Introduction

Nowadays, rapid industrialization, technological advancements, and increasing urbanization have created various challenges, particularly in developing countries. Although some people may appear content and joyful, those who play minor roles and find contemporary life monotonous often suffer from boredom and sadness (Kaushal and Srivastava, 2021). When citizens enjoy good physical and mental health, they have dynamism in life. Yet, the contemporary era, which is rooted in proficiency, and technology, which is known as the era of tension, fretfulness, and neurological confusion, has adverse effects on individuals’ well-being and has created new societal, and wellness concerns in societies (Zabihkhah and Afshar, 2015). World Health Organization (WHO) has set a target to expand public health worldwide; Based on WHO (2018), health is not just about the absence of disability or illness in people, but also about the state of social, mental, and physical well-being that some researchers try to improve. Some scholars try to develop tourism well-being with two sub-categories, which are typically outlined as (1) medicinal tourism and (2) health tourism, while others are promoting it with three sub-groups: (1) wellness, (2) therapeutic, and (3) medicinal tourism (Yan and He, 2020; Büyüközkan et al., 2020; Charak, 2019). However, "health tourism" is used in most countries by industry players for wellness tourism (WT) concepts. The absence of feeling good in WT alters the optimal mood for maintaining good health. WT encompasses a wide range of health indicators, including the physical, subjective, and communal well-being of individuals (Lim et al., 2015). It is important to note that wellness vacations typically take place in pristine locations with picturesque scenery, favorable weather, and nutritious cuisine that are conducive to healthy activities like walking and yoga (GWI, 2018). In WT, there is a feeling of harmony in physical, mental, emotional, and spiritual well-being. Wellness services, especially the features of a healthy lifestyle and hydrotherapy properties which include local landscapes, and cultures, enjoyment of nature, foods with high quality, exercise, and relaxation were considered in current years (Luo et al., 2018; Koncul, 2012; Cohen and Bodeker, 2008; Deng et al., 2020). The new tourism industry creates great chances for the development of rural districts where there is a high potential for tourism attraction (Hoang et al., 2020).

However, the shock caused by the COVID-19 pandemic created an unforeseeable crisis in the tourism industry. Referring to Organization for Economic Cooperation and Development (OECD), the pandemic led to a 60% failure in the global tourism industry in 2020. If the trend continues, this number could reach 80%. Meanwhile, 75% of the OECD tourism sector belongs to national tourism, which is projected to improve more rapidly. Due to its diverse tourist attractions in various provinces, Iran has been recommended as a potential destination for both domestic and international tourists (Esiyok et al., 2017). However, COVID-19 has disturbed more than 80% of the tourism industry in this country. In early June 2020, Iran reported the second uppermost level of COVID-19 transmission, with nearly 149,000 cases and the highest number of deaths in Asia (WHO, 2020, Abbaspour et al., 2021). This country experienced a sharp increase in the number of travelers, and tourists in 2019, which was predicted to keep up its growth even at a faster pace in 2020. However, with the outbreak of COVID-19, not only did the number of tourists not increase, but also dropped by 90% compared to the previous year. The tourism industry has endured heavy irreparable damage in all cities of Iran. East Azerbaijan province, with its pristine natural environment and medicinal properties such as medicinal plants in the foothills of Sabalan and mineral springs, has great potential to attract both domestic and foreign tourists. However, the COVID-19 pandemic has severely impacted the tourism industry in the region. In current times, wellness tourism (WT) places greater emphasis on the natural and scenic attractions of destinations. As overcrowding is discouraged to preserve the environment, this approach may offer a viable solution in the context of the COVID-19 pandemic. WT encompasses the connections made throughout the travels by people or groups driven by a desire to maintain or improve their health, and well-being. All societal members have suffered severe psychological harm as a result of the coronavirus (Dubey et al., 2020). The COVID-19 pandemic has not only caused global health concerns but has also led to a rise in several psychological disorders, such as anxiety, depression, and post-traumatic stress disorder (Shahyad and Mohammadi, 2020). Additionally, studies have suggested that individuals who contract the virus may experience a decline in cognitive function. Moreover, because of the contemporary situation of COVID-19, affected people are severely subjected to mental syndromes, such as anxiety, fear, hopelessness, and depression which can be overcome by developing WT (Yao et al., 2020). Furthermore, this pandemic has led to the bankruptcy of many economic enterprises (Prokopy et al., 2020; Uğur and Akbıyık, 2020). The pandemic has caused an economic failure for many famous businesses as clients got stuck at home, and markets were shut down (Corbet et al., 2021; Tucker, 2020; Kumar and Kumara, 2020; Tucker, 2020), with people, especially villagers, being severely affected (Prokopy et al., 2020), which can be tackled by attracting tourists to the pristine nature of rural areas (Huang and Xu, 2018). In light of this, regional WT will start to redistribute income and resources to less developed industries during the COVID-19 epidemic. The development of wellness-based tourism (WBT) has the potential to boost the economy and enhance the country’s competitiveness as a well-being destination (Mangwane and Ntanjana, 2020). National and local tourism plays a crucial role in sustaining economic growth at the local level, creating employment opportunities, stimulating business growth, and promoting infrastructure development (Prentice and Hsiao, 2021). The COVID-19 pandemic affected the international economy, including Iran’s economy and trade. Currently, the economic situation is confronted with damage and threats, and to find the best solution to deal with it, the current situation should be evaluated by drawing on past experiences (OECD, 2020). Major crises, such as the COVID-19 epidemic, create chances for systems to be revised to make them resilient to future shocks. The importance of rural areas in sustaining the economy and supporting public health has been highlighted during the COVID-19 pandemic. Rural economic institutions have provided essential goods and services to homes, hospitals, and healthcare facilities throughout the crisis. In some countries, rural areas are perceived as safe havens and urban residents use them as temporary retreats to escape the hustle and bustle of city life. Attending to the future, this epidemic could change patterns in consumption, and production activities, as well as promote habits of remote working and forms of mobility, which may open up new opportunities for sustainable development in rural areas. New opportunities will be created in some rural areas by revisiting the globalization of production chains (Agnoletti et al., 2020; Barbier and Burgess, 2020).

