Nazrin IRS Report

A Study on Ayurveda tourism in Kerala, with special reference to Ernakulam district .
CHAPTER 1
INTRODUCTION
School of Management Studies, CUSAT Page |

1.1Tourism Industry
Tourism Industry is deemed as one of the worlds largest industries to be earning

foreign exchange, the travel and tourism sector indeed has a lot to offer to the growing
population, owing to the increasing number of job opportunities in a number of
associated departments like government tourism departments, immigration and customs
services, travel agencies, airlines, tour operators, and resorts and hotels in addition to
many associated service industries such as airline catering or laundry services, Guides,
Interpreters, Tourism promotion, and the like.Although it would seem all glamorous,
the industry has much more to offer and requires hardworking and diligent individuals.
Also, as per popular researches and studies, the tourism sector has created about 11
million jobs and has the potential to create another 37 million jobs in the future.
Although the future of the industry is quite bright but still there is a lot of development
in terms of infrastructure and skilled personnel. Well groomed individuals are the need
of any industry and especially ones where direct client interface is as much as this
industry. The country requires more and more skilled, confident, well groomed and
diligent aspirants to be a part of the travel and tourism industry.
1.2 Types of Tourism
Tourism in India is economically important and is growing rapidly. The World

Travel & Tourism Council calculated that tourism generated6.4
trillion (US$95 billion) or 6.6% of the nation's GDP in 2012. It supported 39.5
million jobs, 7.7% of its total employment. The sector is predicted to grow at an
average annual rate of 7.9% till 2023 making India the third fastest growing tourism
destination over the next decade. India has a large medical tourism sector which is
expected to grow at an estimated rate of 30% annually to reach about95
billion(US$1.4 billion) by 2015. The Ministry of Tourism designs national policies for
the development and promotion of tourism. In the process, the Ministry consults and
collaborates with other stakeholders in the sector including various Central
Ministries/agencies, state governments, Union Territories and the representatives of the
private sector.

Concerted efforts are being made to promote new forms of tourism such as rural,
cruise, medical and eco-tourism.The Ministry also maintains the Incredible
India campaign.India is home to various tourist attractions and destinations which
provides healing abilities and are competent of providing rewarding experiences of life.
India is a destination of all seasons and is home to the Himalayan ranges in the north, a
long coastline surrounded by mesmerizing seas in the south. In addition, India boasts of
landscapes, historical sites and royal cities, clean beaches, calm mountain retreats, rich
cultures and festivities to stimulate.All around the year, India offers distinct range of
destinations and experiences. There are lovely retreats amidst the beauty in the
Himalayan ranges or the lush-heights of the Western Ghats with cool trekking options,
tall peaks, or stretches of white water for the adventure lovers in summer season.
Winter season in India comes alive with cultural feasts of music and dance. To refresh
in winter season, sun-clad beaches are the best locations.
1.2.1 Adventure Tourism
As a kind of tourism in India, adventure tourism has recently grown in India. This
involves exploration of remote areas and exotic locales and engaging in various
activities. For adventure tourism in India, tourists prefer to go for trekking to places
like Ladakh, Sikkim, and Himalaya. Himachal Pradesh and Jammu and Kashmir are
popular for the skiing facilities they offer. Whitewater rafting is also catching on in
India and tourists flock to places such as Uttaranchal, Assam, and Arunachal Pradesh
for this adrenalin-packed activity.
1.2.2 Wildlife Tourism

India has a rich forest cover which has some beautiful and exotic species of wildlife
some of which that are even endangered and very rare. This has boosted wildlife
tourism in India. The places where a foreign tourist can go for wildlife tourism in India
are the Sariska Wildlife Sanctuary, Keoladeo Ghana National Park, and Corbett
National Park.
1.2.3 Medical Tourism
Tourists from all over the world have been thronging India to avail themselves of cost-
effective but superior quality healthcare in terms of surgical procedures and general
medical attention. There are several medical institutes in the country that cater to
foreign patients and impart top-quality healthcare at a fraction of what it would have
cost in developed nations such as USA and UK. The city of Chennai attracts around
45% of medical tourists from foreign countries.
1.2.4 Pilgrimage Tourism
India is famous for its temples and that is the reason that among the different kinds of
tourism in India, pilgrimage tourism is increasing most rapidly. The various places for
tourists to visit in India for pilgrimage are Vaishno Devi, Golden temple, Char Dham,
and Mathura Vrindavan.
1.2.5 Cultural Tourism
India is known for its rich cultural heritage and an element of mysticism, which is why
tourists come to India to experience it for themselves. The various fairs and festivals
that tourists can visit in India are the Pushkar fair, TajMahotsav, and SurajKundmela.
The types of tourism in India have grown and this has boosted the Indian economy.
1.2.6 Eco Tourism

Ecotourism is a form of tourism involving visiting fragile, pristine, and relatively

undisturbed natural areas, intended as a low-impact and often small scale alternative to
standard commercial (mass) tourism. Its purpose may be to educate the traveller, to
provide funds for ecological conservation, to directly benefit the economic
development and political empowerment of local communities, or to foster respect for
different cultures and for human rights.
1.3 Health Tourism
Health tourism/Medical tourism can be defined as the process of traveling outside the
country of residence for the purpose of receiving medical care. Growth in the
popularity of medical tourism has captured the attention of policy-makers, researchers
and the media. Originally, the term referred to the travel of patients from less-
developed countries to developed nations in pursuit of the treatments not available in
their homeland. Health/Medical tourism is a booming niche tourism market in the
tourism industry. Medical tourism (also called medical travel or health tourism) is a
term initially coined by travel agencies and the mass media to describe the rapidly
growing practise of travelling to another country to obtain healthcare. Goodrich and
Goodrich (1987: 217) defined medical tourism as the best attempt on the part of a
tourist facility or destination to attract tourists by deliberately promoting its healthcare
services and facilities in addition to its regular tourists amenities. The high cost of
treatment, long waiting time, less insurance coverage in developed countries and the
attitude of people to spend holidays in a quality manner with the aim of improving
health is the main reason for the increasing trend in medical tourism. The attractiveness
of the destination has a great influence on determining a persons destination of choice,
expectations/ satisfaction, intentions to revisit, perceptions of benefits and motivations,
the amount of money spent and the duration of stay (Henkel et al., 2006).
Countries all over the world have analysed a wide scope for this market and are trying
hard to capture a large market share by attracting a large number of tourists with their

destinations specific attributes and wide variety of tourism products. This has created
an immense competition in the health tourism market for the major players like
Thailand, India, Costa Rica, etc. Thus it has become a need of the hour to know the
competitive advantage of their destination, attracting tourists. It is always thought that
the destination with more attractiveness will have the priority to be chosen the most and
revisited. There are many attributes of a destination which may or may not attract
tourists who travel for a particular type of tourism. This raises the need to identify the
attributes that lead tourists to choose one destination over another.
In India, Kerala is emerging as the prime destination for Ayurveda Health

Tourism. It is famous for its tourist attractions like beaches, backwaters, hill stations
and Ayurveda. Ayurvedic medical practice is the most ancient medical system which is
more popular in Kerala where it is practised in a traditional way. The states equitable
climate, natural abundance of forests and the cool monsoon season are best suited for
curative and rejuvenative Ayurvedic treatments. The presence of moisture in the air and
on the surface of skin makes it an ideal place for natural medicines to work effectively
at their highest levels. Compared to other states, having different soil constitution, in
Kerala the soil is rich in alkaloid which enhances the intensity and potential of many
Ayurvedic medicines. Ayurveda has become a huge selling point for Kerala Tourism
Industry and the state promotes it as a part of medical tourism in the international
market.
Today popularity of Kerala Ayurvedic treatment has gained such a momentum that
tourist from across the world come to Kerala only for Ayurveda. There are number of
resorts and hospitals throughout the state which offers Ayurveda holiday packages. The
volume of tourist arrivals in Kerala had experienced a stupendous growth of 7.7 per
cent in 2014 from 4.3 per cent in 2001 (Annual Report of Tourism Statistics,
Department of Tourism, and Government of Kerala). Also based on a Continuous
Tourism Survey Report (2012 2013), it was reported that 3.1 per cent of foreign
tourist and 3.71 per cent of domestic tourists visited Kerala for health treatment.

