisure activities; on the other hand, the older elders were mainly motivated to travel by educational attractions and national attractions” (p. 17).

Moreover, Fleischer and Pizam (2002) did a review of the past studies regarding travel motion and made an inference that “the older elders were generally motivated to travel by the desire to relax, interact, learn, and to gain excitement” (p. 108). In the same manner, Horneman et al. (2002) in his study revealed that “the motivation for the elderly was moving towards the desire to rest or relax, the desire for physical exercise or fitness, and the desire for education” (p. 34).

The most recent study done by Huang and Tsai (2003) did a review of the previous studies concerning travel motivation and found out that “the motivation to travel can be categorized into various groups, for instance, rest and relaxation, education, adventure, socializing, and escape from daily patterns of life” (p. 565). In the same way, Jang and Wu (2006) concluded that “the significant push and pull motivations of the tourists were: the desire to seek knowledge, and the urge to be safe” (p. 308).

Elderly tourist profiles and requirements

An exploration of the past studies concerning travel motivation factors mainly focused on elderly travellers by checking on their profiles, tastes and needs. A study conducted by Anderson and Langmeyer (1982) to assess the profiles of the senior travellers mainly concentrated on two elderly groups (over 50 years and below 50 years). The study found out that “both the two groups were motivated to travel by the desire to fulfil their pleasure, the desire to rest or relax, and the desire to meet families or friends; however, the group which was above 50 years of age had a higher probability of touring historical sites” (p. 22). In addition, a study conducted by Javalgi et al. (1992) confirmed that “younger tourists are more educated as compared to the elderly tourists, thus, they always carry out an information search before they proceed with their visit” (p. 16). In addition, the study also found out that “the elderly tourists had adopted a culture of purchasing trip packages that covered the costs of both transportation and accommodation” (p. 17).

A research done by Zimmer et al. (1995) focused on the nature of the old tourists. The findings of the study revealed that a persons’ age, ability to move and the level of knowledge are the most outstanding variables. A study conducted by Koss (1994) found out that “the elderly tourists preferred tourism packages that offered them excitements and added value to their lives” (p. 37). In a related study, Bai et al. (2001) conducted a study that focused on elderly tourists from Britain, Germany and Japan. They found out that “the elderly tourists preferred to have packaged tours; this was evident by the significant number of the tourists in travel parties” (p. 152).

Criteria of behaviour of the elderly tourists

Several studies have been carried out to check on the patterns of behaviour of the elderly tourists. In his study, Shoemaker (1989) concentrated on elderly tourists from Pennsylvania by exploring their travel behaviours and their motivations to travel. He further “segmented the market for the elderly tourists into three groups, for instance, tourists travelling as a family, tourists who rested actively, and the older set of tourists” (p. 18). A research that was done by Romsa and Blenman (1989) also revealed similar results. The research paid greater attention to the nature and pattern of the German tourists with regard to their destination choice, accommodation choice, and the period of time that they took during the travel.

Another study conducted by Huang and Tsai (2003) on the elderly tourists from Taiwan revealed that “the elderly tourists were reluctant to sign up for an all-inclusive tour package” (p. 565). Instead, the elderly tourists preferred to have elegant tours which had a high quality in terms of provision of services. Littrell (2004) conducted a study that sought to explore on the tourism activities of the elderly tourists and their behaviour when it comes to shopping. The study found out that “the profiles of the tourists were diverse with regard to their probability to shop at retail outlets, their choice of shopping malls, and their sources of information concerning the available shopping activities” (p. 351).

Motivation is regarded as a shape of the state of needs that influences a person to engage in a certain action or activity that has a higher probability of granting him/her a certain level of desired satisfaction (Moutinho, 2000, p. 13). Motivation is a procedure concerning preferences made by individuals or subordinate organisms among substitute forms of deliberate activity (Britton, et al., 1999, p. 27). Barcelo (2000) suggested that “the present and immediate influence on the vigour, direction and persistence of action can be termed as motivation” (p. 24). Kinni (1994) found out that “business managers are striving to establish and maintain an atmosphere that is more favourable for the satisfaction of tourists, who are striving together in groups towards attainment of pre-determined goals” (p. 14). In the same way, Robson (2002) insinuated that “motivation can be offered to workers as per the following methodologies: the customary or traditional approach; implicit bargaining; human relations approach; internalized motivation; and competition” (p. 62).

