weldest health and well-being in tourism destination

WelDest project has been funded with support from the European Commission. This report reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Lead by FH-Prof. Dr. Kai T. Illing, FH JOANNEUM University of Applied Sciences

WelDest

Research Report 2014

Health and Well-Being in Tourism Destination

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http://weldest.blogspot.com

WelDest Research Report 2014

ABSTRACT

WelDest is an Erasmus/LLP funded project (2012 – 2014). The aim of the project is to create a development framework to be used by public bodies, destination management organizations and private companies when developing holistic health and well‐being (H&WB) tourism destinations. WelDest also aims to identify the current knowledge and competence needs in managing and developing health and well‐being tourism destinations. The project combines the expertise of 5 Higher Education Institutes, 10 industry and 15 associate partners from Austria, the Czech Republic, Finland, Germany, and the UK.

The main research question is: “How can a destination be developed into a health and well‐being destination”? This research report consists of results from both primary and secondary research. The primary research comprises of 52 stakeholder interviews (qualitative interviews with a structured questionnaire that were analysed quantitatively). Furthermore some 784 persons answered the customer survey which was available in English, German, Finnish, Russian and Czech languages. The survey was distributed in paper form and fully digitally (in Finland) and was also available as a link at the WelDest blog. Respondents were those who had spent time and used the facilities in a particular H&WB destination or a potential H&WB destination.

This WelDest research report focuses on health and well‐being tourism, destination development, and destination management and has brought the following results: As for the implications for the management of wellness and spa hotels, public spa centers, health spa villages, and DMOs, they all should pay more attention to the many features and elements guests expect when coming to a H&WB destination. The many things destination managers and their stakeholders have to have in mind when developing a region/destination under the auspices of health and well‐being refer to challenges on different management levels, as destination development takes place not only on a company level, but also on a destination level, and on a political level, with regional or national dimensions when it comes to things such as environmental protection or health insurance which is asked to pay for medical treatments.

The dichotomy between health and wellness can also be seen in the quantitative part of the stakeholder interviews. The results reveal a strong emphasis on wellness issues and a weaker emphasis on health related issues, although the latter ones play an important role, too. The stakeholders did not attach too much importance to “outdoor and indoor sport”, although active holidays might not necessarily be the same as “outdoor and indoor sport”. As the consumers attach as much importance to “indoor and outdoor sport” as to “enjoying natural scenery and nature”, an active holiday in the outdoors is among the highly demanded activities. Nonetheless, pampering and indulging spa procedures belong to the most important ones. Furthermore, the stakeholders stress the importance of proper communication among the players of the destination and the use of regular and personal contacts.

A health and well‐being destination needs to dispose of both nature and skilled staff working in certain facilities. Hotels with a wide range of spa services are complemented with well‐ maintained nature offering the opportunity for various activities. Thus, a critical mass must be reached satisfying the clients’ needs in the field of relaxation and healthy activities. Various professions have to work together closely to provide a seamless chain of services. The destination is to be managed and marketed professionally as a unit and disposes of a strong brand image.


ZUSAMMENFASSUNG

WelDest ist ein Erasmus/LLP‐ gefördertes Projekt (2012‐2014). Das Ziel des Projektes ist es, einen Entwicklungsrahmen zu erschaffen, der von öffentlichen Einrichtungen, Standort Management Organisationen und privaten Unternehmen genutzt werden kann, um ganzheitliche gesundheits‐ und wohlbefindensorientierte Tourismusstandorte zu entwickeln. WelDest zielt auch darauf ab, den aktuellen Wissensstand und die Kompetenzen, die für das Management und die Entwicklung von gesundheits‐ und wohlbefindensorientierten Tourismusstandorten benötigt werden, zu identifizieren. Das Projekt kombiniert die Expertise von 5 Hochschulinstituten, 10 Industrie‐ und 15 assoziierte Partner aus Österreich, der Tschechischen Republik, Finnland, Deutschland und Großbritannien.

Die Hauptforschungsfrage lautet: „Wie kann ein Standort sich zu einen gesundheits‐ und wohlbefindensorientierten Standort entwickeln?“ Dieser Report beinhaltet die Resultate aus Primär‐ und Sekundärforschung. Die Primärforschung besteht aus 52 Interviews mit Interessenvertretern (qualitative Interviews mit einem strukturierten Fragebogen, der quantitativ analysiert wurde). Weiterhin beantworteten 784 Personen die Kundenbefragung, die in Deutsch, Englisch, Finnisch, Russisch und Tschechisch zur Verfügung stand. Die Umfrage wurde in Papierform verteilt und voll digitalisiert (in Finnland) und war auch als Link auf dem WelDest Blog verfügbar. Befragt wurden diejenigen, die Zeit an verschiedenen oder potentiellen gesundheits‐ und wohlbefindensorientierten Standorten verbrachten und die Einrichtungen nutzten.

Dieser WelDest Forschungsbericht konzentriert sich auf den gesundheits‐ und wohlbefindensorientierten Tourismus, Standortentwicklung und Standortmanagement und hat folgende Ergebnisse gebracht: das Management von Wellness‐ und Spa Hotels, öffentliche Thermen, Kur‐Dörfer und DMOs (Destination Management Organisationen) sollten den vielen Funktionen und Elementen, die die Gäste erwarten, mehr Aufmerksamkeit widmen. Die vielen Dinge, die Standortmanager und ihre Akteure bei der Entwicklung einer Region/eines Standortes unter der Schirmherrschaft von Gesundheit und Wohlbefinden im Kopf haben müssen, stehen im Zusammenhang mit Herausforderungen auf unterschiedlichen Managementebenen, da die Standortentwicklung nicht nur auf Unternehmensebene ein Faktor, sondern auch auf Standortebene, politischer Ebene mit regionalen oder nationalen Dimension, wenn es zu Dingen wie Umweltschutz oder Krankenversicherung, welche für medizinische Behandlungen aufkommen muss, kommt.

Die Dichotomie zwischen Gesundheit und Wellness kann auch im quantitativen Teil der Interessenvertreter‐Interviews erkannt werden. Die Ergebnisse zeigen einen starken Schwerpunkt auf Wellness‐Fragen und einem schwächeren Wert auf gesundheitsbezogenen Themen, obwohl die letzteren ebenso eine wichtige Rolle spielen. Die Akteure messen "Outdoor‐und Indoor‐Sport" nicht zu viel Bedeutung zu, auch wenn aktiver Urlaub nicht unbedingt das gleiche wie "Outdoor‐und Indoor‐Sport" ist. Da die Verbraucher genauso viel Wert auf " Indoor‐und Outdoor‐Sport" als auch auf das "genießen natürlicher Landschaften und Natur" legen, ein aktiver Urlaub in der Natur gehört zu den stark nachgefragten Aktivitäten. Dennoch gehören verwöhnende Anwendungen zu den wichtigsten Angeboten. Darüber hinaus betonen die Interessenvertreter, wie wichtig die richtige Kommunikation unter den Hauptakteuren der Standorte und die Verwendung von regulären und persönlichen Kontakten sind.

Ein gesundheits‐ und wohlbefindensorientierter Standort muss sowohl von der Natur als auch von qualifizierten Mitarbeitern profitieren. Hotels mit einer breiten Palette an Wellness‐Dienstleistungen, die durch eine gepflegte Natur ergänzt sind, bieten die Möglichkeit für verschiedenste Aktivitäten. So kann eine kritische Masse erreicht werden, um die Bedürfnisse der Kunden im Bereich der Entspannung und gesunde Aktivitäten zu befriedigen. Verschiedene Berufe müssen eng zusammenarbeiten, um eine nahtlose Kette von Dienstleistungen zu gewährleisten. Der Standort muss professionell verwaltet werden und als Einheit über ein starkes Markenimage auftreten.


ABSTRAKT

Projekt WelDest je řešen v období 2012 – 2014 a je finančně podporován ze strany Evropské komise, a to konkrétně programem Erasmus v rámci Programu celoživotního vzdělávání. Cílem projektu je vytvoření rozvojového rámce, který bude využíván veřejnými subjekty, organizacemi destinačního managementu a soukromými firmami při komplexním rozvoji destinací zaměřených na zdraví a well‐being (H&WB). WelDest se také zaměřuje na identifikaci současných potřeb v oblasti znalostí a kompetencí v procesu řízení a podpory rozvoje H&WB destinací cestovního ruchu. Na projektu spolupracují odborníci z pěti vysokých škol, deset partnerů z podnikatelské sféry a patnáct přidružených partnerů z Rakouska, České republiky, Finska, Německa a Spojeného království.

Předkládaná výzkumná zpráva odpovídá na hlavní otázku, a to: “Jak může být destinace rozvíjena směrem k destinaci podporující zdraví a pohodu svých návštěvníků neboli health and well‐being destinaci?“. Zpráva obsahuje výsledky jak z primární tak i sekundární části průzkumu. Primárního průzkumu se zúčastnilo 52 důležitých aktérů cestovního ruchu ve zkoumaných destinacích. Byli to zejména manažeři destinací na národní, regionální a lokální úrovni, dále významní podnikatelé v oblasti hotelnictví a manažeři zdravotnických zařízení či lázeňských společností. Jako výzkumná metoda byl použit strukturovaný rozhovor. Dále byl proveden průzkum u 784 respondentů pomocí dotazníkového šetření na území všech zúčastněných států ve všech příslušných jazykových mutacích, a navíc byl dotazník dostupný i v ruském jazyce. Dotazník byl distribuován jak v tištěné, tak i elektronické podobě a navíc bylo možné ho vyplnit přes link na blogu projektu WelDest. Oslovení respondenti byli lidé, kteří strávili čas v současné H&WB destinaci nebo v potenciální H&WB destinaci.

Výzkumná zpráva z oblasti rozvoje destinací podporujících zdraví a pohodu a jejich destinačního managementu přináší následující výsledky: Ukázalo se, že vedení lázeňských a wellness hotelů, lázeňských center, lázeňských míst a organizace destinačního managementu by měly věnovat více pozornosti základním rysům a prvkům očekávání hostů, kteří do H&WB destinací přijíždějí. Manažeři a všichni významní aktéři podílející se na rozvoji destinací musejí mít na paměti, že rozvoj destinací směrem ke zdraví a well‐being s sebou přináší potřebu řízení na různých úrovních, a to podnikové, destinační a politické úrovni v regionální i národní dimenzi, právě pokud řízení zasahuje do takových oblastí jakou je například ochrana životního prostředí nebo zdravotní pojištění.

Dichotomie neboli rozpor mezi zdravotním cestovním ruchem a wellness je patrný z kvantitativní části strukturovaného rozhovoru prováděného mezi aktéry. Výsledky odhalily silný důraz na oblast wellness a menší důraz pak na zdravotní cestovní ruch, ačkoliv ten samozřejmě hraje také významnou roli. Aktéři nepřikládají příliš velký důraz sportovním aktivitám ve vnitřním i vnějším prostředí, ačkoliv aktivní dovolená nemusí být nutně totéž a je důležitým elementem H&WB destinací. Hosté H&WB destinací nepřikládají tak silný důraz sportovním aktivitám ve vnitřním i vnějším prostředí jako takovým, ale spíše možnosti užít si okolní přírodu, a aktivní dovolená v přírodě patří pak mezi nejžádanější atributy H&WB dovolené. Nicméně využívání lázeňských procedur patří mezi nejdůležitější z nich. Kromě toho aktéři pokládají za velmi důležitou vlastní komunikaci mezi partnery v destinaci s využitím běžných a osobních kontaktů.

H&WB destinace potřebuje mít k dispozici jak přírodu, tak zkušený personál v příslušných zařízeních cestovního ruchu. Hotely, které disponují širokou škálou lázeňských služeb, doplňují své nabídky dobře udržovanými přírodními podmínkami, které nabízejí možnosti k různým aktivitám. Skutečnou nezbytností je uspokojení potřeb klientů z hlediska odpočinku a zdraví. Různé profese musí úzce spolupracovat, aby mohly poskytovat zdánlivě nekonečný řetěz služeb. Destinace musí být řízena a nabízena profesionálně jako celek se silnou značkou.


TIIVISTELMÄ

WelDest on EU:n Elinikäisen oppimisen ohjelman (LLP) vuosina 2012 ‐2014 rahoittama projekti, jonka tavoitteena on luoda kokonaisvaltainen terveys‐ ja hyvinvointimatkailukohteen kehittämismalli matkailun julkisen sektorin toimijoiden, matkailukohteiden johtamisesta vastaavien organisaatioiden sekä alan yksityisten yritysten käyttöön. WelDest ‐projektissa selvitetään myös, millaista tietoa ja osaamista terveys‐ ja hyvinvointimatkailukohteiden johtamisessa ja kehittämisessä tarvitaan tällä hetkellä. Projektiin osallistuu 5 korkeakoulua, 10 yrityspartneria sekä 15 verkostopartneria Itävallasta, Tsekin tasavallasta, Suomesta, Saksasta ja Isosta Britanniasta.