The main reason for this growth may be the aggressive media campaigns made by the
state government and the word of mouth publicity made by the tourists who have
visited earlier. In this context, the researcher has identified the factors influencing
destination attractiveness of Kerala Ayurveda Health Tourism from the perspective of
tourists. The medical tourism industry in India has a potential to contribute around 25
per cent in the country's GDP (gross domestic product) over the next five years if the
potential will be fully-tapped. Medical tourism boom is happening in other Asian
countries including Malaysia, Singapore and Thailand, whereas India is losing out to its
competitors due to many factors.
Figure 1.1 Health Tourism Structure
HEALTH TOURISM
WELLNESS TOURISM MEDICAL TOURISM
Holistic / Spiritual Medical surgery
Cosmetic surgery
Yoga & Meditation
Dentistry
Recreation
Operations
AYURVEDA
Fertility
Rejuvenation
Source: Smith and Puzcko (2008)
1.4 Ayurveda Tourism

Wellness is generally used to mean a healthy balance of the mind, body and spirit that
results in an overall feeling of well-being. Wellness Tourism can, therefore, be defined
as travel that involves to experience an active process of becoming aware of and
making choices toward a more successful existence. In other words, Wellness is a
view of health that emphasizes the state of the entire being and its ongoing
development. India has always been known for its rich heritage of Wellness traditions
and has enormous possibilities to offer to Wellness seekers. Carrere and Bridges
(2006) have defined medical tourism as travel which is systematically planned to
maintain ones physical and mental health condition. Connell (2006) describes medical
tourism as a popular mass culture where people travel to overseas countries to obtain
healthcare services and facilities such as medical, dental and surgical care whilst having
the opportunity to visit the tourist spots of that country.
Bookman & Bookman (2007) have defined medical tourism as travel with the aim of
improving ones health, and also an economic activity that entails trade in services and
represents two sectors: medicine and tourism. The Indian Wellness industry is one of
the fastest growing segments of the travel and leisure industry. India has the potential to
become a leading Wellness destination for the global travelers. Therefore, there is a
need to position India as preferred destination for Wellness Tourism, wellness being an
integral part of the Indian way of life. Ayurveda is considered to be the most ancient
medicinal form. It mainly developed during Vedic times; the origin can be traced back
to more than 5000 years. Etymologically it is composed of two words Ayur and Veda.
Ayur means life and Veda means science or knowledge. Hence, literally Ayurveda
means Science of Life. Ayurveda is not only a medicinal system it is a way of life, a
philosophy. Life according to Ayurveda is a combination of senses, mind, body and
soul. It deals not only with the physical aspect but also spiritual health too. The laws of
the nature govern it. The Ayurvedic treatment not only cures a particular disease but
also goes deep into the root cause. The concept of Ayurveda is to promote health rather
than just treat disease. All the remedies and suggestions are solely based on nature. It
cures a particular disease not just from the physical aspect but it also takes the mental,
emotional and spiritual well being into account.

According to Ayurveda the structural aspect of every individual is made up of five
elements, namely: earth, water, fire, air and space. The functional aspect of the body
is governed by three biological humours. Traditional techniques and processes are used
to prepare the medicines at home, while certain amount of mechanization is inevitably
used for large-scale production. The beauty of the therapeutics is that they contain the
active principles in their natural forms and their administration in prescribed dozes does
not cause any side effects to the patients. India is known worldwide for its Ayurveda
treatment. There are various centres across the country, which gives an authentic
Ayurveda treatment. Kerala is the most famous destination for Ayurveda treatment
in India. It attracts tourists not only from other parts of India but also from different
countries. The treatment mainly comprises of powders, tablets, decoctions, medicated
oils etc. prepared from natural herbs, plants and minerals.
Kerala owns a non detachable tradition of Ayurveda that has surpassed the many attacks
and intrusions both in land and foreign. For about many centuries the Ayurveda Vaidyas
(traditional practitioners of Ayurveda) were almost the only opening for people needs
curing from every kind of ailments in Kerala. The mastery over the legacy of eight
families of Vaidyas (Ashtavaidyas) and their followers treated the whole state for
hundreds of years. Likes the other Indian states, the position of Ayurveda in Kerala is
not substitution but mainstream. As a matter of fact, today Kerala is the only State in
India which practices this rishi medicinal science with utmost commitment. Being the
only sector of treatment or the people, the Vaidyas of Kerala were in task to describe
the theories of Ayurveda and adjoin them actively in to fruitful healing systems in
everyday life. Thus the majority of the contemporary proceedings and protocols of
Ayurveda have enlarged in and around Kerala.
Ayurveda is a kind of traditional treatment prevalent in India. The form took birth about
3000 to 5000 years ago. It's a kind of healing that uses natural medicines, oils,
ointments and techniques. Ayurveda, "the complete knowledge for long life" Ayur
means life and veda means knowledge. Monsoon is said to be the ideal season for
Ayurvedic treatments. During this time, the atmosphere is clean and best for treatment

and rejuvenation. This is when the pores of the skin are open and get cleansed easily.
The atmosphere at t his time of the year is also congenial as it is dust-free and cool.
Monsoon is the perfect time for massages with therapeutic oils.
There are several unique herbal formulations describe d in Kerala texts. Many of them
have now received national level acclaim and they are included in the Ayurvedic
Formulary of India. One important aspect of Kerala formulations is that the stress is
more on herbal components rather than on metals or minerals. There is also the history
of Ayurvedic physicians developing some areas of specializations like pediatrics,
ophthalmology, martial therapy, etc. This holistic science is the knowledge of complete
balance of the Body, Mind and spirit, including the emotions and psychology, on all
levels. It includes in its consideration, longevity, rejuvenation and self-realization
therapies through herbs, diet, exercise, yoga, massage, aromas, tantras, mantras, and
meditation.
In order to promote Ayurveda Tourism, Kerala Tourism Development Corporation

(KTDC) encourages accreditation of Ayurveda treatment centers with tourism
department of Kerala as Olive leaf certified and Green Leaf certified. The
members of Olive leaf and Green leaf are benefited of listing their names in the
official web sites of KTDC. This accreditation ensures quality in the field of Kerala
Ayurveda Tourism industry.
1.4.1 Ayurveda Based Wellness Tourism in India
Ayurveda, the ancient form of medicine, was developed more than 5000 years ago
during the Vedic times. Ayurveda, being literally known as the Science of life believes
that human life is a combination of senses, body, mind and soul. Hence Ayurvedic
treatments not only deal with physical aspect of a person, but the spiritual aspect too,
and are governed by the laws of nature. Ayurvedic therapies include active principles
in natural forms and when taken in prescribed dozes, do not cause much side-effect on

