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Article

Exploring Determinants of Wellness Tourism and Behavioral Intentions: An SEM-Based Study of Holistic Health

by
Kestsirin Theerathitichaipa
1,
Manlika Seefong
1,
Pattarawadee Prasomsab
1,
Panuwat Wisutwattanasak
2,
Chinnakrit Banyong
3,
Vatanavongs Ratanavaraha
1,
Nanthana Jansirisuk
4,
Atthaphon Ariyarit
5 and
Rattanaporn Kasemsri
6,*
1
School of Transportation Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
2
Institute of Research and Development, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
3
School of Industrial and Logistics Management Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
4
Suranaree University of Technology Hospital, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
5
School of Mechanical Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
6
School of Civil Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
*
Author to whom correspondence should be addressed.
Sustainability 2025, 17(17), 7824; https://doi.org/10.3390/su17177824
Submission received: 30 July 2025 / Revised: 25 August 2025 / Accepted: 28 August 2025 / Published: 30 August 2025
(This article belongs to the Special Issue Health and Sustainable Lifestyle: Balancing Work and Well-Being)
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Abstract

Amid globalization, tourism has increasingly emphasized health and well-being through sustainable, wellness-oriented services. Thailand has been recognized as having strong potential to become a regional hub for wellness tourism, supported by its efficient healthcare system and diverse attractions. This study aims to identify key indicators of wellness tourism based on holistic health principles and to examine their relationships with tourists’ intentions to use wellness services. Data were collected from 1200 wellness tourists in Thailand through stratified random sampling and analyzed using Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM). The results revealed six significant wellness factors, with Environmental Wellness being the most influential. In addition, gender, income, and occupation were found to positively affect wellness tourism behavior. Attitude and subjective norms also significantly influenced tourists’ intentions to engage in wellness services. This study provides policy recommendations to assist tourism and public health agencies in promoting wellness tourism and enhancing health-focused travel experiences.

1. Introduction

Wellness tourism is one of the fastest-growing trends in the tourism industry, aiming to enhance both physical and mental well-being through various activities. These activities may include relaxation, healthcare, yoga practice, spa treatments, and even medical therapies and cosmetic surgeries. Nowadays, people are increasingly seeking travel experiences that prioritize health improvement through stress-reducing and relaxing activities [1].
Thailand is strategically located in the heart of Southeast Asia, serving as a vital gateway between China, India, and the CLMV countries (Cambodia, Laos, Myanmar, and Vietnam). In terms of tourism potential, Thailand is recognized as one of the world’s leading destinations for wellness tourism [2]. According to 2017 data from the International Healthcare Research Center, Thailand ranked sixth globally in the wellness tourism industry [3]. It also had the highest number of medical tourists in Asia, accounting for 38% of the region’s total [4]. Additionally, the Medical Travel Quality Alliance ranked Thai hospitals among the top five healthcare facilities in the world for wellness tourism [5]. Thailand’s public health system is highly developed, with many hospitals accredited to international standards and staffed by highly qualified medical professionals [6]. This makes the country exceptionally well-prepared to deliver high-quality health and medical services. Moreover, the Global Wellness Institute (GWI) reported that Thailand generated the fourth highest revenue globally from wellness tourism. Between 2017 and 2019 [7], the country welcomed approximately 3.6 million medical tourists, generating an estimated THB 41 billion in tourism revenue. Thailand’s unique strengths, such as its cultural heritage, traditional Thai massage, and diverse natural attractions including beaches, mountains, waterfalls, and local traditions, have contributed to its high market value in the global wellness tourism industry, with consistent growth expected. Thailand is also a top global tourist destination. According to the 2019 UNWTO Tourism Highlights report, Thailand ranked seventh among the most-visited countries worldwide [8,9]. As a result, the wellness tourism sector serves as a key driver in attracting tourists back to Thailand. From the above evidence, it can be concluded that Thailand is well-positioned to develop itself into a regional hub for wellness tourism in Southeast Asia.
There are several studies that have explored factors promoting health tourism. For example, in 2017, a study in Turkey examined the factors influencing health tourism and the selection of healthcare facilities across countries. The study used interviews with healthcare experts and tourists, and key findings showed that factors such as cultural distance, political and economic stability, and regulations and legal frameworks were identified as important factors affecting the choice of international healthcare facilities [10]. In 2019, a study in Bali focused on the factors affecting the intentions of health tourists. Data was collected through questionnaires and analyzed using factor analysis. The findings revealed that factors such as belief in the benefits of spas, price, past experience, moral obligation for health, environmental awareness, personal value, socializing programs, and health maintenance were influential in shaping tourists’ intention to enjoy health tourism [11]. In 2023, a study conducted in China investigated the civic behavior of health and wellness tourists by utilizing a questionnaire survey at two popular wellness tourism destinations. The researchers applied partial least squares structural equation modeling (PLS-SEM) to analyze the data. The key findings revealed that perceived restorativeness and tourist engagement were significant predictors of psychological ownership and tourist citizenship behavior (TCB) [12]. Most recently, in 2024, a study in Croatia examined the factors affecting tourist satisfaction in health-focused tourism. The study used survey data and conducted impact-asymmetry analysis and impact-range analysis. The key findings indicated that factors like cleanliness, punctuality, and safety were significant influences on tourist satisfaction levels [13].
Currently, the focus of healthcare behavior is not solely on physical health but also encompasses mental health, relationships with others, and intangible aspects such as spirituality and inner wisdom in order to achieve completeness in all aspects. This is referred to as holistic healthcare [14]. Today, this concept plays a significant role in enhancing human happiness. Furthermore, the concept of holistic healthcare has gained attention from researchers worldwide. One study analyzed the psychological aspects of adjusting the evaluation of holistic health and body completeness in nurses in Turkey. Factors such as emotional, physical, nutritional, and spiritual well-being were collected and analyzed using Exploratory Factor Analysis (EFA) through SPSS v27 and R Project. The key finding from the study revealed that emotional awareness accounted for 64.929% of the variance in the analysis results [15]. In the same vein, a study conducted in Thailand examined the essential characteristics of the health tourism experience framework, which included physical, mental, spiritual, and environmental factors. These factors were collected and tested statistically through descriptive statistics and Confirmatory Factor Analysis (CFA). The important result from the study indicated that the mental experience contributed the most to the variance [16]. Although previous research has attempted to investigate this issue, it still requires further consideration to uncover deeper insights into wellness tourists. Therefore, to fill the gaps in prior studies, the present research expands its scope by examining wellness tourism indicators encompassing the six dimensions of holistic health: physical, mental, spiritual, social, emotional, and environmental. However, this study goes beyond considering only these six factors by incorporating demographic variables into the model, including age, gender, income, and occupation. These variables have been underexplored in previous research, particularly in the context of Thailand, which possesses high potential to become a leading hub for health tourism in Southeast Asia. Including these demographic factors may facilitate the discovery of new insights and offer a better understanding of tourist behavior. Moreover, this study integrates the Theory of Planned Behavior (TPB) into the conceptual framework to examine tourists’ intentions to utilize health tourism services in greater depth. All of these factors are analyzed within the comprehensive framework of this study, employing key analytical tools such as Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM) to validate findings and extend them from additional perspectives. Finally, this study not only presents results and in-depth findings but also offers significant policy recommendations aimed at sustainably and effectively developing and promoting health tourism services. These insights offer valuable guidance for relevant stakeholders and organizations.
Therefore, this research was conducted in Thailand, one of the countries with the greatest potential for developing the wellness tourism industry. The primary objective of this study is to examine the key indicators of wellness tourism and analyze the relationship between wellness tourism factors and tourists’ intention to use wellness tourism services. The analysis is based on survey data that reflect the actual perceptions and experiences of current wellness tourists. Advanced statistical modeling techniques were employed to explore and validate the underlying relationships between variables with accuracy and reliability. The results aim to reveal significant insights that contribute to the enhancement and strategic development of wellness tourism in the country. Furthermore, this study offers policy recommendations to guide the development of wellness tourism services. These findings can support relevant agencies and stakeholders in adapting and improving service offerings to better meet the needs and expectations of health-conscious travelers, thereby promoting more effective and sustainable tourism development.
The remainder of this study is structured as follows: Section 2 presents a review of the relevant prior literature, which serves as the theoretical foundation for this research. Section 3 provides a detailed explanation of the research methodology, including the conceptual framework, operational procedures, questionnaire development, respondent information, and data collection process. Section 4 presents the results derived from statistical analysis. Section 5 offers an in-depth interpretation of the findings and discusses their significance. Finally, Section 6 summarizes the key results and contributions of this study, proposes policy recommendations to promote wellness tourism in various aspects for practical implementation, and highlights this study’s limitations while suggesting directions for future research.

2. Literature Review

In the past, the definition of holistic health was described as a temporary state of physical, mental, and social relationships [17]. However, in the present day, when the world is undergoing numerous changes, people have placed great importance on maintaining their bodies and being more aware of their health due to the increasing severity of pandemics in today’s society, such as the COVID-19 outbreak [18,19]. These imminent threats have all contributed to motivating individuals to take better care of their health. Holistic health in the past may not fully reflect the thoughts and feelings of people today, as human behaviors regarding body care have changed. Healthcare now involves not only maintaining physical health but also taking care of mental well-being. Therefore, it is necessary to consider other important elements, including the body, mind, society, spirit, intellect, and the environment, to better reflect the perspectives of people today. These aspects will be further elaborated on in detail.

2.1. Wellness Tourism

Physical Wellness may refer to having a positive attitude towards the body, understanding how to take care of one’s health, and making choices that lead to appropriate health behaviors. A review of the previous literature indicates that physical well-being consists of both physical health and health-related behaviors [20,21]. Therefore, based on the literature review, we summarized the factors related to Physical Wellness, including nutrition and exercise.
Mental Wellness may refer to a state of mental well-being, having positive feelings toward oneself and others, emotional maturity, the ability to adapt to overcome challenges or changes, and the ability to live normally within society. Good mental health is crucial at any stage of life. A review of the previous literature reveals that the completeness of Mental Wellness affects overall well-being [22,23]. Therefore, based on the literature review, we summarized the factors related to Mental Wellness, which include life satisfaction, happiness, and life purpose.
Spiritual Wellness may refer to the awareness and understanding of the value of life, having a purpose in life, and being able to live according to one’s beliefs or convictions. A review of the previous literature indicates that spiritual health is a fundamental dimension that affects both social and emotional health [24,25,26]. Therefore, based on the literature review, we summarized the factors related to Spiritual Wellness, which include faith and inner peace.
Social Wellness may refer to having positive interactions with others, being able to communicate and engage in activities with those around you appropriately, and adapting smoothly to society. A review of the previous literature reveals that healthcare services play an important role in Social Wellness [27,28,29]. Therefore, based on the literature review, we summarized the factors related to Social Wellness, including social well-being, quality of life, and interpersonal interactions.
Emotional Wellness may refer to the ability to recognize and manage various emotions, cope with stress and pressure in life with understanding, and adapt to changes and difficult times. A review of the previous literature indicates that effective healthcare promotes Emotional Wellness [30,31]. Therefore, based on the literature review, we summarized the factors related to Emotional Wellness, including individual needs, values, and personal goals.
Environmental Wellness may refer to all aspects of health related to the environment, understanding how the social, natural, and built environments impact health and well-being. A review of the previous literature reveals that environmental health awareness promotes the care of physical, mental, and spiritual health [32,33,34]. Therefore, based on the literature review, we summarized the factors related to Environmental Wellness, including environmental conditions and environmental preservation.
Based on the review of the existing literature collected and synthesized by the researchers, a total of 13 studies across 10 countries were identified that examined factors related to holistic health, as presented in Table 1. Most of the research on holistic health has focused primarily on physical, mental, and social dimensions. However, no previous studies were found to have comprehensively evaluated all key dimensions of holistic health. To address this research gap, the present study incorporates all six dimensions into a unified framework to examine and assess the indicators that influence wellness tourism.