However, businesses and rural residents are facing several pressures, including epidemic pressures and related containment measures (Wilkinson, 2020). Rural areas face unique challenges in responding to the COVID-19 pandemic, including demographic features such as a larger share of the elderly population, as well as geographical characteristics that result in greater distances to healthcare facilities. Additionally, reduced staffing and available healthcare facilities further impede their capacity to respond effectively to the crisis. As a result of their growing dependence on commercial activities like tourism, trade, and worldwide demand is predicted to fall even further, which will hurt the rural economy (Chiwona-Karltun et al., 2021). Furthermore, the general reduction in aggregate demand has had an impact on several critical sectors. WT is closely linked to the well-being and satisfaction of tourists, making it an excellent solution for creating job opportunities in tourism destinations and improving overall economic welfare. Thus, it can be very useful to identify the determinants of destination choice in WT, as well as enumerate capabilities and attractions. The present study focuses on improving the tourism market in rural areas, which will contribute to poverty alleviation and rural development. The flow of life in the villages, and small towns continues in its traditional way, and most of the natives of these areas preserved the customs of their ancestors. Such customs can be of great help to rural tourism. This is why World Tourism Organization has named this year "Tourism and Rural Development" which is working to help rural communities regain their forgotten traditions. Especially during the COVID-19 outbreak, the term "tourism and rural development" might serve as a reminder of the enormous ability of communities to attract visitors. The COVID-19 pandemic has caused significant damage to the global tourism industry. However, there are always ways to improve the situation, and rural areas may serve as a viable solution. Compared to large cities, rural areas are less crowded and are less likely to transmit the virus, making them an attractive option to recover from the pandemic’s impact (OECD, 2020). Based on previous studies in this field (Table 1), no study was done on the WBT model in rural areas. Therefore, no research has ever addressed the dimensions, and factors concerning the selection of WT purposes simultaneously. Therefore, this study aimed to identify several dimensions and use the structural equation model to look into the variables impacting WT in Northwest Iran. It is possible to develop rural areas and ease tensions brought on by current circumstances by precisely identifying and prioritizing the factors affecting the choice of tourist locations.

Table 1 A brief review of the theoretical framework.
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A brief review of the literature

Kangas (2010) contends that expressions for remedial tourism vary from therapeutic tourists to healing ones. Lunt and Carrera (2011) stated that health tourism is associated with the overview of an individual journey to another country for remedial practices with a concentration on medical and hospital preparation. Gan and Frederick (2011) define medical tourism companies as organizations that specialize in identifying the best overseas clinics and hospitals for medical treatment, as well as arranging transportation and lodging during recovery. Furthermore, Hall (2011) stated the presence of convinced relationships among different fields of health, wellness, and medical tourism, comprising welfare tourism, and transplant tourism. Various scholars showed that the idea of health tourists concerns those people attempting to prevent and postpone medication. Therefore, Wu and Baleanu (2014) stated that wellness tourists are mostly people who choose to escape from the city to calm down, enrich body health, and participate in social behaviors. Perkumienė and Pranskūnienė (2019) define well-being tourism (WT) as a rapidly growing industry that encompasses a diverse range of travel experiences, from leisurely trips to destinations focused on physical and mental health care services. Lee et al. (2019) differentiate between remedial travel, which involves traveling to various countries for prevention or vaccination, and medical travel, which is focused on health checkups, surgeries, and medical treatment. Based on Khan et al. (2020), global medical travel is defined as the residents of their home country traveling to overseas destination clinics with the individual intent of earning the required medical treatment. Several other academics contended that India, Malaysia, Thailand, and many other countries advertise themselves as main destinations for health tourism (Turner et al., 2020).

