Wellness and healthy lifestyle

in tourism settings
Ana Težak Damijani
c

Abstract Ana Težak Damijanic  is

Purpose – This paper aims to examine the concept of wellness as a form of healthy lifestyle in tourism based at Institute of
settings. Agriculture and Tourism,
Design/methodology/approach – Data were collected through a self-complete questionnaire  , Croatia.
Porec
administered to a sample of guests staying in wellness hotels in Croatia. These data were processed
using univariate statistics (general description of the sample), cluster analysis (segmentation purposes),
multinomial regression analysis (profiling the clusters) and confirmatory factor analysis (confirmation of
wellness-related lifestyle).
Findings – Six wellness-related lifestyle dimensions (diet, fitness, social interactions, cultural diversity,
health awareness and personal development) were confirmed, and four segments emerged (high-level
wellness, diet- and health-oriented, fitness-oriented and low-level wellness clusters). They differed in their
travel motivation.
Originality/value – This paper suggests a wellness-related lifestyle scale that integrates the elements of
wellness intervention models and healthy lifestyle, confirms the link between healthy lifestyle and travel
motivation and establishes the importance of the social, intellectual and spiritual dimensions of a tourist’s
lifestyle.
Keywords Wellness, Tourism marketing, Scale construction, Healthy lifestyle, Wellness tourist product
Paper type Research paper

Introduction
The lifestyle of modern tourists may cause different imbalances resulting in the deterioration
of their health and, eventually, a disease; therefore, health preservation and promotion
present an important issue in tourism (Andrijaševic and Bartoluci, 2004). Tourism can be
beneficial to a tourist’s health, because it provides different physical, psychological and
intellectual benefits (Chen and Petrick, 2013; Hunter-Jones and Blackburn, 2007; Smith and
Puczko , 2009). Thus, research related to tourists’ health is usually the focus of wellness
tourism (Azman and Chan, 2010; Kim and Batra, 2009; Koh et al., 2010; Konu, 2010; Mak
et al., 2009; Mueller and Kaufmann, 2001; Pesonen et al., 2011; Pesonen and Tuohino,
2017; Voigt et al., 2011), healthy lifestyle (Chen et al., 2014; Hallab et al., 2003; Hallab,
2006; Kim and Batra, 2009) and well-being concept (Chen et al., 2013c; Gao et al., 2017;
Gilbert and Abdullah, 2004). Although the terms wellness, healthy lifestyle and well-being
revolve around tourist health, they are not synonyms.
Research on wellness tourism usually focuses on determining tourists’ motivational factors
(Azman and Chan, 2010; Kim and Batra, 2009; Konu and Laukkanen, 2009; Mak et al.,
2009) and benefits (Koh et al., 2010; Voigt et al., 2011; Williams et al., 1996), identifying
 and Bartoluci, 2004; Chen
important attributes of wellness as a tourist product (Andrijaševic
et al., 2013a, 2013b; Mueller and Kaufmann, 2001; Williams et al., 1996) and identifying and
profiling the segments (Dimitrovski and Todorovic , 2015; Dryglas and Salamaga, 2017; Received 8 February 2019
Revised 10 May 2019
Kamenidou et al., 2014; Voigt et al., 2011). Healthy lifestyle research usually concentrates Accepted 2 June 2019

DOI 10.1108/TR-02-2019-0046 © Emerald Publishing Limited, ISSN 1660-5373 j TOURISM REVIEW j