2.2. Theory of Planned Behavior (TPB)

TPB is one of the most significant theoretical frameworks for explaining individual behavior. This theory has been widely applied in various contexts, particularly in the study of tourist behavior [48,49]. For instance, it has been used to explore the determinants of tourists’ intention to revisit wellness tourism destinations. Research findings indicate that attitude, subjective norms, and perceived behavioral control significantly influence wellness tourists [50]. Moreover, a study on the factors influencing Gen Y individuals’ intention to engage in wellness tourism revealed that subjective norms have a positive effect on behavioral intention [51]. In summary, TPB provides a solid foundation for explaining human attitudes, subjective norms, and behavioral control that directly affect tourists’ intention to use wellness tourism services [52].

2.3. Research Conceptual Framework

However, within the context of developing countries, research on wellness tourism remains limited. Therefore, based on the study objectives, this research was conducted to measure the factors influencing wellness tourism by applying the concept of holistic health. The framework considers six factors encompassing health promotion services related to Physical, Mental, Spiritual, Social, Emotional, and Environmental Wellness (as proposed in Hypotheses H1a–H1f). Additionally, this study analyzes the relationships between wellness tourism factors and tourists’ intention to use wellness tourism services by employing the Theory of Planned Behavior (TPB). To fill gaps in previous research, this study also incorporates demographic variables including age, gender, income, and occupation into the model (as proposed in Hypotheses H2–H9) to uncover new insights. The detailed conceptual framework is illustrated in Figure 1 and described as follows.
Hypothesis 1: 
The appropriate measurement model for wellness tourism factors should consist of a multidimensional structure comprising six dimensions: Physical Wellness (H1a), Mental Wellness (H1b), Spiritual Wellness (H1c), Social Wellness (H1d), Emotional Wellness (H1e), and Environmental Wellness (H1f).
Hypothesis 2: 
Gender has a positive influence on wellness tourism services.
Hypothesis 3: 
Age has a positive influence on wellness tourism services.
Hypothesis 4: 
Income has a positive influence on wellness tourism services.
Hypothesis 5: 
Occupation has a positive influence on wellness tourism services.
Hypothesis 6: 
Wellness tourism has a positive influence on behavioral intention to use wellness tourism services.
Hypothesis 7: 
Attitude has a positive influence on behavioral intention to use wellness tourism services.
Hypothesis 8: 
Subjective norms have a positive influence on behavioral intention to use wellness tourism services.
Hypothesis 9: 
Perceived behavioral control has a positive influence on behavioral intention to use wellness tourism services.

3. Methodology

3.1. Research Methodology

The research process began with a comprehensive review of the literature and theories related to factors influencing wellness tourism, aiming to identify gaps in previous studies and to examine applicable statistical theories and methods for this investigation. Subsequently, a questionnaire was developed, and data were collected from a sample of Thai tourists through face-to-face interviews, totaling 1200 respondents. Once the data were fully collected, they were analyzed using statistical modeling methods, starting with Exploratory Factor Analysis (EFA). This method was employed to identify clusters of correlated variables forming latent factors without relying on predetermined hypotheses [53]. Confirmatory Factor Analysis (CFA) was then used to verify the relationships among the components of each variable and to confirm whether the grouped items were consistent and correlated, ensuring the statistical significance of the factors [54]. Subsequently, Structural Equation Modeling (SEM) was applied to examine the causal relationships among the variables [55]. The Mplus program was applied for the analysis to obtain the results of the CFA and SEM model. The final stage involved presenting the statistical results and discussing the findings, followed by policy recommendations aimed at relevant agencies to promote the development of wellness tourism. The overall research process is illustrated in Figure 2.

3.2. Questionnaire Development

In this study, the questionnaire was designed in three sections: (1) Demographic Information. This section gathered general information about the respondents, including gender, age, marital status, residential region, education level, occupation, income, and presence of chronic illnesses. (2) Indicators Influencing Wellness Tourism, comprising six factors: Physical Wellness services, Mental Wellness services, Spiritual Wellness services, Social Wellness services, Emotional Wellness services, and Environmental Wellness services. This section contains 23 items, based on the holistic healthcare framework [17]. (3) Behavioral Constructs Influencing Intention to Use Wellness Tourism Services, consisting of four factors: intention to use, perceived behavioral control, attitude, and subjective norms. This section contains 17 items, based on the Theory of Planned Behavior (TPB) [52]. The questionnaire employed a 7-point Likert rating scale, where 1 = strongly disagree, 2 = disagree, 3 = somewhat disagree, 4 = neutral, 5 = somewhat agree, 6 = agree, and 7 = strongly agree. The employed measures are considered reliable, as referenced in Ferri Sanz et al. (2019) and Huang (2010) [56,57].
Additionally, we verified the content validity of the questionnaire using the Item-Objective Congruence (IOC) index, which was evaluated by three experts in the fields of tourism and medicine. The results showed that the IOC values ranged between 0.67 and 1.00, all exceeding the threshold of 0.50, indicating that every item met the standard criteria [58].

3.3. Respondents and Data Collection

In this study, the respondents were tourists within Thailand, specifically in the northeastern region, including four provinces: Nakhon Ratchasima, Chaiyaphum, Buriram, and Surin. Also known as Nakhonchaiburin, this group of provinces plays a significant role in Thailand’s tourism industry due to its distinctive cultural identity and a wide range of tourist attractions. These include heritage tourism, following the trails of Khmer civilization (such as religious and historical sites); eco-tourism; and sports tourism. These attractions have recently attracted increasing interest from both domestic and international tourists. The tourism routes among the four provinces are well-connected, and the region is supported by a comprehensive transportation system, including both land and rail networks. The sample was selected using stratified random sampling, targeting wellness tourists visiting the northeastern provinces of Thailand. Prior to sampling, the total population of the four provinces under study was considered, based on the 2024 population registry statistics from the Department of Provincial Administration, National Statistical Office [59]. This information was used to allocate the sample proportionally according to the size of each province. Among the study areas, Nakhon Ratchasima accounted for the largest share of the sample (39%), as it represents the largest province among the study areas, followed by Buri Ram (24%), Surin (20%), and Chaiyaphum (17%). The target population comprised 1200 respondents, distributed across the study regions. Stratification was implemented to ensure adequate representation of key demographic characteristics within each group. The demographic variables considered included the following: age, divided into four groups: 18–25 years (Gen Alpha), 26–43 years (Gen Y), 44–58 years (Gen X), and 59–77 years (Baby Boomer); gender, divided into male and female; income, divided into four levels: ≤THB 10,000, THB 10,001–15,000, THB 15,001–20,000, and ≥THB 20,000; and occupation, categorized as farmers/farming organizations, entrepreneurs, private employees, government officers, and students. This stratification ensured that the collected data were well-distributed and representative of the population for analysis. Data collection was conducted between December 2024 and January 2025.
During the data collection phase, face-to-face interviews were conducted with respondents aged 18 years and above. Prior to each interview, informed consent was obtained by asking whether the respondent was willing to participate. If the respondent declined, the interview was immediately terminated. Therefore, only individuals who voluntarily agreed to participate were included in the survey. Furthermore, during the survey, we explained the objectives and fundamental concepts to the participants to ensure that they fully understood the study details and provided accurate and complete information. The Ethics Committee of Suranaree University of Technology, Thailand, reviewed and approved the key ethical considerations of the survey, as the data posed no greater risk to participants than the risks they typically encounter in daily life. In addition, the questions contained no personal or identifiable information, thereby minimizing any potential physical or psychological stress for the participants. Moreover, our field data collectors invited participants to join this study through verbal invitation and provided them with information sheets. All participants were fully informed about this study. Consequently, our survey was approved by the Ethics Committee of Suranaree University of Technology (18 December 2024; COE No. 197/2024). A total of 1200 valid responses were collected, which is considered adequate for statistical analysis. Previous research recommends that the sample size for structural equation modeling (SEM) should be at least 15 times the number of observed variables [60]. Since this study included 44 observed variables, the minimum required sample size was 660.
We collected general information from the survey respondents and found that 675 respondents (56%) were female, while 525 respondents (44%) were male. The majority of respondents were aged between 26 and 43 years, totaling 454 people (38%), followed by the age group of 18–25 years with 301 respondents (25%), the 44–58 age group with 249 respondents (21%), and the 59–77 age group with 196 respondents (16%). Additionally, most respondents resided outside urban areas (686 respondents, 57%), while 514 respondents (43%) lived in urban areas. Regarding education, the majority had obtained a bachelor’s degree (47%), followed by those with a high school diploma (19%). In terms of occupation, the largest proportion of respondents were government employees (27%), followed by private sector employees (25%). For income levels, 34% of respondents earned less than or equal to THB 10,000, followed by 25% earning between THB 15,001 and 20,000. The primary purpose of travel for respondents (within one week) was for work or education, reported by 708 respondents (59%), followed by leisure or tourism (183 respondents, 15%), hospital visits (180 respondents, 15%), and other reasons such as shopping or visiting relatives (129 respondents, 11%). Regarding health conditions, the majority of respondents (920 people, 77%) reported having good health with no chronic diseases, while 280 respondents (23%) reported having chronic conditions such as vision problems, diabetes, or hypertension.

4. Results

4.1. Descriptive Statistics

The descriptive statistical results from a sample of 1200 tourists revealed basic statistical indicators, including mean and standard deviation, to confirm the suitability of the data for further analysis. As shown in Table 2, the skewness values ranged from −1.398 to −0.871, and the kurtosis values ranged from 0.669 to 2.810. These values fall within acceptable thresholds, with skewness below the absolute value of 2 and kurtosis below the absolute value of 7 [61,62]. Therefore, it can be concluded that the data are approximately normally distributed and suitable for subsequent statistical analyses. Detailed information on the questionnaire is provided in Appendix A Table A1.

