3. Materials and Methods
The formulation of the expectations of patients and potential patients required research in Polish spa resorts. The research was carried out in 2018 on a representative sample of 810 people. Due to the fact that the respondents were mainly people who have already completed spa therapy, this research required reaching these people in their everyday life conditions. The questionnaire contained 34 questions and was divided into three parts. The first and last parts included questions for all participants, while the second part contained two sets of questions—one for spa visitors and one for potential visitors. Answers that were given by the respondents in the first part decided what set of questions they received in the second part. This way, the conducted research allowed us to gather the opinions of spa visitors and to get to know the expectations of potential clients. Tourists who visited a spa in the last 10 years were asked about their experiences and needs. Potential clients, meanwhile, explained why they have not visited a spa so far, and what their expectations are. It should be noted that research has so far not been carried out in the field of value propositions for the clients of spa tourism.
The survey was made available on the internet on community portals related to spa resorts. This, of course, means a certain limitation of research to people using the computer and the internet, but, considering that the number of young people (up to 30 years old) participating in the research was almost as high as the number of middle-aged (30–65 years) and older people (over 65 years), this factor related to the limitation of the research to the internet network did not significantly affect the reliability of the obtained results.
After the initial selection of the collected questionnaires, 753 respondents were qualified for further analyses, of which 63.5% (478 people) were people who stayed in one of the 45 Polish spa resorts in the last 10 years. The second group of respondents consisted of 275 people who have never been to a spa resort but express their willingness to go to one and have particular expectations. Thus, the respondents were divided into two main groups—patients and spa tourists (P and ST) and potential patients (PSP).
Opinions from 478 patients were obtained, a number which exceeded the minimum random sample size estimated at 474 surveys (for the assumed level of maximum statistical error of the sample of ± 4.5%, and the confidence level p = 0.95). In the case of potential patients, the maximum statistical error of the random sample is ± 6%, with the assumed significance level α = 0.05.
The development of the data collected consisted in performing a statistical analysis of both one-dimensional (in the form of a classical or positional descriptive analysis) and two-dimensional (in the form of an analysis of the pairs of characteristics) characters, as well as in a multidimensional dimension, with the application of a correspondence analysis. A correspondence analysis allows for the bringing of a complex form of a multidimensional phenomenon to a two-dimensional plane analyzed from various perspectives. Taxonomic distances between points among mutual interdependencies indicate the interrelations of particular feature variants [51
]. Thanks to this, it was possible to establish dependencies between quality variables.
In some cases, the level of significance of differences between the obtained average values was also studied. To compare two average values in the studied independent groups (ST and P vs. PSP) in the case of variables of normal distribution, the t-
Student test was applied, first determining the uniformity of variations (with the use of Fisher–Snedecor test) [52
]. To compare two groups with variations of distribution other than normal (and they were in the majority), the U
test was used (Mann–Whitney) [53
]. In the case of non-uniform variations of features characterized by normal distribution, the C
test was used (Cochran–Cox) [54
]. A comparative analysis of three and more independent groups of distribution other than normal was made with the use of an ANOVA test of Kruskal–Wallis. In the case of non-uniformity of variable variations of normal distribution, the tests were carried out with independent variations estimation. The significance of differences between structure indicators was verified with the chi-squared test. The presence of normality of distribution of the studied variables was verified with the Shapiro–Wilk test [55
]. When verifying statistical hypotheses, the statistical tests were used, taking into account significance at the level of α ≤ 0.05. In the interdependence analysis, linear Pearson correlation coefficients (rxy
), and a t
-Student significance test for correlation coefficient were used [56
4. Results and Discussion
The studied sample consisted of 73.4% women and 26.6% men, thus reflecting the structure of patients observed in many other researches carried out in spa resorts [57
]. A similar structure was observed in particular subgroups of the surveyed patients (77.3% women and 22.7% men) and potential patients (67.5% women and 32.5% men). Among those surveyed, only 1.4% visited foreign spa resorts, and 1.6% of them were respondents living outside of Poland. This is due to the specific nature of trips to spas in Poland, which are generally national in nature and are related to the participation of the National Health Fund, the dominant health insurer.
