H7N9 Virus and Food Contamination at Maleic Acid Impacts on Inbound Tourism for Elderly to Taiwan

Introduction

Overview

This chapter covers the background to the study, problem statement, research objectives and hypotheses and the significance of the study.

Background to the study

The wide spread of the H7N9 Virus and food contamination have contributed to Health Tourism. Health entails a particular notion of health (Müller & Lanz-Kaufmann, 2002, p. 12). Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of health is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Health can, therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in.

Health directs the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, health involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or will to aid in his/her functionality. An individual will achieve a higher degree of health when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment (Ardell, 1977, p. 54).

The condition of being combined with a positive attitude in a continuous process entails the vibrant development of health (Travis, 1984, p. 33). The neutral point in the health continuum shows that no apparent sickness exists yet a low intensity of health prevails. The individual is protected from premature death by returning them to the neutral point. The main aim of the health model is not only just to aid in the healing of the individual’s diseases, but also to elevate the individual to a higher rank of health.

The definition of health according to Müller and Lanz-Kaufmann is in line with the definition given by Ardell (1977). Health is a health condition whereby the individual’s body, intellect and spirit work in unison. The elements that define health include: self-conscientiousness, health and prettiness, food nutrition, recreation, mental education, social interaction and sensitivity to the environment (Travis, 1984, p. 33). In addition, Müller and Lanz-Kaufmann noted that the hospitality industry should strive to refurbish its market in order to provide products that promote health so that the tourists can enjoy their trips better.

Statement of the problem

Health tourism is considered to be a subset of health tourism. Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Health tourism involves the individuals visiting hotels or recreational centres that provide health services. Health tourism, being a subset of healthcare tourism does not entail elective surgery.

It is required that health hotels should have an up-to-standard health infrastructure in order to provide the best services to the tourists. There are various extents of health as there are various extents of illness. Health tourism, therefore, is in line with the individual’s intent to improve the class of his/her life, physical health, mental health and social interaction. The individuals stay in specific hotels that have the capability to make available the relevant professional expertise and professional care. The various service packages of the hotels include: physical training, dieting activities and mental training. The hotels that function in line with health tourism should therefore strive to safeguard the individual’s physical health, mental health, and social relations.

Objectives of the study

The general objective of this study was to determine the influence of health tourism’s participation of the elderly. In line with the general objective, the study examined the following specific objectives:

1. To determine the effectiveness of the H7N9 Virus of elderly participation in health tourism;
2. To determine the influence of food non-contamination on elderly participation in health tourism;
3. To determine the influence of the desire for entertainment on elderly participation in health tourism;
4. To investigate the influence of the urge to take a vacation on elderly participation in health tourism;

Hypotheses of the study

In order to meet the above objectives, the following hypotheses were tested:

1. Ho₁: The H7N9 Virus motivate the elderly tourists to travel;
2. Ho₂: Food non-contamination motivate the elderly tourists to travel;
3. Ho₃: The urge for entertainment motivate the elderly tourists to travel;
4. Ho₄: The urge to take a vacation motivate the elderly tourists to travel;

Justification of the Study

The findings of this study are of great value to policy makers and regulatory authorities. It provides the policy makers with a wide exposure with regard to the assessment of the influence of health tourism’s participation for the elderly, thus enabling them to adopt the relevant strategies in line with the situation. The findings of this study also add to the body of knowledge of related studies.

Scope of the Study

The scope of this study was in line with the general objective, which was to explore on the influence of health tourism’s participation of the elderly. Using primary data and applying statistical techniques, the study explained the variables to meet the research objectives. The study used a cross-sectional research design to meet the objectives. The data of the survey were analysed using statistical techniques such as SPSS and ANOVA analysis.

Literature Review

Introduction

This chapter reviews the theories both empirical and theoretical that are closely linked to the influence of health tourism’s participation of the elderly.

Decisive models of tourists’ actions

The process of tourists’ behaviour is both complex and vigorous. In the context of tourism, the tourist behaviour process is considered to be complex due to the fact that tourism products are intangible and the purchasing power of the tourists is accumulated (Correia, 2002). Three sets of models have emerged as a result of the interdisciplinary status of health tourist behaviour. The models include: microeconomic models, structural models and processional models. In the case of microeconomic models, health tourists normally have the motive to increase their utility to the maximum subject to a combination of constraints such as: time, income and the level of technology (Morley, 1992). In the case of structural models, the connection between the input and output is scrutinized. Consequently, for the case of processional models, the tourist’s judgments are put in examination (Abelson & Levi, 1985).

The classical economic theory is the main basis of the microeconomic model that analyses the behaviour of the health tourists. When taking into consideration the demand for manageable goods or services, classical economic theory is very instrumental. In addition, the classical economic theory brings into focus the limitations that relate to tourism analysis. Samuelson (1991) asserts that the notion that the tourists strive to maximize the utility that they derive from health tourism contributes to the process of tourism analysis. Moreover, the destination sites for tourists are not considered as objects that can directly be used, but rather products that have characteristics that facilitate the derivation of utility (Lancaster, 1966, p. 140); this utility is subject to various constraints. Morley (1992, p. 254) brings into focus the utilization of microeconomic theory to the field of tourism. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of health tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000).

Scholarly studies that relate to the analysis of the influence of health tourism’s participation of the elderly are founded on the basis of various models that are considered to be outstanding. These models stem from the perspective of the processional models. The first model is the Nicosia model (1966) which concentrates on the correspondence that occurs between the tourist and the firm, and how the firm convinces the tourist to acquire her products. Another model dubbed Howard and Sheth’s model (1969) integrated the input notion that describes the conduct of the tourists; in addition, the model states the ways by which the tourists incorporate these inputs in their decision making process. The Howard and Sheth’s model has continued to be regarded as the most important model for analysing tourist activities.

Health tourist performance can be assessed by paying regard to the analytic analysis of desire, anticipations, conception and satisfaction. Gallarza, Saura and Garcia (2002, p. 63) emphasized on the use of statistical tools (such as multivariate analysis that depend on other analyses like correlation matrix, sampling techniques and regression analyses) on tourism. Qualitative choice models are very efficient in assessing the health tourist behaviours; such models entirely depend on multinomial logit (Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118). In the recent past, many academic scholars have applied structural models on researches that relate to the influence of health tourism’s participation for the elderly (Baker & Compton, 1998, p. 800).

Tourist decision making processes

There are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Before the tourist proceeds to make the purchase, the pre-decision stage usually precedes. This stage normally entails serious decision making by the tourist as he/she has to make the best choice out of the many alternatives. The kind of choices that the tourists have in this stage include: the travel destination, the activities to engage in during the travel and the level of expenditure that the tourist expects to commit. Very many tourists are motivated to travel because of the various activities that they intend to engage in or carry out (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466).

The pre-decision stage gives way for the decision stage. At this point the tourists make decisions paying attention to the time they have available for the travel and the amount of income that they want to commit on the travel. The decision stage is mostly concerned with the purchase of products. The post-purchase stage stems from the factors that determine the process of making choices and checks whether the tourist has been satisfied with the decisions or the choices that he/she had opted for. This stage, therefore, plays an important role in assessing the likelihood of making the purchase again and also in recommending or opposing the choice or the decision (Abelson & Levi, 1985; Barros & Proença, 2005, p. 300).

Speculative factors

Motivating factors

Generally, motivation refers to a certain need that influences a person to assume a certain demeanour in order to satisfy that need. The motivation theories can be linked to the psychological factors like: wants, desires and goals, as the theories provide a description of the psychological factors (Fodness, 1994, p. 563). The psychological factors of needs, desires or goals induce an urgent urge in the person’s mind which leads him/her to purchase goods or services; thus, motivation directly influences the feelings of the individuals (Gartner, 1993, p. 200; Dann, 1996, p. 43; Baloglu, 1997, p. 226). Tourists who have divergent motives may assess a tourist destination in the same manner especially if they are of the opinion that the destination provides them with the maximum health utility.

