WelDest Primary Research Report

ERASMUS Lifelong Learning Program

Health & Well-being in Tourism Destination
2012 - 2014

Work Package 4:
Research Report
Date:
Author:
Distribution:
File name

2014_01_21
Team FHJ; Lead: Prof. Dr. Kai Illing
WelDest team and public
2014_01_17_WelDestResearchReport_
FHJ_final
12.0
Research Report

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Date
11.11.2013
26.11.2013
15.1.2014
17.1.2014

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Content
1

RESEARCH REPORT – INTRODUCTION ............................................................................. 6

1.1

Terms and abbreviations ................................................................................................................. 7

1.1.1

Terms ........................................................................................................................................... 7

1.1.2

Abbreviations ............................................................................................................................... 8

2

STAKEHOLDER INTERVIEWS PART A – A QUANTITATIVE APPROACH ........................ 9

2.1

Methodology .................................................................................................................................. 9

2.2

Research results ............................................................................................................................ 10

2.2.1
Which of the following options best describe the role of health and well-being in your
destination now and by 2020? ................................................................................................................. 10
2.2.2

What do you think are the most important reasons customers come to your destination? .... 11

2.2.3
Which elements prevent your guests from recognizing your destination as health and
wellbeing destination? ............................................................................................................................. 13
2.2.4
How important are the following competencies for you regarding the management of your
destination? .............................................................................................................................................. 14
2.2.5

What is your personal need for further training regarding the following competencies? ........ 16

2.2.6
points

Please evaluate the present performance of your destination regarding the following specific
................................................................................................................................................... 19

2.2.7
How important are the following specific points regarding the development of a HW&Bdestination? .............................................................................................................................................. 21
2.2.8

Please define the level of your current job ................................................................................ 24

2.2.9

What is the highest level of education you have completed so far? ......................................... 24

2.2.10

How many years of experience do you have in the following categories? ........................... 25

2 WP 4: Research | WelDest 2012 - 2014

3

STAKEHOLDER INTERVIEWS PART B – A QUALITATIVE APPROACH .........................26

3.1

Methodology ................................................................................................................................ 26

3.2


3.2.1

Definition of a H&WB destination .............................................................................................. 28

3.2.2

Key service supply, resources, staff competencies and elements of H&WB destinations......... 30

3.2.3

SWOT Analysis of H&WB destinations ....................................................................................... 33

3.2.4

Importance of nature/sustainability in H&WB destinations now and in the future .................. 35

3.2.5

Role of national/regional health policy in H&WB destinations now and in the future ............. 37

3.2.6

Destination development now and in the future ...................................................................... 38

3.2.7

Resources in destination development...................................................................................... 40

3.2.8

Processes in destination development now and in the future .................................................. 42

3.2.9

Balance between needs of tourists and needs of locals ............................................................ 43

3.2.10

Competencies needed in the destination ............................................................................. 44

3.2.11

Core business of the destination in the future ...................................................................... 45

3.3

Discussion ..................................................................................................................................... 46

4

CONSUMER RESEARCH .....................................................................................................48

4.1

Methodology ................................................................................................................................ 48

4.2


4.2.1

In which country are you right now while filling in this questionnaire? .................................... 49

4.2.2
Please write down some key words, which come into your mind if you think of a H&WB
destination................................................................................................................................................ 49
4.2.3
What kind of services, staff competences and elements attract / did attract you to come to a
destination like this? ................................................................................................................................ 51
4.2.4
How did you come to the idea to visit this destination you are currently staying at / you have
stayed at? ................................................................................................................................................. 54
4.2.5

What was the overall reason for you to come to this destination? ........................................... 55

4.2.6

Which services, activities, and elements do you value the most in this destination? ............... 57


4.2.7
Which of the following options best describe your needs when choosing a health and wellbeing holiday? .......................................................................................................................................... 58
4.2.8
To which extent does/did the destination as a whole meet your expectations regarding the
health and well-being related offering during your stay? ........................................................................ 59
4.2.9

How would you score the destination’s services in general? .................................................... 62

4.2.10
To which extent were/are you able to use the variety of services offered in the H&WB
destination? .............................................................................................................................................. 64
4.2.11
How do/ did you check the influence of your current holiday on your health at the end or
after the stay? .......................................................................................................................................... 65
4.2.12
Which of the following alternatives best describe your expectation of the price level of an
H&WB holiday compared to a standard holiday of the same length? ..................................................... 66
4.2.13
Which are the elements which prevent you from recognizing a destination as a health and
well-being destination? ............................................................................................................................ 67
4.2.14

What is the highest level of education you have completed so far? .................................... 68

4.2.15

Sex ......................................................................................................................................... 68

4.2.16

Your age................................................................................................................................. 69

4.2.17

Origin ..................................................................................................................................... 70

5

DISCUSSION OF THE RESULTS: STAKEHOLDER AND CONSUMER RESEARCH 71

5.1

The term „health“ and related meanings ...................................................................................... 71

5.2

Elements which prevent guests from recognizing a destination as a H&WB destination ............... 72

5.3

The quality of services ................................................................................................................... 74

5.4

Country-specific analysis 1: What people do for their health ........................................................ 74

5.5

Country-specific analysis 2: Price level .......................................................................................... 76

5.6

Specific analysis: Health activities and education .......................................................................... 77

5.7

H&WB destination: Characteristics and definition ........................................................................ 79

6

SUMMARY AND MANAGERIAL IMPLICATIONS ............................................................80

7

LIMITATIONS ......................................................................................................................83

7.1

Qualitative stakeholder analysis ................................................................................................... 83

7.2

Consumer Research....................................................................................................................... 83

7.3

Limitations in general .................................................................................................................... 83

8

APPENDIX ............................................................................................................................84

8.1

Stakeholder questionnaire – part A ............................................................................................... 84

8.2

Stakeholder questionnaire – part B ............................................................................................... 91

8.3

Consumer questionnaire ............................................................................................................... 94

8.4

Literature ...................................................................................................................................... 99

8.5

List of charts ................................................................................................................................ 100


1

Research report – Introduction

This WelDest research report focuses on health tourism, wellness tourism, and
destination management. The aim of WelDest is to create a development framework to
be used by public bodies, destination management organizations and private companies
when developing holistic health and well-being destinations (H&WB). The project
“Health and Well-being in Tourism Destination” (WelDest) combines the expertise of 5
Higher Education Institutes, 10 industry and 15 associate partners from Austria, the
Czech Republic, Finland, Germany, and the UK.
The purpose of the research is to conduct research that is relevant to the health and
well-being tourism industry and destinations. The goal is to create a development
framework to be used by public bodies, DMOs and private companies at tourism
destinations willing to strengthen the elements influencing the well-being level of
tourists and locals alike.
One of the objectives of the research is to identify the current knowledge and
competence needs in managing and developing health and well-being destinations
(needs analyses to be conducted among core partner target groups: industry partners,
associated partners and HEI-partners, and outside the partnership: representative
sample of managers, developers, experts and policy makers responsible for destination
development).
The WelDest research consists of both primary and secondary research. The report at
hand is the primary research paper which comprises two different approaches. The
first is based on stakeholder interviews and the second on consumer research. The
stakeholders were interviewed on the basis of two different approaches, quantitative
(questionnaire part A) and qualitative (questionnaire part B):


WelDest research
Primary research

Stakeholder interviews
Part A

Secondary research

Consumer interviews

Part B

Chart 1: Structure of the WelDest-research

1.1

Terms and abbreviations

1.1.1

Terms

Facilities: Something which is built for a special purpose. The term infrastructure is
rarely used in this report as it means basic equipment such as roads and bridges.
This report uses the word destination instead of region as it deals with tourism. If the
word region is used, the report refers to regions in general without referring to tourism
specifically.
Consumers or guests are visitors to a destination.
Positioning: To endow a destination with a clear brand identity in order to distinguish
it from its competitors.
Healthy activities: This report uses phrases such as “healthy activities” or “to do
something for one’s health” to comprise all things done to improve the guests’
health. Thus, certain terms as for example “health promotion” can be avoided as they
are confined to strict definitions.


1.1.2

Abbreviations

H&WB

Health & well-being

USP

Unique Selling Proposition

DMO

Destination Management Organization


2

Stakeholder interviews part A –
A quantitative approach

2.1

Methodology

Methodology for the stakeholder needs analysis concerning health and well-being
destinations (part A) was developed, beginning in October 2012, by the university
partners and the industry partner CHC. There were three feedback loops, involving all
project partners, regarding further improvement of the questionnaire. The final
version was created in April 2013.The questionnaire comprises two parts: The first
part uses a quantitative approach (see chapter 8.1), the second part has open
questions (qualitative approach, interviews, see Chapter 8.2). The latter part was
done on the basis of an interview guideline either face to face or via telephone. Ten
to eleven standardized interviews were conducted by each of the WelDest partners
in their own countries and then uploaded to Webropol 1. The data were transferred
into MS Excel and analysed descriptively by FHJ. Frequency analyses were chosen,
with the results shown in graphs.
The choice of the interviewees was conducted according to the following suggestions
ensuring a broad sample of different professions and management levels:
•

Regional developers (e.g. LEADER managers, staff of regional management authorities).

