International Journal of Hospitality Management 35 (2013) 122132

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International Journal of Hospitality Management

journal homepage: www.elsevier.com/locate/ijhosman

Essential customer service factors and the segmentation of older

visitors within wellness tourism based on hot springs hotels
Kaung-Hwa Chen a , Hsiou-Hsiang Liu a , Feng-Hsiang Chang b,
a

Department of Tourism Management, National Kaohsiung University of Applied Sciences, No. 415, Chien Kung Road, Kaohsiung 807, Taiwan
Department of Leisure, Recreation and Tourism Management, Tzu Hui Institute of Technology, No. 367, Sanmin Road, Nanjhou Hsian, Pingtung 926,
Taiwan
b

a r t i c l e
Keywords:
Older adults
Wellness tourism
Customer service
Segmentation

i n f o

a b s t r a c t
Tourism-related industries have emphasized the wellness tourism market when numerous countries
now face an aging population. Many studies have indicated that strong customer service increases competitive advantage. However, customer service-related research from the perspectives of customers and
operators is rare. This study adopted a two-phase approach to incorporate the perspectives of older adults
and operators in wellness tourism into the service factors. We extracted service factors from face-to-face
interviews with senior managers and experienced consultants of the hot springs hotel industry conducted in Phase 1. During Phase 2, we interviewed older adults at hot springs, and performed exploratory
and conrmatory factor analyses to examine the reliability and validity of customer service factors. The
results highlighted the following seven customer service factors: health promotion treatments, mental
learning, experience of unique tourism resources, complementary therapies, relaxation, healthy
diet, and social activities. According to these service factors, the older adults interviewed were divided
into a holistic group, physiocare group, and leisure and recreation group using cluster analysis. Finally,
we propose socio-demographic variables for describing the specic characteristics of the three clusters
identied.
2013 Elsevier Ltd. All rights reserved.

1. Introduction
Population aging has become increasingly severe in developed
countries. For example, recent forecast data from Eurostat projects
that people aged 65 and older will comprise more than 28% of the
population in Germany, 25% in Italy, and 23% in France by 2030
(European Commission, 2012). Currently, the median age in Japan
is 41, making it the fastest aging country in the world (Barrows
et al., 2012). In Taiwan, the proportion of the population aged over
65 years has steadily increased since 1993, with the elderly population reaching 10.7% at the end of 2010. The aging index for Taiwan
in 2010 (68.6%) was lower than that for Canada, Japan, and other
European countries, but higher than that for the U.S., New Zealand,
and other Asian countries (Taiwan Ministry of the Interior, 2012).
The results of a senior population survey published by the Statistics
Department of the Ministry of the Interior, Taiwan, showed that the
three life aspects ranked most desirable by seniors were a healthy
life, a harmoniously life spent with family, and nancial security. The top three concerns for the elderly were personal health,
nancial problems, and personal care issues (Taiwan Ministry
of the Interior, 2010).

Corresponding author. Tel.: +886 88647367x135; fax: +886 88647123.

E-mail address: chang.taiwan@gmail.com (F.-H. Chang).
0278-4319/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijhm.2013.05.013

A population age distribution shifting toward the elderly is

a current trend evidenced by the previous paragraph. Regarding the tourism and leisure industry, the senior-targeted market
provides superior and innovative business opportunities for services and products within the traditional tourism and leisure
industry (Szmigin and Carrigan, 2001). Le Serre (2008) highlighted that in the twenty-rst century, the tourism industry
faces a changing and competitive environment resulting from
hurricanes and other environmental catastrophes, military conicts and wars, information technology developments, greater
competition between airline companies, and aging demographics. Nevertheless, the senior market presents an opportunity
for the tourism industry worldwide to grow through wellness
tourism.
Wellness tourism is a holistic traveling style that aims at developing, maintaining and improving the bodymindspirit (Smith
and Kelly, 2006a,b). Such travel experiences appeal to tourists aged
65 years and others. People over 50 years of age, who are economically secure and experience work stress, also regard wellness
tourism as a lifestyle (Smith and Puczk, 2009). Therefore, for convenience, in this study people aged over 50 were labeled older
adults or older tourists because 50 years is commonly used as
the criterion to dene older adults in other studies (Blazey, 1992;
Hawes, 1988; Janke et al., 2006; Lehto et al., 2002; Milman, 1998;
Whitford, 1998).

K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

The Taiwan Tourism Bureaus (2010) annual tourism report

showed that for domestic tourists, the proportion of tourists aged
between 50 and 59 years increased from 7.1% in 1997 to 16.9% in
2009, and that for tourists aged over 60 years nearly doubled from
6.8% to 11.5% during the same period. In 2008, people aged between
50 and 59 years comprised 19.45% of the total number of domestic international travelers, and people aged over 60 years occupied
10.93%. Furthermore, a high proportion of older adults comprise
the international tourism market. People aged 50 years accounted
for 31.85% of the total number of international travelers in 2011
(Taiwan Tourism Bureau, 2012).
Smith and Kelly (2006b) highlighted that the main targets of the
wellness tourism market are post-World War II baby boomers (people born in the year after the end of WWII became 60 years of age
in 2006) and women. The demographics of age are associated with
increased opportunity for market services and products oriented
to tourism and leisure (Nazareth, 2007). The older adult market is
becoming increasingly attractive for the tourism and leisure industry (Hsu et al., 2007; Hunter-Jones and Blackburn, 2007).
Several studies have found that health is a crucial motivator
encouraging older adults to participate in tourism (Guinn, 1980;
Horneman et al., 2002; Romsa and Blenman, 1989) and the type
of tourism motivated by health is wellness tourism. Therefore,
the service requirements of wellness tourism are important. Wellness tourism has been developed in regions outside Taiwan for a
long time, taking advantage of the specic natural resources in the
region, such as hot springs, mineral springs, the seawater, and the
comfortable climate (Pollock et al., 2000). These natural resources
are combined with recreational facilities to build a complete health
resort that caters to tourists seeking a soothing experience for their
body, mind, and spirit (Erfurt-Cooper and Cooper, 2009).
Older adults became more aware of their personal options for
improving their health through preventive therapies on a personal level. Erfurt-Cooper and Cooper (2009) elaborated that this
increased awareness encompasses preventive therapies based on
travel to health resorts and spas. However, this motivation to seek
out wellness benets from natural hot and mineral spring waters
could not have been more welcome for the health tourism industry,
as it brought in the wake of the desire for wellness a much-needed
revival of many hot and mineral spring resorts.
Customer service has an important role for hot spring hotels
targeted to the elderly market (Chang and Chen, 2011). The hotel
industry is dynamic in that the guest dictates the pace and type of
service, and increasing competitiveness in the industry has resulted
in satisfactory service being the minimum expectation of guests
(Crick and Spencer, 2010). Assessments of customer service that
reect various aspects of the service are possible and necessary
when adopting various standards. However, many studies have
identied a gap between the services provided by operators or com
panies and the services preferred by customers (Kisperska-Moron,
2005; Nysveen et al., 2003).
The aim of this study was to compile insight from industry
experts to establish wellness tourism service factors based on the
perspectives of operators and tourists aged over 50 years. We conducted a survey with tourists at a hot springs to verify the service
items included in the wellness tourism service factors to provide a
reference of crucial wellness tourism customer service items and
resource management for domestic operators of hot spring hotels.