The important motivational elements that have been pointed out by different scholars in their studies include: the urge to get away from the daily programs or work; and the urge to seek for alternative enjoyable experiences (McCabe, 2000, p. 1050). The push-pull model was generated by Crompton (1979, p. 410). The model postulates that tourism is driven by two main forces; the first force, known as push, pushes the tourist out of his/her home driven by the desire to travel to an unspecified destination. In this context, the motivation of the push force depends on the satisfaction anticipated by the tourist, the urge for adventure, prestige, knowledge, and the desire to make new friendships. The second force, known as pull, provides the tourist with the direction regarding the choice of the destination (Uysal, Mclellan & Syrakaya, 1996, p. 62). The motives of the pulling force influence the tourist’s choice of the place to visit; the forces are connected to the features of the destination and the infrastructures that define tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied (Mohsin & Ryan, 2003, p. 117; Beerli & Martin, 2004, p. 670; Uysal, Mclellan & Syrakaya, 1996, p. 62; Fodness, 1994, p. 563). When the tourist has already pointed out the need, he/she proceeds to identify the destination that grants him/her the maximum satisfaction; the next stage after this is the learning stage.

The tourist’s learning course

The learning process enables the tourist to gain the knowledge concerning a product and how the product will impact on the satisfaction of the tourist. Bettman and Park (1980) studied the learning process before developing another model that processes information about the behaviour of the tourists when they are making decisions concerning the destinations that they want to visit. Actually, the tourist has the ability to retain at most seven destination sites and at least two destination sites (Miller, 1956, p. 83).

The learning process presents a number of destination sites to the tourist, who has a strain in remembering all of the destinations; thus, it is practical to choose a manageable number of destination sites that do not pose any hardship to the tourists. The analysis of the tourist learning can be viewed from the behavioural perspective or from the cognitive perspective. From the behavioural perspective, the tourist learning takes place in three parts, namely: gathering of information, making a choice and the learning experience. When the behaviour of the tourist is repetitive, then the benefits of the result are realized (Guy, Curtis and Crotts, 1990, p. 422)

Perception factors of the tourists

Perception refers to the way in which the travel tourists regard the value of the product (Sheth, Newman & Gross, 1991, p. 163; Correia & Crouch, 2004; Correia, Valle & Moço, 2005). The concept of perception stems from the cognitive point of view or from the behavioural point of view. Thus, it should be noted that perception occurs as a result of the process of tourist learning together with their motivations. Previous researches concerning tourist motivation reveal that the tourists’ selection and assessment of travel products are influenced mostly by affective factors (Fodness, 1994, p. 558).

Every tourist is driven by his/her personal motivational factors to travel; these motivational factors are both internal and external and they define the tourists’ insights regarding the destination (Baloglu & McCleary, 1999, p. 870; Gartner, 1993, p. 193; Correia, Valle & Moço, 2005). The internal motivational factors stem from the push motives while the external motivational factors stem from the pull motives. Perception is a dynamic process due to the fact that the tourists have the ability to select, to organize and to spell out the various stimuli into a useful and clear manner. The perception of the tourist, therefore, varies from the real characteristics of a product to the manner in which the tourist grasps and analyses information (Dann, 1981, p. 190; Pearce, 1982, p. 153). Perception can occur selectively if the tourist decides to be selective in his/her exposure, attention, perceptual blockage and perceptual defence. It is a common practice for the tourists to select only things they need and block out the things that they regard as unnecessary or unfavourable to them.

Satisfaction factors of the tourists

Each tourist has a different interpretation of the concept of satisfaction, thus, its definition is divergent among the various tourists. Many scholars in their research articles have linked the definition of satisfaction to the distinction between expectation and experience (Woodside, Frey & Daly, 1989, p. 12). Bultena and Klessig (1969, p. 349) gave a definition of satisfactory experience as a part of the level of the correspondence between the tourists’ desires and the experiences that they undergo. Satisfaction does not entirely stem from the pleasures that the tourists derive from the travelling experience, but rather it is the analysis that checks out whether the experience satisfied the tourist as it was expected to (Hunt, 1977, p. 459). Various researches have revealed that satisfaction and the brand’s attitude mean one and the same thing (LaTour & Peat, 1979, p. 433).

Affective reactions have a major influence on the experiences of the tourists’ consumption process with regard to their judgments on post-purchase satisfaction (Madrgal, 1995, p. 212; Spreng, MacKenzie & Olshavsky, 1996, p. 17; Barsky, 1992, p. 54; Oliver, 1993, p. 422). In this case, it is assumed that the satisfaction of the tourists is dependent on the performance of the product (health), the perceptions of the tourist in relation to the product, and the motivations that the tourists have. The ratio between the performance and the perception rises as the level of the tourist’s satisfaction also rises (Barsky, 1992, p. 54); the ratio depends on the nature of the experiences that the tourists have in relation to the experience they had envisaged or desired. The dissatisfaction of the tourists comes about when there is a major disparity between what the tourists had expected and what they actually experience in terms of the performance of the products.

Behavioural objective factors of the tourist

The intention by the tourist to make a purchase depends on their motives relating to both the behavioural and social norms. The motives of the tourists depend on the level of expectations that they have concerning the probability of assuming a certain behaviour and the assessment of how they regard it (Fishbein & Ajzen, 1980). Lam and Hsu (2006) in their study used the theory of reasoned action to show that the intention of the tourists to choose a destination site depends on the recognized behaviour and the past behaviour (Fishbein & Ajzen, 1980). The image that the travelling tourist portrays depends on the quality of the destination site, the anticipated satisfaction, the eagerness of the tourists to return and their enthusiasm to propose the destination to their friends. When the destination site is of a high quality, the tourists will be persuaded to return to the site because of the high level of satisfaction he/she experiences; the level of satisfaction will further influence whether the tourists will recommend the destination site to their friends. Further, studies show that the more a tourist visits a site, the more he/she is motivated to return, especially with regard to mature destinations (Kozak, 2001, p. 792).

Theory and Hypotheses Development

The tourists rely on information sources for travel awareness

Studies by Baloglu and McCleary (1999) confirm that tourists utilize the various sources of information so as to be familiar with the destined site. The sources of information include: the media (i.e. newspapers, televisions, internet, or travel magazines), information from friends or relatives through word of mouth, among others (Um & Crompton, 1990, p. 436; Fakeye & Crompton, 1991, p. 12; Dann, 1977, p. 186). The information is very beneficial to the tourists in their decision making process. There are four basic types of sources of information, they include: neutral information sources (tourism firms), commercial information sources (travel agencies), social information sources (relatives or friends) and promotional information sources (internet, magazines, radios or television) (Bargeman & Poel, 2006, p. 711; Crotts, 1999).

Various information sources motivate the tourists to visit

In their study, Um and Crompton (1990) established that travel tourists use the various sources of information to bring about a cognitive perception or an affective perception. Tourism is like any other product, thus, the tourist should seek for all the relevant information that relate to the product before deciding to purchase it. Woodside and Lyosnski (1989) in their study revealed the influence of the information sources on how they trigger the needs of the tourist. Tourists who are uncertain always resort to use travel agencies rather than media sources to get information relating to a destination site (Money & Crotts, 2003, p. 195). Health tourists are motivated by the promotional campaigns or publicity of the destination site (Crompton, 1979, p. 412; Kotler, Haider & Rein, 1993).

The sources of information initiate pull motivations in the tourist’s mind

The sources of information act as forces that affect pull motivations on the minds of travel tourists (Woodside & Lyosnski, 1989; Holbrook, 1978, p. 550; Gartner, 1993, p. 200).

Push motivations are instigated by internal motives of the tourists

Push motivations that are instrumental in influencing the tourist’s trip are classified as internal factors (Dann, 1977, p. 186). These internal factors that influence the push motivations include: the feeling of loneliness by the tourist, the urge of the tourist to travel, and the desire of the tourist to gain social recognition. In addition, Crompton (1990) regards internal factors as the factors that trigger the urge to travel in order to relax, socialize, earn prestige and get away from the daily routine.

