APPLYING THE EXTENDED THEORY OF PLANNED BEHAVIOR TO UNDERSTAND TOURIST DECISION-MAKING IN SANATORIUM AND RESORT ORGANIZATIONS
DOI:
https://doi.org/10.2478/eoik-2025-0092Keywords:
health resort organizations, scale, Theory of planned behavior, Kazakhstan, medical and health tourism, tourist trust, intention, behavorAbstract
The study analyzes the consumer behavior of tourists in relation to san-
atoriums, the influence of the external environment, personal opinions
and perceptions of the quality of service on the intention to visit san-
atorium-resort facilities. An extended model of the classical theory of
consumer behavior and decision-making, supplemented by variables of
trust and quality of service, is used as a theoretical basis. The Saryagash
district of Turkestan region was chosen as the leading center of balne-
ological tourism in Kazakhstan. The purpose of the work is to identify
the interrelationships of factors influencing the intention of tourists to
visit sanatoriums, as well as to determine the influence of intentions
on their behavior in order to predict trends in the sanatorium segment.
The methodology is based on partial least squares (PLS-SEM) imple-
mented in the Smart PLS 4.0 program, which includes a measurement
model and a structural model. The empirical part was performed using
a questionnaire distributed through social networks, WhatsApp and
e-mail among 457 respondents from Kazakhstan aged 18 and older.
The questionnaire contained 50 questions; a “snowball” sample was
used. The survey period is from 05.01.2024 to 02.02.2025.
The results confirmed the significance of the extended factors of the
model, as well as all the proposed hypotheses. The data obtained can be
used by researchers and sanatorium-resort organizations to improve the
quality of services and the competitiveness of the industry.
References
Abbasi, G.A., Su-Yee, S. and Goh, Y.-N. (2020a), “An integrative approach for determining consumers
mobile advertising related attitudes and intentions”, International Journal of Interactive Mobile
Technologies (iJIM), 14(15). https://doi.org/10.3991/ijim.v14i15.14955
Abbasi, G.A., Yow, B.C. and Goh, Y.N. (2020b), “Does the milk powder scare matter? A survey exam-
ining Penang’s consumer purchase intention with attitude as the mediator”, International Food
Research Journal, 27(2), 327-338. https://doi.org/10.24010/soid.1368627
Ajzen, I. (1991), “The theory of planned behavior”, Organizational Behavior and Human Decision Pro-
cesses, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Alfdool, S. M., Teruel-Serrano, M. D., & Alonso-Monasterio, P. (2025). The brand image influence on
the relationship between social media advertising and sustainable tourism practices in Petra
(Jordan). ECONOMICS - Innovative And Economics Research Journal, 13(1), 25–44. https://
doi.org/10.2478/eoik-2025-0014
An, S., Suh, J. and Eck, T. (2019), “Examining structural relationships among service quality, perceived
value, satisfaction and revisit intention for Airbnb guests”, International Journal of Tourism
Sciences, 19 (3), 145-165. https://doi.org/10.1080/15980634.2019.1663980
Bashynska, I., Smokvina, G., Yaremko, Y., Lemko, Y., Ovcharenko, T., & Zhang, S. (2022). Assessment
of investment and innovation image of the regions of Ukraine in terms of sustainable trans-
for-mations. Acta Innovations, 43, 63–77. https://doi.org/10.32933/ActaInnovations.43.6
Beerli-Palacio, A. and Martín-Santana, J.D. (2018), “Cultural sensitivity: an antecedent of the image
gap of tourist destinations”, Spanish Journal of Marketing - ESIC, 22 (1), 103-118. https://doi.
org/10.1108/SJME-03-2018-002
Bianchi, C., Milberg, S. and Cúneo, A. (2017), “Understanding travelers’ intentions to visit a short
versus long-haul emerging vacation destination: the case of Chile”, Tourism Management, 59,
-324. https://doi.org/10.1016/j.tourman.2016.08.013
Blunch, N. (2013). Introduction to Structural Equation Modeling Using IBM SPSS Statistics and Amos.
