Factors Influencing Geothermal-Based Health Tourism Development: A Thematic Analysis in Natural Hot Spring Destinations of Northwest Iran

Abstract

Tourism has become an essential driver of local and national economies, and health tourism is one of its fastest-growing sectors. In this context, destination branding plays a vital role in enhancing competitiveness and creating distinctive identities. However, building a destination brand often faces major obstacles, particularly in emerging destinations. This study investigates the challenges of branding Sareyn, a well-known hot spring destination in northwest Iran, as a geothermal-based health tourism hub. The research is qualitative and exploratory, employing thematic analysis of semi-structured interviews with 18 experts, including academics, practitioners, and tourism stakeholders. Data were analyzed and categorized to identify central themes shaping the branding process. The results reveal two groups of themes. The first consists of key challenges such as infrastructure limitations, governance and policy issues, weak marketing strategies, insufficient research, human resource gaps, low investment, limited networking, and concerns about sustainable development. The second includes supportive factors that could strengthen branding efforts, namely complementary attractions and services, competitive advantages, and the necessity of targeted marketing. Overall, the study demonstrates that Sareyn holds significant potential as a geothermal health tourism destination but requires systematic planning, stakeholder collaboration, and improved management strategies. The results provide significant directions for policymakers and tourism managers, showing pathways to strengthen the city’s brand and contribute to the broader development of health tourism in Iran.

1. Introduction

1.1. Tourism Industry and Health Tourism

Tourism is an important economic activity that enhances local and national economies worldwide by increasing job opportunities, income, and living standards (Mondal, 2020; de la Maza et al., 2024). Health tourism, one of the fastest-growing sectors globally (Kazakov & Oyner, 2021; Romão et al., 2022), has attracted considerable attention due to its economic, social, and wellness impacts. While destination branding is widely recognized as a key strategy to create competitive advantage and distinctive identities, research on geothermal-based health tourism in Iran, particularly in natural hot spring destinations such as Sareyn, remains limited. This gap highlights the need for focused studies that explore the challenges and enabling factors in branding such destinations. Addressing this research gap, the present study investigates Sareyn as a case study, aiming to identify critical obstacles and supportive elements that influence its development as a geothermal health tourism hub. Despite extensive research on health tourism and destination branding globally, little attention has been given to geothermal destinations in Iran. This study innovatively combines qualitative thematic analysis with established branding models to identify both challenges and enabling factors, providing actionable insights for policymakers and destination managers. Given the intense competition among destinations, identifying factors that contribute to creating a competitive advantage in tourism has become a significant challenge (Pike & Page, 2014; Tleuberdinova et al., 2024). One key resource for tourism destinations is branding, and studies on the concept of brand management have been a central topic in marketing throughout the twentieth century (Bastos & Levy, 2012; Matiza & Slabbert, 2024). A brand represents the promise that service providers make to their customers (Armstrong & Kotler, 2014). Respecting all aspects of this promise is a crucial element in the relationship between the two parties involved (Schallehn et al., 2014). Brands convey how consumers perceive and feel about a product and its performance (Almeyda-Ibáñez & George, 2017). A destination brand exists in the eyes and minds of the viewers and must be credible and authentic (Mandagi et al., 2024b). Through branding, a destination emphasizes its key features, develops and presents them to its target audience, and this process can strengthen or even change its reputation, a process known as branding (Mandagi et al., 2024a).

Health practices and the travel motivations associated with them have long been established (Steward, 2012; Walton, 2016). Modern health tourism, though grounded in traditional practices, has evolved through contemporary healthcare trends that emphasize preventive and holistic well-being (Cohen & Bodeker, 2008). Key tourist motivations include relaxation, self-development, and environmentally conscious behaviors (Smith & Diekmann, 2017). Health tourism has gained attention as an essential research topic in tourism studies due to its association with the adoption of healthy lifestyles. Additionally, health tourism has become significant due to its impacts on the economy and globalization (Hall, 2013).

Health tourism involves individual or group travel to resorts and specialized destinations with the aim of maintaining physical and mental health. According to a literature review, health tourism can be divided into two distinct research categories: medical (treatment of diseases, surgery, biological research) and wellness (balance of mind, spirit, body, environment, and human quality of life) (Hartwell et al., 2018). Achieving competitiveness in global health tourism relies on facilitating unique experiences. In Kerala, rich natural resources and traditional Ayurveda practices form the basis of a distinct health tourism product, using local heritage and landscapes to support product differentiation. Implementing this strategy to create a shared health tourism experience of visiting natural resources and local communities requires strong coordination among various stakeholders (Binkhorst & Den Dekker, 2013; Kotler et al., 2017; Page et al., 2017).

1.2. Branding and Place Branding

“Brand” refers to the overall perception and associations people have with a name, while “branding” involves actively shaping and maintaining that image (Stigel & Frimann, 2006). Branding goes beyond advertising by aiming to build a strong, distinctive identity that reflects values influencing customer behavior (Tasci & Kozak, 2006). As Kavaratzis and Ashworth (2005) notes, branding is a continuous process that guides other marketing efforts. In place branding, similar to corporate branding, the focus is on the identity and values of the location rather than individual products (Rainisto, 2003). It aims to create a unified image that connects local products to the broader character of the place (Jojic, 2018). Place branding has grown in prominence over the past two decades, driven largely by globalization and the increased flow of people, goods, and information (Armstrong & Kotler, 2014). However, the field remains fragmented due to varying theories, methods, and perspectives. Scholars differ on key drivers of place branding, with some emphasizing brand image (Campelo et al., 2011; Veasna et al., 2013), others focusing on brand personality (Hultman et al., 2017), and some highlighting brand equity (Bose et al., 2016) as central factors. The contradictory results in existing studies indicate the need for a comprehensive perspective that considers all the various factors.