Projektin tavoitteena on selvittää, miten matkailukohteesta voidaan kehittää terveys‐ ja hyvinvointimatkailukohde. Projektin aikana on tehty asiaa selvittävä tutkimus sekä yhteenveto aiempien tutkimusten tuloksista. Tutkimuksessa haastateltiin 52 eri sidosryhmien edustajaa. Haastattelut olivat laadullisia ja niissä käytettiin lisäksi strukturoitua kyselylomaketta, jonka tulokset analysoitiin kvantitatiivisesti. Haastattelujen lisäksi tehtiin asiakaskysely englanniksi, saksaksi, suomeksi, venäjäksi ja tsekiksi. Kyselyyn vastasi yhteensä 784 henkilöä. Useimmissa tutkimukseen osallistuneissa maissa kysely toteutettiin jakamalla paperille tulostettuja kyselylomakkeita, Suomessa kysely tehtiin sähköisenä ja lisäksi siihen pääsi vastaamaan myös WelDest ‐blogissa olleen linkin kautta. Vastaajat olivat vierailleet terveys‐ ja hyvinvointimatkailukohteissa tai sellaisissa matkailukohteissa, joilla on potentiaalia kehittyä sellaisiksi.

Tämä tutkimusraportti keskittyy terveys‐ ja hyvinvointimatkailuun, matkailukohteen kehittämiseen sekä johtamiseen. Tutkimuksen tulokset osoittivat, että kylpylähotellien, terveyskylpylöiden ja hyvinvointimatkailukohteiden johtamisessa tulisi kiinnittää enemmän huomiota asiakkaiden niihin kohdistamiin odotuksiin. Terveys‐ ja hyvinvointimatkailukohteen kehittäminen ei ole vain yritystasolla tapahtuvaa toimintaa, se liittyy myös alueellisen, kansallisen ja poliittisen tason kysymyksiin kuten ympäristönsuojeluun tai sairausvakuutusjärjestelmiin, joiden odotetaan kattavan lääketieteellisestä hoidosta aiheutuneita kustannuksia.

Asiantuntijahaastattelujen kvantitatiivinen analyysi osoitti terveys‐ ja hyvinvointikäsitteiden jakautuvan kahteen osa‐alueeseen: sekä hyvinvointiin että terveyteen liittyvät tekijät ovat yhtä tärkeitä, vaikka edelliset painottuivatkin haastatteluissa jälkimmäisten kustannuksella. Luonnosta ja sen tarjoamista virkistysmahdollisuuksista nauttimisen lisäksi kuluttajat pitävät yhtä tärkeinä myös monipuolisia sisä‐ ja ulkoliikuntamahdollisuuksia. Aktiiviloman viettäminen ja ulkoilumahdollisuuksien hyödyntäminen on kuluttajan näkökulmasta tärkeää, mutta lisäksi tarjolla on oltava myös mahdollisuuksia hemmottelevien hoitojen ja palvelujen hyödyntämiseen. Asiantuntijat puolestaan korostivat eri toimijoiden välisen viestinnän sekä säännöllisten henkilökohtaisten kontaktien ylläpitämisen merkitystä.

Terveys‐ ja hyvinvointimatkailukohteen on tarjottava sekä luontoelämyksiä että ammattitaitoisen henkilökunnan palveluja. Varsinaisten kylpyläpalvelujen lisäksi kylpylähotellien odotetaan tarjoavan myös mahdollisuuksia monenlaisiin aktiviteetteihin luonnonläheisessä ja hyvin hoidetussa ympäristössä. Tarjonnan kriittinen massa onkin edellytys asiakkaiden rentoutumiseen ja terveyttä edistäviin aktiviteetteihin liittyvien tarpeiden tyydyttämiseksi. Asiakkaalle on voitava tarjota saumaton palveluketju, jossa eri alojen ammattilaiset toimivat tiiviissä yhteistyössä. Tämän lisäksi hyvinvointimatkailukohdetta pitää johtaa ja markkinoida ammattimaisesti yhtenä kokonaisuutena ja sen pitää luoda itselleen vahva brändi.


Contents 1 RESEARCH REPORT – INTRODUCTION.............................................................................9

1.1 Terms and abbreviations ............................................................................................................ 10

1.1.1 Terms ......................................................................................................................................... 10

1.1.2 Abbreviations ............................................................................................................................. 11

2 STAKEHOLDER INTERVIEWS PART A – A QUANTITATIVE APPROACH.....................12

2.1 Methodology .............................................................................................................................. 12

2.2 Research results ......................................................................................................................... 13

2.2.1 Which of the following options best describe the role of health and well‐being in your destination now and by 2020? ................................................................................................................. 13

2.2.2 What do you think are the most important reasons customers come to your destination? .... 14

2.2.3 Which elements prevent your guests from recognizing your destination as health and wellbeing destination? ............................................................................................................................. 16

2.2.4 How important are the following competencies for you regarding the management of your destination? .............................................................................................................................................. 17

2.2.5 What is your personal need for further training regarding the following competencies? ........ 19

2.2.6 Please evaluate the present performance of your destination regarding the following specific points 22

2.2.7 How important are the following specific points regarding the development of a HW&B‐destination? .............................................................................................................................................. 24

2.2.8 Please define the level of your current job ................................................................................ 27

2.2.9 What is the highest level of education you have completed so far? ......................................... 27

2.2.10 How many years of experience do you have in the following categories? ........................... 28


3 STAKEHOLDER INTERVIEWS PART B – A QUALITATIVE APPROACH.........................29

3.1 Methodology .............................................................................................................................. 29


3.2.1 Definition of a H&WB destination .............................................................................................. 31

3.2.2 Key service supply, resources, staff competencies and elements of H&WB destinations......... 33

3.2.3 SWOT Analysis of H&WB‐destinations ....................................................................................... 36

3.2.4 Importance of nature/sustainability in H&WB destinations now and in the future .................. 38

3.2.5 Role of national/regional health policy in H&WB destinations now and in the future ............. 39

3.2.6 Destination development now and in the future ...................................................................... 41

3.2.7 Resources in destination development ...................................................................................... 43

3.2.8 Processes in destination development now and in the future .................................................. 44

3.2.9 Balance between needs of tourists and needs of locals ............................................................ 45

3.2.10 Competencies needed in the destination ............................................................................. 46

3.2.11 Core business of the destination in the future ...................................................................... 47

3.3 Discussion .................................................................................................................................. 48

4 CONSUMER RESEARCH.....................................................................................................51

4.1 Methodology .............................................................................................................................. 51


4.2.1 In which country are you right now while filling in this questionnaire? .................................... 52

4.2.2 Please write down some key words, which come into your mind if you think of a H&WB‐destination ............................................................................................................................................... 52

4.2.3 What kind of services, staff competences and elements attract / did attract you to come to a destination like this? ................................................................................................................................ 54

4.2.4 How did you come to the idea to visit this destination you are currently staying at / you have stayed at? ................................................................................................................................................. 57

4.2.5 What was the overall reason for you to come to this destination? ........................................... 58

4.2.6 Which services, activities, and elements do you value the most in this destination? ............... 60


4.2.7 Which of the following options best describe your needs when choosing a health and well‐being holiday? .......................................................................................................................................... 61

4.2.8 To which extent does/did the destination as a whole meet your expectations regarding the health and well‐being related offering during your stay? ........................................................................ 62

4.2.9 How would you score the destination’s services in general? .................................................... 65

4.2.10 To which extent were/are you able to use the variety of services offered in the H&WB‐destination? .............................................................................................................................................. 67

4.2.11 How do/ did you check the influence of your current holiday on your health at the end or after the stay? .......................................................................................................................................... 68

4.2.12 Which of the following alternatives best describe your expectation of the price level of an H&WB holiday compared to a standard holiday of the same length? ..................................................... 69

4.2.13 Which are the elements which prevent you from recognizing a destination as a health and well‐being destination? ............................................................................................................................ 70

4.2.14 What is the highest level of education you have completed so far? .................................... 71

4.2.15 Sex ......................................................................................................................................... 71

4.2.16 Your age ................................................................................................................................. 72

4.2.17 Origin ..................................................................................................................................... 73

5 DISCUSSION OF THE RESULTS: STAKEHOLDER AND CONSUMER RESEARCH..........74

5.1 The term health and related meanings ........................................................................................ 74

5.2 Elements which prevent guests from recognizing a destination as a H&WB destination ............... 75

5.3 The quality of services ................................................................................................................ 77

5.4 Country‐specific analysis 1: What people do for their health ....................................................... 77

5.5 Country‐specific analysis 2: Price level ........................................................................................ 79

5.6 Specific analysis: Health activities and education ........................................................................ 80

5.7 H&WB destination: Characteristics and definition ....................................................................... 82

6 SUMMARY AND MANAGERIAL IMPLICATIONS............................................................83

7 LIMITATIONS......................................................................................................................86


7.1 Qualitative stakeholder analysis ................................................................................................. 86

7.2 Consumer Research .................................................................................................................... 86

7.3 Limitations in general ................................................................................................................. 86

8 APPENDIX............................................................................................................................87

8.1 Stakeholder questionnaire – part A ............................................................................................. 87

8.2 Stakeholder questionnaire – part B ............................................................................................. 94

8.3 Consumer questionnaire ............................................................................................................. 97

8.4 Literature ................................................................................................................................. 102

8.5 List of charts ............................................................................................................................. 103


p. 9 weldest.blogspot.com

1 Research report – Introduction

This WelDest research report focuses on health tourism, wellness tourism, and destination management. The aim of WelDest is to create a development framework to be used by public bodies, destination management organizations and private companies when developing holistic health and well‐being destinations (H&WB). The project “Health and Well‐being in Tourism Destination” (WelDest) combines the expertise of 5 Higher Education Institutes, 10 industry and 15 associate partners from Austria, the Czech Republic, Finland, Germany, and the UK.

The purpose of the research is to conduct research that is relevant to the health and well‐being tourism industry and destinations. The goal is to create a development framework to be used by public bodies, DMOs and private companies at tourism destinations willing to strengthen the elements influencing the well‐being level of tourists and locals alike.

One of the objectives of the research is to identify the current knowledge and competence needs in managing and developing health and well‐being destinations (needs analyses to be conducted among core partner target groups: industry partners, associated partners and HEI‐partners, and outside the partnership: representative sample of managers, developers, experts and policy makers responsible for destination development).

The WelDest research consists of both primary and secondary research. The report at hand is the primary research paper which comprises two different approaches. The first is based on stakeholder interviews and the second on consumer research. The stakeholders were interviewed on the basis of two different approaches, quantitative (questionnaire part A) and qualitative (questionnaire part B):



Chart 1: Structure of the WelDest‐research

1.1 Terms and abbreviations

1.1.1 Terms

Facilities: Something which is built for a special purpose. The term infrastructure is rarely used in this report as it means basic equipment such as roads and bridges.

This report uses the word destination instead of region as it deals with tourism. If the word region is used, the report refers to regions in general without referring to tourism specifically.

Consumers or guests are visitors to a destination.

Positioning: To endow a destination with a clear brand identity in order to distinguish it from its competitors.

Healthy activities: This report uses phrases such as “healthy activities” or “to do something for one’s health” to comprise all things done to improve the guests’ health. Thus, certain terms as for example “health promotion” can be avoided as they are confined to strict definitions.

WelDest research

Primary research Secondary research

Stakeholder interviews Consumer interviews

Part A Part B



1.1.2 Abbreviations

H&WB Health & well‐being

USP Unique Selling Proposition

DMO Destination Management Organization



2 Stakeholder interviews part A – A quantitative approach

2.1 Methodology

Methodology for the stakeholder needs analysis concerning health and well‐being destinations (part A) was developed, beginning in October 2012, by the university partners and the industry partner CHC. There were three feedback loops, involving all project partners, regarding further improvement of the questionnaire. The final version was created in April 2013.The questionnaire comprises two parts: The first part uses a quantitative approach (see chapter 8.1), the second part has open questions (qualitative approach, interviews, see Chapter 8.2). The latter part was done on the basis of an interview guideline either face to face or via telephone. Ten to eleven standardized interviews were conducted by each of the WelDest partners in their own countries and then uploaded to Webropol1. The data were transferred into MS Excel and analysed descriptively by FHJ. Frequency analyses were chosen, with the results shown in graphs.

The choice of the interviewees was conducted according to the following suggestions ensuring a broad sample of different professions and management levels:

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

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

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

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

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

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

1Webropol is an online solution for conducting surveys, gathering data, managing feedback, and reporting data (http://www.webropol.com/)



2.2 Research results

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

2.2.1 Which of the following options best describe the role of health and

well‐being in your destination now and by 2020?

Chart 2: What describes the role of H&WB now and in future?

How to read the chart: 21 responses stress that H&WB will play "an essential part of the tourism

offering alongside other services" in the future.

5

9

10

15

10

3

4

21

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

H&WB will be/is a minor offering

1. H&WB will be a part of the destination strategybut not yet implemented at the destination level2. H&WB is already a part of the destination

strategy

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

for the future now

38/39 responses



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

2.2.2 What do you think are the most important reasons customers come

to your destination?

