Electronic word of mouth for the choice of wellness tourism destination image and the moderating role of COVID-19 pandemic

Abstract

Purpose

Information technology as a source of information and decision-making has wider acceptance in contemporary times. Studies have identified the importance of electronic word of mouth (eWOM) and its impact on decision-making. The primary objective of this research is to investigate the relationship between eWOM (pre-travel), destination image (post-visit), tourist satisfaction and eWOM intentions post the COVID-19 crisis. This study is important as it is anticipated that in the post-pandemic world, tourists would seek well-being-enhancing experiences more often than any other form of tourism.

Design/methodology/approach

Data were collected through an online questionnaire circulated over a period of six months from November 2020 to April 2021. Non-probability purposive sampling technique was used.

Findings

The results depicted that wellness destination’s image has a significant influence on wellness tourists’ satisfaction level and their eWOM intentions. Furthermore, it also came to light that the satisfaction level of wellness tourist satisfaction was found to be significantly influencing their eWOM intentions. The mediating role of wellness tourists’ satisfaction was found to be significant from destination image (post-visit) to eWOM intentions. COVID-19 pandemic perceived health risk was also found to be significantly moderating the relationship between eWOM (pre-travel) and eWOM intentions.

Originality/value

Pre-travel online information about a wellness destination is an important determinant of travel decisions, especially during the COVID-19 crisis. This empirical study proves that effective use of this information can advance a destination’s marketing efforts and ensure future demand.

Citation

Goyal, C. and Taneja, U. (2023), "Electronic word of mouth for the choice of wellness tourism destination image and the moderating role of COVID-19 pandemic", Journal of Tourism Futures, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/JTF-08-2022-0207

Introduction

Tourism refers to the movement of people from one location to another in search of peace, solace, pleasure, relaxation, enjoyment, health and sometimes self-discovery (Sotiriadis et al., 2016). Health tourism in general has been referred to as a branch of tourism comprising two subsets namely medical and wellness. Wellness tourism is related to activities directed towards balancing one’s quality of life, environment, body, mental state and spirit (Hartwell et al., 2018). It is one of the booming industries in the world specifically after the COVID-19 crisis as people are further inclined towards refining their quality of life by improving their physical, mental and emotional well-being (Kazakov and Oyner, 2021). As per the report by the Global Wellness Institute in 2021, wellness tourism grew 8% annually between 2017 and 2019 and is expected to grow at 21% annually through 2025 (Global Wellness Institute, 2021). In 2022, Globe News Wire [1] published an article estimating the global wellness tourism market’s value to grow to $US1,250.27bn by 2027 from $US822.44bn as estimated back in 2021.

Past literature suggests a host of advantages for the destinations promoting wellness tourism including entrepreneurial and upgraded employment opportunities which in turn can enhance the well-being of the local people. Wellness destinations have the possibility to earn more from wellness tourists, compared to any other type of tourists, as they tend to spend excessively to fulfil their desire to attain inner peace, tranquillity and transformation. Presumably higher inflow from wellness tourists can be channelised towards modernisation and upgradation of the destination. Lastly, the destinations can earn tourist loyalty through effective strategies and improved service delivery which can help cater to seasonal tourism problems. Information and experience are the two governing factors on which the growth of the tourism sector hinges (Capriello et al., 2013). One of the major weaknesses inherent in the tourism sector is that its product offerings are primarily intangible in nature which is an uncontrollable factor. The industry thus faces the challenge that it is not possible to gauge the product before consumption and hence exchange of information plays an important role (Lewis and Chambers, 2000). The tourism industry is using the Internet to market its services as more and more people use the Internet as their first point to gather information (Büttcher et al., 2016). Various studies propose that after Internet searches the next unbiased and effective method for gathering reliable information is electronic word of mouth (eWOM) (Blazevic et al., 2013).

Destinations choose what to offer based on their resources, unique setting and natural inheritance. India, as a country, holds immense potential in terms of wellness services. It is well received on an international platform due to its ancient knowledge in the field of Ayurveda, yoga and meditation, naturopathy, and spirituality (Karn and Swain, 2017; Suban, 2022). Post the COVID-19 pandemic, like other major world economies, India too is heavily relying on tourism to revive its economy. Under the aegis of central government, the Ministry of Tourism has taken certain initiatives to promote niche tourism products like wellness and adventure tourism and has also invested in the industry. Despite the rising demand for wellness services, the current level of research in this field is limited and needs further discovery (Budiawan et al., 2020). Therefore, it is important to further delve into the marketing side of wellness tourism to acquire more knowledge about it and decode the future trends of this industry.

Past research in wellness tourism mainly relates to the various push and pull motivational factors, benefits sought, intent to travel for wellness services, travel behaviour and socio-demographic factors (Voigt, 2008). To date, little is known about how wellness tourists use eWOM and based on their image of wellness destinations how willing they are to positively contribute to eWOM after their visit. This research strives to enhance the academic literature in the field of wellness tourism and the use of positive eWOM before and after a visit to a wellness destination. It focuses on two aspects of eWOM information processing. In addition, this study reconnoitres the moderating effect of COVID-19 to lay out more appropriate strategies for the wellness destination. The below-mentioned research questions are addressed in this study:

RQ1.

What is the role of electronic word of mouth in the wellness tourism industry?

RQ2.

What is the impact of the COVID-19 pandemic on different attributes of the wellness industry?

Examination of the above research questions can help the stakeholders to engage wellness tourists better in the wellness sector. It can help them in devising unique products backed by their ingenious knowledge. Besides, it is expected that the outcomes of this study will help in advancing academic knowledge by understanding the impact eWOM has in this sector.

