Research on Influencing Factors of Tourism Support Behavior of Residents in Health and Wellness Tourism Destination: The Moderating Role of Active Health

Abstract

At this stage, there is a relative lack of research on the tourism support behavior impacts of residents in health and wellness tourism. This study examines the effects of residents’ perceived tourism impacts and perceived justice on tourism support behaviors and explores the mediating role of affect and the moderating role of active health. Using the “cognitive-affective-behavioral” theory as a framework, this study conducted structural equation modeling on a sample of 500 residents in the BDH Life and Health Industry Innovation Demonstration Zone. It was found that the relationship between residents’ perceived benefits, distributional justice and procedural justice, and tourism support behaviors was positive, while the relationship between perceived costs and tourism support behaviors was negative; that positive affect played a mediating role between residents’ cognitive dimensions and tourism support behavior; and that active health played a moderating role between residents’ cognitive dimensions and tourism support behaviors. This study further enriches the theoretical research related to health and wellness tourism by exploring the role mechanism between the cognition and behavior of residents in health and wellness tourism destinations. It provides a theoretical basis for the comprehensive development of health and wellness tourism and the sustainable development of tourism destinations.

1. Introduction

With economic and social development, people’s attention to health is increasing day by day, and the elderly and sub-healthy groups have become an important clientele for the development of health and wellness tourism. Due to the fast-paced social environment and life pressure, 70% of the Chinese population is facing sub-health, and the degree of aging continues to increase. With more than 21% of the elderly population aged 60 and above, these groups have increasing demand for health, leisure, and wellness, and the public’s willingness to engage in health and wellness tourism is also increasing. In the context of aging, sub-health, and the epidemics of recent years, “public health awareness has become increasingly prominent” [1]. Epidemics have brought about a change in public health awareness and ideology, and “people’s critical awareness of epidemics has also fuelled their desire to travel for their health” [2]. Under the development strategy of “Healthy China” and the strong support of national policies, health and wellness tourism is booming, and the development system of health and wellness tourism is constantly improving, with a broad space for future development.

Previous studies have included residents as stakeholders in sustainable tourism development [3]. As important stakeholders in the development of sustainable tourism, residents play the roles of service providers, policy decision-makers, and tourism impact bearers and play an important role in the promotion of the destination brand and the establishment of its image. “In order to develop and sustain local tourism, the behavioral responses of local residents are critical” [4]. However, “centred on community stakeholders, they are often overlooked or ignored in tourism planning and decision-making” [5]. At present, the development of health and wellness tourism has begun to bear fruit. However, it has also produced certain negative impacts, including the transformation of traditional health care services to commercial opportunism, the increase in the cost of wellness services, the decline in the accessibility of health care services and local stigma, and more, and the issue of the negative impacts of the development of health and wellness tourism sites on the residents needs to be urgently resolved [6,7]. These issues can change residents’ attitudes and undermine tourism support behavior [8]. Therefore, it is necessary to understand in advance the perceptions of residents on health and wellness tourism destinations and their supportive attitudes towards health and wellness tourism. Currently, research on health and wellness tourism is mainly focused on spatial planning and conservation management [9], tourist perception [10], sustainable development [11,12], and function of wellness tourism [13,14], and research on the perception perspective of residents in health and wellness tourism is still relatively scarce.

The study of residents’ tourism perception and tourism support behavior has always been an important topic in the field of tourism and is an important condition for achieving sustainable tourism development. In the context of sustainable tourism development, “the main motivation for residents to support tourism stems from improved economic conditions and social well-being of the community” [15]. Ap [16] pointed out in his study that residents’ tourism impact perceptions and attitudes are important remediation factors that must be taken into account in the planning and development, marketing, and operation of tourism projects, and the study concluded that residents will have either positive or negative attitudes based on tourism impact perceptions. Hsu and colleagues [17] used structural equation modeling to quantitatively analyze the data and found that the residents’ perceived economic benefit dimension in the island context had a positive effect on supporting sustainable tourism development, while social cost perception had no significant impact on supporting sustainable tourism. In the context of health and wellness tourism research, there is a paucity of research on residents of health and wellness tourism destinations, an important stakeholder. There is also a lack of research on the relationship between residents’ perceptions and tourism support behavior, and it is necessary to integrate new theories for supplementary research.

Active health concepts and behavior are important factors in improving the health status of individuals and are positive actions that people take to prevent disease, maintain good health, and improve the quality of life, as well as a belief in life [18]. Currently, scholars mostly apply active health in the context of sociology in the context of health medicine, physical education, and sports research, which is closely linked to the social issues of population aging. Kroesen et al. [19] explored the relationship between active traveling (walking and cycling) and health status (body mass index and mental health). The results showed that the effect of active traveling on mental health was significant. Eronen et al. [20] investigated the role of health literacy in active aging in populations with varying numbers of chronic diseases. Higher health literacy allowed older adults, including those with multiple chronic conditions, to maintain higher levels of active aging. Thus, the positive contribution of active health has been demonstrated in the field of sociology, but the combination of active health and wellness tourism research is less common. The cognition of tourists and residents related to active health has a significant impact on the development of health and wellness tourism. It is worth exploring whether different levels of active health affect residents’ perceptions of health and wellness tourism and, consequently, tourism support behavior.

Based on the above, this study focuses on the following questions: “What is the mechanism of action between residents’ perceptions and behaviors in health and wellness tourism destinations?” “Does active health play a moderating role between health and wellness tourism perceptions and residents’ tourism support behaviors?” The purpose of this study is to explore the influencing factors of residents’ tourism support behaviors in health and wellness tourism destinations and to construct a model of the relationship between the influences of residents’ tourism support behaviors in health and wellness tourism. Existing studies related to health and wellness tourism lack exploration of the residents’ perspective and pay less attention to the impact of health and wellness tourism development on local residents and their attitudes towards this development. This study enriches the research on residents’ perspectives and improves the research system of health and wellness tourism. The differences in the level of active health of residents may affect their perception of health and wellness tourism to varying degrees, so active health is introduced as a moderating variable in the relationship between residents’ cognitive dimensions and behavioral dimensions to gain a deeper understanding of the mechanism of residents’ cognition and tourism support behavior and further improve the research system of tourism support behavior of residents in health and wellness tourism. A questionnaire was used to explore residents’ perceptions, promote resident support behaviors based on the results of the analysis, and provide recommendations for achieving coordinated and sustainable development of health and wellness tourism destinations.

2. Literature Review and Hypothesis Development

2.1. Theoretical Framework

Cognitive-affective-behavioral (CAB) theory is an important theory in the field of cognitive psychology and is the basis proposed by psychologists to explain the causes of individual behavior. Individuals undergo a cognitive-affective-behavioral process of psychological change after being stimulated by the external environment, which in turn triggers the production of a particular behavior. It suggests that cognition as an antecedent activates emotion, which in turn influences behavior [21]. According to Dweck [22], the cognitive-affective-behavioral theory is a paradigm that describes the process of behavior formation based on the interaction between the individual and the environment. According to this theory, an individual perceives an objective object, the perception determines the emotion, and the emotion triggers the behavior, and the individual’s emotion mediates the relationship between the perception and the behavior. Zheng et al. [23] examined tourists’ energy-saving behavior and loyalty by applying the cognitive-affective-behavioral model and found that destination image positively and directly affects tourists’ energy-saving behavior and loyalty. Based on the “cognition-affective-behavioral” theory, this paper expands the study of residents’ support behavior from a cognitive perspective to an emotional perspective and explains the transmission mechanism of residents’ perception and support behavior in the development of health and wellness tourism.

2.2. The Impact of Perceived Tourism Impacts on Tourism Support Behavior

Broadly speaking, tourism impact perception reflects the perception or evaluation of various tourism phenomena by tourism destination stakeholders. Resident perceptions of tourism impacts encompass cost-benefit evaluations within their living environments. Current scholarly consensus categorizes these impacts through a benefit-cost dichotomy, with multidimensional analyses spanning economic, sociocultural, and environmental domains.

