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

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, 

The paper about Multi-Criteria Decision Making for Assessing and Evaluating Health and Wellness Tourism Destination Potential Using the 6AsTD Framework is usitable for the journal sustainability.

 

The  Abstract is somewhat inappropriate since it is too long. Authors should follow the journal – authors instructions,

 

The authors may uses the 2,3,4 paragraph,

The 1 paragraph can be a part of the introduction

The 5 paragraph can be the last paragraph in introduction or literature review since it  briefly described the main goals of the paper.

The main strengths f this paper is its very broad a description of the problem, a methodology using 6AsTD framework that is very well and scientifically used, and the fact that the topic will be interesting to readers in the field of wellness tourism.

The main contributions will be useful for the south Asian scientists and tourism participants (e.g hotels, apartment/tourism facilities holders, beauty sector) in the field of wellness  

 

The introduction part within lines about using 6AsTD on page 3 should have a reference, (like stated in methodology, reference 22/23) since this is the 1 time it is introduced in the text. Further the HWT and MSCDM concept should be linked to some references as well.

The Thailand case should also be linked to at least some other Asian studies about wellness tourism or some other worlwide. 

 

The weakness of this paper les in the methodology section;

• the testability of the hypothesis, since there are non
• the description of the sample size (participants, number, sociodemographic, economic features etc.)
• the sample gathering process should be described
• the raw data gathering process should be described
• how many participants denied the participation,
• how many officials, civilians, tourism workers answered the interview
• how did You use (methodology) the words and transcribed the interview in (technique) to transfer them into mathematical data (Likert scale) ?

The conclusion should highlight more precisely the link with the aim of the paper and its main contributions with their concrete findings for 6AsTD , HWT and MSCDM concept.

also compare other authors findings with the Thailand case

Furthermore the authors should describe how their model will help the tourism sector and particular participants in the tourism sector.

 

kind regards, the reviewer

Author Response

Response to Reviewer Comments

Dear Reviewer,

We are deeply grateful for the opportunity to revise and enhance our manuscript titled: "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."

We sincerely appreciate the thoughtful and highly constructive feedback you provided during the peer review process. Your insightful suggestions and comments have been invaluable in elevating the quality, clarity, and scholarly rigor of our work.

In particular, we wish to express our heartfelt thanks for your detailed and careful evaluation. We greatly value your recognition of the study’s significance and its relevance to the field.

Please find below our detailed, point-by-point responses to your comments. All recommended revisions have been comprehensively included in the updated manuscript. To facilitate the review, all changes are clearly indicated and highlighted accordingly.

Questions for General Evaluation    

Questions for General Evaluation	Reviewer’s Evaluation	Response and Revisions
Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?	Must be improved	We have thoroughly revised the Introduction and Literature Review sections to better contextualize the study within existing theoretical frameworks and empirical studies. The revised manuscript now provides a clearer explanation of how the 6AsTD framework, health and wellness tourism (HWT) theory, and MCDM methods are integrated and how our study contributes to this growing body of knowledge.
Are the research design, questions, hypotheses and methods clearly stated?	Must be improved	We have significantly expanded and clarified the Methodology section. In particular, we now clearly explain that the study adopts an exploratory mixed-methods design, which does not rely on formal hypothesis testing. We have added comprehensive details regarding research design, data collection methods, sampling procedures, and how qualitative data were converted to quantitative metrics for the TOPSIS analysis. These changes aim to enhance methodological transparency and rigor.
Are the arguments and discussion of findings coherent, balanced and compelling?	Must be improved	The Discussion and Conclusion sections have been extensively revised. We now provide a more structured and balanced interpretation of results, clearly linking findings to the 6AsTD framework and HWT-MCDM integration.
For empirical research, are the results clearly presented?	Must be improved	We have revised the Results section to improve clarity and coherence. Results are now presented with better-structured tables, participant demographics, and a step-by-step breakdown of the criteria identification, weighting, and ranking process.
Is the article adequately referenced?	Can be improved	We have thoroughly reviewed and revised the reference list to ensure that all necessary citations are included and relevant to the theoretical background, methodology, and empirical findings
Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?	Must be improved	The Conclusion section has been thoroughly rewritten to clearly reflect the study’s objectives, main findings, theoretical contributions, and practical implications for the tourism sector. The revised section now includes a direct comparison with other regional studies, as well as actionable insights for tourism stakeholders. We have also added a discussion of limitations and proposed directions for future research.