Literature review

Wellness and wellness tourism

The concept of wellness dates to 1959 when an American doctor, Halbert Dun, defined wellness as a state comprising an overall sense of well-being of body, mind and spirit (Mueller and Kaufmann, 2001). Wellness is being progressively recognised by people as the foundation for life specially post the COVID-19 pandemic. Additionally, physical fitness too is considered as an integral part of wellness. In European countries, sunshine, sea air and the use of seawater in cosmetic and health treatment, referred to as thalassotherapy, is accepted as indulging in wellness. However, in Asian contexts, wellness relates to an extended version of the above-mentioned practices to include spiritual activities, the practice of yoga, meditation, massages and lifestyle modifications as well. India is one of the Asian countries with a rich wellness heritage dating back to 5000 BC (Markus et al., 2019).

Wellness tourism as a practice, dates to the 18th and 19th ancient Greek and Roman eras (Smith and Kelly, 2006), and involves travelling with an intention to achieve harmony between spiritual, mental and physical well-being for peaceful existence (Chen et al., 2008) furthering it with changes in lifestyle. As a concept, it is interpreted differently across different countries for some it is to do with fun and leisure (Heung et al., 2011) while for others it is about stability and sanctity (Steiner and Reisinger, 2006), while still others attach it to emotional well-being (Smith and Kelly, 2006) and some categorise it as health-promoting relaxation therapies (Smith and Puczko, 2009). Back in 2000, Muller and Kaufman (2000) defined wellness tourism as a branch of health tourism. Wellness tourism was referred to as a subset of health tourism which is primarily undertaken by healthy people with an aim to preserve their health. The main reason for growth in wellness tourism is work–life imbalance leading to stress (Heung et al., 2011). Wellness tourism can thus be understood as a movement of tourists away from their place of residence aimed at aligning one’s mind and body.

Social media and travel

Living in the 21st century, it is unthinkable to envision life in the absence of technology. Knowingly or unknowingly technology casts an influence on one’s decision-making ability. Social media platforms acting as knowledge-sharing networks have become popular in the tourism industry as well, especially in the area of consumer behaviour (Öz, 2015). It has become easier to reach a large audience with a myriad mix of options such as emails, reviews, blogs, chat rooms, instant messenger and virtual communities, available online to disseminate information. Most of these sources pass information asynchronously which gives time to both the sender and receiver to respond. Kotoua and Ilkan, in a study conducted in 2017, found that using a simple website is no longer effective as a tool to market products or services. Customers need a blend of online information from marketers, as well as from past customers, for it to be effective (Kotoua and Ilkan, 2017). Most of the exchange in the Internet era takes place through online platforms; hence, it is important for marketers to gauge the influence of eWOM on potential tourists as well as the eWOM intentions of tourists post service consumption. Unfortunately, due to information overload on social media, the messages get diluted, and a potential reader finds it hard to assimilate and decipher information (Xiang and Gretzel, 2010).

WOM and eWOM

Interpersonal communication is a time-honoured concept in the field of hospitality and tourism. The oldest definition of word of mouth (WOM) was given by Katz and Lazarsfeld (1966), who described WOM as information barter between consumers. Anderson (1998) has defined traditional WOM as private face-to-face communication between two or more parties in an informal environment where they share their experiences related to the consumption of a product or service. In the latest literature, WOM has been referred to as the non-digital communication between two or more people concerning their views of a product or service they have used. It is supposed to be one of the most credible communication channels (Jalilvand and Samiei, 2012).

Shannon and Weaver (1949) developed a communication model that helps to bring out some differences between traditional WOM and eWOM. Due to an increase in the use of the Internet and web browsing, the way people process information has changed significantly and this change is reflected in the way traditional WOM has been replaced by eWOM. eWOM leads to an impersonal source–receiver relationship, lack of physical contact, information solicitation from unknown platforms, and a longer span of message retention (Hennig-Thurau and Walsh, 2003). Information exchange can be either done in person (also referred to as WOM) or through electronic means (eWOM). It is an important service promotion tool, whether done in physical or virtual space, for the service providers because of the intangible nature of the service. With WOM being extended to electronic media, it has become more convenient to access information and eWOM plays a significant role in guiding purchase behaviour (Cheung and Lee, 2012). The elementary difference between eWOM and WOM is that eWOM takes place between two people with the use of the Internet while WOM takes place without the use of the Internet. Various studies list major differences between traditional WOM and eWOM. Primarily, it is believed that eWOM is widely available to anyone at any point in time and is not constrained by either time or location. It remains available for a longer duration and thus gets embedded into deeper memory and casting a greater influence than traditional WOM on a potential consumer’s decision-making process (Lee, 2009). WOM communication can take place either pre- or post-consumption of services. It has been observed over time that WOM exerts a substantial influence on purchase behaviour (East et al., 2007). It is considered to be most influential in the formation of destination image (Baloglu and McCleary, 1999) and casts an influence on prospective consumer’s decision and their post-purchase behaviour. The literature supports the proposition that consumers have greater faith in information received through WOM than through paid commercials and advertisements (Gruen et al., 2006).

This research focuses on both aspects of eWOM information processing, i.e. how a consumer seeks information through eWOM pre-consumption and their intention to contribute to the eWOM post-consumption of wellness services in India. The early studies on WOM pertain to discussions around post-experience WOM behaviour. Lately, authors including Godes and Mayzlin (2004) and Duan et al. (2008) extended the literature by talking about the influence online reviews (one of the fundamental ways of eWOM) exert on a consumer’s before-consumption behaviour and after-consumption behaviour.