•

Hospitality managers from wellness-hotels, spas/medical spas, and fitness clubs.

•

Health managers such as health promoters, medical doctors, nutrition experts, or sport
scientists.

•

Local tourism managers, such as authorities from destination tourism boards.

•

A policy-maker holding a relevant job with national importance (e.g. federal tourism board).

1

Webropol is an online solution for conducting surveys, gathering data, managing feedback, and reporting
data (http://www.webropol.com/)


All project partners were asked to choose at least one of their interviewees from
each the above mentioned groups.

2.2

Research results

The following chapters present the results of the survey with the sequence of
questions corresponding with the questionnaire (chapter 8.1).

2.2.1

Which of the following options best describe the role of health
and well-being in your destination now and by 2020?
for the future

now

21

H&WB will be/is an essential part of the tourism
offering alongside other services

15

1. H&WB will be a part of the destination strategy
but not yet implemented at the destination level
2. H&WB is already a part of the destination
strategy

H&WB will be/is a minor offering

H&WB will be/is the core tourism offering of our
destination

4
10

3
9

10
5
38/39 responses

Chart 2: What describes the role of H&WB now and in future?
How to read the chart: 21 responses stress that H&WB will play "an essential part of the
tourism offering alongside other services" in the future.


The chart clearly shows that the idea of health and well-being serves as a promising
approach for further destination development. Conversely, health and well-being as a
"minor offering" plays a less important role in future.

2.2.2

What do you think are the most important reasons customers
come to your destination?
Natural scenery

24

Doing something for health

24

Reputation / image of destination

19

Culture

11

Others, such as major events,
regional cuisine and wine

9

Price level

8

Visiting friends and relatives

5

Suitable accommodation

5

40 responses
Multiple answers

Chart 3: Reasons for coming to the destination

9 respondents selected "other reasons, please specify" listing ideas such as "major
events”, “regional cuisine”, and “wine." According to this chart, "suitable
accommodation" and "visiting friends and relatives" play a minor role. Interestingly,
the stakeholders attach more importance to “health” than the guests do themselves
(see chart 20).
Those, who ticked "doing something for health", could fill in a subsequent question,
the analysis of which is presented in the next chart:


Relaxation

25

Pampering spa services

21

Enjoying natural scenery and its nature

19

Outdoor and indoor sport

11

Natural healing resources

10

Clinical/medical services
Other reasons, such as fun, sport, outdoor
events…

9
2

36 responses
Multiple answers

Chart 4: Specifications from those who ticked „to do something for his or her health“

Interestingly, the two most important items deal with approaches which are aimed at
reducing stress. Obviously, health in a more medical sense plays a less important role.
The responses may give deep insight into the clients’ needs and the situation of the
societies they live in.


2.2.3

Which elements prevent your guests from recognizing your
destination as health and wellbeing destination?

Lack of medical services/infrastructure

15

Lack of wellness and spa services /
infrastructure

14

Others, such as lack of overall concept,
lack of willingness on the part of service…

11

Sprawling cities, villages and industrial areas

8

No medical staff available

8

Outdated health-promoting facilities,
such as old-fashioned baths, gyms, etc.

6

Bad quality of services, such as signage of
walking trails,…

6

Lack of natural environment

4

Too many disturbing industries

3

Too many tourists

2

Too expensive

2

Too much traffic

2

40 responses
Multiple answers

Chart 5: Reasons which prevent guests from recognizing a destination as H&WB destination

Interestingly, it is not the industry and traffic which disturb according to the
stakeholders. They believe it is the "lack of medical services" and the "lack of
wellness and spa facilities" which prevent guests from recognizing a destination as a
H&WB destination. These results show a contradiction of what was stated in the
previous question (chart 4), with medical services playing a less important role (9
responses). It seems that stakeholders are confused as to what is meant by a H&WB
destination.


2.2.4

How important are the following competencies for you regarding
the management of your destination?


not important at all

not very important

Recognition of customer expectations

quite important
1

very important

6

33

Recognition of service gaps

11

29

Rhetoric /Presentation / Communication

11

29

Sales & Marketing know-how
Networking skills to contribute to destination d.

13
1
1

27

13
3

HRM

15

34

Complaint management

25

12

21

2

Problem solving within the organisation

22

17 20

Quality management

3

17 20

Process- & project management

3

17 19

2

Team leading
Self-management
Understanding of H&WB related concepts/…
Responsible management (sustainable issues)

19
18

1

5

15 17

1

7

12
6

15 18

5

Knowledge management

9
1

5

1
4
2

Business law

3

Intercultural communication & foreign language
Others

7
1

Chart 6: Importance of certain competencies


16
15
13

5

Employment law

19

15

Recruiting process

Understanding the benefits of applied research

21

16

Innovation management

IT skills and e-Business

16
16

21

13
12
11 13
10
10
13

21

17
17
40 responses
Multiple answers

The chart reveals the importance of the “recognition of customer expectations” as
one of the core competencies with respect to the management of a H&WB
destination. The next three items include communication in the form of rhetoric and
presentation, marketing, and networking.
In this chart, "quality management" plays quite an important role in comparison to
other questions in which it is assigned less importance..
"Others" was ticked up just one time and mentions "appraisals, HR-procedures,
health and safety".

2.2.5

What is your personal need for further training regarding the
following competencies?

Charts no. 6 and no. 7(previous and next) belong together as they are part of an
importance-performance-analysis. This approach compares the importance of
defined services and their present performance by the interviewee, assuming that a
high need for training reveals an insufficient performance at present or an increasing
demand for this capability in future. Chart no. 7 and its blue bars combines the
previous chart with the result of the performance analysis (red bars),, taking only
“very important and quite important” (blue) and ”high and some need for further
training” (red) into account.
If there are differences between importance and performance, a gap arises indicating
a need for action. The need for action arises if both bars (blue and red) are
particularly long, as is the case with respect to “recognition of customer
expectations”. Another example: “Quality management” is rather important too
(blue bar, 37 votes), but the necessity for training seems to be comparatively low (red
bar, only 17 votes).


performance ("high and some need for further training")
importance ("very important and quite important")
27

Recognition of customer expectations

39

24

Recognition of service gaps
Rhetoric /Presentation / Communication

23

Sales & Marketing know-how

23

Networking skills to contribute to destination d.

40

23

40
38

24

HRM

37

19

Complaint management

33

20

Problem solving within the organisation
Quality management

40

37

17

37

Process- & project management

23

Team leading

23

37

20

Self-management

32
24

Understanding of H&WB related concepts/…

32

22

Responsible management (sustainable issues)

37

24

Innovation management

33

22

Knowledge management

34

19

Recruiting process

31
22

IT skills and e-Business

34

20

Understanding the benefits of applied research
Employment law

16

Business law

34

16

Intercultural communication & foreign language

36

24
27
23
24

35 responses
Multiple answers

Chart 7: Need for further training compared to the importance of the competence in question

It appears that those competencies which get the most points with regard to “very
important” (chart 6, upper part) seem to have the highest need for further training.
Example: The “recognition of customer expectations” gets a high ranking with
respect to a need for the training (chart no. 7, first red bar).


The first two items in chart no. 7 deal with the customers and their expectations and
related service gaps.
The second group of training needs comprise communicative issues such as
“rhetoric/presentation”, “sales/marketing”, and “networking skills”. Legal subjects
such as "employment law" and “business law" play a minor role, as is the case with
"intercultural communication & foreign languages”.


2.2.6

Please evaluate the present performance of your destination
regarding the following specific points
I strongly disagree

I disagree

I agree
2

There is an understanding of the importance of
strategic destination development

13
3

We follow a destination brand identity

11

2

15

15

11

We provide an innovation friendly environment

10

19

9
3

We collect and utilize destination level data
systematically (knowledge management)

13
14

9
3

Aspects of sustainability will be considered in
decision making processes

19

8
3

We are involved in destination-wide decision
making processes

12

17

8
2

We have an effective destination management
organization

13

18

7
8

There is a commitment and co-operation of all
actors (private and public)

7

12
13

3

We follow joint sales & marketing strategies

14
15

7
2

There is an adequate development process- &
project management in place

11

24

3
2

There is transparency in communication
processes

16

20

2
7

There is a feeling of togetherness and common
goals amongst the actors
We use a quality management system (e.g. ISO,
EFQM,…)

I strongly agree

15
15

2
8
1

Chart 8: Evaluation of the present performance of the destination


12

18
65 responses
Multiple answers

Interestingly, the statement concerning the "commitment and co-operation of all
actors" gets quite a critical evaluation as eight interviewees "strongly disagree". This
corresponds to other questions in this research the responses to which high
importance was attached to inter-regional communication and networking in
general.