4.2. Exploratory Factor Analysis (EFA)

We conducted an Exploratory Factor Analysis (EFA) to identify observable indicators representing components of each latent factor and to compute the principal factors. The EFA results, as shown in Table 3, are both reliable and acceptable. The Kaiser–Meyer–Olkin (KMO) measure was 0.972, which is considered excellent. The analysis accounted for up to 83.569% of the total variance, a result that exceeds the variance explained by models in previous studies [15]. This indicates that the EFA model used in this study provides a better explanation of the variance. The factors can be classified into six groups: (1) Physical Wellness, as referenced by Andrews, T., G. Crosby, R. Carrigan, C. Fewell, S. Ly, M. Papworth, K. Santos, A. Timilsina and T. T. Donnelly [36] and Arphawatthansakul, L. and S. Punyasiri [46]. (2) Mental Wellness, as referenced by Chan, C. W., F. K. Y. Wong, S. M. Yeung and F. Sum [35] and Locsin, B. [44]. (3) Spiritual Wellness, as referenced by George, R. J., S. A. Menon, C. Sahu, H. Patel, N. Thakur and S. T. Sam [41]. (4) Social Wellness, as referenced by Wong, E., F. Mavondo, L. Horvat, L. McKinlay and J. Fisher [43]. (5) Emotional Wellness, as referenced by Steele, L. [39]. (6) Environmental Wellness, as referenced by Schoon, P. M. and K. Krumwiede [42]. Although the research questions in this study are partially based on previous studies, most of the questions were newly developed by the research team in order to examine the opinions of contemporary tourists. When examining the accuracy and reliability of these factors, Cronbach’s alpha values ranged from 0.899 to 0.941, which are within the acceptable range based on previous studies [63,64].
Although the Kaiser criterion recommends retaining only factors with eigenvalues greater than 1, in the context of this study, some factors with eigenvalues below 1 (e.g., 0.874, 0.591, 0.559, 0.494) were still retained. These factors were kept because they exhibited high factor loadings with the observed variables, indicating that they explained meaningful relationships within the variable structure. In addition, the scree plot showed that these factors contributed to the factor structure before the point of inflection (elbow), and parallel analysis confirmed that their eigenvalues exceeded those generated from random data. This approach aligns with the criteria suggested by Fabrigar, L. R., D. T. Wegener, R. C. MacCallum and E. J. Strahan [65] and Hair, J. F. [66]. Therefore, retaining factors with eigenvalues below 1 is justified, as these factors provide important theoretical insights and enhance the interpretability of the six-factor solution in the context of wellness tourism.
For the questionnaire responses regarding a pair of closely related variables, respondents may perceive the two variables as having the same meaning, which could pose an obstacle to model analysis and potentially affect the observed variable correlations, which should not exceed ±0.80 [67]. The latent structural correlation matrix is presented in Table 4. From the figure, it can be seen that no variable pair exceeds the acceptable correlation threshold. Therefore, all variables can be used for model analysis. Additionally, we examined the Heterotrait–Monotrait Ratio of Correlations (HTMT). The results, shown in Table 5, range from 0.785 to 0.866, all below the minimum threshold of 0.90 [68], with the 95% confidence interval excluding 1.00. This supports discriminant validity. Taken together, these results confirm that common method bias is not a threat in this study, and discriminant validity is established.

4.3. Analysis of Model Results

The results of the overall model evaluation (goodness-of-fit statistics) are presented in Table 6. It was found that this model fits the data well based on the following indices: χ2/df should be less than 5 [69,70]; comparative fit index (CFI) should be greater than 0.95 [60]; Tucker–Lewis index (TLI) should be greater than 0.95 [71]; root mean square error of approximation (RMSEA) should be less than 0.05 [72]; and standardized root mean square residual (SRMR) should be less than 0.08 [73]. The model in this study has the following statistics: chi-square test of model fit χ2 = 3282.267, df = 838, χ2/df = 3.917; comparative fit index (CFI) = 0.957; Tucker–Lewis index (TLI) = 0.952; root mean square error of approximation (RMSEA) = 0.049; and standardized root mean square residual (SRMR) = 0.066. Upon reviewing all the values, they meet the conditions outlined in the literature. Therefore, it can be concluded that this model is consistent with the empirical data.
The evaluation and explanation of the importance of each item are presented in Table 7. The CFA results from the measurement model indicate that Physical Wellness, Mental Wellness, Spiritual Wellness, Social Wellness, Emotional Wellness, and Environmental Wellness are all significant components of wellness tourism. The component loadings ranged from 0.838 to 0.968. All six factors demonstrated construct reliability (CR) values ranging from 0.901 to 0.940, exceeding the recommended threshold of 0.7 [74,75]. The minimum acceptable statistical value of AVE should not be lower than 0.5 [76]. In this study, the average variance extracted (AVE) ranged from 0.731 to 0.840, which exceeds the minimum threshold suggested in previous studies. These results confirm that all factors are appropriate for the model. Furthermore, the SEM results from the structural model revealed that personal factors, such as age, gender, income, and occupation, significantly influence wellness tourism, supporting Hypotheses H2 to H5. It was also found that wellness tourism attitude and subjective norms significantly influence the intention to engage in wellness tourism services, thereby supporting Hypotheses H6 to H8. Conversely, Hypothesis H9 was not supported, as perceived behavioral control did not have a statistically significant influence on the intention to use wellness services.
Figure 3 illustrates the results of the measurement model for the wellness tourism construct, which consists of six latent factors. Each factor is represented by a group of observed variables (S1–S23). The standardized factor loadings (γ) and corresponding t-values confirm the reliability and significance of the indicators. The highest-loading item in each group is summarized below.
Group 1: Physical Wellness (S1–S4)—This dimension is represented by four indicators. The highest loading is observed in S4 (γ = 0.920, t = 107.712), which states, “Wellness tourism provides comprehensive facilities, such as fitness centers and swimming pools.” This indicates that physical amenities are perceived as essential components of wellness tourism experiences.
Group 2: Mental Wellness (S5–S8)—This dimension is represented by four indicators. The highest loading is observed in S6 (γ = 0.879, t = 114.167), which states, “Wellness tourism makes you feel that your life is filled with happiness.” This indicates that mental well-being and positive emotional states are central to tourists’ perceptions of wellness tourism.
Group 3: Spiritual Wellness (S9–S11)—This dimension is represented by three indicators. The highest loading is observed in S10 (γ = 0.913, t = 143.125), which states, “Wellness tourism gives a positive feeling when seeing family or loved ones experience it just like I did.” This indicates the role of shared spiritual experiences in enhancing overall well-being.
Group 4: Social Wellness (S12–S15)—This dimension is represented by four indicators. The highest loading is observed in S15 (γ = 0.881, t = 114.108), which states, “Wellness tourism helps society achieve equality and provides a good and comprehensive service system.” This indicates the social dimension of wellness tourism, focusing on fairness, inclusivity, and service accessibility.
Group 5: Emotional Wellness (S16–S18)—This dimension is represented by three indicators. The highest loading is observed in S17 (γ = 0.927, t = 175.563), which states, “Wellness tourism is intriguing and interesting.” This indicates the importance of emotional appeal in motivating participation in wellness-related activities.
Group 6: Environmental Wellness (S19–S23)—This dimension is represented by three indicators. The highest loading is observed in S19 (γ = 0.873, t = 111.045), which states, “Wellness tourism can enhance the well-being of travelers as they enjoy and immerse themselves in nature.” This indicates that environmental factors and natural surroundings play a critical role in the perceived value of wellness tourism.
Furthermore, we present the results of the second-order CFA, which includes six latent variables identified as factors influencing wellness tourism. The analysis showed that all six external latent variables had factor loadings ranging from 0.838 to 0.968, all exceeding the recommended threshold of 0.70 [77,78], indicating the validity of the wellness tourism construct. Among these, Environmental Wellness had the highest loading (γ = 0.968, t = 192.487), followed by Spiritual Wellness (γ = 0.935, t = 143.044), Mental Wellness (γ = 0.933, t = 158.171), Social Wellness (γ = 0.923, t = 143.044), Emotional Wellness (γ = 0.909, t = 142.141), and lastly, Physical Wellness (γ = 0.838, t = 86.058).

5. Discussion

5.1. Indicators of the Wellness Tourism Factors

The empirical results from the model can contribute to improving the quality of health services to better meet the needs of wellness tourists as well as support Thailand’s development as a hub for wellness tourism. Among the factors analyzed, Environmental Wellness was identified as the most significant, with the highest component loading of 0.968. This factor includes observed variables S19 to S23 and was found to be critically important to wellness tourists. This finding aligns with previous studies indicating that environmentally focused wellness services positively impact overall health [79]. Furthermore, promoting environmental sustainability and enhancing the value of natural resources contribute significantly to the development of wellness tourism [80]. Within the Environmental Wellness factor, the indicator with the highest loading in the model is S19: “Wellness tourism can enhance the well-being of travelers as they enjoy and immerse themselves in nature.” This result corresponds with research showing that interaction with nature provides happiness to wellness tourists, facilitates rapid recovery from stress, and supports emotional mental health therapy [81].
Additionally, the second most influential factor is Spiritual Wellness, with a component loading of 0.935. This factor comprises observed variables S9 to S11 and is identified as an important factor for wellness tourists. This finding aligns with previous studies indicating that Spiritual Wellness services are significantly related to physical activities and good healthcare [82]. Promoting spiritual health is considered essential for achieving holistic well-being [83]. The third-ranked factor is Mental Wellness, with a component loading of 0.933, consisting of variables S5 to S8. Mental Wellness is found to be a key factor influencing wellness tourists. This corresponds with earlier research showing that mental health promotion services are strongly associated with nature-based tourism destinations aimed at health restoration [84]. Fourth is Social Wellness, with a component loading of 0.923, encompassing variables S12 to S15. Social Wellness is recognized as an important factor for wellness tourists, consistent with prior research that found Social Wellness services influence participation intentions in wellness activities through feelings of satisfaction [85]. Fifth is Emotional Wellness, with a component loading of 0.909, composed of variables S16 to S18. Emotional Wellness plays a significant role for wellness tourists, supported by studies demonstrating that Emotional Wellness services directly affect the quality of wellness tourism experiences [86]. Finally, Physical Wellness has a component loading of 0.838 and includes variables S1 to S4. Physical Wellness is a crucial factor for wellness tourists, as previous studies have shown that Physical Wellness services are an important health dimension impacted by wellness tourism [45].
Therefore, the results of this study conclude that these factors can be used as statistically significant indicators for wellness tourism promotion services. This supports the first hypothesis of the model, which posited that an appropriate measurement model for wellness tourism factors should comprise six dimensions: Physical Wellness (H1a), Mental Wellness (H1b), Spiritual Wellness (H1c), Social Wellness (H1d), Emotional Wellness (H1e), and Environmental Wellness (H1f). Hence, this hypothesis is accepted.

