This study aims to develop and test a theoretical model that predicts individuals’ intention to engage in medical tourism. Structural equation modeling (SEM) was performed to test the study hypotheses by using data collected from 246 US residents. The study results indicated that perceived benefits were positively, and perceived barriers negatively, associated with attitude, and perceived barriers had a negative impact on perceived behavioral control. The study results further revealed that attitude, perceived behavioral control, and subjective norm positively influenced individuals’ intention to engage in medical tourism. Finally, a significant moderating effect of perceived severity was found on the relationships between perceived benefits and attitude, perceived barriers and attitude, and attitude and behavioral intention. The findings of the study offer valuable theoretical contributions and practical implications in the context of medical tourism.
AlexandrisK.StodolskaM.2004. “The Influence of Perceived Constraints on the Attitudes toward Recreational Sport Participation.” Society and Leisure27 (1): 197–217.
2.
AjzenI.1985. “From Intentions to Actions: A Theory of Planned Behavior.” In Action Control, edited by J. KuhlBeckmanJ., 11–39. Berlin: Springer.
3.
AjzenI.1991. “The Theory of Planned Behavior.” Organizational Behavior and Human Decision Processes50 (2): 179–211.
4.
AjzenI.DriverB. L.1992. “Application of the Theory of Planned Behavior to Leisure Choice.” Journal of Leisure Research24 (3): 207–24.
5.
AjzenI.FishbeinM.1980. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall.
6.
BoltonS.SkountridakiL.2017. “The Medical Tourist and a Political Economy of Care.” Antipode49 (2): 499–516.
7.
CerkoneyK. A. B.HartL. K.1980. “The Relationship between the Health Belief Model and Compliance of Persons with Diabetes Mellitus.” Diabetes Care3 (5): 594–98.
8.
ChakrabortyN.IslamM. A.ChowdhuryR. I.BariW.AkhterH. H.2003. “Determinants of The Use of Maternal Health Services in Rural Bangladesh.” Health Promotion International18 (4): 327–37.
9.
ChampionV. L.SkinnerC. S.2008. “The Health Belief Model.” Health Behavior and Health Education: Theory, Research, and Practice4:45–65.
10.
ChenC. C.PetrickJ. F.2016. “The Roles of Perceived Travel Benefits, Importance, and Constraints in Predicting Travel Behavior.” Journal of Travel Research55 (4): 509–22.
11.
ChenM. F.TungP. J.2014. “Developing an Extended Theory of Planned Behavior Model to Predict Consumers’ Intention to Visit Green Hotels.” International Journal of Hospitality Management36:221–30.
12.
ChooH.ChooH.AhnK.AhnK.PetrickJ. F.PetrickJ. F.2016. “An Integrated Model of Festival Revisit Intentions: Theory of Planned Behavior and Festival Quality/Satisfaction.” International Journal of Contemporary Hospitality Management28 (4): 818–38.
13.
ChuangT. C.LiuJ. S.LuL. Y.LeeY.2014. “The Main Paths of Medical Tourism: From Transplantation to Beautification.” Tourism Management45:49–58.
ConnerM.NormanP.2005. Predicting Health Behaviour. London: McGraw-Hill Education.
16.
CrawfordD. W.GodbeyG.1987. “Reconceptualizing barriers to family leisure.”Leisure Sciences9 (2): 119–127.
17.
CrooksV. A.TurnerL.SnyderJ.JohnstonR.KingsburyP.2011. “Promoting Medical Tourism to India: Messages, Images, and the Marketing of International Patient Travel.” Social Science & Medicine72 (3): 726–32.
18.
DavisF. D.BagozziR. P.WarshawP. R.1992. “Extrinsic and Intrinsic Motivation to Use Computers in the Workplace” Journal of Applied Social Psychology22 (14): 1111–32.
19.
DawsonK. A.GyurcsikN. C.Culos-ReedS. N.BrawleyL. R.2001. “Perceived Control: A Construct That Bridges Theories of Motivated Behavior.” In Advances in Motivation in Sport and Exercise, edited by RobertsG. C.321–56. Champaign IL: Human Kinetics.
20.
De ArellanoA. B. R. 2007. “Patients without Borders: The Emergence of Medical Tourism.” International Journal of Health Services37 (1): 193–98.
21.
DeMiccoF. J., ed. 2017. Medical Tourism and Wellness: Hospitality Bridging Healthcare (H2H). Boca Raton, FL: CRC Press.
22.
DrinkertA.SinghN.2017. “An Investigation of American Medical Tourists’ Post Travel Experience.” Journal of Hospitality Marketing and Management26 (3): 335–46.
23.
Duarte AlonsoA.SakellariosN.PritchardM.2015. “The Theory of Planned Behavior in the Context of Cultural Heritage Tourism.” Journal of Heritage Tourism10 (4): 399–416.
