Multi-Criteria Decision-Making for Assessing and Evaluating Health and Wellness Tourism Destination Potential Using the 6AsTD Framework: A Case Study of Nakhon Ratchasima Province, Thailand

Abstract

Health and wellness tourism is a rapidly expanding segment of the global tourism industry, driven by increasing consumer awareness of well-being and lifestyle enhancement. As the demand for wellness travel grows, destinations are expected to offer high standards of safety, hygiene, rehabilitation, and holistic experiences. This study aims to identify and evaluate the key attributes and determinants for developing health and wellness tourism destinations by applying the 6As Tourism Development framework: Attractions, Accessibility, Amenities, Activities, Available Packages, and Ancillary Services. A multi-criteria decision-making approach, specifically the TOPSIS, was employed to assess destination potential through a case study of Nakhon Ratchasima Province, Thailand. The results indicate that Attractions, Accessibility, and Amenities are the top three priorities for wellness tourists. Sub-criteria such as natural scenery, cultural significance, accessibility for all, safety, and accommodation quality are particularly influential. Three districts in Nakhon Ratchasima were found to exhibit distinct strengths—Pak Chong is best suited for rehabilitative tourism (e.g., aroma and water therapy), aligning with mind and nutrition wellness components; Wang Nam Khiao is ideal for ecotourism and cultural experiences, supporting environmental and nutritional dimensions; while Mueang Nakhon Ratchasima excels in sports tourism, supporting physical and nutritional well-being. The study offers practical insights for policymakers and tourism stakeholders to design sustainable, visitor-centered wellness destinations. The proposed framework supports strategic planning and resource allocation for health-focused tourism development.

1. Introduction

The diversification of global tourism in recent decades has given rise to specialized forms of travel, among which health and wellness tourism (HWT) has gained increasing prominence. This form of tourism promotes physical, mental, and spiritual well-being through various types of travel experiences and the combination of traditional travel experiences with health-oriented activities [1]. According to the Global Wellness Economy Monitor [2], the wellness economy reached an unprecedented $6.3 trillion in 2023, with projections estimating growth to nearly $9.0 trillion by 2028. HWT not only benefits the tourism industry but also stimulates various other industries, such as transportation, food, accommodation, entertainment, etc. [3]. It could be seen that wellness tourism is a large umbrella that potentially includes various business sectors, including culture and food exploration, nature expenditure, fitness activities, spas, yoga, and meditation. For example, the food industry could become healthy food services, and sightseeing activities in natural scenery could become sport trips [4].

HWT encompasses a wide range of activities, not only spa and yoga sessions but also unique cultural traditions, historical sites, traditional and healthy foods, and natural resources such as hot springs and mountains [5]. The form of health and wellness treatment promoted for tourists in each country tends to be different, depending on the destination, local resources, or social circumstances of the destination. For example, natural health practices, including homeopathy, are most prevalent in the United States, Europe, the Middle East, Australia, New Zealand, and various South Pacific nations. According to the Global Wellness Institute [6], in Southeast Asian countries, the focus is on healing that ties spirituality and alternative therapies by promoting activities that improve well-being through the surrounding environment. In addition, it is worth noting that Western travelers are increasingly drawn to Eastern philosophies and therapies available in various Asian countries, including shiatsu and onsen (hot springs) in Japan acupuncture, reflexology, tui na, and tai chi in China, Ayurvedic practices in India, and traditional Thai massage in Thailand [7]. In addition to the availability of diverse philosophies and therapies, the affordability of health and wellness treatments in Asian countries is a significant factor motivating Western tourists to visit the region. Consequently, Asia has emerged as a global leader in HWT, leading to intense competition among Asian countries.

Hekmat et al. [8] demonstrated that an increasing number of consumers perceive HWT tourism as a holistic experience. This perspective emphasizes not only the significance of products directly associated with health and wellness treatments but also the importance of leisure activities, safety and hygiene, accessibility, recreation, and cultural experiences. For these reasons, to stay competitive and attract tourists, understanding the core attributes and determinants of health and wellness destinations from the tourists’ perspective is crucial for developing sustainable and successful HWT destinations [9,10]. The competitiveness of a wellness tourism destination means the readiness of an area to facilitate the development, improvement, or changes, and the appeal of that area to attract wellness tourists [11].

In this context, there is a need to identify the attributes and determinants that are most important for tourists when selecting destinations. Based on this premise, many researchers, policymakers, and practitioners consider the significance of destination competitiveness and its attributes’ effects in planning and developing a tourism destination [12].

Hence, this study aims to develop a framework for assessing and evaluating health and wellness tourism destinations. This study leverages the 6As tourism destination development framework (6AsDT) from Buhalis [13] and Buhalis and Amaranggana [14]—comprising Attractions, Accessibility, Amenities, Activities, Available Packages, and Ancillary Services—to examine the key attributes and determinants that shape service quality and visitor satisfaction.

Based on an identified set of attributes and determinants of HWT destinations, the study proposed a framework for assessing and evaluating the HWT destinations based on identified attributes and determinants using a Multi-Criteria Decision-Making (MCDM) approach, specifically the TOPSIS. A case study of Nakhon Ratchasima, Thailand, is conducted to verify and validate the attributes and determinants, offering empirical insights into health and wellness destination development and assessment.

This paper is structured into five main sections. Section 1 presents the study’s background and introduction. Section 2 reviews existing literature on health and wellness tourism, along with methodologies for assessing and identifying the potential of tourism destinations. Section 3 outlines the methodology employed in this study. First, a literature review and expert interviews helped identify attributes and determinants within the 6AsTD. Second, a mean-based thresholding technique was used to filter unnecessary attributes and determinants. Third, a weighting method prioritized these sub-criteria. Finally, the TOPSIS method was applied to rank tourism activities across districts. Section 4 explores the implications of the study’s findings. Section 5 summarizes the study’s conclusions, encapsulating the core insights and implications of the research.

2. Literature Review

2.1. Health and Wellness Tourism (HWT)

Health and Wellness Tourism (HWT) encompasses travel experiences focused on improving or maintaining physical, mental, and spiritual well-being through a range of holistic activities. It frequently intersects with other forms of niche tourism, such as cultural, culinary, and eco-tourism, offering a comprehensive approach to well-being. This industry drives economic growth by creating jobs, supporting local products, and empowering women. It also connects to health practices, helping to revive traditional wellness methods and improve mental health. In addition, HWT helps protect natural and cultural heritage, supports the environment, and promotes sustainable tourism [3].

In general, HWT is classified into two main types: Health Promotion Tourism, which emphasizes preventive health practices in natural and cultural environments, and Health Healing Tourism, which is centered on medical treatments and rehabilitation efforts. According to Liao et al. [15], the health benefits of wellness tourism can be classified into four main areas: physical fitness, mental well-being, quality of life, and environmental health.