Pull motivations are instigated by external motives of the tourists

In their study, Uysal and Hagan (1993) confirm that the characteristics of the tourist’s travel destination are connected to the pull factors. The tourist’s choice of the travel location is mostly influenced by the pull motives (Crompton, 1990, p. 53). Examples of pull motivation factors include: the available hospitality, accommodation, cost of the trip, type of food, nightlife, among others.

The process of tourist participation in health tourism is both complex and vigorous. In the context of tourism, the tourist behaviour process is considered to be complex due to the fact that tourism products are intangible and the purchasing power of the tourists is accumulated (Correia, 2002). The classical economic theory is the main basis of the microeconomic model that analyses the behaviour of the tourists. When taking into consideration the demand for manageable goods or services, classical economic theory is very instrumental. In addition, the classical economic theory brings into focus the limitations that relate to tourism analysis. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of travel tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000). There are various factors that influence the decision making process of the tourists; the main outstanding factor is actually the decision process. Tourism products, just like other normal products have several attributes which play the role of distinguishing them from the possible substitute products (Song & Witt, 2000; Lancaster, 1966, p. 140).

Qualitative choice models are very efficient in assessing the participation of health tourists; such models entirely depend on multinomial logit (Stynes & Peterson, 1984, p. 310; Barros & Proença, 2005, p. 302; Fleischer & Pizam, 2002, p. 118). There are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994).

Elderly tourists’ participation motivations

Motivation refers to the category of a need or a plight that urges a person to engage in a certain action that is expected to offer his/her satisfaction (Moutinho, 2000, p. 13). In other instances, motivation has been taken to mean the drive that exists within a person that compels him/her to do a certain thing so as to meet a psychological need or a biological need (Fridgen, 1996, p. 46). Travel motivation is the kind of motivation that is connected to the reason why people decide to travel (Hsu & Huang, 2008, p. 52). The motivation that is connected to the tourists’ travel encompasses a wide spectrum of the tourists’ behaviours and their previous travel experiences. Examples of the motivations that lead people to travel include: the desire to relax, the urge to gain excitement, the need to interact with friends socially, the spirit of adventure, the urge to interact with families, the drive to improve personal status, and the urge to get away from the daily routines or stress. Pearce (1982) connected tourists’ motivation and behaviour to the Maslow’s (1954) hierarchy of human needs; he was of the opinion that “the main reason that made the tourists to be attracted to the destined place of visit was their desire to attain self-actualization, the feeling of love or belongings, and also to attain the physiological needs” (p. 42).

There exist various available literatures that explain the various factors that motivate tourists to travel. In their study, Cleaver et al. (1999) revealed that “the market for the elderly is not uniform, and they pointed out seven segments that relate to the motivation for the elderly tourists. The segments include: thinkers, nostalgic, physicals, learners, status seekers, friendly and escapists” (p. 8). In addition, Backman et al. (1999) pointed out the similarities and contrasts that exist between the younger elders (55 to 64 years) and the other elders (65 years and above). In their study, they revealed that “the main motivation factors that drove the younger elders to travel was the need to relax or to engage in leisure activities; on the other hand, the older elders were mainly motivated to travel by educational attractions and national attractions” (p. 17). Moreover, Fleischer and Pizam (2002) did a review of the past studies regarding travel motion and made an inference that “the older elders were generally motivated to travel by the desire to relax, interact, learn, and to gain excitement” (p. 108). In the same manner, Horneman et al. (2002) in his study revealed that “the motivation for the elderly was moving towards the desire to rest or relax, the desire for physical exercise or fitness, and the desire for education” (p. 34).

The most recent study done by Huang and Tsai (2003) did a review of the previous studies concerning travel motivation and found out that “the motivation to travel can be categorized into various groups, for instance, rest and relaxation, education, adventure, socializing, and escape from daily patterns of life” (p. 565). In the same way, Jang and Wu (2006) concluded that “the significant push and pull motivations of the tourists were: the desire to seek knowledge, and the urge to be safe” (p. 308).

Elderly tourist profiles and requirements

An exploration of the past studies concerning travel motivation factors mainly focused on senior or elderly travellers by checking on their profiles, tastes and needs. A study conducted by Anderson and Langmeyer (1982) to assess the profiles of the senior travellers mainly concentrated on two elderly groups (over 50 years and below 50 years). The study found out that “both the two groups were motivated to travel by the desire to fulfil their pleasure, the desire to rest or relax, and the desire to meet families or friends; however, the group which was above 50 years of age had a higher probability of touring historical sites” (p. 22). In addition, a study conducted by Javalgi et al. (1992) confirmed that “younger tourists are more educated as compared to the elderly tourists, thus, they always carry out an information search before they proceed with their visit” (p. 16). In addition, the study also found out that “the elderly tourists had adopted a culture of purchasing trip packages that covered the costs of both transportation and accommodation” (p. 17).

Zimmer et al. (1995) conducted a study that mainly dwelt on the attributes of the elderly travellers; the study found out that “the most crucial discriminating variables that existed between those who travel and those who do not travel were: mobility problems, age, and level of education” (p. 8). A study conducted by Koss (1994) found out that “the elderly tourists preferred tourism packages that offered them excitements and added value to their lives” (p. 37). In a related study, Bai et al. (2001) conducted a study that focused on elderly tourists from Britain, Germany and Japan. They found out that “the elderly tourists preferred to have packaged tours; this was evident by the significant number of the tourists in travel parties” (p. 152).

Patterns of behaviour of the elderly tourists

Several studies have been carried out to check on the patterns of behaviour of the elderly tourists. In his study, Shoemaker (1989) concentrated on elderly tourists from Pennsylvania by exploring their travel behaviours and their motivations to travel. He further “segmented the market for the elderly tourists into three groups, for instance, tourists travelling as a family, tourists who rested actively, and the older set of tourists” (p. 18). Romsa and Blenman (1989) conducted a study that focused on the patterns of vacation for elderly German tourists by concentrating on their travel modes, travel destination, length of stay, type of accommodation chosen, and vacation memories. They found out that “all the above listed factors were instrumental in influencing the tourists to travel” (p. 182).

Another study conducted by Huang and Tsai (2003) on the elderly tourists from Taiwan revealed that “the elderly tourists were reluctant to sign up for an all-inclusive tour package” (p. 565). Instead, the elderly tourists preferred to have elegant tours which had a high quality in terms of provision of services. Littrell (2004) conducted a study that sought to explore on the tourism activities of the elderly tourists and their behaviour when it comes to shopping. The tourist travel activities that were explored in this study included sports tourism, cultural tourism, outdoor tourism and entertainment tourism. The study found out that “the profiles of the tourists were diverse with regard to their probability to shop at retail outlets, their choice of shopping malls, and their sources of information concerning the available shopping activities” (p. 351).

Motivation is regarded as a shape of the state of needs that influences a person to engage in a certain action or activity that has a higher probability of granting him/her a certain level of desired satisfaction (Moutinho, 2000, p. 13). Motivation is a procedure concerning preferences made by individuals or subordinate organisms among substitute forms of deliberate activity (Britton, et al., 1999, p. 27). Barcelo (2000) suggested that “the present and immediate influence on the vigour, direction and persistence of action can be termed as motivation” (p. 24). Kinni (1994) found out that “business managers are striving to establish and maintain an atmosphere that is more favourable for the satisfaction of tourists, who are striving together in groups towards attainment of pre-determined goals” (p. 14). In the same way, Robson (2002) insinuated that “motivation can be offered to workers as per the following methodologies: the customary or traditional approach; implicit bargaining; human relations approach; internalized motivation; and competition” (p. 62).

Travel motivation can be explained as the magnitude of the commitment, vigour, and originality in the part of the tourist. For many tour managers, amidst of ever gradually increasing more aggressive business atmosphere of the recent years, finding out, means to motivate the clients. In reality, a variety of varied hypotheses and means of tourist motivation have appeared, extending from increased involvement to monetary incentives and employee empowerment. For small tourist enterprises, motivation can occasionally be predominantly challenging where the promoters have frequently worked for many years for establishing a company that he may be reluctant to delegate significant authorities to others. But the business owners should be aware of such drawbacks. Some of the issues connected to unmotivated travellers include deteriorating morale, less contentment, and widespread dissuasion. If permitted to prolong, these issues can lessen earnings, competitiveness, and productivity especially for small business.

