An overview is given of the short history and rapid rise of medical tourism, its documentation, and current knowledge and analysis of the industry. Definitions of medical tourism are limited hence who medical tourists are and how many exist are both indeterminate and inflated. Definitions often conflate medical tourism, health tourism and medical travel, and are further complicated by the variable significance of motivation, procedures and tourism. While media coverage suggests long-distance travel for surgical procedures, and the dominance of middle class European patients, much medical tourism is across nearby borders and from diasporas, and of limited medical gravity, conflicting with popular assumptions. Numbers are usually substantially less than industry and media estimates. Data must remain subject to critical scrutiny. Medical travel may be a better form of overall categorisation with medical tourism a sub-category where 'patient-tourists' move through their own volition. Much medical tourism is short distance and diasporic, despite being part of an increasingly global medical industry, linked to and parallel with the tourism industry. Intermediaries (medical tourism companies) are of new significance. Opportunities are diffused by word of mouth with the internet of secondary value. Quality and availability of care are key influences on medical tourism behaviour, alongside economic and cultural factors. More analysis is needed of the rationale for travel, the behaviour of medical tourists, the economic and social impact of medical tourism, the role of intermediaries, the place of medical tourism within tourism (linkages with hotels, airlines, travel agents), ethical concerns and global health restructuring. © 2012 Elsevier Ltd.
Tsung Hung Lee
This study aims to assess the support of community residents for sustainable tourism development using the latent variables of community attachment, community involvement, perceived benefits, perceived costs, and support for sustainable tourism development and elemental data of the residents of the Cigu wetland, which is located in southwest Taiwan. The analytical results suggest that community attachment and community involvement are critical factors that affect the level of support for sustainable tourism development. The benefits perceived by host residents affect the relationship between community attachment and support for sustainable tourism development and between community involvement and support for sustainable tourism development. Several managerial implications of this study are introduced, and recommendations for future research are presented. © 2012 Elsevier Ltd.
Ana María Munar | Jens Kr Steen Jacobsen
Social media are increasingly relevant as part of tourism practices affecting destinations and businesses. Based on a destination-specific survey, this study charts and explores summer holidaymakers' motivations for social media contributions and their willingness to share content through various social media. The findings in relation to the much-visited destination of Mallorca offer an understanding of the adoption of tourist social media in technologically-advanced markets with high levels of ICT use. The results provide insights into such motivational factors as personal and community-related benefits as well as the social capital that influences a sharing of user-generated content. The study reveals a dominance of visual content, along with the relevance of altruistic and community-related motivations and motivational differences between types of content creators. Sharing practices through social media appear as valuable articulations of sociability and emotional support, while having lesser relevance as information sources for holiday decision-making. The paper additionally shows the extent to which old and new technologies overlap and complement each other. © 2014 Elsevier Ltd.
Hongmei Zhang | Xiaoxiao Fu | Liping A. Cai | Lin Lu
Extant literature is inconclusive on the linkage between destination image and tourist loyalty, due to the multi-dimensional nature of the two concepts. The present study attempts to draw some informative conclusions about the relationship through a meta-analysis. A research framework was proposed in which 14 hypotheses were developed. A total of 66 independent studies were synthesized and analyzed. The findings reveal that the impact of destination image on tourist loyalty is significant, with varying degrees. Specifically, overall image has the greatest impact on tourist loyalty, followed by affective image and cognitive image. Cognitive-affective joint image fails to demonstrate a stable impact on tourist loyalty. Of the three levels of tourist loyalty, destination image has the greatest impact on composite loyalty, and then on attitudinal loyalty and behavioral loyalty, successively. The findings are discussed in light of their theoretical and practical implications for destination marketing and management. © 2013 Elsevier Ltd.
It has long been recognised that it is incumbent on those responsible for the planning of tourism to seek to optim ise the well-being of local residents whilst minimising the costs of tourism development.It is not surprising, therefore, that academic attention has long been paid to the social impacts of tourism in general and to the understanding of host communities' perceptions of tourism and its impacts in particular. Nevertheless, despite the significant volume and increasing scope of the research, the extent to which understanding of residents' perceptions of tourism has been enhanced remains uncertain. Thus, the purpose of this Progress Review is to explore critically the development of the research into residents' perceptions of tourism. Highlighting key themes and trends in the literature, it identifies a number of limitations in the research, including a narrow case study base, a dependence on quantitative methods, a focus on perceptions as opposed to responses, and the exclusion of the tourist from the majority of the research. Consequently, it argues for a multidimensional approach to the research. © 2013 Elsevier Ltd.