Existing research divides HWT into two main fields: medical and well-being tourism. The medical aspect focuses on illness, surgery, and therapeutic treatments within biological research, while the well-being aspect takes a broader approach, emphasizing the balance of mind, body, spirit, environment, and overall quality of life [16].

Majeed and Gon Kim [17] further categorize HWT based on the health conditions of the tourists into two groups: those with non-critical disease conditions and those with critical health conditions. Tourists with non-critical health conditions often seek conventional medical treatments or alternative therapies like yoga, meditation, massage, and wellness check-ups in health resorts, temples, or natural environments.

Conversely, wellness tourists with serious health conditions, such as those receiving cancer treatment, can benefit from a blend of conventional medical care and complementary health therapies. These travelers often engage in therapeutic activities, including spending time in natural settings or participating in gentle exercises like walking or breathing techniques. Hartwell et al. [16] highlighted three essential areas of wellness tourism research: destinations focused on health and well-being, the influence of tourism on the health of local communities, and its impact on the well-being of tourists. More recently, Kongtaveesawas et al. [18] highlighted that HWT experiences involve physical activities aimed at enhancing both physical and mental health. Their study also emphasized environmental concerns, which align with the widely accepted PMSE wellness tourism experience framework, covering physical, mental, spiritual, and environmental aspects.

Nonetheless, the perceived values and expectations from the destinations of customers are varied and different experience concepts in terms of cultural diversification. Hence, understanding the general attributes and determinants of health and wellness destinations is crucial for developing sustainable and successful destinations.

2.2. Health and Wellness Tourism (HWT) in Thailand

The tourism industry is a crucial driver of Thailand’s economy, contributing significantly to both domestic and international markets. In recent years, Thailand has experienced steady growth in its tourism sector, marked by a consistent rise in international tourist arrivals and an increase in average spending per trip, with an annual growth rate of approximately 2%. Thailand remains a popular destination for tourists from developed countries due to its relatively low costs [19]. In 2018 alone, the country generated nearly USD 3.5 billion in tourism revenue. Wellness services contribute around 3% of Thailand’s GDP, with 90% of this figure derived from the beauty, anti-aging, and preventive medicine sectors, while the remaining 10% comes from spa treatment businesses [20]. To stay competitive in the global tourism market, Thailand has increasingly focused on developing high-value products and services, particularly in the HWT sector. This niche market has gained momentum as global awareness of health and well-being continues to grow. The demand for holistic health practices, such as yoga, meditation, and traditional healing methods, has risen significantly, further highlighting the potential of HWT. According to the Global Wellness Economy Monitor [21], Thailand ranks fourth in the Asia-Pacific region for its wellness tourism market size. Csirmaz and Pető [22] noted that many countries in the region have rich resources and traditions that can be incorporated into health and wellness tourism. Examples include the Japanese and Korean bath cultures, Indonesian body treatments, Thai massage techniques, and the Southeast Asian cosmetic industry. Acknowledging this potential, HWT has become a key focus of Thailand’s national development strategies, including the 20-year National Strategic Plan (2018–2037) and the Bio-Circular-Green (BCG) economic model. These strategies highlight the significance of HWT in increasing national revenue and enhancing service quality to align with international standards.

In Thailand, HWT is a thriving alternative tourism sector, integrating the country’s natural resources, cultural heritage, and health traditions to promote overall well-being. Popular HWT programs include Traditional Thai Medicine Tours, which showcase traditional Thai massage techniques at landmarks like Wat Pho, and Herbal Cuisine Tours, where tourists explore herbal wisdom through culinary experiences and participate in yoga and meditation. Additionally, Rural Herbal Medicine Tours allow travelers to learn from local herbalists, while Natural Agriculture Tours offer insights into sustainable farming practices, such as growing chemical-free vegetables, based on the King Rama IX sufficiency economy philosophy. According to Kongtaveesawas et al. [18], the characteristics of HWT in Thailand consist of four main key characteristics, namely, Physical Attributes: Activities like spa treatments and detox programs that enhance physical health; Mental Attributes: Experiences that promote mental well-being, such as mindfulness and relaxation techniques; Spiritual Attributes: Opportunities for spiritual growth, including meditation and cultural practices; Environmental Attributes: The importance of the destination’s atmosphere, including hygiene and local culture. Other wellness experiences in Thailand include Hot Spring and Mineral Bath Tours, which offer relaxation at natural hot spring resorts, and Meditation and Spiritual Retreats, which provide guided meditation sessions in serene monasteries. For those seeking to connect with nature, Nature and Biodiversity Tours invite travelers to national parks and forests, where activities like hiking and herbal foraging are combined with wellness services [23]. These diverse offerings emphasize Thailand’s commitment to integrating natural, cultural, and health-focused elements, promoting holistic well-being for travelers. The growing appeal of HWT brings significant economic, social, and environmental benefits to destinations, attracting a broad range of travelers and contributing to sustainable tourism development.

2.3. Tourism Destination Development: The 6AsTD Framework and Multi-Criteria Decision-Making (MCDM)

2.3.1. The 6AsTD Framework in Tourism Destination Development

The 6AsTD framework is a widely used model for evaluating tourism destinations, focusing on six critical components: Attractions, Accessibility, Amenities, Available Packages, Activities, and Ancillary Services [13,14]. Each component consists of several sub-criteria that contribute to a destination’s success, offering a holistic perspective from the tourist’s viewpoint. Numerous studies have adopted the 6AsTD framework to guide strategic planning and resource allocation.

Based on the review literature on the 6AsTD framework, the criteria and sub-criteria of the six key components of the 6AsTD framework are defined as follows: Attractions (A1): This component focuses on features that draw visitors to the destination, such as natural landscapes (A11), artificial tourism sites (A12), cultural attractions (A13), and special events (A14). Accessibility (A2): This evaluates how easy it is for tourists to access the destination, considering transportation routes (A21), terminals (A22), and both internal (A23) and external (A24) public transportation options. Amenities (A3): Amenities include necessary facilities such as lodging (A31), restaurants (A32), public utilities (A33), and shopping centers (A34), ensuring tourist comfort. Available Packages (A4): The availability and variety of tour packages, such as guided tours (A41), organized packages (A42), and special interest tours (A43), contribute to the destination’s appeal. Activities (A5): This component assesses the range of activities, from sightseeing to adventure sports and cultural experiences, that engage tourists during their visit. Ancillary Services (A6): Supporting services such as communication channels (A61), internet access (A62), financial services (A63), medical services (A64), and postal services (A65) are crucial for enhancing the tourist experience [24,25,26,27,28,29,30].