 on tourists’ behavioural aspects such as diet, fitness and stress management (Hallab, 2006;
Hallab et al., 2003; Kim and Batra, 2009) and on determining the relationship between a
healthy lifestyle and travel motives (Hallab et al., 2003). The well-being concept in tourism
settings centres around psychological, social and spiritual effects that travel has on tourists
(Chen et al., 2013c; Gao et al., 2017).
A cross-section of these research areas is evident through the concept of wellness-related
lifestyles (Chen et al., 2014). This concept is a form of healthy lifestyle and includes both
physical aspects that are common in healthy lifestyle research and psychological, social
and spiritual factors that are crucial in well-being research (Chen et al., 2014). The wellness-
related lifestyle concept is based on the wellness concept proposed by Mueller and
Kaufmann. Mueller and Kaufmann (2001, p.2) consider wellness ‘a state of health featuring
the harmony of body, mind and spirit, with self-responsibility, physical fitness/beauty care,
healthy nutrition/diet, relaxation/meditation, mental activity/education and environmental
sensitivity/social contacts as fundamental elements’. However, in their work, they focussed
on wellness as a type of tourist product. Additionally, different wellness intervention models
intended for counselling-oriented professions (Hattie et al., 2004) are disregarded. This
research builds upon the research on the wellness-related lifestyle scale proposed by Chen
et al. (2014) and wellness intervention models (Botha and Brand, 2009; Els and De La Rey,
2006; Hattie et al., 2004; Myers et al., 2000; Myers et al., 2004; Witmer and Sweeney, 1992)
and suggests an alternative approach to health preservation and promotion in tourism
settings. Therefore, this research contributes to theory and practice by integrating wellness
intervention models into wellness, well-being and healthy lifestyle research in the tourism
context. Furthermore, the relationship between wellness-related lifestyle and wellness tourist
products is investigated, thus linking healthy lifestyle to wellness tourism.

Literature review
Health is one of the oldest travel motives in tourism (Swarbrooke and Horner, 2007).
Wellness tourism, as a subcategory of health tourism, promotes tourists’ health, and its
target market is ‘healthy’ people (Mueller and Kaufmann, 2001). It integrates different health
promotion programmes and treatments (Mueller and Kaufmann, 2001) that usually include
various natural agents, and different services and products such as beauty treatments,
exercise, anti-stress management, diet, sauna, baths and massages (Andrijaševic  and
Bartoluci, 2004; Bennett et al., 2004; Chen et al., 2013a, 2013b; Kamenidou et al., 2014;
Mueller and Kaufmann, 2001). They are designed to satisfy tourist needs such as desire to
relax, socialise, escape, and indulge (Koh et al., 2010; Mak et al., 2009; Voigt et al., 2011).
By satisfying these needs, wellness tourism directly impacts tourist well-being (Chen and
Petrick, 2013).
Although wellness tourists are interested in different wellness services and products (Hallab
et al., 2003; Mueller and Kaufmann, 2001), their motives for visiting wellness and other
facilities are different (Williams et al., 1996), and they seek different benefits from these
services (Koh et al., 2010; Voigt et al., 2011). The users of wellness services are more
adventuresome and active during travel and are more interested in various activities
(Williams et al., 1996). The sub-segments of wellness tourists differ on the basis of their
motivation and sought benefits (Dimitrovski and Todorovic , 2015; Voigt et al., 2011) and
their perception of wellness facilities (Dryglas and Salamaga, 2017; Kamenidou et al.,
2014). In contrast, tourists following healthy lifestyle principles are more interested in visiting
wellness facilities (Kim and Batra, 2009) and are more likely to choose health promotion-
and preservation-related products and services (Hallab et al., 2003; Hallab, 2006).
Research related to tourists’ healthy lifestyle usually includes behavioural aspects such as
diet, fitness, smoking, drinking alcohol and stress management (Hallab et al., 2003; Kim
and Batra, 2009). However, health, as defined by World Health Organization (1948, from
Smith and Puczko , 2009), is a state of complete physical, mental and social well-being and