Kyungmi Kim | Muzaffer Uysal | M. Joseph Sirgy
© 2012 Elsevier Ltd. The objective of this study is to test a theoretical model that links community residents' perceptions of tourism impact (economic, social, cultural, and environmental) with residents' satisfaction with particular life domains (material well-being, community well-being, emotional well-being, and health and safety well-being) and overall life satisfaction. The model also posits that the strength of these perceptual relationships is moderated by the stage of tourism development in the community. The model was tested using a survey of 321 respondents from communities varying in their level of tourism development. The results were mostly supportive of the overall model. Theoretical and managerial implications of the study findings are discussed.
Beverley A. Sparks | Helen E. Perkins | Ralf Buckley
Online review sites provide increasingly important sources of information in tourism product purchases. We tested experimentally how source, content style, and peripheral credibility cues in online postings influence four consumer beliefs, and how those in turn influence attitudes and purchase intentions for an eco-resort. We compared tourists' posts to managers' posts, containing vague versus specific content, and with or without peripheral certification logos. First, we tested effects of tourists' beliefs about utility, trustworthiness, quality and corporate social responsibility on attitude toward the resort and purchase intentions. Second, we tested the role of source, content, and certification on the beliefs. The interactions are complex, but broadly tourists treat specific information posted by customers as most useful and trustworthy. Their purchase intentions are influenced principally by their overall attitude toward the resort and their beliefs in its corporate social responsibility. •We use an online travel context to test three aspects of communication content.•Specific information posted by customers is seen as useful and trustworthy.•Certification logos influence perceptions of corporate social responsibility.•Trust emerges as an important variable for the industry to consider. © 2013 Elsevier Ltd.
Steven Pike | Stephen J. Page
This article presents the first narrative analysis of the areas of research that have developed within the destination marketing field since its commencement in 1973. Given the broad extent of the field, and the absence of any previous reviews in four decades, a key challenge is in providing a focus for such a disparate body of knowledge. The review is structured around one principal question: 'To what extent is the Destination Marketing Organisation (DMO) responsible for the competitiveness of the destination?'. In pursuit of this underlying question, we address a number of themes including nomenclature and the DMO, the evolution of the destination marketing literature, competitiveness as the DMO reason d'être, and DMO effectiveness including issues of branding and positioning, and future research themes in the field. © 2013 Elsevier Ltd.
Julian K. Ayeh | Norman Au | Rob Law
Despite the growing enthusiasm about social media, empirical research findings suggest that the majority of Internet users are not using consumer-generated media (CGM) for travel planning. Yet little is presently known about the relevant factors determining CGM usage for the specific purpose of travel planning. Using an online survey of travel consumers, this study investigates the intention to use consumer-generated media for travel planning by introducing new factors into the conventional TAM and using a partial least squares' estimation. Findings shed light on the differences in terms of the antecedents in this context. While the study demonstrates the theoretical validity and the empirical applicability of the TAM model to the context of CGM usage for travel planning, it goes further to verify the significant roles of distinctive factors like travelers' perceptions of similarity of interest, trustworthiness and enjoyment. Several managerial and research implications emerge. © 2012 Elsevier Ltd.
Stephen Wearing | Nancy Gard McGehee
This paper examines the current state of 'volunteer tourism,' both as a field of study and modern phenomenon. The foundation of the review rests upon themes initiated over 10 years ago in Volunteer Tourism: Experiences That Make a Difference (Wearing, 2001). The review begins with a discussion of the explosive growth of volunteer tourism (research and practice) and continues with an analysis of the literature utilizing a multiphasic format that reflects the volunteer tourism process. Specifically, the paper includes a review of research in the area of pre-trip motivations, continues through work focussing on the volunteer tourism experience itself with emphasis on the role of the volunteer tourism organization and the community, and ends with discussion of the literature in the areas of post-trip reflections and transformations. Conclusions include recommendations for future research. © 2013 Elsevier Ltd.
