The physical, mental, spiritual, and environmental (PMSE) framework for enhancing wellness tourism experiences and its validation in the context of Kerala, India

Parakkal, Anju Kandan; Thazhathethil, Bindu Vazhakkatte; George, Babu Article The physical, mental, spiritual, and environmental (PMSE) framework for enhancing wellness tourism experiences and its validation in the context of Kerala, India Administrative Sciences Provided in Cooperation with: MDPI – Multidisciplinary Digital Publishing Institute, Basel Suggested Citation: Parakkal, Anju Kandan; Thazhathethil, Bindu Vazhakkatte; George, Babu (2024) : The physical, mental, spiritual, and environmental (PMSE) framework for enhancing wellness tourism experiences and its validation in the context of Kerala, India, Administrative Sciences, ISSN 2076-3387, MDPI, Basel, Vol. 14, Iss. 7, pp. 1-16, https://doi.org/10.3390/admsci14070140 This Version is available at: https://hdl.handle.net/10419/320955 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ Citation: Kandan Parakkal, Anju, Bindu Vazhakkatte Thazhathethil, and Babu George. 2024. The Physical, Mental, Spiritual, and Environmental (PMSE) Framework for Enhancing Wellness Tourism Experiences and Its Validation in the Context of Kerala, India. Administrative Sciences 14: 140. https://doi.org/10.3390/ admsci14070140 Received: 21 May 2024 Revised: 26 June 2024 Accepted: 29 June 2024 Published: 2 July 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). administrative sciences Article The Physical, Mental, Spiritual, and Environmental (PMSE) Framework for Enhancing Wellness Tourism Experiences and Its Validation in the Context of Kerala, India Anju Kandan Parakkal 1, Bindu Vazhakkatte Thazhathethil 1and Babu George 2,* 1Department of Tourism Management, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu 641043, India; [email protected] (A.K.P.); [email protected] (B.V.T.) 2School of Business, Alcorn State University, Lorman, MS 39096, USA *Correspondence: bgeor[email protected] Abstract: Wellness tourism has emerged as a thriving sector in Kerala, India, renowned for its Ayurveda treatments, yoga, and holistic well-being offerings. However, a comprehensive framework capturing the key dimensions of wellness tourism experiences remains underexplored. This study aims to validate the physical, mental, spiritual, and environmental (PMSE) framework within the context of Kerala’s wellness tourism industry. A quantitative research design was employed, utilizing data collected from wellness tourists who participated in various wellness services in Kerala. Confirmatory factor analysis (CFA) was conducted to assess the fitness of the PMSE framework. The findings reveal that mental experience and physical experience, with their respective sub-attributes, contribute significantly to the overall wellness tourism experience. The validated PMSE framework provides valuable insights for stakeholders, enabling them to enhance the quality and competitiveness of wellness tourism services in Kerala. By prioritizing the mental and physical dimensions of wellness experiences, Kerala can strengthen its position as a leading wellness tourism destination. This study advances the theoretical understanding of wellness tourism experiences and offers practical implications for destination management and service providers in Kerala’s wellness tourism industry. Keywords: wellness tourism; PMSE framework; tourism experience; confirmatory factor analysis; Kerala 1. Introduction Wellness tourism has emerged as a thriving sector within the global travel industry (George and Henthorne 2009;Zhong et al. 2021). This niche market has witnessed rapid expansion and is poised for continued growth, outpacing the broader tourism landscape (Thal et al. 2021). Projections from the Global Wellness Institute (2018) indicate that wellness tourism will sustain its upward path, with expectations of even higher growth rates compared to the overall tourism sector. To meet the escalating demand for wellness experiences, various stakeholders, including hotels, resorts, wellness treatment centers, and specialized travel packages, are increasingly incorporating health and wellness services into their offerings (Dillette et al. 2021;Paraskou and George 2017). The global wellness economy, a significant driver of this industry, has demonstrated impressive growth, surging at a rate of 6.6% annually. From USD 4.3 trillion in 2017, it reached USD 4.9 trillion in 2019, far surpassing the 4.0% growth rate of the overall global economy (Global Wellness Institute 2021). Forecasts suggest that the wellness tourism market will continue to thrive, with an anticipated Compound Annual Growth Rate (CAGR) of 10.17% from 2023 to 2031 (Wellness Tourism Market 2023). However, it is crucial to acknowledge the challenges posed by external factors, particularly the profound impact of the COVID-19 pandemic, which has significantly disrupted the operations of Adm. Sci. 2024,14, 140. https://doi.org/10.3390/admsci14070140 https://www.mdpi.com/journal/admsci Adm. Sci. 2024,14, 140 2 of 16 key players in both the tourism and wellness industries (Cheer 2020;Stankov et al. 2020; Sivanandamoorthy 2021). The onset of the COVID-19 pandemic has