Chart 3: Reasons for coming to the destination

9 respondents selected "other reasons, please specify" listing ideas such as "major events”, “regional cuisine”, and “wine." According to this chart, "suitable accommodation" and "visiting friends and relatives" play a minor role. Interestingly, the stakeholders attach more importance to “health” than the guests do themselves (see chart 20).

Those, who ticked "doing something for health", could fill in a subsequent question, the analysis of which is presented in the next chart:

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Suitable accommodation

Visiting friends and relatives

Price level

Others, such as major events,regional cuisine and wine

Culture

Reputation / image of destination

Doing something for health

Natural scenery

40 responses Multiple answers



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

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

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Other reasons, such as fun, sport, outdoorevents…

Clinical/medical services

Natural healing resources

Outdoor and indoor sport

Enjoying natural scenery and its nature

Pampering spa services

Relaxation




2.2.3 Which elements prevent your guests from recognizing your

destination as health and wellbeing destination?

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

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

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Too much traffic

Too expensive

Too many tourists

Too many disturbing industries

Lack of natural environment

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

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

No medical staff available

Sprawling cities, villages and industrial areas

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

Lack of wellness and spa services /infrastructure

Lack of medical services/infrastructure




2.2.4 How important are the following competencies for you regarding

the management of your destination?



Chart 6: Importance of certain competencies

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Intercultural communication & foreign language

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IT skills and e‐Business

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Knowledge management

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Responsible management (sustainable issues)

Understanding of H&WB related concepts/…

Self‐management

Team leading

Process‐ & project management

Quality management

Problem solving within the organisation

Complaint management

HRM

Networking skills to contribute to destination d.

Sales & Marketing know‐how

Rhetoric /Presentation / Communication

Recognition of service gaps

Recognition of customer expectations

not important at all not very important quite important very important




The chart reveals the importance of the “recognition of customer expectations” as one of the core competencies with respect to the management of a H&WB destination. The next three items include communication in the form of rhetoric and presentation, marketing, and networking.

In this chart, "quality management" plays quite an important role in comparison to other questions in which it is assigned less importance..

"Others" was ticked up just one time and mentions "appraisals, HR‐procedures, health and safety".

2.2.5 What is your personal need for further training regarding the

following competencies?

Charts no. 6 and no. 7(previous and next) belong together as they are part of an importance‐performance‐analysis. This approach compares the importance of defined services and their present performance by the interviewee, assuming that a high need for training reveals an insufficient performance at present or an increasing demand for this capability in future. Chart no. 7 and its blue bars combines the previous chart with the result of the performance analysis (red bars),, taking only “very important and quite important” (blue) and ”high and some need for further training” (red) into account.

If there are differences between importance and performance, a gap arises indicating a need for action. The need for action arises if both bars (blue and red) are particularly long, as is the case with respect to “recognition of customer expectations”. Another example: “Quality management” is rather important too (blue bar, 37 votes), but the necessity for training seems to be comparatively low (red bar, only 17 votes).



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

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

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Intercultural communication & foreign language

Business law

Employment law

Understanding the benefits of applied research

IT skills and e‐Business

Recruiting process

Knowledge management

Innovation management

Responsible management (sustainable issues)

Understanding of H&WB related concepts/…

Self‐management

Team leading

Process‐ & project management

Quality management

Problem solving within the organisation

Complaint management

HRM

Networking skills to contribute to destination d.

Sales & Marketing know‐how

Rhetoric /Presentation / Communication

Recognition of service gaps

Recognition of customer expectations

performance ("high and some need for further training")

importance ("very important and quite important")

35 responsesMultiple answers



The first two items in chart no. 7 deal with the customers and their expectations and related service gaps.

The second group of training needs comprise communicative issues such as “rhetoric/presentation”, “sales/marketing”, and “networking skills”. Legal subjects such as "employment law" and “business law" play a minor role, as is the case with "intercultural communication & foreign languages”.



2.2.6 Please evaluate the present performance of your destination

regarding the following specific points

Chart 8: Evaluation of the present performance of the destination

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We use a quality management system (e.g. ISO, EFQM,…)

There is a feeling of togetherness and commongoals amongst the actors

There is transparency in communicationprocesses

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

We follow joint sales & marketing strategies

There is a commitment and co‐operation of allactors (private and public)

We have an effective destination managementorganization

We are involved in destination‐wide decisionmaking processes

Aspects of sustainability will be considered indecision making processes

We collect and utilize destination level datasystematically (knowledge management)

We provide an innovation friendly environment

We follow a destination brand identity

There is an understanding of the importance ofstrategic destination development

I strongly disagree I disagree I agree I strongly agree




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



2.2.7 How important are the following specific points regarding the

development of a HW&B‐destination?

Chart 9: Importance of certain points for the destination development

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

Process‐ & project management with regard todestination development

Providing an innovation friendly environment

Transparency in communication processes

Consideration of sustainability in decisionmaking processes

Joint sales & marketing strategies

Systematic collection and utilization ofdestination level data

Involvement in destination‐wide decisionmaking processes

A destination management organization

Common understanding of the importance ofstrategic destination development

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

Feeling of togetherness and common goalsamongst the actors

Destination brand identity

not important Quite important important very important




Many of the above mentioned items deal with communication and cooperation.

If "very important" and "important" are taken together many items have more or less the same number of responses. So, we propose to differentiate between "important" and "very important".

The "use of quality management system" and certifiable quality seals such as ISO 9001 and EFQM seem to be of less importance, at least in this question.

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

„not important“ 0 points

„quite important“ 1 point

„important“ 2 points

„very important“ 3 points.

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



Chart 10: Interpretation of the previous questions

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Process‐ & project management with regard todestination development


Transparency in communication processes

Consideration of sustainability in decisionmaking processes

Joint sales & marketing strategies

Systematic collection and utilization ofdestination level data

Involvement in destination‐wide decisionmaking processes

A destination management organization

Common understanding of the importance ofstrategic destination development

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

Feeling of togetherness and common goalsamongst the actors

Destination brand identity

points not important0 points

Quite important1 point

important2 points

very important3 points

Linear (points)



2.2.8 Please define the level of your current job

Chart 11: Level of the current job

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

Chart 12: Highest level of education

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

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Owner/entrepreneur

Others, such as director of customeroperations, mayor, academic university

professor, senior manager, resort…

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Mid‐management (e.g. department head)

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Basic education

Doctoral degree

Secondary school

Bachelor's degree or similar

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40 responses

39 responses



2.2.10 How many years of experience do you have in the following

categories?

Chart 13: Years of experience

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

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Destination management or regional authority

Health related services such as (thermal) spa, public / private health care, etc.

39 responses



3 Stakeholder interviews part B – A qualitative approach

3.1 Methodology

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

Terms and Definitions

SWOT

Role of nature

Role of national / regional health policy

Current situation in destination development

Internal versus external resources in destination development

Instruments to be applied for destination development

Locals versus tourists

Training and education on a destination level

Future Markets

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



1. Conducting the interviews

Preparation for the interview

The interview itself

How to get the data in analyzable form

Data selection and analysis

2. Interview Guideline

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

Ten to eleven interviews were conducted by each WelDest partner. The interviews were either done face to face or via telephone. The selection of interviewees was conducted by every project partner (see chapter 2.1). The interviewees, chosen as experts in their field, were first contacted via telephone or e‐mail to make an appointment for the interview. Therefore, the experts selected comprised regional developers, hospitality managers, health managers, local tourism managers, and policy makers on a national level. The confidentiality and the anonymity of the data were assured to the interviewees. Before the interview started the interviewees were asked to get permission to audiotape the interview.

An interview guideline was used during each interview in which it was recommended to use open questions and to avoid closed questions in order to keep the interviewee talking.

The face to face interviews were recorded, transcribed and then translated into English when needed. One protocol for each interview was compiled in English or German. It was recommended to use an audiotape for writing the protocol to avoid a loss of information. Furthermore, some basic information had to be gathered before the interview started, such as the interview number, the interviewee (first name, last name), his/her function, interviewee initial number (partner country, interview number; e.g. AT1), date of interview, length of interview, and name of the interviewer. All teams fed their interview protocols into Webropol to make them available to FHJ for analyzing.

The interviews were transcribed according to Froschauer & Lueger, 2003. Afterwards, the categorizing of the data was done with aid of MaxQDA 2007 to ensure a professional categorizing system. The Austrian transcripts were used to validate the categories of the interview. This was to ensure a comprehensive system of categories (word‐clusters). In other words: The Austrian transcripts were used as kind of a pretest. Additionally, the



categorization was discussed in a team meeting with all partner countries, with almost all suggestions for improvement being taken into account. Then, the interviews from all partners were categorized according to the same categorizing system.

Most of the interviews took about one hour. The shortest interview time was 30 minutes, and the longest interview took 2 hours.


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

3.2.1 Definition of a H&WB destination

The first question deals with the definition of a H&WB destination. About half of the interviewees think that health and wellness are two different things. The term health is attached more with sick people as medical issues, whereas wellness has a more holistic view of the person, and comprises the body, mind, and soul. This holistic view is, according to the interviewees, very important for H&WB destinations. Nevertheless, most interviewees stated that expertise in medicine and health are core factors:

“If you talk about health tourism or well‐being tourism then there should be evidence, something that “tastes” right, not only pampering as such. Well‐being can be many things but in this, especially when discussing rehabilitation it has to be real and true.” (FIN10, 7)

Core factors for the definition of a H&WB destination are wellness offers, possibilities to relax, spa facilities, and well‐being. These are as important as expertise in medicine and health. There can be a negative association with the term wellness because it is not defined properly and almost all hotels use the term to market themselves.

When it comes to nature and environment, interviewees stressed the importance of a sound, beautiful, clean nature and the use of local natural resources such as thermal water for thermal baths, because they distinguish destinations from one another.



“Why should a guest even go to a thermal spa, because almost each higher categorized hotel has all offerings that thermal spas have, too? And you get to the point what a thermal spa is all about: It is the thermal water, which is simply not available everywhere.” (AUT04, 9)

Another distinctive feature can be a unique offering of services, providing different types of services and also a wide range of services. In order to be able to offer these services, sufficient facilities are necessary. This also involves indoor and outdoor activities like hiking, biking, going for walks or going to the gym, etc. Another important aspect is to provide healthy food and also organic/regional healthy products. Not only physical goods, but also the service attitude and the friendliness of the staff contribute to an enhanced experience during a holiday in a H&WB destination. Qualified staff plays an important role in the perception of the delivery of services for guests.

“Personally I can forgive small shortcomings in accommodation, but the way people treat you, the cleanliness and the friendliness, the presence of flowers etc. not really. Inner feelings and emotions are definitely decisive for clients, they are absolutely essential.” (CZK08, 7)

Destinations should also take into consideration their historical values and culture which they can identify with authenticity. Some interviewees stated that homogenous offers in the destination help the guests to become oriented, and they function as a positioning statement. The whole destination should offer a chain of services for the guests so that they can experience their holiday as a complete package. Interdisciplinary co‐ordination is necessary to achieve this goal.

Differences between the countries of the interviewees could be especially seen in the following points: It seems that the Finns have a very holistic approach to wellness. According to them, it should involve the body, mind, and soul of individuals, whereas they associate health with medical services and recovering from an illness. For the other countries this holistic approach is important as well, but Finns put a very high importance on it. So there should be a distinction between the two terms „wellness“ and „medical,“ which the Austrian interviewees also put a focus on. As for the Austrians and the Finns, the term wellness is quite imprecise and overused and should therefore not be part of a definition of a H&WB‐destination. The British stressed that the term H&WB is not understood in the UK as there is the term spa tourism, which is not directly



linked to health. Travelers normally have no associations with the term H&WB, but understand the term spa tourism well.

If we look at the answers from the point of view of the various professions of our interviewees, health managers put a strong focus on natural resources, nature, and environment of H&WB destinations as well as medical expertise and wellness offers. Hospitality managers are more service‐oriented and focus on well‐being offers. Regional developers, on the other hand, emphasized the importance of a homogenous offer and health‐promoting expertise. The chain of services is crucial to them. Local tourism managers put a focus on well‐being and a holistic approach.

Summary

It seems that health and wellness are seen as two different things. Health is associated with medical issues and wellness has a more holistic approach, at least for the interviewees. This holistic approach is important for H&WB destinations, and competencies in health and medicine are core factors for H&WB destinations. Other core factors mentioned include wellness services, possibilities to relax, spa facilities, and well‐being.

The interviewees stressed the importance of a sound, beautiful, and clean nature as well as capitalizing on local (authentic) resources. It seems to be necessary to offer different types of services, and appropriate facilities are necessary, too. Service quality and friendliness were also emphasized, as was the need for qualification.

3.2.2 Key service supply, resources, staff competencies and elements of

H&WB destinations

The second question is about the key service supply, resources, staff competencies, and elements of a H&WB destination.