Tourist behaviour

Tourist behaviour can be evaluated in three distinct time phases, i.e. pre-travel (pre-visit), during travel (onsite behaviour) and post-travel (post-visit evaluation) (Chen and Tsai, 2007). Addo et al. (2020) pointed out the great shift in purchase behaviour of people moving from in-store to online purchases. This paper asserts that eWOM, due to its wide reach, faster diffusion and technological advancement has a greater impact on influencing the travel decision of wellness tourists.

eWOM pre-travel

eWOM is defined as “any positive or negative statement made by potential, actual, or former customers about a product or company, which is made available to a multitude of people and institutions via the internet” (Hennig-Thurau and Walsh, 2003). It is a process of gathering information from past users for the benefit of potential users before they make a purchase decision, and it further helps in information dissemination by overcoming barriers of time and place (Chu and Kim, 2011). eWOM entails communicating through electronic media, such as online discussion forums, electronic bulletin board systems, newsgroups, blogs, review sites and social networking sites (Cheung et al., 2008). The presence of innumerable online platforms provides plenty of opportunities for tourists to share their reviews and ratings online. It is the most potent way of promoting tourism destinations (Litvin et al., 2008) and is said to have numerous advantages over WOM such as low cost of information dissemination, extensive reach, broader scope and greater lifespan of communication. The industry supports the proposition that favourable online reviews regarding a place or service are likely to increase the likelihood of booking (Campbell, 2012). A study by Castaneda in 2007 revealed positive role of eWOM on tourist satisfaction due to believably unbiased information available on online sources which enables them to align their expectations with their needs (Castaneda et al., 2007). According to Tourism Economics reports, 34% of European travellers saw an effect of online reviews on their travel choices (Tourism Economics, 2013) as it does away with any kind of personal bias which might exist in the case of a known person disseminating information as in traditional WOM (Abubakar et al., 2016). In addition, a study by Gruen et al. (2006) determined the impact of eWOM on their behavioural intentions. Some authors have studied the influence of eWOM on destinations though limited research has been conducted on post-visit eWOM intentions and resulting behavioural outcomes. Early studies in the field of eWOM were primarily on how eWOM has become an important source of information followed by studies on eWOM-related consumer behaviour (Litvin et al., 2008). Broadly, eWOM can be viewed from four perspectives: senders’ perspective, receivers’ perspective, tourism organisers’ perspective and third parties’ perspective. This study focuses on the receivers’ perspective. Very little is known from the existing literature about the use of eWOM as a source of information pre-travel and its impact on travel decisions. It is unclear how much information gathered through eWOM pre-travel is used to narrow down the choice of destination. Cheung and Thadani (2012) in their review of literature on eWOM concluded that adoption of existing eWOM before travel is an important variable but this is not reflected in tourism studies and especially in the wellness tourism domain. The following hypotheses are proposed:

H1.

eWOM (pre-travel) has a significant impact on eWOM intentions.

H2.

eWOM (pre-travel) has a significant impact on wellness tourist satisfaction.

Destination image

Fakeye and Crompton (1991) defined destination image as an individual’s psychological outlook and perception of a particular destination. A destination’s image is a result of factors ranging from safety, cultural and natural environment of a place. It can be recognised from affective as well as cognitive perspectives. Affective perspective refers to the general feelings of a tourist whereas cognitive refers to information about a tourist destination and their beliefs (Jamaludin et al., 2012). Hultman et al. (2015) in a paper concluded that a destination character impacts tourists’ promotion behaviour. Souiden et al. (2017) further support the idea that destination image acts as a predecessor to forming an attitude towards a destination. Based on the empirical evidence by these authors, it can be inferred that destination image is a predictor of a tourist’s post-tour behaviour. The outcome of a study carried out by Chi and Qu (2008) supports the direct effect of destination image on tourist satisfaction. Research by Assaker and Hallak (2013) confirms a significant relationship between destination image and tourist satisfaction. Findings additionally suggest a positive relationship between destination image and tourists’ satisfaction (Girish et al., 2017; Martín-Santana et al., 2017). The following hypothesis is proposed:

H3.

Destination image (post-visit) significantly influences wellness tourist’s satisfaction.

Tourist satisfaction

Satisfaction depends on post-service experience where a tourist compares expectations with actual experience. If the service experience falls short of expectations, then a tourist feels dissatisfied, but if the service experience surpasses expectations, then a tourist is satisfied (Çoban, 2012). Tourist satisfaction plays an important role as it influences the eWOM intentions in the future and acts as a marketing tool to draw the attention of potential tourists. Studies by San Sam Martin et al. (2018) and Song et al. (2013) confirm the impact of satisfaction on revisit intentions and WOM stating that a satisfied tourist is bound to positively endorse the experience and products. Satisfaction casts a sizeable influence on consumer behaviour. A satisfied consumer is more likely to repeat the action of purchase irrespective of the product category, similarly, a satisfied tourist is more likely to revisit the destination (Ahn et al., 2017).

Studies point to the mediating effect of satisfaction between destination image and tourist behavioural intentions post-tour (Assaker and Hallak, 2013; Hultman et al., 2015). A study by Chu and Kim (2011) shows that when tourists are satisfied it not only improves their loyalty but also boosts positive behavioural disposition. Most of the tourism literature confirms the positive relationship between tourist satisfaction and positive WOM (Tsao and Hsieh, 2012), yet there is another set of researchers who have proven that satisfactory behaviour need not necessarily create a desire to recommend the services to others (Dolnicar et al., 2015). Therefore, there is a need to further examine the relationship between satisfaction and intention to recommend using social media platforms. Castaneda et al. (2007) found a positive correlation between tourist satisfaction and eWOM. This study validates the idea that the more information a tourist gathers from online sources it enables them to plan their trip to the minutest details to not fall short on expectations and satisfaction. By effective segmentation, targeting, positioning and other marketing mix strategies, marketers can increase tourist satisfaction (Cohen et al., 2014).

eWOM intentions

eWOM intention has been documented as one of the post-visit behavioural outcomes of tourists and with its growing importance for customer retention it is important to evaluate it in depth. Positive eWOM has received little attention in the past literature as more emphasis has been upon two components, namely revisit intentions and tourist loyalty (Jalilvand et al., 2017). Destination image and tourist satisfaction are precursors for several behavioural outcomes including positive eWOM intentions (Chen and Law, 2016). Thogersen et al. (2009) suggested that dissatisfaction is positively correlated to negative eWOM intentions. eWOM has got attention in the literature but little research has been published in the area of factors influencing eWOM intentions (Yang, 2017). The following hypotheses are proposed:

H4.