2.3.2. Multi-Criteria Decision-Making (MCDM) in Tourism Studies

Decision-making in tourism often involves evaluating multiple, sometimes conflicting, criteria. MCDM techniques provide systematic and robust tools for comparing alternatives based on various qualitative and quantitative factors. Several studies have applied the 6AsTD framework in conjunction with MCDM techniques. For example, Arif et al. [24] combined the 6AsTD framework with the TOPSIS method to prioritize tourism destinations based on the destination’s attributes, providing a comprehensive analysis of tourism potential. In another study, Arif et al. [25] integrated the 6AsTD framework with blockchain technology to rate tourism destinations using data collected from tourists, enabling more accurate and decentralized destination evaluations. Arif et al. [26] applied the 6AsTD framework to develop a Multi-Criteria Recommender System (MCRS), which utilizes rating values between users to provide recommendations for selecting tourist destinations. Similarly, Agustan et al. [27] employed the 6AsTD framework with TOPSIS to assess local governments’ priorities for destination development in Wakatobi, Indonesia. The analysis highlighted the significance of each 6AsTD component in determining tourism potential. Each variable within these components was evaluated, revealing important insights into the strengths and weaknesses of the destination. Other studies have applied the pure 6As framework to different tourism contexts. Govekar et al. [28] used the framework to develop a model for smart beach management, emphasizing sustainable and innovative strategies. Additionally, Agustina Riski and Wulandari [29] applied the 6As framework to assess the educational tourism potential of Desa Coklat Bali, demonstrating its versatility across different types of destinations. Lopes and Rodríguez-López [30] conducted a study to rank wellness tourism destinations in Northern Portugal using MCDM methods, specifically the PROMETHEE and GAIA approaches. These tools assist tourism experts and planners in identifying optimal destinations. Unlike the 6AsTD framework, the study utilizes the Travel and Tourism Development Index (TTDI), which comprises five subindexes: enabling environment, tourism policy and conditions, infrastructure, tourism demand drivers, and sustainability.

Among the various MCDM methods, TOPSIS has emerged as one of the most popular approaches. TOPSIS ranks alternatives based on their distance to an ideal (best) and anti-ideal (worst) solution, making it highly suitable for tourism destination evaluation where both strengths and weaknesses must be considered simultaneously [24,27]. The selection of TOPSIS in this study is based on several reasons: It provides clear and interpretable rankings of alternatives as well as can handle multiple criteria effectively, and is computationally efficient. Moreover, TOPSIS supports quantitative integration of expert judgments, making it ideal for studies like this one that rely on stakeholders and expert inputs. Other MCDM methods, such as AHP, PROMETHEE, and GAIA, have their own merits, but they often involve more complex pairwise comparisons or assumptions not as well suited to the structure of this study. Hence, TOPSIS is selected for its simplicity, compatibility with 6AsTD, and demonstrated effectiveness in tourism-related decision-making contexts. It has been widely validated in tourism research, including applications involving the 6AsTD framework [24,27].

The 6AsTD framework has proven to be an effective tool for evaluating and developing tourism destinations, particularly when integrated with MCDM methods specifically. In the context of HWT, this study aims to identify the critical attributes and determinants within the 6AsTD essential for developing and accessing HWT destinations. Experts’ insights into the tourism industry, related stakeholders, tourists, etc., gathered through a survey questionnaire, will be utilized to evaluate the sub-criteria within each primary variable of the 6AsTD framework.

3. Methodology

3.1. Study Design and Method

This study adopts an exploratory, mixed-methods design aimed at identifying, assessing, and prioritizing key attributes and determinants of HWT destinations. A case study in Nakhon Ratchasima Province is used to test the framework. The research does not involve hypothesis testing but is grounded in a systematic framework to support decision-making in HWT development.

The methodological approach integrates both qualitative and quantitative components to ensure a comprehensive evaluation. Qualitative data were obtained through expert interviews, focus group discussions, and a literature review to identify relevant criteria based on the 6AsTD framework. Quantitative data were collected through structured surveys using a Likert scale, enabling the prioritization of criteria and the evaluation of site suitability through a Multi-Criteria Decision-Making (MCDM) process. The methodology consists of four key stages as shown in Figure 1.

• Literature Review and Expert Interviews/Assessment: A comprehensive literature review and expert interviews are conducted to identify and analyze the attributes and determinants of the Tourism Destination Framework (6AsTD), providing a basis for assessing and evaluating the potential of HWT in a given region.
• Mean-based thresholding: A mean-based threshold is used to estimate the unnecessary attributes and determinants of 6AsTD based on the expert judgment of the Linkert scale of 1–5 (not necessary to most necessary).
• Weighting method for attributes and determinants of 6AsTD: A weighting method is applied to prioritize the sub-criteria within the 6AsTD framework. This process involves expert judgment, statistical techniques, or a combination of both to ensure an objective and reliable prioritization of factors influencing wellness tourism development.
• Multi-Criteria Decision-Making (MCDM): TOPSIS is used as an MCDM approach to evaluate assessing and evaluating the suitability of HWT activities in each location. This method ranks tourism activities based on their proximity to an ideal solution, ensuring a data-driven decision-making process.

3.2. Study Area

Nakhon Ratchasima, Thailand’s largest province by area and population, spans 20,493 square kilometers and houses over 2.6 million residents. Its geographical diversity, including mountainous landscapes, cultural sites, and urban centers, positions it as a strong contender for HWT development. The province already supports traditional Thai medicine, herbal food tourism, natural agriculture, hot springs, and eco-tourism, providing a strong foundation for an integrated HWT supply chain.

The study focuses on three key districts—Mueang Nakhon Ratchasima, Wang Nam Khiao, and Pak Chong—selected for their diverse HWT offerings (Figure 2). These districts represent a cross-section of the province’s tourism landscape, ensuring a comprehensive assessment of the sector’s potential. Each district has been chosen for its unique characteristics. These include a combination of modern urban amenities, cultural and traditional wellness practices, ecological attractions, sustainable agriculture, organic health products, and a variety of wellness-focused facilities such as resorts, hot springs, and spas. Across the districts in the province, eight HWT activities were selected and analyzed in this study, namely, Ecotourism, Cultural Tourism, Food Tourism, Culinary Tourism, Sport City, Cycling Tourism, Aroma Therapy, and Water Therapy. The selection is based on multiple factors, including tourist preferences from the survey, the region’s unique characteristics, theoretical frameworks on health and wellness tourism, and the provincial policy for tourism development.

3.3. Data Collected

3.3.1. Type of Data Collected

The data collection process in this study was structured to systematically assess and evaluate the potential and sustainability of HWT in Nakhon Ratchasima Province.

Primary data were collected through participatory surveys and semi-structured interviews, targeting key stakeholders such as tourism service providers, local authorities, and tourists. The interviews, conducted with HWT experts, local government representatives, and community leaders, offered qualitative insights into the internal and external factors affecting the region’s tourism landscape, contributing to a deeper understanding of strategic priorities.