 

Point-by-point response to reviewer

Comment and suggestion 1: The Abstract is somewhat inappropriate since it is too long. Authors should follow the journal – authors instructions. The authors may use the 2, 3, 4 paragraph; the 1st paragraph can be a part of the introduction.  The 5th paragraph can be the last paragraph in the introduction or literature since it briefly described the main goals of the paper.

Response 1: Thank you for pointing this out. We have completely revised the abstract to comply with the journal’s guidelines and your valuable suggestions. The updated abstract is now a single paragraph and does not exceed 200 words. It follows a structured abstract style (Background, Methods, Results, Conclusion) without using subheadings, as required. The revised version reads:

“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 wellbeing.

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.”

Comment and suggestion 2: The introduction part within lines about using 6AsTD on page 3 should have a reference, (like stated in methodology, reference 22/23) since this is the 1^st time it is introduced in the text. Further the HWT and MCDM concept should be linked to some references as well. The Thailand case should also be linked to at least some other Asian studies about wellness tourism or some other worldwide. 

Response 2: Thank you for pointing this out. We have revised the introduction to include appropriate citations when introducing the 6AsTD framework and clarified the conceptual linkage to HWT and MCDM. And also add the other context of wellness tourism from other country than just Thailand case. These comparisons provide a broader context for our findings and demonstrate how destination-specific characteristics influence the prioritization of wellness tourism attributes. The added comparisons support the generalizability and relevance of the 6AsTD framework beyond Thailand.

“Hence, this study aims to develop the framework for assessing and evaluating the 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.”

 

Comment and suggestion 3: Overall comment about Methodology Section.

Response to Comment 3: We sincerely thank the reviewer for the thoughtful and constructive comments regarding the methodology section. We fully recognize the importance of presenting a clear, rigorous, and transparent methodological approach to enhance the credibility and reproducibility of our study. In response, we have carefully revised and expanded the Methodology section—particularly more explanation in hypothesis and the Data Collection component—to address the specific points raised. These revisions include detailed information on the study design, sample size and composition, participant recruitment procedures, data gathering process, and the techniques used to convert qualitative interview data into quantitative metrics for analysis. The revised content aims to provide greater clarity and methodological robustness to support the study's findings.

Below is the separation explanation and response to each comment in the Method Section. 

Comment and Suggestion: The testability of the hypothesis, since there are none.

Explanation: We sincerely thank the reviewer for raising this point. We would like to clarify that this study adopts an exploratory mixed-methods design, and thus, it does not formulate or test formal hypotheses. The primary objective is not to establish causal relationships but rather to identify, assess, and prioritize key attributes and determinants of HWT destinations using expert judgment. This approach is widely accepted in exploratory research, particularly in fields where stakeholder perspectives are central to evaluation and planning.

To improve clarity and address the reviewer’s concern, we have revised Section 3.2, now titled " 3.1 Study Design and Method", to explicitly reflect the exploratory nature of the study.

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 ex-pert interviews, focus group discussions, and literature review to identify relevant criteria based on the 6AsTD framework. Quantitative data was 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 Fig. 3.

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), provides a basis for assessing and evaluating the potential of HWT in a given region.
2. Mean-based thresholding: A mean-based threshold is used to estimate the unnecessary attributes and determinants of 6AsTD based on the expert judgment of Linkert scale of 1-5 (not necessary to most necessary).
3. 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.
4. 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.

Comment and suggestion 4: The weakness of this paper is less in the methodology section (Data Collection)

Response 4: We sincerely thank the reviewer for the valuable comments regarding the weaknesses in the methodology section. In response, we have significantly revised and expanded the section to improve its clarity, rigor, and transparency. Specifically, we have added detailed information about the sample size, participant composition, sociodemographic characteristics, data collection procedures, response rates, and how qualitative interview data were transformed into quantitative data for analysis using a Likert scale. These revisions have been incorporated under the following subsections:

3.1 Study Area

3.2 Study Design and Method

3.3 Data Collection

3.3.1 Type of Data Collected

3.3.2 Data Collection Procedure

Below is the revised 3.3 Data Collection Section:

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 was collected through participatory surveys and semi-structured interviews, targeting key stakeholders such as business operators, 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 was sourced through a literature review, which analyzed the sub-criteria of 6AsTD. This review, along with expert interviews and assessment, identified attributes and determinants relevant to 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 was collected through field-level surveys involving 50 participants in Nakhon Ratchasima province. This group included tourists, community members, tourism business operators, 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 & Weighting
Health and Wellness Tourists	30	14 / 16	25–60	General tourists with interest in HWT	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
Tourism Business Operators	15	8 / 7	30–60	Spa owners, resort managers, retreat operators	Random Sampling
Local Officials	10	6 / 4	35–60	District tourism officers	Purposive Sampling

 

Comment and suggestion 4: The conclusion should highlight more precisely the link with the aim of the paper and its main contributions with their concrete findings for 6AsTD, HWT and MCDM concept. also compare other authors findings with the Thailand case. Furthermore, the authors should describe how their model will help the tourism sector and particular participants in the tourism sector.

Response: We sincerely thank the reviewer for the thoughtful and constructive feedback. In response, we have significantly revised the Conclusion section to strengthen the alignment between the study’s aim and its key contributions. The conclusion is revised:

Conclusion

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 accommodations—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.

Contributions

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. [16], 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. [16].

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 operationalizing the 6AsTD framework within a 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 [34]. 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.

 

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The subject of this article concerns a growing segment of the global tourism economy - health and wellness tourism (HWT). In the context of the growing importance of mental health, sustainable lifestyles and the search for destinations that foster physical and emotional regeneration, this study is both timely and relevant for policy makers, entrepreneurs and destination development researchers. The main achievement of the work is the integration of the 6As Tourism Destination Framework (6AsTD) model with the TOPSIS method, in order to multi-criteria evaluate the potential of wellness destinations. The combination of the 6AsTD model with TOPSIS methods has already been used (e.g. for general tourism planning), but what is new is the introduction of a new context - the introduction of the model for the evaluation of wellness tourism, using precisely defined sub-criteria.

I ask the authors to clarify the following:

-Please shorten the summary. In its current form, it contains more than 500 words. In the requirements of the journal, the abstract should be a maximum of 200 words.

-keywords - we write the abbreviation TOPSIS without ‘-’, it is a well-known abbreviation for the method. There is no need to include the full name in the keywords.

-The paper lacks a literature review on MCDM methods and the TOPSIS method. Please take this into account.

-Why did the authors choose to use the TOPSIS method? Please justify this and include it in the manuscript.

-How were the experts selected? How many experts participated in the assessment? Were the experts trained on the rating scale and on the method? Please describe this in detail.

-How were the evaluation criteria identified?

-Please cite some publications from Sustainability magazine.

Author Response

Response to Reviewer Comments

Dear Reviewer,

We would like to express our sincere appreciation for your time and thoughtful evaluation of our manuscript titled: "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."

Your insightful feedback and specific suggestions were extremely valuable in improving the manuscript. The detailed observations you provided—helped us enhance the conceptual clarity, methodological explanation, and overall presentation of the study.

We have carefully revised the manuscript in line with your recommendations, and we provide a detailed, point-by-point response to each of your comments below. We believe that the changes have significantly strengthened the quality and clarity of the paper.

Thank you once again for your constructive input and support in improving our work.

Questions for General Evaluation    

Questions for General Evaluation	Reviewer’s Evaluation	Response and Revisions
Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?	Can be improved	We have revised Section 2.3 by separating it into two detailed subsections: (1) The 6AsTD Framework in Tourism Destination Development and (2) Multi-Criteria Decision Making (MCDM) in Tourism Studies. These revisions include a literature review of MCDM methods—especially TOPSIS—and their application in tourism research, thereby improving theoretical contextualization.
Are the research design, questions, hypotheses and methods clearly stated?	Yes	Thank you. No revisions needed.
Are the arguments and discussion of findings coherent, balanced and compelling?	Yes	Thank you. No revisions needed.
For empirical research, are the results clearly presented?	Can be improved	We have clarified and strengthened the presentation of results in both the abstract and results section. This includes highlighting the priority criteria identified through TOPSIS and detailing the distinct strengths of each district in Nakhon Ratchasima in relation to HWT potential.
Is the article adequately referenced?	Can be improved	We ensured all references are correctly formatted according to MDPI guidelines. This enhancement supports the theoretical background, methodology, and findings.
Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?	Can be improved	We have revised the conclusion to more clearly link it to the results derived from the TOPSIS analysis and 6AsTD framework evaluation. It now provides a stronger synthesis of findings and offers clearer policy and practical implications supported by the data.