2. Literature review
2.1. Dening wellness and wellness tourism
There is no rigorously developed denition of wellness. Smith
and Puczk (2009) stated that wellness is a complex concept,

123

Social contacts

Mind:
mental activity/education

Health:
nutrition/
diet

Self
responsibility

Body:
physical
fitness/
beauty
care

Relaxation:
rest/meditation

Environmental sensitivity

Fig. 1. Extended wellness model (Mueller and Lanz Kaufmann, 2001).

containing elements of lifestyle; physical, mental, and spiritual

well-being; and ones relationship with oneself, others, and environment. Konu et al. (2010) also contended that wellness includes
various related concepts, such as well-being, happiness, quality of
life, holistic practice, and spiritual beliefs. Nevertheless, wellness is
relative, subjective, and perceptual (Adams, 2003).
Mueller and Lanz Kaufmann (2001) expanded the interpretation of wellness provided by Ardell (1977) to include a state of
health featuring harmony between the body, mind, and spirit,
with self-responsibility, physical tness/beauty care, healthy nutrition/diet, relaxation/meditation, mental activity/education, and
environmental sensitivity/social contacts as fundamental elements (Fig. 1). Messerli and Oyama (2004) viewed wellness as
a way of life to create a healthy body, soul, and mind through
acquired knowledge and positive interventions. Accordingly, wellness became a type of self-discovery lifestyle in an era of increased
stress, and well-being is considered a holistic philosophy, supporting temporary feelings of happiness and long-term contentment.
But, in a larger sense, it is hardly possible to dene wellness in a
single sentence. Wellness is a multi-dimensional concept, which
may include physical, mental, spiritual, sexual, educational, occupational, economic, political, social, cultural, ethical, environmental
and existential attributes.
Wellness tourism is regarded as a subcategory of health tourism
(Mueller and Lanz Kaufmann, 2001; Nahrstedt, 2004). Several
researchers have classied health tourism products into medical or non-medical groups according to the product features
and services. The medical group refers to medical tourism with
a primary focus on medical treatment and a secondary focus
on leisure travel. The non-medical group is focused solely on
wellness without medical interventions, the prevention of illness
for healthy tourists, and tourism activities that actively promote
health instead of the negatively approach of preventing illness
(Harahsheh, 2002; Mueller and Lanz Kaufmann, 2001). Additionally, Jallad (2000) classied health tourism into medical tourism
and wellness tourism, medical tourism aims to treat an illness
or facilitate physical recovery following surgery through stays in
a hospital or medical center to receive care, whereas wellness
tourism aims to provide relaxation, leisure, and an escape from
daily stresses to disease-free tourists through stays in health spa
resorts.

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Furthermore, Kaspar (1996) dened health tourism as the sum

of all the relationships and phenomena resulting from a change
of location and residence by people to promote, stabilize and, as
appropriate, restore their physical, mental and social well-being
when using health services, and when the place they are staying is neither their principle or permanent place of residence
or work. Mueller and Lanz Kaufmann (2001) dened wellness
tourism in a narrower sense as the sum of all the relationships
and phenomena resulting from a journey or residence by people whose main motive is to preserve or promote their health.
They stay in specialized hotels that provide appropriate professional knowledge and individual care. They require comprehensive
service packages that include physical tness/beauty care, nutrition/diet, relaxation/meditation, and mental activity/education.
2.2. Spa and wellness tourism
The theme for many types of spa tourism is water-based healing, with an emphasis on relaxation and cures. Examples such as
springs, hot springs, saunas, and steam rooms emphasize healing,
recovery, and physical rest (Cohen, 2008). Spa tourism is recognized
as the most renowned form of wellness tourism, and the term is
often interchangeable with wellness tourism (Smith and Puczk,
2009). Almost all wellness tourism services include some healthorientated services referred to as spa treatment (Erfurt-Cooper
and Cooper, 2009). Although different providers dene spa differently, the desire remains to promote health and happiness.
The emergence of the spa industry that integrates industry, customs, and therapeutic methods is a recent global phenomenon. The
emergence of a global spa industry is considered a natural response
to the human desire for wellness in the context of the evolution
of consciousness, globalization, and various global crises (Cohen,
2008). Joppe (2010) argued that the spa industry would be required
to place a greater emphasis on learning by inviting knowledgeable speakers from conventional and complementary elds and
alternative medicine elds to educate consumers wishing to make
informed decisions regarding their health.
The various services of spas are categorized according to the
available regional resources, including natural resources such as
therapeutic water, climate, mud, and caves for meditation. Spa
offerings in Asia are mainly built around traditional and spiritual massages and hot spring therapies (Puczk and Bachvarov,
2006). Table 1 shows the wellness resources used to develop
tourism development in various countries. Spa therapies exist in
different forms and reect current cultural, social, and political
environments. Currently, spa therapies have been redeveloped,
consolidated, and branded to create a novel global industry from
related industries. The emergence of spas has also added a new
standard icon to global luxury hotels and resorts. While the global
spa industry is still evolving, it is apparent that the industry is
beginning to embrace wellness as part of its core business (Cohen,
2008).
2.3. The customer service requirements of the older tourists
According to Turban et al. (2002), Customer service is a series
of activities designed to enhance the level of customer satisfaction,
that is, customers feeling that a product or service has met their
expectations. The most popular classications divide the elements
associated with customer service into the following three groups:
pre-transaction, transaction, and post-transaction (Ballou, 1994;
La Londe and Zinszer, 1976). For the hot springs hotel industry,
customer service involves providing services (or experiences) to
customers before, during, and after purchase. From the perspective
of the overall sales process, customer service plays an important role in an organizations ability to obtain prots. From this