Secondary data were sourced through a literature review, which analyzed the sub-criteria of 6AsTD. This review, along with expert interviews and assessments, identified attributes and determinants relevant to the potential of health and wellness destinations. The literature also provided context for sustainability, wellness tourism trends, and supply chain management, ensuring a robust theoretical foundation.

3.3.2. Data Collection Procedures

The data collection process in this study was structured to systematically assess and evaluate the potential and sustainability of health and wellness tourism (HWT) in Nakhon Ratchasima Province through both qualitative and quantitative methods.

Phase 1: Criteria Identification, Elimination, and Weighting

Primary data in the initial phase was collected from two key groups using participatory surveys and structured group discussions: (1) 30 general health and wellness tourists and (2) 20 experts from tourism government agencies and academic institutions. These participants were selected using purposive sampling, based on their experience and familiarity with general tourism and HWT. Participants were first asked to identify sub-criteria under the 6As Tourism Destination (6AsTD) framework. They were guided by a list of attributes and determinants identified through a prior literature review and their own opinion. Redundant or overlapping sub-criteria were then consolidated. To refine this list, the same respondents rated the importance of each sub-criterion using a 5-point Likert scale. A simple mean threshold was applied to eliminate sub-criteria with scores below the overall mean. The resulting final set of sub-criteria was subsequently rated again using a 10-point Likert scale to determine their relative importance (weights). These weights served as inputs for the MCDM process in later stages.

Phase 2: District-Level Evaluation of Tourism Activities

In the second phase, data were collected through field-level surveys involving 50 participants in Nakhon Ratchasima province. This group included tourists, community members, HWT service providers, and local government officials. Participants were selected using a mix of purposive and randomized sampling to ensure relevant experience while avoiding sampling bias. Participants evaluated local HWT activities based on the finalized and weighted sub-criteria. Their ratings were used as input for the TOPSIS analysis, facilitating a comparative assessment of HWT development potential across the districts.

Table 1. Summary of participant demographics’ and sampling methods.

Participant Group	No. of Participants	Gender (M/F)	Age Range (Years)	Occupation/Role	Sampling Method
Group 1: Criteria Identification and Weighting
Health and Wellness Tourists	30	14/16	25–60	General tourists with an interest in health and wellness	Purposive
Experts (Government and Academia)	20	11/9	30–65	Tourism officials, researchers, consultants	Purposive
Group 2: District-Level Evaluation
Tourists	10	5/5	20–55	Domestic visitors	Random
Local Community Members	15	6/9	25–65	Shopkeepers, wellness providers	Random
HWT service providers	15	8/7	30–60	Spa owners, resort managers, retreat operators	Random
Local Officials	10	6/4	35–60	District tourism officers	Purposive

shows a summary of participants’ demographics and sampling methods.

3.4. Multi-Criteria Decision-Making (MCDM)

MCDM is a method dealing with making a decision based on multiple criteria. It is aimed at supporting structuring, analyzing, and recommending alternative solutions to assist decision-makers in several service sectors, including the tourism industry. This study employs an MCDM method, specifically TOPSIS, to evaluate the suitability of tourism destinations and their support for HWT activities. The details of the methodology are outlined below.

3.4.1. Criteria Identification

To effectively assess the potential and suitability of a destination for health and wellness tourism, it is crucial to break down the broad categories of the 6AsTD Framework into more specific sub-criteria tailored to this niche market. The 6AsTD framework, which includes Attractions, Accessibility, Amenities, Available Packages, Activities, and Ancillary Services, serves as a comprehensive tool for evaluating tourism destinations by Buhalis [13]. However, for a focused analysis of health and wellness tourism, it is essential to identify sub-criteria that reflect the specific needs and preferences of wellness travelers.

In this study, sub-criteria are identified based on insights from existing literature, tourism expert interviews, and a focus group of wellness tourists. These sub-criteria will ensure that each dimension of the 6AsTD framework is contextualized for the health and wellness sector. By identifying these sub-criteria, this research aims to provide a more comprehensive and sector-specific application of the 6AsTD framework. The result is a set of tailored indicators that will be used to evaluate the region’s potential and suitability for health and wellness activities for developing a competitive HWT offering.

3.4.2. Mean-Based Thresholding

Mean-based Thresholding, the average (mean) score or rating of each sub-criterion, $C_i$, is calculated based on an expert and focus group of wellness tourist evaluations $S_{ij}$. A predefined threshold, typically based on the average score $\overline{S_i}$ is used to determine the relevance of each sub-criterion. Sub-criteria $C_i$ that have a mean score $\overline{S_i}$ below the threshold $\left(T\right)$ are eliminated, as they are considered less significant. This approach helps in simplifying the decision-making process by focusing only on the most important factors. The result of this approach will be further used in the next section.

The process of Mean-based Thresholding can be outlined in a sequence of steps as follows:

(1)

Mean Score Calculation:

$$\overline{S_i}={\displaystyle \frac{1}{m}}\sum _{j=1}^m{S}_{ij} ; i=\mathrm{1,2},\dots ,n j=\mathrm{1,2},\dots ,m$$

(1)

(2)

Threshold Definition:

Let T represent the threshold value, which is typically based on the overall average of all mean scores across sub-criteria. This can be calculated as follows:

$$T={\displaystyle \frac{1}{n}} \sum _{i=1}^n\overline{S_i} ; i=\mathrm{1,2},\dots ,n$$

(2)

(3)

Elimination of Less Important Sub-criteria:

Sub-criteria with a mean score $\overline{S_i}$ below the threshold T are considered less significant and are eliminated from further analysis. Formally, a sub-criterion $C_i$ is eliminated if:

$$\overline{S_i}<T$$

(3)

Only sub-criteria $C_i$ that satisfy $\overline{S_i}>T$ will be retained for further analysis.

(4)

Final Decision-Making Model

The final set of weighted sub-criteria forms the input for the subsequent analysis. This ensures that only the most relevant sub-criteria (those with a mean score above the threshold) contribute to the decision-making process, simplifying the evaluation while focusing on key factors.