2.2.7

How important are the following specific points regarding the
development of a HW&B-destination?
not important

Quite important

important

Destination brand identity

1

Feeling of togetherness and common goals
amongst the actors

2

1

Commitment and co-operation of all actors
(private and public)

1

Common understanding of the importance of

4

2

3

27
11

4

26
13

1

23
17

2

22

17
6

14

3

14

11

15
14

Chart 9: Importance of certain points for the destination development


19

17
17

3

Use of a quality management system (e.g. ISO,
EFQM,…)

21

18
18
5

Providing an innovation friendly environment
Process- & project management with regard to
destination development

28

9

Consideration of sustainability in decision
making processes
Transparency in communication processes

30
11

Involvement in destination-wide decision
making processes

Joint sales & marketing strategies

33
8

A destination management organization

Systematic collection and utilization of
destination level data

very important

23

40 responses
Multiple answers

Many of the above mentioned items deal with communication and cooperation.
If "very important" and "important" are taken together many items have more or less
the same number of responses. So, we propose to differentiate between "important"
and "very important".
The "use of quality management system" and certifiable quality seals such as ISO
9001 and EFQM seem to be of less importance, at least in this question.

The next chart deals with the same data while trying to present the outcome in
another way. There are points given to each category:
•

„not important“

•

„quite important“ 1 point

•

„important“

2 points

•

„very important“

3 points.

0 points

If calculated together, one gets a result in the middle of the next chart which delivers
deeper insight into the outcomes:


points

not important
0 points
very important
3 points

important
2 points

108

2

1

4

8

30

109
1

11

28

101
2

9

27

103
3

11

13

23

101
1

17
22

99
2

17
21

91
6

14
19

93
18
18

90
5

Feeling of togetherness and common goals
amongst the actors
Commitment and co-operation of all actors
(private and public)
Common understanding of the importance of
A destination management organization

26

99
4

3

Destination brand identity

33

107
1

Quite important
1 point
Linear (points)

17
17

91
3
14

23

72
15
14
11

Involvement in destination-wide decision
making processes
Systematic collection and utilization of
destination level data
Joint sales & marketing strategies
Consideration of sustainability in decision
making processes
Transparency in communication processes

Providing an innovation friendly environment
Process- & project management with regard to
destination development
Use of a quality management system (e.g. ISO,
EFQM,…)

Chart 10: Interpretation of the previous questions


2.2.8

Please define the level of your current job

Mid-management (e.g. department head)

14

Executive Manager (e.g. CEO)

11

Others, such as director of customer
operations, mayor, academic university
professor, senior manager, resort…

8

Owner/entrepreneur

7
40 responses

Chart 11: Level of the current job

2.2.9

What is the highest level of education you have completed so far?

Master's degree or similar

17

Bachelor's degree or similar

8

Secondary school

7

Doctoral degree
Basic education

6
1
39 responses

Chart 12: Highest level of education

The comparatively high number of doctoral degrees results from the fact that quite a
lot of medical doctors were among the interviewees, as experts from the health
industry were part of this survey.


2.2.10

How many years of experience do you have in the following
categories?
Working in hotels / restaurants
Destination management or regional authority
Health related services such as (thermal) spa, public / private health care, etc.
14

more than 6 years

11
2

4 to 6 years
1to 3 years
Less than 1 year

4

5

4

8

1
1

17

2
5

39 responses

Chart 13: Years of experience

The chart delivers insight into the job experience of the interviewees. The majority of
them have more than 6 six years of job experience in tourism, health, or destination
management.


3

Stakeholder interviews part B – A qualitative
approach

3.1

Methodology

The development of the stakeholder needs analysis (qualitative questionnaire, part B)
was developed, beginning in October2012, by the university partners. There were
three feedback loops, involving all university partners and the industry partner CHC,
for ensuring the quality of the questionnaire. The final version was created in April
2013. Part B was developed as a semi-structured interview guideline consisting of 12
questions. The topics of the semi-structured questions were:
•

Terms and Definitions

•

SWOT

•

Role of nature

•

Role of national / regional health policy

•

Current situation in destination development

•

Internal versus external resources in destination development

•

Instruments to be applied for destination development

•

Locals versus tourists

•

Training and education on a destination level

•

Future Markets

Through the development of a guideline which described the implementation and
analysis of the interviews in detail, standardization was ensured. In that way it was
ensured the method for conducting the interviews was the same in all partner
countries. This document “Notes for qualitative stakeholder needs analysis” was
divided into three sections:


•

1. Conducting the interviews
•

Preparation for the interview

•

The interview itself

•

How to get the data in analyzable form

•

Data selection and analysis

•

2. Interview Guideline

•

3. Template for interview protocols (a form into which the transcription of an interview was
to be filled in).

Ten to eleven interviews were conducted by each WelDest partner. The interviews
were either done face to face or via telephone. The selection of interviewees was
conducted by every project partner (see chapter 2.1). The interviewees, chosen as
experts in their field, were first contacted via telephone or e-mail to make an
appointment for the interview. Therefore, the experts selected comprised regional
developers, hospitality managers, health managers, local tourism managers, and
policy makers on a national level. The confidentiality and the anonymity of the data
were assured to the interviewees. Before the interview started the interviewees were
asked to get permission to audiotape the interview.
An interview guideline was used during each interview in which it was recommended
to use open questions and to avoid closed questions in order to keep the interviewee
talking.
The face to face interviews were recorded, transcribed and then translated into
English when needed. One protocol for each interview was compiled in English or
German. It was recommended to use an audiotape for writing the protocol to avoid a
loss of information. Furthermore, some basic information had to be gathered before
the interview started, such as the interview number, the interviewee (first name, last
name), his/her function, interviewee initial number (partner country, interview
number; e.g. AT1), date of interview, length of interview, and name of the
interviewer. All teams fed their interview protocols into Webropol to make them
available to FHJ for analyzing.
The interviews were transcribed according to Froschauer & Lueger, 2003. Afterwards,
the categorizing of the data was done with aid of MaxQDA 2007 to ensure a
professional categorizing system. The Austrian transcripts were used to validate the

categories of the interview. This was to ensure a comprehensive system of categories
(word-clusters). In other words: The Austrian transcripts were used as kind of a
pretest. Additionally, the categorization was discussed in a team meeting with all
partner countries, with almost all suggestions for improvement being taken into
account. Then, the interviews from all partners were categorized according to the
same categorizing system.
Most of the interviews took about one hour. The shortest interview time was 30
minutes, and the longest interview took 2 hours.

3.2

Research results

Overall, 52 interviews were conducted (10 in Finland, Germany, and the United
Kingdom, and 11 in Austria and the Czech Republic) comprising 15 regional developers,
15 hospitality managers, 12 health managers, 8 local tourism managers, and 2 policy
makers.

3.2.1

Definition of a H&WB destination

The first question deals with the definition of a H&WB destination. About half of the
interviewees think that health and wellness are two different things. The term health
is attached more with sick people as medical issues, whereas wellness has a more
holistic view of the person, and comprises the body, mind, and soul. This holistic view
is, according to the interviewees, very important for H&WB destinations.
Nevertheless, most interviewees stated that expertise in medicine and health are
core factors:
“If you talk about health tourism or well-being tourism then there should be
evidence, something that “tastes” right, not only pampering as such. Wellbeing can be many things but in this, especially when discussing rehabilitation
it has to be real and true.” (FIN10, 7)
Core factors for the definition of a H&WB destination are wellness offers, possibilities
to relax, spa facilities, and well-being. These are as important as expertise in medicine
and health. There can be a negative association with the term wellness because it is
not defined properly and almost all hotels use the term to market themselves.