Table 1
Natural resources used to develop wellness tourism by different countries.
Country

Wellness tourism resources

Japan
Israel
Cuba

Spa, deep-sea water, hot springs, hot spring resorts

Spa, mud therapy, sea water therapy bath
Spa, hot springs, health resorts, sea recreation activities,
tropicalrain forest climate
Spa, health resorts, mud therapy, nature, culture,
recreation activities, yoga
Spa, deep-sea water
Spa, hot springs, salt therapy
Yoga, meditation centers
Pilgrimage, comprehensive retreat centers
Spa, hot springs, mineral springs, health resorts, climate,
health exams, beauty care, mud therapy, physiotherapy,
sea water therapy bath, comprehensive retreat centers
Spa health resorts, pilgrimage, sea water therapy bath
Spa, yoga, comprehensive retreat centers
Spa, health resorts, nature, indigenous culture, outdoor
recreational activities
Spa, massage, meditation centers
Comprehensive retreat centers, salt therapy
Spa, hot springs, mineral springs, sea water therapy bath,
climate, health resorts
Spa, health resorts, salt therapy
Spa, health resorts, sea water therapy bath, mud therapy

Yukon, Canada
Taiwan
Hungary
India
Spain
Greece

France
U.S.A.
Hawaii, U.S.A.
Thailand
Austria
Italy
Germany
Australia

Source: Smith and Puczk (2009).

perspective, customer service must be included in the overall

approach for systematic improvement. A customer service experience can alter a customers entire perception of an organization.
Customer service is a broad term that varies from between
companies. Providers and customers also interpret that concept
2005). The importance of customer
differently (Kisperska-Moron,
service varies according to the products, industry, and customer.
Gilbert and Wong (2003) suggested that in the aviation industry, understanding customer service dimensions establishes service
differentiation strategies that satisfy customers of different target markets. Schegg et al. (2003) indicated that customer service
improvements immediately provide hotels with a competitive
advantage.
The importance of the older adult travel market has been widely
recognized by tourism marketers and researchers (Hsu et al., 2007;
Hunter-Jones and Blackburn, 2007; Nazareth, 2007; Szmigin and
Carrigan, 2001). The literatures of this study focus on older adults
travel motivations, experience characteristics, service needs, and
experience activities; then, they are treated as the bases for the
service suppliers who concentrate on older adults travel market to
design and provide services.
Jang and Wu (2006) examined the motives and factors inuencing travel for older adults. Factor analysis indicated two motivations
for travel, pushing and pulling, in which the most important
motives were the pursuit of knowledge and a clean and safe
environment. Additionally, the results of Huang and Tsai (2003)
acknowledged that when older adults in Taiwan travel, they value
culture, history, and beautiful landscapes. Therefore, they are more
easily attracted by travel products related to culture and nature.
Grougiou and Pettigrew (2011) proposed a model of how seniors
evaluate their service encounter interactions. The model emphasizes the need for service providers to recognize the characteristics
of frontline service staff that contribute to satisfactory service
encounters for seniors. For older tourists, Dixon (2012) argued that
professionals in leisure and tourism services may want to consider
marketing information and products for education or enlightenment that permit customization and personalization. Moreover,
older tourists are likely to want programs and products that can
be changed to different levels of complexity and adapted for climate, budget, and their level of health. Professionals in leisure
and tourism settings would need to have specic leadership skills

K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

and knowledge to offer education and enlightenment experiences.

Personal trainers could develop programs that incorporate and
measure greater body awareness or relaxation states, such as Yoga,
Tai Chi, or Ai Chi.
Nimrod and Rotem (2010) focused on older adults and proposed
nine destination activities based on a national postal survey of 298
Israeli retirees. The nine activity types factors were back country,
educational, city-based, physical, cultural, non-physical,
themed, simple pleasures, and spiritual. Concern regarding
the decline in physical activity (PA) programs designed for elderly
people has increased because evidence suggests that these health
promotion interventions may can reduce the negative effects of
aging (Marques et al., 2011). Moreover, the promotion of physical
activity among older adults should emphasize moderate-intensity
aerobic activity, muscle-strengthening exercises, a reduction in
sedentary behavior, and risk management (Nelson et al., 2007).
The preceding studies imply that managerial connotations are
involved in service suppliers design and organization of service
quality for older adults. Thus, the ultimate goal for this study, was
to construct a model of the customer service factors that satises
the demands of older adults. Quality function deployment (QFD)
is an extremely useful tool for transforming customer opinions
into product design through quality engineering. For example, Liu
and Xu (2003) endeavored to integrate the QFD framework into
the customer satisfaction measurement problem, and to develop
a new multi-phase QFD model for evaluating the customer satisfaction index. Das and Mukherjee (2008) attempted to develop an
AHP-QFD framework for designing a tourism product that satises
tourists travel needs.
2.4. Studies regarding the segmentation of older tourists
Tourism segmentation studies have traditionally developed
segmentation variables from secondary data or a review of the literature. Seniors comprise an important segment of the travel and
tourism market. With an aging population, the highest number of
new seniors, in the form of baby boomers, have begun to join
the mature travel market (Lehto et al., 2008). Recently, the behavior of senior travelers has become an important area of interest
because of the size and growth potential of the senior travel market.
For example, Tung and Ritchie (2011) investigated the memorable
experiences of the senior travel market. They conducted in-depth
interviews with 42 respondents, the results of which highlighted
the following ve characteristics: identity formation, family milestones, relationship development, reenactment nostalgia, and the
pursuit of freedom. The practical implication of this study was that
marketers could facilitate a grandparent-to-grandchildren experience, where seniors create new memories with their grandchildren
instead of their children. This type of intergenerational experience
can be promoted as a valuable and essential experience of life.
Horneman et al. (2002) described a study proling senior travelers
according to their demographic and psychographic characteristics. Boksberger and Laesser (2009) reported the segmentation of
Swiss senior travelers according to their travel motivations. Based
on stakeholder theory, Tkaczynski et al. (2010) recommended a
two-step approach for destination segmentation, incorporating the
views of multiple stakeholders. Lehto et al. (2008) used a travel
activities and motivation survey to comparative assess the baby
boomer generation and the silent generation regarding the tourism
experiences sought and actual vacation activities. Le Serre (2008)
contended that seniors tourism consumption behaviors could be
used in the future to predict senior tourism segmentation and
develop new tourism products that satisfy the needs of this market.
Littrell et al. (2004) developed proles of senior travelers based
on their travel activities and augmented the proles by comparing
and contrasting the shopping variables of tourists. The ndings of