Chen et al. [24] conducted a study on perceived tourism impacts and found that economic impacts are not necessarily the main perceived benefits and that impacts such as social factors have also received extensive attention. It has also been suggested that the perceived impact of tourism and responses to tourism development should be conceptualized and measured at the individual and community levels [25]. Godovykh et al. [26] found, based on panel data, that tourists have a negative effect on residents’ well-being in the short term and a positive effect on residents’ well-being in the long term. Tourism development has both positive and negative effects on the community, affecting the ability of the community to meet the needs of the residents, which in turn affects the residents’ sense of identity with the community. Peters et al. [27] found that socio-cultural influences were greater than economic and environmental influences in their exploration of the perceived influence of local residents on attitudes towards tourism development. Wu et al. [4] found that “perceived economic benefits mediate between affective solidarity, stakeholder attitudes, and support for sustainable tourism development”. Against the backdrop of the far-reaching impact of the COVID-19 pandemic on the global tourism industry, research has been extended to public health crisis scenarios, with Thotongkam et al. [28] introducing a health beliefs model, revealing that perceived health risks (e.g., susceptibility to infections and perceived severity) act as a novel “cost” dimension that significantly inhibits tourism expenditure, and Vieira et al. exploring the impact of perceived economic benefits on tourism development. Vieira et al. [29] explored the impact of perceived risk on residents’ support for sustainable tourism development in low-density areas, while Shen et al. [30] deepened the theoretical research in crisis contexts, confirming that the negative impact of risk perception on supportive behaviors not only stems from direct health threats but also involves the costs of crowding out healthcare resources and increasing the risk of disease. Based on the literature review, it can be seen that people’s perceived tourism impacts can have a close impact on residents’ affect and supportive attitudes, and residents’ perceived tourism impacts play an important role in the study of sustainable development of tourist destinations.

Many studies understand residents’ support for tourism as an attitude known as tourism support. Bulter [31] found that residents’ attitudes towards local tourism development varied at different stages of development in tourist destinations, with certain negative impacts occurring after the mature stage of development. Social exchange theory (SET) is one of the theoretical frameworks applied by a wide range of scholars to determine residents’ tourism support behavior by exploring the perceived tourism impacts of residents in tourism destinations. Social exchange theory is a more important theory to study residents’ attitudes and support for tourism development and is widely used by scholars in different tourism scenarios to explore the perceived tourism impacts on residents of tourism destinations. According to the social exchange theory, in the process of tourism development, tourism subjects from all parties will form their attitudes towards tourism development based on the comparison of benefits and costs in the exchange process of tourism development [32]. “Residents’ behaviours are dominated by benefits, and when residents perceived tourism impacts on the local community that are positive and beneficial to the residents themselves, residents will engage in support behaviours accordingly” [33]. Later on, scholars applying social exchange theory have continuously improved the theoretical model by including affective elements such as place attachment [34] and social relationship elements such as residents’ tolerance [35], community participation [36], etc., to make up for the shortcomings of the theory of social exchange and to make the research system of factors influencing residents’ tourism support behavior more complete.

Health and wellness tourism, as a multifaceted socioeconomic phenomenon, generates economic opportunities while triggering resident concerns over inflation, ecological strain, and infrastructure pressure. Grounded in social exchange theory, resident support stems from comparative evaluations of tourism impacts. Perceived benefits and perceived costs are important components of residents’ perceptions of tourism impacts, which are their subjective perceptions of the benefits and harms caused by tourism development. When residents can perceive more benefits than costs in tourism development, they are more willing to join in this social exchange process and participate in tourism development [37,38]. Gursoy and Rutherford [39] showed that positive tourism impact perception positively influences residents’ support for tourism development and negative tourism impact perception negatively influences residents’ support for tourism development. Studies by Lee [40] showed that positive tourism impact perception has a facilitating effect on support for tourism development and negative tourism impact perception has a weakening effect. Based on the social exchange theory, this study sets two dimensions of perceived benefits and perceived costs, combines the literature review, and makes the following assumptions:

H1: 

Perceived tourism impacts have a significant effect on residents’ tourism support behavior.

H1a: 

Perceived benefits have a significant positive effect on residents’ tourism support behavior.

H1b: 

Perceived costs have a significant negative effect on residents’ tourism support behavior.

2.3. The Impact of Perceived Justice on Tourism Support Behavior

In the process of health and wellness tourism development, there are many stakeholders, and conflicts of interest are inevitable. However, residents are in a disadvantaged position in the process of health and wellness tourism development due to the limitations of their ability to participate in terms of capital, technology, and resources, as well as their weak sense of participation, and therefore, residents may develop a sense of deprivation. In the process of tourism development, residents will make a perceived justice evaluation of tourism development based on benefits and costs, which will affect the attitude towards tourism support. Adams formally proposed equity theory, which focuses on whether the distributional outcomes are fair and reasonable. This concept is known as “distributive justice” and it is often used in the discipline of organizational behavior to explain the behavior of employees. At present, scholars mostly apply equity theory to evaluate the subjective perception of fairness of individuals and put forward the concept of perceived justice.

Some scholars have applied equity theory to the field of tourism destinations to explore the relationship between residents’ perceived fairness and their tourism support behavior in the context of tourism destinations. Viewing the destination as a complex organization that includes the government, tourism enterprises, and residents, where residents will receive the corresponding benefits and pay the corresponding costs in the process of tourism development and where residents make judgments based on the benefits and costs to form a sense of perceived justice. A high level of perceived justice can generate positive attitudes and behavior. Wang et al. [41] applied the theory of organizational fairness to rural tourism destinations and found that residents’ perceived fairness significantly affects residents’ tourism support behavior. Kim et al. [42] studied the impact of community residents’ governmental perceived justice on social capital, government, and environmental development support based on social exchange theory and organizational equity theory. At present, there is less attention paid to residents’ perception of fairness in health and wellness tourism places, so this paper explores the mechanism of the impact of residents’ perceived justice on tourism support behavior in health and wellness tourism.

A review of the literature reveals that scholars mostly split perceived justice into different dimensions to develop measurements, with the two-factor theory (distributive justice and procedural justice) being the most common view. Sieger et al. [43] found that employees’ perceptions of distributive justice and procedural fairness perceptions were important predictors of psychological ownership of family firms. In this paper, with reference to previous studies and common perceptions of organizational justice, perceived justice is divided into two dimensions consisting of distributive and procedural fairness. Accordingly, the following hypotheses are made:

H2: 

Perceived justice has a significant positive effect on residents’ tourism support behavior.

H2a: 

Distributive justice has a significant positive effect on residents’ tourism support behavior.

H2b: 

Procedural justice has a significant positive effect on residents’ tourism support behavior.

2.4. The Relationship Between Perceived Tourism Impacts, Perceived Justice, Tourism Support Behavior, and Affect

In the process of health and wellness tourism development, all parts of resident health and wellness tourism development are in close contact and communication, including the government, enterprises, tourists, and other stakeholders. At the same time, tourism planning and development will also bring about changes in lifestyle and space. Under the influence of a series of tourism, residents will produce corresponding positive or negative affects based on cognitive judgement, and these affects will trigger corresponding residents’ social behaviors, including tourism support behaviors for health and wellness tourism development.

Research has shown that individuals’ emotions also affect their judgment, decisions, and behavior [44]. Currently, residents and tourists are focusing more and more on the satisfaction of emotional aspects, and affect has become one of the core elements of the tourism process [45]. Affect may be the transmission mechanism of residents’ tourism affecting perceived support behavior. Affect is an individual’s attitudinal experience of whether an objective thing meets his or her needs, and in a tourism environment where tourism development activities meet the needs of residents or do not involve their interests, residents tend to produce a welcoming attitude and positive affects such as delight, joy, and pride or a rejecting attitude, producing negative affects such as frustration, dislike, and anger.