5.2. The Relationship Between Demographic Characteristics and Wellness Tourism

Demographic variables are important factors to consider when examining the motivations behind wellness tourism. The findings of this study reveal that gender has a positive influence on wellness tourism, supporting Hypothesis 2. This suggests that gender differences positively affect behavior in wellness tourism. This aligns with previous research indicating that women may perceive greater value and benefits in preventive healthcare than men, making gender a significant factor influencing the popularity of medical tourism [87]. Additionally, income was found to have a positive effect on wellness tourism, supporting Hypothesis 4. This can be explained by the fact that income differences positively influence wellness tourism behaviors. Prior studies have shown that individuals with higher incomes tend to seek preventive healthcare rather than waiting to treat illness and that income significantly affects motivation in decision-making related to wellness tourism [88]. Finally, occupation was found to have a positive influence on wellness tourism, supporting Hypothesis 5. This suggests that occupational differences positively affect wellness tourism behaviors. This finding is novel, as previous studies have not explored this relationship extensively. It can be concluded that certain occupational groups are more inclined toward wellness tourism because their job characteristics impact income, free time, health values, and stress levels, which in turn relate to their choices of wellness tourism destinations and services. Therefore, it can be concluded that gender, income, and occupation are all statistically significant positive factors influencing wellness tourism.
On the other hand, the results also reveal an important finding: although age is statistically significant, it has a negative relationship with wellness tourism. This contradicts the original hypothesis, leading to the rejection of Hypothesis 3. This suggests that age may negatively influence participation in wellness tourism, a finding not previously reported. It can be explained that age differences may act as a barrier to decision-making for wellness tourists. Specifically, older individuals are less likely to participate in wellness tourism activities, possibly due to health, physical, and travel limitations. This contrasts with previous studies, which found that health-promoting tourism has a positive impact on aging, emphasizing that personal characteristics of older adults—such as physical strength, social readiness, and a positive attitude—significantly influence the benefits they gain from wellness tourism [89].

5.3. The Relationship Between Wellness Tourism Factors and the Theory of Planned Behavior (TPB) in Relation to the Intention to Use Wellness Tourism Services

The findings revealed that wellness tourism has a positive influence on the intention to use wellness tourism services, leading to the acceptance of Hypothesis 6. This suggests that individuals’ perceptions and experiences with wellness tourism positively contribute to their intention to use such services. This result aligns with previous studies indicating that the perceived value of wellness tourism significantly influences service usage intention [90].
In addition, it was found that attitude has a positive influence on the intention to use wellness tourism services, leading to the acceptance of Hypothesis 7. This indicates that individuals with a positive attitude toward wellness tourism are more likely to intend to engage in such services. Moreover, subjective norms also have a positive influence on the intention to use wellness tourism services, resulting in the acceptance of Hypothesis 8. This suggests that individuals influenced by social factors or significant others such as family, friends, or their surrounding community tend to have a higher intention to choose wellness tourism services. These findings are consistent with prior research, which found that attitude and subjective norms directly affect the behavioral intention to engage in wellness tourism services [91]. Therefore, it can be concluded that wellness tourism, attitude, and subjective norms are all statistically significant positive predictors of the intention to use wellness tourism services.
However, it was found that perceived behavioral control was not statistically significant, resulting in the rejection of Hypothesis 9. This indicates that perceived behavioral control does not exert a positive influence on the intention to engage in wellness tourism services. This can be explained by the fact that although individuals may feel capable of participating in wellness tourism, such perceptions do not directly affect their intention to use the services within the context of the sampled population. Therefore, these results reflect a deviation from the proposed hypothesis. While previous studies in tourism-related contexts have reported a significant effect of perceived behavioral control on behavioral intention [92,93], the present study found contradictory results, highlighting contextual differences in this case. The findings suggest that even though the highest factor loading indicates that respondents perceive participation in wellness tourism as easy and comparable to maintaining health through conventional practices, this perceived ease alone may not be sufficient to stimulate intention. Instead, tourists may consider other more influential factors, such as attitude, awareness of wellness tourism, and subjective norms.

6. Conclusions, Implications, and Research Limitations

Thailand is one of the countries with high potential to become a hub for wellness tourism in Southeast Asia due to its internationally recognized medical services and abundant tourism resources. The country is home to several world-class tourist destinations, including UNESCO World Heritage Sites such as the Dong Phayayen–Khao Yai Forest Complex in Nakhon Ratchasima Province and the Phanom Rung Historical Park in Buriram Province. These destinations have the ability to attract both domestic and international tourists who wish to experience new forms of tourism combined with healthcare in the modern era. Therefore, this study aims to examine the key factors affecting wellness tourism in Thailand. This study presents a model that combines Exploratory Factor Analysis and Confirmatory Factor Analysis to identify new findings from the created model. The results reveal valuable insights into the factors influencing health tourism through interviews with 1200 tourists.

6.1. Conclusions

The summary of the key findings from this study revealed that all 23 observed variables in the model significantly indicated the six factors of wellness tourism. Among them, Environmental Wellness exhibited the highest factor loading, followed by Spiritual Wellness, Mental Wellness, Social Wellness, Emotional Wellness, and Physical Wellness, respectively. These results also demonstrate a high level of domain reliability. When considering the demographic variables, gender, income, and occupation were found to have a statistically significant positive influence on wellness tourism. Although age was also statistically significant, it demonstrated a negative relationship, suggesting that age may act as a limiting factor in wellness tourism behavior. Furthermore, the findings indicate that wellness tourism, attitude, and subjective norms have a statistically significant positive effect on the intention to use wellness tourism services. In contrast, perceived behavioral control was not statistically significant in the model. Nevertheless, this study not only presents important new insights but also offers policy recommendations to guide the development of wellness tourism services in a way that more effectively meets the needs of users.
Therefore, the theoretical contribution of this study lies in expanding knowledge in the field of wellness tourism by integrating multiple dimensions of holistic health including physical, mental, spiritual, social, emotional, and environmental aspects. Additionally, this study analyzes the relationships between wellness tourism factors and the intention to use wellness tourism services through the application of the Theory of Planned Behavior (TPB). This approach leads to the development of an empirical framework that validates the interrelationships among these constructs, providing a solid foundation for future research. Furthermore, this study contributes to refining and testing theoretical hypotheses, particularly in the context of wellness tourists in Thailand, which is located in Southeast Asia and has been insufficiently explored in the existing literature. From a practical perspective, the findings offer valuable recommendations for policymakers, including both government agencies and tourism industry operators. These recommendations can be applied to enhance the development of wellness tourism that effectively meets tourists’ comprehensive well-being needs. Moreover, the results can serve as a guideline to enhance the competitiveness of tourism destinations and to sustainably attract wellness tourists.

6.2. Implementation

The researchers propose policies for promoting wellness tourism along with development guidelines appropriate for driving these policies forward based on the key findings identified in the model. Accordingly, all development policies are presented and prioritized. The policy that should receive the highest priority is the Environmental Wellness Tourism Promotion Policy, followed by the others in order of importance. All details are presented in Table 8.
These policies will enable stakeholders in tourism development—both in the public sector, such as the Department of Tourism and the Ministry of Public Health, and in the private sector, such as hotel and restaurant operators—to effectively apply them in formulating guidelines or strategies for the advancement of wellness tourism. This will, in turn, help create wellness tourism activities that attract a greater number of tourists.

6.3. Limitation of the Study

Regarding the limitations of this study, data were collected only from tourists in four provinces within the northeastern region of Thailand. Therefore, future studies could expand the geographical scope to include perspectives from people across all regions of the country. Moreover, this type of research can be extended to other countries as well given that wellness tourism remains an important issue that warrants further investigation. Future researchers are encouraged to explore this topic from additional perspectives in order to uncover more in-depth information and new findings.

Author Contributions

Conceptualization, K.T. and R.K.; methodology, K.T., P.W. and C.B.; software, K.T.; validation, P.W., N.J. and R.K.; formal analysis, K.T. and R.K.; investigation, K.T.; resources, K.T., M.S., P.P. and N.J.; data curation, K.T., M.S. and P.P.; writing—original draft preparation, K.T. and R.K.; writing—review and editing, K.T., R.K., P.W. and C.B.; visualization, K.T. and R.K.; supervision, V.R., A.A. and R.K.; project administration, V.R., A.A. and R.K.; funding acquisition, R.K. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by Suranaree University of Technology (SUT), Thailand Science Research and Innovation (TSRI), and National Science, Research and Innovation Fund (NSRF) (Project code: 204314).

Institutional Review Board Statement

This study was approved by the Human Research Ethics Committee of Suranaree University of Technology (protocol code COE No. 197/2567, date of approval: 18 December 2024). The authors have obtained all the ethical approvals about this paper. The authors declare to obey all the academic ethical standards.

Informed Consent Statement

Informed consent was obtained from all subjects involved in this study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

The authors express their gratitude to the Suranaree University of Technology (SUT), Thailand Science Research and Innovation (TSRI), and National Science, Research and Innovation Fund (NSRF) (Project code: 204314) for their support in conducting this research.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. List of items in the questionnaire.
Table A1. List of items in the questionnaire.
Description
Physical Wellness
  • Wellness tourism offers healthy food options that are hygienic, beneficial to the body, and delicious.
  • Wellness tourism provides a favorable environment that is eco-friendly and suitable for recovery, featuring fresh air and close proximity to nature.
  • Wellness tourism offers beautifully decorated hotels with impressive services.
  • Wellness tourism provides comprehensive facilities, such as fitness centers and swimming pools.
Mental Wellness
  • Wellness tourism provides a sense of relaxation and satisfaction with the services.
  • Wellness tourism makes you feel that your life is filled with happiness.
  • Wellness tourism provides relaxation and alleviates concerns about health care.
  • Wellness tourism makes you feel that you are effectively taking care of both your physical and mental health.
Spiritual Wellness
  • Wellness tourism provides a sense of confidence in the services offered.
  • Wellness tourism gives a positive feeling when seeing family or loved ones experience it just like I did.
  • Wellness tourism provides a sense of peace and tranquility when experiencing services such as meditation, yoga, and others.
Social Wellness
  • Wellness tourism helps improve the physical health of people in Thai society.
  • Wellness tourism makes society more compassionate and considerate towards one another.
  • Wellness tourism helps develop Thailand’s health and tourism businesses, such as healthcare services and beauty enhancement businesses.
  • Wellness tourism helps society achieve equality and provides a good and comprehensive service system.
Emotional Wellness
  • Wellness tourism provides a sense of value and worth.
  • Wellness tourism is intriguing and interesting.
  • Wellness tourism can effectively meet the needs of health tourists.
Environmental Wellness
  • Wellness tourism can enhance the well-being of travelers as they enjoy and immerse themselves in nature.
  • Wellness tourism helps raise awareness about environmental issues, such as pollution.
  • Wellness tourism helps foster a sense of the importance of preserving the environment.
  • Wellness tourism impacts the accessibility of natural resources, such as eco-tourism and nature conservation tourism.
  • Wellness tourism helps ensure the proper allocation and utilization of available resources.
Intention
  • I intend to use wellness tourism services, which involve traveling for the purpose of maintaining or improving health while also engaging in leisure activities.
  • I intend to recommend wellness tourism to members of my family.
  • I intend to recommend wellness tourism to people in my social circle.
  • I intend to engage in wellness tourism services should the opportunity arise.
Attitude
  • I recognize the significance of wellness tourism.
  • Attitudes regarding good healthcare play a significant role in encouraging tourism participation.
  • Wellness tourism positively impacts the well-being of people in Thai society.
  • I have awareness of and a good understanding of wellness tourism.
Subjective Norms
  • If a friend recommends that I try wellness tourism services, I believe this recommendation would have a greater influence on my decision to use them.
  • If a celebrity (such as an actor, YouTuber, or influencer) uses or reviews wellness tourism services, it would increase my desire to try them.
  • Promotions and advertising via different media channels regarding wellness tourism motivate my interest in utilizing these services.
  • Visual and appealing content about wellness tourism on media platforms like TikTok motivates me to consider using the services.
Perceived Behavioral Control
  • Traveling to the wellness service location is convenient and within my ability.
  • The process of booking or purchasing wellness care programs is not beyond my ability.
  • I perceive that wellness tourism services are as accessible and straightforward to use as regular healthcare services.
  • I perceive wellness tourism services as straightforward and easy to access.
  • Although I have never experienced wellness tourism, I think the services are easy to use and available to all.