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not merely the absence of disease or infirmity”. Therefore, this approach to healthy lifestyle
presents a relatively narrow approach to tourists’ health because it includes physical
behavioural aspects and, to a certain extent, emotional behavioural aspects. Psychological,
social and spiritual behavioural aspects are part of the well-being research (Chen et al.,
2013c; Gao et al., 2017). However, wellness-related lifestyle includes aspects from both
lines of research (Chen et al., 2014).
The well-being concept usually consists of positive and negative effects and life satisfaction
dimensions, and through these dimensions, it includes various aspects such as personal
growth, purpose in life, relations with other people and happiness (Chen et al., 2013c; Gao
et al., 2017; Gilbert and Abdullah, 2004). While research on tourists’ well-being examines
the influence of tourism on tourists’ everyday life (Chen and Petrick, 2013), research on
healthy lifestyle and wellness-related lifestyle focuses on the issue of how lifestyle impacts
tourism (Hallab et al., 2003).
The concept of wellness-related lifestyle is based on a concept proposed by Mueller and
Kaufmann and includes seven factors, namely social contact, healthy diet, travel, vacation,
holistic achievement, fitness and environmental protection (Chen et al., 2014). However, the
roots of this concept can be found in Dunn’s research and his conceptual development of
wellness. The concept of high-level wellness is based on the definition of health and
emphasises the importance of connecting the body, mind and spirit (Dunn, 1957, 1959).
Initially, it was defined through the three main dimensions, i.e. the body, the mind and the
spirit (Dunn, 1959), but later, this concept was expanded. While wellness tourism research
has its origin in this concept, another direction of wellness research developed, namely in
the area of wellness intervention models (Hattie et al., 2004).
Wellness intervention models are usually theoretical models of well-being that are very
extensive because they include various behavioural aspects (Hattie et al., 2004; Witmer and
Sweeney, 1992). Some of the identified dimensions in applied studies are dimensions such
as spirituality, self-regulation, work, friendship and love (Witmer and Sweeney, 1992);
creative self, coping self, social self, essential self and physical self (Hattie et al., 2004);
cognitive-emotional, relational, physical and spiritual wellness (Myers et al., 2004); and
physical fitness and nutrition, medical self-care, safety, environmental wellness, social
awareness, sexuality and emotional awareness, emotional management, intellectual
wellness, and spirituality and values (Botha and Brand, 2009). However, all the above-
mentioned dimensions are essentially part of the five most common dimensions, namely
social, emotional, physical, intellectual and spiritual (Roscoe, 2009). In tourism settings,
wellness and the wellness dimensions are scattered across research related to wellness
tourism, well-being and healthy lifestyle.
In summary, tourists’ health preservation and promotion is the common denominator of the
well-being concept, healthy lifestyle and wellness tourism. The well-being concept
concentrates on how tourism satisfies tourists’ psychological, social and spiritual factors,
while healthy lifestyle links physical behavioural factors to tourism. Applied wellness
intervention models contain more behavioural factors from more tangible aspects (physical
such as diet, fitness and avoidance of harmful substances) to the more intangible aspects
(emotions, spirituality etc.). However, these models are very extensive. Therefore, the
concept of wellness-related lifestyle presents a sort of compromise between these fields of
research. However, it is not widely researched in tourism settings and can include different
approaches from the one chosen by Chen et al. (2014). In contrast, wellness tourism
research is more product oriented; i.e. different health promoting services and products are
at the core of such research. Therefore, the present study regarded wellness as a form of
lifestyle, accepted the term and concept of wellness-related lifestyle proposed by Chen
et al. (2014) and linked it to wellness tourism through tourists’ motivations. With this in mind,
the goals of this study were threefold:

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 1. to determine the wellness dimensions of wellness-related lifestyle;
2. to segment tourists on the basis of this concept; and

3. to determine the differences among the segments with respect to push and pull travel
motives related to wellness tourist products.