The motivation theories can be linked to the psychological factors like: wants, desires and goals, as the theories provide a description of the psychological factors (Fodness, 1994, p. 563). The psychological factors of needs, desires or goals induce an urgent urge in the person’s mind which leads him/her to purchase goods or services; thus, motivation directly influences the feelings of the individuals. Tourists who have divergent motives may assess a tourist destination in the same manner especially if they are of the opinion that the destination provides them with the maximum utility.

The significant elements of motivation that have been pointed out by different scholars in their studies include: the push to get away from the daily programs or work; and the urge to seek for alternative enjoyable experiences (McCabe, 2000, p. 1050). The push-pull model was generated by Crompton (1979). The model postulates that “tourism is driven by two main forces; the first force, known as push, pushes the tourist out of his/her home driven by the desire to travel to an unspecified destination” (p. 410). In this context, the motivation of the push force depends on the satisfaction anticipated by the tourist, the push to adventure, esteem, awareness, and the desire to make new friendships.

Pull is the second force that provides the tourist with the direction regarding the choice of the destination (Uysal, Mclellan & Syrakaya, 1996, p. 62). The drive of the pull force influences the tourist’s selection of the place to visit; the forces are linked to the attributes of the destination and the infrastructures that describe tourism. The features of the destination enable the tourist to make judgments as to whether their desires will be fully satisfied. When the tourist has already pointed out the need, he/she proceeds to identify the destination that grants him/her the maximum satisfaction.

It is very beneficial for the elderly tourists to learn about the travel destination before making up their minds to travel. A study conducted by Guy, Curtis and Crotts (1990) confirm that the tourists’ learning about a destination is determined by their previous experiences or by the kind of information that they receive either directly or indirectly concerning the destination. Tourists who are doubtful normally depend on information from travel agencies so that they can be furnished with the essential information regarding the destination site (Money & Crotts, 2003, p. 195). The search for information relating to the destined visit site by the tourists is motivated by the various contingencies in the marketplace and the nature of the visits (Fodness & Murray, 1997, p. 506). Tourists who travel on a habitual basis have a more likelihood to receive information that relates to the travel product or the travel destination; with this regard they are more passionate to spread the information to other interested travellers (Jamrozy, Backman & Backman, 1996, p. 912).

The elderly tourists have different perceptions concerning the kind of travel destination that they wish to have. Perception refers to the way in which the travel tourists regard the value of the product. The concept of perception stems from the cognitive point of view or from the behavioural point of view. Thus, it should be noted that perception occurs as a result of the process of tourist learning together with their motivations. Previous researches concerning tourist motivation reveal that the tourists’ selection and assessment of travel products are influenced mostly by affective factors (Fodness, 1994, p. 558).

Every tourist is motivated by his/her personal motivational factors to travel; these motivational factors are both internal and external and they define the tourists’ insights regarding the destination (Baloglu & McCleary, 1999, p. 870; Gartner, 1993, p. 193; Correia, Valle & Moço, 2005). The internal motivational factors originate from the push motives while the external motivational factors originate from the pull motives. Perception is a self-motivated process due to the fact that the tourists have the capability to choose, to systematize and to spell out the various stimuli into a useful and clear manner.

The awareness of the tourist, therefore, fluctuates from the real characteristics of a product to the manner in which the tourist captures and analyses information (Dann, 1981, p. 190; Pearce, 1982, p. 153). Awareness of the tourist can occur selectively if the tourist decides to be selective in his/her exposure, attention, perceptual blockage and perceptual defence. It is a common practice for the tourists to select only things they need and block out the things that they regard as unnecessary or unfavourable to them.

There are two impressions of insight that stem from the tourists’ learning process. One of the impressions is the cognitive perception, while the other one is the emotional perception. When the elderly tourist assesses the features of the desired destination, cognitive perception is achieved; on the other hand, emotional perception relies on the thoughts of the tourist with regard to the desired destination (Gnoth, 1997, p. 292). Both the two insights (cognitive and emotional) are essential for putting together models of perception of the tourists’ travel products.

Every tourist has a great aspiration to satisfy his/her incentive when they decide to travel. Each tourist has a different explanation of the notion of satisfaction, thus, its definition is divergent among the various tourists. Many scholars in their research articles have connected the definition of satisfaction to the dissimilarity between expectation and experience (Woodside, Frey & Daly, 1989, p. 12). Bultena and Klessig (1969) gave a definition of satisfactory experience as “a part of the level of the correspondence between the tourists’ desires and the experiences that they undergo” (p. 349). Satisfaction does not entirely originate from the pleasures that the tourists gain from the travelling experience, but rather it is the analysis that checks out whether the experience satisfied the tourist as it was expected to (Hunt, 1977, p. 49). A variety of researches have made known that satisfaction and the brand’s attitude mean one and the same thing.

Affective responses have a great effect on the experiences of the tourists’ consumption process with regard to their judgments on post-purchase satisfaction. In this circumstance, it is assumed that the satisfaction of the tourists is relative to the performance of the product, the awareness of the tourist in relation to the product, and the motivations that drive the tourists. The ratio between the performance and the perception rises as the level of the tourist’s satisfaction also rises (Barsky, 1992, p. 54); the ratio depends on the nature of the experiences that the tourists have in relation to the experience they had envisaged or desired. The frustration of the tourists comes about when there is a major disparity between what the tourists had anticipated and what they actually experience in terms of the performance of the products.

A variety of scholars have expressed their disapproval concerning the conceptualization of satisfaction with regard to the expectations that the tourists have. Satisfaction is perceived to have a connection with surprise (Arnould & Price, 1993, p. 26). As well, Miller (1977) concluded that tourist satisfaction can occur in various forms; for instance, desirable satisfaction, ideal satisfaction, and tolerable satisfaction. When tourists go for the holidays, their satisfaction levels are highly connected to their level of motivation. When the travel destination is attractive, the needs and the motivation of the tourists are highly satisfied (Truong, 2005, p. 229). The perception of the destination encompasses a variety of factors and various attraction sites that the tourist believes to have the capacity to satisfy his/her desires or expectations. Therefore, when the post-purchase behaviour analysis is taken on, it is expected to make out whether the travel tourists have been contented by the tourist products or whether they have been discontented by the same. The analyses of the post-purchase tourist behaviour are related to the concept of push and pull satisfaction. When the concept of push and pull satisfaction is likened to motivation, both the tangible and intangible components of the post-purchase analysis can be measured (Truong, 2005, p. 229).

The purpose of the tourist to make a purchase depends on their motives relating to both the behavioural and social norms. The intention of the tourists depends on the level of expectations that they have concerning the likelihood of adopting a certain behaviour and the assessment of how they regard it (Fishbein & Ajzen, 1980). Lam and Hsu (2006) in their study used the theory of reasoned action to show that the intention of the tourists to choose a destination site depends on the standard behaviour and the past behaviour (Fishbein & Ajzen, 1980). The picture that the travelling tourist depicts depends on the quality of the destination site, the anticipated satisfaction, the eagerness of the tourists to return and their enthusiasm to propose the destination to their friends. When the destination site is of a high quality, the tourists will be persuaded to return to the site because of the high level of satisfaction he/she experiences; the level of satisfaction will further affect whether the tourists will recommend the destination site to their friends. Further, studies show that the more a tourist visits a site, the more he/she is motivated to return, especially with regard to mature destinations (Kozak, 2001, p. 792).