Unlike corporate branding, destination branding involves numerous diverse stakeholders, making it harder for any single group to shape the destination’s image (Govers et al., 2007; Ruiz-Real et al., 2020). Because destinations offer a variety of tourism services, broad stakeholder recognition and acceptance are essential, adding complexity to the process (Fyall & Garrod, 2019). Successful branding requires interactive collaboration, shared goals, and effective communication among stakeholders (Blichfeldt, 2018). When built on mutual understanding, destination brands can become a lasting competitive advantage (Giannopoulos et al., 2021).

1.3. Tourism Branding: Dimensions and Challenges

Branding cities, regions, or countries poses unique challenges due to the complex nature of destinations. Unlike consumer goods, destinations encompass various independent public and private services, limiting centralized control (Hankinson, 2009; Pike, 2014) Effective destination branding must cater to diverse tourist experiences (Gartner, 2014) and consider both the experiential aspects and tourist decision-making behavior (Almeyda-Ibáñez & George, 2017). This process involves balancing hard factors like infrastructure and accessibility with soft elements such as local culture, environment, and hospitality (Morgan et al., 2011). Branding helps create a competitive advantage by establishing a connection between the mentioned product and a wide range of characteristics, meaning that for consumers, the image of a destination is shaped not only by its physical attributes or the services provided but also by other intangible symbolic features.

Tourism branding involves shaping a distinct identity that leaves a lasting image in tourists’ minds. It has become a vital asset for countries aiming to attract visitors, helping highlight key features of a destination (Tien et al., 2019). As a management tool, destination branding integrates customer perceptions and guides the actions of tourism businesses (Tran & Rudolf, 2022). It also serves as a communication bridge between tourists, local businesses, and tourism organizations. To stay competitive globally, countries must build and promote cohesive tourism brands using elements like slogans, logos, websites, and coordinated marketing strategies. Promoting a health tourism destination internationally requires a strong, distinctive brand that reflects both local identity and consumer expectations (Blain et al., 2005). A brand should include a clear name and visual symbols that promise a memorable experience and build emotional ties with tourists. However, Morrison (2019) emphasizes that branding is more about managing a destination’s reputation than just creating logos or slogans. The core aim is to establish a positive, recognizable image that sets the destination apart and enhances its visibility and appeal over time. Challenges are obstacles that currently hinder the branding process, such as poor infrastructure or governance issues; while enablers are supporting elements that, if ignored, could become challenges in the future. For example, the hot springs and natural advantages of Sarvin are a strength, but excessive use or lack of complementary services can turn them into obstacles. This distinction provides a clearer understanding of the existing issues and potential risks in the branding process.

1.4. Literature Review

Place branding has been explored across various contexts, including urban (Kemp et al., 2012), rural (Wheeler et al., 2011), mixed environments (Barnes et al., 2014), cities (Usakli & Baloglu, 2011), regions (Martin & Capelli, 2017), and countries (Hudson, 2016). Researchers have also examined different dimensions of place branding, such as brand image, value, experience, personality, and identity (e.g., Hultman et al., 2017; Bose et al., 2016; Ren & Blichfeldt, 2011). The diversity of studies conducted on the themes and dimensions of place branding indicates the necessity of integrating commonly used structures within a conceptual framework and presenting a cohesive and integrative perspective on place branding. Related studies on destination branding and health tourism are presented in

Table 1. Related studies on destination branding and health tourism.

Objective	Author, Date	Results
Presenting a causal relationship model between tourist motivation and health tourism destination branding in Maha Sarakham, Thailand	Siribowonphitak (2024)	Reduced tourist visits due to high tourist motivation
Examining the link between branding and competitiveness in health tourism	Santos et al. (2022)	The presence of a significant positive relationship between branding and market share
Branding strategies and ecotourism architectures for the development of health tourism in Egypt	El Shiaty et al. (2023)	Enhancing health tourism through sustainable architecture of eco-lodges, providing a matrix for integrating elements of eco-lodge architecture and branding strategy elements
Health tourism destination branding (forest) for disaster reduction, Mount Batur UNESCO Global Geopark, Bali	Mihardja et al. (2023)	The positive impact of branding on creating advantages for attractions and recreation in the forest by tourists, local communities, and as a factor in reducing the risk of rock fall.
Branding and competition in health tourism.	Tran and Rudolf (2022)	Emphasis on creating and maintaining destination branding in the virtual space, Combining researchers’ contributions in place branding and social media, proposing suggestions for future research
Stakeholder-based common analysis for health tourism branding in Kerala, India	Romão et al. (2022)	Developing a stakeholder-based participatory process for collaboration in branding strategy development (including destination inspection through surveys, online analysis to discover the relative importance of health tourism-related features), the necessity of aligning resources with strategic priorities
A strategic approach to the development of spiritual tourism destination branding among millennials	Ashton (2021)	Emphasizing the importance of spiritual tourism as part of health tourism, challenges related to the complexity of tourist behavior in selecting and valuing tourism products and services for a richer experience and better quality of life
Challenges in the destination tourist branding process: Herzegovina tourism destination	Šantić and Madžar (2020)	Identifying key challenges (ethical, leadership, participation, authenticity, cognitive aesthetics, communication and interaction, digitalization, evaluation)
Destination tourism branding challenges in Serbia: Prolom Banja	Perić and Mandarić (2020)	Determining tourists’ perceptions of Prolom Banja and identifying key elements influencing the Prolom Banja brand as a specialized destination in health tourism
Examining destination image through consumer behavior.	Baptista and Matos (2018)	Literature review, and presenting the evolution of destination image in destination branding evolution

.