As far as the service supply is concerned, interviewees agreed that the offered services have to be of high quality in order to satisfy the customer. There should be a broad range of offers. According to the interviewees, a H&WB destination must provide well‐being offers such as services for relaxation, beauty treatments, and spa procedures. However, the same importance is attached to medical offers like rehabilitation, prevention, and education in achieving a healthier lifestyle. Additionally, outdoor and indoor sport activities were mentioned as key services of a H&WB destination. Another issue is tailor‐made services for special interest groups. Extremely important for H&WB



destinations is the way the services are offered. There should be a network that provides supporting products and services, so customers feel that the offer in the region is homogenous and comprising. The chain of services is crucially important for the experiences of the guests. As one Czech interviewee summarized:

“At the end of the day, health and well‐being are all about the services (…).” (CZK09, 13)

The key resources of H&WB destinations evolve around the big topics of nature, environment and landscape. These factors are seen as being very important to the overall impression of the destination. Furthermore, natural resources available in destinations should be used in tourism, for example thermal water for spa treatments or regional and healthy products in restaurants. The other big topic for the interviewees in this category is the facilities. Interviewees agreed that a minimum level of facilities in H&WB destinations is necessary in order to deliver appropriate services. Most important in this field are the facilities for well‐being, and spa facilities like pools, saunas, gyms, relaxation, and treatment rooms.

“Definitely for me it’s the nature and natural conditions, for example forest, river, clean mountain water and healing climate, and of course the landscape and of course the facilities for doing activities, like hiking trails and trails for biking, in the winter for cross‐country and other winter sports. In the same time the place should be able to offer spa services starting from the bath and massages to spa centers.” (CZK09, 10)

Crucial to H&WB destinations are the staff competencies. The offered services must be delivered in a professional manner. Also very important is the qualification, training, education and knowledge which they have obtained. All these things enable the staff to be capable of delivering services of high quality. Almost all interviewees agreed on the fact that social skills and the direct interaction with the guests are the key factors that enhance the guests’ well‐being as well.

“I think that the human factor is crucial, I mean service standards, staff standards and their ability to be affable. The education of people working in the field of tourism is essential as well.” (CZK08, 7)



Another important aspect is the public transport system, which should be sufficient so that guests can easily reach the destination and places of interest within the region. The culture and heritage of the destination should not be left out, but rather included in the packages, as guests are interested in the history and traditions of the locals. When it comes to the positioning of the H&WB destination, it is very important to communicate a clear USP. Guests want to know what they can expect from the destination and choose the appropriate offering for themselves. This is explained in the statement below:

“If we talk about a USP, for example we are the health destination for weight reduction; appropriate services like exercise should be coordinated. In other words: specific joint‐friendly sports or also the facilities for example a lake or a therapeutic bath where these things can be offered. The whole offer should be a smooth concept, adjusted to the hotels with their programs, all factors that influence the medical indications of diseases. (…) Target‐group‐specific offers with target‐group‐specific staff in all areas.” (AUT08, 13)

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

Summary

According to the interviewees the key service supply of a H&WB destination should be of high quality and combine medical services with well‐being, relaxation, and spa offers. There should be a network that provides supporting services and products to the guests.

Interviewees think that the key resource for H&WB destinations is nature and environment. Natural resources like thermal water also play an important role. Sufficient facilities have to be available to deliver the desired services to the consumers.

Professionally trained staff has to get adequate training and education in the core areas. Most important to the interviewees are social skills.



3.2.3 SWOT Analysis of H&WB‐destinations

The third question dealt with a SWOT‐analysis of the interviewees’ own H&WB destinations. Interviewees were asked to name the strengths (S), weaknesses (W), opportunities (O) and threats (T) of their HW&B‐destinations. Many factors were identified by the interviewees with the answers matching partly with the key competencies of H&WB destinations.

The most important strength for H&WB destinations mentioned is a beautiful and sound nature and environment, which have to be maintained as they can become a weakness if they are not taken care of. The history, culture, and traditions of H&WB destinations should be included in the tourism offers as it underlines authenticity. Good facilities combined with accessibility and public transport are very important factors. Other factors mentioned are the reputation of a H&WB destination, professional staff and the preparation of relaxation offers.

“Strengths are the tradition, the location, the natural curative resources, the human resources, their language skills somewhat, and the demand for the type of service that we supply. Also the natural environment, which is relatively clean (…)“ (CZK10, 13)

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

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

Regarding the opportunities of H&WB destinations, the biggest potential according to the interviewees can be seen in attracting new target groups. Often, H&WB destinations focus on strictly defined target groups which do not have enough potential. Also the



improvement of networking and co‐operation in the destination is seen as an opportunity.

“(…) attract more people in a broader age range, but that is not easy because of the competitors in the market and so on the other hand because of the expanding number of people, because of the expanding part that is older in the long run, a spa has this association with people who are older because this is becoming such a growing part of the market.” (AUT05, 9)

The biggest threat for H&WB destinations according to the interviewees is the high level of competition. Many destinations and companies link themselves with H&WB, which could potentially also lead to an oversupply in the near future. For the interviewees uncertainty is also associated with potential political friction or economic recessions. The withdrawal of public financing for H&WB destinations, especially for health tourism2, is seen as big hazard because it is not clear whether consumers will be willing to pay for health activities themselves.

“(…) potentially in a certain segment of H&WB tourism there is already a little bit of an oversupply (…)” (AUT01, 13)

Austrian interviewees advance the view that prevention and medical services belong to the biggest opportunities for the future development of H&WB destinations. Czech interviewees think that the biggest weaknesses of their H&WB destinations are the low service quality which results from a lack of qualified staff. For the British heritage, history, and reputation are key strengths of H&WB destinations. Hospitality managers think that qualified staff is the biggest strength of H&WB destinations.

Summary

This chart presents the SWOT Analysis of H&WB‐destinations from the interviewees.

Strengths Weaknesses

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



sound nature / landscape / environment history / culture / tradition good facilities reputation / image / brand professional / qualified staff accessibility / public transport location relaxation / health / retreat offers

unqualified staffno positioning / marketing of a USP weak facilities weak public transport / accessibility no networking in the destination Unclean environment low financial resources

Opportunities enlargement of target groups / segments networking / co‐operation in the destination nature / natural attractions differentiation / positioning facilities and infrastructure (renewal, expansion of both roads and public transport as well as spa resorts)

Threatshigh competition political friction economic / financial crisis or recession withdrawal of state / public financing

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

in the future

The fourth question is about the importance of nature at present and in the future (2020).

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

“(…) It’s extremely important to take care of ecology and nature now and it will be even more important within ten years. Because if we’re not going to take care of the nature (…) even within seven to ten years we will have nothing to offer. So the more we take care of it now, the more we will be able to offer in 2020.” (CZK09, 16)

On the subject of sustainability there was agreement that it is very important for H&WB destinations in order to maintain the scenery and natural resources, although there is mostly no sustainability codex applied in the destinations so far. Some interviewees put a focus on local networks and the marketing of regional products.



“Sustainability is interpreted locally (…) as developing local partnerships and supporting the rural economy. It is about developing links between wellness and other products. It is about retaining a distinct local mix of shops and other businesses. It is about integrating local products, especially local food to the wider tourism offering.” (UK01, 16)

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

Summary

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

The importance of these two elements is already very high in H&WB destinations and interviewees think that this will probably increase even more in the future.

3.2.5 Role of national/regional health policy in H&WB destinations now

and in the future

The fifth question is about the role of national / regional health policy in H&WB destinations at the moment and in the future (2020).

Interviewees think that the political influence on H&WB destinations largely depends on the services available. Destinations concerned with offering cures3and medical

3The Central European concept of „Kur“ (nowadays called ambulant prevention) is part of the preventive health care at least in the German speaking countries which aims at subsidizing treatments in health spa centers to maintain the ability of employees to work. Thus, “Kur” does not mean curing from a surgical and clinical point of view but is based on treatments using natural remedies such as healing water or healing climate.



treatments for example have bigger connections with health policy than destinations operating with well‐being services. About half of the interviewees stated that politics play no significant role in their destination, but almost the same number said that health policy has a big influence on the development of their destination. Some also agreed that politics does have some impact on them, if not largely.

“Health policy, of course there is a connection, that is without question (…)“. (AUT11, 42)

On the contrary, a Finn and an English interviewee said:

“I cannot say more to regional health politics – we are not that medical, that it would reflect on us. (…).” (FIN09, 19)

“There has been no contact between tourism and the health authority, no mention of tourism in the (…) health strategy.” (UK05, 19)

Most destinations are familiar with some sort of subsidies, financial aid or co‐payments by the government or health insurance companies, which have just as large an influence on the type of guests as on the treatments and the qualifications of the staff. For the future, interviewees think that health policy will have a big influence on cuts in subsidies. More prevention offers in the future are desired, but it is unclear whether politics will support these services or not. Generally, interviewees wish to have more co‐operations with health policy in the future.

“(…) so the key here, it seems to me, is that national and regional health policies become more orientated to prevention that’s to be driven by economics. It won’t be possible anymore to focus on treatment. There is much too little emphasis upon Austria’s health policy now, and the same for regional policy in the location, and they are directly connected with one another (…).” (AUT05, 17)

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



Summary

The influence of health policy on H&WB destinations depends largely upon the offered services. Destinations focusing on medical procedures or cures have more connections with health politics than destinations with well‐being offers. Nevertheless, almost all H&WB destinations are familiar with some sort of financing through the state or health insurance companies.

For the future, interviewees think that politics will have a bigger influence on H&WB destinations and hope that more preventive services are offered. Interviewees also seek more cooperation between the public and private sectors.

3.2.6 Destination development now and in the future

This question deals with the topic of destination development in general. It has a focus on the current situation and future development of H&WB destinations.

Most interviewees think that co‐operation, partnerships, and networks support destination development in a positive way. Common destination planning and development are seen as improving the performance of destination for tourists and politicians, if the latter ones officiate in a fluently communicating and conflict‐free destination. According to the interviewees, many of their H&WB destinations have developed their tourism product recently. Infrastructure and facilities are another issue for H&WB destinations as they should satisfy customer needs. Interviewees also stated that a focus was put on the marketing and positioning of the destinations. Regular meetings are held to ensure co‐operation and planning.

“(…) health and wellness is clearly being seen as an important development opportunity for destinations. (…).” (UK04, 22)

The interviewees also had some negative associations with the current destination development. The biggest limiting factors for H&WB‐destinations at the moment seem to be financial factors. Many wish for more financial support from government and feel a big influence from the current recession. Some regions also miss co‐operation from all stakeholders and feel that there is a lack of networking. Other negative factors



mentioned are political frictions and a lack of time for appropriate destination development.

“(…) in this recession the development of the destination is pretty small, so basically we just try to survive the competition and the recession.”(FIN05, 22)

In the future, interviewees stated that their H&WB destinations plan to invest in their facilities both on maintenance and construction. Many of the interviewees also hope that co‐operation and networking become bigger topics in all regions in order to enhance destination development. A focus will be put on H&WB offers and, generally, services will be diversified in order to attract more market segments. For some the protection of the local environment is the most important aspect in the future development.

“As an example every company is trying to understand how to attract more foreign visitors, instead they should do it together and they could offer bigger entities that would attract more than a single company offering.” (FIN03, 22)

Looking at the question from the point of view of different countries, a difference can be seen concerning the Czech interviewees. For the Czech interviewees the presence of a destination management organization (DMO) is a very important aspect in destination development, and should be further enhanced in the future. Other countries did not put a special focus on this subject.

Summary

Common regional planning and acting is seen as improving the performance of destinations for both tourists and politics. Many destinations have recently developed their facilities and the range of services offered to attract more consumers. According to the interviewees, marketing and positioning are both attached with the utmost importance.

Interviewees think that the biggest limiting factors for current destination development are financial issues, mostly due to recession.

Future development is aimed at improving facilities and the co‐operation and networking in the destinations. The range of services will be diversified.



3.2.7 Resources in destination development

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

“(…) there needs to be a mixture of both, active participation of the locals but at the same time external experts, that means a combination of both (…).” (AUT08, 38)

From the internal point of view, interviewees think that it is very important to gain ideas for development internally and also make decisions internally, but with the help of external consultants. Local co‐operation and partnerships can also foster development and help to work towards a common goal. In this context, stakeholder management plays a central role. Some H&WB‐destinations are guided by a DMO and feel that this guidance is very helpful for the development.

“We work with a destination management organization very closely; we have representation on the board. We take advantage of what the DMO is doing. We communicate, offer proposals to their strategies, we meet. They do it well, and they‘re interested in opinions from the field.” (CZK06, 25)

Concerning external resources, most interviewees stated that they have used external consultants in their destination development process so far to get an outside view. The examination of best practice examples and benchmarking is very common and provides them with new ideas. The interviewees stress that memberships in different associations and organizations also contribute to the conflux of external knowledge which has to be exchanged systematically within the destination. Most interviewees said that their H&WB destinations are familiar with external investments.