People visiting spa resorts were mostly under the care of a spa doctor (79%). Only every fifth respondent stayed in spa resorts without medical care (21%). A total of 61.2% of spa resort visitors came there with their insurer’s referral.
The patients surveyed included mostly retirement and disability pensioners (36.6%) and white-collar workers (36.6%), while white-collar workers prevailed among potential patients (41.1%). Many respondents (54.0%) declared that they were studying and working at the same time. Most of the respondents had secondary education (58.0%) and higher education (34.4%).
The purpose of stay which prevailed among spa resort visitors was therapy (63.6%), but there were also people there mainly to relax (14.6%), take preventive treatment (8.3%), or take advantage of tourist attractions (7%). The correlation analysis confirmed, however, that the purpose of visits at spa resorts was correlated with the length of stay at spa resorts (rs = 0.475, p < 0.05). People declaring a health-related purpose stayed at the spa for much longer than people declaring their arrival for recreational purposes.
A three-week stay at a spa resort (the standard length of spa therapy) was declared by 61.0% of the respondents. A total of 11.4% of patients arrived for two weeks, and 6.1% of respondents arrived for a week. Weekend trips to spa resorts were not very often chosen by patients (6.6%).
Three out of four respondents (75.3%) were staying in sanatoriums, spa hospitals, and preventoriums during their stay at the spa. Every fifth respondent (21.1%) stayed in another hotel establishment (hotel, guesthouse, spa center). Only 1.6% of the respondents stayed there with friends and relatives.
The respondents were asked about the features guaranteeing a successful stay at a spa resort. Respondents could indicate the three most important features. The obtained results indicate that the two key factors influencing the evaluation of the stay of the patient are: Spa treatment quality (65.5%) and accommodation quality (63.3%), i.e., two basic elements of a spa product. These factors were indicated by two out of three respondents. Another important feature is the wide range of spa treatments, therefore offering an interesting differentiation compared to other resorts. This feature was indicated by 40.8% of the respondents. Every fourth respondent (26.8%) attributed a high importance to catering services and to the spa landscape (24.1%). In addition, the silence and peace that the patients can experience at a spa resort (17.3%) are valuable to them, as are a wide range of attractions of the local culture (12.9%).
The respondents were also asked what they value most during their stay at a spa resort. Two out of three respondents answered that they most valued maintaining or improving their health conditions using natural therapeutic raw materials (66%), i.e., the achievement of the primary purpose of their stay at a spa resort—an effective spa treatment. Having a rest in a place with a therapeutic climate was the second most popular response—it was selected by 38.7% of respondents. Every third respondent (29.8%) also pointed to elements related to spa recreation (i.e., better mood, relaxation, beauty, weight loss, improvement of fitness, and sports results). Every sixth respondent (17%) stressed the health, physical, and emotional security achieved through constant medical care. A similar group of people reported (15.9%) valuing the opportunities for entertainment and contact with other people at a spa resort. Only every eleventh respondent visiting spas indicated the possibility of practicing various forms of tourism as the key value (8.6%).
The preferences of patients in terms of the spa values most important to them were also surveyed. Every third respondent pointed to the climate of a spa resort (33.7%), and every fourth respondent pointed either to the natural resources present at a spa (24.7%) or to natural therapies (24.2%). Every tenth respondent appreciated peace and a slow lifestyle at a spa resort (9.0%).
The research also allowed us to identify the reasons for the non-usage of spa resorts until now by potential patients. A majority of them (63.4%) said that they have not visited a spa resort because they did not need treatment nor preventive healthcare. Almost every third respondent said there was no such occasion (29.6%). A total of 8.5% of respondents said that they have not visited a spa resort because it is a place for old and sick people. The same number of people stated that they did not find anything interesting for themselves in the offer of spa resorts. Another 8.5% of respondents do not take part in spa treatments due to a lack of sufficient free days of holiday leave. A total of 7% of respondents admitted that they cannot afford such a travel.
Every third respondent (32.4%) wanted to be treated as a guest, not as a patient, which suggests the desire to treat spa travels as leisure travels with a therapeutic goal—not as a continuation of hospital treatment.