 

Point-by-point response to reviewer

Comment 1: Please shorten the summary. In its current form, it contains more than 500 words. In the requirements of the journal, the abstract should be a maximum of 200 words.

Response 1: We fully agree with your suggestion. The abstract has been revised to comply with the journal’s requirement and is now a single paragraph of under 200 words, structured according to Background, Methods, Results, and Conclusion.

“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 wellbeing.

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.”

Comment 2: Keywords – we write the abbreviation TOPSIS without “-”, it is a well-known abbreviation for the method. There is no need to include the full name in the keywords.

Response 2: Thank you for pointing this out. We have revised the keywords accordingly and removed the full name of TOPSIS, retaining only the abbreviation as recommended.

“Keywords: Health and Wellness Tourism (HWT); Multi-Criteria Decision-Making (MCDM); 6As Tourism Destination (6AsTD); TOPSIS”

Comment 3: The paper lacks a literature review on MCDM methods and the TOPSIS method. Please take this into account. Why did the authors choose to use the TOPSIS method? Please justify this and include it in the manuscript.

Response 3: Thank you for your valuable suggestion. We have revised Section 2.3 of the manuscript by dividing it into two subsections: (1) The 6AsTD Framework in Tourism Destination Development and (2) Multi-Criteria Decision Making (MCDM) in Tourism Studies. This restructuring helps clarify the distinct contributions of the 6AsTD framework and MCDM methods.

In particular, we have incorporated a literature review of MCDM techniques with a focus on TOPSIS.

The rationale for selecting TOPSIS is summarized as follows:

• It ranks alternatives based on their proximity to ideal and anti-ideal solutions.
• It provides clear, interpretable results and handles multiple criteria efficiently.
• It integrates expert judgment quantitatively, aligning well with our research design.
• It has been widely validated in tourism studies, including those applying the 6AsTD framework [24,27].

Below is the revised part in the manuscript:

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 As shown in Fig. 1 [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 review literature on 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 ex-ternal (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 [25-31].

.

Figure 1. The 6AsTD Framework

 

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. [25] 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. [26] 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. [27] 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. [28] 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. [29] used the framework to develop a model for smart beach management, emphasizing sustainable and innovative strategies. Additionally, Agustina Riski & Wulandari [30] 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 [31] 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 & 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 [25,28]. 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 relies 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 [25,28].

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 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.

Comment 4: Expert selection and data collection

How were the experts selected? How many experts participated in the assessment? Were the experts trained on the rating scale and on the method? How were the evaluation criteria identified? Please describe this in detail.

Response 4: We appreciate your request for more methodological detail. We have significantly expanded Section 3.3 of the manuscript to clarify the process of expert selection and data collection.

In summary:

• Experts were selected through purposive sampling based on professional experience in tourism or health and wellness.
• Number of experts: 20 from government and academia, supported by 30 general HWT tourists for initial criteria identification.
• Criteria Identification: Identified through a literature review and stakeholder input, then refined using mean threshold screening and weighting procedures. Participants were guided through structured sessions using pre-validated Likert scales and reviewed lists of criteria derived from literature.

Below is the revised part in the manuscript:

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 was collected through participatory surveys and semi-structured interviews, targeting key stakeholders such as business operators, 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 was sourced through a literature review, which analyzed the sub-criteria of 6AsTD. This review, along with expert interviews and assessment, identified attributes and determinants relevant to 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 was collected through field-level surveys involving 50 participants in Nakhon Ratchasima province. This group included tourists, community members, tourism business operators, 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 & Weighting
Health and Wellness Tourists	30	14 / 16	25–60	General tourists with interest in HWT	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
Tourism Business Operators	15	8 / 7	30–60	Spa owners, resort managers, retreat operators	Random Sampling
Local Officials	10	6 / 4	35–60	District tourism officers	Purposive Sampling

 

Comment 5: Please cite some publications from Sustainability magazine.