24.
EarpJ. A.EnnettS. T.1991. “Conceptual Models for Health Education Research and Practice.” Health Education Research6 (2): 163–71.
25.
FetscherinM.StephanoR. M.2016. “The Medical Tourism Index: Scale Development and Validation.” Tourism Management52:539–56.
26.
FishbeinM.AjzenI.1975. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Boston, MA: Addison-Wesley.
27.
FleischerA.PizamA.2002. “Tourism Constraints among Israeli Seniors.” Annals of Tourism Research29 (1): 106–23.
28.
FornellC.LarckerD. F.1981. “Structural Equation Models with Unobservable Variables and Measurement Error: Algebra and Statistics.” Journal of Marketing Research18 (3): 382–88.
GeorgeD.MalleryM.2010. SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 Update. Boston, MA: Pearson.
31.
GomesA. R.GonçalvesA. M.MadduxJ. E.CarneiroL.2018. “The Intention-Behavior Gap: An Empirical Examination of an Integrative Perspective to Explain Exercise Behavior.” International Journal of Sport and Exercise Psychology16 (6): 607–21.
32.
GhoshT.MandalS.2018. “Medical Tourism Experience: Conceptualization, Scale Development, and Validation.” Journal of Travel Research58 (8): 1287–301.
33.
GreenE. C.MurphyE.2014. Health Belief Model. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. New York: John Wiley.
34.
GuvencG.AkyuzA.AçikelC. H.2011. “Health Belief Model Scale for Cervical Cancer and Pap Smear Test: Psychometric Testing.” Journal of Advanced Nursing67 (2): 428–37.
35.
HairJ. F.AndersonR. E.TathamR. L.BlackW.1998. Multivariate Data Analysis. Upper Saddle River, NJ: Prentice Hall.
36.
HajianS.VakilianK.NajabadiK. M.HosseiniJ.MirzaeiH. R.2011. “Effects of Education Based on the Health Belief Model on Screening Behavior in High Risk Women for Breast Cancer.” Tehran, Iran. Asian Pacific Journal of Cancer Prevention12 (1): 49–54.
37.
HanH.HyunS. S.2015. “Customer Retention in the Medical Tourism Industry: Impact of Quality, Satisfaction, Trust, and Price Reasonableness.” Tourism Management46 (1): 20–29.
38.
HanH.HyunS. S.2017. “Drivers of Customer Decision to Visit an Environmentally Responsible Museum: Merging the Theory of Planned Behavior and Norm Activation Theory.” Journal of Travel and Tourism Marketing34 (9): 1–14.
39.
HanefeldJ.LuntN.SmithR.HorsfallD.2015. “Why Do Medical Tourists Travel to Where They Do? The Role of Networks in Determining Medical Travel.” Social Science & Medicine124:356–63.
40.
HaydonH. M.ObstP. L.LewisI.2018. “Examining Women’s Alcohol Consumption: The Theory of Planned Behavior and Self-Identity.” Substance Use and Misuse53 (1): 128–36.
41.
HeungV. C.KucukustaD.SongH.2010. “A Conceptual Model of Medical Tourism: Implications for Future Research.” Journal of Travel and Tourism Marketing27 (3): 236–51.
42.
HuangS.HsuC. H.2009. “Effects of Travel Motivation, Past Experience, Perceived Constraint, and Attitude on Revisit Intention.” Journal of Travel Research48 (1): 29–44.
43.
HungK.LawR.2011. “An Overview of Internet-Based Surveys in Hospitality and Tourism Journals.” Tourism Management32 (4): 717–24.
44.
JanzN. K.BeckerM. H.1984. “The Health Belief Model: A Decade Later.” Health Education Quarterly11 (1): 1–47.
KamranA.AhariS. S.BiriaM.MalpourA.HeydariH.2014. “Determinants of Patient’s Adherence to Hypertension Medications: Application of Health Belief Model among Rural Patients.” Annals of Medical and Health Sciences Research4 (6): 922–27.
47.
KimJ. E.ZaneN.2016. “Help-Seeking Intentions among Asian American and White American Students in Psychological Distress: Application of the Health Belief Model.” Cultural Diversity and Ethnic Minority Psychology22 (3): 311–43.
48.
KingJ. B.1982. “The Impact of Patients’ Perceptions of High Blood Pressure on Attendance at Screening: An Extension of the Health Belief Model.” Social Science & Medicine16 (10): 1079–91.
49.
LamT.HsuC. H.2006. “Predicting Behavioral Intention of Choosing a Travel Destination.” Tourism Management27 (4): 589–99.
50.
LeeM.HanH.LockyerT.2012. “Medical Tourism—Attracting Japanese Tourists for Medical Tourism Experience.” Journal of Travel and Tourism Marketing29 (1): 69–86.
51.