Decision making process of the elderly tourists

Scholarly articles have pointed out that there are three fundamental stages that are involved in the process of decision making by the tourists; the stages include: the pre-decision, the decision and the post-purchase assessment (Crompton & Ankomah, 1993, p. 466; Bentler & Speckart, 1979, p. 457; Um & Crompton, 1990, p. 438; Ryan, 1994). Before the tourist carries on to make the purchase, the pre-decision stage normally paves the way. This stage normally involves serious decision making by the tourist as he/she has to make the best preference out of the many alternatives. The kind of choices that the tourists have in this stage include: the travel destination, the activities to engage in during the travel and the level of expenditure that the tourist expects to commit. Very many tourists are motivated to travel because of the various activities that they intend to engage in or carry out (Crouch & Jordan, 2004, p. 120; Crompton & Ankomah, 1993, p. 466).

The pre-decision stage leads to the decision stage. At this point the tourists make decisions paying attention to the time they have available for the travel and the amount of income that they want to commit on the travel. The decision stage is mostly concerned with the purchase of products. The post-purchase stage originates from the factors that determine the process of making choices and checks whether the tourist has been satisfied with the decisions or the choices that he/she had opted for. This stage, therefore, plays an important role in assessing the likelihood of making the purchase again and also in recommending or opposing the choice or the decision (Abelson & Levi, 1985; Barros & Proença, 2005, p. 300).

There are three sets of models that have emerged as a result of the interdisciplinary status of the elderly tourists’ behaviour. The models include: microeconomic models, structural models and processional models. In the case of microeconomic models, elderly tourists normally have the motive to increase their utility to the maximum subject to a combination of constraints such as: time, income and the level of technology (Morley, 1992). In the case of structural models, the connection between the input and output is scrutinized. Consequently, for the case of processional models, the tourist’s judgments are put in examination (Abelson & Levi, 1985).

The microeconomic models that analyses the behaviour of the tourists are found on the basis of the classical economic theory. When taking into consideration the demand for manageable goods or services, classical economic theory is very instrumental. In addition, the classical economic theory brings into focus the limitations that relate to tourism analysis. Samuelson (1991) asserts that the notion that the tourists strive to maximize the utility that they derive from tourism contributes to the process of tourism analysis. Moreover, the destination sites for tourists are not considered as objects that can directly be used, but rather products that have characteristics that facilitate the derivation of utility (Lancaster, 1966, p. 140); this utility is subject to various constraints. Morley (1992) brings into focus the utilization of microeconomic theory to the field of tourism. Microeconomic analysis creates a platform that is beneficial for the analysis of the behaviour of elderly tourists (Paraskevopoulos, 1977; O’Hagan & Harrison, 1984, p. 922; Song & Witt, 2000).

Research Methodology

Introduction

Methodology is the process of instructing the ways to do the research. It is, therefore, convenient for conducting the research and for analysing the research questions (Snell & Dean, 1992, p. 480). The process of methodology insists that much care should be given to the kinds and nature of procedures to be adhered to in accomplishing a given set of procedures or an objective. Methodology gives a description of distinct methods or procedures that are to be used in analysing the data. These methods or procedures stand for a creative generic structure; thus, their order may be rearranged, or they may be combined or broken down into sub-processes.

With this regard, research methodology can entail elaboration of the generic processes and procedures; as well, research methodology can be elaborated through figurative means and can be adjusted to eliminate obscurity in the school of thought with tenacious conceptions or doctrines as they associate to a specific field or discipline of inquiry especially if the philosophical and/or principal of the presumptions that signify a specific methodology or a specific study is known as reasoning methodology. A section on the methodology in academic research of the researchers will always be generally de rigueur.

The research strategy

First, with regard to the qualitative research, areas of study were chosen with determination, paying attention to whether the areas of study are in line with the features that have been predetermined (Creech, 1995, p. 33). Next, the part played by the researchers was to obtain a higher critical care (Creech, 1995, p. 33). This is mainly done in qualitative research due to the fact that there is every chance of the researcher assuming a transcendental or a ‘neutral’ position. Thus, this appears to be more elusive both in philosophical and/or practical terms. It is for this reason that the qualitative researchers are frequently pressed to mirror on their part in the research procedures and make things obvious in their research analyses.

Research Process

In the research process, the choices of the two processes: deductive and inductive processes can be used for carrying out the research. A deductive approach is described as a study in which the theory is tested by the empirical observation, and is referred as moving from the general to the specific. Deductive research establishes a theory and then checks on the data; it uses quantitative data and it is a very structured approach. On the other hand, inductive approach is a study in which the theory is developed from observation of reality and is the opposite of deductive research; it moves from the specific observations to the general statements.

Inductive approach does not start with the theory, and is very flexible using qualitative data. This study mainly used the inductive process in the case of exploring the influence of health tourism’s participation for the elderly because the theory is developed from the observations of the reality, and during the process, there are qualitative data that are used for data analysis (Snell & Dean, 1992, p. 480; Skinner, 1953, p. 306; Creech, 1995; Bryman & Bell, 2003, p. 214).

Quantitative and Qualitative Approach

Quantitative approach

Quantitative research approach refers to the use of statistical techniques, mathematical techniques and calculation techniques to empirically analyse data (Bryman & Bell, 2003, p. 217). Quantitative methodology aims at utilizing mathematical and statistical theories and models to analyse the data. Quantitative methodology validates the hypotheses and conclusions that have been drawn from qualitative methodology (Carter, 2009, p. 239). The scientific procedures and processes that are utilized in quantitative methodology encompass: deriving models and theories; designing instruments for data gathering; controlling the variables empirically; and analysing data through the use of models (Robson, 2002, p. 212).

Qualitative approach

Qualitative approach is mostly concerned with the human motives and the reasons behind such motives (Snell & Dean, 1992, p. 482). The main questions that come with qualitative approach are ‘why?’ and ‘how?’, in addition to ‘what?’, ‘where?’ and ‘when?’. With regard to this, a researcher utilizing the qualitative approach will tend to use smaller samples rather than larger samples (Carter, 2009, p. 239). Qualitative approach strictly generates only the information that applies to the designated case study; any additional information is treated as guesses. Once hypotheses are drawn through qualitative approach, they are tested through quantitative approach (Robson, 2002, p. 212).

Validity and Reliability

Validity refers to whether an instrument actually measures what it is supposed to measure, given the context in which it is applied. Reliability is concerned with consistence of measures. The level of an instruments’ reliability is dependent on its ability to produce the same results when used repeatedly. To achieve validity and reliability, the data was checked for coding errors and omissions while coding into excel sheets. The database was also verified for accuracy and completeness of all the entries to ensure reliability of data is achieved.

Questionnaire Administration

Data can be classified into two and they are secondary data and primary data. Primary data refer to the new data (observation, survey, interview, experiment, etc.) that the researcher needs to collect for the research while secondary data refers to the existing data that are available in various sources including books, journals, internet, etc. (Easterby, Thorp & Lowe, 2008, p. 216). For primary data collection, the issue is to focus on sampling. As far as the researcher is considered, the sampling technique is significant. For example, the sample size that is determined should not be too small as this will make it difficult to generalize the data. It is to be noted that reliable results can be originated from larger sample sizes (Bryman & Bell, 2003, p. 309).

The primary data sources comprise observation and participant observation, questionnaires and interviews, texts and documents, focused group, case study, etc. Questionnaires are practical approaches of collecting data. Respondents were also given the analogue questions that were supplemented by in depth interviews. The outstanding advantages of using questionnaires are that the data are accurate, anonymous, and they can cover a broad location without any geographical limitation. The disadvantages of using questionnaires are that they could be expensive, impersonal, delay in getting results, and the response rate can be very low (Easterby, Thorp & Lowe, 2008, p. 216). In this study, questionnaires were issued in 17 hotels in Taiwan. The hotels were selected with regard to their location and size.

Respondents and Unit of Analysis

In this study the questionnaires were issued to tourists visiting hotels in Taiwan. The study chose a target of 1,249 respondents and received feedback from 1,130 respondents. This is equivalent to a 90.5% response rate which is very good. In this research, data from the survey were entered into the Excel spreadsheet program for future analysis. The data was analysed using SPSS, regression and correlation analysis.

Findings, Data Analysis and Interpretation

Introduction

This section covers the analysis of the data, presentation and interpretation. The results were analysed using SPPS, ANOVA, regression and correlation analysis.