Methodology
This study focussed on guests staying in wellness hotels, because it was a part of a larger
research project linking health, travel motives and customer value. The survey was
conducted from May to June in 2013 in 15 hotels situated in a coastal part of Croatia. They
were selected taking into account the regional dispersion of wellness hotels (four wellness
regions) and hotel categorisation (three-star, four-star and five-star hotels). In the process of
onsite data collection, the researcher was stationary, while the responders were mobile
(Veal, 2006). As a self-complete questionnaire was administered, the minimal number of
300 responders was set to satisfy the requirement for performing a data analysis (Hair et al.,
2010).
For the data-gathering purpose, the questionnaire was designed to include questions on
䊏 wellness-related lifestyle;
䊏 perceived value;
䊏 motivational factors; and
䊏 respondents’ characteristics.
It was designed in Croatian and then back-translated into English, German, Italian, Russian,
French, Spanish and Slovenian. No changes were made to the original translations because
the only detected differences were in the usage of different synonyms. A five-point Likert
scale (1-totally not important to 5-totally important) was used to measure the wellness-
related lifestyle and motivational factors.
The wellness-related lifestyle was measured as the tourists’ perception of wellness. It
was operationalised as a multidimensional construct incorporating five theoretical
dimensions (Table I). The items used for measuring the dimensions were adopted from
the existing literature on consumer behaviour, tourist behaviour and applied wellness
intervention models. Initially, 57 items were generated. This list was first examined by a
psychologist and then by four tourism experts to achieve content adequacy; later, it
was pilot tested (Hinkin et al., 1997). The pilot test was conducted in five wellness
hotels from 23rd December 2011 to 6th January 2012, resulting in 160 questionnaires.
An exploratory factor analysis identified six dimensions (diet, social interactions,
cultural diversity, exercising, health awareness and personal development). They were
used in the main study.
Motivational factors were examined through the concept of pull and push factors (Table I).
For measuring the push factors, we used 18 items, resulting in three factors labelled as
health trend, relaxation and award and novelty. Cronbach’s alpha coefficients varied from
0.73 to 0.89 and accounted for 51.11 per cent of the accumulated variance. The pull factors
were explored as wellness hotel attributes and tourist destination attributes. The wellness
hotel attributes included 24 items that produced three factors labelled as basic wellness,
intangible wellness and extra wellness. Cronbach’s alpha coefficients varied from 0.80 to
0.91 and accounted for 58.85 per cent of the accumulated variance. Tourists’ destination
attributes included 20 items that resulted in three factors labelled as cultural and natural
heritage, entertainment and recreation, and landscape. Cronbach’s alpha coefficients
varied from 0.80 to 0.91 and accounted for 58.85 per cent of the accumulated variance.

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 Table I Variables’ conceptualization
Dimension Conceptualization Sources

Dimensions of wellness theory model (Roscoe, 2009)

Social Quality and extend of interaction with others and the community;
interpersonal interactions
Emotional Awareness and control of feelings; capability to manage one’s
feelings and to act accordingly; developmental view of the self;
ability to cope with stress; realistic but positive assessment of
one’s limitation; fulfilling relationships
Physical Optimum level of physical activity; improvement of
cardiovascular; fitness, flexibility and strength; maintaining
healthy diet; taking actions to prevent and detect illness;
avoidance of harmful substances
Intellectual Engagement in creative and stimulating activities; orientation
and achievement toward personal and professional growth
Spiritual Process of finding meaning and purpose in life; shared
connection with others, nature, the universe, and a higher power;
development of values and a personal belief system
Dimensions of motivation factors
Push factors Fitness; health improvement; feel younger; weight control;
healthy lifestyle; feel healthier; visit a trendy place; stress relief;
escape; reward; peaceful place; see landscape; experience
new cultures and new things
Pull factors
Wellness Sauna; whirlpool; solarium; traditional and alternative massages;
hotels beauty treatments; atmosphere; surroundings; relaxation;
attributes personal; advices; care for special needs; supervised sport;
detoxification
Tourists Museum and exhibitions; architecture; theatre; cultural heritage;
destination natural heritage; events; entertainment facilities; shops; sports
attributes and recreation facilities; landscape
Els and De la Rey (2006), Roscoe (2009)
Jayanti and Burns (1998), Kim and Batra
(2009); Kraft and Goodell (1993), Myers et al.
(2004)
Granzin et al. (1998), Hallab (2006); Hallab
et al. (2003), Hong (2009); Jayanti and Burns
(1998), Kim and Batra (2009); Kraft and
Goodell (1993), Myers et al. (2000)
Divine and Lepisto (2005), Hong (2009); Kraft
and Goodell (1993)
Els and De la Rey (2006), Myers et al. (2000);
Roscoe (2009)
Kim and Batra (2009), Koh et al. (2010); Konu
and Laukkanen (2009), Mak et al. (2009);
Pesonen et al. (2011), Voigt et al. (2011)
 and Bartoluci (2004); Bennett
Andrijaševic
et al. (2004); Mueller and Kaufmann, 2001;
Pesonen et al. (2011)
Dunne et al. (2007); Jönsson and Devonish
(2008); Yoon and Uysal (2005)

The data were processed using statistical methods consisting of univariate statistics
(general description of the sample), multivariate statistics (cluster analysis: hierarchical and
non-hierarchical techniques for segmentation purposes, and multinomial logit regression to
profile the clusters) and structural equation modelling (for confirming wellness-related
lifestyle scale). Cluster validation was done using a one-way ANOVA analysis and 12
measures that were not included as items of the wellness-related lifestyle (Hair et al., 2010).
The independent variables used for profiling were motivational factors.