Affect can be categorized into a number of types, most commonly classified as positive and negative affect. One of the most widely used measurement tools for affect is the Positive and Negative Affect Schedule (PANAS) developed by Watson et al. [46], which classifies affect into two main categories: positive affect and negative affect. The “cognitive-affective-behavioral” theory suggests that individuals’ perceptions of things affect their emotions, which in turn affect their behavioral tendencies and specific behaviors. Perceived tourism impacts, as the cognitive part of this study, have been confirmed by some scholars in their relationship with positive and negative affects. Evaluation of an activity elicits joy if it is beneficial, and different evaluative contexts elicit different emotional responses. Accordingly, the following hypotheses are proposed:

H3: 

Residents’ perceived tourism impacts have a significant effect on affect.

H3a: 

Residents’ perceived benefit has a significant positive effect on positive affect.

H3b: 

Residents’ perceived benefits have a significant negative effect on negative affect.

H3c: 

Residents’ perceived costs have a significant negative effect on positive affect.

H3d: 

Residents’ perceived cost has a significant positive effect on negative affect.

Failure to deal with perceived justice can lead to negative attitudes, low life satisfaction, and community identity among residents. Cheung and Law [47] also showed that the higher the perception of organizational fairness (distributive, procedural, and interaction justice), the higher the tendency of the employees to have a relatively high level of affective attachment and responsibility to the organization, i.e., a higher sense of identification with the organization. By the same reasoning, the higher the perceived justice of the residents of health and wellness tourism destinations, the higher the sense of identification with the development of health and wellness tourism in the destination tends to be. The following hypotheses are therefore made:

H4: 

There is a significant effect of perceived justice on affect among residents.

H4a: 

There is a significant positive effect of residents’ perceived justice in distribution on positive affect.

H4b: 

Residents’ perceived justice in distribution has a significant negative effect on negative affect.

H4c: 

There is a significant positive effect of residents’ perceived justice of procedures on positive affect.

H4d: 

There is a significant negative effect of residents’ perceived justice of procedures on negative affect.

According to the “cognitive-affective-behavioral” theory, affect plays an intermediary role between cognition and behavior. Positive emotions not only stimulate positive behavioral intentions but also have an initiating and expanding effect on an individual’s cognitive ability and the cognitive scope of the environment and stimulus events. Accordingly, the following hypotheses are proposed:

H5: 

Residents’ affect has a significant effect on tourism support behavior.

H5a: 

Residents’ positive affect has a significant positive effect on tourism support behavior.

H5b 

: Residents’ negative affect has a significant negative effect on tourism support behavior.

H6: 

The affect dimension mediates the cognitive dimension and tourism support behavior.

2.5. The Role of Active Health in the Relationship Between Residents’ Cognitive Dimensions and Tourism Support Behavior

Active health, as an intervention model, emphasizes the shift from “passive health” to “active health” through integrated health services, body-nurture integration, and other interventions. On an individual level, active health reflects the positive attitude that individuals seek to achieve a state of health. Residents’ active health will lead them to better participate in health and wellness tourism activities and combine their active health knowledge with the importance of active health and wellness activities, thus influencing support behavior.

Differences in individual active health knowledge, concepts, and behaviors can directly affect residents’ related perceptions, making them react differently even when faced with stimuli from the same tourism development environment. Increased public health literacy facilitates the promotion of citizen participation in community health initiatives and government responsibility for addressing health justice [48]. Chi et al. [49] found that destination familiarity moderates the relationship between perceived quality of a destination and willingness to travel. The prior knowledge experience of the general public moderates the relationship between their perceptions and behavioral intentions. If residents are more aware of active health, their familiarity with health and wellness tourism will be relatively higher, their perception of uncertainty and risk will be lower, and the value associations in the cognitive evaluation process will be easier to achieve, which in turn will impact their perceived tourism support behavior [50,51].

Residents with a high level of active health pay attention to their own health, pay more attention to local health and wellness policies as well as health and wellness tourism activities, and can better participate in health and wellness tourism activities, reduce negative perceptions, enhance positive perceptions, and support the development of health and wellness tourism. When the level of active health residents’ participation in recreation and wellness tourism is low, they do not pay enough attention to recreation and wellness tourism, which leads to low positive perceptions or high negative perceptions of residents and affects the support behavior. This is because the residents’ active attention to recreational tourism is not enough, so the tourism support behavior is more dependent on passive perception, relying on external stimuli perceived to judge their own support behavior, so active health, residents’ perception of external stimuli, and other factors formed a substitutional relationship in influencing tourism support behavior.

In a study by He et al. [52] on the moderating effects of destination social responsibility (DSR), it was found that the effect of service quality on environmentally responsible behavior in tourism is significantly weakened when DSR is present. In this study, active health, as a prior knowledge literacy of residents, may modulate the relationship between perceived and tourism support behaviors by enhancing residents’ access to health and forming a value compensation mechanism for perceived justice.

There are two types of moderating roles, facilitating and inhibiting, and there is a special case in the measurement procedure of moderating variables where there is a relationship between the effects of the independent variable and the moderating variable on the dependent variable, i.e., the substitution relationship. The present study wishes to explore the moderating role of active health in the cognitive and affective dimensions in the context of health and wellness tourism. Therefore, the following hypothesis is made:

H7: 

Active health has a moderating role between residents’ cognitive dimensions and tourism support behavior.

Based on the above assumptions, this paper constructed a hypothetical model with perceived benefit, perceived cost, procedural justice, and distributive justice as independent variables, positive and negative affect as mediating variables, tourism support behavior as a dependent variable, and active health as a moderating variable, as shown in Figure 1.

3. Methodology

3.1. Questionnaire Design and Scale Measurement

Most of the measurement items in this study were borrowed from mature scales that have been empirically tested in previous studies. A large amount of literature summarizing the scales was read, and the scale items were designed in combination with health and wellness tourism scenarios. The questionnaire of this study is divided into four parts: The first part includes the demographic characteristics of the respondents. The second part is the measurement of cognitive scales, including the dimensions of perceived benefits, perceived costs, distributional justice, procedural justice, and active health. The third part is the measurement of residents’ affect, including both positive and negative affect dimensions. The fourth part is the measurement of tourism support behavior. The scales are based on a 7-point Likert scale ranging from “strongly disagree” to “strongly agree” on a scale of 1 to 7. The specific scale design method is as follows:

(1)

The perceived tourism impacts dimension contains two variables, perceived benefits and perceived costs. Scale design refers to the relevant measurements of Lee [40] and Nunkoo [53] et al. scholars. Perceived benefits have four items, and perceived costs have five items.

(2)

The content of the perceived justice scale mainly refers to the study of Colquitt [54] and combines the actual situation with the design of distributive and procedural justice scales. Distributive justice and procedural justice are each set up with four question items.

(3)

The content of the affect scale mainly refers to the two-dimensional structure of the positive affect negative affect scale compiled by Watson [46] and the research of Oliver and Swan [55] and Zhou [56], and identifies four items each for residents’ positive affect and negative affect questions.

(4)

The active health scale design is based on the definition of active health and Jordan et al. [57] and related scholars’ studies with six question items.

(5)

The design of the tourism support behavior scale refers to the studies of Ribeiro et al. [58] and Olya et al. [59], and the questions were adjusted to the actual situation of the case site, with five questions.

3.2. Case Site Selection

As China’s first Life and Health Industry Innovation Demonstration Zone, Beidaihe (BDH) has a favorable ecological environment and a comfortable climate and is rich in high-quality natural resources for health and wellness tourism, such as the ocean, beaches, forests, and wetlands. In terms of cultural heritage, the BDH area included in the Demonstration Zone has a long history of health and wellness and became a tourist summer resort during the Qing government. By the end of 2023, the demonstration zone completed 624 industrial and infrastructure projects with an investment of RMB 40 billion. By 2030, the annual increase of the life and health industry will reach RMB 100 billion, and the development pattern of the life and health industry will be built with the comprehensive development of “medicine, pharmacy, health care, health, and tourism”. BDH is China’s earliest established life and health industry innovation demonstration, and its health and wellness tourism development model in practice through continuous exploration tends to mature, and as a national demonstration area, has a typicality. In the process of understanding the case selection, it was found that there are problems such as marginalization of residents, weak sense of participation, lack of value perception, and ambiguous support attitude in the development of health and wellness tourism in the demonstration area, so it is urgent to carry out relevant research to understand the residents’ perception of health and wellness tourism and tourism support behaviors. Therefore, this paper selected the BDH Life and Health Industry Innovation Demonstration Zone as a case study.