Descriptive statistics

The tourist sites were visited by at least 50% of all the tourists coming to Taiwan. In this study 1,249 questionnaires were issued to respondents; only 1,130 were successfully filled out. The results revealed that the female respondents were 53% as compared to the male respondents who were 47%. All the respondents had an average age of 45.39 years with a standard deviation of 14. Actually, the majority of the respondents were aged between 34 and 58 years. In addition, a major number of the respondents had obtained a higher level of education. The respondents had varied backgrounds with regard to their occupations; for instance, 70% were employees, managers were 17% and 13% were hotel owners.

With regard to the country of origin, 30% of the respondents came from Germany, followed by Austria (18%), Italy and the UK (12%), Russia (10%), and the rest were classified as other countries. In addition, a big number of the respondents (53%) had visited Taiwan initially. First time visits were more than repeat visits. Many of the respondents were travelling together with their spouses, and 33% were travelling with their spouses together with not less than one child. The respondents were grouped into three categories; the first category was, high level health, the second category was moderate level health, and the third category was low level health. Using a Chi-square test and ANOVA, the important differences among the three categories of the respondents were noted. The results are summarised in Table 4.1 and Table 4.2.

Table 4.1 Relationship between tourists’ characteristics and health groups

Country of origin had the largest size effect, hence indicating an average strength. The size effect for the other variables was comparatively low. The important differences among the three groups were confirmed for size of settlement, visiting with children, visiting with spouse, relying on brochures for information, relying on TVs for information, motivation by the H7N9 Virus, motivation by food non-contamination, willing to stay in another part of Taiwan, food and drinks prices, tour of Spain, tour of Greece, sex/gender, occupation, first visit or repeat visit, country of origin, and education level. High level health tourists did not prefer to: stay in villages (28%), and to travel together with the children (44%) as compared to the two remaining groups. In addition, high level health tourists had a higher likelihood of relying on brochures to obtain information about the destination site (53%) and also to tour Spain (51%).

On the other hand, 21% of the tourists in the category of low level health visited with their partners or spouses. This percentage was the least as compared with the other categories. 13% of low level health category of tourists relied on TVs for information regarding the destination site. 17% of the tourists in the category of moderate level health considered the H7N9 Virus as their main motivational factors to visit as opposed to 59% of the tourists in the category of high level health who did not consider the H7N9 Virus as the main motivational factors.

38% of the German tourists and 40% of the Italian tourists regarded health to be very essential to their lifestyle. In addition, 54% of Russian tourists and 71% of the UK’s tourists confirmed that health was very essential to their lifestyle. 33% of the respondents in the category of low level health had elementary or high school level of education. 28% of the tourists in the category of high level health complained about the high prices of food and drinks in the hotels.

The Chi-square test confirmed the overall significance of the variables, but the post hoc test did not reveal any considerable relationship between the three categories of health and motivation by food non-contamination, motivation to travel, willingness to stay in another part of Taiwan, and tour of Greece. With regard to these variables, it was noted that 49% of the tourists in the category of high level health were highly willing to stay in another side of Taiwan as compared to the other groups, 46% of the same tourists were motivated by food non-contamination, while 52% were willing to tour Greece and 50% were visiting for the first time.

Table 4.2 ANOVA analysis of tourists’ characteristics by health category

NOTE: * = Significant at 0.01

Mean with subscripts vary at p<0.05.

The three categories of tourists varied with regard to having a house, having a car, clothes and shoes, vacation, entertainment, stay period, insight of the vacation, and the age as shown in Table 4.2 above.

The respondents who had the view that health was not essential to their lifestyle regarded having a house, car, clothes and shoes as the least significant. The relevance of having a vacation and entertainment varied significantly among the three categories of tourists. The two variables were the most significant to high level health tourists and were less significant to low level health tourists. Also the period of stay during the trip varied significantly among the three categories of tourists. The high level health tourists preferred to stay for long as opposed to the low level health tourists who preferred to stay for a shorter period. The high level health group had the perception that lack of money influenced their vacation; the opposite was true for the low level health group. In terms of age, the high level health group was the oldest among the three groups.

Conclusions and Recommendations

Conclusion

Health tourism is considered to be a subset of health tourism. Health tourism can be defined as the movement of individuals from one location to the other with the aim of advancing, steadying and re-establishing their physical health, mental health and social relationships. Health tourism involves the individuals visiting hotels or recreational centres that provide health services. Health tourism, being a subset of healthcare tourism does not entail elective surgery.

• Even though health tourism has been in existence in Taiwan, health tourism emerged as a subdivision of health tourism. Many tourists are motivated by the H7N9 Virus which are mainly income created. Health tourism, therefore, emerged as a segment of the market that took into consideration the two constituents (the H7N9 Virus). The packages of health tourism are presented in all the tourist destination sites.
• Health of the tourists are always accompanied by tranquillity, calmness and privacy, therefore, the consumers of health tourism always have a different mode of lifestyle as compared to other tourism consumers who do not seek for health services. Health tourism is mostly based on the socio-demographic attributes of the tourists. These attributes were the basis of categorising the health tourists into three groups.
• The period of stay during the trip varied significantly among the three categories of tourists. The high level health tourists preferred to stay for long as opposed to the low level health tourists who preferred to stay for a shorter period. The high level health group had the perception that lack of money influenced their vacation; the opposite was true for the low level health group. In terms of age, the high level health group was the oldest among the three groups.

Recommendations

A good number of tourists regarded health tourism to be very significant to their lifestyles, thus, Taiwan should make health tourism to be an activity on its own. This will ensure that the tourists are satisfied with every aspect, thus, making the holidays enjoyable.

In addition, the tourism season should be expanded so that the tourists can have a longer time to stay during their vacation. Relevant marketing strategies should be used to market the tourist destination sites.

Statement of contribution

Summary

The main aim of this study was to determine the influence of health tourism’s participation of the elderly. The study focused on the tourism sector of Taiwan. The study explored various factors that motivated the elderly tourists to participate in health tourism, in line with main objective. The study relied on primary data using structured questions to explain the main objective and the data was analysed using statistical tools like SPSS, and ANOVA analysis.

The study categorized the tourists into three groups with regard to the level of health, for instance, high level health, moderate level health and low level health. The results of the study revealed that the variables of the study varied significantly among the three groups, for instance, tourists who fell in the category of high level health preferred to take long vacations and had a greater urge for entertainment. All in all, health tourism is regarded as a segment of health tourism and many tourists make the visits for health purposes.

The findings of this study are very relevant to the elderly tourists, tourist planners and tourist marketers. It is also adequate for the country to improve and protect the physical appearance of tourist destination sites to enable her to be in a competitive position as compared to the other countries. Moreover, the ease of accessibility to the tourist destination sites should be improved so as to give an easy time for the elderly tourists to move around. Accommodation facilities and other social amenities should be upgraded so that they can be up to standard and fit the specifications and the requirements of the elderly tourists.

Contributions and impacts

Health entails a particular notion of health. Health can be defined as a condition in which the body functions well physically, mentally, socially, with no presence of diseases or frailty. The concept of health is therefore separated from visiting health spas, as the spas are like hospitals that treat illnesses. Health can, therefore, be defined as an incorporated functioning mode that leans towards getting the best out of an individual’s potentials or abilities, given the particular environment in which the individual lives in.

Health directs the advancement of an individual to an upward or forward direction in order to realize a high degree of functioning of the individual. In addition, health involves the advancement of the entire body of the individual with regard to the individual’s mind, spirit, or the will to aid in his/her functionality. An individual will achieve a higher degree of health when he/she is self-responsible, aware of the basic nutritional requirements, manages stress effectively, and sensitive to the surrounding environment.

The entire process of the tourists’ decision making is analysed by processional models. The models are paid much consideration to the underlying factors that influence the decision making process of the health tourists. In simple terms, processional models give out information that relates to the behaviour of the tourists in their decision making process. There are various factors that influence the decision making process of the tourists; the main outstanding factor is actually the decision process. Tourism products, just like other normal products have several attributes which play the role of distinguishing them from the possible substitute products.