LugtigaP.DasbM.ScherpenzeelaA.2014. “Nonresponse and Attrition in a Probability Based Online Panel for the General Population.” In Online Panel Research: A Data Quality Perspective, edited by CallegaroM.BakerR.BethlehemJ.GöritzA. S.KrosnickJ. A.LavrakasP. J., 135–53. New York: John Wiley.
52.
LuntN.CarreraP.2011. “Systematic Review of Web Sites for Prospective Medical Tourists.” Tourism Review661 (2): 57–67.
53.
LuntN.HorsfallD.SmithR.ExworthyM.HanefeldJ.MannionR.2014. “Market Size, Market Share and Market Strategy: Three Myths of Medical Tourism.” Policy and Politics42 (4): 597–614.
54.
LovelockB.LovelockK.2018. “‘We Had a Ball . . . As Long as You Kept Taking Your Painkillers’: Just How Much Tourism Is There in Medical Tourism? Experiences of the Patient Tourist.” Tourism Management69:145–54.
55.
MartinD. S.RamamonjiariveloZ.MartinW. S.2011. “MEDTOUR: A Scale for Measuring Medical Tourism Intentions.” Tourism Review661 (2): 45–56.
56.
MasonA.WrightK. B.2011. “Framing Medical Tourism: An Examination of Appeal, Risk, Convalescence, Accreditation, and Interactivity in Medical Tourism Web Sites.” Journal of Health Communication16 (2): 163–77.
57.
McDermottM. S.OliverM.SimnadisT.BeckE. J.ColtmanT.IversonD.CaputiP.SharmaR.2015. “The Theory of Planned Behavior and Dietary Patterns: A Systematic Review and Meta-Analysis.” Preventive Medicine81:150–56.
MehtaP.SharmaM.LeeR. C.2014. “Designing and Evaluating a Health Belief Model Based Intervention to Increase Intent of HPV Vaccination among College Males.” International Quarterly of Community Health Education34 (1): 101–17.
61.
MoghavvemiS.OrmondM.MusaG.IsaC. R. M.ThirumoorthiT.MustaphaM. Z. B.ChandyJ. J. C.2017. “Connecting with Prospective Medical Tourists Online: A Cross-sectional Analysis of Private Hospital Websites Promoting Medical Tourism in India, Malaysia and Thailand.” Tourism Management58:154–63.
62.
MomeniK.JanatiA.ImaniA.Khodayari-ZarnaqR.2018. “Barriers to the Development of Medical Tourism in East Azerbaijan Province, Iran: A Qualitative Study.” Tourism Management69:307–16.
63.
NunnallyJ. C.1970. Introduction to Psychological Measurement. New York: McGraw-Hill.
64.
NyaupaneG. P.AndereckK. L.2008. “Understanding Travel Constraints: Application and Extension of a Leisure Constraints Model.” Journal of Travel Research46 (4): 433–39.
65.
NyaupaneG. P.MoraisD. B.GraefeA. R.2004. “Nature Tourism Constraints: A Cross-Activity Comparison.” Annals of Tourism Research313:540–55.
66.
O’connorP. J.MartinB.WeeksC. S.OngL.2014. “Factors That Influence Young People’s Mental Health Help-Seeking Behavior: A Study Based on the Health Belief Model.” Journal of Advanced Nursing70 (11): 2577–87.
67.
ParkS. H.HsiehC. M.LeeC. K.2017. “Examining Chinese College Students’ Intention to Travel to Japan Using the Extended Theory of Planned Behavior: Testing Destination Image and the Mediating Role of Travel Constraints.” Journal of Travel and Tourism Marketing34 (1): 113–31.
QuineL.RutterD. R.ArnoldL.1998. “Predicting and Understanding Safety Helmet Use among Schoolboy Cyclists: A Comparison of the Theory of Planned Behavior and the Health Belief Model.” Psychology and Health13 (2): 251–69.
71.
QuintalV. A.LeeJ. A.SoutarG. N.2010. “Risk, Uncertainty and the Theory of Planned Behavior: A Tourism Example.” Tourism Management31 (6): 797–805.
72.
RamamonjiariveloZ.MartinD. S.MartinW. S.2015. “The Determinants of Medical Tourism Intentions: Applying the Theory of Planned Behavior.” Health Marketing Quarterly32 (2): 165–79.
73.
ReddyS. G.YorkV. K.BrannonL. A.2010. “Travel for Treatment: Students’ Perspective on Medical Tourism.” Inter-national Journal of Tourism Research12 (5): 510–22.
74.
RichA.BrandesK.MullanB.HaggerM. S.2015. “Theory of Planned Behavior and Adherence in Chronic Illness: A Meta-Analysis.” Journal of Behavioral Medicine38 (4): 673–88.
75.