References

  1. Smith, M.; Puczkó, L. Health and wellness tourism; Routledge: Oxfordshire, UK, 2008. [Google Scholar]
  2. Kulshreshtha, S.K.; Michopoulou, E. Wellness Tourism in Asia: Emerging Destinations to Rejuvenate, Relax and Retreat; Springer Nature: Berlin/Heidelberg, Germany, 2025. [Google Scholar]
  3. Statistics, W. Monitoring Health for the SDGs Sustainable Development Goals; World Health Organization: Geneva, Switzerland, 2017. [Google Scholar]
  4. The International Healthcare Research Center. Medical Tourism Association. 2017. Available online: https://www.healthcareresearchcenter.org/ (accessed on 28 March 2025).
  5. Medical Travel Quality Alliance. Thailand—The hub of Asia’s Medical Tourism. 2019. Available online: https://mtqua.org/countries/thailand-medical-tourism/ (accessed on 28 March 2025).
  6. Public Relations Department. Development of Medical and Health Tourism. 2023. Available online: https://thailand.go.th/issue-focus-detail/001_03_037?hl=th (accessed on 29 March 2025).
  7. Institute, G.W. The Global Wellness Economy: Country Rankings: Data for 2019–2022; Global Wellness Institute: Miami, FL, USA, 2024. [Google Scholar]
  8. Thailand National Tourism. Thai Tourist Attractions Ranked in the World. 2023. Available online: https://www.thailandconnex.com/%E0%B8%AA%E0%B8%96%E0%B8%B2%E0%B8%99%E0%B8%97%E0%B8%B5%E0%B9%88%E0%B8%97%E0%B9%88%E0%B8%AD%E0%B8%87%E0%B9%80%E0%B8%97%E0%B8%B5%E0%B9%88%E0%B8%A2%E0%B8%A7%E0%B9%84%E0%B8%97%E0%B8%A2/ (accessed on 29 March 2025).
  9. World Tourism Organization. International Tourism Highlights—2019 Edition; UNWTO: Madrid, Spain, 2019. [Google Scholar]
  10. Aydin, G.; Karamehmet, B. Factors affecting health tourism and international health-care facility choice. Int. J. Pharm. Healthc. Mark. 2017, 11, 16–36. [Google Scholar] [CrossRef]
  11. Wendri, I.G.M.; Bakta, I.M.; Suprapti, N.W.S.; Ardika, I.W. Various factors contributive toward tourist intention in enjoying wellness tourism. Int. J. Linguist. Lit. Cult. 2019, 5, 61–70. [Google Scholar] [CrossRef][Green Version]
  12. Yao, Y.; Wang, G.; Ren, L.; Qiu, H. Exploring tourist citizenship behavior in wellness tourism destinations: The role of recovery perception and psychological ownership. J. Hosp. Tour. Manag. 2023, 55, 209–219. [Google Scholar] [CrossRef]
  13. Mikulić, J.; Šerić, M.; Krešić, D. Asymmetric effects of wellness destination and wellness facility attributes on tourist satisfaction. Tour. Rev. 2024, 79, 969–980. [Google Scholar] [CrossRef]
  14. Mato-Juhasz, A.; Kiss-Toth, E.; Szegedi, K. Holistic health model of sustainable development. Eur. Sci. J. 2016, 12. [Google Scholar] [CrossRef]
  15. Vardar Inkaya, B.; Bilgehan, T.; Avino, K. A psychometric analysis of the adaptation of the integrative health and wellness assessment to Turkish. Estud. Public. Health J. 2025, 10, 72. [Google Scholar]
  16. Kongtaveesawas, N.; Prasarnphanich, P.; Sinthupinyo, S.; Ashton, A.S. Attribute framework validation for wellness tourism within the context of Thailand. Sustainability 2022, 14, 5953. [Google Scholar] [CrossRef]
  17. Saylor, C. The circle of health: A health definition model. J. Holist. Nurs. 2004, 22, 97–115. [Google Scholar] [CrossRef] [PubMed]
  18. Ciotti, M.; Ciccozzi, M.; Terrinoni, A.; Jiang, W.-C.; Wang, C.-B.; Bernardini, S. The COVID-19 pandemic. Crit. Rev. Clin. Lab. Sci. 2020, 57, 365–388. [Google Scholar] [CrossRef]
  19. Velavan, T.P.; Meyer, C.G. The COVID-19 epidemic. Trop. Med. Int. Health 2020, 25, 278. [Google Scholar] [CrossRef] [PubMed]
  20. Hung, S.-T.; Cheng, Y.-C.; Wu, C.-C.; Su, C.-H. Examining physical wellness as the fundamental element for achieving holistic well-being in older persons: Review of literature and practical application in Daily Life. J. Multidiscip. Healthc. 2023, 1889–1904. Available online: https://www.tandfonline.com/doi/abs/10.2147/JMDH.S419306%4010.1080/tfocoll.2024.0.issue-approaches-for-evidence-based-medicine (accessed on 29 March 2025). [CrossRef]
  21. Williams, G.C.; Teixeira, P.J.; Carraça, E.V.; Resnicow, K. Physical wellness, health care, and personal autonomy. In Human Autonomy in Cross-Cultural Context: Physical Wellness, Health Care, and Personal Autonomy; Springer: Dordrecht, The Netherlands, 2011; pp. 133–162. [Google Scholar]
  22. Bodeker, G.; Pecorelli, S.; Choy, L.; Guerra, R.; Kariippanon, K. Well-being and mental wellness. In Oxford Research Encyclopedia of Global Public Health; Oxford University Press: Oxford, UK, 2020. [Google Scholar]
  23. Orth, Z.; Moosajee, F.; Van Wyk, B. Measuring mental wellness of adolescents: A systematic review of instruments. Front. Psychol. 2022, 13, 835601. [Google Scholar] [CrossRef] [PubMed]
  24. Hawks, S. Spiritual wellness, holistic health, and the practice of health education. Am. J. Health Educ. 2004, 35, 11–18. [Google Scholar] [CrossRef]
  25. Koenig, H.G. Spirituality, wellness, and quality of life. Sex. Reprod. Menopause 2004, 2, 76–82. [Google Scholar] [CrossRef]
  26. Wray, M.; Laing, J.; Voigt, C. Byron Bay: An alternate health and wellness destination. J. Hosp. Tour. Manag. 2010, 17, 158–166. [Google Scholar] [CrossRef]
  27. da Costa, R.A.; Almeida, L.F.; Chim-Miki, A.F.; Brandão, F. Identifying social value in tourism: The role of sociocultural indicators. J. Hosp. Tour. Manag. 2025, 62, 148–162. [Google Scholar] [CrossRef]
  28. Khattak, A.M.; Khan, W.A.; Pervez, Z.; Iqbal, F.; Lee, S. Towards a self adaptive system for social wellness. Sensors 2016, 16, 531. [Google Scholar] [CrossRef]
  29. Rehman, R.; Hussain, M.; Syed, F.; Khan, R. Social wellbeing: A positive energy for wellness in medical students. J. Postgrad. Med. Inst. 2014, 28. Available online: https://jpmi.org.pk/index.php/jpmi/article/view/1590 (accessed on 29 March 2025).
  30. McNeeley, M.F.; Perez, F.A.; Chew, F.S. The emotional wellness of radiology trainees: Prevalence and predictors of burnout. Acad. Radiol. 2013, 20, 647–655. [Google Scholar] [CrossRef]
  31. Park, C.L.; Kubzansky, L.D.; Chafouleas, S.M.; Davidson, R.J.; Keltner, D.; Parsafar, P.; Conwell, Y.; Martin, M.Y.; Hanmer, J.; Wang, K.H. Emotional well-being: What it is and why it matters. Affect. Sci. 2023, 4, 10–20. [Google Scholar] [CrossRef]
  32. Amaya, M.; Melnyk, B.M.; Neale, S. Environmental wellness. Am. Nurse Today 2018, 13, 94–95. [Google Scholar]
  33. Dolnicar, S.; Greene, D. Research for environmentally sustainable tourism–All talk, no action? J. Hosp. Tour. Manag. 2025, 62, 28–33. [Google Scholar] [CrossRef]
  34. Katpar, S.; Khan, R.; Siddiqu, R.; Hussain, M.; Rehman, R. Perceptions of medical students regarding dimensions of environmental wellness. JPMA J. Pak. Med. Assoc. 2016, 66, 373. [Google Scholar]
  35. Chan, C.W.; Wong, F.K.Y.; Yeung, S.M.; Sum, F. Holistic health status questionnaire: Developing a measure from a Hong Kong Chinese population. Health Qual. Life Outcomes 2016, 14, 28. [Google Scholar] [CrossRef]
  36. Andrews, T.; Crosby, G.; Carrigan, R.; Fewell, C.; Ly, S.; Papworth, M.; Santos, K.; Timilsina, A.; Donnelly, T.T. Enhancing employees’ health and well-being: Developing a successful holistic wellness challenge. Int. J. Nurs. Stud. Scholarsh. 2019, 6. Available online: https://journalhosting.ucalgary.ca/index.php/ijnss/article/view/61842 (accessed on 29 March 2025).
  37. Težak Damijanić, A. Wellness and healthy lifestyle in tourism settings. Tour. Rev. 2019, 74, 978–989. [Google Scholar] [CrossRef]
  38. Meera, S.; Vinodan, A. Attitude towards alternative medicinal practices in wellness tourism market. J. Hosp. Tour. Insights 2019, 2, 278–295. [Google Scholar] [CrossRef]
  39. Steele, L. Health and wellness: Holistic and complementary methods. In Good Health and Well-Being. Encyclopedia of the UN Sustainable Development Goals; Springer: Cham, Switzerland, 2020; pp. 293–304. [Google Scholar]
  40. Dillette, A.K.; Douglas, A.C.; Andrzejewski, C. Dimensions of holistic wellness as a result of international wellness tourism experiences. Curr. Issues Tour. 2021, 24, 794–810. [Google Scholar] [CrossRef]
  41. George, R.J.; Menon, S.A.; Sahu, C.; Patel, H.; Thakur, N.; Sam, S.T. Level of holistic health & wellness and its percieved influencing factors among baccalaureate nursing students: A mixed approach. Int. J. Nurs. Educ. 2020, 12, 36–41. [Google Scholar]
  42. Schoon, P.M.; Krumwiede, K. A holistic health determinants model for public health nursing education and practice. Public Health Nurs. 2022, 39, 1070–1077. [Google Scholar] [CrossRef]
  43. Wong, E.; Mavondo, F.; Horvat, L.; McKinlay, L.; Fisher, J. Healthcare professionals’ perspective on delivering personalised and holistic care: Using the theoretical domains framework. BMC Health Serv. Res. 2022, 22, 281. [Google Scholar] [CrossRef]
  44. Locsin, B. Holistic Health: Integrating psychological factors for a balanced life. J. Asian Multicult. Res. Med. Health Sci. Study 2023, 4, 19–26. [Google Scholar] [CrossRef]
  45. Liao, C.; Zuo, Y.; Xu, S.; Law, R.; Zhang, M. Dimensions of the health benefits of wellness tourism: A review. Front. Psychol. 2023, 13, 1071578. [Google Scholar] [CrossRef] [PubMed]
  46. Arphawatthansakul, L.; Punyasiri, S. The structural equation model of decomposed theory of planned behavior to visit thailand as holistic wellness destination via life quality & well-being. J. Roi Kaensarn Acad. 2024, 9, 162–184. [Google Scholar]
  47. Argus-Calvo, B.; Clegg, D.J.; Francis, M.D.; Dwivedi, A.K.; Carrola, P.A.; Leiner, M. A holistic approach to sustain and support lifelong practices of wellness among healthcare professionals: Generating preliminary solid steps towards a culture of wellness. BMC Med. Educ. 2024, 24, 1364. [Google Scholar] [CrossRef]
  48. Jeong, H. The impact of wellness perception on behavioral intention of templestay participants as a wellness tourism resource. J. Hosp. Tour. Stud. 2024, 26, 49–65. [Google Scholar] [CrossRef]
  49. Zhou, Y.; Liu, L.; Han, S.; Sun, X. Comparative analysis of the behavioral intention of potential wellness tourists in China and South Korea. Humanit. Soc. Sci. Commun. 2023, 10, 489. [Google Scholar] [CrossRef]
  50. Dash, A. Understanding the determinants of revisit intentions in wellness tourism through domestic and global lenses. J. Qual. Assur. Hosp. Tour. 2025, 1–24. [Google Scholar] [CrossRef]
  51. Do, T.T.; Nguyen, H.N.T. Understanding Gen Y’s Intentions toward Wellness Tourism in Vietnam: A Theory of Planned Behavior Approach. In Routledge Handbook of Tourism and Hospitality Development in Vietnam; Routledge: Oxfordshire, UK, 2025; pp. 296–311. [Google Scholar]
  52. Ajzen, I. The theory of planned behavior: Frequently asked questions. Hum. Behav. Emerg. Technol. 2020, 2, 314–324. [Google Scholar] [CrossRef]
  53. Kyriazos, T.A. Applied psychometrics: Sample size and sample power considerations in factor analysis (EFA, CFA) and SEM in general. Psychology 2018, 9, 2207. [Google Scholar] [CrossRef]
  54. Theerathitichaipa, K.; Wisutwattanasak, P.; Banyong, C.; Seefong, M.; Jomnonkwao, S.; Champahom, T.; Ratanavaraha, V.; Kasemsri, R. Measurement model for determining the disparity factors of intercity railway transportation. Civ. Eng. J. 2024, 10, 668–688. [Google Scholar] [CrossRef]
  55. Ullman, J.B.; Bentler, P.M. Structural equation modeling. In Handbook of Psychology: Research Methods in Psychology, 2nd ed.; Schinka, J.A., Velicer, W.F., Eds.; John Wiley & Sons, Inc.: Hoboken, NJ, USA, 2012; Volume 2. [Google Scholar]
  56. Ferri Sanz, M.; Durá Ferrandis, E.; Garcés Ferrer, J. Service quality scales and tourists with special needs: A systematic review. Sustainability 2019, 11, 3844. [Google Scholar] [CrossRef]
  57. Huang, S. Measuring tourist motivation: Do scales matter? Tourismos 2010, 5, 153–162. [Google Scholar]
  58. Agah, J.; Ocheni, C.; Ezugwu, I.; Nnaji, A.; Nnenanya, G.; Eke, J. Application of item objective congruence index (ioc-index) for proper alignment of 2020 physics wassce items with objectives and content. J. Educ. 2024, 9, 57–63. [Google Scholar]
  59. Department of Provincial Administration. Population Statistics Data. 2024. Available online: https://catalog.dopa.go.th/dataset/dopa-star (accessed on 9 April 2025).
  60. Cangür, Ş.; Ercan, I. Comparison of model fit indices used in structural equation modeling under multivariate normality. J. Mod. Appl. Stat. Methods 2015, 14, 152–167. [Google Scholar] [CrossRef]