125

their work provided further support that senior travelers are not
a single tourism group. Kim et al. (2003) applied technical information as the method for segmenting the older tourist market.
They segmented the West Australian older tourist market using
an articial neural network. Mueller and Lanz Kaufmann (2001)
surveyed over 400 wellness guests (not necessarily older tourists)
at eight wellness hotels. The cluster analysis results provided
the following four guest segments: demanding health guests,
independent infrastructure users, care-intensive cure guests,
and undemanding recreation guests. The main distinguishing
characteristics were the importance of software and/or wellness
facilities, and the relevance of the recreation and/or health promotion motive.
3. Methodology
For this study, we adopted a two-phase analytical process to
explore tourists and operators understanding of wellness tourism
service factors. Phase 1 involved analysis of in-depth interviews
conducted with operators. We conducted quantitative analysis of
survey questionnaires completed by older adults at hot springs in
Taiwan for Phase 2.
3.1. In-depth interviews
Experts were selected for this survey using the snowball sampling method. We contacted two senior managers and one expert
of hot spring hotels, who had previously served as senior managers and possessed over 10 years of experience working in hotels,
and conducted individual in-depth interviews. After the interviews,
the three interviewees were asked to recommend senior managers
who were highly familiar with managing wellness tourism and
working in hotels in the main hot springs areas in Taiwan. These
recommended people in specic hot spring areas would then recommend other appropriate interviewees in that area. Thus, we
conducted interviews using both the individual in-depth interviews and focus group methods to accommodate the interviewees
regional distribution and time constraints. Face-to-face interviews
were conducted with 13 senior managers of hot spring hotels
and experienced experts during Phase 1. The participants included
senior managers (in the position of Vice President or above) in
Wulai (northern Taiwan) (1 participant), Tainan (central Taiwan) (1
participant), Bolai (southern Taiwan) (3 participants), and Chiben
(eastern Taiwan) (5 participants), as well as three experienced
former hot springs operators turned business consultants. The
discussion topic was set: What are the important services for
developing wellness tourism targeted to tourists over 50 years of
age?
The coding process and analytical method were as follows: (1)
we examined the interview transcripts individually and organized
the service items suggested by the interviewees; (2) the service
items were compared, and renewed integration or modication
of the names of related service items was discussed; and (3) we
assigned temporary classications to service items, including the
names of service factors and the category of service items.
The key service factors for developing health tourism for tourists
over 50 years of age include personnel service, environment,
healthy diet, health promotion treatments, social activities,
relaxation, experience of unique tourism resources, and mental learning (Table 2). Table 2 shows the service items included in
these eight service factors.
3.2. Questionnaire design and survey
In Phase 2 of this study, the opinions of senior managers and
experts in the industry obtained during Phase 1 were compiled

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K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

Table 2
Classication of SPA service on wellness tourism.

Table 4
Descriptive statistics of the demographic variables of interviewed subjects.

Service factor

Service item

Variables

Personnel service

Service personnel equipped with basic medical and

emergency knowledge; service personnel is
compassionate toward customers; provide butler care
service
Provide herbal bath; provide massage; provide
post-surgery recovery care; Provide hot spring therapy
guidance; provide medication consultation; Provide
traditional healing; provide aquatic workout guidance;
provide tness exercise guidance; provide weight
control guidance; provide essence oil massages;
provide exfoliation services
Comprehensively planned walking trails; with
transport convenience; clean and hygienic hot spring
bath environment; With image of honor; with
barrier-free facilities; safe spa facilities; gym
Use of non-toxic or detoxication food ingredients;
Health restorative meals; Provide local ingredients
based cuisines
Atmosphere of relaxed tranquility; provide landscape
therapy (environment and psychological consultation);
provide meditation environment; provide DVD music
Provide mahjong rooms; provide recreation rooms for
chatting and chess; provide family activities
Provide cultural custom experiences; local cultural
celebration involvement; community development;
provide private attractions; provide nocturnal
exploration activities
Provide enlightenment lectures by resident religious
and spiritual mentors; provided relaxed learning
atmosphere; provide psychological consultation;
provide book clubs; provide art exhibitions; provide
musical performances; provide group DIY activities

Gender
Male
Female
Age
5064
65 and above
Level of education
Junior high and lower
Senior high/higher vocational
education
Junior college
University
Postgraduate and above
Marital status
Single
Married
Other
Monthly disposable income (NTD)
20,000 and lower
20,00140,000
40,00160,000
60,00180,000
80,001100,000
100,001 and above
Region of residence
North
Central
South
East
Off shore islands
Other
Main companion of the current trip
Family
Friends
Colleagues
Classmates
Other
Domestic tour in the preceding
year