The motivation theories can be linked to the psychological factors like: wants, desires and goals, as the theories provide a description of the psychological factors (Fodness, 1994, p. 563). The psychological factors of needs, desires or goals induce an urgent urge in the person’s mind which leads him/her to purchase goods or services; thus, motivation directly influences the feelings of the individuals. Tourists who have divergent motives may assess a tourist destination in the same manner especially if they are of the opinion that the destination provides them with the maximum utility.

Pull is the second force that provides the tourist with the direction regarding the choice of the destination (Uysal, Mclellan & Syrakaya, 1996, p. 62). The drive of the pull force influences the tourist’s selection of the place to visit; the forces are linked to the attributes of the destination and the infrastructures that describe tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied. When the tourist has already pointed out the need, he/she proceeds to identify the destination that grants him/her the maximum satisfaction.

It is very beneficial for the elderly tourists to learn about the travel destination before making up their minds to travel. A study conducted by Guy, Curtis and Crotts (1990) confirm that the tourists’ learning about a destination is determined by their previous experiences or by the kind of information that they receive either directly or indirectly concerning the destination. Tourists who are doubtful normally depending on information from travel agencies so that they can be furnished with the essential information regarding the destination site (Money & Crotts, 2003, p. 195). The search for information relating to the destined visit site by the tourists is motivated by the various contingencies in the marketplace and the nature of the visits (Fodness & Murray, 1997, p. 506). Tourists who travel on a habitual basis have a more likelihood to receive information that relate to the travel product or the travel destination; with this regard they are more passionate to spread the information to other interested travellers (Jamrozy, Backman & Backman, 1996, p. 912).

The perception of the destination encompasses a variety of factors and various attraction sites that the tourist believes to have the capacity to satisfy his/her desires or expectations. Therefore, when the post-purchase behaviour analysis is taken on, it is expected to make out whether the travel tourists have been contented by the tourist products or whether they have been discontented by the same. The analyses of the post-purchase tourist behaviour are related to the concept of push and pull satisfaction. When the concept of push and pull satisfaction is likened to motivation, both the tangible and intangible components of the post-purchase analysis can be measured (Truong, 2005, p. 229).

The purpose of the tourist to make a purchase depends on their motives relating to both the behavioural and social norms. The intention of the tourists depends on the level of expectations that they have concerning the likelihood of adopting a certain behaviour and the assessment of how they regard it (Fishbein & Ajzen, 1980). Lam and Hsu (2006) in their study used the theory of reasoned action to show that the intention of the tourists to choose a destination site depends on the standard behaviour and the past behaviour (Fishbein & Ajzen, 1980; Kozak, 2001, p. 792).

Decision making process of the elderly tourists

Scholarly articles have pointed out that there are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Before the tourist carries on to make the purchase, the pre-decision stage normally paves the way. This stage normally involves serious decision making by the tourist as he/she has to make the best preference out of the many alternatives. The kind of choices that the tourists have in this stage include: the travel destination, the activities to engage in during the travel and the level of expenditure that the tourist expects to commit. Very many tourists are motivated to travel because of the various activities that they intend to engage in or carry out (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466).

The pre-decision stage leads to the decision stage. At this point the tourists make decisions paying attention to the time they have available for the travel and the amount of income that they want to commit on the travel. The decision stage is mostly concerned with the purchase of products. The post-purchase stage originates from the factors that determine the process of making choices and checks whether the tourist has been satisfied with the decisions or the choices that he/she had opted for. This stage, therefore, plays an important role in assessing the likelihood of making the purchase again and also in recommending or opposing the choice or the decision (Abelson & Levi, 1985; Barros & Proença, 2005, p. 300).

There are three sets of models that have emerged as a result of the interdisciplinary status of the elderly tourists’ behaviour. The models include: microeconomic models, structural models and processional models. In the case of microeconomic models, elderly tourists normally have the motive to increase their utility to the maximum subject to a combination of constraints such as: time, income and the level of technology (Morley, 1992). In the case of structural models, the connection between the input and output is scrutinized. Consequently, for the case of processional models, the tourist’s judgments are put in examination (Abelson & Levi, 1985).