Results and discussion

In all, 548 responders were used in the analysis. Most of the responders stayed in four-star
hotels in the Istria or Kvarner region. The proportion of female responders (56 per cent) was
slightly higher than that of males (44 per cent). A majority of the responders were between
35 and 54 years of age (48 per cent). Most of them had obtained higher education (68 per
cent). In general, the responders were employees (45 per cent), 16 per cent were self-
employed and approximately 14 per cent were managers. Most of them were from Austria
(23 per cent) and Germany (23 per cent), almost 11 per cent were from the UK, and about
10 per cent originated from Italy. The most frequent monthly net income was between
e1,000 and e2,000 (38 per cent). Almost 65 per cent of the responders came to the hotel
with their partner. About 2/3 of the responders visited the hotel for the first time, but most of
them (57 per cent) had already visited the region.
The individual items measuring wellness-related lifestyle were examined through checks for
the accuracy of data entry, missing data and distribution. The cases with the missing values

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 were replaced using the MCMC method for item imputation. Then, the confirmatory factor
analysis was performed to examine the relationship between the items and their
corresponding latent construct (Table II). The model fit indices for the measurement model
were acceptable, and all the indicators significantly loaded onto their respective latent
construct and were higher than 0.50 (Hu and Bentler, 1999). Each construct (Table III) had
an estimated composite reliability that exceeded the value of 0.60 and an extracted
variance higher than the recommended threshold of 0.50 (Hair et al., 2010). The results for
the correlations showed that all six wellness-related lifestyle dimensions were interrelated;
they were all positive, and none of them were excessive.
Six factors depicting wellness-related lifestyle were confirmed. Factors labelled as diet and
fitness corresponded to the aspects in physical dimension; the social intervention factor
contained items part of the social and emotional dimension; the spiritual dimension was
manifested through the cultural diversity dimension, while personal development and health
awareness were aspects of the intellectual dimension (Roscoe, 2009). These factors
correspond, to a certain extent, to the findings of Chen et al. (2014), who identified seven
factors, namely social contact, healthy diet, travel, vacation, holistic achievement, fitness
and environmental protection. The findings of Kim and Batra (2009), Hallab (2006) and

Table II Results of confirmatory factor analysis

Factor Item Mean SD Standard load

Diet Limitation of fat intake 3.39 1.20 0.78

Avoidance of food with nitrates and preservatives 3.36 1.26 0.68
Limitation of carbohydrates intake 3.19 1.25 0.77
Avoidance of food with high cholesterol level 3.22 1.25 0.79
Limitation of red meat intake 3.22 1.33 0.60
Social interactions Enjoy in socialising with other people 4.17 0.86 0.81
Community acceptance 4.22 0.81 0.78
Creation of a long lasting relationship with friends 4.17 0.92 0.77
Willingness to help 4.45 0.74 0.58
Enjoy in life 4.33 0.84 0.63
Cultural diversity Living in harmony with people and other life forms that are not a threat 4.49 0.84 0.81
Respect for human rights regardless of differences among people 4.35 0.94 0.83
Respect people with different beliefs 4.34 0.92 0.60
Fitness Effort to stay fit 3.87 1.00 0.80
Achieving active lifestyle 3.60 1.08 0.82
Exercise at least 30 min a day 3 days a week 3.13 1.41 0.73
Health awareness Often read about health 3.45 1.17 0.89
Often talk about health with friends and family 3.50 1.04 0.80
Interest in health-related information 3.89 1.00 0.79
Personal development Development of new skills 3.53 1.04 0.79
Education for the purpose of self-development 3.33 1.24 0.79
Interest in various areas 3.90 0.94 0.51
Notes: x 2 = 469.55, df = 194, p-value = 0.000; CFI = 0.946; SRMR = 0.05; RMSEA = 0.05; PClose = 0.38

Table III Scales reliability and discriminant validity

CR AVE Diet Social interactions Cultural diversity Fitness Health awareness Personal development