Every fourth respondent (25.3%) suggested the introduction of smaller rooms (single and double) in sanatoriums and spa hospitals. The same number of respondents suggested a stronger development of cultural activities in spa resorts (24.7%).
The ideas of introducing transport which facilitates access to and return from a spa, as well as the care of a psychologist and leisure animator were also popular, receiving 15.0% and 12.2%, respectively. Many respondents support the idea of abolishing the obligation to charge patients who, for important reasons, must shorten their stay at a spa resort (18.1%), which unfortunately happens in the case of patients coming to a spa resort with a medical referral.
In the case of respondents who have been to a spa resort (P and ST) and those who have not been there yet (PSP), the opinion on the need to raise the accommodation standard was supported to the same extent (p = 0.908). However, in the case of a higher standard of medical service and the need to be a “guest” and not a “patient,” the percentage of indications was different (p = 0.039). A significantly higher percentage of responses of potential patients who recognize the current state as necessary for improvement was visible. A similar situation occurred in the case of proposals to introduce single and double rooms. The greatest differences were observed in terms of entertainment. Potential patients more often expressed the need to develop cultural activities (Δ = +20.4%, p = 0.007) (Δ—intergroup difference [%]) and to take care of a child during treatment (Δ = +16.6%, p = 0.069). Differences in terms of proposals concerning the introduction of care of psychologists and leisure animators were also observed (Δ = +9.7%, p = 0.227), as was the introduction of educational classes and lectures (Δ = +8.9%, p = 0.287); however, those differences were statistically irrelevant. Potential patients were also five times more likely to feel the necessity of introducing spiritual care during the treatment; however, this difference was also statistically irrelevant (p = 0.662).
The differences show the weakness of spa resort offerings so far due to their non-adaptation to the expectations of potential recipients. Particularly, one can point here to the expectations of families and single mothers who would like to take advantage of treatments and rest at spa resorts while staying there with their child, as well as the expectations of people demonstrating some spiritual needs (retreat during a spa treatment and pilgrimage in the parishes of the spa resort or in surrounding areas). One of the unused segments of recipients was also people with conceptions of stereotypes that limited their tendency to want to spend time at a spa resort. This may be indicated by the need to boost spa resorts’ cultural life, which often fades away in the autumn and winter period. A response to this need may be the services of a leisure animator or a psychologist at a sanatorium.
The occurrence of interactions between particular responses and the qualitative character of the majority of the surveyed features enabled the use of a multidimensional analytical tool in the form of a correspondence analysis. The obtained models are characterized by a high quality of comparisons, thanks to the high level of explanation of the response—the sum of the eigenvalue in the form of the percentage of explained information from both axes amounts to 90%.
The first statement (Figure 2
) reveals the relationships that emerged between the purpose of the stay at a spa resort and the length of stay. At the point of intersection of both axes (0,0), the dominant groups of recipients can be noticed. These are therapeutic and preventive stays lasting from two weeks to over a month. It can also be observed that people coming to Polish spa resorts for beauty purposes spend four-to-six days there in general. However, holiday and tourist stays were often connected with a few day stay at a spa resort (a weekend or one week). Other forms of stay can also be identified, including meeting stays, which generally involved one day or a weekend.
The next statement concerns the age groups and ways of making decisions on a person’s own arrival to a spa resort (Figure 3
), which may be of great importance for marketing strategies. The analysis reveals that the personal choice of the place of stay at a spa resort was most often reported by middle-aged people (30–50 years), while, in the 50–70 age groups, the place of stay was usually selected by insurers. The situation is slightly different in the case of the youngest age group (up to 30 years of age), because there the choice of treatment was made both by family and friends as well as by the patient himself or herself.
The third statement (Figure 4
) concerns the relationship between the purpose of stay and the expenses during the treatment. The analysis confirms that patients coming for spa treatment and to meet people spend the least amount of money during their stay. This is understandable, as these are usually stays paid by the insurer.