When it comes to nature and environment, interviewees stressed the importance of a
sound, beautiful, clean nature and the use of local natural resources such as thermal
water for thermal baths, because they distinguish destinations from one another.
“Why should a guest even go to a thermal spa, because almost each higher
categorized hotel has all offerings that thermal spas have, too? And you get to
the point what a thermal spa is all about: It is the thermal water, which is
simply not available everywhere.” (AUT04, 9)

Another distinctive feature can be a unique offering of services, providing different
types of services and also a wide range of services. In order to be able to offer these
services, sufficient facilities are necessary. This also involves indoor and outdoor
activities like hiking, biking, going for walks or going to the gym, etc. Another
important aspect is to provide healthy food and also organic/regional healthy
products. Not only physical goods, but also the service attitude and the friendliness
of the staff contribute to an enhanced experience during a holiday in a H&WB
destination. Qualified staff plays an important role in the perception of the delivery
of services for guests.
“Personally I can forgive small shortcomings in accommodation, but the way
people treat you, the cleanliness and the friendliness, the presence of flowers
etc. not really. Inner feelings and emotions are definitely decisive for clients,
they are absolutely essential.” (CZK08, 7)
Destinations should also take into consideration their historical values and culture
which they can identify with authenticity. Some interviewees stated that
homogenous offers in the destination help the guests to become oriented, and they
function as a positioning statement. The whole destination should offer a chain of
services for the guests so that they can experience their holiday as a complete
package. Interdisciplinary co-ordination is necessary to achieve this goal.
Differences between the countries of the interviewees could be especially seen in the
following points: It seems that the Finns have a very holistic approach to wellness.
According to them, it should involve the body, mind, and soul of individuals, whereas
they associate health with medical services and recovering from an illness. For the
other countries this holistic approach is important as well, but Finns put a very high
importance on it. So there should be a distinction between the two terms „wellness“


and „medical,“ which the Austrian interviewees also put a focus on. As for the
Austrians and the Finns, the term wellness is quite imprecise and overused and
should therefore not be part of a definition of a H&WB-destination. The British
stressed that the term H&WB is not understood in the UK as there is the term spa
tourism, which is not directly linked to health. Travelers normally have no
associations with the term H&WB, but understand the term spa tourism well.
If we look at the answers from the point of view of the various professions of our
interviewees, health managers put a strong focus on natural resources, nature, and
environment of H&WB destinations as well as medical expertise and wellness offers.
Hospitality managers are more service-oriented and focus on well-being offers.
Regional developers, on the other hand, emphasized the importance of a
homogenous offer and health-promoting expertise. The chain of services is crucial to
them. Local tourism managers put a focus on well-being and a holistic approach.

Summary
It seems that health and wellness are seen as two different things. Health is associated
with medical issues and wellness has a more holistic approach, at least for the
interviewees. This holistic approach is important for H&WB destinations, and
competencies in health and medicine are core factors for H&WB destinations. Other
core factors mentioned include wellness services, possibilities to relax, spa facilities, and
well-being.
The interviewees stressed the importance of a sound, beautiful, and clean nature as well
as capitalizing on local (authentic) resources. It seems to be necessary to offer different
types of services, and appropriate facilities are necessary, too. Service quality and
friendliness were also emphasized, as was the need for qualification.

3.2.2

Key service supply, resources, staff competencies and elements of
H&WB destinations

The second question is about the key service supply, resources, staff competencies,
and elements of a H&WB destination.
As far as the service supply is concerned, interviewees agreed that the offered
services have to be of high quality in order to satisfy the customer. There should be a
broad range of offers. According to the interviewees, a H&WB destination must

provide well-being offers such as services for relaxation, beauty treatments, and spa
procedures. However, the same importance is attached to medical offers like
rehabilitation, prevention, and education in achieving a healthier lifestyle.
Additionally, outdoor and indoor sport activities were mentioned as key services of a
H&WB destination. Another issue is tailor-made services for special interest groups.
Extremely important for H&WB destinations is the way the services are offered.
There should be a network that provides supporting products and services, so
customers feel that the offer in the region is homogenous and comprising. The chain
of services is crucially important for the experiences of the guests. As one Czech
interviewee summarized:
“At the end of the day, health and well-being are all about the services (…).”
(CZK09, 13)

The key resources of H&WB destinations evolve around the big topics of nature,
environment and landscape. These factors are seen as being very important to the
overall impression of the destination. Furthermore, natural resources available in
destinations should be used in tourism, for example thermal water for spa
treatments or regional and healthy products in restaurants. The other big topic for
the interviewees in this category is the facilities. Interviewees agreed that a minimum
level of facilities in H&WB destinations is necessary in order to deliver appropriate
services. Most important in this field are the facilities for well-being, and spa facilities
like pools, saunas, gyms, relaxation, and treatment rooms.
“Definitely for me it’s the nature and natural conditions, for example forest,
river, clean mountain water and healing climate, and of course the landscape
and of course the facilities for doing activities, like hiking trails and trails for
biking, in the winter for cross-country and other winter sports. In the same
time the place should be able to offer spa services starting from the bath and
massages to spa centers.” (CZK09, 10)

Crucial to H&WB destinations are the staff competencies. The offered services must
be delivered in a professional manner. Also very important is the qualification,
training, education and knowledge which they have obtained. All these things enable
the staff to be capable of delivering services of high quality. Almost all interviewees


agreed on the fact that social skills and the direct interaction with the guests are the
key factors that enhance the guests’ well-being as well.
“I think that the human factor is crucial, I mean service standards, staff
standards and their ability to be affable. The education of people working in
the field of tourism is essential as well.” (CZK08, 7)

Another important aspect is the public transport system, which should be sufficient
so that guests can easily reach the destination and places of interest within the
region. The culture and heritage of the destination should not be left out, but rather
included in the packages, as guests are interested in the history and traditions of the
locals. When it comes to the positioning of the H&WB destination, it is very
important to communicate a clear USP. Guests want to know what they can expect
from the destination and choose the appropriate offering for themselves. This is
explained in the statement below:
“If we talk about a USP, for example we are the health destination for weight
reduction; appropriate services like exercise should be coordinated. In other
words: specific joint-friendly sports or also the facilities for example a lake or a
therapeutic bath where these things can be offered. The whole offer should
be a smooth concept, adjusted to the hotels with their programs, all factors
that influence the medical indications of diseases. (…) Target-group-specific
offers with target-group-specific staff in all areas.” (AUT08, 13)

Viewed from the point of view of the country and profession, there are some
differences. For the Austrian interviewees qualified staff is the most important key
competency of a H&WB destination. On the other hand, for the English,
complementary services (which do not belong to the core competencies) seem to be
very important. Hospitality managers put a clear focus on the quality of staff and
customer service.

Summary
According to the interviewees the key service supply of a H&WB destination should be of
high quality and combine medical services with well-being, relaxation, and spa offers.


There should be a network that provides supporting services and products to the guests.
Interviewees think that the key resource for H&WB destinations is nature and
environment. Natural resources like thermal water also play an important role. Sufficient
facilities have to be available to deliver the desired services to the consumers.
Professionally trained staff has to get adequate training and education in the core areas.
Most important to the interviewees are social skills.

3.2.3

SWOT Analysis of H&WB-destinations

The third question dealt with a SWOT-analysis of the interviewees’ own H&WB
destinations. Interviewees were asked to name the strengths (S), weaknesses (W),
opportunities (O) and threats (T) of their HW&B-destinations. Many factors were
identified by the interviewees with the answers matching partly with the key
competencies of H&WB destinations.
The most important strength for H&WB destinations mentioned is a beautiful and
sound nature and environment, which have to be maintained as they can become a
weakness if they are not taken care of. The history, culture, and traditions of H&WB
destinations should be included in the tourism offers as it underlines authenticity.
Good facilities combined with accessibility and public transport are very important
factors. Other factors mentioned are the reputation of a H&WB destination,
professional staff and the preparation of relaxation offers.
“Strengths are the tradition, the location, the natural curative resources, the
human resources, their language skills somewhat, and the demand for the
type of service that we supply. Also the natural environment, which is
relatively clean (…)“ (CZK10, 13)

The weaknesses largely correspond with the strengths, which mean that if the
strengths of H&WB destinations are not taken care of, they can quickly turn into
weaknesses. A further point mentioned in the weaknesses is the positioning and
marketing of a USP. There was general agreement that too many destinations market
themselves in the same way, thus not being distinguishable from others. In part, this
can be traced back to a low level of co-operation in the destination as well as to low
financial resources.


“The weakness is the co-operation between public, state, and local
authorities. Even among business units we are speaking different languages
and we are not setting the same goals. And every four years the authorities
are changing their priorities according to the political situation. It is kind of
difficult. And I would say that this is the obstacle to growth.” (CZK09, 13)

Regarding the opportunities of H&WB destinations, the biggest potential according to
the interviewees can be seen in attracting new target groups. Often, H&WB
destinations focus on strictly defined target groups which do not have enough
potential. Also the improvement of networking and co-operation in the destination is
seen as an opportunity.
“(…) attract more people in a broader age range, but that is not easy because
of the competitors in the market and so on the other hand because of the
expanding number of people, because of the expanding part that is older in
the long run, a spa has this association with people who are older because this
is becoming such a growing part of the market.” (AUT05, 9)

The biggest threat for H&WB destinations according to the interviewees is the high
level of competition. Many destinations and companies link themselves with H&WB,
which could potentially also lead to an oversupply in the near future. For the
interviewees uncertainty is also associated with potential political friction or
economic recessions. The withdrawal of public financing for H&WB destinations,
especially for health tourism 2, is seen as big hazard because it is not clear whether
consumers will be willing to pay for health activities themselves.
“(…) potentially in a certain segment of H&WB tourism there is already a little
bit of an oversupply (…)” (AUT01, 13)

Austrian interviewees advance the view that prevention and medical services belong
to the biggest opportunities for the future development of H&WB destinations. Czech

2

The treatments of which can be paid by the health insurance as it can be part of the health care
legislation.


interviewees think that the biggest weaknesses of their H&WB destinations are the
low service quality which results from a lack of qualified staff. For the British heritage,
history, and reputation are key strengths of H&WB destinations. Hospitality
managers think that qualified staff is the biggest strength of H&WB destinations.