Lin et al. (2024) examined ESG measurement in the tourism and hospitality industry of a developing country. Using ESG reports and 20 interviews with industry professionals, they found that improvements in environmental practices, social benefits, and governance structures are needed to enhance compliance and sustainability. Avraham and Vidić (2024) investigated recovery marketing strategies to re-attract tourists after COVID-19 in several countries. They analyzed past crisis strategies alongside post-pandemic consumer surveys and identified six effective image repair approaches suitable for future tourism recovery. Miraz et al. (2025) examined how digital literacy, marketing ability, and healthcare facilities affect tourists’ intention to visit Asian countries. Using survey data from Thailand, Indonesia, India, Singapore, and Brunei, they found these factors strongly shape travel intentions, moderated by AI. Hassan and Meyer (2025) analyzed the influence of countries’ ESG risk ratings on international tourism demand in the Visegrád Four from 1995–2019. They found that tourists’ perception of ESG risks, alongside income levels, significantly affects tourism demand, highlighting the need for policies that mitigate ESG risks. Riu (2025) studied digital narratives in promoting medical tourism in Indonesia. Through qualitative case studies, the research found that cohesive online storytelling strengthens brand equity and boosts Indonesia’s competitiveness in global medical tourism. Kulkarni et al. (2025) examined health tourism research during COVID-19 using a bibliometric analysis of 211 studies from 2020–2024. Focusing on medical and wellness tourism, they found that health tourism played a key role in the sector’s survival and post-pandemic recovery. Health and wellness tourism is shaped by environmental, social, governance, and marketing factors, along with healthcare quality, influencing tourist decisions and destination competitiveness. Research on geothermal health tourism in Northwest Iran is limited, with local cultural, community, and natural resource aspects largely unexplored. Future studies should integrate perspectives of tourists, communities, and operators, focusing on governance, sustainability, and promotion to support growth and preservation of geothermal health tourism in the region.

To strengthen the theoretical foundation, this study uses key constructs from well-known destination branding models. Aaker’s (1996) brand model emphasizes brand awareness, perceived quality, brand loyalty, and brand associations, while Keller’s (1993) customer-based brand equity (CBBE) model focuses on the construction of brand knowledge through identity, meaning, reactions, and customer relationships. The present study combines these frameworks by mapping the identified challenge and enabling factors to key components of these models. For example, infrastructure and governance challenges affect perceived quality and brand credibility, while marketing and competitive advantage factors affect brand awareness and loyalty. By linking empirical results to these well-known models, this study both applies and extends existing theory to the context of health tourism branding in Saryen. Despite extensive studies on destination branding and health tourism globally, little research has addressed geothermal destinations in Iran. Furthermore, most previous research has not clarified the difference between existing challenges and factors that may eventually become challenges. Using thematic analysis, this research examines both dimensions in the survey and provides a practical framework for sustainable strategies in branding.

1.5. Objective

One of the regions in Iran with high potential for attracting health tourists that is capable of generating significant foreign exchange revenue in this field is the city of Sareyn. Located 25 km from Ardabil at the foothills of Mount Sabalan, Sareyn has become an important tourist destination in Iran and even the Middle East due to various reasons such as its natural attractions including mineral hot springs and the establishment of spa resorts (Goodarzi et al., 2016). Sareyn is renowned for its hot springs, situated near the inactive volcano in Mount Sabalan, whose water contains diverse compounds with significant therapeutic effects on various illnesses (Gilanian et al., 2011). The aim of this research is to explore the existing challenges facing the branding of Sareyn city as a health tourism destination and investigate the influential factors in its branding. This study seeks to propose solutions and recommendations to address the current problems and obstacles in strengthening health tourism.

2. Materials and Methods

2.1. Study Area Description

Sareyn is universally recognized as the “City of Hot Springs,” boasting springs bubbling from the heart of the earth, drawing millions of tourists annually to this beautiful region with its abundant therapeutic properties. Sareyn, located 25 km west of Ardabil at the foothills of Mount Sabalan, lies in a mountainous region with a cold climate and high precipitation that keeps its heights snow-covered (Alimohamadian & Mostafazadeh, 2025; Gimechi et al., 2025). Renowned for its hot springs and natural scenery, it is a major tourist destination in northwestern Iran. Situated 30 km west of Ardabil in Ardabil Province, this captivating city offers extraordinary natural landscapes, renowned for its cool climate during the hot seasons. With lush pastures rich in herbs, diverse medicinal plants, and balanced climatic conditions, Sareyn serves as a hub for medicinal plant cultivation, beekeeping, and honey production in Ardabil Province.

Some notable attractions in the city of Sareyn are present in Figure 1, and

Table 2. Characteristics of some tourist attractions in the city of Sareyn, Ardabil province.