Diet 0.85 0.53 0.73

Social interactions 0.84 0.52 0.33 0.72
Cultural diversity 0.79 0.57 0.25 0.52 0.75
Fitness 0.83 0.61 0.44 0.32 0.31 0.78
Health awareness 0.87 0.68 0.57 0.36 0.28 0.36 0.83
Personal development 0.75 0.50 0.31 0.30 0.28 0.31 0.40 0.71
  
Notes: Significant at 0.05, significant at 0.01, significant at 0.001; italic figures in diagonal are the square root of the AVE

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Hallab et al. (2003) are partially supported, because they mostly focus on aspects of the
physical dimension, such as cholesterol level, nutrition, exercise, blood pressure and
smoking. Considering the applied wellness intervention models, the factors of diet, fitness
and social interactions correspond to a certain extent to the findings of Myers et al. (2000),
Hattie et al. (2004), and Botha and Brand (2009). In general, cultural diversity was the most
important aspect, while social interaction was the second most important factor. The other
factors were generally important, but their level of importance was either low or medium.
Additionally, the results stressed the importance of the social, spiritual and intellectual
factors of wellness-related lifestyle, connecting them to the concept of well-being (Chen
et al., 2013c; Gao et al., 2017).
The wellness-related lifestyle dimensions were cluster analysed. The number of clusters was
determined by splitting the sample and using the hierarchical clustering technique. A
hundred observations were randomly selected. The Ward method, with squared Euclidean
distance, was used to establish the preliminary number of clusters. A four-cluster solution
was selected on the basis of the largest and most plausible proportionate change. A non-
hierarchical cluster analysis procedure (k-means) was utilised to finalise the cluster solutions
using the a priori determined number of clusters. The latter procedure confirmed the four-
cluster solution (Table IV). The identified clusters were named according to the cluster
centroids. Cluster 1 (N = 211), being the largest, represented 39 per cent of the guests
staying in wellness hotels, while Cluster 4 (N = 69) was the smallest and represented 13 per
cent of the guests staying in wellness hotels. Cluster 2 (N = 150) represented 27 per cent
and Cluster 3 (N = 118) represented 22 per cent of the guests staying in wellness hotels.
Although the clusters differed statistically in all six measures, three dimensions of wellness-
related lifestyle stood out, i.e. diet, health awareness and fitness. Thus, the clusters were
subsequently named taking into account these variables. The guests staying in wellness
hotels in Cluster 1 expressed the highest importance on all six wellness-related lifestyle
dimensions; therefore, this cluster was labelled “high-level wellness”. In contrast, the guests

Table IV Results of cluster analysis and cluster validation

Final cluster centers
1 2 3 4
High level Diet and health Fitness Low level
Measures wellness oriented oriented wellness F value

Diet 3.99 3.29 2.60 2.22 146.95

Social interactions 4.55 4.34 4.20 3.38 81.64
Cultural diversity 4.59 4.54 4.57 3.20 105.18
Fitness 4.27 2.68 3.96 2.42 274.20
Health awareness 4.32 3.70 2.80 2.66 182.40
Personal development 4.06 3.54 3.25 2.83 59.43
Cluster validation results
Effort to be physically active 4.312,3,4 3.171,3,4 3.891,2,4 2.711,2,3 86.811
Walks as much as possible 4.412,3,4 3,361,3,4 3.781,2,4 2,801,2,3 56.358
Obtaining health information from different
sources 3.982,3,4 3.311,3,4 2.501,2 2.321,2 79.857
Natural balance should not be tempered with 4.572,4 4.381,4 4.304 3.481,2,3 30.990
Respect natural forces 4.592,3,4 4.351,4 4.151,4 3.291,2,3 32.297
Nutritionally balanced meals 3.892,3,4 3.411,4 3.191,4 2.651,2,3 33.841
Fruit and vegetables in everyday diet 4.412,3,4 4.051,4 3.771,4 2.981,2,3 43.193
Limitation of fast food consumption 4.362,3,4 3.721,4 3.641,4 2.771,2,3 38.144
Interest in meeting different groups of people 4.092,3,4 3.761,4 3.581,4 2.941,2,3 23.735
Enjoy in group activities 3.952,3,4 3.491,4 3.261 2.941,2 19.001
Interest in art, music and literature 4.062,3,4 3.591,4 3.291,4 2.751,2,3 27.293
Having new and original ideas 3.982,3,4 3.651,4 3.441, 3.121,2 18.435
Notes:  Significant at 0.05,  significant at 0.01,  significant at 0.001; mean with subscripts differ at p < 0.05