SAGE Publications, 2013. — 312 p. ISBN 978-1-4462-4899-7. https://books.google.kz/books/
about/Introduction_to_Structural_Equation_Mode.html?id=dmDez8-ygc4C&redir_esc=y
Bonilla-Quijada, M., Tugores-Ques, J., & Olmo Arriaga, J.L. (2021). Promotion of urban tourism: in-
sights into user engagement on social media. Information Technology and Tourism, 23(4), 611–
https://doi.org/10.1007/s40558-021-00213-6
Bryman, A., & Bell, E. (2011). Business research methods (3rd ed). Oxford University Press, 2011. —
p. ISBN 0199583404, 9780199583409. https://books.google.kz/books?id=YnCcAQAAQ-
BAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
Bui T. T. B (2023), Applying the extended theory of planned behavior to understand domestic tourists’
behaviors in post COVID-19 era. Leisure & Tourism, Research article Cogent Social Sciences
: 2166450. https://doi.org/10.1080/23311886.2023.2166450
Chen Y.-C., Shang, R.-A., & Li, M.-J. (2014). The effects of perceived relevance of travel blogs’ content
on the behavioral intention to visit a tourist destination. Computers in Human Behavior, 30,
– 799. https://doi.org/10.1016/j.chb.2013.05.019
Consumer Packaged Goods Practice The trends defining the $1.8 trillion global wellness market in 2024
Global Wellness Summit. https://www.globalwellnesssummit.com
Ghazanfar Ali Abbasi, Janani Kumaravelu, Yen-Nee Goh and Karpal Singh Dara Singh (2021) Under-
standing the intention to revisit a destination by expanding the theory of planned behaviour
(TPB) Spanish Journal of Marketing - ESIC (2021) 25 (2), 282–311. https://doi.org/10.1108/
SJME-12-2019-0109
Godlewska A., MazurekKusiak А., Soroka А. Push and pull factors infuencing the choice of a health
resort by Polish treatment-seekers. BMC Public Health (2023) 23:2192. https://doi.org/10.1186/
s12889-023-17086-5
Omarova K. et al. / Economics - Innovative and Economics Research Journal, doi: 10.2478/eoik-2025-0092
Golets, A., Farias, J., Pilati, R., & Costa, H. (2020). COVID-19 pandemic and tourism: The impact of
health risk perception and intolerance of uncertainty on travel intentions. National Library of
Medicine. 2023;42(3), 2500-2513. https://doi.org/10.1007/s12144-021-02282-6
Han, H., & Hyun, S. S. (2015). Customer retention in the medical tourism industry: Impact of quali-
ty, satisfaction, trust, and price reasonableness. Tourism Management, 46, 20–29. https://doi.
org/10.1016/j. tourman.2014.06.003
Han, J.H., Kim, J.S., Lee, C.K. and Kim, N. (2019), “Role of place attachment dimensions in tourists’
decision-making process in Citt_aslow”, Journal of Destination Marketing and Management,
, 108-119. https://doi.org/10.1108/JPMD-08-2020-0083
Hasan, M.K., Abdullah, S.K., Lew, T.Y. and Islam, M.F. (2019), “The antecedents of tourist attitudes to
revisit and revisit intentions for coastal tourism”, International Journal of Culture, Tourism and
Hospitality Research, 3(2), 218-234. https://doi.org/10.1080/23311975.2017.1412874
Hasan, M.K., Ismail, A.R. and Islam, M.D.F. (2017), “Tourist risk perceptions and revisit intention: a
critical review of literature”, Cogent Business and Management, 4(1), 1412874. https://doi.org/
1080/23311975.2017.1412874
Hasan, M.K., Abdullah, S.K., Islam, F. and Neela, N.M. (2020), “An integrated model for examining
tourists’ revisit intention to beach tourism destinations”, Journal of Quality Assurance in Hospi-
tality and Tourism, 1-22. https://doi.org/10.1080/1528008X.2020.1740134
Hsiao, C.-H., & Yang, C. (2010). Predicting the travel intention to take high speed rail among college
students. Transportation Research Part F: Traffic Psychology and Behaviour, 13(4), 277–287.