The microeconomic models that analyses the behaviour of the tourists are found on the basis of the classical economic theory. When taking into consideration the demand for manageable goods or services, classical economic theory is very instrumental. In addition, the classical economic theory brings into focus the limitations that relate to tourism analysis. Samuelson (1991) asserts that the notion that the tourists strive to maximize the utility that they derive from tourism contributes to the process of tourism analysis. Moreover, the destination sites for tourists are not considered as objects that can directly be used, but rather products that have characteristics that facilitate the derivation of utility (Lancaster, 1966, p. 140); this utility is subject to various constraints. Morley (1992) brings into focus the utilization of microeconomic theory to the field of tourism. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of elderly tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000).

Research Methodology

Introduction

Methodology is the process of instructing the ways to do the research. It is, therefore, convenient for conducting the research and for analysing the research questions (Snell & Dean, 1992, p. 480). The process of methodology insists that much care should be given to the kinds and nature of procedures to be adhered to in accomplishing a given set of procedures or an objective. Methodology gives a description of distinct methods or procedures that are to be used in analysing the data. These methods or procedures stand for a creative generic structure; thus, their order may be rearranged, or they may be combined or broken down into sub-processes.

The research strategy

First, with regard to the qualitative research, areas of study were chosen with determination, paying attention to whether the areas of study are in line with the features that have been predetermined (Creech, 1995, p. 33). Next, the part played by the researchers was to obtain a higher critical care (Creech, 1995, p. 33). This is mainly done in qualitative research due to the fact that there is every chance of the researcher assuming a transcendental or a ‘neutral’ position. Thus, this appears to be more elusive both in philosophical and/or practical terms. It is for this reason that the qualitative researchers are frequently pressed to mirror on their part in the research procedures and make things obvious in their research analyses.

Moreover, qualitative research procedures evaluate contextually and holistically, instead of being isolationist and reductionist. However, the most customary division between the employment of quantitative and qualitative research particularly in the social sciences is that quantitative methods are employed to evaluate the main hypotheses. This is so to establish content correctness and to evaluate measures that the researcher believes he/she should evaluate. This is regarded as one of the striking benefits of qualitative research.

Research Process

Qualitative research is a way in which research questions are captured in various academic fields of study, conventionally used in the social sciences, but also in research on market and other areas (Snell & Dean, 1992, p. 480). Exhaustive apprehensions of human demeanour with regard to qualitative researchers are being carried out with an aim to assess the causes that relate to such demeanour. The qualitative method investigates the question as to how and why decision making is carried out; hence, focused and smaller samples are more frequently preferred for huge samples (Skinner, 1953, p. 306).

Quantitative methods on the other hand verified the validity and truthfulness of the hypotheses. Creech (1995) further asserts that qualitative methods can be explained as a source of data or an explanation based on the dimensions of the graph or a non-mathematical data collection.

During the research process, qualitative approaches have the benefit of permitting for more multifariousness in the capacity to adapt to new developments as well as in responses of research itself (Bryman & Bell, 2003, p. 215). Qualitative research takes a lot of time to conduct besides being much more expensive. In various kinds of research, more cost effective methods of qualitative research have been designed; this has helped to solve the problem of high costs and the speed of conducting the research. It is important that the research should be conducted timely, paying much attention to the limited resources in relation to the cost (Bryman & Bell, 2003, p. 214).

Research Methodology

Methodology gives a description of distinct methods or procedures that are to be used in analysing the data. These methods or procedures stand for a creative generic structure; thus, their order may be rearranged, or they may be combined or broken down into sub-processes. With this regard, research methodology can entail elaboration of the generic processes and procedures; as well, research methodology can be elaborated through figurative means and can be adjusted to eliminate obscurity in the school of thought with tenacious conceptions or doctrines as they associate to a specific field or discipline of inquiry especially if the philosophical and/or principle of the presumptions that signify a specific methodology or a specific study is known as reasoning methodology.

Quantitative and Qualitative Approach

Quantitative approach

Quantitative research approach refers to the use of statistical techniques, mathematical techniques and calculation techniques to empirically analyse data (Bryman & Bell, 2003, p. 217). Quantitative methodology aims at utilizing mathematical and statistical theories and models to analyse the data. Quantitative methodology validates the hypotheses and conclusions that have been drawn from qualitative methodology (Carter, 2009, p. 239). The scientific procedures and processes that are utilized in quantitative methodology encompass: deriving models and theories; designing instruments for data gathering; controlling the variables empirically; and analysing data through the use of models.