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 staying in wellness hotels in Cluster 4 expressed the lowest importance on all six wellness-
related lifestyle dimensions; hence, this cluster was labelled “low-level wellness”. Diet, health
awareness and fitness were the variables that differentiated Cluster 2 from Cluster 3.
Cluster 2 expressed the high importance of diet health awareness and thus was labelled
‘diet and health oriented’, while for the guests staying in wellness hotels in Cluster 3, fitness
was a highly important element; thus, this cluster was labelled ‘fitness oriented’.
The application of wellness-related lifestyle in wellness tourism settings resulted in four
clusters (high-level wellness, diet- and health-oriented, fitness-oriented and low-level
wellness clusters). Diet, fitness and health awareness were factors that stood out while
differentiating among the segments. These results partially support the findings of Hallab
et al. (2003) who identified two clusters (high- and low-level living-conscious segments) that
differed in health-oriented destination attributes. Although diet and fitness were important
factors in the differentiation among the segments, this research revealed the importance of
consumers’ intellectual aspect, i.e. health awareness.
In all, 12 measures related to healthy lifestyle and not included as wellness-related lifestyle
dimensions were used to validate the clusters. All of them were significant, verifying the
statistical differences among the clusters and providing support for the criterion validity of
the items (Table IV).
A multinomial logit regression was used to profile the clusters on the basis of the importance
of motivational factors (Tabachnick and Fidell, 2013). Before the multinomial regression was
performed, the test for the presence of multicollinearity was performed. The tests indicated
that multicollinearity was not present. The value of each independent variable was
measured using the average scores of items which represented each factor. The
dependent variable had four categories.
The multinomial logistic regression results indicated a significant model (Table V). The low-
level wellness cluster was selected as a reference category, as most of the wellness-related
lifestyle dimensions were deemed unimportant. The findings highlighted significant
differences between the low-level wellness cluster and the other three clusters.
Entertainment and recreation, and landscape were significant variables in differentiating
between the high-level wellness cluster and the low-level wellness cluster; health trend and
intangible wellness were significant variables in differentiating between the diet- and health-
oriented cluster and the low-level wellness cluster, while health trend was significant in
differentiating between the fitness-oriented cluster and the low-level wellness cluster. Travel
motives explained 20 per cent of the total variance in the model.

Table V Results of multinomial logistical regression

High level wellness Diet- and health-oriented Fitness-oriented
Variable b S.E. b S.E. b S.E.

Intercept 5.12 0.99 4.26 1.03 1.47 0.91

Health trend 0.07 0.20 0.41 0.21 0.53 0.21
Relaxation and award 0.07 0.19 0.22 0.20 0.34 0.20
Novelty 0.07 0.19 0.25 0.19 0.01 0.20
Basic wellness 0.24 0.20 0.25 0.20 0.21 0.20
Extra wellness 0.10 0.21 0.04 0.22 0.01 0.23
Intangible wellness 0.41 0.23 0.70 0.24 0.14 0.22
Cultural and natural heritage 0.35 0.19 0.28 0.20 0.31 0.20
Entertainment and recreation 0.45 0.21 0.39 0.21 0.13 0.22
Landscape 0.54 0.22 0.01 0.22 0.22 0.22
Notes: x 2 = 112.70 ; 2 Log Likelihood = 1327.11; Cox and Snell R2 = 0.19; Nagelkerke R2 = 0.20;

significant at 0.05,  significant at 0.01,  significant at 0.001; reference category was low level
wellness cluster

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Destination attributes (entertainment and recreation possibilities, and landscape) were
important in the differentiation between high-level and low-level wellness clusters, while
intangible attributes of wellness (atmosphere, communication with wellness service
providers etc.) were crucial in the differentiation between diet- and health-oriented and low-
level wellness clusters. Moreover, fitness, and diet- and health-oriented clusters probably
perceived health orientation, as a push factor, more as a necessity that complemented their
lifestyle choices than a trend compared with the low-level wellness cluster. These findings
confirmed the link between healthy lifestyle and travel motivation determined by Kim and
Batra, 2009; Hallab et al. (2003) and Hallab (2006).