https:// doi.org/10.1016/j.trf.2010.04.011
Hashim, N. A. A. N., Noor, M. A. M., Awang, Z., Aziz, R. C., & Yusoff, A. M. (2018). The influence
of tourist perceived risk towards travel intention: A conceptual paper. International Journal of
Academic Research in Business and Social Sciences, 8(16), 92–102. http://dx. doi.org/10.6007/
IJARBSS/v8-i16/5120
Hume, L. and DeMicco, F. (2007), ‘‘Bringing hotels to healthcare: a Rx for success’’, Journal of Quality
Assurance in Hospitality & Tourism, 8(1), 75-84. https://doi.org/10.1300/J162v08n01_04
Jang, S., (Shawn), Bai, B., Hu, C., & Wu, C.-M. E. (2009). Affect, travel motivation, and travel inten-
tion: A senior market. Journal of Hospitality & Tourism Research, 33(1), 51–73. https://jour-
nals.sagepub.com/doi/abs/10.1177/1096348008329666
Lapteva N. (2021). Travel intentions and risk perception in times of Covid-19 A study on the Millen-
nial generation of Cologne, Germany. https://www.diva-portal.org/smash/get/diva2:1580101/
FULLTEXT01.pdf
Lovelock, C., Wirtz, J. and Chew, J. (2009), Essentials of Services Marketing, Prentice-Hall, Managing
Service Quality 19(4):486-487 New York, NY. https://doi.org/10.1108/09604520910971575
Martin D.S., Ramamonjiarivelo Zo H., 2011 MEDTOUR: A scale for measuring medical tourism inten-
tions, Tourism Review 66(1/2):45-56. https://doi.org/10.1108/16605371111127233
McKinsey & Company The $2 trillion global wellness market gets a millennial and Gen Z glow-up. https://
www.mckinsey.com/industries/consumer-packaged-goods/our-insights/future-of-wellness-trends
Meng, B. and Choi, K. (2019), “Tourists’ intention to use location-based services (LBS)”, International
Journal of Contemporary Hospitality Management, 31(8), 3097-3115. https://doi.org/10.1108/
IJCHM-09-2018-0734
Meng, B. and Cui, M. (2020), “The role of co-creation experience in forming tourists’ revisit intention to
home-based accommodation: extending the theory of planned behavior”, Tourism Management
Perspectives, 33, 100581. https://doi.org/10.1016/j.tmp.2019.100581
Merli, R., Preziosi, M., Acampora, A. and Ali, F. (2019), “Why should hotels go green? Insights from
guests experience in green hotels”, International Journal of Hospitality Management, 81, 169-179.
https://doi.org/10.1016/j.ijhm.2019.04.022
Applying the Extended Theory of Planned Behavior to Understand Tourist Decision-Making in Sanatorium and
Resort Organizations
Mondéjar-Jiménez, J.A., Ferrari, G., Secondi, L. and Principato, L. (2016), “From the table to waste: an
exploratory study on behaviour towards food waste of Spanish and Italian youths”, Journal of
Cleaner Production, 138, 8-18. https://doi.org/10.1016/j.jclepro.2016.06.018
Morgan, R. M., & Hunt, S. D. (1994). The commitment-trust theory of relationship marketing. Journal
of Marketing, 58(3), 20–38. https://doi.org/10.2307/1252308
Mrkaić Ateljević, A. (2025). Bibliometric Analysis as a Basis for Research on Sustainability in Tour-
ism in Bosnia and Herzegovina. Collection of papers new economy 3(1), 57-70. https://doi.