Health promotion
treatments

Environment

Healthy diet

Relaxation

Social activities
Experience of
unique tourism
resources
Mental learning

Table 3
The frequency distribution of the questionnaire respondents from six hot spring
regions.
Hot spring region

Frequency

Percentage

Guguan
Chiben
Wulai
New Beitou
Jiaosi
Guan Zih Ling
Total

134
97
92
66
106
83
578

23.2
16.8
15.9
11.4
18.3
14.4
100.0

into wellness tourism service factors that formed the basis of the
survey questionnaire regarding the key items for spa services
in hot spring hotels. The questionnaire comprised two sections,
the rst of which contained the 43 service items within the
service factors. A 5-point Likert scale was employed, and each
question was rated from 5 (extremely important) to 1 (extremely
unimportant). The second section concerned the demographic
and travel characteristic items for older adults. Purposive sampling was conducted for older adults staying in hot spring hotels
in six major hot spring regions, Jiaosi (northern Taiwan), New
Beitou (northern Taiwan), Wulai (northern Taiwan), Guguan
(central Taiwan), Guan Zih Ling (southern Taiwan), and Chiben
(eastern Taiwan). The survey period was between November
2011 and January 2012, with 578 valid questionnaires retrieved.
Table 3 shows the number of valid questionnaires obtained from
each area.
4. Data analysis and discussion
4.1. Prole of respondents
Table 4 shows that male tourists accounted for more than
half of the interviewed respondents at 50.5%, and female tourists

Number of times

Percentage

292
282

50.5
48.8

475
103

82.2
17.8

128
229

22.1
39.6

87
110
16

15.1
19.0
2.8

26
514
38

4.5
88.9
6.6

175
229
80
30
18
29

30.3
39.6
13.8
5.2
3.1
5.0

258
130
144
31
2
4

44.6
22.5
24.9
5.4
0.3
0.6

244
186
57
12
64
5.87 (on average)

42.2
32.2
9.9
2.1
11.1

accounted for 48.8%. The senior group (aged 65 years and above)
accounted for 17.8% of the respondents, and prospective seniors
accounted for 82.2%. Regarding monthly disposable income, the
20,001 to 40,000 TWD range comprised the largest proportion
of respondents (39.6%). The second largest group (30.3%) had a
monthly disposable income of less than 20,000 TWD. Only 5% of
the respondents had a monthly disposable income of more than
100,000 TWD. The majority of the respondent had less than a
junior college-level education because 39.6% had only completed
senior high school/higher vocational training, and 22.1% had a
junior high school or lower level of education. The respondents
who held at least a university degree accounted for 21.8%. Most
of the respondents lived in northern Taiwan (44.6%), followed by
southern Taiwan (24.9%); the lowest number of respondents lived
in offshore island areas (0.3%). At the time of the interview, the
majority of the respondents were traveling with family (42.2%), and
22.5% were traveling with friends. The average number of times the
respondents have participated in a domestic tour in the preceding
year was 5.87.
4.2. Item analysis of the service items
To incorporate the inuence of both customers service needs
and operators service provision, 43 service items were extracted
from in-depth interviews with industry experts and compiled
into a questionnaire. The service items were ltered according
to tourists understanding of the service items to ensure consistency among the service items. The reliability of the service items
determined using Cronbachs was 0.935, indicating a high level

K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

127

Table 5
Customer service item analysis result.
Customer service dimensions
Personnel service
Service personnel equipped with basic medical and emergency
knowledge
Service personnel is compassionate toward customers
Provide butler care service
Health promotion treatments
Provide herbal bath
Provide massage
Provide post-surgery recovery care
Provide hot spring therapy guidance
Provide medication consultation
Provide traditional healing
Provide aquatic workout guidance
Provide tness exercise guidance
Provide weight control guidance
Provide essence oil massages
Provide exfoliation services
Environment
Comprehensively planned walking trails
With transport convenience
Clean and hygienic hot spring bath environment
With image of honor
With barrier-free facilities
Safe spa facilities
Gym
Healthy diet
Use of non-toxic or detoxication food ingredients
Health restorative meals
Provide local ingredients based cuisines
Relaxation
Atmosphere of relaxed tranquility
Provide landscape therapy (environment and psychological
consultation)
Provide meditation environment
Provide DVD music
Social activities
Provide mahjong rooms
Provide recreation rooms for chatting and chess
Provide family activities
Experience of unique tourism resources
Provide cultural custom experiences
Local cultural celebration involvement
Community development
Provide private attractions
Provide nocturnal exploration activities
Mental learning
Provide enlightenment lectures by resident religious and spiritual
mentors
Provide psychological consultation
Provided relaxed learning atmosphere
Provide book clubs
Provide art exhibitions
Provide musical performances
Provide group DIY activities

of consistency. The elimination of any item did not increase the

overall reliability. The correlation coefcient for each item and
the total score for the 43 items were subsequently calculated.
Items with a correlation coefcient lower than 0.5 were eliminated. Table 5 shows that 11 items with correlation coefcients
lower than 0.5 were eliminated. All service items in the experience of unique tourism resources, health promotion treatments,
and mental learning dimensions achieved a correlation coefcient greater than 0.5. Although the correlation coefcient of
the service item provide cultural experience was slightly less
than 0.5, unique local culture provides industry operators with
signicant appeal and competitiveness, and unique cultural experiences are an important travel motivation for tourists. Therefore, we
retained the service item provide cultural experience. A total of
10 items were eliminated and 33 items retained following the item
analysis.