3.3. Data Collection

The study used a questionnaire survey method to conduct a large-scale questionnaire distribution in May and June 2023 in BDH District and BDH New Area, based on the villages and communities near the core scenic spots of recreation (villages and communities near the scenic spots of Tiger Stone, Pigeon’s Nest, Xianluodao Island, and Fishing Island Hot Springs, etc.), and also combined with the actual situation of the on-site interviews with the residents to provide as much detail and depth as possible on the perception and attitudes of the residents near the BDH Innovation Demonstration Area towards the development of recreation and tourism wellness tourism perception and attitude. The data for the study were obtained through face-to-face interviews using a convenience sampling method. The distribution of questionnaires was not closed until 500 valid questionnaires had been collected. A total of 613 questionnaires were distributed, and 613 were returned, resulting in a 100% response rate. Through screening, 500 valid questionnaires were obtained, and the validity rate of the questionnaires was 81.5%.

4. Data Analysis and Results

4.1. Sample Descriptive Statistics

4.1.1. Demographic Profile Analysis

The descriptive analysis of the demographics of this study included seven aspects: gender, age, education, occupation, monthly income, whether they were engaged in the tourism industry, and the average number of health and wellness tourism trips per year, and the results are shown in

Table 1. Demographic characterization of the sample.

Basic Information	Categorical Variable	Frequency	Percentage	Basic Information	Categorical Variable	Frequency	Percentage
Gender	Male	229	45.8%	Age	18–24 years	70	14.0%
	Female	271	54.2%		25–34 years	116	23.2%
Occupation	Civil servants or career staff	66	13.2%		35–44 years	132	26.4%
	Company employees	94	18.8%		45–54 years	90	18.0%
	Self-employed individuals	105	21.0%		55–64 years	65	13.0%
	Freelancers	27	5.4%		65 and above	27	5.4%
	Students	48	9.6%	Education	Primary and below	24	4.8%
	Farmers	27	5.4%		Junior high school	106	21.2%
	Retirees	59	11.8%		High school (including junior colleges and technical schools)	146	29.2%
	Other practitioners	74	14.8%		University (including college)	193	38.6%
Monthly income	Less than ¥3000	137	27.4%		Master’s degree or above	31	6.2%
	¥3000–4999	187	37.4%	Number of health and wellness trips per year	0	209	41.8%
	¥5000–6999	114	22.8%		1–2 times	182	36.4%
	¥7000–8999	41	8.2%		3–5 times	63	12.6%
	9000 and above	21	4.2%		6–8 times	16	3.2%
Whether engaged in the tourism industry	Yes	120	24.0%		More than 8 times	30	6.0%
	No	380	77.0%

.

4.1.2. Descriptive Analyses of Measurement Items for Each Variable

The 500 valid questionnaires that were obtained were statistically analyzed and tested for normal distribution. As shown in

Table 2. Descriptive statistics of measurement question items for each variable (n = 500).

Dimension	Observed Variables	M	SD	Skewness	Kurtosis
Perceived benefits	PB1	5.51	1.306	−0.869	0.544
	PB2	5.53	1.222	–0.78	0.196
	PB3	5.48	1.139	−0.622	0.031
	PB4	5.77	1.064	−1.139	2.111
Perceived costs	PC1	4.13	1.427	−0.01	−0.353
	PC2	3.64	1.343	0.153	−0.27
	PC3	3.17	1.336	0.39	−0.135
	PC4	2.94	1.233	0.274	−0.564
	PC5	3.09	1.339	0.297	−0.577
Distributive justice	DJ1	4.78	1.236	−0.625	0.929
	DJ2	4.79	1.22	−0.722	1.084
	DJ3	4.91	1.145	−0.631	0.926
	DJ4	4.9	1.168	−0.607	1.029
Procedural justice	PJ1	4.52	1.38	−0.228	−0.4
	PJ2	4.78	1.261	−0.259	−0.201
	PJ3	5.11	1.226	−0.436	−0.304
	PJ4	4.68	1.371	−0.265	−0.22
Active health	AH1	5.25	1.265	−0.644	0.359
	AH2	5.3	1.187	−0.709	0.588
	AH3	5.21	1.213	−0.651	0.425
	AH4	5.03	1.302	−0.642	0.468
	AH5	5.24	1.32	−0.93	0.941
	AH6	5.34	1.28	−0.882	0.98
Positive affect	PA1	5.24	1.155	−0.526	0.42
	PA2	5.2	1.225	−0.543	0.213
	PA3	5.33	1.192	−0.659	0.621
	PA4	5.73	1.166	−1.212	2.018
Negative affect	NA1	3.05	1.256	0.47	−0.143
	NA2	3.04	1.273	0.409	−0.277
	NA3	2.86	1.336	0.686	0.141
	NA4	2.96	1.409	0.676	−0.109
Supporting behavior	SB1	5.22	1.228	−0.466	−0.015
	SB2	5.49	1.175	−0.591	−0.02
	SB3	5.81	1.093	−0.94	0.858
	SB4	5.72	1.199	−0.902	0.486
	SB5	5.64	1.149	−1.032	1.347

, the absolute value of skewness of each variable question item in this study is less than 3, and the absolute value of kurtosis is less than 10, obeying the normal distribution, which is suitable for the next analysis.

4.1.3. Analysis of Variance

ANOVA can test whether two or more sample means are significantly different. ANOVA was used to test the impacts of demographic factors (whether engaged in tourism industry and number of health and wellness trips per year) on perceived benefits, perceived costs, procedural justice, distributive justice, positive affect, negative affect, active health, and support behavior. First, an independent samples t-test was conducted to analyze the effect of “whether engaged in tourism industry” on these variables, and the results are shown in

Table 3. Independent samples t-test.

Whether Engaged in the Tourism Industry	Yes	No	F	p
Supporting behavior	5.61 ± 0.92	5.57 ± 1.01	0.469	0.639
Negative affect	2.93 ± 1.06	3.00 ± 1.14	−0.562	0.574
Positive affect	5.39 ± 1.04	5.37 ± 1.04	0.227	0.82
Active health	5.17 ± 1.06	5.25 ± 1.04	−0.717	0.474
Procedural justice	4.64 ± 1.02	4.82 ± 1.12	−1.547	0.123
Distributive justice	4.93 ± 0.93	4.82 ± 1.07	1.114	0.267
Perceived costs	3.34 ± 0.89	3.41 ± 1.06	−0.71	0.478
Perceived benefits	5.40 ± 1.06	5.63 ± 0.93	−2.156	0.032 *

* p < 0.05.

. The results show that the significance level of whether or not the sample is engaged in the tourism industry is greater than 0.05 for the variables of tourism support behavior, negative affect, active affect, active health, procedural justice, distributional justice, and perceived cost, indicating that there is no significant difference, and the significance level of whether or not the sample is engaged in the tourism industry is less than 0.05, indicating that whether or not the sample is engaged in the tourism industry is correlated with a significant difference in the perceived benefit. Non-tourism industry residents have a stronger perception of the benefits of health and wellness tourism and are more concerned with the positive external effects of health and wellness tourism.

For the factor of “number of health and wellness tourism trips per year”, its effect on these variables was analyzed by one-way ANOVA. As 41.8% of the respondents in the sample indicated that they had no experience with health and wellness tourism, which is a large sample size, and the sample size of each group choosing three times or more is small, the sample was divided into three groups for analysis, namely, the low-frequency group (0 times), the medium-frequency group (1–2 times), and the high-frequency group (3 times or more), and the results are shown in

Table 4. One-way ANOVA.

