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Department of Tourism Management, National Kaohsiung University of Applied Sciences, No. 415, Chien Kung Road, Kaohsiung 807, Taiwan
Department of Leisure, Recreation and Tourism Management, Tzu Hui Institute of Technology, No. 367, Sanmin Road, Nanjhou Hsian, Pingtung 926,
Taiwan
b
a r t i c l e
Keywords:
Older adults
Wellness tourism
Customer service
Segmentation
i n f o
a b s t r a c t
Tourism-related industries have emphasized the wellness tourism market when numerous countries
now face an aging population. Many studies have indicated that strong customer service increases competitive advantage. However, customer service-related research from the perspectives of customers and
operators is rare. This study adopted a two-phase approach to incorporate the perspectives of older adults
and operators in wellness tourism into the service factors. We extracted service factors from face-to-face
interviews with senior managers and experienced consultants of the hot springs hotel industry conducted in Phase 1. During Phase 2, we interviewed older adults at hot springs, and performed exploratory
and conrmatory factor analyses to examine the reliability and validity of customer service factors. The
results highlighted the following seven customer service factors: health promotion treatments, mental
learning, experience of unique tourism resources, complementary therapies, relaxation, healthy
diet, and social activities. According to these service factors, the older adults interviewed were divided
into a holistic group, physiocare group, and leisure and recreation group using cluster analysis. Finally,
we propose socio-demographic variables for describing the specic characteristics of the three clusters
identied.
2013 Elsevier Ltd. All rights reserved.
1. Introduction
Population aging has become increasingly severe in developed
countries. For example, recent forecast data from Eurostat projects
that people aged 65 and older will comprise more than 28% of the
population in Germany, 25% in Italy, and 23% in France by 2030
(European Commission, 2012). Currently, the median age in Japan
is 41, making it the fastest aging country in the world (Barrows
et al., 2012). In Taiwan, the proportion of the population aged over
65 years has steadily increased since 1993, with the elderly population reaching 10.7% at the end of 2010. The aging index for Taiwan
in 2010 (68.6%) was lower than that for Canada, Japan, and other
European countries, but higher than that for the U.S., New Zealand,
and other Asian countries (Taiwan Ministry of the Interior, 2012).
The results of a senior population survey published by the Statistics
Department of the Ministry of the Interior, Taiwan, showed that the
three life aspects ranked most desirable by seniors were a healthy
life, a harmoniously life spent with family, and nancial security. The top three concerns for the elderly were personal health,
nancial problems, and personal care issues (Taiwan Ministry
of the Interior, 2010).
2. Literature review
2.1. Dening wellness and wellness tourism
There is no rigorously developed denition of wellness. Smith
and Puczk (2009) stated that wellness is a complex concept,
123
Social contacts
Mind:
mental activity/education
Health:
nutrition/
diet
Self
responsibility
Body:
physical
fitness/
beauty
care
Relaxation:
rest/meditation
Environmental sensitivity
124
Table 1
Natural resources used to develop wellness tourism by different countries.
Country
Japan
Israel
Cuba
Yukon, Canada
Taiwan
Hungary
India
Spain
Greece
France
U.S.A.
Hawaii, U.S.A.
Thailand
Austria
Italy
Germany
Australia
125
their work provided further support that senior travelers are not
a single tourism group. Kim et al. (2003) applied technical information as the method for segmenting the older tourist market.
They segmented the West Australian older tourist market using
an articial neural network. Mueller and Lanz Kaufmann (2001)
surveyed over 400 wellness guests (not necessarily older tourists)
at eight wellness hotels. The cluster analysis results provided
the following four guest segments: demanding health guests,
independent infrastructure users, care-intensive cure guests,
and undemanding recreation guests. The main distinguishing
characteristics were the importance of software and/or wellness
facilities, and the relevance of the recreation and/or health promotion motive.
3. Methodology
For this study, we adopted a two-phase analytical process to
explore tourists and operators understanding of wellness tourism
service factors. Phase 1 involved analysis of in-depth interviews
conducted with operators. We conducted quantitative analysis of
survey questionnaires completed by older adults at hot springs in
Taiwan for Phase 2.
3.1. In-depth interviews
Experts were selected for this survey using the snowball sampling method. We contacted two senior managers and one expert
of hot spring hotels, who had previously served as senior managers and possessed over 10 years of experience working in hotels,
and conducted individual in-depth interviews. After the interviews,
the three interviewees were asked to recommend senior managers
who were highly familiar with managing wellness tourism and
working in hotels in the main hot springs areas in Taiwan. These
recommended people in specic hot spring areas would then recommend other appropriate interviewees in that area. Thus, we
conducted interviews using both the individual in-depth interviews and focus group methods to accommodate the interviewees
regional distribution and time constraints. Face-to-face interviews
were conducted with 13 senior managers of hot spring hotels
and experienced experts during Phase 1. The participants included
senior managers (in the position of Vice President or above) in
Wulai (northern Taiwan) (1 participant), Tainan (central Taiwan) (1
participant), Bolai (southern Taiwan) (3 participants), and Chiben
(eastern Taiwan) (5 participants), as well as three experienced
former hot springs operators turned business consultants. The
discussion topic was set: What are the important services for
developing wellness tourism targeted to tourists over 50 years of
age?