Cronbach after elimination

of this item

Item-to-total
correlation

Note

0.936

0.11

Eliminated

0.936
0.933

0.11
0.55

Eliminated

0.933
0.933
0.933
0.932
0.932
0.932
0.932
0.932
0.932
0.932
0.933

0.58
0.55
0.57
0.66
0.65
0.61
0.66
0.64
0.63
0.60
0.58

0.934
0.935
0.935
0.933
0.934
0.935
0.933

0.39
0.24
0.19
0.56
0.36
0.32
0.55

0.933
0.934
0.933

0.50
0.44
0.50

0.933
0.934

0.53
0.54

0.934
0.934

0.50
0.42

0.935
0.933
0.933

0.34
0.51
0.57

0.933
0.933
0.933
0.933
0.933

0.48
0.51
0.54
0.52
0.53

0.933

0.57

0.932
0.932
0.932
0.932
0.932
0.932

0.60
0.64
0.68
0.64
0.66
0.63

Eliminated
Eliminated
Eliminated
Eliminated
Eliminated

Eliminated

Eliminated

4.3. Reliability and validity analysis of service items

The main service factors were extracted from the service items
retained from the previous item analysis, with the reliability and
validity of the extracted service factors assessed. Two analysis procedures were included in this process. Exploratory factor analysis
was performed to identify service factors and determine their reliability and validity values using Cronbachs and discriminant
validity as respective indicators. Conrmatory factor analysis was
subsequently performed to verify the service factors and examine the reliability and validity according to the average variance
extracted (AVE) and construct reliability (CR) values, respectively.
4.3.1. Exploratory factor analysis
We performed exploratory factor analysis to appropriately
reduce the service items for hot springs tourists. The Bartlett test

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K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

Table 6
Explorative factor analysis result.
Factor

Item

Factor loading

Mean score of item

Cronbachs

Explained variance (%)

Health promotion
treatments

Provide aquatic workout guidance

Provide tness exercise guidance
Provide weight control guidance
Provide hot spring therapy guidance
Provide medication consultation
Provide traditional healing
Provide essence oil massages
Provide exfoliation services
Provide butler care service
Provided relaxed learning atmosphere
Provide book clubs
Provide art exhibitions
Provide musical performances
Provide psychological consultation
Provide enlightenment lectures by resident religious
and spiritual mentors
Provide group DIY activities
Local cultural celebration involvement
Provide cultural custom experiences
Community development
Provide private attractions
Provide nocturnal exploration activities
Provide massage
Provide herbal bath
Provide post-surgery recovery care
Provide landscape therapy (environment and
psychological consultation)
Provide meditation environment
Atmosphere of relaxed tranquility
Provide local ingredients based cuisines
Use of non-toxic or detoxication food ingredients
Provide recreation rooms for chatting and chess
Provide family activities

0.831
0.817
0.797
0.738
0.737
0.724
0.716
0.657
0.545
0.814
0.800
0.796
0.779
0.761
0.738

3.43
3.41
3.44
3.51
3.40
3.31
3.33
3.25
3.43
3.27
3.08
3.19
3.19
3.02
3.04

0.919

34.1

0.928

11.94

0.726
0.791
0.766
0.763
0.730
0.548
0.739
0.706
0.635
0.823

3.28
3.60
3.57
3.48
3.49
3.17
3.43
3.48
3.33
3.72

0.825

7.45

0.834

5.25

0.760

4.05

0.773
0.633
0.735
0.656
0.767
0.727

3.46
4.03
3.78
3.92
3.12
3.62

0.693

3.39

0.669

3.25

Mental learning

Experience of
unique tourism
resources

Complementary
therapies
Relaxation

Healthy diet
Social activities

of sphericity and KaiserMeyerOlkin (KMO) measure of sampling

adequacy were performed. A KMO value close to 1 is indicative
of a good correlation between the scaled items and suitability for
factor analysis. We obtained a KMO value of 0.907, and a p-value
of less than .0001, which conrmed the suitability of the items
for exploratory factor analysis. We conducted principle component
analysis, where the eigenvalue denoted the number of factors. If the
eigenvalue exceeded 1, items with a factor loading greater than 0.5
were extracted using the varimax rotation method. Table 6 shows
the seven factors extracted, that is, health promotion treatments,
mental learning, experience of unique tourism resources, complementary therapies, relaxation, healthy diet, and social
activities. A total explained variance of 69.44% was determined.
The image of honor and a gym items did not achieve a factor loading of 0.5 and were eliminated. However, a factor loading
greater than 0.5 was determined for the remaining items. The
Cronbachs used to indicate factor reliability exceeded 0.6 for
each item, reaching an acceptable level. Table 6 indicates that

healthy diet and relaxation were two service factors the interviewed older adults valued more highly. Regarding the overall
service items, Atmosphere of relaxed tranquility (M = 4.03) was
considered the most important item. Use of non-toxic or detoxication food ingredients (M = 3.92) was ranked as the second most
important item. Additionally, both Provide local ingredients based
cuisines (3.78) and Provide landscape therapy (environment and
psychological consultation) (M = 3.72) were valued service items.
Discriminant validity was determined according to the correlation
coefcient between the factors. The analysis results indicated that
the correlation coefcient for the seven factors ranged between
0.218 and 0.521, with no correlation coefcient close to 1 observed.
Thus, discriminant validity was established for the seven factors
(Table 7).
4.3.2. Conrmatory factor analysis
The 31 items ltered by exploratory factor analysis were
used to verify the reliability and validity of the factors listed

Table 7
Factor correlation coefcient matrix.
Health promotion
treatments
Health promotion treatments
Mental learning
Experience of unique tourism
resources
Complementary therapies
Relaxation
Healthy diet
Social activities
**

p < 0.01.

Mental learning

0.474**
0.330**

0.521**

0.663**
0.218**
0.259**
0.406**

0.378**
0.340**
0.311**
0.423**

Experience of
unique tourism
resources

0.239**
0.383**
0.413**
0.392**

Complementary
therapies

0.253**
0.263**
0.278**

Relaxation

Healthy diet

0.439**
0.344**

0.331**

K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

129

Table 8
Conrmatory factor analysis result.
Factors

Item

Factor loading

AVE

CR

Health promotion
treatments (M = 3.40)