Name	Specifications
Gavmishgoli Hot Spring	Located in Sareyn at an altitude of 1940 m above sea level, Gavmishgoli is considered the city’s most abundant mineral spring in terms of water yield and extent. Its slightly acidic, colorless water is recommended for the treatment of various ailments, including chronic rheumatic pains, women’s diseases, and heart conditions
Alvars Ski Resort	Nestled in the highlands of Mount Sabalan, 12 km from the Alvars village (a 3000-year-old village) and 24 km from Sareyn city, this ski resort is the largest in the country. Operational for eight months of the year due to snow cover, it features asphalt roads, ski training slopes, two training class stations, a guesthouse, and a restaurant.
Golestan Valley (Alvars Valley)	Regarded as one of the most beautiful natural landscapes, Golestan Valley is one of the eastern valleys of the Sabalan region, attracting numerous tourists due to its abundant springs, natural glaciers, lush meadows, and gardens.
Gorgor Spring	One of the most famous springs in the Sabalan region, situated in Alvars Valley at an altitude of 2420 m above sea level.
Sabalan Spa Complex	As the largest spa complex in the Middle East and Iran, it offers various facilities, including covered pools, Jacuzzis, dry and steam saunas, showers, individual baths, separate medical and therapeutic services for women and men, dedicated parking, and numerous amenities.
Vargesaran Waterfall	Located in the verdant foothills of Mount Sabalan, it is considered one of the most pristine attractions in Sareyn.
Gharesou Hot Spring	Its water temperature fluctuates in different seasons, reaching 44 degrees Celsius, with a continuous flow on the ground’s surface.
Anahita Ancient Hill	Situated in the western part of Sareyn, archaeological excavations have revealed artifacts dating back to the late second and early first millennium BCE.
Kanzagh Village	Known for its ancient caves, the old village’s historic district with a chessboard pattern, natural landscapes, and the ruins of the ancient village.
Beshbajlar Hot Spring	One of Sareyn’s oldest hot springs, known locally as “Darelar souie,” surrounded by lush meadows and trees, with a water temperature of 35 degrees Celsius.
Biledaragh Village (Viladareh)	A tourist attraction located 3 km north of Sareyn, renowned for its landscapes, natural resources such as mineral waters, beautiful valleys with trees and flower-covered meadows, and honeycombs.
Ancient Rocky Village of Viand Kalkhouran	A unique village made of stone houses, located 5 km southwest of Sareyn on the Ardabil communication road, representing an exceptional and rare ancient architectural and historical phenomenon in the country.
Irdamousi Forest Valley	A beautiful and scenic valley located 14 km west of Ardabil, starting from the vicinity of Sareyn and extending to the village of Nouran, featuring stunning views, rivers and springs, vast meadows, and fruit orchards.
Atashgah Village	A historic village known for its ancient hills, temples, old fireplaces, and lush, beautiful nature.

, which collectively contribute to Sareyn’s allure, making it a must-visit destination for tourists seeking natural and historical wonders.

2.2. Methodology

The present study employs a fundamental approach utilizing the qualitative analysis method known as thematic analysis. Thematic analysis is a fundamental and effective qualitative method, essential for many analyses (Holloway & Todres, 2003). While Boyatzis (1998) views it as a flexible tool rather than a specific method, Braun and Clarke (2006) argue it should be recognized as a distinct, adaptable approach. Braun and Clarke (2019) propose six phases for thematic analysis, including familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and preparing a report.

In the first phase, data rewriting (if necessary), reading and rereading the data, and noting initial ideas are conducted. In the second phase, a preliminary list of interesting ideas extracted from the data is prepared. In the third phase, all data are initially coded and collected, resulting in a list of different codes identified in the dataset. The fourth phase involves a two-tier examination and refinement of themes. In the fifth phase, a satisfying thematic map is extracted from the research data, and themes are defined and then named. The sixth and final phase involves analyzing and selecting clear and convincing output samples, finalizing the analysis of selected outputs, linking the analysis to research questions and literature, and preparing a scientific report based on the analysis (Attride-Stirling, 2001).

The data collection tool and semi-structured interview information were gathered using the snowball sampling method, involving a total of 18 experts from academic, tourism, and branding fields (including representatives from cultural heritage organizations, handicrafts and tourism industries, marketing and media professionals, and tour guides), who responded to the interview questions. Experts were selected based on their professional experience and expertise in health tourism, destination branding, or related fields, ensuring a comprehensive perspective on the subject. The sample consisted of academics, tourism professionals, marketing specialists, tour guides, and cultural heritage representatives, representing the broader population of experts and active individuals in tourism. Interviews were conducted until data saturation was reached, meaning that no new themes or perspectives emerged from additional participants. Most participants were male, with 12 men and 6 women out of a total of 18 participants. The interviewees had a background in tourism, with experience ranging from 5 to 25 years, and included employees from the Cultural Heritage, Handicrafts, and Tourism Organization. In addition, professionals in marketing and media, as well as tour guides, also participated in the interviews. To ensure sample diversity, the 18 experts were purposefully selected from different professional backgrounds, including academia, tourism management, marketing, cultural heritage organizations, and tour guiding. Participants varied in gender, years of experience (ranging from 5 to 25 years), and organizational affiliations, providing a comprehensive perspective on geothermal health tourism branding in Sareyn. This diversity ensured that multiple viewpoints were captured and that the study reached data saturation, with no new themes emerging after 15 interviews.

To determine data saturation, the interview analysis process was reviewed stepwise. After about 15 interviews, it was observed that no new concepts and themes were being extracted from the data and that subsequent interviews only confirmed existing information. Therefore, by conducting 18 interviews, all themes and subthemes relevant to the research objectives were covered, thus achieving data saturation. This approach is in line with the guidance of Braun and Clarke (2006), which emphasizes that the number of samples in qualitative analyses should continue until conceptual saturation is reached. The characteristics of the questionnaire used in the study are presented in

Table 3. Expert interview questions on health tourism branding in Sareyn city.

No.	Question
1	Could you discuss the importance of branding in attracting health tourists to Sareyn city?
2	In your opinion, what are the key elements that make Sareyn a suitable destination for health tourism?
3	What do you think are the main challenges Sareyn faces in becoming a health tourism brand?
4	How does Sareyn differentiate itself from its competitors in health tourism branding?
5	In your view, what is the role of a city’s infrastructure and facilities in becoming a tourism brand?
6	What actions should the government or relevant institutions take to transform Sareyn into an international health tourism brand?
7	Are there specific challenges in marketing and advertising the health tourism brand of Sareyn?
8	How do you analyze the role of sustainable development principles in city branding for health tourism?
9	How do you see the future path of branding Sareyn as a health tourism destination?

.

Sample interview questions included: ‘What factors hinder effective branding of Sareyn as a health tourism destination? and Which local resources and services could enhance the city’s brand identity? The coding method was employed, and the codes were categorized into three groups: basic, organizing, and global codes (Attride-Stirling, 2001).