3.4.3. Criteria Scoring

Scoring function was applied to estimate each weight value of the sub-criteria. Experts were allowed to assess each value based on preference score $e$ from 0 (extremely unimportant) to 10 (extremely important). Afterwards, the corresponding weight for each criterion i = {1, 2, …, n}, w_i is given by the following:

$$w_i={\displaystyle \frac{1}{W}} \sum _{e=1}^{10}{\mu }_{i,e}$$

(4)

$$Where W=\sum _{i=1}^n\sum _{e=1}^{10}{\mu }_{i,e}$$

(5)

3.4.4. Technique for Order Preference by Similarity to the Ideal Solution (TOPSIS)

TOPSIS is a multi-criteria decision-making method designed to identify the optimal option from a set of alternatives. The fundamental concept is to choose the alternative that is closest to the ideal solution and furthest from the worst possible option. The TOPSIS methodology involves a series of steps, as detailed by Jahanshahloo et al. [31]:

(1)

Calculate the normalized decision matrix. The normalized value $n_{ij}$ is calculated as follows:

$$n_{ij}={\displaystyle \frac{x_{ij}}{\sqrt{\sum _{j=1}^m{x_{ij}}^2}}}; j=1,2,\dots ,m; i=1,2,\dots ,n$$

(6)

(2)

Calculate the weighted normalized decision matrix. The weighted normalized value $v_{ij}$ is calculated as follows:

$$v_{ij}=w_i\times n_{ij}; j=1,2,\dots ,m; i=1,2,\dots ,n$$

(7)

where $w_i$ is the weight of the ith attribute or creation and criterion, and $\sum _{i=1}^n{w}_i=1$

(3)

Determine the positive ideal and negative ideal solution.

$$A^{+}=\left\{v_1^{+}, v_1^{+},\dots \dots , v_n^{+} \right\}=\left\{\left({max}_j v_{ij}\left|i\in I\right.\right), \left({min}_j v_{ij}\left|i\in J\right.\right) \right\}$$

(8)

$$A^{-}=\left\{v_1^{-}, v_1^{-},\dots \dots , v_n^{-} \right\}=\left\{\left({min}_j v_{ij}\left|i\in I\right.\right), \left({max}_j v_{ij}\left|i\in J\right.\right) \right\}$$

(9)

where $I$ is associated with benefit criteria, and J is associated with cost criteria.

(4)

Calculate the separation measures using the n-dimensional Euclidean distance. The separation of each alternative from the ideal solution is calculated as follows:

$$d_j^{+}=\sqrt{\sum _{i=1}^n{\left(v_{ij}-v_{ij}^{+}\right)}^2} ; j=1,2,\dots \dots \dots \dots \dots m.$$

(10)

Similarly, the separation from the negative ideal solution is given as follows:

$$d_j^{-}=\sqrt{\sum _{i=1}^n{\left(v_{ij}-v_{ij}^{-}\right)}^2} ; j=1,2,\dots \dots \dots \dots \dots m.$$

(11)

(5)

Calculate the relative closeness to the ideal solution. The relative closeness of the alternative:

$$R_j={\displaystyle \frac{d_j^{-}}{d_j^{+}+d_j^{-}}} ; i=1,2,\dots \dots , m.$$

(12)

Since $d_j^{-}$ ≥ 0 and $d_j^{+}$ ≥ 0, then, clearly R ∈ [0, 1].

(6)

Rank the preference order

4. Results and Discussion

4.1. Analysis of 6AsTD Framework

4.1.1. Identified Criteria

This study employed the 6AsTD, proposed by Buhalis [13], as the foundation for evaluating the potential of locations for HWT. Each of the components represents a key dimension in determining the suitability of a destination for health- and wellness-oriented experiences. To identify specific sub-criteria under each component, a multi-method approach was applied, combining an extensive literature review, expert interviews, tourist surveys, and internal brainstorming discussions within the research team. This approach ensured both theoretical depth and practical relevance.

The literature review drew on various academic sources, including the works of [18,24,25,26,27,28,29,30,32,33], which provided valuable insights into the essential elements influencing HWT destinations. These were further refined through in-depth discussions with tourism professionals and feedback from tourists, which helped validate the real-world applicability of the identified criteria. Brainstorming sessions among the research team also contributed to shaping and finalizing the list of sub-criteria.

As a result, a total of 39 attributes and determinants were identified and categorized under the six components of the 6AsTD framework. Within the Attractions component, five sub-criteria were determined, namely natural scenery or environment, cultural significance, health and wellness appeal, uniqueness of experience, and the presence of artificial tourism sites. Under Accessibility, six key sub-criteria were recognized, which include proximity to public transport hubs, quality of infrastructure, availability of transportation, accessibility for all users, ease of accessing information, and convenience in booking. The Amenities category also comprised six sub-criteria: availability of accommodation options such as resorts or hotels, dining and nutrition services, recreational facilities including sauna and steam rooms, safety and hygiene standards, opportunities for health-related shopping, and access to fitness facilities and public parks. In the case of Available Packages, seven sub-criteria were synthesized. These include a variety of wellness-focused packages, the possibility of customization, cost-effectiveness, appropriate duration, such as weekend or two-day packages, comprehensiveness of health packages, availability of coaching or expert-led programs, and the inclusion of group-based activities like aerobic dance. Similarly, seven sub-criteria were identified for the Activities component, including physical wellness activities such as sports or yoga, the level of engagement they offer, innovativeness such as plastic surgery options, special events with knowledge-sharing or storytelling elements, natural therapy activities like forest bathing or health-oriented hiking, mental therapy programs, and nutrition-focused activities. Lastly, the Ancillary Services component comprised eight sub-criteria, which cover health and wellness support services, the availability of local guides and experts, medical services, complementary services, financial services such as ATMs and banks, postal services, internet access including free Wi-Fi, and communication infrastructure such as mobile signal availability.

Altogether, these 39 sub-criteria offer a comprehensive assessment tool for determining the critical attributes and determinants for identifying the region’s potential in supporting HWT initiatives. They form a solid foundation for subsequent stages of analysis and decision-making in destination planning and development.

Table 2. Summarizes the attributes and determinants for each of the 6AsTD.

Main Criteria	Sub-Criteria
Attractions:	Natural Scenery/Environment
	Cultural Significance
	Health and Wellness Appeal
	Uniqueness of Experience
	Artificial tourism sites
Accessibility:	Proximity to Public Transport Hubs
	Quality of Infrastructure
	Availability of Transportation
	Accessibility for All
	Accessibility for information
	Easily for booking
Amenities:	Accommodation Options (resort/hotel)
	Dining and Nutrition
	Recreational Facilities (sauna/stream)
	Safety and Hygiene
	Health-related Shopping
	Fitness and public park
Available Packages:	Variety of Packages (wellness activities)
	Customization Options
	Cost-Effectiveness
	Duration (e.g., 2 days package)
	Comprehensive Health Package
	Health Programs with Coaching/Experts
	Group packages (Aerobic dance)
Activities:	Physical Wellness activities (Sport/Yoga)
	Engagement Level
	Innovativeness (plastic surgery etc.)
	Special events (Knowledge/storytelling)
	Natural Therapy Activities (Forest Bathing, Health-Oriented Hiking, etc.)
	Mental therapy
	Nutritional Activities
Ancillary Services:	Health and Wellness Support
	Local Guides and Experts
	Medical Services
	Complementary Services
	Financial services (ATM/bank)
	Postal services
	Internet access (free WI-FI)
	Communication channels (signal call)

presents a detailed summary of these attributes and determinants categorized under each of the six components of the 6AsTD framework.