prompted a profound shift in people’s priorities, placing a heightened emphasis on health and well-being (Markose et al. 2023; Sthapit et al. 2023). This shift has notably expanded the potential of the wellness travel market (Chen et al. 2023). Recent studies predict that the socio-cultural changes triggered by the pandemic will have a lasting impact on consumer behavior and preferences (Eichelberger et al. 2021). In response to the challenges posed by the pandemic, there is a growing recognition of the need to diversify tourism-related activities and offerings, promoting exploration of distant and untapped locations, a perspective long advocated by scholars and planners alike (Chugh 2021). Scholarly insights suggest that the pandemic will play a pivotal role in shaping consumer behavior, fostering a positive influence on wellness tourism (Chugh 2021;Kongtaveesawas et al. 2022). This anticipation underscores the potential for a transformative period in the wellness travel sector as individuals seek safer and more health-conscious travel options. India, with its rich history of wellness practices, stands to benefit from this shift in consumer preferences. Wellness tourism stands as a cornerstone in India’s diverse tourism product mix, prominently featuring recognized elements such as yoga, meditation, and Ayurveda (Dutt 2022). The establishment of the Ayush Ministry by the Indian government plays a pivotal role, providing a solid legal and institutional foundation for promoting alternative medical practices, including the flourishing field of wellness travel. Kerala, in particular, has carved out a niche for itself as a premier Ayurveda destination, attracting both domestic and international travelers seeking diverse treatment options (Bandyopadhyay and Nair 2019). To further assert Kerala’s position and compete globally in the wellness tourism market, it is essential to more precisely define the characteristics that distinguish its wellness tourism experience. Despite the abundance and quality of wellness-related resources and services offered by numerous stakeholders, there is a need for a comprehensive framework that captures the specific factors required for a robust wellness tourism experience in Kerala. This study aims to investigate these factors, exploring their applicability in the context of Kerala. Leveraging existing theories, wellness attributes, and models, the goal is to shed light on how Kerala can enhance its performance and compete within the dynamic global wellness tourism market. 2. Theoretical Framework 2.1. Concept of Wellness Tourism Over the past few decades, there has been a notable paradigm shift in the theoretical and methodological focus of tourism research, with a growing emphasis on well-being (George and Nedelea 2009;Kay Smith and Diekmann 2017). This transition has been marked by a diverse array of terminologies, including “quality of life”, “life satisfaction”, and “wellness” (Smith and Puczkó2016). Despite this evolution, wellness tourism research remains in its infancy. The World Tourism Organization and European Travel Commission define “health tourism” as travel primarily motivated by a desire to contribute to physical, mental, or spiritual health through medical and wellness activities. However, the Global Wellness Institute (GWI) notes that the umbrella term “health tourism” encompasses modalities ranging from medical procedures to yoga retreats. In essence, “health tourism” is a broad concept encompassing travel for medical and wellness purposes to enhance overall well-being (Global Wellness Institute 2018). Wellness, as conceptualized by Smith, represents holistic health with multiple facets—physical, mental, environmental, spiritual, emotional, and social—all working in harmony to promote well-being (Kay Smith and Diekmann 2017). The intricate nature of this definition underscores the complexity of comprehending well-being and wellness. Beyond individual benefits, wellness contributes to economic growth, empowers women, supports regional products, and preserves cultural heritage. The positive impact of wellness extends beyond the individual, connecting to Adm. Sci. 2024,14, 140 3 of 16 broader societal aspects. It aids in reviving ancient wellness practices, addressing mental health issues, supporting environmental conservation, promoting sustainable tourism, and preserving natural and cultural resources (Global Wellness Institute 2019). Furthermore, wellness is linked to increased social capital and an enhanced quality of life. Wellness travelers, driven by a holistic approach to health and well-being, expect a diverse range of medical care, encompassing both traditional and complementary therapies. Their health and well-being, as well as their behavioral intentions, are influenced by the perceived positive trade-off between their expectations and the actual experiences encountered in wellness tourism (Majeed and Kim 2022). 