the patient. India has been known since ages for its Ayurvedic treatments. At present
there are numerous Ayurvedic centers and Spas for authentic Ayurvedic treatments. In
India, Kerala is the most renowned destination for Ayurvedic treatments, attracting
tourists not only from India, but from various other countries. The tourists arriving in
India opt for Ayurvedic massages and treatments, not only for treating a specific
problem or disease, but also for de-stressing, relaxing, for cleansing and detoxifying
and for weight loss and beauty treatments.
There are plenty of Ayurveda Resorts in India in the states of Kerala, Karnataka,
Rajasthan and Goa. A few such Resorts offering Ayurvedic treatment packages in India
are the Somatheeram Beach Resort in Manaltheeram, Hotel Aquaserene in Kollam,
Hotel Swagath Holiday in Kovalam, For Palace Devigarh at Udaipur, Club Mahindra
Lakeview Resort at Munnar, Kumarakom Lake Resort in Kumarakom, Taj Malabar at
Kochi, and the Marriott Resort and Taj Holiday Village at Goa. The most popular Spa
resorts in India that offer good Ayurvedic therapies include Golden Palms Spa and
Resorts, Angsana Spa at Bangalore and Ananda Spa Resort in Rishikesh.
Based on every individuals need and constitution, these Ayurvedic Spas and Resorts
provide treatments based on Ayurvedic medications like the Panchakarma, Herbal
treatments, Meditation, Yoga and Rejuvenation Therapies. Other treatments such as
Physiotherapy and Aromatherapy are also included as packages for tourists arriving for
Ayurvedic treatments in India. Medical Tourism The objective is to promote India as a
quality Healthcare destination for persons across the globe, so as to gainfully utilize the
health care expertise and infrastructure available in the country. Scope of Health
Tourism and present status in India Health Tourism holds immense hope. The Indian

systems of medicines, i.e. Ayurveda, Yoga, Panchakarma, Rejuvenation Therapy, etc.
are among the most ancient systems of medical treatment, of the world. India can
provide Medical and Health care at international standard at comparatively low cost.
Southern States of India, especially Kerala, has developed Health Tourism as one of the
products for the promotion of tourism in Kerala. Health Tourism has also been
promoted as one of the USP's of the State. Most of the hotels/resorts are coming up
with the Ayurveda centres as an integral part. Most of the foreign tourists are now
coming to India only for Ayurveda. The leading tour operators have included Ayurveda
in their brochures.
1.4.2Ayurveda Based Wellness Tourism in Kerala
Kerala The mesmerizing land located in the south of India enjoys geographical
features that are unique and rich. This state is also the only place in India which
practices Ayurveda in its purest form. Ayurveda is the traditional Indian system of
medicine that has brought true health, happiness and wellbeing to millions of
individuals throughout the ages. This ancient art of healing has been in practice for over
5000 years, and was also the mainstream medicine in the ancient times. Derived from
its ancient Sanskrit roots ayus (life) and ved (knowledge) and offering a rich,
comprehensive outlook to a healthy life, it is the only medical science in this universe
which is useful even when one is not ill. Ayurveda is a complete science of health that
is being applicable in all stages of life starting from birth, neonates, infants, childhood,
youth, old age and even life before and after death. For many people, the image of
Ayurveda is limited to the use of herbal or home/kitchen remedies and a traditional way
of treatment.
In reality, Ayurveda is a much serious medical science, which strongly emphasizes on

the diagnosis, examination, analysis of the disease, diet, medicinal properties, dose,
frequency of the medicine and the medium with which it should be consumed. The
Medicare in Ayurveda has broadly two parts: one is preservation of health and
prevention of diseases and the second, diseases and their treatment. Ayurveda follows a

totally different way of treating diseases known as Panchakarma, which means
literally Five Therapies which are the subtly harmonizing purification procedures that
dissolve metabolic waste products and toxins generated from the environmental ill
effects, in a gentle and effective way from the tissues and eliminate them from the
body. This treatment is advisable to the diseased as well as the healthy. Ayurveda also
has a comprehensive system of massages and body treatments that gives relief from a
wide range of illnesses, from migraine and sinus to arthritis and paralysis; that detoxify
and cleans the body through controlled emesis, purgation, making the individual sweat;
and that makes the body receptive to further treatment. These therapies are more
effective in Kerala due to the almost year around humid climate of the state.
1.4.3Ayurveda Tourism in Ernakulam District
The district has cent percent literacy rate in the Kerala state. Ernakulam district is well
knitted with better transportation facilities. Own culture, along with hospitality and real
authentic Ayurveda attracts foreign tourists (inbound tourists) as well as domestic
tourists (intra bound tourists). Though it has a resemblance of metropolitan city, the
district maintains its old legacy in its nature. Compared with other districts, Ernakulam
district has very distinctive role in the medical tourism industry. There are many
positive factors that drive the Ayurveda tourism industry. The district has
Ayurveda college :1 govt., 2 self financing

48 Ayurveda medical shops
9 large scale Ayurveda medicine manufacturers
32 small scale Ayurveda medicine manufactures
87Ayurveda treatment centers (classified & non classified)
13 Government Ayurveda clinics

76 govt. Ayurveda hospitals & dispensaries
67 hotels / resort with Ayurveda facilities and products
14 treatment centers / hotels / resorts classified Ayurveda centers

7 Olive leaf certified treatment centers
7 Green leaf certified treatment centers
3000 -5000 foreign nationals visit Ernakulam for Ayurveda (as per Kerala
tourism ministry estimation)
Nearly 3 lakh employees in the district contribute to the Ayurveda tourism
sector
Ayurveda tourism industry has 20-25% growth rate every year (as per Kerala
tourism Department)
1.4.4 Promoting Ayurveda Tourism
Around 1994, Kerala Tourism recognized that sustainable marketing was the key to
promote the destination but ongoing presence in international market was also vital.
The aggressive branding in domestic and international market had worked wonders and
Kerala Tourism strategically decided to promote Gods Own Country as a stand-alone
destination. With this decision, Kerala Tourism started independent exhibition stands
both within India and internationally at trade fairs, road-shows. Along with efforts to
promote the state as a stand-alone destination, Kerala Tourism adopted a multi-sectoral
strategy and also focused on infrastructure development and up gradation of facilities
including two new airports in Kochi and Kozhikode, approach roads to tourists
destinations and also public amenities.To innovate with the product offerings, the
tourism department identified new destinations and developed circuits like
Kumarakom, Munnar, Wayanad and other destinations like Kovalam and Thekkady
were added to the Kerala portfolio. The addition of these destinations brought central
Kerala into the limelight as the hub of tourism activities. It also introduced a niche and
unique segments like Backwaters and Ayurveda.
With a focused approach, these two segments became popular internationally and the
average duration of stay in Kerala went up from 4.4 days to 14 days. The hike in

average duration of stay disclosed the potential of Kerala. Tourism had started to pick
up, foreign tour operators started including Kerala in their holiday programmes and
catalogues, destination management companies came into existence and also
investments started flowing in, stated Venu. Kerala Tourism launched another niche
product Ayurveda Sanctuary targeting the growing wellness tourism market
internationally. The Ayurveda Sanctuary was also promoted to bring in more traffic
during the off tourist season i.e. the monsoons. Under the PPP model, Kerala Tourism
launched the first edition of Kerala Travel Mart, a pure buyer-seller meet.
1.5 Statement of the Problem
The study is conducted to know about the Ayurveda tourism industry in Kerala and to
analyse the attributes attracting tourist to choose Ernakulam district for their Ayurveda
treatment. This study is also analyzingwhether tourist is aware about the Ayurveda
promotional activities taken by Government of Kerala, Tourism department in
promoting Ayurveda tourism in Kerala. By this we can understand whether the
strategies adopted by Government are going in right path or not.
1.6 Objective of the Study
To study the satisfaction of tourist with regards to various destination

attributes in attracting Ayurveda tourism.
To study the importance of Ayurveda tourism in Ernakulam district.
To analyse various marketing strategies adopted by Government of Kerala to
promote Ayurveda tourism

CHAPTER 2
REVIEW OF LITERATURE
2.1 Destination Choice

The choice, consumption and later evaluation of destination experiences, is a complex
and important area. Consumers are often highly involved. The experience involves both
products and services requiring a relatively high level of expenditure. It also usually
involves a degree of risk within a relatively unfamiliar environment. Such factors mean
that consumers can hold strong and influential attitudes toward different destinations.
The factors and processes that influence destination choice have received considerable
research attention. In addition, studies have begun to investigate satisfaction levels
relating to the quality of the destination experience.
2.1.1 Factors affecting destination choices
The three broad phases of tourism as mentioned in the preceding paragraph namely, the
dynamic phase, a static one, and the consequential give rise to different ingredients of
the industry. These ingredients can be grouped into three macro level components
namely,
[A] Transportation (Dynamic phase)
[B] The Destination (Static phase)
[C] Range of facilities in the destination like accommodation and services of guide etc.
All the three factors individually and collectively affect the satisfaction level of the
visitors. At the same time, it must be noted that it is possible to exploit each of these
factors for marketing a destination. In other words, these three elements may be
regarded as the broad product mix of a destination as it is possible to modify and
improvise these elements in order to implement a particular marketing strategy. The
factors mentioned in B and C above in many cases may be combined into one bundle
and then promoted as one entity since both the elements affect each other to a great
extent. The constituents of these two elements like safety, pleasure, facilities available
etc. could individually influence the tourists desirability of the destination.