“(…) we try to get the influence from elsewhere because otherwise we have the cave effect; we only see the shadows but do not see what is happening out there.” (FIN05, 22)

Summary

According to the interviewees, a mix of external and internal resources is vital for the development of H&WB‐destinations. Current tourism trends, research, and science should be monitored to be able to react to changes in customer behavior etc. Interviewees think that government and the public sector have a big influence on their H&WB destinations as they predetermine certain regulations.

Interviewees feel that internal ideas should be supported by external guidance and local co‐operations and partnerships. The presence of a DMO facilitates the development of a H&WB destination.

The H&WB destinations are familiar with the use of external consultants and external investments for the development of their region. Examination of best practice examples and benchmarking is a common feature as well as membership in organizations.

3.2.8 Processes in destination development now and in the future

Question number eight is about the processes used for destination development now and in the future.

Currently, most interviewees said that they use regular and personal communication in meetings to develop their destination. Also the co‐operation of stakeholders is a common tool used for the development of H&WB‐destinations, and co‐operation between the public and private sectors is vital as well. Interviewees develop their destinations with the aid of various platforms such as forums, membership organizations, and associations. Other points mentioned are on‐going research and the monitoring of tourism trends, as well as promotion and marketing of their H&WB‐destinations.

“Attend exhibitions, conferences, networking events, trade publications. Discuss new product development with other companies. Owners travel abroad for ideas regarding key and emerging trends.” (UK09, 32)



For the future, interviewees think that local guidelines for co‐operation will be the most important instruments for destination development. This includes the continuous involvement of locals in the decision‐making processes. Important points that will remain in the future, according to interviewees, are market‐research, trend analyses, and also the marketing of H&WB destinations.

“Developing local partnerships is the key to any future success. There is a close working relationship with local businesses (…).” (UK01, 28)

Summary

Most interviewees said they use regular, personal communication to develop their destination. Another common tool for destination development mentioned by the interviewees is the co‐operation of stakeholders and the public and private sectors. According to the interviewees, various platforms as well as market‐research and marketing are used for destination development.

Interviewees think that in the future co‐operation on a destination level will be the most important process for destination development. This also involves the participation of local inhabitants. Research and marketing will remain important in the future.

3.2.9 Balance between needs of tourists and needs of locals

This question deals with the balance between the needs of tourists and the needs of locals.

The interviewees’ opinions vary largely on this topic. About half of the interviewees think that the relationship between tourists and locals is problematic, but the other half thinks that there are no conflicts between tourists and locals.

“Finding the balance is very challenging! I feel however, that the local inhabitants are positive about this; what is good for tourism is good for the locals, too. But we would need to give them more information about what we do and use them in the development and raise their status, increase their role in the development.” (FIN01, 34)

There is general agreement that the facilities and the range of services should be for both groups and that facilities are improved regularly. Locals should participate in tourism development, being able to advance their opinions. Furthermore, interviewees



think that tourism creates a lot of jobs for locals and supports local businesses. Some interviewees also stated that there are discounts or benefits for locals using tourism facilities.

“It is important to develop agreement for tourism development with local residents. Advice on wise sustainable growth needs a bottom‐up approach and local mechanisms to ensure the views of locals are considered.” (UK04, 34)

Summary

In the interviewee’s opinion, finding a balance between needs of locals and needs of tourists is very challenging. One half of the interviewees think that the relationship between tourists and locals is problematic; the other half thinks that there are no conflicts between these groups.

There is general agreement that both the facilities and services should be used by tourists and locals as well. Locals should also participate in tourism development. Interviewees think that tourism creates jobs for locals and supports local businesses.

3.2.10 Competencies needed in the destination

The next question is about the competencies which are needed in H&WB destinations.

The interviewees’ answers show that many competencies are needed. As far as staff development is concerned, competencies such as management skills, marketing and selling skills, as well as social skills seem to be of special importance. However, the most important competency in the future is the knowledge of foreign languages. Interviewees feel that their H&WB‐destinations lack these skills at the moment. Connected with this topic is customer service, which should also be improved in the future. Interviewees also hope that staff has a comprehensive knowledge about the destination and its range of services.

“Very often we're able to deliver quality itself but we’re not able to smile, that’s very simple. This is what I see very often. I used to say that we’re not in the post office, we’re serving guests. We’re not sitting at the counter and waiting for the guests to come. We should approach them and make advances to the guests.” (CZK09, 37)



Interviewees feel that the physical goods and services which they offer should be further developed in the future to attract more guests. Another important topic is the development of supporting services (explanation: a bike rental company needs a bike‐route, a medical spa needs a pharmacy) and the improvement of single steps within one process (process management of successive steps such as information, booking, payment, which are altogether realized as one service), also called a service chain.

“(…) We would need development in the direction of cluster management, where it is clearly defined, what are the core competencies, core strengths. And along these core competencies a high degree of liability of the service chain is needed, and we are lacking liability for long periods for now.” (AUT07, 75)

Summary

The training and education of staff is the most important aspect in the needed competencies for H&WB‐destinations according to the interviewees. Language skills make up the largest part in this area. Also important are customer service and the regional knowledge of staff. Management skills, marketing, and sales as well social skills could also be further developed according to the interviewees.

Interviewees feel that the goods and services have to be improved as part of a chain of services. Another important topic for interviewees is an adequate information policy.

3.2.11 Core business of the destination in the future

The last question which was addressed to the interviewees is about the core business of their destinations in the future.

Almost all interviewees think that H&WB will be the focus of their destinations in the future. Interviewees also think that there will be a trend towards more active holidays with a focus on sports and outdoor activities. This will need further investment in the expansion and maintenance of related facilities.

“I think health and well‐being is a good theme as you can connect it with experiences and nature values in overall well‐being.” (FIN03, 40)



Concerning the target groups, interviewees think that domestic tourism and tourism from nearby countries will grow in importance. For some interviewees, international visitors will also play a big role in H&WB destinations. Another trend seems to be that older people remain more active and more interested in H&WB destinations and will therefore become a big target group in the future.

“Close‐by markets will be growing according to all studies.” (FIN02, 40)

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

Summary

As for the future, almost all interviewees want their destinations to focus on H&WB. They also think that there will be a trend towards more active holidays and that is why bigger investment in outdoor and sport facilities is needed.

Interviewees think that domestic tourism and tourism from nearby countries will grow in importance. Some also see international visitors as playing an even bigger role in future. Older people become more active and interested in H&WB, which makes them a future target group.

3.3 Discussion

As stated in the analysis of the qualitative interviews with the stakeholders, the dichotomy between health and wellness can be seen also in the quantitative part of the stakeholder interviews (part A). The results of question 2 (part A, chart no. 4) reveal a strong emphasis on wellness issues (the first two bars from the top) and a quite weak emphasis on health related issues (lower part of the chart).

Question two of the qualitative stakeholder interview (chapter 3.2.2) reveals the necessity of the quality of all services offered. This might be understood as a contradiction to the results of the interview part A (chart no. 8) which attached little importance to quality issues. But part A somehow stresses the aspect of certifiable quality management systems, whereas the statements in part B emphasized a broader



approach to quality in the sense of delivering services satisfying the expectations of the clients. The way services are offered plays as important a role in part A as in part B.

The results of the stakeholder interview part B stress the importance of the staff competencies in general. Part A specified which competencies are among the most important ones. We learned that the importance of "recognition of customer expectations” is one of the core competencies with respect to the management of a H&WB destination. Other important items comprise various communicative issues such as rhetoric, presentation, marketing, and networking.

Regarding the SWOT‐analysis as part of question 3 in the stakeholder survey (chapter 3.2.3), many responses stress the importance of nature, landscape, and a healthy environment. This corresponds with the results in part A (chart no. 3) which rank this environmental and nature‐based issue at the top together with “doing something for health”.

Question no. 8 (chapter 3.2.8) of the stakeholder interview part B stresses the importance of proper communication among the players of the destination and the use of regular and personal contacts. We refer to the results of the chart of question no. 9(chapter 2.2.7) that also attaches very much importance to better communication within a H&WB destination.

Question 9 of the stakeholder interview (part B) points out that at least the half of all interviewees thinks that the relationship between tourists and locals is somehow problematic. It is foremost a matter of communication to harmonize the different expectations and needs of all players in a destination for the sake of smoothly running the destination development. This problem was not mentioned by the consumers at all, who obviously do not feel the tensions between locals and tourists as keenly.

Question no. 10 of the stakeholder interview (part B, chapter 3.2.10) deals with the competencies necessary for the destination management and its personnel. Very much importance is attached to language skills. The managers themselves rank “intercultural communication & foreign languages” very low, with the question they answered focusing on their individual need. Pondering the core business of the future in H&WB‐destinations (chapter 3.2.11), the stakeholders think there will be a trend towards more active holidays. However, other parts of the research did not correspond with that: In part A (chart no. 4) the stakeholders did not attach that much importance to “outdoor and indoor sport”, although active holiday might not necessarily be the same as “outdoor and indoor sport”. As the consumers attach as much importance to “indoor and outdoor sport” as to “enjoying natural scenery and nature” (chart no. 20), an active



holiday in the outdoors is among the highly demanded activities. Nonetheless, pampering and indulging spa procedures belong to the most important ones.

An intensely debated issue in the theory of regional development is the relationship of the influence on development processes of locals or non‐locals, also described with the terms endogenous and exogenous approaches in regional development. It is clear that the stakeholders want to have a balance between these two approaches (chapter 3.2.7).



4 Consumer research

4.1 Methodology

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

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

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

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

The quantitative research:

Those, who filled in the questionnaire electronically, did so via link to Webropol so that the questionnaires were immediately archived in Webropol. The questionnaires of those who filled in the questionnaire in hardcopy form, were collected, re‐translated into English and then fed into Webropol.

Webropol itself disposes of a reporting function which creates charts transferring them to Excel which offers further tools for data processing.

The qualitative research:

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

The results presented in chapter 4.2 are based on quantitative and qualitative data.

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




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

4.2.1 In which country are you right now while filling in this

questionnaire?

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

4.2.2 Please write down some key words, which come into your mind if

you think of a H&WB‐destination

There were 1638 exploitable answers from the consumers, categorized in different clusters as follows:

Word‐clusters (bold) and related issues

Number of responses

Nature

Calm, clean, silence, fresh air, sun, forest, water 383

Relaxation recover, detox, recreation

374

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

235

Treatments 227

98

122

173

187

204

Austria

Czech Republic

United Kingdom

Finland

Germany

784 responses



Massage, therapies Active life Exercising, hiking, doing sport, biking

196

Food

Regional, organic, healthy food 118

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

169

altogether 1638

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

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

The results of this chart present a quite clear image of what a H&WB destination should consist of: lovely nature with spa facilities which are altogether inviting for relaxation, treatments, and sport activities.

Comparing these results with what the stakeholders think guests feel attracted by in their destination (chapter 2.2.2), some differences and similarities can be detected:

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

105

118

196

227

235

374

383

Other meanings

Healthy Food

Active life

Treatments

Facilities

Relaxation

Nature

1638 responsesMultiple answers



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

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

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

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

4.2.3 What kind of services, staff competences and elements attract / did

attract you to come to a destination like this?

There were 1333 exploitable answers from the consumers categorized in different clusters as follows:

Word‐clusters (bold) and related issues

Number of

responses Staff social skills, friendly, services, professional

208

Treatments massages, variety, diversity, versatile

140

Cleanliness hygiene, clean

32

USP new, stunning, unique

8

Water springs, pools, healing water

80

Culture historic, tradition, regional originality

18

Facilities spa, exotic, steam bath, pools, modern, hotel, swimming, renovated, facilities, wellness‐area, sauna, hotel, furnishing

169

Atmosphere decoration, calm, relaxation, peaceful, luxurious, pampering, safety, homey, rituals, hospitality, silence, recreation

111

Sport outdoor, gym, exercise, fitness, hiking, biking, motion

87

Communication Sales, marketing, prices, cost‐performance‐ratio, packages, image, services, reputation, information, web‐site

99

Food healthy, eating, variety

76

Nature landscape, environment, natural attractions, scenery, garden, air

117

Accessibility not far from home, short distances within spa, transport

24



Medical post‐operative care, rehabilitation, health, doctor, healing, recuperation, healing climate

59

Quality high quality

34

Location peaceful, pleasant, surroundings

44

Entertainment activities, shopping

27

total 1333

Presented as chart it turns out to be as follows:

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

It turns out that factors such as “staff”, “facilities”, and “treatments” are up for debate. The middle‐ranking issues are “nature”, “atmosphere”, “sales”, “sport”, “water”, “food”, and “medical”.

Comparing these results, one gets a quite holistic approach to what a H&WB destination actually consists of. The thicker the bar the more responses it got:

8

18

24

27

32

34

44

59

76

80

87

99

111

117

140

169

208

USP

Culture

Accessibility

Entertainment

Cleanliness

Quality

Location

Medical

Food

Water

Sport

Communication

Atmosphere

Nature

Treatments

Facilities

Staff



Chart 17: The H&WB triangle



4.2.4 How did you come to the idea to visit this destination you are

currently staying at / you have stayed at?