RoncancioA. M.WardK. K.SanchezI. A.CanoM. A.ByrdT. L.VernonS. W.VernonMaria Eugenia Fernandez-EsquerFernandezM. E.2015. “Using the Theory of Planned Behavior to Understand Cervical Cancer Screening among Latinas.” Health Education and Behavior42 (5): 621–26.
RosenstockI. M.1974. “Historical Origins of the Health Belief Model.” Health Education Monographs24:328–335.
78.
SalariR.FilusA.2017. “Using the Health Belief Model to Explain Mothers’ and Fathers’ Intention to Participate in Universal Parenting Programs.” Prevention Science18 (1): 83– 94.
79.
SeowA. N.ChoongY. O.MoorthyK.ChanL. M.2017. “Intention to Visit Malaysia for Medical Tourism Using the Antecedents of Theory of Planned Behavior: A Predictive Model.” International Journal of Tourism Research19 (3): 383–93.
80.
SirakayaE.WoodsideA. G.2005. “Building and Testing Theories of Decision Making by Travelers.” Tourism Management26 (6): 815–32.
81.
SnyderJ.CrooksV.TurnerL.JohnstonR.2013. “Understanding the Impacts of Medical Tourism on Health Human Resources in Barbados: A Prospective Qualitative Study of Stakeholder Perceptions.” International Journal for Equity in Health12 (1): 112–21.
82.
SparksB.PanG. W.2009. “Chinese Outbound Tourists: Understanding Their Attitudes, Constraints and Use of Information Sources.” Tourism Management30 (4): 483–94.
83.
SuessC.BalogluS.BusserJ. A.2018. “Perceived Impacts of Medical Tourism Development on Community Wellbeing.” Tourism Management69:232–45.
84.
TangC. F.LauE.2017. “Modelling the Demand for Inbound Medical Tourism: The Case of Malaysia.” International Journal of Tourism Research19 (5) :584–93.
85.
TurkingtonC.DempsterM.MaguireJ.2018. “Adjustment to Hand Injury: Cross-sectional Survey Exploring Adjustment in Relation to Illness Perceptions and Coping Strategies.” Journal of Hand Therapy31 (4): 502–10.
86.
TurnerL.2007a. “First World Health Care at Third World Prices: Globalization, Bioethics and Medical Tourism.” BioSocieties2 (3): 303–25.
87.
TurnerL.2007b. “Medical Tourism.” Canadian Family Physician53 (10): 1639–41.
VenkateshV.MorrisM. G.DavisG. B.DavisF. D.2003. “User Acceptance of Information Technology: Toward a Unified View.” MIS Quarterly27 (3): 425–78.
90.
WangF.DengZ.PetrickJ. F.2018. “Exploring the Formation Mechanisms of Urban Residents’ Travel Behavior in China: Perceptions of Travel Benefits and Travel Constraints.” Journal of Travel and Tourism Marketing35 (7): 909–21.
91.
WeinsteinN. D.2000. “Perceived Probability, Perceived Severity, and Health-Protective Behavior.” Health Psychology191:65.
92.
WuL.ChenJ. L.2005. “An Extension of Trust and TAM Model with TPB in the Initial Adoption of On-line Tax: An Empirical Study.” International Journal of Human-Computer Studies62 (6): 784–808.
93.
YeB. H.YuenP. P.QiuH. Z.ZhangV. H.2008. “Motivation of Medical Tourists: An Exploratory Case Study of Hong Kong Medical Tourists.” Paper presented at the Asia Pacific Tourism Association APTA Annual Conference, Bangkok, Thailand.
94.
YuJ.LeeT. J.NohH.2011. “Characteristics of a Medical Tourism Industry: The Case of South Korea.” Journal of Travel and Tourism Marketing28 (8): 856–72.
95.
YuJ. Y.KoT. G.2012. “A Cross-cultural Study of Perceptions of Medical Tourism among Chinese, Japanese and Korean Tourists in Korea.” Tourism Management33 (1): 80–88.
96.
ZareiA.MalekiF.2019. “Asian Medical Marketing, a Review of Factors Affecting Asian Medical Tourism Development.” Journal of Quality Assurance in Hospitality & Tourism20 (1): 1–15,
97.
ZemoreS. E.AjzenI.2014. “Predicting Substance Abuse Treatment Completion Using a New Scale Based on the Theory of Planned Behavior.” Journal of Substance Abuse Treatment46 (2): 174–82.
98.
ZhangH.ZhangJ.ChengS.LuS.ShiC.2012. “Role of Constraints in Chinese Calligraphic Landscape Experience: An Extension of a Leisure Constraints Model.” Tourism Management33 (6): 1398–407.
99.
ZolfagharianM.RajammaR. K.NaderiI.TorkzadehS.2018. “Determinants of Medical Tourism Destination Selection Process.” Journal of Hospitality Marketing & Management27 (7): 775–94.