It must be pointed out here that tourism being a service, the amount of information or
knowledge the traveler is going to gather on a destination is very crucial; which might
even influence the whole decision making process. The prospective visitor may have
limited or incomplete information (on comparable destinations that would constitute
the primary choice set) at his/her disposal, which means that the traveler is going to
decide about a destination without having full or reasonable information.
Echtner and Reitchie, Hunt, and Phelps(2008) used many structured attributes for
measurement of images, which can also be used for measuring the destination choice
factors. A bi-polar scale to measure Australias image to certain segments of tourists the
structured list used by Phelps consisted of scenic beauty (of Menorca--the Spanish
island, British resorts etc.), climate, and cultural/historical attributes. Gartner again
described the roles of different components like traditional advertising, information
from professional tour operators, and earlier visitors recommendation in his study of
choice of destinations.
Lai and Graefe(2000) too used variables like accessibility, attractions, range of
facilities, safety etc. for developing possible destination choice criteria while studying
Taiwanese overseas travelers.
Fennell (1999) had identified three separate zones of tourist attractions the nuclei (or
the core attraction), the inviolate belt, which is generally not separable from the nuclei,
and the zone of closure that comprises of desirable tourist infrastructure including
information. Considering the literature referred to and the findings of a pilot survey,
twenty variables are identified as the factors responsible for destination choices.
The attributes for the study are Self satisfaction, value, accessibility, infrastructure,
quality, image, value & knowledge.
2.1.1.1 Tourist Self satisfaction
Tourist satisfaction is considered one of the prime variables to sustain competitive

business in the tourism industry because it affects the choice of destination,
consumption of products and services. Tourist satisfaction has been one of the key areas
of tourism research for more than four decades.

Oliver (1981) an evaluation of the surprise inherent in a product acquisition and/or

consumption experience. In essence, the summary psychological state resulting when
the emotion surrounding disconfirmed expectations is coupled with the consumers
prior feelings about the consumption experience. The evaluative response to the
current consumption event, the consumers response in a particular consumption
experience to the evaluation of the perceived discrepancy between prior expectations
(or some other norm of performance) and the actual performance of the product
perceived after its acquisition.
2.1.1.2 Values
Values are considered to be important and influential determinants of the human

behavior. Being organized along the continuum of a relative importance to each other
within a set, they create a personal system of values. Value is one of the most
ambiguous variables of the consumer behavior due to its abstract nature and difference
in opinions about it by various scholars (Rao and Monroe, 1989; Zeithaml, 1988).
Many researchers define value as an enduring belief about one thing to be more
desirable than another; as criteria for evaluating things; or as an utility which is
acquired from experiencing consumption. Value is not something that one has, but it is
what one can attach to something determining his/her personal judgment about that
thing to be liked or disliked to a certain extent.
Literature on economics, sociology, marketing, and consumer behavior offers various

concepts of value and various definitions that explain the essence of it. Several of them
are as follows: (1) Values are bundles of likes and dislikes, viewpoints, rational
judgments and associated patterns that determine the worldview; (2) Value is an
enduring belief that a specific mode of conduct or end-state of existence is personally
or socially preferable to an opposite or converse mode of conduct or end-state of
existence (3) Perceived value is the consumer overall assessment of the utility based
on the perceptions of what is received and what is given (4) Value is a cognitive
trade-off between perceived quality and sacrifice

2.1.1.3 Accessibility
Accessibility refers to the design of products, devices, services, or environments for

people who experience disabilities. The concept of accessible design and practice of
accessible development ensures both "direct access" (i.e. unassisted) and "indirect
access" meaning compatibility with a person's assistive technology (for example,
computer screen readers).'Accessibility' is the term referred to the relationship between
both private and public transport forms in tourism. It is an important element of the
tourism product which any travelers from the generating regions to tourist destination.
Also, it coversthe transport within and between, chosen destinations. These include air,
sea, and land transport. Just as the attraction and facilities and services attract visitors;
ease of accessibility to any destination is regarded as a very crucial attribute which
tourists consider before their last buying decision is mode.
Moreover, the geographical proximity of the chosen destination, which contributes to

the time to reach the destination, the cost of travelling to there and the frequency of
transport. Safetyconcerns and the level of comfort also influence on the flows of
tourism and on the type of product which tourists purchase (Middleton, 2001;
Prideaux, 1999).
2.1.1.4 Quality
Arguments and empirical evidence that can explain the relationship between the quality
of tourism services, destination image, tourist experience, and tourist satisfaction
toward destination preference can be explained in the following. First, the relationship
between service quality and destination preference is described by Gronross in
Bateson (1992), which explains the pattern of the relationship between service quality
and purchase propensity that if the firm fail to render an acceptable serviceoffering,
the perceived service quality may not be good enough and the customerdoes not
return. Quality services can lead to customer satisfaction, and satisfied customers can
be retained and only retained customers can become loyal to the service providers.
During the service delivery, customers overall experience are affected by various

potential interactions such as interactions with service personnel, interactions with
internal and external physical
surroundings (including equipments), and interactions with other customers. On the

other hand, consumers make their decisions based upon their perceptions regardless of
their accuracy or inaccuracy. It is around these perceptions that marketers must build
their competitive strategies. Customer preference analysis is really a call to action. By
understanding the preference or expectations of customers, the organization or resort
can design strategies that are truly responsive to vital customer expectations that can
differentiate in the market place.
Recently, there seems to be dramatic increase in consumer satisfaction research.

Organizations are now using customer satisfaction data to determine service quality in
order to increase customer retention. Many empirical studies have documented that
customer satisfaction culminates in higher customer loyalty, increased market share,
and profitability Therefore, consumer satisfaction is essential to any business survival
due to its substantial bottom line of financial implications as well as quality and service
considerations. It is a judgment that a product or service feature or the product, or
service itself provides a pleasurable level of consumption related fulfillment.
2.2 Research Gap
Research gap in this study is that as the study was on Ayurveda tourism there was a
wide chance to know about the industry & its developments.
Customers tend to compare their perceptions of performance with these reference

points when evaluating service quality (Zeitaml and Bitner, 2000). Thus, customer
preference and perceptions are the first and possibly, most critical step in delivering
quality services. Quality services can lead to customer satisfaction, and satisfied
customers can be retained and only retained customers can become loyal to the service
providers. So customer satisfaction can be maintained only by quality services, better

facilities & good image about the destination in the minds of tourist. This is used in my
study to analyse the attracting attributes.
CHAPTER 3
RESEARCH
METHODOLOGY

3.1 Significance of the Study
The study was conducted to know about Ayurveda Tourism in Kerala with special
reference to Ernakulam district and to know what are the attributes attracting tourist to
Ernakulam for Ayurveda treatment. This study is also done to know about the
satisfaction level of tourist in choosing the destination for Ayurveda treatment. By this
study Ayurveda industry will get an insight about the Ayurveda Tourism industry,
various attributes attracting tourist & the effectiveness of Ayurveda tourism
promotional activities taken by Government of Kerala.
3.2 Objective of the Study
To study the satisfaction of tourist with regards to various destination

attributes in attracting Ayurveda tourism.
To study the importance of Ayurveda tourism in Ernakulam district.
To analyse various marketing strategies adopted by Government of Kerala to
promote Ayurveda tourism.
3.3 Hypothesis
The Push factors & Pull factors - Value, self satisfaction, quality of service,
infrastructure & transportation faculties, image of destination etc leads tourist to choose
Ernakulam for their treatment. There is a positive relation between attributes &
destination choice.
H1 - Self satisfactionof tourist is positively related to destination choice

H2 Valuefor money positively related to destination choice.
H3 Accessibilityfor tourist positively related todestination choice.