Destination image (post-visit) significantly influences eWOM intentions.

H5.

Wellness tourist satisfaction significantly influences eWOM intentions.

H6.

Wellness tourist satisfaction mediates the effect of destination image (post-visit) on eWOM intentions.

COVID-19 perceived health risk

Recently, the world was hit by the worst pandemic ever, COVID-19, which made people grow noticeably fearful and hesitant about travel. It has had distressing effects on the world tourism industry since the virus spreads by coughing, sneezing and talking and its transmission often goes unnoticed. The tourism industry which was one of the fastest-growing industries before the COVID-19 pandemic was worst hit by pandemic, but it is expected to re-emerge sooner than others, especially the wellness tourism segment (Crossley, 2020). Just like the global recession of 2008, the COVID-19 pandemic too has affected the mental health and well-being of people. It has left individuals looking for newer avenues to relax and rejuvenate. One of the ways to lessen the effect of this pandemic is to focus more on domestic tourists than on international tourists as countries did in the past during the SARS, influenza and H1N1 pandemic, which raised similar travel fears (Todman-Lewis, 2017). A prerequisite for post-pandemic travelling is to instil a sense of security to put faith in the service provider (Chung and Kwon, 2009). Once built, this trust will guide long-term connections between tourists and service providers and impacts tourists’ post-purchase behaviour, i.e. future repeat visit intention. A recent global study advocated 80% of travellers would pay more for safer arrangements (The Jakarta Globe, 2020).

Wachyuni and Kusumaningrum (2020), in their recent study conducted in Indonesia, concluded that a majority of tourists show an inclination to travel within six months of the end of this pandemic. Potential tourists have shown a proclivity to travel for human needs (i.e. internal needs such as peace and self-actualisation) and have already made plans about where to go and with whom to travel. This leads us to believe that the future of the wellness industry is bright and various studies suggest a state of over-tourism due to stress and anxiety caused by the pandemic (Assaf and Scuderi, 2020).

Today’s modern tourists embrace change and are ready to adapt to the new environment even during uncertain times due to the mental pressure experienced by many during isolation and quarantine periods. The need to stay well has emerged more prominently than ever in the past as people face deeper psychological problems like stress, anxiety, confusion, depression, frustration, boredom and financial challenges to name a few (Brooks et al., 2020). Raised concerns over restoration of overall well-being among people have led to a rise in the demand for wellness services. All of the above research indicates an urgent need to look into internal well-being and hence a growth in the wellness tourism sector. The authors proposed to study the moderating effect of COVID-19 perceived health risk (C19PHR) on various constructs (Majeed and Ramkissoon, 2020). The following hypotheses are proposed:

H7.

COVID-19 pandemic perceived health risk moderates the relationship between destination image (post-visit) and eWOM intentions.

H8.

COVID-19 pandemic perceived health risk moderates the relationship between destination image (post-visit) and wellness tourist satisfaction.

H9.

COVID-19 pandemic perceived health risk moderates the relationship between eWOM (pre-travel) and eWOM intentions.

H10.

COVID-19 pandemic perceived health risk moderates the relationship between wellness tourist satisfaction and eWOM intentions.

Proposed model

With the deeper influence that wellness tourism casts upon societal and financial well-being, it is imperative to conduct research in this area in the present times. Numerous studies have identified the importance of eWOM and its effects, but very few studies have thrown light on eWOM absorption pre-travel and tourists’ eWOM intentions post-travel in the wellness tourism domain. Little research has been done in the area of potential wellness tourists gathering eWOM information before travel, their contentment level, destination image (post-visit) and their eWOM intentions post-travel in the same study. No studies in the tourism context have simultaneously examined the structural relationships among eWOM (pre-travel), destination image (post-visit), tourist satisfaction and eWOM intentions. Therefore, to bridge this gap, the objective of this research is to investigate the relationships among online WOM (before travel), destination image (post-visit), tourist satisfaction, online WOM intentions post-travel, socio-demographics and travel behaviour of tourists in the wellness industry.

The questionnaire consists of two parts. Part 1 of the questionnaire comprises statements to measure Electronic Word-of-Mouth Pre-Travel (eWOMpre), Destination Image (post-visit), Wellness Tourist Satisfaction, Electronic Word-of-Mouth Post-Travel, and C19PHR. eWOM pre-travel is adapted from previous studies and measured with the following four statements, “I often read other tourist’s online travel reviews to know what wellness destinations make good impressions on others.”, “I often read other tourist’s travel reviews to make sure I choose the right wellness destination.”, “I frequently gather information from tourist’s online travel reviews before I travel to a certain wellness destination.” and “Tourist’s online travel reviews make me confident in travelling to a wellness destination.” (Bambauer-Sachse and Mangold, 2011; Jalilvand and Samlei, 2012). Chen and Tsai (2007) and Su et al. (2017) identified destination image (post-visit) as a latent construct measured by the following three items, “India as a wellness destination left me with a profound and good impression.”, “India as a wellness destination has a good image among wellness tourists.” and “I believe that India as a wellness destination has a better image than other comparative wellness destinations.”. Further, the concept of tourist satisfaction has been measured by various authors.