Number of Health and Wellness Trips Per Year	0	1–2 Times	3 Times and Above	F	P
Supporting behavior	5.49 ± 1.06	5.60 ± 0.91	5.72 ± 0.98	2.033	0.132
Negative affect	3.01 ± 1.21	2.93 ± 1.07	2.99 ± 1.05	0.252	0.778
Positive affect	5.23 ± 1.05	5.62 ± 0.95	5.25 ± 1.08	8.308	0.000 ***
Active health	5.02 ± 1.16	5.39 ± 0.87	5.37 ± 1.02	7.401	0.001 ***
Procedural justice	4.64 ± 1.13	4.93 ± 1.11	4.76 ± 0.99	3.439	0.033 *
Distributive justice	4.58 ± 1.01	5.10 ± 0.98	4.92 ± 1.10	13.239	0.000 ***
Perceived costs	3.33 ± 1.07	3.40 ± 0.97	3.50 ± 1.01	1.013	0.364
Perceived benefits	5.51 ± 1.01	5.73 ± 0.89	5.42 ± 0.98	4.381	0.013 *

*** p < 0.001, * p < 0.05.

.

The results show that the significance level of the sample for the number of times a year for tourism support behavior, negative affect, and perceived cost is greater than 0.05 for the three items, which does not show a significant difference, but for the five items of positive affect, active health, procedural justice, distributive justice, and perceived benefits, the significance levels are 0.000, 0.001, 0.033, 0.000, and 0.013, respectively, which indicates a significant difference. Positive affect was significantly higher among residents who had had 1–2 health and wellness tourism experiences, while there was no significant difference between the low-frequency group (0 times) and the high-frequency (3 times and above) group, and moderate tourism experiences can enhance residents’ positive affective perceptions of health and wellness tourism; residents who had experiences of health and wellness tourism, regardless of frequency, scored significantly higher than non-participants in terms of their awareness of active health, which suggests that the experience of health and wellness tourism itself also stimulates the residents to pay attention to health and wellness; residents in the 1–2 times group have a significantly higher perception of procedural justice than those in the 0 times group, and the high-frequency group is in between, reflecting that residents who have moderately participated in tourism activities are more concerned about the normality of the development process, and those who have not had experience in health and wellness tourism do not have enough perception due to the lack of experience; residents in the 1–2 times group also have a significantly higher perception of distributional justice than the other two groups, and the high-frequency group is also significantly higher than the non-participant group, suggesting that residents who have participated in health and wellness tourism are more concerned about the normality of the development process than those who have had experience in health and wellness tourism, suggesting that residents who have had experience in health and wellness tourism are more concerned about the normality of the development process than the non-participant group. This indicates that residents who have participated in health and wellness tourism pay more attention to the fairness of the distribution of benefits; the perceived benefits of health and wellness tourism of residents in the 1–2 times group are significantly higher than those of the other two groups and are lowest in the high-frequency group; residents who have not had any experience of health and wellness tourism and those who have had experiences 1–2 times have relatively greater expectations for the development of health and wellness tourism, whereas high-frequency people are relatively more sensitive to the negative effects (such as crowding and price increases) of tourism development, resulting in the perception that the benefits are not significant.

4.2. Measurement Model Testing

4.2.1. Reliability Analysis

In this study, the reliability and internal consistency of the scale were judged by testing the Cronbach’s α of each dimension. The test results are shown in

Table 5. Reliability and correlation coefficient of variables in each dimension.

Dimension	Cronbach’s α	AH	SB	NA	PA	PJ	DJ	PC	PB
Active health	0.908	0.791
Supporting behavior	0.901	0.726 ***	0.807
Negative affect	0.874	−0.539 ***	−0.648 ***	0.799
Positive affect	0.897	0.690 ***	0.718 ***	−0.661 ***	0.832
Procedural justice	0.858	0.692 ***	0.706 ***	−0.619 ***	0.677 ***	0.778
Distributive justice	0.896	0.518 ***	0.576 ***	−0.481 ***	0.549 ***	0.598 ***	0.827
Perceived costs	0.822	−0.500 ***	−0.605 ***	0.745 ***	−0.584 ***	−0.573 ***	−0.429 ***	0.696
Perceived benefits	0.833	0.554 ***	0.601 ***	−0.494 ***	0.633 ***	0.619 ***	0.514 ***	−0.435 ***	0.747

Diagonal values represent the square root of the construct AVE value, *** p < 0.001.

, and the Cronbach’s α of the eight variables in this paper are between 0.8 and 0.9, indicating that the internal consistency of the scale is high and can meet the requirements of hypothesis testing.

4.2.2. Confirmatory Factor Analysis

In this paper, the model is constructed with the help of Amos24.0 software, and the model fit is as follows: The CMIN/DF is 2.283, which is less than 3, its GFI, AGF, and NLI are 0.867, 0.843, and 0.896, respectively, which are greater than 0.8 and less than 0.9, which are in the acceptable range, and the TLI and CFI are 0.931 and 0.938, respectively, which are greater than 0.9. The RMSEA is <0.08. Overall, the model fit is better, the model is valid and credible, and it is suitable for empirical analysis.

The standardized loading of the corresponding latent variables of each question item in this paper are all higher than 0.45, and the CR value of each dimension of the variable is close to or greater than 0.90. The AVE value is only the AVE value of the perceived cost, which is 0.48, which is close to 0.5 and acceptable, and the AVE values of the other latent variables are all greater than 0.5. It can be seen that the data have a better combination of validity (

Table 6. Confirmatory factor analysis load.

Dimension	Norm	Items	S.E.	P	CR	AVE
Perceived benefits	PB4	Health and wellness tourism development has strengthened local infrastructure (e.g., roads, recreational facilities, service facilities, etc.).	0.721		0.830	0.560
	PB3	Health and wellness tourism development promotes local health and wellness activities.	0.822	***
	PB2	The development of health and wellness tourism has attracted many investors to the local area.	0.680	***
	PB1	The development of health and wellness tourism has provided residents with more employment opportunities and increased their incomes.	0.758	***
Perceived costs	PC5	Health and wellness tourism development leads to local environmental damage and pollution.	0.683		0.820	0.480
	PC4	Residents can clash with tourists during the development of health and wellness tourism.	0.698	***
	PC3	Law and order problems have increased after the development of health and wellness tourism.	0.679	***
	PC2	Health and wellness tourism development leads to strain on local service resources.	0.764	***
	PC1	The development of health and wellness tourism has caused local prices to rise, raising the cost of daily life for residents.	0.653	***
Distributive justice	DJ4	Your acquisition reflects your performance in generating health and wellness tourism development efforts.	0.832		0.900	0.680
	DJ3	Your acquisition reflects your contribution to the development of health and wellness tourism in your community.	0.830	***
	DJ2	Your acquisition appropriately reflects the work you have accomplished to develop health and wellness tourism.	0.840	***
	DJ1	Your acquisition reflects the efforts you have invested in the development of health and wellness tourism efforts.	0.807	***
Procedural justice	PJ4	I am able to complain and question about problems in the development of health and wellness tourism.	0.771		0.860	0.610
	PJ3	Policies and practices comply with ethics and morality in the development of health and wellness tourism.	0.741	***
	PJ2	Good consistency of relevant policies and practices in the development of health and wellness tourism.	0.811	***
	PJ1	I can express my views and feelings when making policy decisions on health and wellness tourism development.	0.789	***
Positive affect	PA1	I am satisfied with the development of local health and wellness tourism.	0.826		0.900	0.690
	PA2	The development of local wellness tourism makes me happy.	0.883	***
	PA3	I’m proud of the growth of local wellness tourism.	0.868	***
	PA4	I’m excited about the development of local wellness tourism.	0.746	***
Negative affect	NA1	I was marginalized during the development of health and wellness tourism, which made me feel excluded.	0.814		0.860	0.640
	NA2	Other people in the development of health and wellness tourism have appropriated the resources and benefits that should belong to me, causing me to feel deprived.	0.822	***
	NA3	The influx of tourists during the development of health and wellness tourism has made me sick of it.	0.819	***
	NA4	I am concerned that health and wellness tourism will be detrimental to the long-term development of the local area (e.g., the impact of negative comments from tourists on the local reputation).	0.739	***
Tourism support behavior	TB1	I am willing to participate in the health and wellness tourism business.	0.724		0.900	0.650
	TB2	I am willing to participate in local recreation and tourism policy decisions and planning.	0.808	***
	TB3	I’m willing to protect local health and wellness tourism resources.	0.842	***
	TB4	As a host, I would like to con travelers and be more hospitable!	0.843	***
	TB5	For the good development of local recreation and tourism, I am willing to spread the positive message of local recreation and tourism to others.	0.811	***
Active health	AH1	I take the initiative to acquire health and wellness knowledge in my daily life.	0.707		0.910	0.630
	AH2	I can understand relevant health literacy information and services.	0.798	***
	AH3	I am able to apply the health literacy information I have gained to promote health in my life.	0.827	***
	AH4	I can take the information I have and use it to make good health decisions.	0.825	***
	AH5	I do health and wellness activities on a daily basis.	0.809	***
	AH6	I will be proactive in changing poor health habits.	0.771	***

*** p < 0.001.

). The diagonal AVE values are all greater than the correlation coefficients of the dimensions, indicating that the dimensions have good differential validity (Table 5).