2.2. Wellness Tourism Frameworks Wellness tourism has garnered significant attention in recent years, with researchers exploring various models and frameworks to comprehend its dynamics and impact on tourists’ well-being. The diverse array of wellness tourism models and frameworks discussed in the literature sheds light on the multifaceted nature of wellness tourism and its implications for tourist experiences and well-being. Researchers are continuously striving to unravel the complexities of wellness tourism by integrating concepts of sustainability, technology, and local well-being into these models, aiming to pave the way for a more holistic and enriching wellness tourism experience that benefits tourists and destinations alike. Majeed and Kim (2022) present a wellness tourism conceptual model that intricately weaves together conventional medical treatments, alternative health treatments, and tourist attractions to influence wellness tourists’ expectations, perceptions of performance, health and well-being (HWB), and behavioral intentions (Majeed and Kim 2022). Valeriani et al. (2022) focus on a wellness tourism model in the recovery sector during the new normal period, emphasizing indicators like a high standard of sanitation, security, staycations, niche tourism, private travel tours, and virtual tourism as key components influencing the wellness tourism experience. He et al. (2023) model how the wellness tourism experience inspires tourist engagement, constructing pathways that link wellness tourism experience, inspiration, and engagement. Chen et al. (2023) introduce a chain mediation model that incorporates the stimulus–organism–response (SOR) model to investigate how the wellness tourism experiencescape influences tourists’ behavior, particularly focusing on authenticity, memorability, organizational identification, and revisit intention. Aluculesei and Avram (2020) discuss the potential of developing rural well-being tourism in the Puglia region of Italy, emphasizing the region’s wellness tradition and the reputation of its thermal centers. Patterson and Balderas-Cejudo highlight the importance of tourism in promoting healthy lifestyles and well-being among older adults, aligning with the goals of Agenda 2030 (Schubert and Schamel 2021). In the context of sustainable tourism development, Schubert and Schamel (2021) propose a dynamic model that considers resident spillovers, aiming to balance the well-being of locals with the impacts of tourism (Li et al. 2021). Puig-Cabrera et al. (2023) explore tourism’s role in enhancing the wellbeing of Small Island Developing States, aligning with the objectives of Agenda 2030 (Houge Mackenzie et al. 2021). The evolving landscape of wellness tourism is also influenced by technological advancements and changing consumer behaviors. Li et al. (2021) investigate the effects of virtual reality tourism on subjective well-being during the COVID-19 pandemic, highlighting how virtual experiences can enhance individuals’ well-being and contribute to destination recovery. Additionally, Houge Mackenzie et al. (2021) propose a conceptual model that explores how adventure sport tourism can enhance well-being, emphasizing the psychological processes that underlie well-being outcomes for adventure sport tourists. 2.3. Characteristics of Wellness Tourism in India In 2017, India secured seventh position on the wellness destination list, investing a substantial USD 16.3 billion in wellness travel, consequently supporting 3.8 million jobs (Global Wellness Institute 2018). This remarkable investment aligns with India’s consistent Adm. Sci. 2024,14, 140 4 of 16 growth in the tourism sector over the past decade. Notably, the emergence of health tourism has contributed significantly to this upward path. India holds second position in Asia for health tourism, trailing behind Thailand. Patients flock to India for a diverse range of treatments, encompassing traditional Ayurvedic and spa therapies along with contemporary medical procedures (Choudhary and Qadir 2022;Subathra et al. 2019). India has been transformed into a globally sought-after destination for wellness and medical care, spurred on by the growing acceptance of alternative medicine and traditional healing methods. The nation’s appeal as a wellness travel hotspot is strengthened by its diverse array of traditional medical practices, such as naturopathy, yoga, homeopathy, Unani, and Ayurveda. This rich healing tradition, combined with India’s robust tourism potential and rich cultural heritage, positions the country as an ideal location for wellness seekers from around the world (Mishra and Panda 2021). Datta (2022) highlights that India, often considered a “land for all seasons and purposes”, boasts a cultural heritage where yoga, practiced for about 5000 years, holds a significant place. The Ministry of Tourism (2020) underscores the dramatic benefits India has derived from attracting a substantial number of tourists through wellness retreats. Despite India’s success in the medical and wellness tourism sector, there remains a need for strategic measures to increase its share in the global wellness tourism market (Bhowmick 2018). Understanding the distinctive aspects of wellness tourism in various cultural contexts is crucial for positioning India effectively on the international stage. 