For the purpose of this study, items for measuring wellness tourist satisfaction were adapted from the works of Su et al. (2017) and He et al. (2018) with the following statements, “In general, I am satisfied with my visit to India/within India for wellness services.” and “Compared to my expectations, I am satisfied with my visit to India/within India for wellness services.”. In line with previous studies by Ha and Jang (2010) and various other authors, Electronic Word-of-Mouth Post-Travel Intentions (eWOMint) were measured using an adapted scale with the following statements, “I will feel good when I can tell others about my wellness experience via online sources in the future.”, “I intend to share about my wellness experience with other members through online sources in the future.” and “I intend to say good things about my wellness experience on online sources.”. The Scale of C19PHR was sourced from Dolnicar (2007) and adapted in accord with Majeed and Ramkissoon (2020) with six statements, “I worry that my health might suffer from the occurrence of infectious disease at the wellness destination.”, “I worry that my traveling decision might be affected by the threat of infectious disease at the wellness destination.”, “I worry that I might be exposed to the risk of contagious diseases.”, “I do not worry about the happening of epidemics at the wellness destination.”, “During traveling to a destination, I constantly worry that something may go wrong.” and “A thermometer to measure fever will help to monitor my health and protect myself from disease (if any).”. Part 2 of the questionnaire consisted of basic demographic questions and questions related to travel behaviour capturing information related to their primary purpose of travel, travel partner, travel duration and types of wellness services availed while on their trip.

These proposed relationships are shown in the conceptual model in Figure 1.

Methodology

Survey instrument and measurement of variables

The survey instrument was developed from existing scales. Comprehensive literature was studied, and its content was assessed by academic colleagues to determine the face validity of its items. To verify content and contextual clarity, the instrument was tested with 30 wellness travellers. All construct items were rated on 7-point Likert scale. Items for wellness tourist satisfaction were rated from Completely Dissatisfied to Completely Satisfied, eWOM Intentions were rated from Very Unlikely to Very Likely, and all the other construct items were rated from Strongly Disagree to Strongly Agree.

Travel behaviour and socio-demographic factors

Market segmentation is the process of dividing the market into smaller sub-segments for planned targeting. This concept is widely applied in the tourism marketing context to understand the profiles of different tourists for effective strategy formulation based on differences among them (Dolnicar, 2002). A substantial body of literature backs the notion that women and men infer and respond differently to perceived risks (Eckel and Grossman, 2008).

Data collection

Data were collected through this survey instrument and circulated online over a period of six months from November 2020 to April 2021. Non-probability purposive sampling technique was used to collect data as due to the onset of COVID-19 pandemic there were travel restrictions. It is the most used sampling method due to the convenience of obtaining responses. More than 170 potential respondents were randomly contacted through various social media platforms, blogs, wellness company websites and personal WOM and asked if they were willing to participate in the study. Some refused to participate stating it was a breach of their privacy while 135 of the contacted respondents responded within reasonable time, with a non-response rate of 20%. To further narrow down to a representative sample, the respondents were asked if they had ever travelled to avail any wellness service in India and to provide further clarity wellness services were defined for them as any one-day residential exposure undertaken at any Indian wellness centre to avail services like spa, mediation, spiritual retreat, yoga, etc. The number of respondents who could complete the survey was 125, 110 of which were useable. Thirteen responses were removed as they were unengaged responses and two were duplicate entries.

Methods

Scale reliability using Cronbach’s alpha

Cronbach’s alpha was calculated to measure the internal consistency and scale reliability. Cronbach’s alpha is the average value of the reliability coefficients that would have been obtained for all possible combinations of items when split into two half-tests (Gliem and Gliem, 2003). The value of the coefficient normally ranges between 0 and 1 and the higher the value the higher the internal consistency of the items. Cronbach’s alpha (α) values greater than (or equal to) 0.7 are generally accepted for reliability. The Cronbach’s alpha value for each of the predictors was greater than 0.80 as shown in Table 1. Thus, the internal consistency in the items on the scale was high.

Reliability and validity

To test the reliability and validity, Composite Reliability (CR), Average Variance Extracted (AVE) and Maximum Shared Variance (MSV) are calculated. For reliability, CR should be greater than 0.70 for all factors. As shown in Table 2, the CR is more than the required threshold for all factors and reliability is established for this study. To test the convergent validity, AVE is calculated, and it should be more than 0.50 for all the latent factors (Fornell and Larcker, 1981). AVE is also above the threshold of 0.50 for all the latent factors of this study as shown in Table 2 (Gefen et al., 2000). For discriminant validity, MSV should be less than AVE and the square root of AVE should be greater than the inter-construct correlations (Gefen et al., 2000). As a result, discriminant validity for this study is validated.

Results

According to the sample’s demographic breakdown, women (54.5%) make up most wellness travellers as compared to men (45.5%). In terms of the age of respondents, most of the young people aged between 18 and 30 years actively seek wellness which totalled roughly 57.2%. Respondents above the age of 40 averaged 30% of the respondents. So, it can be assumed that younger people below 30 years and people above 40 years are more willing to take wellness trips and take care of their well-being than people in the ages between 30 and 40 years. About 41.3% of the travellers were married, with the remaining being either single, widowed, divorced or separated.

Structural model

With reliability and validity established, the structural model was tested using AMOS 21. Table 3 shows the estimates and the p-values of the hypotheses tested. The relationships are significant at p-value less than 0.05.

Table 4 shows the standard regression weight estimates of the relationships in the model. The model was an optimum fit with GFI of 0.881, CFI of 0.959, RMSEA of 0.073 and model χ²/df of 1.582 shown in Table 5 as the values were above the acceptable threshold values of 0.80 (for GFI and CFI), 0.08 (for RMSEA) and less than 5 (for χ²/df). Thus, the model shown in Figure 2 was accepted as the final research model.