Response 5: Thank you for the suggestion. We have reviewed relevant publications in Sustainability and incorporated citations where appropriate, particularly in the literature review and discussion sections. These references help strengthen our theoretical foundation and contextualize our findings within the existing body of work.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors.

This document is the result of a great deal of work by the authors. But there aren't enough fundamental research data to clearly show how this study was carried out.

The paper states that the research was conducted based on Literature Review and Expert Interviews/Assessment. However, such a small number of literature units cannot be used as a sufficient and relevant number for this study.

It is not possible to completely evaluate the credibility of the results because the values, or sizes, pertaining to the number of groups or individuals interviewed, as well as the location, time, and questionnaires used to conduct this research, are unknown.

Which expert interviews and assessments were carried out is unknown from the text. Additionally, it is unclear which sample was utilized and precisely when and where they were carried out.

Since the paper does not provide quantitative elements of the research base, it is not possible to further monitor the quality of the text.

Abstract has almost 600 words and does not adhere to the instructions of the authors of this journal. Look at the instructions and adjust your work accordingly.

Instruction for Abstract:

Abstract: The abstract should be a total of about 200 words maximum. The abstract should be a single paragraph and should follow the style of structured abstracts, but without headings: 1) Background: Place the question addressed in a broad context and highlight the purpose of the study; 2) Methods: Describe briefly the main methods or treatments applied. Include any relevant preregistration numbers, and species and strains of any animals used; 3) Results: Summarize the article's main findings; and 4) Conclusion: Indicate the main conclusions or interpretations. The abstract should be an objective representation of the article: it must not contain results which are not presented and substantiated in the main text and should not exaggerate the main conclusions.

The first statement in Introduction needs to be modified because it is extremely similar with the beginning of the abstract. It needs to be modified.

The findings of the Global Wellness Economy Monitor (2024) are presented in the Introduction section of the study. Nevertheless, the references do not include this material. In the references, there is literature from 2022.g. (under number 5), the cited work (under number 2) from 2021.g. and Global Wellness Institute. (2018).

Conclusion

The paper's conclusion needs to be improved. It is necessary to base the conclusion on the results of the investigation conducted. In regard to the new information, clarifications, and modifications made to the text, the conclusion has to be revised. Let's move on to the most significant study findings.

In a separate chapter or subsection, explain the difficulties the author encountered, as well as the author's future research.

Literature is not sufficient for this study. It is necessary to expand the list with relevant literature. The authors must verify that the literature citations are accurate.

Author Response

Response to Reviewer Comments

Dear Reviewer,

On behalf of all co-authors, I would like to extend our deepest gratitude for your valuable time, thoughtful review, and insightful suggestions regarding our manuscript titled: "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."

Your comments were  among the most insightful and constructive comments we have received. We highly appreciate the comprehensive review and the thoughtful recommendations you offered, which has significantly contributed to enhancing the quality and academic rigor of our work. We hold your professional insights in the highest regard.

We are also sincerely thankful for the opportunity to revise and improve our manuscript in response to your guidance. Each of your comments has been carefully considered, and we have made comprehensive revisions to address all the points raised. These changes are detailed in the point-by-point responses provided below.

Thank you once again for your invaluable contribution to the improvement of our research.

With great respect and appreciation,

Questions for General Evaluation    

Questions for General Evaluation	Reviewer’s Evaluation	Response and Revisions
Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?	Must be improved	We have expanded the literature review and clarified the use of the 6AsTD framework contextualizing it within recent wellness tourism research, including the updated 2024 Global Wellness Economy Monitor citation. This strengthens theoretical grounding and empirical relevance.
Are the research design, questions, hypotheses and methods clearly stated?	Not applicable	The methodology section was substantially revised to clearly describe the mixed-methods design, data sources, sampling, data collection procedures, and analysis steps (qualitative expert interviews, surveys, MCDM-TOPSIS).
Are the arguments and discussion of findings coherent, balanced and compelling?	Must be improved	We improved coherence by restructuring discussions to highlight key findings per district and their alignment with 6AsTD attributes and EMBN model. The conclusion now explicitly ties results to theoretical and practical implications, ensuring balanced, compelling argumentation.
For empirical research, are the results clearly presented?	Must be improved	Results presentation was enhanced with detailed district-level comparisons, clear explanation of TOPSIS rankings, and integrated discussion of attributes influencing HWT potential. Tables and figures were clarified for better readability.
Is the article adequately referenced?	Must be improved	We updated and corrected the references, including proper citation of the latest 2024 Global Wellness Economy Monitor, ensuring all key data sources are correctly acknowledged.
Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?	Must be improved	The conclusion was rewritten to base all statements explicitly on study results, including prioritized attributes and district-specific findings. We added a new subsection addressing limitations and future research, fulfilling the reviewer’s suggestion for transparency and scope.