Summary
This chart presents the SWOT Analysis of H&WB-destinations from the interviewees.
Strengths
sound nature / landscape / environment
history / culture / tradition
good facilities
reputation / image / brand
professional / qualified staff
accessibility / public transport
location
relaxation / health / retreat offers
Opportunities
enlargement of target groups / segments
networking / co-operation in the destination
nature / natural attractions
differentiation / positioning
facilities and infrastructure (renewal,
expansion of both roads and public transport
as well as spa resorts)

3.2.4

Weaknesses
unqualified staff
no positioning / marketing of a USP
weak facilities
weak public transport / accessibility
no networking in the destination
Unclean environment
low financial resources
Threats
high competition
political friction
economic / financial crisis or recession
withdrawal of state / public financing

Importance of nature/sustainability in H&WB destinations now
and in the future

The fourth question is about the importance of nature at present and in the future
(2020).
Generally, interviewees stressed that nature and sustainability are very important
aspects for H&WB destinations. The protection of the environment is a crucial topic
which should be pursued in the future. In general, interviewees think that H&WB
destinations are to make use of their local natural resources such as thermal water
and marshland for swimming pools and spa treatments (wrappings). According to the
interviewees, nature is one of the core reasons to travel to H&WB destinations and
their unique selling proposition (USP). Nature can also be used for outdoor activities
like hiking, biking and so on.

“(…) It’s extremely important to take care of ecology and nature now and it
will be even more important within ten years. Because if we’re not going to
take care of the nature (…) even within seven to ten years we will have
nothing to offer. So the more we take care of it now, the more we will be able
to offer in 2020.” (CZK09, 16)
On the subject of sustainability there was agreement that it is very important for
H&WB destinations in order to maintain the scenery and natural resources, although
there is mostly no sustainability codex applied in the destinations so far. Some
interviewees put a focus on local networks and the marketing of regional products.
“Sustainability is interpreted locally (…) as developing local partnerships and
supporting the rural economy. It is about developing links between wellness
and other products. It is about retaining a distinct local mix of shops and other
businesses. It is about integrating local products, especially local food to the
wider tourism offering.” (UK01, 16)

When asked about the future importance of nature and sustainability in H&WB
destinations, most interviewees said that the importance of these topics will
increase. Others stated that they will have the same importance in the future
because these are already now very important topics.

Summary
Nature and sustainability are both very important elements for H&WB destinations. They
can act as USP for destinations and core reasons for guests to travel to certain
destinations. Interviewees think that the protection of the environment is crucial in
order to be able to offer outdoor activities. This should be underlined even more in the
future. Natural resources such as marshland can be used for spa treatments in tourism
offers.
The importance of these two elements is already very high in H&WB destinations and
interviewees think that this will probably increase even more in the future.


3.2.5

Role of national/regional health policy in H&WB destinations now
and in the future

The fifth question is about the role of national / regional health policy in H&WB
destinations at the moment and in the future (2020).
Interviewees think that the political influence on H&WB destinations largely depends
on the services available. Destinations concerned with offering cures 3and medical
treatments for example have bigger connections with health policy than destinations
operating with well-being services. About half of the interviewees stated that politics
play no significant role in their destination, but almost the same number said that
health policy has a big influence on the development of their destination. Some also
agreed that politics does have some impact on them, if not largely.
“Health policy, of course there is a connection, that is without question (…)“.
(AUT11, 42)

On the contrary, a Finn and an English interviewee said:
“I cannot say more to regional health politics – we are not that medical, that it
would reflect on us. (…).” (FIN09, 19)
“There has been no contact between tourism and the health authority, no
mention of tourism in the (…) health strategy.” (UK05, 19)

Most destinations are familiar with some sort of subsidies, financial aid or copayments by the government or health insurance companies, which have just as large
an influence on the type of guests as on the treatments and the qualifications of the
staff. For the future, interviewees think that health policy will have a big influence on
cuts in subsidies. More prevention offers in the future are desired, but it is unclear

3

The Central European concept of „Kur“ (nowadays called ambulant prevention) is part of the preventive
health care at least in the German speaking countries which aims at subsidizing treatments in health spa
centers to maintain the ability of employees to work. Thus, “Kur” does not mean curing from a surgical
and clinical point of view but is based on treatments using natural remedies such as healing water or
healing climate.


whether politics will support these services or not. Generally, interviewees wish to
have more co-operations with health policy in the future.
“(…) so the key here, it seems to me, is that national and regional health
policies become more orientated to prevention that’s to be driven by
economics. It won’t be possible anymore to focus on treatment. There is
much too little emphasis upon Austria’s health policy now, and the same for
regional policy in the location, and they are directly connected with one
another (…).” (AUT05, 17)

Again, there are some differences between the countries concerning the importance
of health policy. The Finns and Austrians largely agreed that health policy influences
their H&WB destinations while Czech and British interviewees think that it doesn’t
influence their destinations a lot.

Summary
The influence of health policy on H&WB destinations depends largely upon the offered
services. Destinations focusing on medical procedures or cures have more connections
with health politics than destinations with well-being offers. Nevertheless, almost all
H&WB destinations are familiar with some sort of financing through the state or health
insurance companies.
For the future, interviewees think that politics will have a bigger influence on H&WB
destinations and hope that more preventive services are offered. Interviewees also seek
more cooperation between the public and private sectors.

3.2.6

Destination development now and in the future

This question deals with the topic of destination development in general. It has a
focus on the current situation and future development of H&WB destinations.
Most interviewees think that co-operation, partnerships, and networks support
destination development in a positive way. Common destination planning and
development are seen as improving the performance of destination for tourists and
politicians, if the latter ones officiate in a fluently communicating and conflict-free


destination. According to the interviewees, many of their H&WB destinations have
developed their tourism product recently. Infrastructure and facilities are another
issue for H&WB destinations as they should satisfy customer needs. Interviewees also
stated that a focus was put on the marketing and positioning of the destinations.
Regular meetings are held to ensure co-operation and planning.
“(…) health and wellness is clearly being seen as an important development
opportunity for destinations. (…).” (UK04, 22)

The interviewees also had some negative associations with the current destination
development. The biggest limiting factors for H&WB-destinations at the moment
seem to be financial factors. Many wish for more financial support from government
and feel a big influence from the current recession. Some regions also miss cooperation from all stakeholders and feel that there is a lack of networking. Other
negative factors mentioned are political frictions and a lack of time for appropriate
destination development.
“(…) in this recession the development of the destination is pretty small, so
basically we just try to survive the competition and the recession.”(FIN05, 22)
In the future, interviewees stated that their H&WB destinations plan to invest in their
facilities both on maintenance and construction. Many of the interviewees also hope
that co-operation and networking become bigger topics in all regions in order to
enhance destination development. A focus will be put on H&WB offers and,
generally, services will be diversified in order to attract more market segments. For
some the protection of the local environment is the most important aspect in the
future development.
“As an example every company is trying to understand how to attract more
foreign visitors, instead they should do it together and they could offer bigger
entities that would attract more than a single company offering.” (FIN03, 22)

Looking at the question from the point of view of different countries, a difference can
be seen concerning the Czech interviewees. For the Czech interviewees the presence
of a destination management organization (DMO) is a very important aspect in


destination development, and should be further enhanced in the future. Other
countries did not put a special focus on this subject.

Summary
Common regional planning and acting is seen as improving the performance of
destinations for both tourists and politics. Many destinations have recently developed
their facilities and the range of services offered to attract more consumers. According to
the interviewees, marketing and positioning are both attached with the utmost
importance.
Interviewees think that the biggest limiting factors for current destination development
are financial issues, mostly due to recession.
Future development is aimed at improving facilities and the co-operation and
networking in the destinations. The range of services will be diversified.