The coding process and analytical method were as follows: (1)
we examined the interview transcripts individually and organized
the service items suggested by the interviewees; (2) the service
items were compared, and renewed integration or modication
of the names of related service items was discussed; and (3) we
assigned temporary classications to service items, including the
names of service factors and the category of service items.
The key service factors for developing health tourism for tourists
over 50 years of age include personnel service, environment,
healthy diet, health promotion treatments, social activities,
relaxation, experience of unique tourism resources, and mental learning (Table 2). Table 2 shows the service items included in
these eight service factors.
3.2. Questionnaire design and survey
In Phase 2 of this study, the opinions of senior managers and
experts in the industry obtained during Phase 1 were compiled
126
Table 2
Classication of SPA service on wellness tourism.
Table 4
Descriptive statistics of the demographic variables of interviewed subjects.
Service factor
Service item
Variables
Personnel service
Gender
Male
Female
Age
5064
65 and above
Level of education
Junior high and lower
Senior high/higher vocational
education
Junior college
University
Postgraduate and above
Marital status
Single
Married
Other
Monthly disposable income (NTD)
20,000 and lower
20,00140,000
40,00160,000
60,00180,000
80,001100,000
100,001 and above
Region of residence
North
Central
South
East
Off shore islands
Other
Main companion of the current trip
Family
Friends
Colleagues
Classmates
Other
Domestic tour in the preceding
year
Health promotion
treatments
Environment
Healthy diet
Relaxation
Social activities
Experience of
unique tourism
resources
Mental learning
Table 3
The frequency distribution of the questionnaire respondents from six hot spring
regions.
Hot spring region
Frequency
Percentage
Guguan
Chiben
Wulai
New Beitou
Jiaosi
Guan Zih Ling
Total
134
97
92
66
106
83
578
23.2
16.8
15.9
11.4
18.3
14.4
100.0
into wellness tourism service factors that formed the basis of the
survey questionnaire regarding the key items for spa services
in hot spring hotels. The questionnaire comprised two sections,
the rst of which contained the 43 service items within the
service factors. A 5-point Likert scale was employed, and each
question was rated from 5 (extremely important) to 1 (extremely
unimportant). The second section concerned the demographic
and travel characteristic items for older adults. Purposive sampling was conducted for older adults staying in hot spring hotels
in six major hot spring regions, Jiaosi (northern Taiwan), New
Beitou (northern Taiwan), Wulai (northern Taiwan), Guguan
(central Taiwan), Guan Zih Ling (southern Taiwan), and Chiben
(eastern Taiwan). The survey period was between November
2011 and January 2012, with 578 valid questionnaires retrieved.
Table 3 shows the number of valid questionnaires obtained from
each area.
4. Data analysis and discussion
4.1. Prole of respondents
Table 4 shows that male tourists accounted for more than
half of the interviewed respondents at 50.5%, and female tourists
Number of times
Percentage
292
282
50.5
48.8
475
103
82.2
17.8
128
229
22.1
39.6
87
110
16
15.1
19.0
2.8
26
514
38
4.5
88.9
6.6
175
229
80
30
18
29
30.3
39.6
13.8
5.2
3.1
5.0
258
130
144
31
2
4
44.6
22.5
24.9
5.4
0.3
0.6
244
186
57
12
64
5.87 (on average)
42.2
32.2
9.9
2.1
11.1
accounted for 48.8%. The senior group (aged 65 years and above)
accounted for 17.8% of the respondents, and prospective seniors
accounted for 82.2%. Regarding monthly disposable income, the
20,001 to 40,000 TWD range comprised the largest proportion
of respondents (39.6%). The second largest group (30.3%) had a
monthly disposable income of less than 20,000 TWD. Only 5% of
the respondents had a monthly disposable income of more than
100,000 TWD. The majority of the respondent had less than a
junior college-level education because 39.6% had only completed
senior high school/higher vocational training, and 22.1% had a
junior high school or lower level of education. The respondents
who held at least a university degree accounted for 21.8%. Most
of the respondents lived in northern Taiwan (44.6%), followed by
southern Taiwan (24.9%); the lowest number of respondents lived
in offshore island areas (0.3%). At the time of the interview, the
majority of the respondents were traveling with family (42.2%), and
22.5% were traveling with friends. The average number of times the
respondents have participated in a domestic tour in the preceding
year was 5.87.