 

Point-by-point response to reviewer

Overall comment: This document is the result of a great deal of work by the authors. But there aren't enough fundamental research data to clearly show how this study was carried out.

The paper states that the research was conducted based on Literature Review and Expert Interviews/Assessment. However, such a small number of literature units cannot be used as a sufficient and relevant number for this study.

It is not possible to completely evaluate the credibility of the results because the values, or sizes, pertaining to the number of groups or individuals interviewed, as well as the location, time, and questionnaires used to conduct this research, are unknown.

Which expert interviews and assessments were carried out is unknown from the text. Additionally, it is unclear which sample was utilized and precisely when and where they were carried out.

Since the paper does not provide quantitative elements of the research base, it is not possible to further monitor the quality of the text.

Response: Thank you very much for this detailed and important feedback. In response, we have clarified and expanded the methodology section of the manuscript to provide a more transparent and complete explanation of our research process. Specifically, we significantly revised the Methodology section as below:

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.

Figure 3. Research framework.

The methodological approach integrates both qualitative and quantitative components to ensure a comprehensive evaluation. Qualitative data were obtained through ex-pert interviews, focus group discussions, and literature review to identify relevant criteria based on the 6AsTD framework. Quantitative data was 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 Fig. 3.

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), provides a basis for assessing and evaluating the potential of HWT in each region.
2. Mean-based thresholding: A mean-based threshold is used to estimate the unnecessary attributes and determinants of 6AsTD based on the expert judgment of Linkert scale of 1-5 (not necessary to most necessary).
3. 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.
4. 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 is 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 (Fig.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, 1. Ecotourism; 2. Cultural Tourism; 3. Food Tourism; 4. Culinary Tourism; 5. Sport City; 6. Cycling Tourism; 7. Aroma Therapy and 8. 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 was collected through participatory surveys and semi-structured interviews, targeting key stakeholders such as business operators, local authorities, and tourist attractions. 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 was sourced through a literature review, which analyzed the sub-criteria of 6AsTD. This review, along with expert interviews and assessment, identified attributes and determinants relevant to 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.

 

 Figure 2. Map of study area.

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 was collected through field-level surveys involving 50 participants in Nakhon Ratchasima province. This group included tourists, community members, tourism business operators, 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 & Weighting
Health and Wellness Tourists	30	14 / 16	25–60	General tourists with interest in HWT	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
Tourism Business Operators	15	8 / 7	30–60	Spa owners, resort managers, retreat operators	Random Sampling
Local Officials	10	6 / 4	35–60	District tourism officers	Purposive Sampling

 

Instruction 1: Abstract has almost 600 words and does not adhere to the instructions of the authors of this journal. Look at the instructions and adjust your work accordingly.

Instruction for Abstract: The abstract should be a total maximum of about 200 words. The abstract should be a single paragraph and should follow the style of structured abstracts, but without headings: 1) Background: Place the question addressed in a broad context and highlight the purpose of the study; 2) Methods: Describe briefly the main methods or treatments applied. Include any relevant preregistration numbers, and species and strains of any animals used; 3) Results: Summarize the article's main findings; and 4) Conclusion: Indicate the main conclusions or interpretations. The abstract should be an objective representation of the article: it must not contain results which are not presented and substantiated in the main text and should not exaggerate the main conclusions.

Response 1: Thank you for pointing this out. We have completely revised the abstract to comply with the journal’s guidelines and your valuable suggestions. It follows the structured abstract style (Background, Methods, Results, Conclusion) without using subheadings, as required.

“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 wellbeing.

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.”