H4 Quality is positively related to the destination choice.
H5 Infrastructure is positivelyrelated to destination choice.
H6 Image of destination is positively related to the destination choice.
H7 - Areafactor is positively related to destination choice.
H8 Knowledge positively related to destination choice.
3.4 Research Design
3.4.1 Type of Study
The study is a descriptive research based both on primary data & secondary data.
Primary data were collected through Questionnaires. The questionnaire administrated
on the various attributes leading to destination choice. Secondary data was obtained
for the purpose of knowing about the marketing strategies of Government of Kerala.
The sample size is 100.
3.4.2 Population
In this study, the population constitutes the tourist coming to Ernakulam for taking
Ayurveda treatment in Ayurveda centers in Ernakulam district.
3.4.3 Sampling Frame
Sampling frame was set by random selection of all Ayurveda centers in Ernakulam. All
individual domestic tourists were considered. Persons who are taking Ayurveda
treatment is been included, Wellness tourist are excluded.
3.4.4 Sample
Samples for the study were selected using convenience sampling. The primary data can
be collected from the respondents throughquestionnaire. Data was collected using a set
of 100 questionnaires, which included general questions & also questions related to
destination attributes. Data analysis was done using correlation.

3.4.5 Sample Number
Sample number taken for the study is 100.
3.4.6 Sampling Method
Convenience Sampling was used for the study. A convenience sample is one of the
main types of non-probability sampling methods. A convenience sample is made up
of people who are easy to reach.
3.4.7 Research Model
There are dependent and independent variables. The models investigate how the
former depend on the latter. The independent variables represent inputs or causes, & the
dependent variables represent the output or outcome whose variation is being studied.
The study is on why tourist choose Ernakulam district for taking Ayurveda treatment.
Based on the model we can say that the Push factors are the psychological factors that
attract them for treatment and pull factors represent destination dimensions.
Here these Independent variables such as Self satisfaction, Value, Accessibility, Quality,
Infrastructure, Image, Area, Knowledge, leads to dependant factor i.e. Destination
choice
PUSH FACTORS
Self satisfaction
Value
DESTINATION
PULL FACTORS
CHOICE
ASDFGHJKL
Accessibility
Quality
Schoolof Management Studies, CUSAT
Infrastructure Page |
Image
Area
Knowledge
Cromptons - Push/ Pull Model
The push/pull model is accepted by many researchers, Push factors are defined as
internal motivesor forces that cause tourists to seek activities to reduce their needs,
while pull factors are destination generated forces and the knowledge that tourists
hold about a destination. Most push factors are intrinsic motivators, such as the desire
for escape, rest and relaxation, prestige, health and fitness, adventure and social
interaction. Pull factors emerge due to the attractiveness of a destination, including
beaches, recreation facilities and cultural attractions. Traditionally, push factors are
considered important in initiating travel desire, while pull factors are considered more
decisive in explaining destination choice.
3.5 Data Collection Method
Both primary & secondary data is been used for the study.
3.5.1 Primary Data
The primary data is collected through structured questionnaire, Interview on

structured questionnaire, & observations on persons who are taking Ayurveda
treatment in Ernakulam.
3.5.2 Secondary Data
The secondary data is collected through books, journals & internet.

3.6 Theoretical Definition
The definition of a tourist is a person who visits a location other than his own home.
Crompton (1977) suggested that destination choice should be conceptualized as being a

function of the interaction between pragmatic constraints such as time, money, and
skills and destination images. More recently, this approach was endorsed by Woodside
and Lysonski (1989) in their general model of traveler choice.
3.7 Operational Definition
Destination Choice can be defined as the factors such as Self satisfaction, value,
Accessibility, Image, Infrastructure, Quality, Knowledge and Area that lead a person to
choose a destination while taking Ayurveda treatment in Ernakulam.
3.8 Statistical Tool
SPSS Statistics is a software package it is used for statistical analysis.
Correlation is used to indicate the extent to which two or more variables fluctuate
together. A positive correlation indicates the extent to which those variables increase
or decrease in parallel; a negative correlation indicates the extent to which one
variable increases as the other decreases.
3.9Limitations of the Study
Time was the major limitation for this study.

Convincing the hospital authority for getting data from patients (tourist)
regarding the study was little difficult.
There was no authenticity in the informations provided in the Tourism
department web sites.

CHAPTER 4
DATA ANALYSIS &

INTERPRETATION

4.1 Tourist Gender
Table 4.1
Gender
Cumulative
Frequency Percent Valid Percent Percent
Valid 2 2.0 2.0 2.0
Female 54 52.9 52.9 54.9
Male 46 45.1 45.1 100.0
Total 102 100.0 100.0
Figure 4.1

Interpretation:
Out of the overall Tourist taking Ayurveda treatment in Ernakulam, most tourist that is
54 % is Female & rest 46 % is Male.
4.2 Type of Tourist

Table 4.2
Type
Cumulative
Valid 2 2.0 2.0 2.0
Domestic 100 98.0 98.0 100.0
Total 102 100.0 100.0

Figure 4.2
Interpretation:
Type of tourist taking Ayurveda treatment in Ernakulam is classified as Domestic &

Foreign. The study was purely done among Domestic tourist.
4.3 Occupational Status
Table 4.3
Occupation
Cumulative
Valid 2 2.0 2.0 2.0
Business 35 34.3 34.3 36.3
Homemaker 22 21.6 21.6 57.8
Other 12 11.8 11.8 69.6
Professional 26 25.5 25.5 95.1
Student 5 4.9 4.9 100.0

Figure 4.3
Interpretation
Occupations of tourists taking Ayurveda are classified as Student, Business, Home

maker, Professionals & others.
4.4 Frequency Of Visit
Table 4.4
Frequency of visit
Cumulative
Valid 2 2.0 2.0 2.0
First time 43 42.2 42.2 44.1
More than 2 10 9.8 9.8 53.9
Second time 47 46.1 46.1 100.0
Total 102 100.0 100.0

Figure 4.4
Interpretation
The above data shows the frequency of visit to Ernakulam district for taking Ayurveda
treatment. Around 43% are first time visitors, 47% second time visitors & the
remaining 10% only visit for more than 2 times.
4.5 Purpose Of Visit
Table 4.5

Purpose of visit
Cumulative
Valid 2 2.0 2.0 2.0
Leisure 10 9.8 9.8 11.8
Culture 4 3.9 3.9 15.7
Ayurveda 71 69.6 69.6 85.3
Medical 9 8.8 8.8 94.1
Spa 6 5.9 5.9 100.0
Total 102 100.0 100.0
Figure 4.5
Interpretation
The above data shows the purpose of visit to Ernakulam district for taking Ayurveda
treatment. Here 71% tourists main purpose is for Ayurveda treatment, hence the study
is related to Ayurveda & the population taken was also Ayurveda centers, the remaining
to experience culture. Spas, leisure etc.
4.6 Days Spend