Attride-Stirling (2001) outlined a three-stage thematic analysis process: descriptive coding, interpretive (organizing) coding, and identifying overarching themes. The first stage, descriptive coding, focuses on highlighting data segments relevant to the research question and key points raised by participants. For a holistic understanding of the context, the analyzed text should be carefully read without attempting to code it. In the second stage (interpretive coding, organizing), certain elements in the text that may assist in understanding the participants’ perspectives and experiences in the research are determined. In this stage, a brief explanation of what is important in the specified sections is written, and descriptive codes are defined. In interpretive coding (organizing), efforts are made to focus on interpreting the meanings of the statements beyond description, often by integrating codes that appear to have a unified meaning. The third stage (integrating themes) identifies several global themes that address the research questions and objectives (Attride-Stirling, 2001; Jafarinia et al., 2021). To ensure reliability of coding, two researchers independently coded the transcripts, and discrepancies were discussed until consensus was reached. This inter-coder agreement process enhanced the trustworthiness and reproducibility of the results. The research methodology steps are presented in Figure 2.

3. Results

The interviews followed Braun and Clarke’s (2006) six-stage thematic analysis. Nine questions were asked, responses were transcribed, and 279 initial statements were coded in ATLAS.ti, resulting in 67 basic, 11 organizing, and 2 global themes. Themes were categorized into challenging factors (infrastructure, marketing, governance, research, human resources, investment, networking, sustainable development) and side factors (marketing necessity, complementary attractions/services, competitive advantages).

Table 4. Sample expert interviews conducted on tourism challenges in Sareyn.

No.	Initial Text	Basic Themes	ID
1	Mountainous location, hot springs, clean air, cool summer	Suitable geographical location	H1
2	Affordable, quality food in Sareyn	Low prices of products	H2
3	Scenic villages enabling tourist accommodation	Complementary services	H3
4	Recreation planning for different age groups	Creation of complementary recreational attractions	H4
5	Weak management, lack of specialist guidance	Poor management	H5
5a	Necessity of expert input	Necessity of using expert opinions	H6
6	Personal/short-term priorities over long-term planning	Long-term planning necessity	H7
6a	Need for comparative studies	Conducting comparative studies	H8
7	Underuse of media for tourism promotion	Inadequate advertising	H9
8	Lack of multi-day stay planning, missing specialized medical centers	Establishment of complementary therapeutic attractions	H10
9	Failure to attract investments	Need for attracting investment	H11
10	Lack of city-level facilities (toilets, maps, multilingual pricing)	Requirement for appropriate urban services	H12
11	Weak transportation and healthcare infrastructure	Weakness in infrastructure	H13
12	Presence of natural mineral waters	Natural mineral waters	H14
13	Need for complementary/recreational and tech-based tourism	Necessity of providing complementary services	H15
14	Close to Tabriz as medical hub	Proximity to Tabriz	H16
15	Develop communication infrastructure	Investment in infrastructure	H17
16	Coordination among institutions	Establishment of collaboration networks	H18
17	Privatize tourism management	Creating opportunities for private sector	H19
18	Organize tourism calendar	Necessity of preparing a tourism calendar	H20
19	Friendly foreign relations for tourists	Improving foreign policy	H21
20	Specialized health tourism courses at university	Establishment of specialized university courses	H22
21	Special investment privileges (banking)	Facilitating investment	H23
22	Tourism insurance for foreign tourists	Offering tourism insurance	H24
23	Investment in medical therapies	Investment in complementary services	H25
24	Flight routes from Ardabil	Strengthening aviation infrastructure	H26
25	Scientific certification of mineral waters	Necessity of studies on mineral waters	H27

shows sample interviews.

The information presented in Table 2 illustrates a sample of interviews with experts and how the basic themes were selected and identified. Specifically, interviewees are denoted by the letter “M,” followed by a Latin alphabet letter indicating the sequence of the interviewee. In

Table 5. Identifying the basic themes of challenges in Saryen’s health tourism.