  61. Garson, G.D. Testing Statistical Assumptions; Statistical Associates Publishing: Asheboro, NC, USA, 2012. [Google Scholar]
  62. Kline, R.B. Principles and Practice of Structural Equation Modeling; Guilford Press: New York, NY, USA, 2023. [Google Scholar]
  63. Bujang, M.A.; Omar, E.D.; Baharum, N.A. A review on sample size determination for cronbach’s alpha test: A simple guide for researchers. Malays. J. Med. Sci. MJMS 2018, 25, 85. [Google Scholar] [CrossRef]
  64. Tavakol, M.; Dennick, R. Making sense of Cronbach’s alpha. Int. J. Med. Educ. 2011, 2, 53. [Google Scholar] [CrossRef]
  65. Fabrigar, L.R.; Wegener, D.T.; MacCallum, R.C.; Strahan, E.J. Evaluating the use of exploratory factor analysis in psychological research. Psychol. Methods 1999, 4, 272. [Google Scholar] [CrossRef]
  66. Hair, J.F., Jr.; Black, W.C.; Babin, B.J.; Anderson, R.E. Multivariate Data Analysis, 7th ed.; Pearson: London, UK, 2009. [Google Scholar]
  67. Akoglu, H. User’s guide to correlation coefficients. Turk. J. Emerg. Med. 2018, 18, 91–93. [Google Scholar] [CrossRef] [PubMed]
  68. Ab Hamid, M.R.; Sami, W.; Sidek, M.M. Discriminant validity assessment: Use of fornell & larcker criterion versus HTMT criterion. J. Phys. Conf. Ser. 2017, 890, 012163. [Google Scholar]
  69. Koç, Ş.; Yavuz, E. Factor analysis for construct validity: An applied study. Sci. Educ. Stud. 2022, 6, 239–258. [Google Scholar] [CrossRef]
  70. Yusof, J.M.; Musa, R.; Rahman, S.A. The effects of green image of retailers on shopping value and store loyalty. Procedia-Soc. Behav. Sci. 2012, 50, 710–721. [Google Scholar] [CrossRef]
  71. Hooper, D.; Coughlan, J.; Mullen, M. Structural equation modelling: Guidelines for determining model fit structural equation modelling: Guidelines for determining model fit. Electron. J. Bus. Res. Methods 2008, 6, 53–60. [Google Scholar]
  72. Schubert, A.-L.; Hagemann, D.; Voss, A.; Bergmann, K. Evaluating the model fit of diffusion models with the root mean square error of approximation. J. Math. Psychol. 2017, 77, 29–45. [Google Scholar] [CrossRef]
  73. Schreiber, J.B.; Nora, A.; Stage, F.K.; Barlow, E.A.; King, J. Reporting structural equation modeling and confirmatory factor analysis results: A review. J. Educ. Res. 2006, 99, 323–338. [Google Scholar] [CrossRef]
  74. Boduszek, D.; Hyland, P.; Dhingra, K.; Mallett, J. The factor structure and composite reliability of the Rosenberg Self-Esteem Scale among ex-prisoners. Personal. Individ. Differ. 2013, 55, 877–881. [Google Scholar] [CrossRef]
  75. Raykov, T. Estimation of composite reliability for congeneric measures. Appl. Psychol. Meas. 1997, 21, 173–184. [Google Scholar] [CrossRef]
  76. Haji-Othman, Y.; Yusuff, M.S.S. Assessing reliability and validity of attitude construct using partial least squares structural equation modeling. Int. J. Acad. Res. Bus. Soc. Sci. 2022, 12, 378–385. [Google Scholar] [CrossRef]
  77. Hair, J.F., Jr.; Hult, G.T.M.; Ringle, C.M.; Sarstedt, M.; Danks, N.P.; Ray, S. Partial Least Squares Structural Equation Modeling (PLS-SEM) Using R: A Workbook; Springer Nature: Berlin/Heidelberg, Germany, 2021. [Google Scholar]
  78. Leguina, A. A primer on partial least squares structural equation modeling (PLS-SEM). Int. J. Res. Method Educ. 2015, 38, 220–221. [Google Scholar] [CrossRef]
  79. Melnyk, B.M.; Szalacha, L.A.; Amaya, M. Psychometric properties of the perceived wellness culture and environment support scale. Am. J. Health Promot. 2018, 32, 1021–1027. [Google Scholar] [CrossRef] [PubMed]
  80. Andreu, M.G.N.-l.; Font-Barnet, A.; Roca, M.E. Wellness tourism—New challenges and opportunities for tourism in Salou. Sustainability 2021, 13, 8246. [Google Scholar] [CrossRef]
  81. Buckley, R. Nature tourism and mental health: Parks, happiness, and causation. J. Sustain. Tour. 2020, 28, 1409–1424. [Google Scholar] [CrossRef]
  82. Rachele, J.N.; Cuddihy, T.F.; Washington, T.L.; McPhail, S.M. The association between adolescent self-reported physical activity and wellness: The missing piece for youth wellness programs. J. Adolesc. Health 2014, 55, 281–286. [Google Scholar] [CrossRef]
  83. Ghiya, G.D. Promoting spiritual health and holistic wellness. J. Health Manag. 2019, 21, 230–233. [Google Scholar] [CrossRef]
  84. Cooper, M.-A.; Buckley, R. Tourist mental health drives destination choice, marketing, and matching. J. Travel. Res. 2022, 61, 786–799. [Google Scholar] [CrossRef]
  85. Phetsome, S.; Ashton, S. The relationship among wellness tourism, attitude toward wellness activities, social media norms, satisfaction wellness activities and intention to participate wellness activities. case study: Thailand riviera area. Rajapark J. 2024, 18, 234–253. [Google Scholar]
  86. Chi, C.G.-q.; Chi, O.H.; Ouyang, Z. Wellness hotel: Conceptualization, scale development, and validation. Int. J. Hosp. Manag. 2020, 89, 102404. [Google Scholar] [CrossRef]
  87. Sivuk, D. Gender-based differences in medical tourists’ destination preferences and their perception of quality of life. In Handbook of Tourism and Quality-of-Life Research II: Enhancing the Lives of Tourists, Residents of Host Communities and Service Providers; Springer: Berlin/Heidelberg, Germany, 2023; pp. 167–180. [Google Scholar]
  88. Pinthong, C.; Rodhring, K. Driving factors influencing international affluent tourists’ decision in wellness tourism in the eastern economic corridor: A case study of chonburi province. J. Appl. Econ. Manag. Strategy 2025, 12, 190–204. [Google Scholar]
  89. Qiao, G.; Ding, L.; Xiang, K.; Prideaux, B.; Xu, J. Understanding the value of tourism to seniors’ health and positive aging. Int. J. Environ. Res. Public Health 2022, 19, 1476. [Google Scholar] [CrossRef]
  90. Gan, T.; Zheng, J.; Li, W.; Li, J.; Shen, J. Health and wellness tourists’ motivation and behavior intention: The role of perceived value. Int. J. Environ. Res. Public Health 2023, 20, 4339. [Google Scholar] [CrossRef]
  91. Pu, L.; Kusirisin, P.; Leelapattana, W.; Yomkerd, J. Factor that influencing tourist behavior intentions of health tourism in the Nanning City of China. J. Multidiscip. Soc. Sci. 2022, 18, 11–20. [Google Scholar]
  92. Khajehshahkoohi, M.; Davoodi, S.R.; Shaaban, K. Factors affecting the behavioral intention of tourists on the use of bike sharing in tourism areas. Res. Transp. Bus. Manag. 2022, 43, 100742. [Google Scholar] [CrossRef]
  93. Quintal, V.A.; Lee, J.A.; Soutar, G.N. Risk, uncertainty and the theory of planned behavior: A tourism example. Tour. Manag. 2010, 31, 797–805. [Google Scholar] [CrossRef]
  94. Fachrudin, H.T.; Yasmin, D.A. Healing environment approach on wellness center design toward sustainable development. IOP Conf. Ser. Earth Environ. Sci. 2025, 1452, 012024. [Google Scholar] [CrossRef]
  95. Nicolaides, A.; Grobler, A. Spirituality, Wellness tourism and quality of life. Afr. J. Hosp. Tour. Leis. 2017, 6, 1–37. [Google Scholar]
  96. Maurya, R.K.; DeDiego, A.C.; Bruce, M.A. Application of yoga as a spiritual practice to enhance counselor wellness and effectiveness. Couns. Values 2021, 66, 57–72. [Google Scholar] [CrossRef]
  97. National Health Commission Office. Economic-Health and Well-being Policy. Available online: https://www.mcot.net/view/MgSN8ebk (accessed on 11 April 2025).
  98. Lakićević, M.; Pantović, D.; Fedajev, A. Investigating factors of customer loyalty formation for wellness spa. Manag. J. Sustain. Bus. Manag. Solut. Emerg. Econ. 2024, 29, 53–62. [Google Scholar] [CrossRef]
  99. Kim, C.E.; Shin, J.-S.; Lee, J.; Lee, Y.J.; Kim, M.-r.; Choi, A.; Park, K.B.; Lee, H.-J.; Ha, I.-H. Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: A cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals. BMC Complement. Altern. Med. 2017, 17, 174. [Google Scholar] [CrossRef]
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Figure 1. Conceptual framework of wellness tourism.
Figure 1. Conceptual framework of wellness tourism.
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Figure 2. Research process steps.
Figure 2. Research process steps.
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Figure 3. Summary of the overall results of the model. (*) denoting that the factors are statistically significant.
Figure 3. Summary of the overall results of the model. (*) denoting that the factors are statistically significant.
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Table 1. A summary of previous studies on factors related to wellness tourism.
Table 1. A summary of previous studies on factors related to wellness tourism.
AuthorCountryYearFactorsMethod
PhysicalMentalSpiritualSocialEmotionalEnvironmental
[35]Hong Kong2016 ●●● EFA
[36]Canada2019●● ● PHPM
[37]Croatia2019● ● Multinomial regression analysis and CFA
[38]India2019●● ●● CFA
[39] South Africa2020●●● ● Complementary methods
[40]USA2021●●● ●Netnography analysis
[41]India2022●●● ANOVA
[42]USA2022 ● ●HHDM
[43]Australia2022 ● ●CFA
[44]Philippines2023 ● ● Descriptive statistical
[45]China2023●● ● ●Large array of interdisciplinary studies
[46]Thailand2024●● SEM
[47] USA2024 ●● Statistical methods
This studyThailand2025●●●●●●EFA and SEM
Note: PHPM = Population Health Promotion Model; ANOVA = analysis of variance; HHDM = Holistic Health Determinants Model; SEM = Structural Equation Model; EFA = Exploratory Factor Analysis; CFA = Confirmatory Factor Analysis.
Table 2. Statistical summary: mean, standard deviation, skewness, and kurtosis (n = 1200).
Table 2. Statistical summary: mean, standard deviation, skewness, and kurtosis (n = 1200).
VariableDescriptionMeanSDSkewnessKurtosis
S1Wellness tourism offers healthy food options that are hygienic, beneficial to the body, and delicious.5.791.135−1.2101.731
S2Wellness tourism provides a favorable environment that is eco-friendly and suitable for recovery, featuring fresh air and close proximity to nature.5.881.057−1.1791.930
S3Wellness tourism offers beautifully decorated hotels with impressive services.5.801.110−1.1221.386
S4Wellness tourism provides comprehensive facilities, such as fitness centers and swimming pools.5.731.214−1.1221.266
S5Wellness tourism provides a sense of relaxation and satisfaction with the services.5.881.086−1.3052.132
S6Wellness tourism makes you feel that your life is filled with happiness.5.871.073−1.020.859
S7Wellness tourism provides relaxation and alleviates concerns about healthcare.5.891.052−1.1061.296
S8Wellness tourism makes you feel that you are effectively taking care of both your physical and mental health.5.911.067−1.2031.783
S9Wellness tourism provides a sense of confidence in the services offered.5.741.105−1.0461.144
S10Wellness tourism gives a positive feeling when seeing family or loved ones experience it just like I did.5.821.100−1.1791.714
S11Wellness tourism provides a sense of peace and tranquility when experiencing services such as meditation, yoga, and others.5.701.182−1.0431.173
S12Wellness tourism helps improve the physical health of people in Thai society.5.751.116−1.0931.426
S13Wellness tourism makes society more compassionate and considerate towards one another.5.691.117−1.0291.298
S14Wellness tourism helps develop Thailand’s health and tourism businesses, such as healthcare services and beauty enhancement businesses.5.791.141−1.1451.544
S15Wellness tourism helps society achieve equality and provides a good and comprehensive service system.5.741.177−1.0451.024
S16Wellness tourism provides a sense of value and worth.5.811.120−1.1641.483
S17Wellness tourism is intriguing and interesting.5.841.116−1.2661.829
S18Wellness tourism can effectively meet the needs of health tourists.5.881.125−1.2841.738
S19Wellness tourism can enhance the well-being of travelers as they enjoy and immerse themselves in nature.5.901.080−1.3132.222
S20Wellness tourism helps raise awareness about environmental issues, such as pollution.5.781.047−1.1241.637
S21Wellness tourism helps foster a sense of the importance of preserving the environment.5.821.069−1.1141.575
S22Wellness tourism impacts the accessibility of natural resources, such as eco-tourism and nature conservation tourism.5.871.086−1.1591.423
S23Wellness tourism helps ensure the proper allocation and utilization of available resources.5.831.079−1.2842.000