Table 4.6

Days spend
Cumulative
Valid 2 2.0 2.0 2.0
1-7 days 19 18.6 18.6 20.6
8-14 days 10 9.8 9.8 30.4
15-21 days 32 31.4 31.4 61.8
More than21 39 38.2 38.2 100.0
Total 102 100.0 100.0
Figure 4.6
Interpretation
From the about table its clear that 39% of tourist spend more than 21 days in
Ernakulam for their treatment, 32% tourist spend 15 21 days, and the remaining
19% & 10% spend 1 week & 2 weeks respectively.
4.7 From Where Ayurveda Treatment Is Being Taken
Table 4.7

Treatment place
Cumulative
Valid 2 2.0 2.0 2.0
Govt 60 58.8 58.8 60.8
Private 40 39.2 39.2 100.0
Total 102 100.0 100.0
Figure 4.7
Interpretation
The above data shows the type of centre from where tourist take Ayurveda treatment is
been taken. 60 % of tourist takes their treatment from Private Ayurveda centers & 40 %
from government Ayurveda hospitals.
4.8 Amount Spent For Treatment

Table 4.8

Amount spend
Cumulative
Valid 2 2.0 2.0 2.0
5001-20000 20 19.6 19.6 21.6
20001-35000 53 52.0 52.0 73.5
35001-50000 18 17.6 17.6 91.2
Above 50000 9 8.8 8.8 100.0
Total 102 100.0 100.0
Figure 4.8
Interpretation
This data shows the Amount spend by the tourist for taking Ayurveda treatments.
Majority of tourist i.e. 53% spend INR between 20001 35000, 20% spend up to
20000. And 18% & 9% spend up to 50000 & above 50000 respectively.
4.9 Organizer For The Visit To Ernakulam
Table 4.9

Organizer
Cumulative
Valid 2 2.0 2.0 2.0
Self 69 67.6 67.6 69.6
Agents 14 13.7 13.7 83.3
Friends 8 7.8 7.8 91.2
Others 9 8.8 8.8 100.0
Total 102 100.0 100.0
Figure 4.9
Interpretation
69% of tourist visit Ernakulam by their own wish. 14% by through travel agents, 8% by
reference from friends & remaining 9% by other ways.
4.10 Source Of Information About Ayurveda Centres
Table 4.10

Source
Frequenc Cumulative
y Percent Valid Percent Percent
Valid 2 2.0 2.0 2.0
Friend 25 24.5 24.5 26.5
Agents 15 14.7 14.7 41.2
Brochure 5 4.9 4.9 46.1
Internet 45 44.1 44.1 90.2
Magazine 6 5.9 5.9 96.1
Others 4 3.9 3.9 100.0
Total 102 100.0 100.0
Figure 4.10
Interpretation
Most of the tourists get Ayurveda centers information from Web/Internet i.e. 45%. 25%
from friends & family 15% from travel agents. The remaining from Brochures,
Magazines & other sources that is 5%, 6% & 4% respectively.
4.11 Attributes attracting tourist
4.11.1 Self Satisfaction
Table 4.11.1

Correlations
Satisfaction self satisfaction
Pearson Correlation 1 -.352**
Satisfaction Sig. (2-tailed) .000
N 100 100
**
Pearson Correlation -.352 1
self satisfaction Sig. (2-tailed) .000
N 100 100
**. Correlation is significant at the 0.01 level (2-tailed).
Interpretation
Relationship between Satisfaction in Destination Choice and Self-Satisfaction of

the Tourist
The correlation analysis is done between Satisfaction in destination choice and self-
satisfaction of the tourist. The correlation value is found out to be -0.352, a negative
correlation value is obtained from the analysis, but the value is close towards zero. So
from the correlation coefficient value we can infer that there is a neutral relationship
between satisfactions in destination choice and self-satisfaction of the tourist. The
result also shows that the tourists are not self satisfied in choosing Cochin as a
destination for Ayurveda Treatment. Because study reveals that satisfaction is being
plotted below average level.
4.11.2 Value
Table 4.11.2

Correlations
Satisfaction value
N 100 100
Pearson Correlation -.555** 1
Value Sig. (2-tailed) .000
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Value of the Tourist
The correlation analysis is done between satisfaction in destination choice and value.
Value includes the wide range of treatments, Value for money spend etc. The
correlation value is found out to be -0.555, a negative correlation value is obtained
from the analysis. So from the correlation coefficient value we can infer that there is a
negative relationship between satisfactions in destination choice and value of the
tourist. The result also shows that the tourists are not satisfied in money they spent.
4.11.3 Accessibility
Table 4.11.3

Correlations
Satisfaction accessibility
Pearson Correlation 1 -.024
N 100 100
Pearson Correlation -.024 1
Accessibility Sig. (2-tailed) .809
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Accessibility
The correlation analysis is done between Satisfaction in destination choice and

Accessibility for the tourist. The correlation value is found out to be -0.024, a negative
correlation value is obtained from the analysis, but the value is close towards zero. So
from the correlation coefficient value we can infer that there is a neutral relationship
between satisfactions in destination choice and accessibility of tourist. The result also
shows that the tourists satisfaction in choosing Cochin as the destination with respect
to accessibility does not have any significant effect.
4.11.4 Quality
Table 4.11.4

Correlations
Satisfaction quality
N 100 100
Quality Sig. (2-tailed) .000
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Quality of Services
The correlation analysis is done between satisfaction in destination choice and quality
of services. The correlation value is found out to be -0.554, a negative correlation value
is obtained from the analysis. So from the correlation coefficient value we can infer that
there is negative relationships between satisfactions in destination choice and quality of
services tourist receive. The result also shows that the tourist is not satisfied in quality
of services provided & is below average level.
4.11.5 Infrastructure
Table 4.11.5

Correlations
Satisfaction infrastructure
N 100 100
Infrastructure Sig. (2-tailed) .000
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Infrastructure
The correlation analysis is done between satisfaction in destination choice and

infrastructure facilities. The correlation value is found out to be -0.544, a negative
correlation value is obtained from the analysis. So from the correlation coefficient
value we can infer that there is a negative relationship between satisfactions in
destination choice and infrastructure facilities.
4.11.6 Image
Table 4.11.6

Correlations
Satisfaction image
N 100 100
Image Sig. (2-tailed) .000
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Image of Destinations
The correlation analysis is done between satisfaction in destination choice and image.
The correlation value is found out to be -0.603, a negative correlation value is obtained
negative relationship between satisfactions in destination choice and destination image.
The result also shows that the tourists satisfaction in choosing Cochin as the
destination is below average level.
4.11.7 Area
Table 4.11.7

Correlations
Satisfaction area
Pearson Correlation 1 .110
N 100 100
Pearson Correlation .110 1
Area Sig. (2-tailed) .277
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Area
The correlation analysis is done between Satisfaction in destination choice and Area.
The correlation value is found out to be 0.110 a positive correlation value is obtained
no relationship between satisfactions in destination choice and area attribute in
destination preference. The result also shows that the tourists satisfaction does not
depend on the area factor.
4.11.8 Knowledge
Table 4.11.8
Correlations

Satisfaction knowledge
N 100 100
Knowledge Sig. (2-tailed) .000
N 100 100
Interpretation
Relationship between Satisfaction in Destination Choice and Knowledge
The correlation analysis is done between satisfaction in destination choice and

Knowledge. The correlation value is found out to be -0.535, a negative correlation
value is obtained from the analysis. So from the correlation coefficient value we can
infer that there is a negative relationship between satisfactions in destination choice and
knowledge of the tourist. The result also shows that the tourists satisfaction in choosing
Cochin as the destination is below average level or comparatively low.
4.1 Organizations Promoting Tourism
4.1.1 Kerala Tourism Development Cooperation