Basic Theme	Code	Basic Theme	Code
Weak air transport	M1A39, M3C35, M3C36, M3C37, M3C38, M3C39, M5E26, M5E27, M5E28, M5E30, M6F28, M6F29, M6F30, M8H26, M13M10, M15O7,	Stakeholder cooperation	M4D36,
Limited accessibility	M3C12, M3C13, M3C14, M6F32, M8H13, M10J6, M15O7,	Stakeholder interactions	M6F39,
No rail services	M3C40, M5F29, M5F31, M10I11, M13M11,M15O8,	Networking	M3C56, M8H18, M13M14,
Low-quality hotels	M1A35, M1A65, M3C18, M10J8, M12L8, M13M12,	Water management	M18R12,
Inadequate insurance	M8H24,	Health and sustainability	M3C52,
Poor hospitals	M5E41, M5E42, M6F33, M6F40,	Sustainability principles	M1A81, M1A83, M4D54, M9I18, M10J22, M11K11, M13M22, M15O16, M16P12, M17Q15, M18R12,
Poor info dissemination	M1A31, M1A32, M7G2,	Waste management	M6F41,
Weak content production	M1A15, M1A18, M1A45, M1A46, M1A47, M1A87, M3C47, M12L2, M15O15,	Private sector advertising	M6F45,
Lack of awareness	M2B29, M9I4, M10J17,	Off-season discounts	M3C48, M5E17,
Government interference	M11K9,	Customer-friendly services	M1A53,
Bad foreign policy	M8H21,	Increase events	M5E18, M14N5,
No comprehensive plan	M6F44, M13M11, M13M15,	Brand image	M13M1, M15O1, M17Q1,
Poor planning	M1A86, M4D8, M4D16, M4D19, M4D25, M4D28,M6F43, M8H7, M12L13, M13M2, M14O18, M18R8,	Service differentiation	M3C2, M7G3,
Bureaucracy	M2B32,	Marketing mix adherence	M3C3,
Tourist distrust	M10J20, M13M18,	Direct marketing	M3C30, M3C50,
Weak HR training oversight	M3C46, M10J3,	Targeted marketing	M16P2,
Ideological perspective	M10J5,	Assess health tourist needs	M1A26, M1A55,
Rapid hydrotherapy growth	M11K1,	Intl. connections	M17Q10,
Weak supervision over services	M10J19, M10J21,	Info tours	M5E19, M5E36,
Short-term planning	M4D29,	Target market ID	M3C51,
Neglect land-use	M6F49,	Brand positioning	M7G1,
Lack of integration studies	M4D4, M4D33,	Specialized marketers	M7G17,
No specialized studies	M4D5, M5E12, M13M7, M13M23,	Domestic and intl. market ID	M2B4, M2B5, M3C50, M3C51, M16P9,
No competitive advantage ID	M1A50, M6F6, M13M24,	Carrying capacity	M1A84, M17Q7,
No comparative studies	M8H8, M13M9,	Complementary attractions	M1A22, M1A52, M6F14, M7G11, M8H4, M8H10, M11K12,
Specialized agencies	M18R3,	Food quality	M7G20,
Specialist doctors	M1A29, M1A30, M11K3,	Standard services	M16P14,
Skilled HR	M4D51, M10J3, M10J10, M11K4, M12L9, M14N7,M15O10, M16P11,	Investment in attractions	M15O4,
Specialized tour guides	M7G14,	Investment in supplementary services	M8H25, M10I12, M11K2, M13M13,
Business facilitation	M3C41,	Organic food	M17Q5,
Adequate budget	M4D48, M17Q9, R18R10,	Suitable climate	M3C9, M5E5, M6F5, M7G10, M10I2, M14N2, M17Q2,
Private sector investment	M4D49, M6F38,	Mineral springs	M2B24, M10I1,
Investment incentives	M1A70, M2B31, M8H23, M18R9,	Medicinal plants	M6F27, M14N3, M17Q4,
University-industry collab	M3C57,	-	-

, identifying the basic themes of challenges in Saryen’s health tourism. For example, the basic theme of inappropriate foreign policy is obtained from the interview of the eighth person (M8) and ID code 21, i.e., (H21).

Table 6. Identifying the challenging factors as a global theme in Saryen’s health tourism.

Basic Themes	Organizing Themes
Air transportation weakness	Infrastructure Challenges
Accessibility issues
Absence of trains
Low quality of hotels
Poor insurance
Poor hospital infrastructure
Poor information dissemination	Marketing Challenges
Content production deficiency
Ignorance	Governance Challenges
Government intervention
Inappropriate foreign policies
Lack of comprehensive plans
Weak planning
Bureaucracy
Tourist distrust
Lack of oversight on human resources training
Ideological viewpoint
Heterogeneous growth of SPA complex
Lack of supervision on the provision of tourism services
Short-term planning
Neglect of land-use planning
Lack of integration among conducted studies	Research Challenges
Absence of specialized studies
Failure to identify competitive advantages
Lack of comparative studies
Specialized agency	Human resource Challenges
Specialized physician
Specialized human resources
Expert tour leader
Facilitation of the business environment	Investment Challenges
Adequate budget
Private sector investment
Investment incentives
University-industry collaboration	Networking Challenges
Stakeholder cooperation
Stakeholder interactions
Networking
Water management	Sustainable Development challenges
Health within sustainable development
Adherence to sustainable development aspects
Waste management

presents the organizing themes and global themes derived from interviews with experts.

The identification of side factors as a global theme has been extracted and is presented in

Table 7. Identification of side factors as a global theme.

Side Factor	Global Theme
Private sector advertising expenditure allocation	The Necessity of Marketing
Providing discounts during the off-peak tourist season
Providing customer-friendly services
Increasing the frequency of events
Creating a brand image
Creating differentiation in services
Adherence to integrated marketing principles
Direct marketing
Targeted marketing
Investigation of health tourist needs
Establishing communication with international companies
Holding info tours
Identifying target markets
Brand positioning
Necessity of employing specialized marketers
Necessity of identifying domestic and international markets
Necessity of considering carrying capacity
Complementary attractions	Attraction Complementary Services
Increasing quality of food products
Necessity of providing standard services
Investment in complementary attractions
Investment in complementary services
Organic food	Geographical Advantages
Suitable weather
Hot Mineral springs
Medicinal plants

.

The relationships between the codes of challenging factors and the codes of side factors are shown in Figure 3 and Figure 4, respectively.

Figure 3 and Figure 4 show that basic themes are interconnected, with challenging and side factors interacting rather than acting independently.

4. Discussion

4.1. Branding Challenges

Infrastructure Challenges: Infrastructures are one of the primary influential factors in urban branding discussions. In the present study, identified infrastructure challenges include weaknesses in air transportation, accessibility issues, lack of railway services, low-quality hotels, and inadequate hospital infrastructure.

Regarding air transportation, several interviewees highlighted issues such as frequent flight cancellations, the absence of flights between Ardabil and other provinces (except Tehran), and vice versa. They also emphasized the necessity of upgrading Ardabil Airport to an international airport. In Ardabil Province, the intercity ground transportation system also lacks high quality and standardization. Roads are not in standard conditions, and the Ardabil railway has yet to commence operation.

Sareyn city ranks second in the country after Mashhad in terms of the number of accommodation units (hotels and hotel apartments). However, considering the quality of service provision compared to global standards, there is a significant need to enhance the quality of hotels in terms of service provision, staff behavior, and facility saturation.

According to available statistics, Sareyn city annually hosts a large number of tourists (especially in the first half of the year). On the other hand, considering the aim of this research, which considers Sareyn city as a health tourism destination, the primary emphasis is on the necessity of establishing specialized hospitals.