Quantitative methodology is relevant for categorizing the observations or variables, examining the variables and generating statistical representations to analyse the observations. A researcher who utilizes quantitative research design has a predetermined knowledge of what to expect. In addition, the researcher employs data collection instruments like questionnaires or other relevant data collection equipments (Bryman & Bell, 2003, p. 216). The kind of data handled through quantitative methodology is mainly in numerical or statistical format. A strong feature of quantitative methodology is that it is the most efficient design to test hypotheses. Its limitation is that the relevant details of the variables or observations may be overlooked (Robson, 2002, p. 212).

Qualitative approach

Qualitative approach is mostly concerned with the human motives and the reasons behind such motives (Snell & Dean, 1992, p. 482). The main questions that come with qualitative approach are ‘why?’ and ‘how?’, in addition to ‘what?’, ‘where?’ and ‘when?’. With regard to this, a researcher utilizing the qualitative approach will tend to use smaller samples rather than larger samples (Carter, 2009, p. 239). Qualitative approach strictly generates only the information that applies to the designated case study; any additional information is treated as guesses. Once hypotheses are drawn through qualitative approach, they are tested through quantitative approach (Robson, 2002, p. 212).

Qualitative approach gives a full detail in terms of the description of the research process. Unlike quantitative research, the researcher has no idea of what results to expect. The researcher mainly relies on observations to collect data. One limitation of qualitative approach is that it consumes a lot of time and demands many resources in terms of money and expertise (Bryman & Bell, 2003, p. 219).

Questionnaire Survey

Questionnaires are pre-formulated set of questions which require the respondents to record their answers usually within closely defined alternatives (Carter, 2009, p. 239). Questionnaires can be administered to the respondents either by mail or personally by the researcher. Before designing a questionnaire, there are three principles to pay attention to, these principles include: principles of wording, principles of measurement and the general set up of the questionnaire.

The principle of wording entails: (a) the content and purpose of the questions, i.e. the researcher need to understand the nature of variables to be tapped; if a variable is subjective such as satisfaction where a respondent’s belief, perceptions, and attitudes are to be measured, the questions should tap the dimensions and elements of the concepts. In addition, where objective variables such as age and income are tapped, a single direct question would be appropriate (Robson, 2002, p. 216). (b) wording and language, i.e. language of the questionnaire should approximate the level of understanding of respondents. Consequently, the choice of words should depend on the level of education of the respondents (Bryman & Bell, 2003, p. 219). (c) type and form of question, i.e. type relates to whether question will be open ended or closed whereas form relates to positively and negatively worded questions [1 -5 with 1 being the lowest] versus [1-5 with 1 being the highest] (Robson, 2002, p. 216). (d) sequencing of questions, i.e. the questions should be structured in a way that they start from general questions to specific questions or from easy to difficult questions (Carter, 2009, p. 239).

The principle of measurement encompasses the principles to be followed to ensure that the data collected are appropriate to test the hypotheses. These principles include: categorization, which entails the adjustment of negative questions to become positive questions; coding; using scales and scaling techniques; and reliability and validity: reliability indicates how stably and consistently the instrument taps the variable

While the validity establishes how well a technique, instrument, or process measures a particular concept (Robson, 2002, p. 214).

Validity and Reliability

Validity refers to whether an instrument actually measures what it is supposed to measure, given the context in which it is applied. Reliability is concerned with consistence of measures. The level of an instruments’ reliability is dependent on its ability to produce the same results when used repeatedly. To achieve validity and reliability, the data was checked for coding errors and omissions while coding into excel sheets. The database was also verified for accuracy and completeness of all the entries to ensure reliability of data is achieved.

Validity of the data represents the data integrity and it connotes that the data is accurate and much consistent. Validity has been explained as a descriptive evaluation of the association between actions and interpretations and empirical evidence deduced from the data (Robson, 2002, p. 214). The canyon of validity is applicable to all guises of evaluation (which are both qualitative and quantitative) by coalescing scientific inquiry and rational debates to prove or disprove the outcomes and interpretations emanating from the data collected (Carter, 2009, p. 239).