Results of structural equation modelling (model fit summary)

A structured equation path model was used to test the hypothesised relationships in the model. The results confirmed that wellness destination image (post-visit) significantly influences wellness tourists’ satisfaction level and significantly influences their eWOM intentions. Wellness tourist satisfaction level was also found to significantly influence their eWOM intentions. The mediating role of wellness tourists’ satisfaction was found significant between destination image (post-visit) and eWOM intentions. COVID-19 pandemic perceived health risk was found to be significantly moderating the relationship between eWOM (pre-travel) and eWOM intentions of wellness tourists.

A previous study by Litvin et al. (2008) suggests that eWOM is one of the most influential sources of information and has an everlasting impact on tourists’ perceptions and destination image formation. The expected relationship between the effect of eWOM (pre-travel) on eWOM intentions (H1) was statistically insignificant. H2 states eWOM (pre-travel) has a significant impact on wellness tourist satisfaction. The empirical results of this study unlike the research findings of Castaneda et al. (2007) suggested that eWOM (pre-travel) does not have a significant impact on wellness tourist satisfaction. H3 states Destination image (post-visit) significantly influences wellness tourist’s satisfaction which was supported by the path coefficient (standardised beta = 0.50, p < 0.001) same as suggested in a study by Chi and Qu (2008) which reiterated that among various other factors, the destination image (post-visit) is a significant factor leading to tourist satisfaction. H4 states Destination image (post-visit) significantly influences eWOM intentions was also supported (standardised beta = 0.32, p < 0.001). In accordance with a previous study by Zhang et al. (2021), in the context of Chinese tourists, the present study supports the idea that a satisfied tourist has positive eWOM intentions. H5 states Wellness tourist satisfaction significantly influences eWOM intentions (standardised beta = 0.64, p < 0.001) which was supported by the path coefficient. H6 states Wellness tourist satisfaction mediates the effect of destination image (post-visit) on eWOM intentions which was supported by the path coefficient. H7, H8 and H10 are not supported, these test the moderating effect of the COVID-19 pandemic perceived health risk between different constructs. Only H9 which states COVID-19 pandemic perceived health risk moderates the relationship between eWOM (pre-travel) and eWOM intentions was tested significant. The results of all the hypotheses tested through the suggested model are tabulated in Table 6.

Discussion

The Ministry of Tourism, Government of India [2] in their latest report on Niche Tourism has cited World Tourism Organization’s (2021) estimate of the increasing significance of health tourism sector, especially in developing countries. A report published by Mordor Intelligence 2021 [3] reported India as the fastest-growing wellness destination before COVID-19 pandemic crisis. India saw a fall in inflow of wellness tourists due to the pandemic in the year 2020 that lead the country to slip to 12th most preferred wellness destinations in the world on the list of 20 most preferred destinations.

Tourism research has studied concepts, such as satisfaction, revisit intentions, recommendations and WOM. This paper attempts to study the impact of eWOM pre-travel and eWOM intentions post-visit for wellness tourists considering the moderating impact of C19PHR. The study supports the literature in numerous ways. It is in conformance with previous studies and supports the argument that a destination’s image casts a significant impact on tourist satisfaction even in the wellness domain. Moreover, this study unveiled a negligible moderating effect of C19PHR on several constructs, which Majeed and Ramkissoon’s (2020) previously published research did not reveal. According to research by Chen and Law (2016), it was found that the destination image of a wellness destination significantly impacts the satisfaction level and eWOM intentions of the wellness tourist.

This study shows that even after securing information through online sources termed as eWOM pre-travel wellness tourists do not intend to post their wellness experiences online referred to as eWOM intentions. However, the destination image (post-visit) of a wellness destination and tourist satisfaction were found to be significantly influencing a wellness tourist’s eWOM intentions. Observing the results of moderating impact of C19PHR scale on the relationship between different constructs, it seems wellness tourists no longer worry about contracting the virus and give top priority to their wellness. The results show a positive and inflated demand for wellness trips in future.

Theoretical contribution

This study contributes to the field of wellness tourism in different ways. It indicates that most of the wellness travellers prefer travelling for pleasure along with their family members after the COVID-19 pandemic has gripped the world. Evidently, wellness tourists trust their family and friends and weighed their WOM suggestions and recommendation more than any other source of information. This research shows more married women travelling for wellness purposes than male travellers indicating greater stress levels experienced by women in comparison to men.

This study provides inputs to further explain the impact of recent COVID-19 pandemic on the wellness industry in the health tourism sector. It found significant association of C19PHR with eWOM publicity in the wellness tourism domain indicating a practical implication for destination managers to communicate their risk management practices through all sources of information dissemination.

This study does not exhibit a substantial relationship of wellness tourists’ e-WOM (pre-travel) with wellness tourist satisfaction and eWOM intentions. Even though e-WOM (pre-travel) may seem to foster loyalty in general, in the case of wellness tourists, it is observed that their dependence on online reviews does not determine their level of satisfaction and does not guide their intentions to voice their opinion on online platforms.

Several authors in the past have established a positive impact of destination image (post-visit) on tourist satisfaction in varying fields of tourism studies using different sample sizes (Chen and Tsai, 2007; Kim, 2018; Reza Jalilvand et al., 2012; Setiawan et al., 2014; Su et al., 2017). The findings of this study are in accordance with the previous studies and show a positive relationship between destination image (post-visit) and wellness tourist satisfaction. Thus, expanding and further validating the existing literature on the positive relationship between destination image and tourist satisfaction in the wellness tourism domain. The positive wellness destination image is said to instil destination loyalty and positive behavioural intentions among tourists. The behavioural intention in the context of spreading eWOM is not a well-researched field as of date. Scholars have also tested the relationship between destination image and eWOM intentions. The findings of this study also suggest a positive link similar to earlier research by Wu and Li (2017) and Zhang et al. (2018) of destination image casting an influence over eWOM intentions.