Ching Fu Chen | Sambath Phou
Drawing on brand relationship theory and attitude theory, this study investigates the relationships among destination image, destination personality, tourist-destination relationship and tourist behavior. Using a sample of 428 foreign tourists visiting the Angkor temple area of Cambodia and the structural equation modeling technique, the results reveal that destination image and destination personality have positive effects on the tourist-destination relationship, which in turn affect tourist behavior. The study lends support to brand relationship theory, indicating that tourists form emotional relationships with destinations, and further supports Bagozzi's (1992) reformulation of attitude theory with regard to the cognitive, affective and behavior sequence. © 2012 Elsevier Ltd.
Haywantee Ramkissoon | Liam David Graham Smith | Betty Weiler
© 2012 Elsevier Ltd. Drawing on literature from environmental psychology, the present study examined place attachment as a second-order factor and investigated its relationships with place satisfaction and visitors' low and high effort pro-environmental behavioural intentions. Confirmatory factor analysis and structural equation modelling were used to test a model using a sample of 452 visitors at the Dandenong Ranges National Park, in Australia. Results supported the four-dimensional second-order factor of place attachment and indicated (a) positive and significant effects of place attachment on both low and high effort pro-environmental behavioural intentions of park visitors, (b) a significant and positive influence of place attachment on place satisfaction, (c) a significant and positive effect of place satisfaction on low effort pro-environmental behavioural intentions, and (d) a negative and significant influence of place satisfaction on high effort pro-environmental behavioural intentions. The main theoretical contribution relates to the inclusion of the four dimensions of place attachment in a single model. Findings are discussed with respect to their applied and theoretical relevance.
Victoria M. Waligo | Jackie Clarke | Rebecca Hawkins
© 2012 Elsevier Ltd. Within the extensive body of literature on sustainable tourism (ST), its successful implementation is an emerging and important theme. The lack of or ineffective stakeholder participation is a major obstacle to ST realisation and there is little clarity as to how best to resolve this problem. This paper presents the findings of a purposive UK-based case study that evaluated stakeholder involvement in the implementation of ST. Using over fifty stakeholders' accounts drawn from eight primary stakeholder groups, a 'multi-stakeholder involvement management' (MSIM) framework was developed. The MSIM framework consists of three strategic levels: attraction, integration and management of stakeholder involvement. Six stages are embedded within the three levels: scene-setting, recognition of stakeholder involvement capacity, stakeholder relationship management, pursuit of achievable objectives, influencing implementation capacity and monitoring stakeholder involvement. These are supported by the overarching notion of 'hand-holding' and key actions [. e.g. managing stakeholder adaptability] that enhance stakeholder involvement in ST.
Zhiwei Liu | Sangwon Park
© 2014 Elsevier Ltd. While the proliferation of online review websites facilitate travellers' ability to obtain information (decrease in search costs), it makes it difficult for them to process and judge useful information (increase in cognitive costs). Accordingly, this study attempts to identify the factors affecting the perceived usefulness of online consumer reviews by investigating two aspects of online information: (1) the characteristics of review providers, such as the disclosure of personal identity, the reviewer's expertise and reputation, and (2) reviews themselves including quantitative (i.e., star ratings and length of reviews) and qualitative measurements (i.e., perceived enjoyment and review readability). The results reveal that a combination of both messenger and message characteristics positively affect the perceived usefulness of reviews. In particular, qualitative aspects of reviews were identified as the most influential factors that make travel reviews useful. The implications of these findings contribute to tourism and hospitality marketers to develop more effec tive social media marketing.
Jung Wan Lee | Tantatape Brahmasrene
The study investigates the influence of tourism on economic growth and CO 2 emissions. In the empirical analysis, unit root and cointegration tests using panel data of European Union countries from 1988 to 2009 are performed to examine the long-run equilibrium relationship among tourism, CO 2 emissions, economic growth and foreign direct investment (FDI). Results from panel cointegration techniques and fixed-effects models indicate that a long-run equilibrium relationship exists among these variables. Furthermore, tourism, CO 2 emissions and FDI have high significant positive effect on economic growth. Economic growth, in turn, shows a high significant positive impact on CO 2 emissions while tourism and FDI incur a high significant negative impact on CO 2 emissions. © 2013 Elsevier Ltd.