4.1.2. Thresholding Results

Following the identification of relevant attributes and determinants within the 6AsTD framework, a mean-based thresholding technique was employed to refine the list of sub-criteria. This process aimed to eliminate elements deemed less significant based on perceptions of two focused respondent groups: health and wellness tourists and experts.

Participants were asked to evaluate each of the 39 sub-criteria using a five-point Likert scale, where a score of 1 represented “not necessary”, and a score of 5 indicated “most necessary”. The mean score for each sub-criterion was calculated. A threshold value of T = 3.19 was established to differentiate between significant and insignificant sub-criteria. Any sub-criterion with a mean score below this threshold was excluded from further consideration.

For instance, the sub-criterion “Artificial Tourism Sites” received an average score of 1.50 and was subsequently eliminated. In total, 15 sub-criteria were excluded from the analysis, resulting in a more concise and focused list of sub-criteria that better reflects stakeholder priorities. These retained sub-criteria are aligned with the six components of the 6AsTD framework and are considered suitable for further weight methods.

Table 3. Mean-based threshold sub-criteria elimination.

Main Criteria	Sub-Criteria	Mean $\overline{{\mathit{S}}_{\mathit{i}}}$	Threshold $\mathit{T}$	Result
Attractions:	Natural Scenery/Environment	4.62	3.19	Retained
	Cultural Significance	3.52	3.19	Retained
	Health and Wellness Appeal	4.4	3.19	Retained
	Uniqueness of Experience	4.34	3.19	Retained
	Artificial tourism sites	1.5	3.19	Eliminated
Accessibility:	Proximity to Public Transport Hubs	1.82	3.19	Eliminated
	Quality of Infrastructure	3.58	3.19	Retained
	Availability of Transportation	4.46	3.19	Retained
	Accessibility for All	4.44	3.19	Retained
	Accessibility for information	3.54	3.19	Retained
	Easily for booking	2.18	3.19	Eliminated
Amenities:	Accommodation Options (resort/hotel)	4.44	3.19	Retained
	Dining and Nutrition	3.5	3.19	Retained
	Recreational Facilities (sauna/stream)	3.54	3.19	Retained
	Safety and Hygiene	4.54	3.19	Retained
	Health-related Shopping	2.12	3.19	Eliminated
	Fitness and public park	1.98	3.19	Eliminated
Available Packages:	Variety of Packages (wellness activities)	3.36	3.19	Retained
	Customization Options	4.6	3.19	Retained
	Cost-Effectiveness	4.44	3.19	Retained
	Duration (e.g., 2 days package)	3.54	3.19	Retained
	Comprehensive Health Package	2	3.19	Eliminated
	Health Programs with Coaching/Experts	2.06	3.19	Eliminated
	Group packages (Aerobic dance)	2.06	3.19	Eliminated
Activities:	Physical Wellness activities (Sport/Yoga)	3.44	3.19	Retained
	Engagement Level	4.52	3.19	Retained
	Innovativeness (plastic surgery etc.)	1.46	3.19	Eliminated
	Special events (Knowledge/storytelling)	1.56	3.19	Eliminated
	Natural Therapy Activities (Forest Bathing, Nature Therapy, Health-Oriented Hiking)	4.4	3.19	Retained
	Mental therapy	1.88	3.19	Eliminated
	Nutritional Activities	3.64	3.19	Retained
Ancillary Services:	Health and Wellness Support	4.6	3.19	Retained
	Local Guides and Experts	1.96	3.19	Eliminated
	Medical Services	4.52	3.19	Retained
	Complementary Services	1.56	3.19	Eliminated
	Financial services (ATM/bank)	1.52	3.19	Eliminated
	Postal services	1.48	3.19	Eliminated
	Internet access (free WI-FI)	3.54	3.19	Retained
	Communication channels (signal call)	3.46	3.19	Retained

presents the evaluation results, including mean scores, threshold comparison, and the final decision regarding each sub-criterion. The remaining sub-criteria to be used in the next analytical phase are illustrated in Figure 3.

4.1.3. Weighting Criteria

To systematically prioritize the various factors influencing the assessment and development of HWT destinations, a weighting methodology was applied to the attributes and determinants retained from the 6AsTD framework. This process incorporated both quantitative statistical techniques and qualitative judgments derived from two focus groups—one comprising health and wellness tourists and the other consisting of domain experts. This integration ensured a balanced and robust evaluation of the relative importance of each criterion.

Initially, participants rated each of the retained sub-criteria. These preliminary scores were subsequently refined through a statistical weighting approach, designed to reflect the relative significance of each factor. The final weights thus represent a composite measure derived from empirical participant ratings, enhancing both objectivity and reliability in the evaluation process. This method allowed for a comprehensive understanding of how each attribute and determinant contributes to the overall development of an HWT destination.

The results of the weighting analysis are presented in

Table 4. Criteria scoring.

Main Criteria	Sub-Criteria	Wi	Total Sum
A1: Attraction	A11: Natural Scenery/Environment	0.05457	0.19808
	A12: Cultural Significance	0.05137
	A13: Health and Wellness Appeal	0.04817
	A14: Uniqueness of Experience	0.04397
A2: Accessibility	A21: Quality of Infrastructure	0.04177	0.18589
	A22: Availability of Transportation	0.04357
	A23: Accessibility for All	0.05377
	A24: Accessibility for information	0.04677
A3: Amenities	A31: Accommodation Options	0.05157	0.18989
	A32: Dining and Nutrition	0.04617
	A33: Recreational Facilities	0.03738
	A34: Safety and Hygiene	0.05477
A4: Available Package	A41: Variety of Packages	0.03338	0.13552
	A42: Customization Options	0.02978
	A43: Cost-Effectiveness	0.04657
	A44: Duration	0.02578
A5: Activities	A51: Physical Wellness activities	0.05137	0.17869
	A52: Engagement Level	0.04138
	A53: Natural Therapy Activities	0.04357
	A54: Nutritional Activities	0.04237
A6: Ancillary Services	A61: Health and Wellness Support	0.04078	0.11193
	A62: Medical Services	0.03518
	A63: Internet access	0.01839
	A64: Communication channels	0.01759

, which displays the relative weights assigned to each criterion. Among the six main components of the 6AsTD framework, Attractions emerged as the most influential factor, receiving the highest overall weight of 0.19808, followed by Accessibility (0.17992) and Amenities (0.16672). Conversely, Available Packages (0.13552) and Ancillary Services (0.11193) received the lowest weights, indicating their relatively lower influence in the assessment framework. At the sub-criteria level, Natural Scenery/Environment and Cultural Significance, under the Attractions category, were identified as the most critical attributes, with weights of 0.05457 and 0.05137, respectively. Within the Accessibility component, the sub-criterion Accessibility for All held considerable significance with a weight of 0.05377. In the Amenities dimension, Safety and Hygiene (0.05477) and Accommodation Options (0.05157) emerged as key priorities.