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

Obviously, the word of mouth recommendation plays a very important role in making the decision to visit a H&WB destination. Digital media play important role, too. Thirdly, “an earlier positive experience in this destination” makes people come again.

Traditional marketing tools such as advertisements play a far less important role. The health insurance and a recommending doctor do not play an important role, either.

31

44

46

86

93

131

144

184

217

241

287

My doctor recommended it to me

An advertisement of the dest.led me to book…

My health insurance sent me here

Other, please specify

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

I read about the destination in print media

I wanted to try a new destination

The positive image of the destination

An earlier positive experience in this destination

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

The destination was recommended by friends




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

Chart 19: The overall reason to come to this destination

“Doing something for health”, “the natural scenery”, and the “image of the destination” seem to be of utmost importance with regard to the overall reasons for the guest to visit a H&WB destination.

Health in general was ticked many times. Those, who “want to do something for his/her health” specified their wishes in an additional question as follows:

66

75

94

123

245

304

369

398

Visiting friends and relatives

Culture

Other reasons, please specify

Price level

Suitable accommodation

Reputation / image of the destination

Natural scenery

To do something for his or her health




Chart 20: What clients want to do for their health

Interestingly, “relaxation and pampering spa services” belong to those services which seem to be most important. Chapter 4.2.2 put a similar emphasis on relaxation as one of the most important things guests want to do. In a more health‐oriented context as it is shown here, relaxation plays an equally important role.

All these items mentioned by the respondents are aspects of health leading to a quite broad definition of what health actually is. It comprises different approaches such as relaxation, pampering spa experiences, natural healing resources, sport, and the natural scenery. Thus, health in a health & wellbeing destination is much more than only clinical services in a nice region.

15

58

121

126

152

174

258

Other reasons






Relaxation




4.2.6 Which services, activities, and elements do you value the most in

this destination?

Chart 21: The most valued services and activities

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

38

50

77

78

110

113

133

164

170

204

214

305

364

Other

Diverse entertainment and cultural services

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

Preventative services

Fitness activities

Professionally skilled staff

Healthy food

Curative treatments

Comfortable accommodation

Hiking, nordic walking and similar outdoor…

Diverse sauna, pool and steam bathing…

Attractive environment

Diverse beauty and pampering treatments




4.2.7 Which of the following options best describe your needs when

choosing a health and well‐being holiday?

Chart 22: Needs when choosing a well‐being holiday

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

33

38

74

80

130

154

241

265

462

495

To find new social relations

Other

To improve my appearance/beauty

To recover/recuperate from an illness

To learn new things about my health and…

To experience something new

To improve my physical condition

To spend time with family/friends

To get mentally refreshed

To escape the pressures of everyday life




4.2.8 To which extent does/did the destination as a whole meet your

expectations regarding the health and well‐being related offering

during your stay?

Chart 23: Meeting the expectation of the clients

This chart reveals a quite high satisfaction with the destination, whereas “extremely well” received much fewer responses. Therefore, potential for further development can be taken from this chart.

If the respondents ticked “did not meet/met my needs” they could proceed to an open question, the results of which are as follows:

There were 1638 exploitable answers from the consumers categorized in different clusters as follows:

No. Word‐clusters …and related aspects

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

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

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

4 Prices too high 5 Facilities in general too big, too old, bad playground, not warm enough

11

92

204

467

Doesn’t meet my needs/ Did not meet my needs

Meets/ Met my needs to some extent

Meets/ Met my needs extremely well

Meets/Met my needs well




6 Activities more, certain kinds of sport, more for kids7 Spa not enough relaxation area, too small, not calm, more facilities 8 Food buffet, bad quality9 Hygiene bad 10 Service in general could not change room, should be better, more complementary

services 11 Entertainment more 12 Location bad, more life in downtown13 Duration of stay wants to stay longer14 Communication false information in brochure, guest misunderstood hotel target

group 15 Travel conditions e.g. lacking travel companion

16 Accommodation bad quality

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



The chart below calculates the number of responses together:

Chart 24: Causes of disappointment with the chosen destination

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

1

1

2

2

2

3

3

3

3

4

4

4

6

7

8

11

Accommodation (bad quality)

Travel conditions (lacking travel companion)

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

Duration of stay (wants to stay longer)

Location (bad, more life in downtown)

Entertainment (more)

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

Hygiene (bad)

Food (buffet, bad quality)

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

Activities (more, certain kinds of sport, more forkids)

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

Prices (too high)

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

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

Treatments (need more, lack of certain t., lackof privacy, more flexibility, more medical)



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

Chart 25: Scoring the destination’s services

This question calls attention to indoor services of the destination’s facilities. With respect to the violet bars (“met my needs extremely well”), it turns out that the classic hotel services such as accommodation and F&B come first, followed by spa‐services, and at the end medical services.

The chart below adds the scores from “meets my needs well” and „meets my needs extremely well“ from the previous, leading to a modified analysis:

19

13

13

14

13

17

10

128

110

108

79

78

101

89

395

423

395

378

380

370

338

149

156

208

259

269

270

286

Services with respect to health promotion andmedical issues

Services concerning information services before Istarted my holiday (e.g. internet)

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

Services concerning booking and reservation

Services with regard to wellbeing, relaxation, andpampering

Services with respect to food & beverage

Services with respect to my accommodation

Meets / Met my needs extremely well

Meets / Met my needs well

Meets / Met my needs to some extent

Doesn’t meet my needs / Did not meet my needs

Linear (Meets / Met my needs extremely well)

5068 responses 1 tick in each row



Chart 26: Which services are scored both „well“ and „extremely well“ with regard to the

destination’s services in general

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

544

579

603

624

637

640

649

Services with respect to health promotion andmedical issues

Services concerning information services beforeI started my holiday (e.g. internet)

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




Services with regard to wellbeing, relaxation,and pampering

well and extremely well

4276 responses 1 tick in each row



4.2.10 To which extent were/are you able to use the variety of services

offered in the H&WB‐destination?

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

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

35

39

40

49

73

212

234

235

249

I was unable to use interesting services/placesoutside my hotel/clinic/spa because ofage/handicap/ lack of transportation

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

I did not find interesting services/places outsidemy hotel/clinic/spa

I would not come to this hotel/spa/clinic again ifthe destination would not have all these

interesting possibilities

I didn’t have enough information about all the possibilities in the destination

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

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

I make use of the regions services regularly

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


I make use of the region’s services regularly



4.2.11 How do/ did you check the influence of your current holiday on your

health at the end or after the stay?

Chart 28: Check of the health status

How to read the chart: 57 respondents state that they will check the influence of the current

holiday upon return home

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

57

74

78

118

143

441

I will have a check done by a specialist uponreturn home

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

I will have a check done by a specialist at the endof the stay

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

I am not interested / I wasn’t interested

I don’t check/ I didn’t check

911 respondents



4.2.12 Which of the following alternatives best describe your expectation

of the price level of an H&WB holiday compared to a standard

holiday of the same length?

Chart 29: Expectation with respect to the price level

How to read the chart: 113 respondents are of the opinion that a holiday in a H&WB‐destination

is much more expensive compared to other regions.

A large majority of respondents think that their holiday in a H&WB destination is more expensive than in other destinations. It is the minority which believes the contrary or does not care about prices. Since just a minority of answers (65 respondents) reflects a lack of interest in prices, the price level in general seems to be a sensible issue to be taken into consideration.

30

65

119

134

139

271

H&WB holiday is cheaper than a standardholiday

Price level does not make a difference forme

Same as a standard holiday

I don’t know

It is much more expensive

It might be a little bit more expensive

758 respondents



4.2.13 Which are the elements which prevent you from recognizing a

destination as a health and well‐being destination?

Chart 30: Elements which prevent people from recognizing a destination as a health and well‐

being destination

How to read the chart: 214 respondents said that “too much traffic” prevent them from

recognizing a destination as a H&WB destination.

It seems that “too much traffic” and “too much disturbing industries” especially interfere with the image of a H&WB‐destination. This leads to the conclusion that a H&WB destination does not work in a densely populated area, and that guests want to have direct access to nature‐based activities.

48

72

83

86

140

149

168

170

187

191

209

217

Other

Sprawling cities, villages, and traffic

Lacking medical services/facilities

Inadequately skilled medical staff

Outdated health‐promoting facilities (eg. old‐fashioned public baths, gyms, etc.)

Lacking wellness and spa facilities


Bad quality of services in general (e.g. signage ofwalking trails, quality of information given by…

Too expensive

Too many tourists

Too much disturbing industries

Too much traffic




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

Chart 31: Highest level of education

How to read the chart: 248 respondents said that they have completed “secondary school”.

4.2.15 Sex

Chart 32: Sex

40

108

136

216

255

Doctoral degree

Basic education (up to 16years)

Master’s degree or similar

Bachelor’s degree or similar

Secondary School

208

544

Male

Female

755 respondents

752 respondents



4.2.16 Your age

Chart 33: Age

How to read the chart: 28 interviewees were under 20 years old.

The majority of the consumers interviewed are aged twenty to sixty.

18

90

72

105

107

63

9

4

Under 20

21‐30

31‐40

41‐50

51‐60

61‐70

71‐80

80+

765 responses



4.2.17 Origin

Chart 34: The origin of the respondents

2

3

4

81

84

162

180

207

Norway

Russia

Australia

Austria

Czeck Republic

UK

Finland

Germany

723 responses



5 Discussion of the results: Stakeholder and consumer research

5.1 The term health and related meanings

We learned about the importance of health and well‐being as a main reason to visit a H&WB destination. From this result arises the question of what people actually expect when they speak of health. This comes out quite clearly in chart 4 (chapter 2.2.2.): If guests want “to do something for his/her health” the stakeholders think mostly of “relaxation”, “pampering spa services”, “enjoying natural scenery and its nature”, “outdoor and indoor sport”, natural healing resources”, and “clinical/medical services” thus asking for a big range of things which are related to the term health.

The comparison with the expectations of the consumers looking at the term health can be easily done by comparing charts:

Stakeholders (chart no. 4)

2

9

10

11

19

21

25

Other reasons, such as fun, sport, outdoorevents…






Relaxation



Consumers (chart no. 20)

Chart 35: Meanings stakeholders and consumers attach to the term “health”

We asked the same question to both stakeholders and consumers. The answers are quite interesting as both groups share the same opinion. Both groups rank “relaxation”, “pampering spa services”, “enjoying natural scenery and its nature”, and “outdoor and indoor sport” first. Medical services in a more traditional sense play a role, too, but seem to be less important.

5.2 Elements which prevent guests from recognizing a

destination as a H&WB destination

The best answer to this question can be easily achieved by a direct comparison of the charts:

15

58

121

126

152

174

258

Other reasons






Relaxation



Stakeholders (chart no. 5)

Consumers (chart no. 29)

Chart 36: What prevent people from recognizing a H&WB destination

According to the stakeholders it is the lack of medical and spa‐related facilities which prevents clients recognizing a destination a H&WB destination, whereas the consumers focus more on stressing factors such as too much traffic, tourists, and industries.

2

2

2

3

4

6

6

8

8

11

14

15

Too much traffic

Too expensive

Too many tourists

Too many disturbing industries


Bad quality of services, such as signage of…

Outdated health‐promoting facilities,…

No medical staff available

Sprawling cities, villages and industrial areas

Others, such as lack of overall concept,…

Lack of wellness and spa services / infrastructure

Lack of medical services/infrastructure

48

72

83

86

140

149

168

170

187

191

209

217

Other

Sprawling cities, villages, and traffic

Lacking medical services/facilities

Inadequately skilled medical staff

Outdated health‐promoting facilities (eg. old‐…

Lacking wellness and spa facilities


Bad quality of services in general (e.g. signage…

Too expensive

Too many tourists

Too much disturbing industries

Too much traffic



5.3 The quality of services

This research discusses the quality of services in different chapters. One bar in this chart above (chart 36) deals with the service quality in general, whereas others assess the importance of particular services. To get an idea of the importance of service quality in general the chart above may serve as an answer. Both the stakeholders and the consumers rank it seventh and fifth, respectively. The stakeholders attach more importance to the facilities and services, whereas the consumers feel disturbed by too much traffic, disturbing industries and too many tourists.

5.4 Country‐specific analysis 1: What people do for

their health

This following chart compares the results from question no. 5 (consumer questionnaire) „to do something for his/her health” with the origin (nationality) of the respondent.



Chart 37: What people do for his/her health connected with the place respondents filled in the

questionnaire

Obviously, “relaxation” got the highest rates in all, except in Austria. Comparing all data it becomes clear that “relaxation”, “spa services” and “healing resources” are the most important activities in UK. Austria is different: “doing sports” and “nature” belong to the most popular.

All in all, we see that the most important “health activity” is “relaxation” (29 %), followed by enjoying “spa services” (20 %), with “nature” (17 %) also being an important item. Doing “sports” (14 %) and using “healing resources” are less important. 2% of the interviewees prefer other not further defined activities.

This country‐specific analysis corresponds largely with what has been said before, as relaxation and sport are attached with high importance, whereas medical treatments play a less important role.