As proposed by different authors in the past, this study reaffirms the instrumental role satisfaction plays in driving positive WOM intentions even in the wellness tourism sector (Prayag et al., 2017; Su and Hsu, 2013). Contemporary studies have explored the significant partial and full mediation effect of satisfaction on behavioural outcomes in the case of niche tourism namely heritage tourism (Chi and Qu, 2008; Chen and Chen, 2010). The mediation effect of wellness tourist satisfaction on image and eWOM intentions was also investigated in this study, and as expected, it was proven to be significant. This illustrates that delighting wellness tourist is of prime importance as only a deeply satisfied tourist will have the inclination to post positive WOM.

The recent COVID-19 pandemic has induced fears in the minds of tourists since it is believed to spread by touch. Since wellness industry mainly encompasses therapeutic services, yoga and ayurvedic massages which involves the therapist touching the tourist, the perception of risk of transmission increases. Many authors have applied the olden concept of perceived health risk in case of COVID-19 (Dolnicar, 2007; Majeed and Ramkissoon, 2020). The authors proposed to study the moderating impact of C19PHR on eWOM (pre-travel) and eWOM intentions which were found significant and indicates that tourists’ read other tourists’ reviews online before travelling and due to risk of contracting COVID-19 they too intend to express their views online for a wide reach. The moderating effects of the C19PHR between destination image and eWOM intentions and between destination image and wellness tourist satisfaction were also found to be insignificant. Furthermore, the moderating impact on eWOM intentions and satisfaction among wellness tourists was found to be negligible.

This study is the first to examine the moderating impact of the COVID-19 pandemic on the wellness industry in view of electronic media, thus adding to the knowledge of customer behaviour. Since India relies heavily on tourism for generation of foreign exchange, this study provides an important foundation for further research on the role and importance of eWOM publicity in the post-pandemic era. With new strains of virus contracted across the world frequently, managers and policymakers need to create a positive change by taking electronic sources into consideration to improve their foothold in this sector.

Managerial implications

The latest report by the Ministry of Tourism, Government of India (2022) [2] seconds India’s potential in hosting wellness tourists from across the world given it is the place of birth of most ancient and holistic healing techniques as the country celebrated its 75th year of independence in 2022. Going forward, India aims to become self-reliant with a greater focus on accelerating the country’s development and believes the wellness sector to significantly contribute to its growth. The Ministries of the Central and State governments and the private sector are endorsing the country as a wellness destination under the “Heal in India” campaign. At this point in time, firms are using social media to promote their brands and gain customer attention, and an empirical research paper in this area is of prime importance. This paper aims at understanding a consumer’s perspective on the use of eWOM pre-travel and its influence on their post-visit destination image and satisfaction post-travel. Additionally, it tries to comprehend the post-experience eWOM objectives of wellness tourists and how these relate to their satisfaction and perception of the destination.

The study shows a significant effect of destination image (post-visit) on wellness tourists’ satisfaction and on tourists’ eWOM intentions. Therefore, service providers in the wellness sector should focus on creating a positive destination image by handling customer relationships well and handling their complaints in a judicious manner so as to generate positive eWOM. Wellness facilities must do more than merely address complaints from unhappy clients or offer incentives.

Many times, since customers expect a reward if they show dissatisfaction on online platforms, the service providers should turn their attention to reaching out to travel influencers and extend free stays to them in lieu of publicity on their social media profiles. The resorts can particularly appeal to these influencers to show how the resort is taking measures to delight their customers and show testimonials of the same.

Marketing managers working in wellness tourism can optimise their operational efficiency by actively managing their reviews and comments on various digital platforms. The information transmitted through online sources pre-travel to a wellness destination casts an unparalleled influence on the travel decisions of wellness travellers more so during the COVID-19 crisis. Effective use of this information can further their marketing efforts and will help to keep their services relevant during the pandemic.

Limitations and suggestions for future studies

This study used purposive sampling and a very small sample size due to the COVID-19 outbreak which had decimated the number of wellness travellers across the country. The Global Wellness Institute forecasts that wellness tourism would rise at a colossal 20.9% annual rate during 2020–2025 given the recovery of wellness travel post-2022 [4]. The above findings are supported by a survey undertaken by American Express [5] which states that tourists are planning to spend the same or more on wellness travel compared to pre-pandemic years.

Further studies can adopt better sampling techniques with larger sample sizes to overcome these limitations. We suggest a complementary qualitative study to further explore the eWOM literature and examine it in tourists’ digital advocacy space. Additional variables, such as perceived value, service quality and trust, can be included in future research. These research findings are specific to the wellness tourism industry in India and additional studies in different geographies are required.

Figures

Figure 1

Conceptual model

Figure 2

Model results

Table 1

Scale reliability using Cronbach’s alpha

Factor	Cronbach’s alpha
EWOMpre	0.882
DI	0.891
WTS	0.933
EWOMint	0.928
COVID_PHR	0.812

Note(s): EWOMpre stands for electronic word-of-mouth pre-travel, DI stands for destination image, WTS stands for wellness tourist satisfaction, EWOMint stands for electronic word-of-mouth intentions, COVID_PHR stands for COVID-19 perceived health risk

Source(s): Table 1 by authors

Table 2

Reliability and validity of constructs for the model

Construct	CR	AVE	MSV
EWOMpre	0.889	0.669	0.068
DI	0.902	0.754	0.336
WTS	0.933	0.875	0.397
EWOMint	0.925	0.804	0.397