4.2.3. Hypotheses Testing

First, the model fit index test is carried out. In the hypothesis testing model fit index table, CMIN/DF is 2.885, less than 3, and its GFI, AGF, and NLI are 0.865, 0.838, 0.886, respectively, greater than 0.8 and less than 0.9, in the acceptable range. TLI and CFI are 0.913 and 0.922, respectively, and the RMSEA is <0.08, indicating that the model fit is acceptable.

The paper analyzed the model’s main effects using Amos24.0 software. The test results show that the standardized path coefficients of perceived benefits, perceived costs, distributive justice, and procedural justice on tourism support behavior are 0.133, −0.142, 0.153, and 0.243, respectively, which pass the significance level test, and the hypotheses H1a, H1b, H2a, and H2b are true. The standardized path coefficient of positive affect on tourism support behavior is 0.265, p < 0.001, which passes the significance level test, and positive affect has a significant positive effect on tourism support behavior. Hypothesis H5a is established. The standardized path coefficient of negative affect on tourism support behavior is −0.124, p > 0.05, which does not pass the significance level test, and hypothesis H5b is not established. This paper attempts to explain the findings of Zhang [60] and other scholars on the behavioral effects of relative deprivation (a kind of negative psychology and affect). It has been found that relative deprivation, as a negative affect, usually leads to negative attitudes and behaviors. However, it can sometimes lead to positive behaviors. This is because residents behave differently after experiencing negative affect, depending on their attributional style and self-efficacy. The conclusion of this study also applies to our research. Even if negative emotions are perceived, tourism destination residents may generate support behaviors by considering the impacts of their own perceived benefits, ability to participate, local cultural identity, prospects for health and wellness tourism development, and positive coping factors. In the pre-survey and on-site interviews, it was found that some residents do not know much about the development of health and wellness tourism, and their affect is in a neutral state. Although there are certain forms of negative affect, such as a low degree of participation, a marginalized position, and a certain sense of exclusion and deprivation, the majority of residents still expressed a high degree of tolerance and support for the development of local health and wellness tourism within an acceptable range. The overall reason for this is related to the wait-and-see attitude of the residents towards the new industry at the early stage of development and their degree of tolerance.

The mediating effect test was still conducted using Amos24.0 software, using the bootstrap method, with the sample size set at 2000 and the confidence interval for bias correction set at 95%. Negative affect does not mediate between the cognitive dimensions and tourism support behavior because of the different primary paths of negative affect to tourism support behavior. Therefore, only the mediating role of positive affect between the dimensions of perception and tourism support behavior was measured in this paper. The results of data analysis showed that the confidence intervals of the indirect effects of perceived benefit, perceived cost, distributive justice, and procedural fairness on tourism support behavior for bias-corrected 95% CI and percentile 95% CI were [0.050, 0.321] and [0.045, 0.197], [−0.261, −0.043] and [−0.255, −0.040], [0.019, 0.100] and [0.019, 0.099], [0.031, 0.166] and [0.026, 0.156], respectively, none of which contained zeros and the indirect effects were all significant. The direct effect interval of perceived benefit on tourism support behavior was not significant, and the direct effect of perceived cost, distributive justice, and procedural justice on tourism support behavior was significant. Therefore, positive affect plays a fully mediating role between perceived benefit and tourism support behavior and a partially mediating role between perceived cost, distributive justice, procedural fairness, and tourism support.

In this study, the moderating effect of active health on residents’ cognitive predictive behavior was examined by the stratified regression method through SPSS24.0 software, and the moderating effect was examined by the significance of the coefficients of the interaction terms between active health and residents’ cognition in each dimension.

(1)

Moderating effect of active health in perceived benefits and tourism support behavior

Moderation tests were conducted using stratified regression analysis with the inclusion of control variables such as demographic information in the first stratum and the independent variable perceived benefit and the moderator variable active health in the second stratum. The relationship between perceived benefit and tourism support behavior was significant, R2 = 0.508, and with the inclusion of an interaction term between the independent and moderator variables int_1 in the third stratum of the model, R2 = 0.509 and R2 = 0.001. This shows that the incremental contribution of the interaction term is very weak; from the coefficient results, the interaction term predicts the dependent variable beta = −0.002, and p = 0.566 shows that the model prediction fails. Active health is not a moderating variable for the perceived benefits to predict tourism support behavior; the results are shown in

Table 7. Results of the test on the moderating effect of active health between perceived benefits and tourism support behavior.

	Model 1	Model 2	Model 3
Gender	0.032	0.057	0.057
Age	0.089	0.072	0.072
Education	0.204 ***	0.075	0.074
Occupation	−0.029	−0.025	−0.025
Monthly income	0.084	0.040	0.044
Whether engaged in the tourism industry	−0.050	−0.079 *	−0.079 *
Number of health and wellness trips per year	0.070	0.018	0.018
Perceived benefits		0.262 ***	0.258 ***
Active health		0.523 ***	0.52 ***
int_1			−0.020
R2	0.059	0.508	0.509
Adjusted R2	0.046	0.499	0.499
F	4.426 ***	56.295 ***	50.629 ***

*** p < 0.001, * p < 0.05.

. The reason why active health is not a moderating variable in the relationship between perceived benefit and tourism support behavior may be that in the process of recreation and wellness tourism development, the residents’ perception of benefit does not change due to differences in individual active health levels. Combined with the interview exchanges during the questionnaire process, it was discovered that the majority of residents are in a marginal position in the process of development of health and wellness tourism, with a low awareness of participation and a low level of participation, and that the overall residents’ perceptions of benefit are roughly the same. Therefore, even though the residents’ active health levels are different, the perception of benefit is roughly the same, and the relationship between perceived benefit and supportive behaviors does not change significantly and therefore does not have a moderating effect.

(2)

Moderating role of active health in perceived costs and tourism support behavior

The moderation test was conducted using a hierarchical regression analysis, with the inclusion of control variables such as demographic information in the first level and the inclusion of the independent variable perceived cost and the moderating variable active health in the second level. The relationship between perceived cost and tourism support behavior was significant, R2 = 0.517, and with the inclusion of an interaction term int_2 for the independent and moderating variables in the third level of the model, R2 = 0.541 and R2 = 0.024. This shows that the incremental contribution of the interaction term exists, and from the coefficient results, the interaction term predicts the dependent variable beta = 0.157, and p = 0.000 shows that the model prediction is successful and active health is the moderating variable of perceived costs in predicting tourism support behavior; the results are shown in

Table 8. Results of the test on the moderating effect of active health between perceived costs and tourism support behavior.

	Model 1	Model 2	Model 3
Gender	0.032	0.054	0.056
Age	0.089	0.052	0.050
Education	0.204 ***	0.081	0.077
Occupation	−0.029	−0.030	−0.027
Monthly income	0.084	0.012	0.038
Whether engaged in the tourism industry	−0.050	−0.042	−0.026
Number of health and wellness trips per year	0.070	0.028	0.026
Perceived costs		−0.277 ***	−0.28 ***
Active health		0.528 ***	0.498 ***
int_2			0.157 ***
R2	0.059	0.517	0.541
Adjusted R2	0.046	0.509	0.531
F	4.426 ***	58.372 ***	57.537 ***

*** p < 0.001.

.