IN1I intend to use wellness tourism services, which involve traveling for the purpose of maintaining or improving health while also engaging in leisure activities.5.791.070−1.3292.537
IN2I intend to recommend wellness tourism to members of my family.5.791.096−1.2712.230
IN3I intend to recommend wellness tourism to people in my social circle.5.821.093−1.2582.298
IN4I intend to engage in wellness tourism services should the opportunity arise.5.851.089−1.3982.810
AT5I recognize the significance of wellness tourism.5.801.056−1.0561.306
AT6Attitudes regarding good healthcare play a significant role in encouraging tourism participation.5.860.980−1.0951.653
AT7Wellness tourism positively impacts the well-being of people in Thai society.5.840.996−1.0841.701
AT8I have awareness of and a good understanding of wellness tourism.5.791.103−1.2942.180
SN9If a friend recommends that I try wellness tourism services, I believe this recommendation would have a greater influence on my decision to use them.5.761.087−1.1271.736
SN10If a celebrity (such as an actor, YouTuber, or influencer) uses or reviews wellness tourism services, it would increase my desire to try them.5.591.202−0.8710.669
SN11Promotions and advertising via different media channels regarding wellness tourism motivate my interest in utilizing these services.5.631.149−0.9270.887
SN12Visual and appealing content about wellness tourism on media platforms like TikTok motivates me to consider using the services.5.631.197−1.0231.058
PB13Traveling to the wellness service location is convenient and within my ability.5.711.118−1.0301.300
PB14The process of booking or purchasing wellness care programs is not beyond my ability.5.671.107−1.0671.527
PB15I perceive that wellness tourism services are as accessible and straightforward to use as regular healthcare services.5.701.139−1.1291.623
PB16I perceive wellness tourism services as straightforward and easy to access.5.731.114−1.0671.491
PB17Although I have never experienced wellness tourism, I think the services are easy to use and available to all.5.781.066−1.0561.346
Note: SD = standard deviation; SK = skewness; KU = kurtosis.
Table 3. Results of Exploratory Factor Analysis (EFA).
Table 3. Results of Exploratory Factor Analysis (EFA).
VariableFactor 1Factor 2Factor 3Factor 4Factor 5Factor 6CommunalitiesCronbach’s α
S10.741 0.8290.914
S20.690 0.815
S30.785 0.842
S40.664 0.799
S5 0.662 0.8310.927
S6 0.636 0.835
S7 0.632 0.817
S8 0.597 0.801
S9 0.582 0.8220.899
S10 0.585 0.846
S11 0.729 0.821
S12 0.727 0.8720.933
S13 0.724 0.872
S14 0.612 0.800
S15 0.695 0.838
S16 0.641 0.8770.935
S17 0.696 0.910
S18 0.667 0.863
S19 0.5000.7780.941
S20 0.7180.813
S21 0.7260.841
S22 0.7190.853
S23 0.6840.846
Eigenvalue15.6791.0240.8740.5910.5590.494
% of Variance68.1704.4513.8002.5712.4312.146
Cumulative%68.17072.62176.42178.99181.42383.569
Name FactorPhysical WellnessMental WellnessSpiritual WellnessSocial WellnessEmotional WellnessEnvironmental Wellness
Note: Goodness of fit for EFA: Bartlett’s test approx. χ2 = 30,884.125, degrees of freedom (df) = 253, p < 0.000.
Table 4. Latent construct correlation matrix.
Table 4. Latent construct correlation matrix.
S1S2S3S4S5S6S7S8S9S10S11S12S13S14S15S16S17S18S19S20S21S22S23
S11
S20.791
S30.730.711
S40.720.650.781
S50.710.680.620.681
S60.680.650.640.700.801
S70.630.670.630.640.720.781
S80.620.640.630.680.730.760.781
S90.640.610.620.680.710.710.660.691
S100.630.620.600.650.720.730.690.730.741
S110.560.500.530.610.570.630.600.600.700.711
S120.580.600.550.610.640.690.660.680.690.670.611
S130.610.590.590.630.620.690.700.690.710.690.660.751
S140.610.570.590.650.650.680.670.680.700.710.650.720.761
S150.540.540.540.600.620.660.680.680.700.680.630.770.780.781
S160.590.640.600.620.630.680.670.690.700.700.620.760.720.690.741
S170.630.620.600.620.640.680.660.700.700.720.620.710.700.650.700.751
S180.610.610.600.630.630.660.650.700.700.700.620.660.670.660.650.780.751
S190.670.640.630.660.690.730.680.710.690.680.610.700.690.690.680.750.770.751
S200.570.620.560.590.580.620.650.630.580.590.520.640.640.580.640.680.680.660.731
S210.600.630.590.620.640.670.670.660.630.640.540.640.660.630.650.700.720.680.730.781
S220.650.640.590.630.670.680.680.700.650.670.550.650.680.680.650.670.710.680.740.730.711
S230.660.630.630.660.670.700.670.720.670.680.600.640.680.690.690.690.720.710.760.740.760.731
Note: Square roots of AVE are shown on the diagonal. All inter-construct correlations are below ±0.80, supporting discriminant validity.
Table 5. HTMT results.
Table 5. HTMT results.
Physical WellnessMental WellnessSpiritual WellnessSocial WellnessEmotional WellnessEnvironmental Wellness
Physical Wellness1
Mental Wellness0.8661
Spiritual Wellness0.8120.8321
Social Wellness0.7930.8360.8181
Emotional Wellness0.7960.8000.8270.8291
Environmental Wellness0.8190.8350.7850.8200.8171
Table 6. Goodness of fit of statistics.
Table 6. Goodness of fit of statistics.
Index Values
Ratio between the chi-square and the number of degrees of freedom (χ2/df)3.917
Comparative fit index (CFI)0.957
Tucker–Lewis index (TLI)0.952
Root mean square error of approximation (RMSEA)0.049
Standardized root mean square residual (SRMR)0.066
Table 7. Hypothesis results (SEM).
Table 7. Hypothesis results (SEM).
HypothesisVariableStandardized CoefficientS.E.t-Statp-ValueCRAVE
Measurement Model (CFA)
Hypothesis 1
H1aPhysical Wellness0.8380.01086.0580.000 *0.9320.775
H1bMental Wellness 0.9330.006158.1710.000 *0.9230.749
H1cSpiritual Wellness 0.9350.007143.0440.000 *0.9010.753
H1dSocial Wellness 0.9230.006143.2650.000 *0.9250.756
H1eEmotional Wellness0.9090.006142.1410.000 *0.9400.840
H1fEnvironmental Wellness0.9680.005192.4870.000 *0.9310.731
HypothesisVariableStandardized CoefficientS.E.t-Statp-ValueResult
Structural model (SEM)
Wellness Tourism Affected on
Hypothesis 2Gender0.1160.00427.1620.000 *Supported
Hypothesis 3Age−0.0470.021−2.2730.023 *Not Supported
Hypothesis 4Income0.0500.0182.7660.006 *Supported
Hypothesis 5Occupation0.0640.0213.0840.002 *Supported
Intention Affected on
Hypothesis 6Wellness Tourism0.1600.0374.2940.000 *Supported
Hypothesis 7Attitude0.6750.04814.2130.000 *Supported
Hypothesis 8Subjective Norms0.1120.00431.7170.000 *Supported
Hypothesis 9Perceived Behavioral Control−0.0070.040−0.1790.858Not Supported
Note: CR = composite reliability, AVE = average variance extracted, * = Statistically significant
Table 8. Policy recommendations based on findings from the model.
Table 8. Policy recommendations based on findings from the model.
PrioritiesPolicyGuidelines
1Environmental Wellness
Tourism Promotion Policy		This approach is consistent with Fachrudin, H. T. and D. A. Yasmin [94], who stated that a well-maintained natural environment can create a calm and comfortable atmosphere, positively influencing an individual’s holistic healthcare. Therefore, development should follow these guidelines:
Key factors → (S19–S23)
Sample Questions
S19: Wellness tourism can enhance the well-being of travelers as they enjoy and immerse themselves in nature.
S22: Wellness tourism impacts the accessibility of natural resources, such as eco-tourism and nature conservation tourism.		(1.1) Health tourism activities that are environmentally friendly should be created, such as relaxation activities and accommodations that allow tourists to experience nature, for example, eco-tourism, eating organic food from local farms, and using health products that do not harm the environment.
(1.2) The quality of products, services, local wisdom, and experiences that contribute to environmentally friendly tourist well-being should be enhanced.
2Spiritual Wellness Tourism
Promotion Policy		This approach is consistent with Nicolaides, A. and A. Grobler [95], who stated that spiritually oriented tourism, especially with a religious focus, can enhance the quality of life for wellness tourists. Therefore, development should follow these guidelines:
Key factors → (S9–S11)
Sample Question
S11: Wellness tourism provides a sense of peace and tranquility when experiencing services such as meditation. 		(2.1) Tourism activities should focus on fostering spiritual tranquility and personal growth. This includes participation in religious activities, such as visiting sacred sites, practicing meditation or mindfulness, and learning about various cultures and traditions.
(2.2) Tourism destinations with religious significance and special architectural features in cities should be developed and preserved, ensuring they are beautiful, serene, and peaceful, for example, World Heritage tourist attractions.
3Mental Wellness Tourism
Promotion Policy		This approach is consistent with Maurya, R. K., A. C. DeDiego and M. A. Bruce [96], who stated that relaxation activities such as yoga can help achieve holistic health and that the attractiveness of wellness and spa destinations positively influences tourist satisfaction. Therefore, development should follow these guidelines:
Key factors → (S5–S8)
Sample Question
S7: Wellness tourism provides relaxation and alleviates concerns about healthcare.		(3.1) Health tourism activities should focus on relaxation and stress-reducing activities, such as visiting spas, receiving traditional Thai massages, practicing yoga, meditating, and exercising in peaceful environments.
(3.2) The potential for promoting health tourism businesses should be developed to meet international quality standards, such as healthcare services and beauty enhancement businesses, to create a sense of safety for clients and tourists.
4Social Wellness Tourism
Promotion Policy		This approach is consistent with the policy of the National Health Commission Office [97], which aims to promote wellness tourism and further develop it into a form of tourism that generates value for society. Therefore, development should follow these guidelines:
Key factors → (S12–S15)
Sample Question
S15: Wellness tourism helps society achieve equality and provides a good and comprehensive service system.		(4.1) Tourism infrastructure should be developed to accommodate all visitors equitably, such as by improving public transportation systems.
(4.2) Tourism activities should be designed to allow visitors to experience community living, fostering closeness and providing an intimate understanding of local life, such as through homestay accommodations.
5Emotional Wellness Tourism Promotion PolicyThis approach is consistent with Lakićević, M., D. Pantović and A. Fedajev [98], who emphasized that creating memorable service experiences can foster tourist loyalty and encourage repeat visits. Therefore, development should follow these guidelines:
Key factors → (S16–S18)
Sample Question
S18: Wellness tourism can effectively meet the needs of health tourists.		(5.1) Medical staff and personnel serving wellness tourists should be developed and trained to comprehensively meet the needs of visitors.
(5.2) Tourism activities should focus on fostering emotional well-being, such as music therapy sessions and coral diving experiences.
6Physical Wellness Tourism
Promotion Policy		This approach is consistent with Kim, C. E., J.-S. Shin, J. Lee, Y. J. Lee, M.-r. Kim, A. Choi, K. B. Park, H.-J. Lee and I.-H. Ha [99], who emphasized that the performance of medical professionals and the quality of services positively influence physical healthcare and contribute to user satisfaction. Therefore, development should follow these guidelines:
Key factors → (S1–S4)
Sample Question
S4: Wellness tourism provides comprehensive facilities, such as fitness centers and swimming pools.		(6.1) Tourism activities should be designed to help restore physical health and fitness, such as physiotherapy, physical exercises, and general workouts.
(6.2) Standards of medical treatment should be enhanced to ensure high quality, and service plans should be developed to comprehensively cover all areas, such as specialized treatments, advanced technological care, surgeries, and cosmetic procedures.
Note: Key factor = the essential questions identified within the model.
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Theerathitichaipa, K.; Seefong, M.; Prasomsab, P.; Wisutwattanasak, P.; Banyong, C.; Ratanavaraha, V.; Jansirisuk, N.; Ariyarit, A.; Kasemsri, R. Exploring Determinants of Wellness Tourism and Behavioral Intentions: An SEM-Based Study of Holistic Health. Sustainability 2025, 17, 7824. https://doi.org/10.3390/su17177824