4.2. Item analysis of the service items
To incorporate the inuence of both customers service needs
and operators service provision, 43 service items were extracted
from in-depth interviews with industry experts and compiled
into a questionnaire. The service items were ltered according
to tourists understanding of the service items to ensure consistency among the service items. The reliability of the service items
determined using Cronbachs was 0.935, indicating a high level
127
Table 5
Customer service item analysis result.
Customer service dimensions
Personnel service
Service personnel equipped with basic medical and emergency
knowledge
Service personnel is compassionate toward customers
Provide butler care service
Health promotion treatments
Provide herbal bath
Provide massage
Provide post-surgery recovery care
Provide hot spring therapy guidance
Provide medication consultation
Provide traditional healing
Provide aquatic workout guidance
Provide tness exercise guidance
Provide weight control guidance
Provide essence oil massages
Provide exfoliation services
Environment
Comprehensively planned walking trails
With transport convenience
Clean and hygienic hot spring bath environment
With image of honor
With barrier-free facilities
Safe spa facilities
Gym
Healthy diet
Use of non-toxic or detoxication food ingredients
Health restorative meals
Provide local ingredients based cuisines
Relaxation
Atmosphere of relaxed tranquility
Provide landscape therapy (environment and psychological
consultation)
Provide meditation environment
Provide DVD music
Social activities
Provide mahjong rooms
Provide recreation rooms for chatting and chess
Provide family activities
Experience of unique tourism resources
Provide cultural custom experiences
Local cultural celebration involvement
Community development
Provide private attractions
Provide nocturnal exploration activities
Mental learning
Provide enlightenment lectures by resident religious and spiritual
mentors
Provide psychological consultation
Provided relaxed learning atmosphere
Provide book clubs
Provide art exhibitions
Provide musical performances
Provide group DIY activities
Item-to-total
correlation
Note
0.936
0.11
Eliminated
0.936
0.933
0.11
0.55
Eliminated
0.933
0.933
0.933
0.932
0.932
0.932
0.932
0.932
0.932
0.932
0.933
0.58
0.55
0.57
0.66
0.65
0.61
0.66
0.64
0.63
0.60
0.58
0.934
0.935
0.935
0.933
0.934
0.935
0.933
0.39
0.24
0.19
0.56
0.36
0.32
0.55
0.933
0.934
0.933
0.50
0.44
0.50
0.933
0.934
0.53
0.54
0.934
0.934
0.50
0.42
0.935
0.933
0.933
0.34
0.51
0.57
0.933
0.933
0.933
0.933
0.933
0.48
0.51
0.54
0.52
0.53
0.933
0.57
0.932
0.932
0.932
0.932
0.932
0.932
0.60
0.64
0.68
0.64
0.66
0.63
Eliminated
Eliminated
Eliminated
Eliminated
Eliminated
Eliminated
Eliminated
128
Table 6
Explorative factor analysis result.
Factor
Item
Factor loading
Cronbachs
Health promotion
treatments
0.831
0.817
0.797
0.738
0.737
0.724
0.716
0.657
0.545
0.814
0.800
0.796
0.779
0.761
0.738
3.43
3.41
3.44
3.51
3.40
3.31
3.33
3.25
3.43
3.27
3.08
3.19
3.19
3.02
3.04
0.919
34.1
0.928
11.94
0.726
0.791
0.766
0.763
0.730
0.548
0.739
0.706
0.635
0.823
3.28
3.60
3.57
3.48
3.49
3.17
3.43
3.48
3.33
3.72
0.825
7.45
0.834
5.25
0.760
4.05
0.773
0.633
0.735
0.656
0.767
0.727
3.46
4.03
3.78
3.92
3.12
3.62
0.693
3.39
0.669
3.25
Mental learning
Experience of
unique tourism
resources
Complementary
therapies
Relaxation
Healthy diet
Social activities
healthy diet and relaxation were two service factors the interviewed older adults valued more highly. Regarding the overall
service items, Atmosphere of relaxed tranquility (M = 4.03) was
considered the most important item. Use of non-toxic or detoxication food ingredients (M = 3.92) was ranked as the second most
important item. Additionally, both Provide local ingredients based
cuisines (3.78) and Provide landscape therapy (environment and
psychological consultation) (M = 3.72) were valued service items.
Discriminant validity was determined according to the correlation
coefcient between the factors. The analysis results indicated that
the correlation coefcient for the seven factors ranged between
0.218 and 0.521, with no correlation coefcient close to 1 observed.
Thus, discriminant validity was established for the seven factors
(Table 7).
4.3.2. Conrmatory factor analysis
The 31 items ltered by exploratory factor analysis were
used to verify the reliability and validity of the factors listed
Table 7
Factor correlation coefcient matrix.