As seen in Table 8, the interaction term int_2 regression coefficients are significantly positive, and perceived costs and tourism support behavior are significantly negative, indicating that the moderating variable (active health) attenuates the negative impacts of perceived costs on tourism support behavior. Active health has a significant inhibitory effect on the relationship between perceived costs and tourism support behavior. That is, the higher the level of residents’ active health, the smaller the negative effect of residents’ perceived costs on tourism support behavior. Hypothesis H7 is valid. The higher the level of active health of residents, the more they are exposed to recreational knowledge, and the higher their familiarity with health and wellness tourism, the lower their perception of risk and uncertainty, and thus the more inclusive they are of health and wellness tourism, which reduces the level of perceived costs of residents through active health impacts and ultimately promotes the formation of tourism support behaviors for recreation and wellness tourism.

(3)

Moderating role of active health in distributive justice and tourism support behavior

The moderation test was conducted using stratified regression analysis. With the addition of control variables such as demographic information in the first stratum and the inclusion of the independent variable distributive justice and the moderating variable active health in the second stratum, the relationship between distributive justice and tourism support behavior was significant, with R2 = 0.522, and, with the addition of an interaction term of the independent and moderating variables int_3 in the third stratum of the model, with R2 = 0.531 and R2 = 0.009. This shows that the incremental contribution of the interaction term exists, and from the coefficient results, the interaction term predicts the dependent variable beta = −0.101, p = 0.003, showing that the model prediction is successful, and active health is the moderator variable of distributive justice predicting tourism support behavior. The results are shown in

Table 9. Results of the test on the moderating effect of active health between distributive justice and tourism support behavior.

	Model 1	Model 2	Model 3
Gender	0.032	0.050	0.045
Age	0.089	0.087 *	0.083 *
Education	0.204 ***	0.093 *	0.095 *
Occupation	−0.029	−0.040	−0.035
Monthly income	0.084	0.066	0.073 *
Whether engaged in the tourism industry	−0.050	−0.044	−0.046
Number of health and wellness trips per year	0.070	−0.031	−0.021
Distributive justice		0.292 ***	0.297 ***
Active health		0.511 ***	0.472 ***
int_3			−0.101 **
R2	0.059	0.522	0.531
Adjusted R2	0.046	0.513	0.521
F	4.426 ***	59.514 ***	55.381 ***

*** p < 0.001, ** p < 0.01, * p < 0.05.

.

As seen in Table 9, the interaction term int_3 regression coefficient is significantly negative, indicating that the moderator variable (active health) weakens the positive influence of distributive justice on tourism support behavior. Active health has a significant inhibitory effect on the relationship between distributive justice and tourism support behavior. That is, the stronger the concept of residents’ active health, the weaker the positive contribution of residents’ distributive justice to tourism support behavior. However, active health has a significant positive influence on tourism support behavior. In the process of enhancing tourism support behavior, there is a substitution relationship between active health and distributive justice.

(4)

Moderating role of active health in procedural justice and tourism support behavior

The moderation test was conducted using stratified regression analysis with the inclusion of control variables such as demographic information in the first stratum and the independent variable procedural justice and the moderator variable active health in the second stratum. The relationship between procedural justice and tourism support behavior was significant, R2 = 0.536, and with the inclusion of the interaction term int_4 of the independent and moderator variables in the third stratum of the model, R2 = 0.544 and R2 = 0.008. This shows that the incremental contribution of the interaction term exists, and based on the coefficient results, the interaction term predicts the dependent variable beta = −0.095, p = 0.004, showing that the model prediction is successful, and active health is the moderator variable of procedural justice in predicting tourism support behavior. The results are shown in

Table 10. Results of the test on the moderating effect of active health between procedural justice and tourism support behavior.

	Model 1	Model 2	Model 3
Gender	0.032	0.069 *	0.068 *
Age	0.089	0.072 *	0.073
Education	0.204 ***	0.091 *	0.090 *
Occupation	−0.029	−0.037	−0.036
Monthly income	0.084	−0.013	0.008
Whether engaged in the tourism industry	−0.050	−0.078 *	−0.071 *
Number of health and wellness trips per year	0.070	0.007	0.007
Procedural justice		0.363 ***	0.372 ***
Active health		0.431 ***	0.396 ***
int_4			−0.095 **
R2	0.059	0.536	0.544
Adjusted R2	0.046	0.528	0.535
F	4.426 ***	62.908 ***	58.318 ***

*** p < 0.001, ** p < 0.01, * p < 0.05.

.

As seen in Table 10, the interaction term int_4 regression coefficient is significantly negative, indicating that the moderator variable (active health) weakens the positive influence of procedural justice on tourism support behavior. Active health has a significant inhibitory effect in the relationship between procedural justice and tourism support behavior. That is, the stronger the level of residents’ active health, the weaker the positive contribution of residents’ procedural justice to tourism support behavior. However, active health has a significant positive effect on tourism support behavior, and in the process of enhancing tourism support behavior, there is a relationship between active health and procedural justice, i.e., a substitution relationship. Hypothesis H7 is valid.

According to the findings of (3) and (4), active health was found to have an alternative moderating role in the relationship between distributive and procedural justice and tourism support behavior. Driven by active health, residents actively maintain health and wellness tourism and participate in health and wellness activities. This allows them to directly or indirectly engage in wellness tourism activities, enriching their perception of the development of health and wellness tourism. As a result, residents generate a sense of pride and satisfaction, which contributes to the enhancement of their tourism support behaviors. These behaviors are particularly stronger with respect to external stimuli such as perceived justice. Therefore, when residents have a high level of active health, active health replaces the positive impact of perceived justice on tourism support behaviors. In this case, the positive impact of perceived justice on tourism support behaviors is weakened, indicating a substitution effect between the two variables. However, when the level of residents’ active health is low and their participation in health and wellness tourism is weak compared to those with high active health, residents are more passive in accepting external stimuli and generating tourism support behaviors.

5. Discussion

The study examined the differential impact of demographic factors (whether engaged in tourism industry and number of health and wellness tourism per year) on the variables. The study revealed that whether one was engaged in tourism industry only made a significant difference in the perceived benefits of health and wellness tourism, while the number of health and wellness trips per year made a significant difference in several dimensions. It is worth noting that the group that participates in health and wellness tourism 1–2 times per year reaches the optimal level in terms of positive affect, perceived justice, and perceived benefit, which reflects that the “marginal benefit” of health and wellness tourism increases and then decreases in accordance with the frequency of tourism. In the process of tourism development, we should focus on raising the psychological expectation of potential participants regarding perceived benefits through publicity and focus on the perception of negative impacts for high-frequency groups.

According to the results of hypothesis testing, the mechanism of influencing residents’ tourism support behavior in health and wellness tourism places is further analyzed. Perceived benefit positively affects residents’ tourism support behavior, and perceived cost negatively affects residents’ tourism support behavior. In the development of health and wellness tourism, residents are keenly aware of its impacts. These include the positive impacts of economic benefits and employment opportunities, as well as the positive impacts of infrastructure and ecological improvements. These positive impacts echo the sustainable development goals (SDGs) of decent work and stable incomes, economic growth, infrastructure upgrading, and the achievement of sustainable communities. However, there are also negative impacts, such as price increases and the influx of health and wellness tourists. These lead to conflicts over resources and human interactions, reflecting the potential conflict between sustainable consumption and production and the reduction of inequalities in the SDGs. Therefore, there is a need to control development efforts and pay attention to the attitudes of the population towards tourism development during the process. Future support attitudes and behaviors are judged based on perceived tourism impacts. Residents’ perceived justice has a significant positive impact on tourism support behavior, which is reflected in the fact that distributive justice and procedural justice have a significant positive impact on tourism support behavior. The higher the residents’ perceived justice in tourism development in health and wellness tourism destinations, the more they will believe that the government, enterprises, and communities value their contributions to tourism development and give them appropriate rewards and compensation, thus generating stronger tourism support behaviors.