Comment 2: The first statement in Introduction needs to be modified because it is extremely similar with the beginning of the abstract. It needs to be modified.

Response 2: We appreciate your observation. The opening sentence in the abstract has been revised to distinguish it from the introduction. We have made it more contextual by introducing the broader background of health and wellness tourism rather than repeating the exact phrasing.

Comment 3: The findings of the Global Wellness Economy Monitor (2024) are presented in the Introduction section of the study. Nevertheless, the references do not include this material. In the references, there is literature from 2022.g. (under number 5), the cited work (under number 2) from 2021.g. and Global Wellness Institute. (2018).

Response 3: Thank you very much for your thoughtful comment regarding citation completeness. We have now corrected the omission by properly including the 2024 Global Wellness Economy Monitor (published in January 2025) in both the Introduction and the References section.

To ensure consistency and proper attribution, the following citations have been revised accordingly:

Page 2.

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 in tourism industry but also stimulates various other industries, such as transportation, food, accommodation, entertainment, etc. [3].

According to, Global Wellness Institute, [6], in Southeast Asian countries, the focus is on healing that ties spirituality and alternative therapies by promoting activities that improve wellbeing through the surrounding environment.

Page 4.

According to the Global Wellness Economy Monitor [22], Thailand ranks fourth in the Asia-Pacific region for its wellness tourism market size.

References:

2. Global Wellness Institute. (2024). 2024 Global Wellness Economy Monitor. Global Wellness Institute. (2025, January 28). https://globalwellnessinstitute.org/industry-research/2024-global-wellness-economy-monitor/
3. Andreu, M. G., Font-Barnet, A., & Roca, M. E. (2021). Wellness tourism, new challenges and opportunities for tourism in Salou. Sustainability, 13(15), 8246. https://doi.org/10.3390/su13158246
4. Global Wellness Institute. (2022). 2022 The Global Wellness Economy: Country Rankings. https://globalwellnessinstitute.org/industryresearch/2022-global-wellness-economy-country-rankings/
5. Global Wellness Institute. (2018). Global Wellness Tourism Economy NOVEMBER 2018. https://globalwellnessinstitute.org/wp-content/ uploads/2018/11/GWI_GlobalWellnessTourismEconomyReport.pdf

 

Comment 4: The paper's conclusion needs to be improved. It is necessary to base the conclusion on the results of the investigation conducted. Regarding the new information, clarifications, and modifications made to the text, the conclusion must be revised. Let's move on to the most significant study findings. In a separate chapter or subsection, explain the difficulties the author encountered, as well as the author's future research.

Response 4: Thank you for this valuable comment. In response, we have made substantial improvements to the Conclusion section to ensure it is firmly grounded in the study’s findings and consistent with the revised content throughout the manuscript. The updated conclusion now highlights the main results more explicitly, including the prioritization of key attributes (Attractions, Accessibility, and Amenities), their implications at the district level, and the relevance for policy and planning in wellness tourism development.

Additionally, we have introduced a new subsection titled “Research Limitations and Future Directions” preceding the Conclusion. This section discusses critical limitations of the study—such as the relatively small expert sample size and the specific geographical scope—and outlines directions for future research, including expanding the stakeholder base and applying the evaluation model to other regions or international wellness destinations.

We sincerely appreciate your insightful recommendation, which helped strengthen the overall clarity and academic rigor of the manuscript’s concluding sections.

Conclusion

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. [16], 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. [19]. 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 a 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 [35]. 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 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 [36], 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.

Comment 6: Literature is not sufficient for this study. It is necessary to expand the list with relevant literature. The authors must verify that the literature citations are accurate

Response 6: Thank you for your valuable suggestion. In response, we have revised Section 2.3 of the manuscript by dividing it into two distinct subsections:

(1) The 6AsTD Framework in Tourism Destination Development, and

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

This restructuring enhances the clarity of our conceptual foundation and better distinguishes the theoretical contributions of the 6AsTD framework and the methodological relevance of MCDM techniques.

We have also undertaken a comprehensive review and significant expansion of the literature, incorporating recent and relevant studies, particularly those applying MCDM methods—such as TOPSIS—in tourism planning and sustainable destination development. These additions aim to strengthen the academic grounding of our study and situate it within the broader scholarly discourse.