Survey Sample Framework

A sample is a subset of the population, i.e. it comprises some elements chosen from the whole population (Barcelo, 2000, p. 626). Sampling is the process of selecting a sufficient number of elements of the population. The study of the sample and an understanding of its properties or characteristics would make it possible to generalize such properties of the population elements; that is, characteristics of the population such as population total, population mean, population standard deviation and population variance [parameters] can be approximated via measures of central tendency, dispersion, and other statistics (Easterby, Thorp & Lowe, 2008, p. 216).

The main reasons for sampling include: it is impractical to collect data from the entire population; sampling is time saving, in addition to saving costs and human resources. Collecting data from the entire population may occasion fatigue and increased errors; hence, sampling is widely preferred (Bryman & Bell, 2003, p. 308). The target population composed of tourists who made visits to five towns in Taiwan. The towns included: Changhua City, Douliu, Nantou City, Hualien City and Taitung City.

Questionnaire Administration

Data can be classified into two and they are secondary data and primary data. Primary data refer to the new data (observation, survey, interview, experiment, etc.) that the researcher needs to collect for the research while secondary data refers to the existing data that are available in various sources including books, journals, internet, etc. (Easterby, Thorp & Lowe, 2008, p. 216). For primary data collection, the issue is to focus on sampling. As far as the researcher is considered, the sampling technique is significant. For example, the sample size that is determined should not be too small as this will make it difficult to generalize the data. It is to be noted that reliable results can be originated from larger sample sizes (Bryman & Bell, 2003, p. 309).

The primary data sources comprise observation and participant observation, questionnaires and interviews, texts and documents, focused group, case study, etc. Questionnaires are practical approaches of collecting data. Respondents were also given the analogue questions that were supplemented by in depth interviews. The outstanding advantages of using questionnaires are that the data are accurate, anonymous, and they can cover a broad location without any geographical limitation. The disadvantages of using questionnaires are that they could be expensive, impersonal, delay in getting results, and the response rate can be very low (Easterby, Thorp & Lowe, 2008, p. 216). In this study, questionnaires were issued in 17 hotels in Taiwan. The hotels were selected with regard to their location and size.

Respondents and Unit of Analysis

In this study the questionnaires were issued to tourists visiting hotels in Taiwan. The study chose a target of 1,249 respondents and received feedback from 1,130 respondents. This is equivalent to a 90.5% response rate which is very good. In this research, data from the survey were entered into the Excel spreadsheet program for future analysis. The data was analysed using SPSS, regression and correlation analysis.

Non-Response Bias

Non-response bias is a situation whereby the respondents give answers that are very different from the possible answer of the participants who did not respond (Bryman & Bell, 2003, p. 310). An illustration on how non-responsive bias occurs is whereby the researcher selects a sample of administrators and conducts a survey with regard to their work commitment, the administrators with a higher level of work commitment might not respond to the survey due to the fact that they have a limited amount of time for participation; on the other hand, administrators with a lower level of work commitment might be shy to respond because of the fear that their colleagues might think of them as inefficient. Thus, in this scenario, a non-response bias can result to the underestimation of the work commitment level or overestimation of the same.

Findings, Data Analysis and Interpretation

Introduction

This section covers the analysis of the data, presentation and interpretation. The results were analysed using SPPS, ANOVA, regression and correlation analysis.

Descriptive statistics

The tourist sites (Changhua City, Douliu, Nantou City, Hualien City and Taitung City) were visited by at least 50% of all the tourists coming to Taiwan. In this study 1,249 questionnaires were issued to respondents; only 1,130 were successfully filled out. The results revealed that the female respondents were 53% as compared to the male respondents who were 47%. All the respondents had an average age of 45.39 years with a standard deviation of 14. Actually, the majority of the respondents were aged between 34 and 58 years. In addition, a major number of the respondents had obtained a higher level of education. The respondents had varied backgrounds with regard to their occupations; for instance, 70% were employees, managers were 17% and 13% were hotel owners.