A preventive stay is most often connected with an expense in the amount of PLN 1500–2000 ($430–570), and a tourist one is connected with an expense of PLN 1000–3000 ($285–860). Leisure and beauty-related stays are connected with the highest but also the most diverse expenses. Some patients coming for leisure or to improve their beauty were spending more than PLN 1000 ($285), and others were spending over PLN 3000 ($860). Visits to relatives and arrivals for sports purposes were generally not involved with cost incurrence by the visitors.
Relations between the purpose and length of stay, expenses, age of patients, sex, and marital status were observed. The dominant group of respondents was observed to be patients arriving to spa resorts for therapeutic and preventive purposes. The above listed types of stay are similar in many respects, which is why they are often considered together. The interdependencies observed in the presented statement confirm the relationship between therapeutic stays and 50+ age groups, the predominance of women, a duration of stay lasting approximately three weeks, and expenses of up to PLN 1000 ($285). The marital status of the respondents is somewhat less explicit (since they are both widows and widowers, as well as married people)—as is the level of education—because there were people with different education in this group. The features that makes it possible to distinguish between therapeutic and preventive stays are the higher expenses paid during (PLN 1500–3000, or $430–860) and the shorter duration of (up to approximately two weeks) the stay of people who came for preventive purposes.
Respondents coming for leisure or tourist purposes were mostly characterized by short stays at spa resorts (from one day to about one week) and expenses at the level of PLN 2000–2500 ($570–715). Similar features could be seen in people arriving for the purpose of beauty improvement.
The youngest people (up to 20 years of age) and those of 30–40 years of age enjoy leisure, tourist, therapeutic, and preventive stays. It is worth noting that this group often includes unmarried persons (most often men), who spend from PLN 1000 to over PLN 3000 PLN ($285–860) during their stay.
The component of the business model of a spa enterprise that has undergone the greatest changes in the last decade is the value proposition that the enterprise offers to its clients. It is no longer just a properly conducted treatment with accommodation and catering services like it was back in the 1990s.
It is worth noticing that, currently, the main values for spa resort clients are the effects of therapeutic and leisure treatment. The beneficial effects of relaxation services, such as stress relief, sense of beauty, beauty improvement, weight loss, fitness, and sports performance, are also important. A significant value is also the patient’s integration with other people (co-patients) with similar health, lifestyles, social situations, interests, or ways of spending free time. An important value indicated by the respondents is the ability to break away from the everyday life.
Summing up the obtained results, key values for the client of a spa enterprise can be formulated. They include (Figure 5
The improvement of health with natural therapeutic resources;
recreation in a place with a healing climate;
achieving the effect of the treatment (relaxation, beauty, improved beauty, weight loss, improvement of fitness, and sports results); and
cognitive, cultural, and religious impressions obtained through various forms of tourism.
One should also remember the expectations of potential patients who, in the described research, expressed the need for:
The development of cultural activities,
the possibility of taking care of a child during treatment,
the introduction of a psychologist and leisure animator,
the introduction of classes and educational lectures, and
the introduction of spiritual care during the treatment.
The obtained results have some limitations, as patients and tourists visiting only Polish spa resorts were subject to the survey. Therefore, it is not possible to generalize the obtained results for all spa enterprises; however, the results may show new trends which could be observed in particular countries.
The obtained form of value proposition for a spa client can also be referred to as the atomic form of a tourist product and, especially, as the core of a tourist product. It is the proposition of value for the client that becomes an essential element, not only of the business model of a tourist enterprise, but of the offered tourist product. This allows the simultaneous entry of the whole form of the business model into the tourist product scheme [58
It is worth noting that one of the most important elements of the obtained form of the value proposition for a spa client is the use of natural resources available to Polish spas, especially the impact of the climate and raw materials used in spa therapy. This element of the spa business model becomes one of the strategic factors determining both the competitive advantage by maintaining the principles of sustainable development and the financial success of the enterprise. It is the spa activity that is one of the best examples of opportunity to find a balance between achieving business and social goals through the sustainable development of spas. It should also be remembered that natural therapeutic resources are extremely important for modern generations, but they are also an exceptional deposit for future generations; as such, these generations should also be able to benefit from them to no less an extent.