org/10.61432/CPNE0301057a
Mussina K., Podsukhina O., Omarova К., Rustemova S., Tleuberdiyeva S., Shaimova A. Online food
delivery services and unceasing behavioral intention: an assessment for integrating expecta-
tion-confirmation and technology acceptance Journal of eastern European and central Asian
research, 11(4), (2024). https://doi.org/10.15549/jeecar.v11i3.1449
Nunkoo, R., & Ramkissoon, H. (2011). Structural equation modelling and regression analysis in tourism
research. Current Issues in Tourism, 15, 1–26. https://doi.org/10.1080/13683500.2011.641947
Novakivskyi, I. ., Kulyniak, I. ., Dziurakh, Y. ., Ohinok, S. ., & Ukrainets, L. . (2024). Modeling the tourism
market behavior based on discrete equilibrium models “Supply – Price – Demand”. ECONOMICS -
innovative and economics research journal, 12(3), 33–53. https://doi.org/10.2478/eoik-2024-0036
Rasoolimanesh, S. M., Seyfi, S., Rastegar, R., & Hall, C. M. (2021). Destination image during the
COVID-19 pandemic and future travel behavior: The moderating role of past experi-
ence. Journal of Destination Marketing & Management, 21, 1–11. https://doi.org/10.1016/j.
jdmm.2021.100620
Russell, S.V., Young, C.W., Unsworth, K.L. and Robinson, C. (2017), “Bringing habits and emotions
into food waste behaviour”, Resources, Conservation and Recycling, 125, 107-114. https://doi.
org/10.1016/j.resconrec.2017.06.007
Seidualin, D. A., Mussina, K. P., & Mukanov, A. H. (2025). PLS-PM model for sustainable development
of ecotourism: Case study of Ulytau Nature Park. ECONOMICS - Innovative and Economics
Research Journal, 13(1), 309–332. https://doi.org/10.2478/eoik-2025-0019
Seow Ai Na, Choong Yuen Onn, Moorthy Krishna, Choong Chee Keong 2020, Predicting medical
tourism behavioural intention using social cognition. Tourism Review of AIEST - International
Association of Scientific Experts in Tourism; Bingley No 2, 374-391. https://doi.org/10.1108/
TR-06-2019-0267
Soliman, M. (2019), “Extending the theory of planned behavior to predict tourism destination revisit
intention”, International Journal of Hospitality and Tourism Administration, 22(5), 524-549,
-26. https://doi.org/10.1080/15256480.2019.1692755
Song, H. J., Lee, C.-K., Kang, S. K., & Boo, S. (2012). The effect of environmentally friendly perceptions
on festival visitors’ decision-making process using an extended model of goal-directed behav-
ior. Tourism Management, 33(6), 1417–1428. https://doi.org/10. 1016/j.tourman.2012.01.004
Veal, A. J. (2011). Research Methods for Leisure and Tourism (4th edition). Pearson Education. United
Kingdom 2018 – 624 p. ISBN: 978-1-292-11529-0 (print) 978-1-292-11531-3 (PDF) 978-1-
-21786-4 (ePub). https://docs.yandex.kz/docs/view?tm=1751265670&tld
Whittaker, A. (2008). Pleasure and pain: Medical travel in Asia. Global Public Health, 3(3), 271–290.
https://doi.org/10.1080/17441690701463936
National Statistics Office, 2025 Population as of January 1, 2025. https://stat.gov.kz
National Statistics Bureau, 2025. Health resort activities as of January 1, 2025. https://stat.gov.kz
National Statistics Bureau, 2025 Population of the Republic of Kazakhstan as of January 1, 2025 https://
stat.gov.kz
Sanatorium and resort activities as of January 1, 2025. https://stat.gov.kz
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 ECONOMICS - INNOVATIVE AND ECONOMICS RESEARCH JOURNAL
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