2.4. Characteristics of Wellness Tourism in Kerala India boasts exceptional travel destinations for wellness seekers, with Kerala standing out prominently, renowned for its Ayurveda practices (Romão et al. 2022), yoga, meditation, and backwater tourism. Recognizing the substantial potential, there is a significant opportunity to position Kerala as a premier wellness travel destination (Manhas et al. 2019). Notably, Kerala has successfully crafted a distinctive, location-based wellness brand and product, making it a standout state in this regard. Around two decades ago, Kerala identified itself as the “land of Ayurveda” (Kannan and Frenz 2019). Since then, the state has been progressively solidifying its status as a leading wellness tourist destination. Leveraging ancient medical treatments like rejuvenation therapies and panchakarma, which are among the oldest methods of medical treatment (Datta 2022), Kerala has become the preferred choice for foreigners seeking Ayurvedic experiences (Kannan and Frenz 2019). It provides services through accredited Ayurvedic wellness centers across the state (Table 1). The Western world has long perceived India as a hub for enlightenment and spirituality, and Kerala’s current tourism initiatives align with marketing campaigns offering visitors not just physical relaxation but also spiritual renewal and transformation (Bandyopadhyay and Nair 2019). Remarkably, despite facing natural and man-made disasters in 2018, Kerala witnessed a 6% increase in visitor arrivals. This positive trend continued in 2019, with a remarkable 8.58% rise in foreign visitor arrivals, according to the state’s tourism data (Kerala Tourism Statistics 2019). Key milestones in Kerala’s tourism industry have been achieved through strategic product development efforts, notably driven by the surging demand for Ayurvedic rejuvenation vacations and heritage attractions, both domestically and internationally. The expanding range of lodging options, including boutique resorts and heritage hotels, has further enriched the tourist experience. Government initiatives have played a crucial role in transforming historic structures into wellness centers, preserving a traditional ambiance. Kerala’s wellness tourism has successfully aligned itself with contemporary market demands, focusing on rejuvenation, spirituality, and culture, attracting leisure travelers from various categories (Nair and Dileep 2021). The latest market shifts in Kerala underline a deliberate integration of wellness, medical, and cultural tourism components, aiming to provide guests with a unique and holistic experience. Noteworthy aspects of the industry include a diverse array of offerings, customized interaction zones, robust social media-driven marketing platforms, and easily Adm. Sci. 2024,14, 140 5 of 16 accessible specialized amenities. Recent treatments are designed around the principles of “escapism”, offering comprehensive packages for rejuvenation and revitalization that harmonize the mind, body, and spirit. Kerala has pioneered the integration of wellness, hospitality, and tourism in unprecedented ways, solidifying its position as a distinguished destination for wellness travel (Dileep and Nair 2021). Table 1. Accredited Ayurveda wellness centers in Kerala. No. Districts Number of Accredited Wellness Centers 1 Thiruvananthapuram 19 3 Kollam 4 4 Idukki 3 5 Kottayam 10 6 Alappuzha 8 7 Ernakulam 10 8 Thrissur 17 9 Malappuram 3 10 Palakkad 1 11 Kozhikode 3 12 Wayanad 3 13 Kannur 1 Source: Kerala Tourism (2018). 2.5. Dimensions of Wellness Tourism Experience Theoretical Framework The term “wellness” is holistic; many researchers emphasizing its multifaceted aspect, which includes “physical and mental health, as well as social and environmental” factors. It is defined as a state of “experiencing harmony in mental, Physical, spiritual, and biological health” (Kotur 2022;Liao et al. 2023). Wellness tourism has evolved from a narrow emphasis on physical health and well-being to a broader concept of holistic health (Dini and Pencarelli 2022). Rapid economic progress, combined with greater social pressure and competition, has hastened the pace of life, resulting in widespread burnout. This burnout emerges in the body, mind, and interpersonal communication, leading to an increase in persons displaying sub-health features. Wellness tourism has grown as a way of life and is a preferred choice for individuals seeking more than just leisure; it also offers opportunities for self-exploration (Dini and Pencarelli 2022;Joseph Sirgy 2019;Liao et al. 2023). Previously, wellness tourism experiences emphasized “relaxation, sensory pleasures, enjoyment, and the natural environment”. However, recent trends have seen wellness tourism evolve to offer more immersive and authentic experiences that prioritize personal growth. Wellness tourism experiences now actively or passively protect people’s health by merging their “cultural, spiritual, nutritional, physical, and environmental demands” (Global Wellness Summit 2020). This study aims to validate the PMSE framework of the wellness tourism experience within Kerala’s wellness tourism industry, drawing on the Push and Pull Motivational Theory to provide a comprehensive understanding of wellness tourism experience dimensions. The Push and Pull Motivational Theory explains the motivations behind wellness tourism by identifying internal desires (push factors) and external