Med

ical Services

Spa services

Relaxation

Sports

Nature

Healing resources

Others

0%

5%

10%

15%

20%

25%

30%

35%

Finland

Austria

Germany

Czech Republic

United Kingdom



5.5 Country‐specific analysis 2: Price level

The following chart analyses the expectation of the price level of H&WB visitors using a country specific approach:

Chart 38: Is a H&WB holiday more expensive or cheaper than a standard holiday?

Obviously, a majority of the interviewees think that a HW&B holiday is more expensive. Nearly no one thinks that a HW&B holiday is cheaper than a standard one, except 11% of Finnish people. About 65% of the Austrians think that a HW&B holiday is more or at least a little bit more expensive. It is also interesting that people from the UK (53%) have the feeling that a HW&B holiday is “a little bit more expensive” than a standard one.

FIN AUT GER CZ UK

More expensive 13% 34% 24% 15% 10% A little bit more expensive 35% 31% 41% 9% 53% The same 16% 10% 21% 22% 7% Cheaper 11% 1% 1% 3% 2%

More expensive

little bit more expensive

the same cheaper I don't know Price level does not make a

difference for me

0%

10%

20%

30%

40%

50%

60%

% of answ

ers

UK

FIN

AUT

GER

CZ



I don't know 17% 14% 8% 33% 20% Price level does not make a difference for me 8% 11% 4% 17% 9%

5.6 Specific analysis: Health activities and education

Chart 399: Do healthy activities depend on education?

In this chart we see that there are hardly any differences in answering this question. Interesting is that “Pampering Spa Services” is very important for people with a doctoral degree.

Relaxation

Clinical/m

edical se

rvices

Outdoor a

nd indoor sport

Pam

pering spa services

Enjoying natural

scen

ery and its n

ature


0%

5%

10%

15%

20%

25%

30%

35%

40%

Basiceducation(up to16years)

SecondarySchool

Bachelor’s degree or similar

Master’s degree or similar

Doctoraldegree



5.7 H&WB destination: Characteristics and definition

At the end of this stage of the research, one of the core terms of this document should be looked at again. The travel industry has a long history with very different definitions of tourism and related terms, with sometimes supply‐oriented, sometimes demand‐oriented definitions en vogue. The following table tries to systematically collect all points stated in this research paper to come to a final proposal for a comprising characterization of what a H&WB destination actually consists of:

Chapter 2.2.2 Chapter 2.2.7 Chapter 3.2.1 Chapter 4.2.6 Chapter 4.2.7

Supply‐oriented Demand‐driven

‐ Natural scenery ‐ Doing some‐thing for health ‐ Reputation and image of destination ‐ pampering spa services ‐ relaxation

‐ brand identity ‐ communication and co‐operation of all relevant players ‐ professional marketing and sales

‐ Holistic approach to health ‐ Medical services ‐ Pampering spa‐services, pools, and thermal baths ‐ Diversified services

‐ Beauty and pampering spa services ‐ Attractive environment ‐ Outdoor sport ‐ adequate Accommodation ‐ Medical treatments Sauna and pools

‐ Escape everyday stress ‐ Mental refreshment

Summarizing these ideas into a definition one can say:

A H&WB destination needs to dispose of both nature and skilled staff working in

facilities. Hotels with a wide range of spa services are complemented with well‐

maintained nature offering the opportunity for various activities. Thus, a critical mass

must be reached satisfying the clients’ needs in the field of relaxation and healthy

activities. Various professions have to work together closely providing a seamless

chain of services. The destination is to be managed and marketed professionally as a

unit and disposes of a strong brand image.



6 Summary and managerial implications

The following mind map is a summary focusing on several questions and their answers with the highest number of responses.

The mind map may give an insight into the manifold nature and intricacy of things which have to be considered on the way to a H&WB destination. The e‐handbook, as one of the very practical results of this research, is to provide a tool capable of assessing the status quo of such a destination time‐effectively and to better develop it.

Chart 40: Summarizing mind map

As for the implications for the management of wellness and spa hotels, public spa centers, health spa villages, and DMOs, they all should pay more attention to the many features and elements guests expect when coming to a H&WB destination. The many things destination managers have to have in mind when developing a region under the auspices of health and well‐being refer to challenges on different management levels, as destination development takes place on a company level (e.g. spa hotel), on a destination level (e.g. hiking trails crossing local borders), and on a political level, with regional or national dimensions if it comes to things such as environmental protection or health insurance which are asked to pay for medical treatments.

These challenges in destination development will be picked up in the e‐handbook, which is to offer more practical solutions for H&WB destination development.



7 Limitations

7.1 Qualitative stakeholder analysis

All partner countries were informed with respect to the way the interviews were to be conducted in order to ensure a standardized procedure. However, there were some differences in doing either face to face interviews or doing telephone interviews. Secondly, the partners agreed on the categorizing of the interviewees along their field of expertise (health manager, tourism manager, policy maker, etc.). However, the categorization clusters might include different experts within the different partner countries. Therefore, this might result in inconsistent clusters of expert categorizations due to the different backgrounds of the interviewees.

7.2 Consumer Research

Question no. 18 of the questionnaire aimed to find out to which destination the interviewees referred to. Since a huge number of unknown regions were mentioned, the team agreed to leave this question out.

7.3 Limitations in general

The limitations of the study can amount to opportunities for future research. Still, within the subject of health and well‐being in destinations it would be interesting to gather data in other countries in order to generate comparative studies. The study could find relevant differences of various kinds. These concerns the behavioral patterns of customers of different countries with regard to the use of services, the understanding of terms and concepts, and the way services are evaluated in the comparison of the consumers of different countries. The data collected offer many opportunities for further analysis as the report in hand limits itself to the most important results.



8 Appendix

8.1 Stakeholder questionnaire – part A

Dear Ms. or Mr., The aim of WelDest is to create a development framework to be used by public bodies, destination management organizations and private companies, when developing holistic health and well‐being destinations (H&WB). The project combines the expertise of five Higher Education Institutes, 10 industry and 15 associate partners from Austria, the Czech Republic, Finland, Germany, and the UK. We would like to ask you, as an expert in your field, to fill in this questionnaire to contribute an important part to our research. After Part A of the questionnaire has been completed, Part B of the research will be done as an interview by telephone or in person. 1. Which of the following options best describe the role of health and well‐being in your destination now and by 2020? Please tick only one option

Now Future Health and Well‐Being (is)… … the core tourism offering of our

destination … an essential part of the tourism offering

alongside other services … a minor offering … already a part of the destination

strategy but not yet implemented at the destination level … plays no role in the destination

Health and Well‐Being will (be)… … the core tourism offering of our

destination … an essential part of the tourism

offering alongside other services offered … a minor offering … part of the destination strategy in the

future … play no role in the destination



2. What do you think are the most important reasons customers come to your destination? Please tick up to three answers

□ the natural scenery

□ the reputation / image of the destination

□ the culture

□ the price level

□ visiting friends and relatives

□ suitable accommodation

□ to do something for his or her health, please specify (multiple answers possible): □ Relaxation □ Clinical/medical services □ Outdoor and indoor sport □ Pampering spa services □ Enjoyingnatural scenery and its nature □ Natural healing resources □ Other reasons………………………. □ Other reasons, please specify: ………………………………………………………………………………………………………………………… 3. Which elements prevent your guests from recognizing your destination as health and wellbeing destination? Please tick up to three answers

□ Too much traffic

□ Too expensive

□ Too many disturbing industries

□ Too many tourists

□ Lack of medical services / facilities

□ Lack of wellness and spa services / facilities

□ Lack of natural environment

□ No medical staff available

□ Bad quality of services in general (e.g. signage of walking trails, quality of information given by local tourism boards, hygiene of spa pools, etc.)

□ Outdated health‐promoting facilities (e.g. old‐fashioned public baths, gyms, etc.)

□ Sprawling cities, villages and industrial areas

□ What else? ……………………………………………………………………………………………….



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

Competence

1 = Not

important

at all

2 = Not

very

important

3 = Quite

important

4 = Very

important

Rhetoric/Presentation/Communication □ □ □ □

Intercultural communication &foreign languages □ □ □ □

Human resources management □ □ □ □

Recruiting process □ □ □ □

Team leading □ □ □ □

Problem solving within the organization □ □ □ □

Employment law □ □ □ □

Recognition of customer expectations □ □ □ □

Recognition of service gaps □ □ □ □

Process‐ & project management □ □ □ □

Quality management □ □ □ □

Understanding the benefits of applied research (e.g. market research, benchmarking)

□ □ □ □

Complaint management □ □ □ □

Knowledge management □ □ □ □

Innovation management □ □ □ □

Responsible management (sustainability issues) □ □ □ □

Networking skills to contribute to destination development

□ □ □ □

Sales & Marketing know‐how □ □ □ □

Understanding of H&WB related concepts/definitions (e.g. health tourism, prevention, wellness)

□ □ □ □

IT skills and e‐Business □ □ □ □

Business law □ □ □ □



Self‐management (e.g. time management □ □ □ □

Other, please specify ………………………………………………

□ □ □ □

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

Competence 1 = No

Need

2 = Low

Need

3 =

Some

Need

4 = High

Need

Rhetoric/Presentation/Communication □ □ □ □

Intercultural communication &foreign languages □ □ □ □

Human resources management □ □ □ □

Recruiting process □ □ □ □

Team leading □ □ □ □

Problem solving within the organization □ □ □ □

Employment law □ □ □ □

Recognition of customer expectations □ □ □ □

Recognition of service gaps □ □ □ □

Process‐ & project management □ □ □ □

Quality management □ □ □ □

Understanding the benefits of applied research (e.g. market research, benchmarking)

□ □ □ □

Complaint management □ □ □ □

Knowledge management □ □ □ □

Innovation management □ □ □ □

Responsible management (sustainability issues) □ □ □ □

Networking skills to contribute to destination development

□ □ □ □

Sales & Marketing know‐how □ □ □ □

Understanding of H&WB related concepts/definitions (e.g. health tourism, prevention, wellness)

□ □ □ □



IT skills and e‐Business □ □ □ □

Business law □ □ □ □

Self‐management (e.g. time management □ □ □ □

Other, please specify ………………………………………………

□ □ □ □

6. Please evaluate the present performance of your destination regarding the following specific points:

In our destination…

1 =

I strongly

disagree

2 =

I disagree

3 =

I agree

4 =

I

strongly

agree

… there is a commitment and co‐operation of all actors (private and public)

□ □ □ □

… there is transparency in communication processes

□ □ □ □

… we have an effective destination management organization

□ □ □ □

… we are involved in destination‐wide decision making processes

□ □ □ □

… we collect and utilize destination level data systematically (knowledge management)

□ □ □ □

… we provide an innovation friendly environment □ □ □ □

… there is an adequate development process‐ & project management in place

□ □ □ □

… we use a quality management system (e.g. ISO, EFQM,…)

□ □ □ □

…. there is an understanding of the importance of strategic destination development

□ □ □ □

… aspects of sustainability will be considered in decision making processes

□ □ □ □

… we follow joint sales & marketing strategies □ □ □ □

… there is a feeling of togetherness and common goals amongst the actors (e.g. authorities, entrepreneurs, locals)

□ □ □ □



… we follow a destination brand identity □ □ □ □

… we have other specific points, such as: ………………………………………………

□ □ □ □

7. How important are the following specific points regarding the development of a Health and Well‐being Destination (H&WB)?

1 =

not

important

2 =

quite

important

3 =

important

4 =

very

important

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

□ □ □ □

Transparency in communication processes □ □ □ □

A destination management organization □ □ □ □

Involvement in destination‐wide decision making processes

□ □ □ □

Systematic collection and utilization of destination level data (knowledge management)

□ □ □ □


□ □ □ □

Process‐ & project management with regard to destination development

□ □ □ □


□ □ □ □

Common understanding of the importance of strategic destination development

□ □ □ □

Consideration of sustainability in decision making processes

□ □ □ □

Joint sales & marketing strategies □ □ □ □

Feeling of togetherness and common goals amongst the actors (e.g. authorities, entrepreneurs, locals)

□ □ □ □

Destination brand identity □ □ □ □ Other important points, such as: ………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………



Socio‐Demographic Data 8. Please define the level of your current job Please tick only one option

□ Owner/entrepreneur □ Executive Manager (e.g. CEO) □ Mid‐management (e.g. department head) □ Other, please specify ……………………………………………………………………………………… 9. What is the highest level of education you have completed so far? Please tick only one option

□ Basic education (up to 16years)

□ Secondary school

□ Bachelor’s degree or similar

□ Master’s degree or similar

□ Doctoral degree 10. How many years of experience do you have in the following categories? Please choose the adequate column(s) and tick the years of your working experience

Working in

hotels / restaurants

Health related services such as (thermal) spa, public / private health care, etc.