These findings are consistent with previous research [18,32,33]. For instance, Mikulić et al. [32] found that natural beauty, personal safety, quality of accommodation, and cultural tourism offerings exerted the strongest influence on wellness tourist satisfaction. The present study further corroborates these results by demonstrating the centrality of environmental quality, security, and cultural value in determining HWT destination appeal.

4.2. MCDM-TOPSIS

To further evaluate and prioritize the suitability of HWT activities across different districts in Nakhon Ratchasima Province, this study applied the TOPSIS. Using the set of weighted criteria derived from Section 4.1.3, experts were invited to assess the relative suitability of eight HWT activities across three distinct locations. These activities were evaluated based on a comprehensive set of criteria, including tourist preferences, accessibility, environmental sustainability, and development potential.

The TOPSIS method was employed to compute the Relative Closeness Coefficient ($R_j$) which indicates how close each activity-location alternative is to the ideal solution while maximizing its distance from the negative-ideal solution. This structured and objective approach enables decision-makers to rank the alternatives effectively, thereby supporting the identification of the most appropriate strategies for sustainable tourism development.

Pak Chong District demonstrates the highest Relative Closeness ($R_j$) values for activities primarily associated with therapeutic and rehabilitative health tourism. As presented in

Table 5. TOPSIS evaluation of health and wellness tourism activities in Pak Chong.

	Activities	${\mathit{D}}_{\mathit{j}}-$	${\mathit{D}}_{\mathit{j}}+$	${\mathit{R}}_{\mathit{j}}$
Pak Chong	1. Ecotourism	0.001145288	0.004126516	−0.00184
	2. Cultural Tourism	0.000225765	0.007336432	−0.00688
	3. Food Tourism	0.004063259	0.001200834	0.00693
	4. Culinary Tourism	0.003547864	0.001448603	0.00565
	5. Sport City	0.000242247	0.007297193	−0.00681
	6. Cycling Tourism	0.000426958	0.006216822	−0.00536
	7. Aroma Therapy	0.007298298	0.000210557	0.01439
	8. Water Therapy	0.00698267	0.000246973	0.01372

, Water Therapy ($R_j$ = 0.01372), Aroma Therapy ($R_j$ = 0.01439), Culinary Tourism ($R_j$ = 0.00565), and Food Tourism ($R_j$ = 0.00693) rank as the most suitable HWT activities in this district. The high scores of Water Therapy and Aroma Therapy, in particular, underscore Pak Chong’s significant potential to serve as a wellness tourism hub, especially for activities that promote physical rehabilitation and mental rejuvenation.

This finding is well-aligned with the district’s natural and environmental assets, such as geothermal springs, herbal plantations, and traditional spa facilities, which contribute directly to the appeal and viability of health-oriented tourism. The alignment between the district’s natural characteristics and the top-ranked activities emphasizes the strategic opportunity for targeted development of health and wellness experiences in Pak Chong.

Wang Nam Khiao District displays the highest Relative Closeness ($R_j$) values for Ecotourism ($R_j$ = 0.97048) and Cultural Tourism ($R_j$ = 0.97735), followed by Culinary Tourism ($R_j$ = 0.69367) and Food Tourism ($R_j$ = 0.72227) as shown in

Table 6. TOPSIS evaluation of health and wellness tourism activities in Wang Nam Khiao.

	Activities	${\mathit{D}}_{\mathit{j}}-$	${\mathit{D}}_{\mathit{j}}+$	${\mathit{R}}_{\mathit{j}}$
Wang Nam Khiao	1. Ecotourism	0.007317158	0.000222569	0.97048
	2. Cultural Tourism	0.007534903	0.000174574	0.97735
	3. Food Tourism	0.003674549	0.001412912	0.72227
	4. Culinary Tourism	0.0034606	0.001528184	0.69367
	5. Sport City	0.000287344	0.006931184	0.03980
	6. Cycling Tourism	0.00034611	0.006552783	0.05016
	7. Aroma Therapy	0.000558324	0.005125303	0.09823
	8. Water Therapy	0.000558324	0.005125303	0.09823

. The exceptionally high scores for Ecotourism and Cultural Tourism indicate that Wang Nam Khiao is particularly well-suited for tourism development rooted in sustainability and cultural heritage. These results align with the district’s rich ecological assets and well-preserved local traditions. The presence of lush natural landscapes, biodiversity, and community-led tourism initiatives provides a robust foundation for promoting ecotourism. Concurrently, the strong cultural identity of local communities supports the development of cultural tourism as a vehicle for preserving indigenous knowledge and fostering meaningful tourist engagement. Together, these factors position Wang Nam Khiao as a model destination for integrated HWT with an emphasis on environmental and cultural sustainability.

Mueang Nakhon Ratchasima District emerges as the most suitable location for sports and rehabilitative health tourism, particularly in activities such as Sport City ($R_j$ = 0.95335), Cycling Tourism ($R_j$ = 0.97112), Culinary Tourism ($R_j$ = 0.63238), and Food Tourism ($R_j$ = 0.71809), as detailed in

Table 7. TOPSIS evaluation of health and wellness tourism activities in Mueang.

	Activities	${\mathit{D}}_{\mathit{j}}-$	${\mathit{D}}_{\mathit{j}}+$	${\mathit{R}}_{\mathit{j}}$
Mueang Nakhon Ratchasima	1. Ecotourism	0.000297666	0.006843805	0.04168
	2. Cultural Tourism	0.000257886	0.007113465	0.03498
	3. Food Tourism	0.003610517	0.0014174	0.71809
	4. Culinary Tourism	0.003081732	0.001791508	0.63238
	5. Sport City	0.006611754	0.000323538	0.95335
	6. Cycling Tourism	0.007162599	0.000213022	0.97112
	7. Aroma Therapy	0.001272773	0.003820796	0.24988
	8. Water Therapy	0.001170336	0.004106051	0.22181

. The district’s established sports infrastructure, including professional-grade venues, training facilities, and extensive cycling routes, supports its capacity to host regional and international sporting events. These assets collectively position Mueang Nakhon Ratchasima as a strategic hub for sports-based wellness tourism, combining physical activity with holistic health experiences.

The comparative ranking of high-potential wellness tourism activities across the three districts—Pak Chong, Wang Nam Khiao, and Mueang Nakhon Ratchasima—reveals distinct strengths and specialized tourism assets unique to each area. Pak Chong demonstrates comparative advantages in therapeutic and rehabilitative activities, Wang Nam Khiao excels in ecotourism and cultural tourism, while Mueang Nakhon Ratchasima leads in sports-based and active wellness, as shown in

Table 8. Attributes of health and wellness triangle of Nakhon Ratchasima Province.