attractions (pull factors) (Mai and Nguyen 2023). In the context of the PMSE framework, the physical dimension addresses push factors such as the desire for health improvement, relaxation, and physical rejuvenation, while pull factors include Kerala’s renowned wellness facilities, such as spas, fitness centers, and natural healing environments. The mental dimension captures push factors like the need for stress relief and psychological well-being, with pull factors Adm. Sci. 2024,14, 140 6 of 16 being destinations that offer mental wellness programs such as meditation, mindfulness workshops, and mental health retreats. For the spiritual dimension, push factors involve the quest for spiritual growth, inner peace, and life purpose, whereas pull factors include spiritual attractions like ashrams, spiritual retreats, and cultural experiences. The environmental dimension aligns with push factors driven by a desire to escape urban life and reconnect with nature, and pull factors represented by Kerala’s natural beauty, eco-friendly accommodations, and activities promoting environmental conservation. By integrating these dimensions, the PMSE framework, supported by the Push and Pull Motivational Theory, offers a holistic approach to understanding the multifaceted motivations and experiences of wellness tourists, thereby enhancing the overall appeal and effectiveness of Kerala’s wellness tourism industry. The present study was conducted in Kerala, India, a region renowned for its remarkable growth in wellness tourism, particularly in the domain of Ayurveda treatments, andoften referred to as “God’s own country” (Romão et al. 2022). The factors shaping wellness tourism experience vary place to place, and comprehensive frameworks addressing these attributes remain unexplored, especially in Kerala. Furthermore, there is a lack of a validated PMSE framework tailored specifically to the development and planning of wellness tourism in Kerala. Thus, we have undertaken the adaptation of the PMSE framework from prior studies (Kongtaveesawas et al. 2022) to assess its suitability and applicability within the context of Kerala. The aim of this study is to authenticate the PMSE framework within Kerala, while pinpointing the dominant attribute that significantly contributes to the overall wellness tourism experience. The study focuses on wellness tourists visiting Kerala, specifically those seeking wellness treatments and answers the question about the key factors that contribute towards the overall wellness tourism experience. The research contributes to the understanding of wellness tourism in Kerala, shedding light on the factors that attract visitors seeking Ayurveda treatments. It also explores the unique positioning of Kerala as a wellness destination, emphasizing the term “wellness tourism” to distinguish itself from the conventional tourism image of India (Bandyopadhyay and Nair 2019). 3. Research Methods This study employed a quantitative research design to validate the PMSE framework within the context of Kerala’s wellness tourism industry. Quantitative methods, specifically confirmatory factor analysis (CFA), were chosen as the right approach for several reasons, as follows: 1. Objective Measurement: Quantitative approaches allow for objective measurement and statistical analysis, providing strong evidence to establish the framework’s validity in a new cultural context. 2. Generalizability: The ability to collect data from a larger sample size increases the generalizability of the results, making them more applicable to the broader wellness tourism industry in Kerala. 3. Framework Validation: CFA is ideally suited to validating existing theoretical frameworks, allowing us to test whether the data fit the hypothesized PMSE model. While quantitative methods were deemed most appropriate, we did consider alternative approaches. In-depth interviews or focus groups could have provided rich, detailed insights but would have limited our ability to statistically validate the PMSE framework and generalize the findings. A mixed-method approach was considered for its potential to provide both breadth and depth of understanding. However, given our primary aim of validating an existing framework, a purely quantitative approach was more efficient and directly addressed our research objectives. While EFA could have been used to explore the underlying structure of the data, we chose CFA because we were working with an established theoretical framework (PMSE) and wanted to confirm its applicability in the Kerala context rather than explore new factor structures. Adm. Sci. 2024,14, 140 7 of 16 The study utilized a questionnaire adapted from Kongtaveesawas et al. (2022), consisting of 26 attributes across the four PMSE dimensions. The questionnaire included sections covering participant demographics, tourism behaviors, and the importance or expectation levels of wellness tourism experience dimensions. Both online and offline questionnaires were employed to ensure privacy and prompt responses. The survey was conducted from 1 April 2023 to 31 May 2023. We employed purposive sampling to ensure that participants had relevant experience with wellness services in Kerala. This approach was crucial for obtaining