Conclusion and implications

This paper explores health preservation and promotion in tourism settings by focussing on
the wellness-related lifestyle concept, wellness intervention models and healthy lifestyle
research. This research confirmed the six-factor structure of wellness-related lifestyle,
determined through the pilot. The factors were labelled as diet, fitness, social interactions,
cultural diversity, health awareness and personal development. Cultural diversity was the
most important aspect, while social interaction was the second most important factor. Diet
and fitness, as physical factors, and health awareness and personal development, as
intellectual factors, were generally important, but their level of importance was either low or
medium. By using this scale in wellness tourism hotels, we determined four clusters of
wellness guests, labelled as high-level wellness, diet- and health-oriented, fitness-oriented
and low-level wellness clusters. The factors that stood out while differentiating among the
segments were diet, fitness and health awareness. The wellness-related lifestyle segments
differed in their travel motivation. Entertainment and recreation possibilities and landscape,
as destination attributes, were important in the differentiation between high- and low-level
wellness clusters; intangible attributes of wellness tourist products were crucial in the
differentiation between diet- and health-oriented and low-level wellness clusters, while
fitness, and diet- and health-oriented clusters differed statistically in the health trend, as a
push factor compared with the low-level wellness cluster.
The study makes several contributions to the extant literature. First, this paper suggests a
wellness-related lifestyle scale that integrates the elements of wellness intervention models
(Botha and Brand, 2009; Els and De La Rey, 2006; Hattie et al., 2004; Myers et al., 2000;
Myers et al., 2004; Witmer and Sweeney, 1992) and healthy lifestyle (Divine and Lepisto,
2005; Hallab et al., 2003; Kim and Batra, 2009; Kraft and Goodell, 1993). Second, it
confirms the link between healthy lifestyle and travel motivations (Hallab, 2006; Hallab et al.,
2003; Kim and Batra, 2009). Additionally, the results support the well-being research
findings in tourism settings (Gao et al., 2017; Gilbert and Abdullah, 2004) by establishing
the importance of social, intellectual and spiritual dimensions of tourists’ lifestyle. However,
well-being researchers examine the benefits of tourism on tourists’ everyday well-being
(Chen and Petrick, 2013; Chen et al., 2013c; Gao et al., 2017; Gilbert and Abdullah, 2004),
while healthy lifestyle, as well as, wellness-related lifestyle research explores how tourists’
lifestyle influences tourists’ destination selection process.
The findings have certain implications for tourism managers. First, the concept of wellness-
related lifestyle provides broader criteria for segmentation purposes than the healthy
lifestyle concept. This enables managers to better understand the needs of their tourists.
Second, the findings determined the importance of intangible wellness attributes for the
diet- and health-oriented segment and the unimportance of the health trend for the diet- and
health-oriented and the fitness-oriented segments. These findings suggest that
atmosphere, personnel and surroundings are elements that managers should pay attention
to when creating tourist products for the diet- and health-oriented segment. They also
suggest that the concept of wellness as something prestigious is not to be stressed out.
Third, the determined link between the wellness-related lifestyle segments and the

j TOURISM REVIEW j
 destination attributes suggest that the development of a year-round tourism centred on
wellness should be complemented by other tourism operators.
There are certain limitations of this study. This study included guests staying in
wellness hotels that offer wellness as an additional tourist product. Therefore, future
research could apply this scale to the tourist population in general and to different
types of accommodation facilities. Consumers’ perception of wellness was used for
measuring wellness-related lifestyle, while questions about responders’ general health
status were not included. Therefore, future research may include questions that would
assist in assessing the responders’ health status such as weight, height and blood
pressure. Moreover, future research could examine the relationship between wellness-
related lifestyle and functional food, healthcare wearables etc. This research did not
include tourists with disabilities or other medical conditions; therefore, future research
might focus on these segments as well.

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Corresponding author
 can be contacted at: tezak@iptpo.hr
Ana Težak Damijanic

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