Additionally, we have thoroughly cross-checked all existing citations to ensure their accuracy, consistency, and proper alignment with the statements made in the text. We appreciate your feedback, which has contributed to improving the depth and rigor of the manuscript.

Below is the revised portion of the manuscript reflecting these changes:

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 As shown in Fig. 1 [12,13]. 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 review literature on 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 ex-ternal (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 [24-30].

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.

 

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Figure 1. The 6AsTD Framework

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 in-sights 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 & 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] con-ducted 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 & 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 relies on stakeholders and expert inputs. Other MCDM methods such as AHP, PROMETHEE, and ELECTRE 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 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.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors

thank YOU for upgrading the paper

it is now of much better quality

AND IT will be of better purpose for readers

kindly

the reviewer

Author Response

Response to Reviewer 1

Dear Reviewer,

On behalf of all co-authors, I would like to express our sincere appreciation for your thoughtful and supportive feedback on the revised version of our manuscript entitled:
"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."

We are deeply grateful for your kind words and are especially encouraged by your recognition that the manuscript has improved in both quality and purpose. Your feedback has been instrumental in shaping the direction and refinement of our work, and we truly value the time and expertise you invested in reviewing our submission.

Your constructive and insightful comments during the first round of review were particularly valuable in helping us strengthen the academic rigor and structure of the manuscript. They prompted us to reflect more deeply on key components of our study and make meaningful revisions that have enhanced the clarity, coherence, and scholarly contribution of our research. Your guidance challenged us to elevate our work, and we believe the manuscript is significantly stronger as a result.

We also greatly appreciate your supportive remarks during the second round of review. Knowing that the revised version meets your expectations and is likely to serve readers more effectively is both motivating and rewarding for us as researchers. Your recognition of our efforts means a great deal.

Thank you once again for your generous and constructive feedback, your kind encouragement, and your role in helping us improve this work. We are truly honored by your engagement with our manuscript and sincerely appreciate your contribution to its development.

With warmest regards and deep respect,
Natdanai Chanlawong
School of Industrial Engineering
Institute of Engineering
Suranaree University of Technology
Nakhon Ratchasima 30000, Thailand
Email: natdanai@sut.ac.th
Date: May 23, 2025

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Change the first sentence in either the Abstract or the Introduction.

What exactly do the authors mean by the term "business operators"? (337)

 

Author Response

Response to Reviewer Comments
Dear Reviewer,

On behalf of all co-authors, I would like to express our sincere gratitude for your continued support, thoughtful critique, and constructive feedback on our manuscript titled:
"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."

We are especially thankful for your insights from the first round of review, which played a pivotal role in enhancing the clarity, structure, and academic rigor of our manuscript. Your suggestions significantly guided us in refining our research narrative and improving methodological transparency, and we are truly honored by your contribution to the development of our work.

In this second round, we have carefully addressed your additional comments and have made the following improvements:

1. Abstract and Introduction Opening Sentence: We revised the first sentence of the Introduction to provide a clearer and more focused entry point for readers. The revised sentence better reflects the scope and objectives of the study while avoiding redundancy.
   Revised sentence (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 traveling 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 sectors, such as transportation, food, accommodation, entertainment, etc. [3].”
2. Clarification of the Term “Business Operators” (Line 337): Thank you for drawing attention to the use of this term. In the original manuscript, “business operators” referred to individuals directly involved in delivering HWT services—such as spa owners, retreat operators, and wellness resort managers.
   Recognizing that this term may appear overly broad, we have revised it to “tourism service providers”, which more precisely reflects the intended stakeholders and aligns with terminology commonly used in tourism studies. This change has been made at Line 337 and throughout the manuscript for consistency and clarity.

All revisions have been clearly highlighted in the revised manuscript for your easy reference.

Once again, we are deeply appreciative of your time, expertise, and the generosity of signing your review report. Your thoughtful engagement with our manuscript has been instrumental in shaping its final form, and we sincerely hope that the revised version meets your expectations.

With great respect and appreciation,
Natdanai Chanlawong
School of Industrial Engineering
Institute of Engineering
Suranaree University of Technology
111 University Avenue, Muang District
Nakhon Ratchasima 30000, Thailand
Email: natdanai@sut.ac.th

Author Response File: Author Response.pdf