Table 4.12.1
KTDC
Cumulative
Valid Poor 12 11.8 12.0 12.0
Average 11 10.8 11.0 23.0
21 20.6 21.0 44.0
5 56 54.9 56.0 100.0
Total 100 98.0 100.0
Missing System 2 2.0
Total 102 100.0
Figure 4.12.1
Interpretation
56% agrees that the promotional & marketing activities taken by KTDC are excellent.
12% says it is poor.
4.1.2 District Tourism Promotion Council (DTPC)
Table 4.12.2

DTPC
Cumulative
Valid Dont know 6 5.9 6.0 6.0
Poor 9 8.8 9.0 15.0
Average 18 17.6 18.0 33.0
Good 36 35.3 36.0 69.0
Excellent 31 30.4 31.0 100.0
Total 100 98.0 100.0
Total 102 100.0
Figure 4.12.2
Interpretation
Tourist agrees that the promotional & marketing activities taken by DTPC are 31%
Excellent & 36% Good. 18% says it is Average & 9% says that the action is poor, 6%
says they dont know about it.
4.12.3 TOURFED - Kerala State Co-Operative Tourism Federation Ltd.
Table 4.12.3

TOURFED
Cumulative
Valid Dont know 46 45.1 46.0 46.0
Average 13 12.7 13.0 59.0
Good 20 19.6 20.0 79.0
Excellent 21 20.6 21.0 100.0
Total 100 98.0 100.0
Total 102 100.0
Figure 4.12.1
Interpretation
This is a noticeable data, here 46% dont know about the promotional & marketing
activities/initiatives taken by TOURFED - Kerala state co-operative tourism federation
ltd. Only 21% says it is excellent & 20% as good.
4.12.4 Kerala Travel Mart (KTM)
Table 4.12.4

KTM
Cumulative
Valid Dont know 14 13.7 14.0 14.0
Average 20 19.6 20.0 34.0
Good 41 40.2 41.0 75.0
Excellent 25 24.5 25.0 100.0
Total 100 98.0 100.0
Total 102 100.0
Figure 4.12.4
Interpretation
41% says the initiatives taken by KTM are 23% excellent & 41% good. KTM plays a
major role in development because it brings the sellers & buyers all over the world to
one platform. 14% dont know about this.
4.12.5 Global Ayurveda Festival (GAF)
Table 4.12.5

GAF
Cumulative
Valid Dont know 63 61.8 63.0 63.0
Average 14 13.7 14.0 77.0
Good 16 15.7 16.0 93.0
Excellent 7 6.9 7.0 100.0
Total 100 98.0 100.0
Total 102 100.0
Figure 4.12.5
Interpretation
Global Ayurveda Festival Kerala is an international Ayurvedic biennial event started to

serve as a force to galvanize Ayurvedic sector to aspire, plan and achieve greater
heights. 63% tourist responded they dont know about Global Ayurveda festival. So
they are unaware about the promotional & marketing activities.
4.12.6 Kerala State Industrial Development Corporation Ltd. (KSIDC)
Table 4.12.6

KSIDC
Cumulative
Valid Dont know 41 40.2 41.0 41.0
Poor 3 2.9 3.0 44.0
Average 34 33.3 34.0 78.0
Good 13 12.7 13.0 91.0
Excellent 9 8.8 9.0 100.0
Total 100 98.0 100.0
Total 102 100.0
Figure 4.12.6
Interpretation
God's Own Medicine, an initiative of Kerala KSIDC to promote Ayurveda globally.

Come to Kerala, the only place in the world where Ayurveda is practiced in perfection
its the main attracting caption. 41% tourist responded they dont know about KSIDC.
9% says Excellent, 13% good, 34% say the promotional activities is average, 3% as
poor.

CHAPTER 5
FINDINGS,
SUGGESTIONS &
CONCLUSION
5.1 Findings
H1 -When analysing Destination Choice and Self-Satisfaction negative
correlation value was obtained. So from this value we can say that there is a

neutral relationship between satisfactions in destination choice and self-
satisfaction of the tourist; this implies that tourist is not satisfied in this attribute
in choosing this destination hence this hypothesis is rejected.

H2- This correlation analysis was done between satisfaction in destination choice
and value, a negative correlation value is obtained from the analysis. This result
shows that the tourist is not satisfied as equal to the money they spent for their
treatment, so this hypothesis is also rejected.

H3- This correlation analysis was done between Satisfaction in destination choice
and Accessibility for the tourist. Here there is a neutral relationship between
satisfactions in destination choice and accessibility of tourist. The result shows
that the Accessibility factor provided for tourist is not satisfied, hence the
hypothesis is rejected.
H4- The correlation analysis was done between satisfaction in destination choice
and quality of services. A negative correlation value is obtained from the analysis.
Quality of services provided to tourist is also not satisfied. Hence this hypothesis
is rejected.
H5- This was done between satisfaction in destination choice and infrastructure
facilities. There is a negative relationship between satisfactions in destination
choice and infrastructure facilities. Even though the city is developing tourists are
not satisfied with the infrastructure facilities so this hypothesis is rejected.
H6- The analysis was done between satisfaction in destination choice and image.
There is a negative relationship between satisfactions in destination choice and
destination image. Even though Ernakulam has its own reputation for Ayurveda

tourism, the tourists are not satisfied with the image they are expecting so this
hypothesis is also rejected.

H7- The correlation analysis was done between Satisfaction in destination choice
and Area. There is a no relationship between satisfactions in destination choice
and area attribute in destination preference. This result also shows that the
tourists satisfaction does not depend on the area factor, so this hypothesis is
rejected.
H8- The correlation analysis is done between satisfaction in destination choice
and Knowledge. There is a negative relationship between satisfactions in
destination choice and knowledge of the tourist. Hence this hypothesis is
rejected.
Majority of the visitors are second time & first time visitors, repeat visitors are
less.
Most of the tourists take treatment from Private Ayurveda hospitals; this is
because of the Quality of infrastructure facility in Private hospital as compare
with Government hospitals.

Tourist come to Ernakulamself organized, they depend very least on travel
agents.
Majority of the tourists depended on Websites of particular centres to choose
Ayurveda centre, few depend on travel agents.

Tourism promotional activities by KTDC, DTPC is going good & tourist is aware
about it.
Tourism activities by TOURFED, GAF & KSIDC is less effective, majority of
the tourist are unaware about these promotional activities by these organization.
5.2 Suggestions

Along with Medical tourism visa an exclusive segment should be made for
Ayurveda tourism visa so that more foreigners can visit Kerala for Ayurveda
treatment.
Most of the tourist takes treatment from Private hospitals, even though
Government Ayurveda centres have more experienced & trained doctor, they are
unaware about this factor because of the less infrastructure facilities &
inadequate promotion.
Most people get information through web so there can be some chances of
misrepresentation & boosting through web sites of Ayurveda centres, in order to
avoid this government should take initiatives to provide information to travel
agents so that travel agents can give information to tourist who are in search of
good Ayurveda treatment.

Various initiatives & promotional activities have been taken by government of
Kerala to promote Ayurveda tourism in Kerala but most of the activities are not
reaching up to the customers.

Kerala has a unique strength which attract tourist that is Gods own medicine
Ayurveda, so this strength have to be maintained & promoted seriously. Correct
marketing plans should be adopted by authorities to promote this idea.