Provide aquatic workout guidance

Provide tness exercise guidance
Provide weight control guidance
Provide hot spring therapy guidance
Provide medication consultation
Provide traditional healing
Provide essence oil massages
Provide exfoliation services
Provide butler care service
Provided relaxed learning atmosphere
Provide book clubs
Provide art exhibitions
Provide musical performances
Provide psychological consultation
Provide enlightenment lectures by resident religious and spiritual
mentors
Provide group DIY activities
Local cultural celebration involvement
Provide cultural custom experiences
Community development
Provide private attractions
Provide nocturnal exploration activities
Provide massage
Provide herbal bath
Provide post-surgery recovery care
Provide landscape therapy (environment and psychological
consultation)
Provide meditation environment
Atmosphere of relaxed tranquility
Provide local ingredients based cuisines
Use of non-toxic or detoxication food ingredients
Provide recreation rooms for chatting and chess
Provide family activities

0.81
0.86
0.84
0.81
0.79
0.82
0.87
0.80
0.69
0.70
0.73
0.81
0.85
0.77
0.78

0.56

0.92

0.59

0.91

0.58

0.87

0.62

0.83

0.57

0.80

0.55

0.71

0.50

0.67

Mental learning
(M = 3.15)

Experience of unique
tourism resources
(M = 3.46)

Complementary
therapies (M = 3.42)
Relaxation (M = 3.74)

Healthy diet (M = 3.85)

Social activities
(M = 3.37)

previously. The t indices of the conrmatory factor analysis

results were CN = 313.61 > 200, 2 = 844.54 (p = 0.000), df = 386,
2 /df = 2.19 < 3, GFI = 0.91, AGFI = 0.89, NFI = 0.97, NNFI = 0.98,
PNFI = 0.71, RMR = 0.045, and RMSEA = 0.045. The factor loading and
error variance value for all customer service items exceeded 0.5
and 0, respectively, which is indicative of a good t between the
model and sample data. The conrmatory analysis results in Table 8
show that the AVE of the seven factors all exceed 0.5, indicating
good convergent validity. Additionally, the CR of the seven factors were all greater than 0.6. The reliability and validity of the
seven factors were conrmed as being ideal (Jreskog and Srbom,
1989).
Finally, after verifying the service factors, the interviewed older
tourists were divided into two groups: an old-older group (aged
65 years and above) and a young-older group (aged between
50 and 64 years). Analysis was performed to determine whether
the importance of the seven service factors differed signicantly
between the two groups. The t-test results showed that no signicant differences existed. Overall, a healthy diet and relaxation
service factors were the most valued by all interviewed older
adults.

4.4. Clustering of older adults

This research subsequently employed the seven service factors as classication variables to implement cluster analysis on
the interviewed older adults and explore the characteristics of the
groups. In the rst step of the two-step procedure, the number
of clusters was examined using hierarchical cluster analysis, and
clusters were then formed using K-mean clustering. The graphical tree of hierarchical cluster analysis showed that grouping
service factors into 2 or 3 clusters was optimal. We determined
that 3 clusters was the most appropriate grouping based on the

0.66
0.62
0.74
0.75
0.76
0.71
0.72
0.72
0.75
0.64
0.63
0.63
0.64
0.54
0.64
0.71

subsequent K-mean analysis. The differences for the seven service

factors between the 3 groups are shown in Table 9. Table 9 shows
that the older adults in Group 1 had a higher regard for all the customer service factors compared to those in the other two groups.
Therefore, we named Group 1 the holistic group, which contained
212 samples. Group 2 demonstrated a higher regard for health
promotion treatments and complementary therapies compared
to Group 3; consequently, we named this group the physiotherapy
group, which comprised 190 samples. Group 3 showed a higher
regard for service factors, such as mental learning, experience
of unique tourism resource s, relaxation, social activities, and
healthy diet, compared to Group 2. Thus, we named this group
the leisure and recreation group, which comprised 176 samples.
This study provides market segmentation references for hotel
owners based on comparisons of the socio-demographic variables
(gender, level of education, monthly disposable income, age, and
main companion of the current trip) between the three groups.
As shown in Table 10, the proportion of men in Group 2 was
higher than that of women; however, for the other two groups,
women comprised a higher proportion. Group 1 had highest proportions of graduates of junior college and above among these
three groups, indicating that the people in this group had a higher
educational level. Group 3 had highest proportions of people over
65 years of age compared to the other groups, indicating that
the people in this group had a higher age. Additionally, Group
1 had the highest proportion (20.1%) of people with a monthly
income higher than 60,000 TWD, and Group 3 had the highest proportion (80.8%) of people with a monthly income less or
equal to 40,000 TWD. The person traveling with family and friends
was the main travel companions in these three groups. By oneway ANOVA, three groups have participated in a domestic tour
in the preceding year were not signicant difference (F = 2.819,
p = 0.061 > 0.05).

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K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

Table 9
Cluster analysis of older tourist by service factor.
Service factors

Group 1 mean (n = 212)

Group 2 mean (n = 190)

Group 3 mean (n = 176)

p-Value

Post hoc comparison

Health promotion treatments

Mental learning
Experience of unique tourism resources
Relaxation
Complementary therapies
Social activities
Healthy diet

4.02
3.80
3.88
4.12
3.95
3.97
4.21

3.41
2.68
3.02
3.29
3.54
2.83
3.51

2.63
2.87
3.44
3.77
2.66
3.23
3.77

0.000
0.000
0.000
0.000
0.000
0.000
0.000

Group 3 < 2 < 1

Group 2 < 3 < 1
Group 2 < 3 < 1
Group 2 < 3 < 1
Group 3 < 2 < 1
Group 2 < 3 < 1
Group 2 < 3 < 1

Table 10
Cluster analysis of older tourist by socio-demographic variables.
Socio-demographic variables

Gender
Female
Male
Level of education
Junior high and lower
Senior high/higher vocational
education
Junior college
University
Postgraduate and above
Monthly disposable income (NTD)
20,000 and lower
20,00140,000
40,00160,000
60,00180,000
80,001100,000
100,001 and above
Age
65 and above
5064
Main companion of the current trip
Family
Friends
Colleagues
Classmates
Other

Group frequency (percentage)

Group 1

Group 2

111 (52.4)
101 (47.6)

82 (43.4)
107 (56.6)

89 (51.4)
84 (48.6)

42 (20.1)
82 (39.2)

37 (19.9)
82 (44.1)

49 (28.0)
65 (37.1)