AMA Style

Theerathitichaipa K, Seefong M, Prasomsab P, Wisutwattanasak P, Banyong C, Ratanavaraha V, Jansirisuk N, Ariyarit A, Kasemsri R. Exploring Determinants of Wellness Tourism and Behavioral Intentions: An SEM-Based Study of Holistic Health. Sustainability. 2025; 17(17):7824. https://doi.org/10.3390/su17177824

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Theerathitichaipa, Kestsirin, Manlika Seefong, Pattarawadee Prasomsab, Panuwat Wisutwattanasak, Chinnakrit Banyong, Vatanavongs Ratanavaraha, Nanthana Jansirisuk, Atthaphon Ariyarit, and Rattanaporn Kasemsri. 2025. "Exploring Determinants of Wellness Tourism and Behavioral Intentions: An SEM-Based Study of Holistic Health" Sustainability 17, no. 17: 7824. https://doi.org/10.3390/su17177824

APA Style

Theerathitichaipa, K., Seefong, M., Prasomsab, P., Wisutwattanasak, P., Banyong, C., Ratanavaraha, V., Jansirisuk, N., Ariyarit, A., & Kasemsri, R. (2025). Exploring Determinants of Wellness Tourism and Behavioral Intentions: An SEM-Based Study of Holistic Health. Sustainability, 17(17), 7824. https://doi.org/10.3390/su17177824

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