Scholarly studies that relate to the analysis of travel motivation are founded on the basis of various models that are considered to be outstanding. These models stem from the perspective of the processional models. The first model is the Nicosia model (1966) which concentrates on the correspondence that occurs between the tourist and the firm, and how the firm convinces the tourist to acquire her products. Another model dubbed Howard and Sheth’s model (1969) integrated the input notion that describes the behaviour of the tourists; in addition, the model states the ways by which the tourists incorporate these inputs in their decision making process. The Howard and Sheth’s model has continued to be regarded as the most important model for analysing the travel motivations of the elderly tourists.

Travel motivation of the elderly tourists can be assessed by paying regard to the analytic analysis of desire, anticipations, conception and satisfaction. Gallarza, Saura and Garcia (2002, p. 63) emphasized on the use of statistical tools (such as multivariate analysis that depend on other analyses like correlation matrix, sampling techniques and regression analyses) on tourism. Qualitative choice models are very efficient in assessing the behaviour of the elderly tourists; such models entirely depend on multinomial logit. In the recent past, many academic scholars have applied structural models on researches that relate to the assessment of the travel motivation of the elderly tourists.

It is required that health hotels should have an up-to-standard health infrastructure in order to provide the best services to the tourists. There exist various extents of health as there exist various extents of illness. Health tourism, therefore, is in line with the individual’s intent to improve the class of his/her life, physical health, mental health and social interaction.

References

Abelson, R. & Levi, A. (1985). Decision Making and Decision Theory. In G.Lindzey & E. Aronson (Eds.), The Handbook of Social Psychology (pp. 11-32). New York: Random House.

Anderson, B. & Langmeyer, L. (1982). The under-50 and over-50 traveler: A profile of similarities and differences. Journal of Travel Research, 20(4), 20-24.

Ardell, D.B. (1977). High Level Health. Berkeley: Rodale Press.

Arnould, E. & Price, L. (1993). River magic: extraordinary experience and the extended service encounter. Journal of Consumer Research, 20(1), 24-45.

Backman, K., Backman, S. & Silverberg, K. (1999). An investigation into the psychographics of senior nature-based travelers. Tourism Recreation Research, 14(1), 13-22.

Bai, B.X., Jang, S., Cai, L.A. & O’Leary, J.T. (2001). Determinants of travel mode choice of senior travelers to the United States. Journal of Hospitality and Leisure Marketing, 8(3/4), 147-168.

Baker, D. & Crompton, J. (1998). Exploring the Relationship between Quality, Satisfaction, and Behavioral Intentions in the Context of a Festival. Annals of Tourism Research, 27(3), 785-804.

Baloglu, S. & McCleary, K. (1999). A Model of Destination Image Formation. Annals of Tourism Research, 26(4), 868-897.

Baloglu, S. (1997). The relationship between destination images and socio-demographic and trip characteristics of international travelers. Journal of Vacation Marketing, 3(1), 221-233.

Barcelo, D. (2000). Sample Handling and Trace Analysis of Pollutants: Techniques and Applications. New York: Elsevier.

Bargeman, B. & Poel, H. (2006). The role of routines in the vacation decision-making process of Dutch vacationers. Tourism Management, 27(4), 707-720.

Barros, C. & Proença, I. (2005). Mixed logit estimation of radical Islamic terrorism in Europe and North America. The Journal of Conflict Resolution, 49(2), 298-314.

Barsky, J. (1992). Customer satisfaction in the hotel industry: meaning and meaning and measurement. Hospitality Research Journal, 16(1), 51-73.

Beerli, A. & Martín, J. (2004). Factors influencing destination image. Annals of Tourism Research, 31, 657-681.

Bentler, P. & Speckart, G. (1979). Models of attitude behavior relations. Psychological Review, 86(5), 452-464.

Bettman, J. & Park, C. (1980). Effects of prior knowledge and experience and phase of the choice process on consumer decision, a protocol analysis. Journal of Consumer Research, 7(1), 234-248.

Britton, P. B., Samantha J. C. & Terry, W. (1999). Rewards of Work. Ivey Business Journal, 15(2), 20-27.

Bryman, A. & Bell, E. (2003). Business Research Methods. Oxford: Oxford University Press.

Bultena, C. & Klessig, L. (1969). Satisfaction in camping: A conceptualization and guide tosocial research. Journal of Leisure Research, 348-364.

Carter, S. L. (2009). The Social Validity Manual. A Guide to Subjective Evaluation of Behavior. New York: Academia Press.

Cleaver, M., Muller, T., Ruys, H. & Wei, S. (1999). Tourism product development for the senior market, based on travel-motive research. Tourism Recreation Research, 24(1), 5-11.

Correia, A. & Crouch, G. (2004). A Study of Tourist Decision Processes: Algarve, Portugal. In G. Crouch, R. Perdue, H. Timmermans & M. Uysal (Eds.), Consumer Psychology of Tourism, Hospitality and Leisure (pp. 45-73). Oxon, UK: CABI Publishing.

Correia, A. (2002). How do tourist choose – A conceptual framework. Tourism and International Interdisciplinary Journal, 50(1), 21-29.

Correia, A., Valle, P. & Moço, C. (2005). Why People Travel to Exotic Places? Journal of Life, Leisure, and Tourism Research, 13(2), 34-40.

Creech, R. (1995). Employee Motivation. Management Quarterly, 36(2), 33.

Crompton, J. & Ankomah, P. (1993). Choice set propositions in destination decisions. Annals of Tourism Research, 20, 461-476.

Crompton, J. (1979). Motivations for pleasure vacations. Annals of Tourism Research, 6(4),408-424.

Crompton, J. (1990). Claiming our share of the tourism dollar. Parks and Recreation, 1(1), 42-88.

Crotts, J. (1999). Consumer decision making and prepurchase information search. In A. Pizam & M. Yoel (Eds.), Consumer behavior in travel and tourism (pp. 13-41). Binghamton, New York: The Haworth Hospitality Press.

Crouch, G. & Jordan, L. (2004). The determinants of convention site selection: A logistic choice model from experimental data. Journal of Travel Research, 43(2), 118-130.

Dann, G. (1977). Anomie, ego-enhancement and tourism. Annals of Tourism Research, 4(4), 184-194.

Dann, G. (1981). Tourist motivation – an appraisal. Annals of Tourism Research, 8(2), 187-219.

Dann, G. (1996). Tourists’ images of a destination – an alternative analysis. Recent Advances and Tourism Marketing Research, 1(1), 41-55.

Easterby, M., Thorp, R. & Lowe, A. (2008). Management Research (3^rd ed.). New York: Sage.

Fakeye, P. & Crompton, J. (1991). Image differences between prospectives, first-time, and repeat visitors to the lower Rio Grande valley. Journal of Travel Research, 32(1), 10-16.

Fishbein, M. & Ajzen, I. (1980). Predicting and Understanding Consumer Behavior: Attitude Behavior Correspondence. New York: Prentice Hall.

Fleischer, A. & Pizam, A. (2002). Tourism constraints among Israeli seniors. Annals of Tourism Research, 29(1), 106-123.

Fodness, D. & Murray, B. (1997). Tourist information search. Annals of Tourism Research, 24(3), 503–523.

Fodness, D. (1994). Measuring tourist motivation. Annals of Tourism Research, 21(3), 555-581.

Fridgen, J.D. (1996). Dimensions of Tourism. MI: Butterworth-Heinemann.

Gallarza, M. Saura, I. & Garcia, H. (2002). Destination image: Towards a conceptual framework. Annals of Tourism Research, 29(1), 56-78.

Gartner, W. (1993). Image formation process. In M. Uysal & D. Fesenmaier (Eds.), Communication and Channel Systems in Tourism Marketing (pp. 191-215). New York: Haworth Press.

Gnoth, J. (1997). Tourism motivation and expectation formation. Annals of Tourism Research, 24(2), 283-304.

Guy, B., Curtis, W. & Crotts, J. (1990). Environmental learning of first-time travellers. Annals of Tourism Research, 17(3), 419-431.