Health promotion
treatments
Health promotion treatments
Mental learning
Experience of unique tourism
resources
Complementary therapies
Relaxation
Healthy diet
Social activities
**
p < 0.01.
Mental learning
0.474**
0.330**
0.521**
0.663**
0.218**
0.259**
0.406**
0.378**
0.340**
0.311**
0.423**
Experience of
unique tourism
resources
0.239**
0.383**
0.413**
0.392**
Complementary
therapies
0.253**
0.263**
0.278**
Relaxation
Healthy diet
0.439**
0.344**
0.331**
129
Table 8
Conrmatory factor analysis result.
Factors
Item
Factor loading
AVE
CR
Health promotion
treatments (M = 3.40)
0.81
0.86
0.84
0.81
0.79
0.82
0.87
0.80
0.69
0.70
0.73
0.81
0.85
0.77
0.78
0.56
0.92
0.59
0.91
0.58
0.87
0.62
0.83
0.57
0.80
0.55
0.71
0.50
0.67
Mental learning
(M = 3.15)
Experience of unique
tourism resources
(M = 3.46)
Complementary
therapies (M = 3.42)
Relaxation (M = 3.74)
0.66
0.62
0.74
0.75
0.76
0.71
0.72
0.72
0.75
0.64
0.63
0.63
0.64
0.54
0.64
0.71
130
Table 9
Cluster analysis of older tourist by service factor.
Service factors
p-Value
4.02
3.80
3.88
4.12
3.95
3.97
4.21
3.41
2.68
3.02
3.29
3.54
2.83
3.51
2.63
2.87
3.44
3.77
2.66
3.23
3.77
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Table 10
Cluster analysis of older tourist by socio-demographic variables.
Socio-demographic variables
Gender
Female
Male
Level of education
Junior high and lower
Senior high/higher vocational
education
Junior college
University
Postgraduate and above
Monthly disposable income (NTD)
20,000 and lower
20,00140,000
40,00160,000
60,00180,000
80,001100,000
100,001 and above
Age
65 and above
5064
Main companion of the current trip
Family
Friends
Colleagues
Classmates
Other
Group 2
111 (52.4)
101 (47.6)
82 (43.4)
107 (56.6)
89 (51.4)
84 (48.6)
42 (20.1)
82 (39.2)
37 (19.9)
82 (44.1)
49 (28.0)
65 (37.1)
35 (16.7)
45 (21.5)
5 (2.4)
29 (15.6)
34 (18.3)
4 (2.2)
23 (13.1)
31 (17.7)
7 (4.0)
70 (34.3)
58 (28.4)
35 (17.2)
21 (10.3)
6 (2.9)
14 (6.9)
53 (28.6)
84 (45.4)
29 (15.7)
4 (2.2)
8 (4.3)
7 (3.8)
52 (30.2)
87 (50.6)
16 (9.3)
5 (2.9)
4 (2.3)
8 (4.7)
36 (17.0)
176 (83.0)
28 (14.7)
162 (85.3)
39 (22.2)
137 (77.8)
89 (43.0)
67 (32.4)
24 (11.6)
7 (3.4)
20 (9.7)
85 (46.2)
52 (28.3)
17 (9.2)
2 (1.1)
28 (15.2)
70 (40.7)
67 (39.0)
16 (9.3)
3 (1.7)
16 (9.3)
Group 3
5. Conclusion
In this two-phase study, we interviewed hot spring experts to
acquire their perspectives on essential customer services to older
adults in wellness tourism. Based on their responses, we compiled
a list of descriptions of needed services. The descriptions were
grouped by similar keywords and/or concepts. Eventually, these
descriptions were used to compile a questionnaire to be distributed
to older adult tourists at hot spring areas in Taiwan.
Through exploratory and conrmatory factor analyses on
the survey data, we identied seven customer service factors,
Health promotion treatments, Mental learning, Experience of
unique tourism resources, Complementary therapies, Relaxation, Healthy diet, and Social activities. These seven service
factors encompass arguments included in previous researches on
older adult tourists (Huang and Tsai, 2003; Jang and Wu, 2006;
Joppe, 2010; Nelson et al., 2007; Nimrod and Rotem, 2010; Tung
and Ritchie, 2011).
The Healthy diet factor identied in this study is unique
and seldom mentioned in previous studies. Taiwanese diet habits
have changed due to the economic growth. Previously, people
concerned whether they had enough food to meet the physical
needs (feeling full). However, consumers in Taiwan demand meals
balanced with nutrition, taste, and other special culinary characteristics now. Moreover, since Japan occupied Taiwan for 50 years,
Japanese hot spring culture has greatly inuenced Taiwanese hot
spring industry. Providing good Japanese culinary arts to wellness
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