3.2.7

Resources in destination development

This question discusses whether internal (endogenous) or external (exogenous)
resources should be exploited for destination development. The general agreement
of interviewees is that a mix of external and internal resources is vital to destination
development. It is very important to make use of external resources, too, such as
consultants or market research data. This also includes the monitoring of tourism
trends and an examination of science and current research. Interviewees think that
the government and public sector have a large influence on destination development
because they predetermine many aspects of H&WB destinations, for example certain
regulation about hotel categories or health offers.
“(…) there needs to be a mixture of both, active participation of the locals but
at the same time external experts, that means a combination of both (…).”
(AUT08, 38)

From the internal point of view, interviewees think that it is very important to gain
ideas for development internally and also make decisions internally, but with the help
of external consultants. Local co-operation and partnerships can also foster


development and help to work towards a common goal. In this context, stakeholder
management plays a central role. Some H&WB-destinations are guided by a DMO
and feel that this guidance is very helpful for the development.
“We work with a destination management organization very closely; we have
representation on the board. We take advantage of what the DMO is doing.
We communicate, offer proposals to their strategies, we meet. They do it
well, and they‘re interested in opinions from the field.” (CZK06, 25)

Concerning external resources, most interviewees stated that they have used
external consultants in their destination development process so far to get an outside
view. The examination of best practice examples and benchmarking is very common
and provides them with new ideas. The interviewees stress that memberships in
different associations and organizations also contribute to the conflux of external
knowledge which has to be exchanged systematically within the destination. Most
interviewees said that their H&WB destinations are familiar with external
investments.
“(…) we try to get the influence from elsewhere because otherwise we have
the cave effect; we only see the shadows but do not see what is happening
out there.” (FIN05, 22)

Summary
According to the interviewees, a mix of external and internal resources is vital for the
development of H&WB-destinations. Current tourism trends, research, and science
should be monitored to be able to react to changes in customer behavior etc.
Interviewees think that government and the public sector have a big influence on their
H&WB destinations as they predetermine certain regulations.
Interviewees feel that internal ideas should be supported by external guidance and local
co-operations and partnerships. The presence of a DMO facilitates the development of a
H&WB destination.
The H&WB destinations are familiar with the use of external consultants and external
investments for the development of their region. Examination of best practice examples
and benchmarking is a common feature as well as membership in organizations.


3.2.8

Processes in destination development now and in the future

Question number eight is about the processes used for destination development now
and in the future.
Currently, most interviewees said that they use regular and personal communication
in meetings to develop their destination. Also the co-operation of stakeholders is a
common tool used for the development of H&WB-destinations, and co-operation
between the public and private sectors is vital as well. Interviewees develop their
destinations with the aid of various platforms such as forums, membership
organizations, and associations. Other points mentioned are on-going research and
the monitoring of tourism trends, as well as promotion and marketing of their
H&WB-destinations.
“Attend exhibitions, conferences, networking events, trade publications.
Discuss new product development with other companies. Owners travel
abroad for ideas regarding key and emerging trends.” (UK09, 32)

For the future, interviewees think that local guidelines for co-operation will be the
most important instruments for destination development. This includes the
continuous involvement of locals in the decision-making processes. Important points
that will remain in the future, according to interviewees, are market-research, trend
analyses, and also the marketing of H&WB destinations.
“Developing local partnerships is the key to any future success. There is a
close working relationship with local businesses (…).” (UK01, 28)
Summary
Most interviewees said they use regular, personal communication to develop their
destination. Another common tool for destination development mentioned by the
interviewees is the co-operation of stakeholders and the public and private sectors.
According to the interviewees, various platforms as well as market-research and
marketing are used for destination development.
Interviewees think that in the future co-operation on a destination level will be the
most important process for destination development. This also involves the
participation of local inhabitants. Research and marketing will remain important in the
future.


3.2.9

Balance between needs of tourists and needs of locals

This question deals with the balance between the needs of tourists and the needs of
locals.
The interviewees’ opinions vary largely on this topic. About half of the interviewees
think that the relationship between tourists and locals is problematic, but the other
half thinks that there are no conflicts between tourists and locals.
“Finding the balance is very challenging! I feel however, that the local
inhabitants are positive about this; what is good for tourism is good for the
locals, too. But we would need to give them more information about what we
do and use them in the development and raise their status, increase their role
in the development.” (FIN01, 34)

There is general agreement that the facilities and the range of services should be for
both groups and that facilities are improved regularly. Locals should participate in
tourism development, being able to advance their opinions. Furthermore,
interviewees think that tourism creates a lot of jobs for locals and supports local
businesses. Some interviewees also stated that there are discounts or benefits for
locals using tourism facilities.
“It is important to develop agreement for tourism development with local
residents. Advice on wise sustainable growth needs a bottom-up approach
and local mechanisms to ensure the views of locals are considered.” (UK04,
34)
Summary
In the interviewee’s opinion, finding a balance between needs of locals and needs of
tourists is very challenging. One half of the interviewees think that the relationship
between tourists and locals is problematic; the other half thinks that there are no
conflicts between these groups.
There is general agreement that both the facilities and services should be used by
tourists and locals as well. Locals should also participate in tourism development.
Interviewees think that tourism creates jobs for locals and supports local businesses.


3.2.10

Competencies needed in the destination

The next question is about the competencies which are needed in H&WB
destinations.
The interviewees’ answers show that many competencies are needed. As far as staff
development is concerned, competencies such as management skills, marketing and
selling skills, as well as social skills seem to be of special importance. However, the
most important competency in the future is the knowledge of foreign languages.
Interviewees feel that their H&WB-destinations lack these skills at the moment.
Connected with this topic is customer service, which should also be improved in the
future. Interviewees also hope that staff has a comprehensive knowledge about the
destination and its range of services.
“Very often we're able to deliver quality itself but we’re not able to smile,
that’s very simple. This is what I see very often. I used to say that we’re not in
the post office, we’re serving guests. We’re not sitting at the counter and
waiting for the guests to come. We should approach them and make advances
to the guests.” (CZK09, 37)

Interviewees feel that the physical goods and services which they offer should be
further developed in the future to attract more guests. Another important topic is the
development of supporting services (explanation: a bike rental company needs a
bike-route, a medical spa needs a pharmacy) and the improvement of single steps
within one process (process management of successive steps such as information,
booking, payment, which are altogether realized as one service), also called a service
chain.
“(…) We would need development in the direction of cluster management,
where it is clearly defined, what are the core competencies, core strengths.
And along these core competencies a high degree of liability of the service
chain is needed, and we are lacking liability for long periods for now.” (AUT07,
75)


Summary
The training and education of staff is the most important aspect in the needed
competencies for H&WB-destinations according to the interviewees. Language skills
make up the largest part in this area. Also important are customer service and the
regional knowledge of staff. Management skills, marketing, and sales as well social skills
could also be further developed according to the interviewees.
Interviewees feel that the goods and services have to be improved as part of a chain of
services. Another important topic for interviewees is an adequate information policy.

3.2.11

Core business of the destination in the future

The last question which was addressed to the interviewees is about the core business
of their destinations in the future.
Almost all interviewees think that H&WB will be the focus of their destinations in the
future. Interviewees also think that there will be a trend towards more active
holidays with a focus on sports and outdoor activities. This will need further
investment in the expansion and maintenance of related facilities.
“I think health and well-being is a good theme as you can connect it with
experiences and nature values in overall well-being.” (FIN03, 40)

Concerning the target groups, interviewees think that domestic tourism and tourism
from nearby countries will grow in importance. For some interviewees, international
visitors will also play a big role in H&WB destinations. Another trend seems to be that
older people remain more active and more interested in H&WB destinations and will
therefore become a big target group in the future.
“Close-by markets will be growing according to all studies.” (FIN02, 40)

Considering differences between the countries, it can be seen that Austrians put a
very clear focus on health and medical offers while the interviewees of the other
countries did not stress that point.


Summary
As for the future, almost all interviewees want their destinations to focus on H&WB.
They also think that there will be a trend towards more active holidays and that is why
bigger investment in outdoor and sport facilities is needed.
Interviewees think that domestic tourism and tourism from nearby countries will grow in
importance. Some also see international visitors as playing an even bigger role in future.
Older people become more active and interested in H&WB, which makes them a future
target group.

3.3

Discussion

As stated in the analysis of the qualitative interviews with the stakeholders, the
dichotomy between health and wellness can be seen also in the quantitative part of
the stakeholder interviews (part A). The results of question 2 (part A, chart no. 4)
reveal a strong emphasis on wellness issues (the first two bars from the top) and a
quite weak emphasis on health related issues (lower part of the chart).
Question two of the qualitative stakeholder interview (chapter 3.2.2) reveals the
necessity of the quality of all services offered. This might be understood as a
contradiction to the results of the interview part A (chart no. 8) which attached little
importance to quality issues. But part A somehow stresses the aspect of certifiable
quality management systems, whereas the statements in part B emphasized a
broader approach to quality in the sense of delivering services satisfying the
expectations of the clients. The way services are offered plays as important a role in
part A as in part B.
The results of the stakeholder interview part B stress the importance of the staff
competencies in general. Part A specified which competencies are among the most
important ones. We learned that the importance of "recognition of customer
expectations” is one of the core competencies with respect to the management of a
H&WB destination. Other important items comprise various communicative issues
such as rhetoric, presentation, marketing, and networking.
Regarding the SWOT-analysis as part of question 3 in the stakeholder survey (chapter
3.2.3), many responses stress the importance of nature, landscape, and a healthy
environment. This corresponds with the results in part A (chart no. 3) which rank this