Note(s): EWOMpre stands for electronic word-of-mouth pre-travel, DI stands for destination image, WTS stands for wellness tourist satisfaction, EWOMint stands for electronic word-of-mouth intentions

Source(s): Table 2 by authors

Table 3

Results of structural equation modelling

			Estimate	S.E	C.R	P
WTS	<---	DI	0.498	0.087	5.719	***
EWOMint	<---	WTS	0.640	0.145	4.423	***
EWOMint	<---	DI	0.319	0.126	2.529	0.011
EWOMint	<---	EWOMpre	0.167	0.069	2.408	0.016
EWOMint	<---	INT_EWOMPreCOVID	0.157	0.082	1.917	0.055
EwomPretravel_4	<---	EWOMpre	1.000
EwomPretravel_3	<---	EWOMpre	1.007	0.093	10.843	***
EwomPretravel_2	<---	EWOMpre	0.858	0.079	10.846	***
EwomPretravel_1	<---	EWOMpre	0.848	0.106	7.989	***
DI3	<---	DI	1.000
DI2	<---	DI	1.020	0.090	11.361	***
DI1	<---	DI	0.893	0.087	10.300	***
WTS2	<---	WTS	1.127	0.087	12.887	***
WTS1	<---	WTS	1.000
eWOMintentionsPostvisit_2	<---	EWOMint	1.000
eWOMintentionsPostvisit_3	<---	EWOMint	0.988	0.076	12.980	***
eWOMintentionsPostvisit_1	<---	EWOMint	0.990	0.069	14.384	***

Note(s): EWOMpre stands for electronic word-of-mouth pre-travel, DI stands for destination image, WTS stands for wellness tourist satisfaction, EWOMint stands for electronic word-of-mouth intentions, COVID_PHR stands for COVID-19 perceived health risk, Int_EWOMPreCOVID stands for interaction effect of electronic word-of-mouth pre-travel and COVID-19 perceived health risk

***represents a value less than 0.001

Source(s): Table 3 by authors

Table 4

Standard regression weight estimates of the relationships in the model

Results of structural equation modelling (estimates)			Estimate
INT_EWOMPreCOVID	<-->	COVPHRS	−0.179
EWOMpre	<-->	DI	0.159
EWOMpre	<-->	INT_EWOMPreCOVID	−0.204

Note(s): Int_EWOMPreCOVID stands for interaction effect of electronic word-of-mouth pre-travel, COVPHRS is COVID-19 perceived health risk, EWOMpre stands for electronic word-of-mouth pre-travel, DI stands for destination image

Source(s): Table 4 by authors

Table 5

Model fit summary

Key statistics	Value
Goodness-of-fit index (GFI)	0.881
Adjusted goodness-of-fit index (AGFI)	0.824
Normed fit index (NFI)	0.898
Relative fit index (RFI)	0.869
Incremental fit index (IFI)	0.960
Tucker–Lewis index (TLI)	0.947
Comparative fit index (CFI)	0.959
Root mean square error of approximation (RMSEA)	0.073
Chi-square/Degree of freedom (CMIN/DF)	1.582

Source(s): Table 5 by authors

Table 6

Hypotheses results

Hypotheses	Supported/Not supported
H1. eWOM (pre-travel) has a significant impact on eWOM intentions	Not Supported
H2. eWOM (pre-travel) has a significant impact on wellness tourist satisfaction	Not Supported
H3. Destination image significantly influences wellness tourist’s satisfaction	Supported
H4. Destination image significantly influences eWOM intentions	Supported
H5. Wellness tourist satisfaction will significantly influence eWOM intentions	Supported
H6. Wellness tourist satisfaction mediates the effect of destination image on eWOM intentions	Supported
H7. COVID-19 pandemic perceived health risk moderates the relationship between destination image and eWOM intentions	Not supported
H8. COVID-19 pandemic perceived health risk moderates the relationship between destination image and wellness tourist satisfaction	Not supported
H9. COVID-19 pandemic perceived health risk moderates the relationship between eWOM (pre-travel) and eWOM intentions	Supported
H10. COVID-19 pandemic perceived health risk moderates the relationship between wellness tourist satisfaction and eWOM intentions	Not supported

Source(s): Table 6 by authors

Notes

1. Globe News Wire, 11 August 2022, “Global Wellness Tourism Market (2022–2027)–Industry Trends, Share, Size, Growth, Opportunity and Forecasts”, https://www.globenewswire.com/en/news-release/2022/08/11/2496761/28124/en/Global-Wellness-Tourism-Market-2022-to-2027-Industry-Trends-Share-Size-Growth-Opportunity-and-Forecasts.html

2. Ministry of Tourism, Government of India, 27 January 2022, “National Strategy and Roadmap for Medical and Wellness Tourism”, https://tourism.gov.in/sites/default/files/2022-05/National%20Strategy%20and%20Roadmap%20for%20Medical%20and%20Wellness%20Tourism.pdf

3. Mordor Intelligence Report, “India Wellness Tourism Market–Growth, Trends, Covid-19 Impact, and Forecasts (2022–2027)”, https://www.mordorintelligence.com/industry-reports/india-wellness-tourism-market

4. New Year 2022 Travel Trends: The Rebound Of Wellness Tourism https://www.forbes.com/sites/alexandrakirkman/2021/12/31/new-year-2022-travel-trends-the-rebound-of-wellness-tourism/?sh=55a5c75a6f96

5. American Express, 21 March 2022, “American Express travel: 2022 global travel trends report shows people are ready and eager to travel and booking trips with more purpose than ever”, https://about.americanexpress.com/newsroom/press-releases/news-details/2022/American-Express-Travel-2022-Global-Travel-Trends-Report-Shows-People-are-Ready-and-Eager-to-Travel-and-Booking-Trips-with-More-Purpose-Than-Ever/default.aspx