35 (16.7)
45 (21.5)
5 (2.4)

29 (15.6)
34 (18.3)
4 (2.2)

23 (13.1)
31 (17.7)
7 (4.0)

70 (34.3)
58 (28.4)
35 (17.2)
21 (10.3)
6 (2.9)
14 (6.9)

53 (28.6)
84 (45.4)
29 (15.7)
4 (2.2)
8 (4.3)
7 (3.8)

52 (30.2)
87 (50.6)
16 (9.3)
5 (2.9)
4 (2.3)
8 (4.7)

36 (17.0)
176 (83.0)

28 (14.7)
162 (85.3)

39 (22.2)
137 (77.8)

89 (43.0)
67 (32.4)
24 (11.6)
7 (3.4)
20 (9.7)

85 (46.2)
52 (28.3)
17 (9.2)
2 (1.1)
28 (15.2)

70 (40.7)
67 (39.0)
16 (9.3)
3 (1.7)
16 (9.3)

Group 3

5. Conclusion
In this two-phase study, we interviewed hot spring experts to
acquire their perspectives on essential customer services to older
adults in wellness tourism. Based on their responses, we compiled
a list of descriptions of needed services. The descriptions were
grouped by similar keywords and/or concepts. Eventually, these
descriptions were used to compile a questionnaire to be distributed
to older adult tourists at hot spring areas in Taiwan.
Through exploratory and conrmatory factor analyses on
the survey data, we identied seven customer service factors,
Health promotion treatments, Mental learning, Experience of
unique tourism resources, Complementary therapies, Relaxation, Healthy diet, and Social activities. These seven service
factors encompass arguments included in previous researches on
older adult tourists (Huang and Tsai, 2003; Jang and Wu, 2006;
Joppe, 2010; Nelson et al., 2007; Nimrod and Rotem, 2010; Tung
and Ritchie, 2011).
The Healthy diet factor identied in this study is unique
and seldom mentioned in previous studies. Taiwanese diet habits
have changed due to the economic growth. Previously, people
concerned whether they had enough food to meet the physical
needs (feeling full). However, consumers in Taiwan demand meals
balanced with nutrition, taste, and other special culinary characteristics now. Moreover, since Japan occupied Taiwan for 50 years,
Japanese hot spring culture has greatly inuenced Taiwanese hot
spring industry. Providing good Japanese culinary arts to wellness

tourism is considered essential in hot spring hotels. This nding

also suggested that the older adults enjoy Japanese food in hot
spring hotels with its perfect combination of healthy, visual enjoyment of food presentations, and the perfection punctuations of
service process and timing (Smith and Puczk, 2009). Moreover,
other service factors identied in this study are heuristic, such as
Provide enlightenment lectures by resident religious and spiritual mentors, Provide musical performances, and Provide art
exhibitions.
Among the service items mentioned in this study, some of
them about older adults recognition of wellness tourism are not
preferred by the interviewees (such as Mental learning and
Social activities). And these service items are the very factors
of service experience that create uniqueness and attraction in
wellness tourism. The practitioners should devise suitable market
strategies to trigger the rst experiential behaviors of older adults,
and further create customers needs. This is one of the referable
results this study offered.
Furthermore, we conducted a cluster analysis based on these
seven service factors to identify unique segmentations among
subjects. The outcome of cluster analysis suggested that the respondents could be further segmented into three sub-groups, Holistic
group, Physiotherapy group, and Leisure and recreation group.
We compared our results to the cluster analysis results reported by
Mueller and Lanz Kaufmann (2001) and contend that the Holistic group, Physiotherapy group, and Leisure and recreation
group proposed in this study respectively correspond to Mueller
and Lanz Kaufmanns Demanding health guests, Care-intensive
health guests, and Undemanding recreation guests.
Theoretically, the differences between tourists and operators understanding of customer service were eliminated through
the two-phase qualitative and quantitative analyses. Specically,
industry experts provided the service factors for wellness tourism
based on their own views, these service factors were converted to
questionnaire to be veried by the older adult tourists. The reliability and validity of the service factors were conrmed and validated.
Eventually, a system of wellness tourism service was established
via these processes.
Regarding the management implications, because the importance of the seven service factors for old-older adults (aged 65 years
and above) and young-older adults (aged between 50 and 64 years)
did not differ signicantly, the service factors could be transformed
into service quality factors for older tourists using transition tools
such as Quality Function Deployment to evaluate service performance.
Each of the three subgroups segmented by the cluster analysis possessed distinct characteristics. The Physiotherapy group
emphasizes preventative treatments and the promotion of health
through health-promoting activities and complementary, noninvasive medical procedures. The importance of other service factors for
this subgroup was comparatively low; thus, the necessary services
for this group involve treatments that promote health. The Holistic group aims to reach a peaceful physical, mental, and spiritual
balance through travel. This subgroup could become a major target market for hot spring hotel industry. The third subgroup, the

K.-H. Chen et al. / International Journal of Hospitality Management 35 (2013) 122132

Leisure and recreation group, can be motivated to participate in

wellness tourism through healthy diets, relaxation, and social activities. Health promotion and convalescence are not relevant for this
group, whose primary objective is enjoyment and socializing with
friends.
In the hot springs hotel industry, returns on investment, sensitivity to market responses, and a variety of business skills are
priorities. Whether a hotel is owned by a family or a company,
modern managing operations should be applied, especially in the
elds of marketing management, nancial management, human
resources management, strategic alliances, hospitality management, hotel management, and business diagnoses.
For further development based on this study, we suggest that
a standard system for quality evaluations similar to the European
Foundation for Quality Management (EFQM) model could be developed through a combination of the seven service factors proposed
in this study.
Although we are condent with the practical aspect of this study,
we also recognized its limitations. Since the law forbids hot spring
hotels to promote curative effects of hot springs or perform invasive
medical operations in Taiwan, the service factors suggested in this
study should be modied according to the laws and regulations of
host countries when they are used as references. In conclusion, this
study has shown that the model is applicable to the other hot spring
hotel areas that developed health and wellness tourism.

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