“ … The role of infrastructures is crucial. Certain urban facilities must be available. When a tourist visits Sareyn, apart from hot springs and some existing shops, there is no other form of entertainment…’

4.2. Marketing Challenges

Marketing and advertising are among the primary factors in tourism branding. Based on the information presented in Table 5, the marketing challenges of tourism can also be attributed to other tourism sites in Iran. Considering that standardized branding has not yet been implemented in Sareyn and there is a need for a systematic branding process, most of the influential factors in marketing recovery have been placed in the side factors group.

“ … If we look at the marketing and advertising domain one of the discussions is identifying the needs of tourists. What kind of tourists visit Sareyn? What are their needs? ….”

According to the aforementioned quote, one of the key issues in marketing Sareyn as a tourist city is identifying the needs of tourists (especially the needs of health tourists). The needs, tastes, and preferences of health tourists visiting Sareyn must be evaluated and identified. In the next step, the identification and selection of the target market become possible, and brand advertising takes shape.

4.3. Governance Challenges

In challenges related to government and policies, most interviewees emphasized the need to reduce the role of the government in the executive sector. Examination of the obtained data indicates that if the government’s role focuses solely on monitoring and supporting activities and groups, the branding process will be more cohesive. Additionally, improving foreign policy and international relations is also emphasized as a significant factor.

“ … Whether we succeed or not in this path depends on the planning of policymakers. It seems that the current progress is average, neither very strong nor very weak. In order for this trend to be more positive, we need some changes in regional policymaking and shifts in perspectives …”

Based on the data obtained from the current research, the lack of a supervisory role of the government is a key challenge. In Sareyn, there are issues regarding negligence in areas such as monitoring the quality of services, issuing licenses for the establishment of service complexes, legislation, and provision of facilities, as well as proper monitoring of the quality of hot spring water. Considering the country’s governance system, the primary supervisory role lies with the government. The challenges associated with this issue require thorough examination and fundamental reforms.

4.4. Research Challenges

The lack of comprehensive scientific studies can be considered as one of the main obstacles to branding the city of Sareyn. Conducting thorough scientific studies with the participation of academics, tourism experts, and other relevant sectors is the first step towards branding.

“ … The upcoming process requires research efforts to ensure compliance with all international brand standards, and we need scientific research to meet this need…”

The outcome of scientific studies can lead to the development of a comprehensive plan for tourism branding in the city of Sareyn. The absence of such a plan is one of the fundamental challenges that most experts have mentioned in their interviews and deemed its design necessary. This plan can be formulated with the collaboration of academics and tourism industry experts, providing a roadmap for the branding process of this city. A comprehensive plan will address the issue from various angles and provide a detailed and comprehensive vision.

4.5. Human Resource Strengthening Challenges

The emphasis on the necessity of training and employing skilled workforce in all sectors has been paramount in the discussion of human resources. Additionally, the need for tourism guides, both local and international, proficient in English and other common international languages, has been highlighted. The existing shortage in this area adversely affects international marketing and target market selection.

“ … Another challenge is the training of specialized personnel directly interacting with tourists. Minimum standards in hiring and employing these personnel have not been adhered to…”

As mentioned, the main issue regarding human resources is the neglect of training and the lack of deployment of skilled and experienced personnel in service provision. Human resources are integral to the tourism and hospitality industry, directly engaging with customers. Ignoring deficiencies in this area will lead to customer dissatisfaction.

4.6. Investment Challenges

In the investment sector, considering the government’s resource constraints, it seems that the most suitable approach is to create opportunities and facilitate space for the private sector and investment. The government should focus on supporting and facilitating the business environment and providing incentive services.

“ … In government management, by delegating tourism management to the private sector and refraining from interfering, it can provide the groundwork for further development…”

The private sector, notwithstanding some limitations and obstacles, can contribute significantly by investing in service centers, constructing five-star hotels, and assisting in job creation. Consequently, the government can address existing challenges by facilitating conditions and encouraging private sector investors, thereby adopting an appropriate solution to tackle the current challenges.

4.7. Networking Challenges

Considering that the activities of groups and organizations alone will not suffice to address the existing problems and challenges, therefore, establishing a collaborative network of all tourism industry stakeholders is essential.

“ … On the one hand, there is no communication network among tourism stakeholders. Integration of communication among universities, tourism organizations, economic actors in the tourism sector, and other relevant government agencies is essential …”

Establishing a cohesive network among tourism industry stakeholders (hoteliers, managers of recreational and service centers, travel agencies, tour operators, and academics) can lead to improved cooperation, increased coordination, interaction, and exchange of knowledge and information, creating business opportunities, resource management, and ultimately, sustainable long-term success.

4.8. Challenges Related to Sustainable Development Principles

Adhering to sustainable development principles is now a fundamental issue in the tourism industry. Observing these principles in all stages of destination branding will optimize destination conditions.

“ … Health tourism and sustainable development principles are closely related. If sustainability goals are not achieved, health will not be achieved. The existence of natural hot springs and favorable climates all contribute to public health and are essentially assets for sustainable development …”

4.9. Side Factors

The purpose of categorizing side factors is to refer to issues that are not currently challenging but may become challenges under the influence of factors and conditions such as mismanagement. In the branding process, some factors may initially be seen as positive but may pose challenges over time. These factors need to be carefully examined considering potential future conditions and circumstances.

4.9.1. The Necessity of Marketing

Major marketing-related factors are categorized within the side factors group, given the importance of the private sector as a significant factor in the branding process, outsourcing marketing based on the facilities of the private sector seems to be an appropriate solution. Moreover, emphasis has been placed on issues such as the need to attract tourists in the second half of the year through providing discounts and organizing targeted and diverse events, as well as conducting informational tours.