With regard to the country of origin, 30% of the respondents came from Germany, followed by Austria (18%), Italy and the UK (12%), Russia (10%), and the rest were classified as other countries. In addition, a big number of the respondents (53%) had visited Taiwan initially. First time visits were more than repeat visits. Many of the respondents were travelling together with their spouses, and 33% were travelling with their spouses together with not less than one child. The respondents were grouped into three categories; the first category was, high level wellness, the second category was moderate level wellness, and the third category was low level wellness. Using a Chi-square test and ANOVA, the important differences among the three categories of the respondents were noted. The results are summarised in Table 4.1 and Table 4.2.

Table 4.1 Relationship between tourists’ characteristics and wellness groups.

Country of origin had the largest size effect, hence indicating an average strength. The size effect of the other variables was comparatively low. The important differences among the three groups were confirmed for size of the settlement, visiting with children, visiting with spouse, relying on brochures for information, relying on TVs for information, motivation by sun and sea, motivation by cultural heritage, willing to stay in another part of Croatia, food and drinks prices, tour of Spain, tour of Greece, sex/gender, occupation, first visit or repeat visit, country of origin, and education level. High level wellness tourists did not prefer to: stay in villages (28%), and to travel together with the children (44%) as compared to the two remaining groups. In addition, high level wellness tourists had a higher likelihood of relying on brochures to obtain information about the destination site (53%) and also to tour Spain (51%).

On the other hand, 21% of the tourists in the category of low level wellness visited with their partners or spouses. This percentage was the least as compared with the other categories. 13% of the low level wellness category of tourists relied on TVs for information regarding the destination site. 17% of the tourists in the category of moderate level wellness considered sun and sea as their main motivational factors to visit as opposed to 59% of the tourists in the category of high level wellness who did not consider the sun and sea as the main motivating factors. The drive of the pull force influences the tourist’s selection of the place to visit; the forces are linked to the attributes of the destination and the infrastructures that describe tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied.

38% of the German tourists and 40% of the Italian tourists regarded wellness to be very essential to their lifestyle. In addition, 54% of Russian tourists and 71% of the UK’s tourists confirmed that wellness were very essential to their lifestyle. 33% of the respondents in the category of low level wellness had elementary or high school level of education. 28% of the tourists in the category of high level wellness complained about the high prices of food and drinks in the hotels.

The Chi-square test confirmed the overall significance of the variables, but the post hoc test did not reveal any considerable relationship between the three categories of wellness and motivation by cultural heritage, motivation to travel, willingness to stay in another part of Croatia, and tour of Greece. With regard to these variables, it was noted that 49% of the tourists in the category of high level wellness were highly willing to stay in another side of Croatia as compared to the other groups, 46% of the same tourists were motivated by cultural heritage, while 52% were willing to tour Greece and 50% were visiting for the first time.

Table 4.2 ANOVA analysis of tourists’ characteristics of wellness category.

NOTE: * = Significant at 0.01

Mean with subscripts vary at p<0.05.

The three categories of tourists varied with regard to having a house, having a car, clothes and shoes, vacation, entertainment, stay period, insight of the vacation, and the age as shown in Table 4.2 above.

The respondents who had the view that wellness was not essential to their lifestyle regarded having a house, car, clothes and shoes as the least significant. The relevance of having a vacation and entertainment varied significantly among the three categories of tourists. The two variables were the most significant to high level wellness tourists and were less significant to low level wellness tourists. Also the period of stay during the trip varied significantly among the three categories of tourists. The high level wellness tourists preferred to stay for long as opposed to the low level wellness tourists who preferred to stay for a shorter period. The high level wellness group had the perception that lack of money influenced their vacation; the opposite was true for the low level wellness group. In terms of age, the high level wellness group was the oldest among the three groups.

Conclusions and Recommendations

Conclusion

Medical tourism is considered to be a subset of health tourism. Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Wellness tourism involves the individuals visiting hotels or recreational centres that provide wellness services. Wellness tourism, being a subset of healthcare tourism does not entail elective surgery.