The study shows that positive affect has a mediating role between residents’ cognitive dimensions and tourism support behavior, and the more residents are subjected to positive feedback during the development of health and wellness tourism, the richer their positive affect is and the more willing they are to support the development of local health and wellness tourism. Therefore, the development process of health and wellness tourism should focus on enhancing residents’ positive affect, promoting residents’ benefits and perceived justice, and enhancing residents’ positive affect towards health and wellness tourism. Although the relationship between negative affect and tourism support behavior in this study is not significant and therefore does not have a mediating role, the data show that the significance p (p = 0.068) value is greater than 0.05 but is also close to the 0.05 significance level, which also reflects a potential problem that the accumulation of negative affect in the long run, when it is more than the level of tolerance of the residents, affects residents’ tourism support behavior. Therefore, in the development process of health and wellness tourism, it is necessary to understand the changes in the demands and affects of residents in the development process and adjust the development strategy at the right time.

The study revealed that active health consciousness serves a crucial moderating role in the relationship between community perceptions and tourism endorsement behaviors. Specifically, it mitigates the adverse impact of cost-related perceptions on support behaviors while functionally substituting the beneficial influence of equity perceptions. Driven by active health, residents actively maintain their health and wellness tourism and participate in health and wellness activities, thus directly or indirectly participating in health and wellness tourism activities, enriching residents’ perceptions of the development of health and wellness tourism, generating a sense of pride and satisfaction, and contributing to the enhancement of residents’ tourism support behaviors, which are weaker with respect to external stimuli such as perceived justice. Therefore, in the case of high levels of residents’ active health, active health replaces the positive impacts of residents’ perceived justice on tourism support behaviors, the positive impacts of residents’ perceived justice on tourism support behaviors are weakened, and there is a substitution effect between the two variables. However, when the level of residents’ active health is low, the degree of participation in health and wellness tourism is weak in comparison to residents with high active health, and residents are more passive in accepting external stimuli and generating tourism support behavior. This indicates that the sustainable development of health and wellness tourism sites is closely related to residents’ perceptions and tourism support behaviors and that it can be used as a substitute for the positive effect of perceived justice on tourism support behaviors. Consequently, the development process of wellness tourism should focus on the construction of the health atmosphere of wellness tourism destinations and implement community health empowerment programs to enhance proactive wellness management, which is conducive to the promotion of residents’ own health and well-being in conjunction with sustainable development goals. It is also important to establish communication channels for tourism benefits to optimize perceived value distribution, thereby creating an integrated sustainability model balancing environmental, social, and economic dimensions.

6. Conclusions and Insights

Taking the BDH Life and Wellness Industry Innovation Demonstration Zone as a case study site, this paper applies the method of structural equation modeling to validate the relationship between perceived tourism impacts, perceived justice, affect, tourism support behavior, and active health among residents of health and wellness tourism destinations, and based on the problems reflected in the data, it puts forward countermeasure suggestions in a targeted manner.

(1)

Tourism support behavior of residents in health and wellness tourism sites is affected by cognition and emotion

The cognitive and affective dimensions of residents in health and wellness tourism have a significant effect on local residents’ tourism support behavior. Among them, perceived benefits, perceived costs, distributive justice, procedural justice in the cognitive dimension, and positive affect in the affective dimension have significant positive or negative impacts on tourism support behaviors, but the impact relationship between negative affects and tourism support behaviors is not in line with the expected hypothesis, which may be related to the early stage of development of health and wellness tourism, the low degree of residents, and the weak awareness of participation.

(2)

Affect mediates the relationship between residents’ cognitive dimensions of health and wellness tourism development and tourism support behavior

Positive affect is an important mediating variable in the relationship between residents’ health and wellness tourism cognition (perceived benefits, perceived costs, distributive justice, and procedural justice) and tourism support behavior impacts. Since the influence of negative affect on tourism support behavior is not significant and the mediation path is not available, negative affect does not mediate between the dimensions of residents’ health and wellness tourism perceptions and tourism support behavior.

(3)

Active health has a moderating role between residents’ cognitive dimensions and tourism support behavior

The results of the study show that the higher the residents’ active health, the weaker the negative perceived tourism impacts of perceived costs on tourism support behavior, which has a moderating effect. Active health has an alternative role between distributive justice and tourism support behavior and procedural justice and tourism support behavior. That is, the higher the degree of active health, the weaker the positive effect of distributive justice and procedural justice on tourism support behavior, but active health has a significant positive effect on tourism support behavior, and collectively there is a substitution relationship between active health and distributive justice and procedural justice in the process of enhancing tourism support behavior. It was found that active health did not play a moderating role between perceived benefits and active health. Therefore, it can be concluded that in the current development stage of the BDH Life and Wellness Industry Innovation Demonstration Zone, residents’ active health affects the relationship between residents’ perceptions and tourism support behaviors, and the influential role of residents’ active health should be focused on in the future development of health and wellness tourism.

Based on the above conclusions, this paper provides the following management insights for the government, tourism enterprises, and communities in health and wellness tourism places:

For the government, firstly, it should ensure the fair distribution of tourism revenues and safeguard the interests of community residents through the establishment of an ecological compensation mechanism and tax incentives to achieve distributive justice. Secondly, in the process of tourism development, the government should improve the decision-making process, increase transparency, and ensure that community residents have the right to know and the right to participate in order to enhance procedural justice. Thirdly, the government should increase the input of health resources in health and wellness tourism sites, such as building health trails and fitness facilities, to promote residents’ active health. Finally, government policies should be integrated with sustainable development goals, such as achieving sustainable development of tourism by promoting health and well-being, decent work, and economic growth.

For tourism enterprises, firstly, enterprises should reasonably distribute tourism revenues, improve the remuneration system of tourism communities, guarantee fair benefit sharing, and ensure that employees and community residents can share the fruits of tourism development. Secondly, enterprises can invest in or participate in health projects in wellness tourism destinations, such as conducting health lectures and setting up health experience zones, to raise the active health awareness of local residents and promote their tourism support behaviors. Thirdly, enterprises should actively participate in community building, pay attention to environmental protection, and achieve a balance between economic benefits and social responsibility.

For communities in health and wellness tourism locations, firstly, they should enhance residents’ sense of participation, establish shared governance committees, promote community empowerment, guarantee the transparency and openness of information, safeguard residents’ rights and interests, and allow residents to participate in tourism decision-making to safeguard their own rights and interests. Secondly, communities can raise residents’ awareness of active health and promote the construction of a healthy atmosphere through health education and publicity activities. Thirdly, communities should establish a feedback mechanism to collect residents’ opinions and suggestions on tourism development, adjust management measures in a timely manner, and ensure that tourism development aligns with residents’ needs. Lastly, communities should pay attention to environmental protection and resource conservation and establish a good partnership with the government and enterprises to jointly promote the sustainable development of health and wellness tourism sites.

“Tourism can effectively mobilise the SDGs to promote the sustainable development of tourism” [61]. Through the above recommendations, stakeholders can work together to promote health and wellness tourism, drive economic growth in the destination, strengthen destination infrastructure, enhance residents’ quality of life and tourism support behaviors, and provide destination residents with more opportunities to improve their future, thus promoting sustainable development.

7. Limitations

Although this study uses a large amount of literature and theory as support for the research design, there are some limitations in the current study, which can be improved and enhanced accordingly in the future. They mainly include the following two aspects:

(1) The sampling range of case sites is not wide enough. During the research process, the author visited the BDH Life and Health Industry Innovation Demonstration Zone three times for research and questionnaire distribution and recovery. Although the final volume of recovered samples can meet the requirements of empirical analyses, all samples are mainly concentrated in the core attraction area. Therefore, follow-up studies can consider the differential analysis of the attitudes of different regional tourism perceptions towards supporting tourism development. (2) Indicators need to be further explored. The indicators in this study are the indicators of the deeper research base of the current academic community, which are closely related to the residents’ perception, and the indicators have universality; future research can choose to root theories or introduce relevant variables from other disciplines for analysis according to the characteristics of health and wellness tourism, so as to enrich the research targeting the indicators of the residents’ perceptions of health and wellness tourism.