Leonidas C. Leonidou | Constantinos N. Leonidou | Thomas A. Fotiadis | Athina Zeriti
Building on the resource-based view, we develop a model of drivers and outcomes of environmentally friendly marketing strategies in the Greek hotel sector. Data collected from 152 hotels reveal that possessing sufficient physical and financial resources is instrumental in achieving effective green marketing strategies. In addition, shared vision and technology sensing/response capabilities help develop a sound environmentally friendly marketing strategy. In turn, the adoption of such a strategy is conducive to obtaining competitive advantage, which subsequently increases the potential to achieve superior market and financial performance. Furthermore, the study finds that the effect of environmental marketing strategy on competitive advantage is stronger in the case of intense competitive situations, while market dynamism has no moderating effect on this association. Several implications can be drawn from the study findings for both corporate and public policy makers and interesting directions for future research are provided. © 2012 Elsevier Ltd.
T. Escobar-Rodríguez | E. Carvajal-Trujillo
This paper examines determinants of purchasing flights from low-cost carrier (LCC) websites. In doing so an extended unified theory of acceptance and use of technology (UTAUT) model is proposed building on earlier work by Venkatesh, Thong, and Xu (2012). The results, derived from a sample of 1096 Spanish consumers of LCC flights, indicate that key determinants of purchasing are trust, habit, cost saving, ease of use, performance and expended effort, hedonic motivation and social factors. Of these variables, online purchase intentions, habit and ease of use are the most important. © 2014 Elsevier Ltd.
Elaine Yin Teng Chew | Siti Aqilah Jahari
Despite the significance of perceived travel risk and destination image, relatively few studies address the effect of perceived travel risks on the formation of destination image, and the mediating role of destination image. This study draws new insights by examining (1) the effects of perceived risks on destination image, and (2) the mediating role of destination image between perceived risks and revisit intention of repeat tourists to a risky destination. With perceived risk and destination image being empirically distinctive constructs, findings revealed that perceived socio-psychological and financial risks influenced both cognitive and affective destination images. Perceived physical risk did not have a significant influence on destination image, although it directly affected revisit intention. Additionally, destination image significantly mediated the relationships between two risks, namely, perceived socio-psychological and financial risks, and revisit intention. Several managerial implications concerning the management of risk perceptions and the promotion of risky destinations are discussed in this study. © 2013 Elsevier Ltd.
Khaldoon Khal Nusair | Anil Bilgihan | Fevzi Okumus | Cihan Cobanoglu
This study aims to develop a theory-based model of relationship commitment in an online social network (OSN) context for Generation Y travelers. An online questionnaire was sent to a systematic random sample of 12,000 students at six U.S. universities. A total of 513 respondents participated in the study. Study results suggest that perceived utility and trust are positively related to both affective and calculative commitment. In terms of the relationship between perceived risk and commitment dimensions, the lower the risk as sociated with OSNs, the more likely customers are to continue the relationship. This study highlights the pivotal role of affective commitment in developing loyalty to travel-related OSNs. © 2012 Elsevier Ltd.
Girish Prayag | Sameer Hosany | Robin Nunkoo | Taila Alders
© 2012 Elsevier Ltd. Using theory of reasoned action and social exchange theory, this study empirically tests a model of residents' support for the 2012 Olympic Games. The model proposes that overall attitude towards the Games mediates the relationship between perceived socio-cultural, economic, and environmental impacts, and residents' support for the Games. Results indicate perceived economic and socio-cultural impacts (positive and negative) influence overall attitude, but contrary to our predictions, perceived environmental impacts (positive and negative) are not related to overall attitude. The model confirms that overall attitude plays a mediating role between perceived socio-cultural, economic, environmental impacts and support for the 2012 Games. Findings highlight the need for researchers to disaggregate the components of perceived impacts when modelling attitudes and support for mega events.