Majority of the tourist are not satisfied on the attributes which attract them to
take treatment from Ernakulam, so concerned authorities should concentrate on
the development of this factor.
5.3 Conclusion

The Indian tourism industry has outperformed the global tourism scenario in terms of
growth, revenue and the volume of international tourist visits. A recent trend has shown
that people from developed countries are seeking treatment from the health
professionals from developing countries. The destination in wellness tourism is often an
alternative space in which one can engage in self analysis without the stresses and
distractions of home as well as work place. In the long run, Wellness tourism can
become the niche for foreign revenue generation as there is an increasing trend in the
number of visitors to Kerala as wellness seekers.
The study reveals that the most favorable factor for Kerala to emerge as the Global
Wellness Hub is not positively relating to the expected value. Marketing Kerala as a
safe quality wellness destination depends on effective distribution channels, hospital-
defined market niche strategies, as well as data collection on the sources of information
used to select Kerala as the preferred Ayurveda destination. The action steps outlined
shall generate critical information to further refine the message, selected medium, and
information on the impact of selected marketing techniques to brand Kerala as the
Wellness Hub of the World.
Kerala government must step in the role of regulator, facilitator in order to encourage
private investment in Ayurveda Tourism sector. To achieve new heights, government
has to put its house in order especially in context of medical visa. A Task force needs to
be made which has members from medical field, tour operators & concerned Ministries
which come out with systematic and feasible approach. Though the government has
plans and target of 180 lakh domestic tourists by 2021, the Ayurveda Tourism Industry
with all its potential has not achieved its best results. But it is not properly affecting the
satisfaction level of tourist, so further activities should focus for satisfying tourist need.
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N 3. Special Issue. Pages. 67-78

14. Ramesh U (2011), Ayurvedic Wellness Tourism In Kerala: A Gate Way For
Entrepreneurs To Emerge Successful.
15. Ramesh U, Kurian Joseph (2011), A Study To Develop An Advanced
Marketing Strategy For Wellness Tourism In Kerala Based On The
Prevailing Scenario
16. Sunil Upadhyaya (2014), Prospects in Medical and Wellness Tourism
India, Journal of Tourism: A Contemporary Perspective, Vol 1(1), 1824
17. Yap SheauFena Kew Mei Lian (1981 Service Quality And Customer
Satisfaction KDU College.
Website
1. Official website Kerala Tourism, Government of Kerala

2. https://en.wikipedia.org/wiki/Medical_tourism_in_India
3. https://www.keralatourism.org/ayurveda/
4. https://www.keralatourism.org/ayurvedacentres/
5. www.prokerala.com Health Ayurveda
6. Serhat Harman, Importance Of Destination Attributes Affecting Destination
Choice downloaded on 27 March 2016, 10:55:07

7. Dr.Kunyanga Catherine Nkirote,
http://www.sciencedirect.com/science/article/pii/s1877042814042372
downloaded on 4 January 2016, 21:42:57.

ANNEXURE
A STUDY ON AYURVEDA TOURISM IN KERALA WITH SPECIAL

REFERENCE TO ERNAKULAM DISTRICT
1. Age: ________
2. Sex: Male Female
3. Type of Tourist: Domestic ________________Foreign _____________
4. Occupation:
Student Homemaker Professional Business
Others (Specify) ___________
5. Frequency of visit to Ernakulam:
First time Second time More than 2 times
6. Purpose of visit :
Leisure/Vacation To experience culture Research
Ayurveda treatments Medical treatment Spas / Massages
7. Days spend :
01 07 days 08 14 days
15 21 days More than 21 days
8. From where Ayurveda treatment is being taken :
Government Ayurveda hospitals
Private Ayurveda hospitals
9. Amount spent for treatment : (in INR)
5,001 20,000 20,001 35,000
35,001 50,000 Above 50,000
10. Organiser for the visit to Ernakulam :

Self Travel agents
Friends Others (specify) _____________
11. Source of information about Ayurveda centres in Ernakulam
Friends & Family Travel agents
Tourism brochures Internet
Television Magazine
Others (specify) ____________
12. What are the attributes attracting you as a tourist while choosing Ernakulam, Kerala
for Ayurveda treatment?
5-Strongly agree 4- Agree 3- Neutral 2- Disagree 1- Strongly disagree
Attributes 5 4 3 2 1
Easy accessibility
Efficiency of Ayurvedic treatments
Quality infrastructure
Personalised care & services
Wide range of Ayurvedic treatments availability
Treatment received is value for money spent
Less expensive compared to your place
Reputation of Kerala as a popular Ayurveda destination
Great place for relaxation
Humidity in the climate that best suits for Ayurvedic
treatment
Experiencing Ayurveda in its traditional form along with
yoga and meditation
To learn about Ayurveda in its traditional form
13. How do you rate the following organizations in promoting & marketing Ayurveda
tourism in Kerala?
(Please rate the following)
5-Excellent 4- Good 3- Average 2- Poor 1- Dont know
Organisations 5 4 3 2 1
Kerala Tourism Development Council (KTDC)
District Tourism Promotion Council (DTPC)
TOURFED - Kerala State Co-operative Tourism Federation
Ltd.
Kerala Travel Mart (KTM)
Global Ayurveda Festival (GAF)
Kerala State Industrial Development Corporation Ltd.
(KSIDC)
Gods Own Medicine

14. Are you satisfied in Ayurveda treatment you received in Ernakulam?
Satisfied Neutral Not satisfied

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A Study on Ayurveda tourism in Kerala, with special reference to Ernakulam district .

School of Management Studies, CUSAT Page |

Tourism Industry is deemed as one of the worlds largest industries to be earning

1.2 Types of Tourism

Tourism in India is economically important and is growing rapidly. The World

School of Management Studies, CUSAT Page |

1.2.1 Adventure Tourism

1.2.2 Wildlife Tourism

School of Management Studies, CUSAT Page |

1.2.3 Medical Tourism

1.2.4 Pilgrimage Tourism

1.2.5 Cultural Tourism

1.2.6 Eco Tourism

School of Management Studies, CUSAT Page |

Ecotourism is a form of tourism involving visiting fragile, pristine, and relatively

1.3 Health Tourism

School of Management Studies, CUSAT Page |

In India, Kerala is emerging as the prime destination for Ayurveda Health

School of Management Studies, CUSAT Page |

Figure 1.1 Health Tourism Structure

WELLNESS TOURISM MEDICAL TOURISM

Holistic / Spiritual Medical surgery

Source: Smith and Puzcko (2008)

1.4 Ayurveda Tourism

School of Management Studies, CUSAT Page |

School of Management Studies, CUSAT Page |

School of Management Studies, CUSAT Page |

In order to promote Ayurveda Tourism, Kerala Tourism Development Corporation

1.4.1 Ayurveda Based Wellness Tourism in India

School of Management Studies, CUSAT Page |

School of Management Studies, CUSAT Page |

1.4.2Ayurveda Based Wellness Tourism in Kerala

In reality, Ayurveda is a much serious medical science, which strongly emphasizes on

School of Management Studies, CUSAT Page |

1.4.3Ayurveda Tourism in Ernakulam District

Ayurveda college :1 govt., 2 self financing

13 Government Ayurveda clinics

School of Management Studies, CUSAT Page |

1.4.4 Promoting Ayurveda Tourism

School of Management Studies, CUSAT Page |

1.5 Statement of the Problem

1.6 Objective of the Study

To study the satisfaction of tourist with regards to various destination

School of Management Studies, CUSAT Page |

2.1 Destination Choice

School of Management Studies, CUSAT Page |

2.1.1 Factors affecting destination choices

[A] Transportation (Dynamic phase)

[B] The Destination (Static phase)

School of Management Studies, CUSAT Page |

2.1.1.1 Tourist Self satisfaction

Tourist satisfaction is considered one of the prime variables to sustain competitive

School of Management Studies, CUSAT Page |

Oliver (1981) an evaluation of the surprise inherent in a product acquisition and/or

Values are considered to be important and influential determinants of the human

Literature on economics, sociology, marketing, and consumer behavior offers various

School of Management Studies, CUSAT Page |

Accessibility refers to the design of products, devices, services, or environments for

Moreover, the geographical proximity of the chosen destination, which contributes to

School of Management Studies, CUSAT Page |

surroundings (including equipments), and interactions with other customers. On the

Recently, there seems to be dramatic increase in consumer satisfaction research.

2.2 Research Gap