“… The private sector must believe that it needs to allocate part of its budget to advertising…”

“… In the off-peak seasons in Sareyn what events are we organizing to consider offering more discounts to attract tourists for these events? …”

One of the themes of particular importance is the organization of informational tours aimed at introducing Sareyn to the audience through influential individuals in the virtual space and famous domestic and even foreign artists. In today’s digital age, utilizing the potential of the virtual space presents an excellent opportunity for tourism industry marketers.

4.9.2. Attractions and Complementary Services

The tourist town of Sareyn has become a health tourism destination due to the presence of hot mineral springs. However, the existence of hot mineral springs alone is not sufficient for branding, and complementary attractions and services need to be provided as well. For example, regarding the creation of complementary attractions, most experts expressed a theoretical saturation about the lack of recreational facilities specifically for children.

“ … The issue of children and related facilities should be seriously addressed. In children’s tourism children play a significant role in parents’ destination choices. For example, in Mashhad extensive advertising has been done for the “Water Waves Land” complex, which is more recognized than Sareyn…”

Complementary attractions and services provide an opportunity for tourists in the city of Sareyn to increase their stay time in this city. It is estimated that by creating attractions and services (such as diverse shopping centers, children’s amusement parks, thematic parks), the duration of tourists’ stay in Sareyn can be increased to 3 to 4 days, achieving this goal requires strengthening accommodation and transportation infrastructure.

4.9.3. Competitive Advantages

The existing competitive advantages in the city of Sareyn have provided the basis for turning this city into a suitable health tourism destination. These features are natural and geographical and have been recognized as unique advantages of this region.

“ … The geographical location of Sareyn and the presence of therapeutic water in Sareyn distinguish it from other competing destinations in branding the city of Sareyn, in a way that if mineral hot springs were located in tropical areas like the city of Ahvaz (although there are some), their use would not be as desirable due to the hot weather. But because these hot springs are located in the cool climate of Sareyn (cold weather in winter), the use of hot springs is enjoyable…”

Competitive advantages (such as being located in the foothills of Mount Sabalan, the existence of Alvars ski resort, unique medicinal plants, and the historical village of Kanzaq) have provided a special opportunity to create a unique identity for the health tourism brand of Sareyn city. The historical village of Kanzaq in the vicinity of Sareyn county has caves that have been carved by hand and with its unique architecture, reflects parts of the ancient life of people in the Sabalan mountain range, dating back to the Parthian period.

5. Conclusions

Today, cities require more than historical and natural attractions to draw tourists, making tourism branding a crucial tool for developing urban tourism. Health tourism has been flourishing in recent years, and tourists seek experiences that have a positive impact on both physical and mental health. Building a strong brand requires creating an attractive narrative, a visual identity, and establishing authenticity for a brand. This study seeks to identify the challenges involved in branding Sareyn, known for its numerous hot springs, as a health tourism destination. Sareyn city, with its hot mineral springs, is an important tourist destination for health tourists in Iran. Sareyn hosts a large number of tourists annually, indicating the popularity of this destination. According to the Fars news agency report, more than one million tourists visited this city during March and April 2023. However, the branding process of this city has not been carried out in a standardized and systematic manner, and it can be said that it is merely a traditional destination that may reach its saturation point in the coming years. This research aimed to identify the challenges ahead of branding this city as a health tourism destination. Branding is a process that requires a systematic and step-by-step plan. To start the branding process, creating a comprehensive plan for branding Sareyn city is necessary, which requires collaboration and the establishment of a participatory network consisting of tourism experts, academic scholars, and marketing specialists. Data obtained from interviews were ultimately categorized into two groups: challenging factors and side factors. Challenging factors include challenges related to infrastructure, marketing, governance, research, human resources, investment, networking, and sustainable development. Side factors include the necessity of marketing, attractions and complementary services, and competitive advantages identified. Challenging factors are those currently existing in the tourism sector (especially health tourism) of Sareyn city. Considering the potential of Sareyn city in attracting domestic and international tourism, infrastructure and governance challenges are closely related. In the process of branding Sareyn city’s tourism, various facilities are needed to address infrastructure problems (as a prerequisite for addressing other challenges). Considering that the tourist city of Sareyn does not have an official brand and this process needs to start from scratch, competitive advantages play a key role in the side factors group. The themes related to competitive advantages all emphasized the natural resources/destinations available in the region, requiring the formulation of strategies for simultaneously exploiting current advantages and readiness to face potential challenges. Branding Sareyn faces obstacles and shortcomings that require serious structural reforms. The potential importance of developing tourism in Sareyn for the economic development of Ardabil and Iran provinces emphasizes the need for more effective planning in the branding of Sareyn. Authorities and stakeholders ought to employ the study results to craft efficient management tactics for branding and marketing Sareyn as a health tourism spot.

Weak infrastructure, limited transportation, and low quality of services threaten the position of the Sareyn brand in health tourism, and strengthening these sectors is essential. Collaboration among stakeholders and creating collaborative networks can improve marketing and advertising coordination and strengthen Sareyn’s competitive advantage. Exploiting natural resources and providing complementary services increase the length of stay of tourists and enhance the brand image. This study provides a framework for identifying challenges and opportunities and has applications for destination planning and management.

This study contributes to the theoretical understanding of destination branding in health tourism, as it integrates challenging and enabling factors into a comprehensive framework. The results provide new perspectives on the interaction of local resources, management, and stakeholder networks in shaping destination branding and provide indications that can be applied to other developing markets with similar conditions. In practical terms, the study suggests that local authorities and tourism managers in Saryen city should prioritize improving infrastructure, developing standard branding programs, encouraging private sector investment, promoting complementary services, and building a strong network of stakeholders. Implementing these recommendations can strengthen Saryen’s position as a competitive health tourism destination. Future research could examine strategies to address branding challenges using case studies and comparative analyses to guide policymakers and stakeholders in Sareyn and similar destinations.