informed responses that accurately reflect the wellness tourism experience across all PMSE dimensions. Respondents were chosen from a pool of individuals with previous experience in wellness services in Kerala. The initial sample size of 320 was determined based on the population of wellness tourists in Kerala, using Yamane’s formula (Najar et al. 2020) to ensure statistical significance. Following field editing and data screening procedures, the final sample size was reduced to 286. This sample size remains statistically robust for CFA, adhering to the general guideline of having at least 10 respondents per observed variable in the model (Hair et al. 2010). AMOS software was used for goodness-of-fit assessment and modification of the measurement model. CFA was employed to assess the fitness of the PMSE framework, providing rigorous evidence supporting the construct validity of the framework and ensuring that the identified dimensions accurately represent the wellness tourism experience. The PMSE attribute framework validation instrument exhibited a good level of reliability, with a Cronbach’s alpha of 0.73. This study adhered to ethical guidelines, ensuring participant confidentiality, informed consent, and respectful representation of cultural practices. Participants were provided with clear information about the research purpose and had the option to withdraw at any stage without consequences. 4. Findings and Discussion A total of 286 responses were gathered through online and offline questionnaires from wellness travelers in Kerala between March and May 2023, employing purposive sampling techniques. The data set underwent descriptive statistical analysis using IBM SPSS version 23.0 to explore its key characteristics. Following data collection, confirmatory factor analysis (CFA) was conducted using AMOS to validate the factors influencing the wellness tourism experience in Kerala. 4.1. Respondents’ Profile Among the 286 respondents, the majority (61%) identified as male. The highest representation fell within the 26–35 age group. Notably, a significant portion (51.4%) rated their health as excellent. A considerable number of respondents had engaged in wellness services for the last two years. During wellness trips, a majority (57%) preferred stays of 3-4 nights. Independent travel was the choice for 35% of the respondents. Leisure activities were the preferred wellness activities for the majority (35%), while 23.1% opted for health and wellness activities. Noteworthy selections included natural sightseeing (14.7%) and spa experiences (11.5%). Regarding wellness tourism destinations in Kerala, Kovalamattracted the highest attention among respondents (25.2%). The average daily spending of tourists during their wellness trip typically ranged between 3001 and 5000. Most respondents provided positive ratings on the PMSE (wellness tourism experience) framework within the context of Kerala. 4.2. Descriptive Statistics Within the framework of the wellness tourism experience under the PMSE model, this article aims to assess various dimensions including physical, mental, spiritual, and environmental experiences. The study adapted 26 attributes (Kongtaveesawas et al. 2022) applicable to wellness tourism experiences in Kerala: 10 associated with physical experience, 5 with mental experience, 5 with spiritual experience, and 6 with environmental Adm. Sci. 2024,14, 140 8 of 16 experience. Descriptive statistics for these 26 attributes are presented in Table 2, detailing their respective means. Table 2. Mean and standard deviation values for wellness tourism experience (N = 286). Code Item Mean Physical Experience 1 P_ex1 Availability of passive wellness tourism activities 4.26 2 P_ex2 Availability of active wellness tourism activities 4.26 3 P_ex3 The detoxification programs 4.11 4 P_ex4 The food quality and/or food service 4.20 5 P_ex5 The destination’s visual arts 4.08 6 P_ex6 Reasonable price of wellness service 4.01 7 P_ex7 Wellness amenities, products, and souvenirs 4.17 8 P_ex8 Supply typology 4.16 9 P_ex9 Hygiene policy of the destination 4.09 10 P_ex10 Accessibility of the wellness center 4.35 Mental Experience 1 M_ex1 Life progress and/or positive change 4.27 2 M_ex2 Escape from daily life and recuperation 4.19 3 M_ex3 Service care and empathy of employees 4.17 4 M_ex4 Being part of community 4.15 5 M_ex5 Understanding new things from host community 4.09 Spiritual Experience 1 S_ex1 Spirit/soul upliftment 4.19 2 S_ex2 Sharing your wellbeing travel experience with destination communities, stakeholders, and others 4.20 3 S_ex3 High level of engagement or interest in destination’s activities 4.17 4 S_ex4 The attributions of knowledge, memories, perceptions, emotions, and self-identity 4.18 5 S_ex5 To be able to recall the experience anytime you like 4.26 Environmental Experience 1 E_ex1 Wellness service, knowledgeable staff, and stakeholders. 4.29 2 E_ex2 Environmental concern and sustainable surroundings 4.27 3 E_ex2 Utility of local products and cuisines 4.21 4 E_ex3 Peaceful destination 4.23 5 E_ex4 Authentic destination 4.24 6 E_ex5 The link between wellbeing and sustainable development 4.20 Source: Primary data. 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