• Even though health tourism has been in existence in Taiwan, medical tourism emerged as a subdivision of health tourism. Many tourists are motivated by sun and sea which are mainly income created. Medical tourism, therefore, emerged as a segment of the market that took into consideration the two constituents (sun and sea). The packages of wellness tourism are presented in all the tourist destination sites.
• Wellness of the tourists are always accompanied by tranquillity, calmness and privacy, therefore, the consumers of wellness tourism always have a different mode of lifestyle as compared to other tourism consumers who do not seek for wellness services. Wellness tourism is mostly based on the socio-demographic attributes of the tourists. These attributes were the basis of categorising the wellness tourists into three groups.
• The period of stay during the trip varied significantly among the three categories of tourists. The high level wellness tourists preferred to stay for long as opposed to the low level wellness tourists who preferred to stay for a shorter period. The high level wellness group had the perception that lack of money influenced their vacation; the opposite was true for the low level wellness group. In terms of age, the high level wellness group was the oldest among the three groups.

Recommendations

A good number of tourists regarded wellness tourism to be very significant to their lifestyles, thus, Taiwan should make wellness tourism to be an activity on its own. This will ensure that the tourists are satisfied with every aspect, thus, making the holidays enjoyable.

In addition, the tourism season should be expanded so that the tourists can have a longer time to stay during their vacation. Relevant marketing strategies should be used to market the tourist destination sites.

Statement of contribution

Summary

The main aim of this study was to explore on medical tourism of international elderly patients in Taiwan. The study focused on the tourism sector of Taiwan. The study explored various factors that motivated the elderly tourists to participate in medical tourism, in line with main objective. The study relied on primary data using structured questions to explain the main objective and the data was analysed using statistical tools like SPSS, and ANOVA analysis.

The study categorized the tourists into three groups with regard to the level of wellness, for instance, high level wellness, moderate level wellness and low level wellness. The results of the study revealed that the variables of the study varied significantly among the three groups, for instance, tourists who fell in the category of high level wellness preferred to take long vacations and had a greater urge for entertainment. All in all, medical tourism is regarded as a segment of health tourism and many tourists make the visits for health purposes.

The findings of this study are very relevant to the elderly tourists, tourist planners and tourist marketers. It is also adequate for the country to improve and protect the physical appearance of tourist destination sites to enable her to be in a competitive position as compared to the other countries. Moreover, the ease of accessibility to the tourist destination sites should be improved so as to give an easy time for the elderly tourists to move around. Accommodation facilities and other social amenities should be upgraded so that they can be up to standard and fit the specifications and the requirements of the elderly tourists.

Contributions and impacts

Wellness entails a particular notion of health. Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of wellness is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Wellness can, therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in.

Medical tourism directs the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, wellness involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or the will to aid in his/her functionality. An individual will achieve a higher degree of wellness when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment.

The entire process of the tourists’ decision making is analysed by professional models. The models are paid much consideration to the underlying factors that influence the decision making process of the wellness tourists. In simple terms, processional models give out information that relates to the behaviour of the tourists in their decision making process. There are various factors that influence the decision making process of the tourists; the main outstanding factor is actually the decision process. Tourism products, just like other normal products have several attributes which play the role of distinguishing them from the possible substitute products.

Scholarly studies that relate to the analysis of travel motivation are founded on the basis of various models that are considered to be outstanding. These models stem from the perspective of the processional models. The first model is the Nicosia model (1966) which concentrates on the correspondence that occurs between the tourist and the firm, and how the firm convinces the tourist to acquire her products. Another model dubbed Howard and Sheth’s model (1969) integrated the input notion that describes the behaviour of the tourists; in addition, the model states the ways by which the tourists incorporate these inputs in their decision making process. The Howard and Sheth’s model has continued to be regarded as the most important model for analysing the travel motivations of the elderly tourists.

Travel motivation of the elderly tourists can be assessed by paying regard to the analytic analysis of desire, anticipations, conception and satisfaction. Gallarza, Saura and Garcia (2002, p. 63) emphasized on the use of statistical tools (such as multivariate analysis that depend on other analyses like correlation matrix, sampling techniques and regression analyses) on tourism. Qualitative choice models are very efficient in assessing the behaviour of the elderly tourists; such models entirely depend on multinomial logit. In the recent past, many academic scholars have applied structural models on researches that relate to the assessment of the travel motivation of the elderly tourists.

It is required that wellness hotel should have an up-to-standard wellness infrastructure in order to provide the best services to the tourists. There exist various extents of wellness as there are various extents of illness. Wellness tourism, therefore, is in line with the individual’s intent to improve the class of his/her life, physical health, mental health and social interaction.

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