environmental and nature-based issue at the top together with “doing something for
health”.
Question no. 8 (chapter 3.2.8) of the stakeholder interview part B stresses the
importance of proper communication among the players of the destination and the
use of regular and personal contacts. We refer to the results of the chart of question
no. 9(chapter 2.2.7) that also attaches very much importance to better
communication within a H&WB destination.
Question 9 of the stakeholder interview (part B) points out that at least the half of all
interviewees thinks that the relationship between tourists and locals is somehow
problematic. It is foremost a matter of communication to harmonize the different
expectations and needs of all players in a destination for the sake of smoothly
running the destination development. This problem was not mentioned by the
consumers at all, who obviously do not feel the tensions between locals and tourists
as keenly.
Question no. 10 of the stakeholder interview (part B, chapter 3.2.10) deals with the
competencies necessary for the destination management and its personnel. Very
much importance is attached to language skills. The managers themselves rank
“intercultural communication & foreign languages” very low, with the question they
answered focusing on their individual need. Pondering the core business of the
future in H&WB-destinations (chapter 3.2.11), the stakeholders think there will be a
trend towards more active holidays. However, other parts of the research did not
correspond with that: In part A (chart no. 4) the stakeholders did not attach that
much importance to “outdoor and indoor sport”, although active holiday might not
necessarily be the same as “outdoor and indoor sport”. As the consumers attach as
much importance to “indoor and outdoor sport” as to “enjoying natural scenery and
nature” (chart no. 20), an active holiday in the outdoors is among the highly
demanded activities. Nonetheless, pampering and indulging spa procedures belong
to the most important ones.
An intensely debated issue in the theory of regional development is the relationship
of the influence on development processes of locals or non-locals, also described
with the terms endogenous and exogenous approaches in regional development. It is
clear that the stakeholders want to have a balance between these two approaches
(chapter 3.2.7).


4

Consumer research

4.1

Methodology

The methodology used in the consumer research comprised the following steps:
•

The consumer questionnaire was developed beginning in October 2012 by the university
partners. There were three feedback loops for improvement, involving all the project
partners. The final version was created in May 2013.

•

The English questionnaire was then translated to Finnish, German, Russian, and Czech as not
all interviewees were able to fill in an English questionnaire.

•

The questionnaire was distributed either electronically or as hardcopy with the recipients
being guests or recent guests in H&WB-destinations. Email-databanks were used from
DMOs or relevant companies such as hotels, thermal spring spas or medical spas.

•

The quantitative research:
•

•

•

Those, who filled in the questionnaire electronically, did so via link to Webropol so that the
questionnaires were immediately archived in Webropol. The questionnaires of those who
filled in the questionnaire in hardcopy form, were collected, re-translated into English and
then fed into Webropol.
Webropol itself disposes of a reporting function which creates charts transferring them to
Excel which offers further tools for data processing.

The qualitative research:
•

•

•

Some questions had an option to fill in comments (“others, please specify”) and those
statements were collected. The next step was to analyze them according to methods in
qualitative research, already described in chapter 3.1.
The results presented in chapter 4.2 are based on quantitative and qualitative data.

The data are ready to be analyzed further with aid of more refined methods (e.g. crossclassified tables). Some interesting results will probably be achieved if country-specific
approaches, gender-specific approaches or age-specific approaches are chosen (see also
chapter 5.4ff.).


4.2

Research results

The sequence of the following sub-chapters corresponds with the sequence of the
questions in the questionnaire.

4.2.1

In which country are you right now while filling in this
questionnaire?
Germany

204

Finland

187

United Kingdom

173

Czech Republic
Austria

122
98
784 responses

Chart 14: In which country the questionnaire has been filled in

4.2.2

Please write down some key words, which come into your mind if
you think of a H&WB-destination

There were 1638 exploitable answers from the consumers, categorized in different
clusters as follows:
Word-clusters (bold)
and related issues

Number of
responses

Nature
Calm, clean, silence, fresh air, sun, forest, water

383

Relaxation
recover, detox, recreation

374

Facilities
Thermal bath, spa, sauna, gym, hotel, comfort, luxury

235


Treatments
Massage, therapies

227

Active life
Exercising, hiking, doing sport, biking

196

Food
Regional, organic, healthy food

118

Other
friendly staff, wellbeing, services, health, wellness, certain destinations

169
altogether

1638

The associations guests have when they think of a H&WB destination seem to focus
on nature, relaxation, spa facilities, its treatments, and various activities.
Nature

383

Relaxation

374

Facilities

235

Treatments

227

Active life
Healthy Food
Other meanings

196
118
105
1638 responses
Multiple answers

Chart 15: What guests think of a H&WB destination

The results of this chart present a quite clear image of what a H&WB destination
should consist of: lovely nature with spa facilities which are altogether inviting for
relaxation, treatments, and sport activities.
Comparing these results with what the stakeholders think guests feel attracted by in
their destination (chapter 2.2.2), some differences and similarities can be detected:


•

Stakeholders put “relaxation” into the category of “doing something for health (second bar
from the top), ranking relaxation very high in the context of this question (see chart no. 4).

•

Both stakeholders and guests attach the utmost importance to “nature” and “natural
scenery.”

•

“Culture” plays a bigger role for the stakeholders than for the guests.

•

The “reputation/image of the region” did not get any scores amongst the guests.

•

“Health” plays a bigger role for the stakeholders than for the guests.

4.2.3

What kind of services, staff competences and elements attract /
did attract you to come to a destination like this?

There were 1333 exploitable answers from the consumers categorized in different
Word-clusters (bold)
and related issues
Staff
social skills, friendly, services, professional
Treatments
massages, variety, diversity, versatile
Cleanliness
hygiene, clean
USP
new, stunning, unique
Water
springs, pools, healing water
Culture
historic, tradition, regional originality
Facilities
spa, exotic, steam bath, pools, modern, hotel, swimming, renovated, facilities,
wellness-area, sauna, hotel, furnishing
Atmosphere
decoration, calm, relaxation, peaceful, luxurious, pampering, safety, homey, rituals,
hospitality, silence, recreation
Sport
outdoor, gym, exercise, fitness, hiking, biking, motion
Communication
Sales, marketing, prices, cost-performance-ratio, packages, image, services, reputation,
information, web-site
Food
healthy, eating, variety


Number
of
responses
208
140
32
8
80
18
169
111
87
99
76

117

Nature
landscape, environment, natural attractions, scenery, garden, air
Accessibility
not far from home, short distances within spa, transport
Medical
post-operative care, rehabilitation, health, doctor, healing, recuperation, healing
climate
Quality
high quality
Location
peaceful, pleasant, surroundings
Entertainment
activities, shopping

24
59
34
44
27
1333

total

Presented as chart it turns out to be as follows:
Staff

208

Facilities

169

Treatments

140

Nature

117

Atmosphere

111

Communication

99

Sport

87

Water

80

Food

76

Medical

59

Location

44

Quality

34

Cleanliness

32

Entertainment

27

Accessibility

24

Culture
USP

18
8

Chart 16: What attracts you to come to this destination?


It turns out that factors such as “staff”, “facilities”, and “treatments” are up for
debate. The middle-ranking issues are “nature”, “atmosphere”, “sales”, “sport”,
“water”, “food”, and “medical”.
Comparing these results, one gets a quite holistic approach to what a H&WB
destination actually consists of. The thicker the bar the more responses it got:

Chart 17: The H&WB triangle


4.2.4

How did you come to the idea to visit this destination you are
currently staying at / you have stayed at?

The destination was recommended by friends

287

I read about the dest. in the internet (or other…

241

An earlier positive experience in this destination

217

The positive image of the destination

184

I wanted to try a new destination

144

I read about the destination in print media

131

I actively looked for a H&WB-dest. to spend…

93

Other, please specify

86

My health insurance sent me here

46

An advertisement of the dest.led me to book…
My doctor recommended it to me

44
31

1504 responses
Multiple answers

Chart 18: To come to the idea to visit a destination

Obviously, the word of mouth recommendation plays a very important role in making
the decision to visit a H&WB destination. Digital media play important role, too.
Thirdly, “an earlier positive experience in this destination” makes people come again.
Traditional marketing tools such as advertisements play a far less important role. The
health insurance and a recommending doctor do not play an important role, either.


4.2.5

What was the overall reason for you to come to this destination?