Destination management or regional authority

Others, please specify ………………

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

□ □ □ □



8.2 Stakeholder questionnaire – part B

PART B: Interview Guideline Notes for interviewers: All questions should be discussed at the beginning with a focus on the present situation. At the end of each question future goals can be targeted (by 2020). The introductory question is to get the interviewees talking. Please note that some questions (7 to 9) might not be answered by hospitality or health managers. In that case make a note and go ahead. For interviews with “authorities of the highest level,” it is necessary to take care that the interviewees have knowledge of regional tourism policies or destination development. Otherwise he/she will not be able to answer some of our specific questions. E.g. the Minister of the Economy in Austria is also responsible for national tourism policies but might not have a detailed knowledge of health and well‐being regions in Austria, BUT the chief of the Styrian Tourism Board has. So please try to ask all questions, and if the interviewee does not know the answer to any question, leave the question out. Terms and Definitions 1. How would you define a Health and Well‐Being destination (H&WB)? Key words: health tourism, wellbeing tourism, wellness‐tourism ………………………………………………………………………………………………………………………… 2. What are the key service supply, resources, staff competencies and elements of a H&WB destination? Key words: service supply (spa services, tourism information, etc.) / resources (e.g. healing climate / water, hiking trails, landscape, etc.) / staff competencies /other elements (public transport system, etc.) …………………………………………………………………………………………………………………………

SWOT 3. What are the strengths, weaknesses, threats and opportunities (SWOT) of your H&WB destination? Key words: SWOT, things to be improved in general, comparison with other comparable destinations, current customer segments, urgent need for action …………………………………………………………………………………………………………………………



Role of nature 4. What is the importance of nature and sustainability in a H&WB destination now and by 2020? Key words: how important is nature, natural assets (e.g. thermal water, pit, etc.) sustainability, ecology, natural health‐promoting resources such as a healing climate, healing water, facilities in the outdoors ………………………………………………………………………………………………………………………… Role of national / regional health policy 5. What is the role of the national / regional health policy in destination development now and by 2020? Key words: impact of health policies on destination development, role of health insurance and medical associations? ………………………………………………………………………………………………………………………… Current situation in destination development 6. How is the destination development now and by 2020? Key words: goals of the destinations players, current decision making process at the destination level, utilization of knowledge management in the destination, communication in the destination between the players, challenges in co‐operation, destination brand identity, What are limiting factors in the further development of the destination ………………………………………………………………………………………………………………………… Internal versus external resources in destination development 7. How and from whom do you try to get ideas / proposals for further development of the destination now and by 2020? Key Words: What internal (e.g. existing knowledge at the destination level, local investments) and external resources (e.g. using consultants, participating in R&D projects like WelDest, external investments) do you use? Describe the decision making process at the destination level and who participates in it. Who is to decide upon the destination’s future? What are the forms of co‐operation between companies and public sector? What is the destination management structure? Is there a (DMO) destination Management Company and what is its role? What is the role of strategic planning? …………………………………………………………………………………………………………………………

Instruments to be applied for destination development Key words: what are the current approaches, forums, tools, instruments, communication techniques used in destination development?



8. Which methods / tools / instruments / processes are currently being used to develop the destination? ………………………………………………………………………………………………………………………… 9. Which methods / tools / instruments / processes will be used in the future to develop the destination? Will a new business environment force you to use new methods / tools / instruments / processes? ………………………………………………………………………………………………………………………… Locals versus tourists 10. How do you try to find a balance between needs of tourists and the needs of the locals? keywords: How to try to satisfy both target groups? Do both groups have a role in destination development? Role of social and economic responsibility. ………………………………………………………………………………………………………………………… Training and education on a destination level 11. Which competencies does the destination need to better serve the guests? key words: What capabilities does the whole destination /singular companies/your management unit need? What kind of education/training would be useful with regards to destination development? ………………………………………………………………………………………………………………………… Future Markets 12. What will be the core businesses of your destination in the future? key words: future target groups, new services to be developed, new facilities to be developed, is H&WB a prominent future market for the destination and to which extent? …………………………………………………………………………………………………………………………



8.3 Consumer questionnaire

Dear guest, The aim of WelDest is to create a development framework to be used by public bodies, destination management organizations and private companies, when developing holistic health and well‐being destinations (H&WB). The project combines the expertise of 5 Higher Education Institutes, 12 industry and 18 associate partners from Austria, the Czech Republic, Finland, Germany, and the UK. You are/were a tourist/guest in this region and use / used services in the sphere of health promotion and wellbeing. We call a region, which offers health promoting services for tourists a “health and wellbeing destination”. 1. In which country are you right now while filling in this questionnaire? □ Finland □ Austria □ Germany □ Czech Republic □ United Kingdom 2. Please write down some key words, which come into your mind if you think of a health and well‐being destination. …………………………………………………….. 3. What kind of services, staff competences and elements attract / did attract you to come to a destination like this? …………………………………………………….. 4. How did you come to the idea to visit this destination you are currently staying at / you have stayed at? Please tick up to three answers

□ The destination was recommended by friends □ My doctor recommended it to me □ My health insurance sent me here □ I read about the destination in print media (newspapers, magazines) □ I read about the destination in the internet (or other digital media) □ I actively looked for a health and wellbeing destination to spend my holiday at □ An advertisementof the destination led me to book my holiday □ I wanted to try a new destination □ An earlier positive experience in this destination □ The positive image of the destination



□ Other, please specify ………………………………………………………………………… 5. What was the overall reason for you to come to this destination? Multiple answers possible

□ the natural scenery □ the reputation / image of the destination □ the culture □ the price level □ visiting friends and relatives □ suitable accommodation □ to do something for his or her health, please specify (multiple answers possible):

□ Relaxation □ Clinical/medical services □ Outdoor and indoor sport □ Pampering spa services □ Enjoying natural scenery and its nature □ Natural healing resources □ Other reasons……………………….

□ Other reasons, please specify: …………………………………………………………………………………………………………… 6. Which services, activities, and elements do you value the most in this destination? Please tick up to three answers

□ Curative treatments □ Preventative services □ Diverse beauty and pampering treatments □ Hiking, nordic‐walking and similar outdoor activities □ Fitness activities □ Diverse sauna, pool and steam bathing facilities □ Services for mind and soul (e.g. retreat) □ Attractive environment □ Comfortable accommodation □ Healthy food □ Diverse entertainment and cultural services □ Professionally skilled staff □ Other, _____________________ 7. Which of the following options best describe your needs when choosing a health and wellbeing holiday? Please tick up to three answers

□ To improve my physical condition



□ To get mentally refreshed □ To recover/recuperate from an illness □ To escape the pressures of everyday life □ To learn new things concerning my health and well‐being □ To spend time with family/friends □ To find new social relations □ To improve my appearance/beauty □ To experience something new □ Other, _____________________ 8. To which extent does/did the destination as a whole meet your expectations regarding the health and well‐being related offering during your stay? Please tick one answer

□ Doesn’t meet my needs/ Did not meet my needs

□ Meets/ Met my needs to some extent

□ Meets/Met my needs well

□ Meets/ Met my needs extremely well

If your expectations were not met, what could the destination have included to satisfy them? ………………………………………………………………………………………………………………………………… 9. How would you score the destination’s services in general? Please tick one answer in each row

Services concerning information services before I started my holiday (e.g. internet)

□ Doesn’t meet my needs / Did not meet my needs

□ Meets / Met my needs to some extent

□ Meets / Met my needs well

□ Meets / Met my needs extremely well






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





Services with respect to health promotion and medical issues

□ Doesn’t □ Meets / □ Meets / □ Meets / Met



meet my needs / Did not meet my needs

Met my needs to some extent

Met my needs well my needs extremely well











Services with regard to wellbeing, relaxation, and pampering





10. To which extent were/are you able to use the variety of services offered in the H&WB destination? Please tick up to four answers

□ I did nearly all my activities in my hotel/spa, so I didn’t use any of the destination’s offerings □ I did not have enough time to make use of the possibilities in the destination □ I did not know how to get to all the interesting services/places in the destination □ I didn’t have enough information about all the possibilities in the destination □ I did not find interesting services/places outside my hotel/clinic/spa □ I was unable to use interesting services/places outside my hotel/clinic/spa because of age/handicap/ lack of transportation □ I make use of the regions services regularly □ I would not come to this hotel/spa/clinic again if the destination would not have all these interesting possibilities □ I made use especially of the destination’s services to help to improve my health status 11. How do/ did you check the influence of your current holiday on our health at the end or after the stay? Please tick the most important answer

□ I don’t check/ I didn’t check □ I am not interested / I wasn’t interested □ I will have a check done by a specialist at the end of the stay. □ I will have a check done by a specialist upon return home.



□ I don’t know / didn’t know where to do this □ I am / was interested in checking this, but there are limiting factors (no time, too expensive etc.) 12. Which of the following alternatives best describe your expectation of the price level of an H&WB holiday compared to a standard holiday of the same length? Please tick one answer

□ It is much more expensive □ It might be a little bit more expensive □ Same as a standard holiday □ H&WB holiday is cheaper than a standard holiday □ I don’t know □ Price level does not make a difference for me 13. Which are the elements which prevent you from recognizing a destination as a health and wellbeing destination? Please tick up to three answers

□ Too much traffic □ Too expensive □ Too much disturbing industries □ Too many tourists □ Lacking medical services/facilities □ Lacking wellness and spa facilities □ Lack of natural environment □ Inadequately skilled medical staff □ Bad quality of services in general (e.g. signage of walking trails, quality of information given by local tourism boards, hygiene of spa pools, etc.) □ Outdated health‐promoting facilities (e.g. old‐fashioned public baths, gyms, etc.) □ Sprawling cities, villages, and traffic □ Other, _____________________ Socio‐Demographic Data 14. What is the highest level of education you have completed so far? □ Basic education (up to 16years) □ Secondary School □ Bachelor’s degree or similar □ Master’s degree or similar □ Doctoral degree



15. Sex □ Male □ Female 16. Your age □ Under 20 □ 21‐30 □ 31‐40 □ 41‐50 □ 51‐60 □ 61‐70 □ 71‐80 □ 80+ 17. Origin Country of residence ………………………………….. Province of residence ………………………………… 18. Which destination? To which destination do you refer to? ………………………………………………………………………………………………………………………………. Thank you very much for participation!

8.4 Literature

Froschauer, U., Lueger, M. (2003). Das qualitative Interview. UTB Uni‐Taschenbücher, Bd.2418.



8.5 List of charts

Chart 1: Structure of the WelDest‐research ................................................................... 10 Chart 2: What describes the role of H&WB now and in future ...................................... 13 Chart 3: Reasons for coming to the destination ............................................................. 14 Chart 4: Specifications from those who ticked „to do something for his or her health“ ......................................................................................................................................... 15 Chart 5: Reasons which prevent guests from recognizing a destination as H&WBdestination ............................................................................................................ 16 Chart 6: Importance of certain competencies ................................................................ 18 Chart 7: Need for further training compared to the importance of the competence in question ........................................................................................................................... 20 Chart 8: Evaluation of the present performance of the destination .............................. 22 Chart 9: Importance of certain points for the destination development ....................... 24 Chart 10: Interpretation of the previous questions ........................................................ 26 Chart 11: Level of the current job ................................................................................... 27 Chart 12: Highest level of education ............................................................................... 27 Chart 13: Years of experience ......................................................................................... 28 Chart 14: In which country the questionnaire has been filled in .................................... 52 Chart 15: What guests think of a H&WB destination ...................................................... 53 Chart 16: What attracts you to come to this destination? ............................................. 55 Chart 17: The H&WB triangle .......................................................................................... 56 Chart 18: To come to the idea to visit a destination ....................................................... 57 Chart 19: The overall reason to come to this destination .............................................. 58 Chart 20: What clients want to do for their health ......................................................... 59 Chart 21: The most valued services and activities .......................................................... 60 Chart 22: Needs when choosing a well‐being holiday .................................................... 61 Chart 23: Meeting the expectation of the clients ........................................................... 62 Chart 24: Cause of disappointment with the destination chosen .................................. 64 Chart 25: Scoring the destination’s services ................................................................... 65 Chart 26: Which services are scored both „well“ and „extremely well“ with regard to the destination’s services in general ............................................................................... 66 Chart 27: How guests made use of services in the health and well‐being destination .. 67 Chart 28: Check of the health status ............................................................................... 68 Chart 29: Expectation with respect to the price level ..................................................... 69 Chart 30: Elements which prevent people from recognizing a destination as a health and well‐being destination .............................................................................................. 70



Chart 31: Highest level of education ............................................................................... 71 Chart 32: Sex .................................................................................................................... 71 Chart 33: Age ................................................................................................................... 72 Chart 34: The origin of the respondents ......................................................................... 73 Chart 35: Meanings stakeholders and consumers attach to the term health ................ 75 Chart 36: What prevent people from recognizing a H&WB‐destination ........................ 76 Chart 37: What people do for his/her health connected with the place interviewees fill in the questionnaire ........................................................................................................ 78 Chart 38: Is a H&WB‐holiday more expensive or cheaper than a standard holiday? .... 79 Chart 39: Do healthy activities depend on the education? ............................................ 80 Chart 40: Summarizing mind map ................................................................................... 84

weldest health and well-being in tourism destination

Health & Medicine