Holbrook, M. (1978). Beyond attitude structure: Toward the informational determinants of attitude. Journal of Marketing Research, 15(1), 545-556.

Horneman, L., Carter, R., Wei, S. & Ruys, A. (2002). Profiling the senior traveler: an Australian perspective. Journal of Travel Research, 41(1), 23-38.

Howard, J. & Sheth, J. (1969). The Theory of Buyer Behavior. New York: John Wiley and Sons.

Hsu, C.H.C. & Huang, S. (2008). Travel motivation: a critical review of the concept’s development. In A.G. Woodside & D. Martin (Eds.), Tourism Management: Analysis, Behavior and Strategy (pp. 50-65). Cambridge: CAB International.

Huang, L. & Tsai, H.T. (2003). The study of senior traveler behavior in Taiwan. Tourism Management, 24(1), 561-574.

Hunt, H. (1977). CS/D – overview and future directions. In H. Hunt (Ed.), Conceptualization and measurement of consumer satisfaction and dissatisfaction (pp. 457-461). Cambridge, MA: Marketing Science Institute.

Jamrozy, U., Backman, S. & Backman, K. (1996). Involvement and opinion leadership in tourism. Annals of Tourism Research, 23(4), 908-924.

Jang, S.C. & Wu, C.M.E. (2006). Senior travel motivation and the influential factors: an examination of Taiwanese seniors. Tourism Management, 27(1), 306-316.

Javalgi, R.G., Thomas, E.G. & Rao, S.R. (1992). Consumer behavior in the US, pleasure travel marketplace: an analysis of senior and non-senior travelers. Journal of Travel Research, 31(2), 14-20.

Kinni, T. B. (1994). The Empowered Workforce. Industry Week, 10(2), 9-14.

Koss, L. (1994). Hotel developing special packages to attract senior travelers. Hotel and Motel Management, 209(3), 30-37.

Kotler, P., Haider, D. & Rein, I. (1993). Marketing Places. New York: Free Press.

Kozak, M. (2001). Repeaters’ behaviour at two distinct destinations. Annals of Tourism Research, 28(3), 784-807.

Lam, T. & Hsu, C. (2006). Predicting behavioral intention of choosing a travel destination.Tourism Management, 27(4), 589-599.

Lancaster, K. (1966). A new approach to consumer theory. Journal of Political Economy, 74(2), 132-157.

LaTour, S. & Peat, N. (1979). Conceptual and methodological issues in consumer satisfaction research. Advances in Consumer Research, 6(1), 431-437.

Littrell, M.A. (2004). Senior travelers: tourism activities and shopping behaviors. Journal of Vacation and Marketing, 10(4), 348-362.

Madrigal, R. (1995). Cognitive and effective determinants of fan satisfaction with sporting event attendance. Journal of Leisure Research, 27(3), 205-227.

Maslow, A. (1954). Motivation and Personality. New York: Harper.

McCabe, A. (2000). Tourism motivation process. Annals of Tourism Research, 27(4), 1049-1052.

Miller, G. (1956). The magic number seven, plus or minus two: Some limits on our capacity for processing information. The Psychological Review, 63, 81-89.

Miller, J. (1977). Studying satisfaction, modifying models, eliciting expectations, posing problems, and making meaningful measurements. In J. Hunt (Ed.), Conceptualization arul measurement of consumer satisfaction and dissatisfaction (pp. 36-51). Cambridge, MA: Marketing Science Institute.

Mohsin, A. & Ryan, C. (2003). Backpackers in the northern territory of Australia. The International Journal of Tourism Research, 5(2), 113-121.

Money, R. & Crotts, J. (2003). The effect of uncertainty avoidance on information search, planning and purchases of international travel vacations. Tourism Management, 24(1), 191–202.

Morley, C. (1992). A microeconomic theory of international tourism demand. Annals of Tourism Research, 19(1), 250-267.

Moutinho, L. (2000). Strategic Management in Tourism. New York: CABI Publishing.

Mueller, H. & Lanz-Kaufmann, E. (2001). Health Tourism: Market analysis of a special health tourism segment and implications for the hotel industry. Journal of Vacation Marketing, 7(1), 5-17.

Müller, H. & Lanz-Kaufmann, E. (2001). Health Tourism: Market analysis of a special health tourism segment and implications for the hotel industry. Journal of Vacation Marketing, 7(1), 5-17.

Nicosia, F. (1966). Consumer Decision Process. New Jersey: Prentice Hall.

OHagan, J. & Harrison, M. (1984). Market shares of U. S. tourist expenditures in Europe: An econometric analysis. Applied Economics, 16(6), 919-931.

Oliver, R. (1993). Cognitive, affective, and attributes base of the satisfaction response. Journal of Consumer Research, 20(1), 418-430.

Paraskevopoulos, G. (1977). An econometric analysis of international tourism. Athens: Centre of Planning & Economic Research.

Pearce, P. (1982). Perceived changes in holiday destinations. Annals of Tourism Research, 9(2), 145-164.

Robson, C. (2002). Real World Research. Oxford: Blackwell.

Romsa, G. & Blenman, N. (1989). Vacation patterns for the elderly German. Annals of Tourism Research, 16(1), 178-188.

Ryan, C. (1994). Leisure and tourism – The application of leisure concepts to tourist behaviour- a proposed model. In A. Seaton (Ed.), Tourism the State of the Art (pp. 36-57). New York: John Wiley & Sons.

Samuelson, P. (1991). Economia (11^th ed.). Lisboa: Fundação Calouste Gulbenkian.

Sheth, J., Newman, B. & Gross, B. (1991). Why we buy what we buy: a theory of consumption values. Journal of Business Research, 22, 159-170.

Shoemaker, S. (1989). Segmentation of the senior pleasure travel market. Journal of travel research, 27(3), 14-22.

Skinner, B. F. (1953). Science and Human Behavior. New York: Free Press.

Snell, S. A. & Dean, J. W. (1992). Integrated Manufacturing and Human Resource Management: A Human Capital Perspective. Academy of Management Journal, 35(1), 467-504

Song, H. & Witt, S. (2000). Tourism Demand Modelling and Forecasting: Modern Econometric Approaches. Oxford: Pergamon.

Spreng, R., Mackenzie, S. & Olshavsky, B. (1996). A re-examination of the determinants of consumer satisfaction. Journal of Marketing, 60(3), 15-22.

Stynes, D. & Peterson, G. (1984). A review of logit models with implications for modelling recreational choices. Journal of Leisure Research, 16(1), 295-310.

Travis, J.W. (1984). The Relationship of Health Education and holistic Health. In J.S. Gordon, D. Jaffe, T. Bresler & E. David (Eds.), Mind, Body and Health, Toward an Integral Medicine. New York: Human Sciences Press.

Truong, T. (2005). Assessing holiday satisfaction of Australian travellers in Vietnam: An application of the HOLSAT model. Asia Pacific Journal of Tourism Research, 10(3), 227-246.

Um, S. & Crompton, J. (1990). Attitude determinants in tourism destination choice. Annals of Tourism Research, 17, 432-448.

Uysal, M. & Hagan, L. (1993). Motivation of pleasure to travel and tourism. In M. Khan, M. Olsen & T. Var (Eds.), VNR’S Encyclopedia of Hospitality and Tourism (pp. 23-63). New York: Van Nostrand Reinhold.

Uysal, M., Mclellan, R. & Syrakaya, E. (1996). Modelling vacation destination decisions: a behavioural approach. Recent Advances in Tourism Marketing Research, 57-75.

Woodside, A. & Lysonski, S. (1989). A general model of travel destination choice. Journal of Travel Research, 27(4), 8-14.

Woodside, A., Frey, L. & Daly, R. (1989). Linking service quality, customer satisfaction and behavioural intention. Journal of Health Care Marketing, 9(1), 5-17.

Zimmer, Z., Brayley, R., Searle, E. & Mark, S. (1995). Whether to go and where to go: identification of important influences on senior and decisions to travel. Journal of Travel Research, 33(3), 3-10.