To do something for his or her health

398

Natural scenery

369

Reputation / image of the destination

304

Suitable accommodation

245

Price level

123

Other reasons, please specify
Culture
Visiting friends and relatives

94
75
66

1674 responses
Multiple answers

Chart 19: The overall reason to come to this destination

“Doing something for health”, “the natural scenery”, and the “image of the
destination” seem to be of utmost importance with regard to the overall reasons for
the guest to visit a H&WB destination.
Health in general was ticked many times. Those, who “want to do something for
his/her health” specified their wishes in an additional question as follows:


Relaxation

258

Pampering spa services

174

Enjoying natural scenery and its nature

152

Outdoor and indoor sport

126

Natural healing resources

121

Clinical/medical services
Other reasons

58
15

904 responses
Multiple answers

Chart 20: What clients want to do for their health

Interestingly, “relaxation and pampering spa services” belong to those services which
seem to be most important. Chapter 4.2.2 put a similar emphasis on relaxation as
one of the most important things guests want to do. In a more health-oriented
context as it is shown here, relaxation plays an equally important role.
All these items mentioned by the respondents are aspects of health leading to a quite
broad definition of what health actually is. It comprises different approaches such as
relaxation, pampering spa experiences, natural healing resources, sport, and the
natural scenery. Thus, health in a health & wellbeing destination is much more than
only clinical services in a nice region.


4.2.6

Which services, activities, and elements do you value the most in
this destination?

Diverse beauty and pampering treatments

364

Attractive environment

305

Diverse sauna, pool and steam bathing…

214

Hiking, nordic walking and similar outdoor…

204

Comfortable accommodation

170

Curative treatments

164

Healthy food

133

Professionally skilled staff

113

Fitness activities

110

Preventative services

78

Services for mind and soul (e.g. retreat)

77

Diverse entertainment and cultural services
Other

50
38

2020 responses
Multiple answers

Chart 21: The most valued services and activities

According to some other charts, spa services (“diverse sauna, pools and steam
bathing facilities”) and an “attractive environment” seem to be the most important
role with regard to the destination’s services. The guests like to do “diverse beauty
and pampering”, “outdoor sports” in an “attractive environment” accompanied by
various spa services.


4.2.7

Which of the following options best describe your needs when
choosing a health and well-being holiday?

To escape the pressures of everyday life

495

To get mentally refreshed

462

To spend time with family/friends

265

To improve my physical condition

241

To experience something new

154

To learn new things about my health and…

130

To recover/recuperate from an illness

80

To improve my appearance/beauty

74

Other

38

To find new social relations

33

1972 responses
Multiple answers

Chart 22: Needs when choosing a well-being holiday

This chart deals with needs of guests who choose a H&WB destination. It reveals that
the majority wants to escape from the burdens of daily life in order to reduce mental
stress and relax. This is another confirmation of points made earlier. The third most
important bar (“to spend time with family/friends”) is consistent with this, as a good
time with friends and family members may contribute to an inner harmony and
peace.


4.2.8

To which extent does/did the destination as a whole meet your
expectations regarding the health and well-being related offering
during your stay?
Meets/Met my needs well

467

Meets/ Met my needs extremely well

204

Meets/ Met my needs to some extent
Doesn’t meet my needs/ Did not meet my
needs

92

11

774 responses
Multiple answers

Chart 23: Meeting the expectation of the clients

This chart reveals a quite high satisfaction with the destination, whereas “extremely
well” received much fewer responses. Therefore, potential for further development
can be taken from this chart.
If the respondents ticked “did not meet/met my needs” they could proceed to an
open question, the results of which are as follows:

There were 1638 exploitable answers from the consumers categorized in different
No.

Word-clusters

…and related aspects

1

Treatments

need more, lack of certain treatments, lack of privacy, more
flexibility, more medical

2

Staff

more active, guidance of exercise, more educated, more
personal touch

3

Destination

only spa in the region, landscape not nice, routes not marked
out, no shopping, not calm enough, too many unpleasant
tourists, rush time

4

Prices

too high


5

Facilities in general

too big, too old, bad playground, not warm enough

6

Activities

more, certain kinds of sport, more for kids

7

Spa

not enough relaxation area, too small, not calm, more facilities

8

Food

buffet, bad quality

9

Hygiene

bad

10

Service in general

could not change room, should be better, more
complementary services

11

Entertainment

more

12

Location

bad, more life in downtown

13

Duration of stay

wants to stay longer

14

Communication

false information in brochure, guest misunderstood hotel
target group

15

Travel conditions

e.g. lacking travel companion

16

Accommodation

bad quality

This table reveals some aspects which count for the destination as a whole. Especially
row 3, but also rows 6, 12, and 14 can be taken as information on how to develop a
destination.


The chart below calculates the number of responses together:
Treatments (need more, lack of certain t., lack
of privacy, more flexibility, more medical)

11

Staff (more active, guidance of exercise, more
ecucated, more personal touch)

8

Destination (only spa in the region, landscape
not nice, routes not marked out, no shopping,…

7

Prices (too high)

6

Facilities in general (too big, too old, bad
playground, not warm enough)

4

Activities (more, certain kinds of sport, more for
kids)

4

Spa (not enough relaxation area, too small, not
calm, more facilities)

4

Food (buffet, bad quality)

3

Hygiene (bad)

3

Service in general (could not change room,
should be better, more complementary…

3

Entertainment (more)

3

Location (bad, more life in downtown)

2

Duration of stay (wants to stay longer)

2

Communication (false information in brochure,
guest misunderstood hotel target group)

2

Travel conditions (lacking travel companion)

1

Accommodation (bad quality)

1

Chart 24: Causes of disappointment with the chosen destination

Depending on the way the categorization has been done, “treatments” and “staff”
seem to be the most important issues, with the destination in general coming directly
behind. What can be learned from this chart is that the guests’ perception of their
journey very much depends on what happens in their place to stay (hotel or similar).
There are not so many issues concerning the destination in general.

4.2.9

How would you score the destination’s services in general?
5068 responses
1 tick in each row

Meets / Met my needs extremely well
Meets / Met my needs well
Meets / Met my needs to some extent
Doesn’t meet my needs / Did not meet my needs
Linear (Meets / Met my needs extremely well)
Services with respect to my accommodation
Services with respect to food & beverage
Services with regard to wellbeing, relaxation, and
pampering
Services concerning booking and reservation
Services concerning information services during
my holiday (e.g. guest relations in hotel)
Services concerning information services before I
started my holiday (e.g. internet)
Services with respect to health promotion and
medical issues

286
10

89
270

17

101
269

13

78
259

14

79
208

13

108
156

13
19

110
149
128

338
370
380
378
395
423
395

Chart 25: Scoring the destination’s services

This question calls attention to indoor services of the destination’s facilities. With
respect to the violet bars (“met my needs extremely well”), it turns out that the classic
hotel services such as accommodation and F&B come first, followed by spa-services, and
at the end medical services.
The chart below adds the scores from “meets my needs well” and „meets my needs
extremely well“ from the previous, leading to a modified analysis:


well and extremely well
Services with regard to wellbeing, relaxation,
and pampering

649

Services with respect to food & beverage

640

Services concerning booking and reservation

637

Services with respect to my accommodation

624

Services concerning information services during
my holiday (e.g. guest relations in hotel)

603

Services concerning information services before
I started my holiday (e.g. internet)
Services with respect to health promotion and
medical issues

579

544

4276 responses
1 tick in each row

Chart 26: Which services are scored both „well“ and „extremely well“ with regard to the
destination’s services in general

As opposed to the previous chart, spa-services turn out to be appreciated most.
Medical services get much less appreciation than other services.


4.2.10

To which extent were/are you able to use the variety of services
offered in the H&WB-destination?

I did nearly all my activities in my hotel/spa, so I
didn’t use any of the destination’s offerings

249

I make useusethethe regions services regularly
I make of of region’s services regularly

235

I did not have enough time to make use of the
possibilities in the destination

234

I made use especially of the destination’s services
to help to improve my health status

212

I didn’t have enough information about all the
possibilities in the destination
I would not come to this hotel/spa/clinic again if
the destination would not have all these
interesting possibilities

73
49

I did not find interesting services/places outside
my hotel/clinic/spa

40

I did not know how to get to all the interesting
services/places in the destination

39

I was unable to use interesting services/places
outside my hotel/clinic/spa because of
age/handicap/ lack of transportation

35

1166 responses
Multiple answers

Chart 27: How guests made use of services in the health and well-being destination

This question wants to find out if a H&WB destination disposes of various services
which were not used for different reasons. It comes out that four bars take the lead
with respect to the number of respondents, with the first two ones listing some
reasons which prevent people from making use of the destination’s services and the
lower ones saying that clients indeed use them. Another bar (73 responses) states
that due to communicative problems guests do not make use of all the services as
they simply do not know about them.


4.2.11

How do/ did you check the influence of your current holiday on
your health at the end or after the stay?

I don’t check/ I didn’t check

441

I am not interested / I wasn’t interested

143

I am / was interested in checking this, but there
are limiting factors (no time, too expensive etc.)

118

I will have a check done by a specialist at the end
of the stay

78

I don’t know / didn’t know where to do this

74

I will have a check done by a specialist upon
return home

57
911 respondents

Chart 28: Check of the health status
How to read the chart: 57 respondents state that they will check the influence of the current
holiday upon return home

Obviously, the majority is not really interested in checking the influence of the
current holiday on the health, although the number of those who show an interest is
not that low.


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