EMBN Model	Mueang (B-N)	Wang Nam Khiao (E-N)	Pak Chong (M-N)
E = Environment Clean air, pollution-free		✓
M = Mind Good mental health, relaxation from stress			✓
B = Physical Body Physical health	✓
N = Nutrition Healthy food	✓	✓	✓

and Figure 4.

A particularly salient observation is the consistent appearance of Food Tourism and Culinary Tourism among the top four activities in all three districts. This recurring pattern suggests that food- and nutrition-based tourism may serve as a strategic linkage, enabling the formation of an integrated wellness tourism network across the province. The shared emphasis on health-conscious culinary experiences and the utilization of locally sourced ingredients presents an opportunity to unify district-level strengths into a coherent provincial tourism identity. By capitalizing on this commonality, Nakhon Ratchasima can advance a holistic and sustainable wellness tourism model that not only leverages local resources and cultural assets but also promotes regional collaboration, inclusive development, and long-term destination competitiveness. Like the four dimensions of the PMSE experience framework, namely, physical, mental, spiritual, and environmental, that holistically served as a mechanism toward wellness tourism in Thailand context [18]. The results of this study show that Nakhon Ratchasima is the capital of the HWT hub, with a key strength of the Nakhon Ratchasima area emphasizing four aspects of health and wellness tourism: environment (E), mind (M), physical body health (B), and nutrition (N).

5. Conclusions

This study presents a comprehensive approach to assessing and evaluating health and wellness tourism (HWT) destination potential by integrating the 6AsTD framework with a multi-criteria decision-making (MCDM) approach, specifically the TOPSIS method. The findings are twofold. First, the study identifies and structures the key attributes and determinants influencing tourist satisfaction in HWT destinations. By adapting the general 6As tourism framework—Attractions, Accessibility, Amenities, Activities, Available Packages, and Ancillary Services—to the context of HWT, this research offers a contextualized and holistic understanding of the elements contributing to successful HWT destinations. Among the six criteria, Attractions, Accessibility, and Amenities emerged as the top priorities for HWT tourists. Within these, critical attributes and determinants such as natural scenery/environment, health and wellness appeal, universal accessibility, transportation availability, and safety and hygiene significantly influence tourist satisfaction, aligned with [32,33]. Second, the study integrates these findings into the TOPSIS evaluation model to assess and rank HWT activities and locations. This integration allows for a detailed assessment of each location’s suitability for specific health and wellness activities and broader strategic positioning, while also identifying areas for improvement based on the 6AsTD framework.

Empirical results show that different districts within Nakhon Ratchasima Province exhibit distinct HWT potential, aligned with the EMBN model—Environment, Mind, Physical Body, and Nutrition. For instance, Wang Nam Khiao District excels in eco-tourism, cultural experiences, and health-focused culinary tourism, aligning with the Environment and Nutrition dimensions. Pak Chong District is recognized for its health and wellness services, such as aromatherapy, traditional Thai massage, herbal steam, and hot spring therapies, reflecting the Mind and Nutrition dimensions. Meanwhile, Mueang District focuses on physical wellness through its sports city initiative, promoting cycling, physical activity, and health-focused cuisine, thus fitting under the Physical Body and Nutrition dimensions. Additionally, the province demonstrates strong capabilities in various forms of health and wellness, supported by medical professionals, hospitals, and high-standard accommodation, positioning Nakhon Ratchasima as a competitive destination for HWT. Its affordability compared to Bangkok further enhances its appeal. By integrating eco-tourism with wellness and medical services, the province can evolve into a comprehensive HWT destination.

The study’s contributions span theoretical, practical, and managerial domains: Theoretical Contribution: This study demonstrates that the 6AsTD framework can be effectively adapted to the HWT context, providing a solid theoretical foundation for evaluating and developing health and wellness destinations. The combination of 6AsTD and MCDM-TOPSIS offers a promising analytical framework for structured decision-making in wellness tourism development. In comparison to Kongtaveesawas et al. [18], who emphasized spiritual and environmental elements in wellness tourism development in northern Thailand, our findings highlight a stronger emphasis on physical and nutritional wellness dimensions in the Nakhon Ratchasima case, reflecting the province’s distinctive policy focus and resource endowments. This contrast underscores the framework’s flexibility across different regional contexts. Practical Contribution: The findings are valuable for stakeholders such as the Thailand Tourism Authority and regional offices (e.g., Nakhon Ratchasima Tourism Authority), as well as businesses involved in health and wellness services. They offer guidance for shaping policies and designing compelling tourism experiences. Consistent with Praprom & Laipaporn [34], the study reinforces the importance of innovating new wellness tourism services to increase attractiveness and value. It also supports the development of wellness programs reflecting holistic attributes—physical, mental, spiritual, and environmental—as emphasized by Kongtaveesawas et al. [18]. Managerial Contribution: The research provides practical insights for experience design and strategic destination management within the Thai context. It recommends that findings be used to guide strategic planning, particularly in positioning Nakhon Ratchasima as a multidimensional health capital through various forms of health and wellness activities. By operating the 6AsTD framework within an MCDM-TOPSIS model, the study delivers a decision-support tool that enables policymakers, tourism planners, and local businesses to prioritize development efforts, allocate resources effectively, and tailor marketing strategies toward high-impact wellness dimensions. Effective policy development should capitalize on these strengths. Moreover, this study suggests general policy actions for HWT destination managers and firms to improve overall tourist satisfaction. Special attention should be paid to the determinants with the strongest association with perceived destination attractiveness, especially complementary services that enhance wellness experiences.

Limitations and Future Research Directions

This research is not without limitations. First, the study’s sample of tourists and experts was limited to Thailand, which may restrict the generalizability of the findings. Different regions and age groups may hold differing perspectives toward HWT destinations [33]. Second, the multi-step process involving various groups in attribute identification, weighting, and evaluation may introduce biases or inconsistencies. Lastly, the evaluation of HWT activities was conducted solely by experts, omitting input from tourists and local residents, which may overlook important user-centered insights.

Future studies should consider incorporating dynamic criteria, tourist segmentation, and seasonal variations to refine destination assessment and strategic planning. As highlighted by But & Ap [35], the impact of tourism depends heavily on both traveler and destination characteristics. However, the influence of tourists’ personal attributes remains underexplored, particularly since many health and wellness tourists may be coping with illness or chronic conditions. Exploring these effects can deepen our understanding of tourist behavior and destination impact. Additional research could investigate other factors not covered in this study that may influence destination choice, tourist satisfaction, and competitiveness. Exploring aspects such as personalization, wellness program pricing, and cross-border wellness mobility may yield valuable insights for both domestic and international markets.