Recent years have seen the emergence of Iranian visitors and foreign patients as a subject of documentaries and field studies, with administrative and formal control still in its early stages. This study has played a crucial role in establishing the initial criteria for WT. The weights given to the criterion were checked in the next stage using quantitative techniques. The contributions of the paper include recognizing criteria linked to sustainability in the context of WBT, ranking tourism destinations, examining the potencies and the dimensions of WT destinations constructed on sustainable components, and applying the model to a practical case study. Hence, the present research was conducted to address the following queries:

  1. 1.

    What are the most important aspects of WBT after the pandemic?

  2. 2.

    What are the most prominent determinants influencing the dimensions of WT after the pandemic?

Theoretical and research background

According to Seongsoo and Jinwon (2022), well-being tourism (WT) accounts for USD 639 billion of the global market share, with its growth rate twice as fast as that of the tourism industry overall. Between 2015 and 2017, WT experienced an annual growth rate of 5.6%. In 2017, wellness tourists made 830 million trips, which is 139 million more than the number of trips made in 2015. The growth rate is related to the increasing desire of consumers to choose a wellness-based approach and increasing engagement in exploring and traveling to untouched nature (Global Wellness Institute, 2018).

With 600.4 thousand overall travels, 272.3 thousand domestic and international trips, and 328.1 thousand international trips in 2017, Iran was rated tenth among the WT markets in the Middle East and North Africa (Global Wellness Institute, 2018). Based on World Tourism Organization (WTO), the tourist population in Iran increased from 2013 to 2015 and decreased from 2015 to 2017 (Fig. 1). The upward trend in WT is significant when compared to global statistics (World Tourism Organization, 2019). While general tourism statistics show a significant decline between 2015 and 2017, WT is not exempt from this decrease, although accurate information on this trend is unfortunately not available.

Fig. 1: The number of general tourists visiting Iran.
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The line graph depicts the number of general tourists visiting Iran from 2013 to 2017 in million people.

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WT has gained a specific status in the world (Cvikl, 2022). WT has significant potential in Iranian villages, particularly those located in Sarab County. Given this potential, WT can serve as a crucial tool for implementing macro-policies based on Iran’s Twenty-Year Vision, which anticipates growth in tourism and cultural heritage (Garjan et al., 2023). Tourism research states that Iran intends to welcome 20 million international visitors over 20 years by 2025. This is despite even though million foreign travelers attended Iran in 2017 (World Tourism Organization, 2019), of whom only 272.3 thousand, i.e., 5.44%, were international wellness tourists (World Health Organization, 2018).

A conceptual/theoretical framework

WT was discussed in various studies, some of which are presented in Table 1. There are few research studies about WT destinations. Considering the significance of the issue, the analysis of WT can be useful in taking measures to identify and improve priority areas, strengthen capabilities in this industry, and ultimately, attract more wellness tourists.

The dimensions of health tourism have been identified as physical (healthy nutrition and physical fitness), social (social interaction and community engagement), and individual (mental, psychological, and emotional well-being) based on relevant studies, opinions, and models (Romeo et al., 2018; World Health Organization, 2018). Moreover, external factors were identified as marketing and price (NajafiNasab et al., 2018), place, quality, and facilities (Tharakan, 2014). Further, the satisfaction of visitors with the facilities experienced can be an efficient factor (Choi et al., 2015) to determine WT destination. Even though "Satisfaction" is one of the most important criteria, most models overlook it (Tahanisaz, 2020). But it was included in this research. As displayed in Fig. 2, three dimensions of wellness include (i) the physical dimension composed of physical activity, using fresh, healthy, and local food, and the feeling of refresher and relief of physical pain, (ii) social dimensions including building friendly and positive relationships, filling leisure time with family and friends, as well as meeting local and new people, and (iii) the individual dimension composed of the feelings of inner peace, and stress relief, the improvement of individual skills and abilities, having new, attractive, and enjoyable experiences, avoiding everyday tasks, along with resting and relaxation. Furthermore, it indicates the external components that affect the destination selection consisting of (i) places (e.g., climatic and natural attractions, cultural heritage and historical attractions of the area, and an attractive image of the region and healthy local food), (ii) quality, and facilities (including access to facilities and infrastructures, quality of equipment and facilities, and the variety of recreational and wellness facilities), (iii) tourism satisfaction (satisfaction with the services including satisfaction of wellness tourists with the value of hotel at the paid price and satisfaction with the services, security, and cleanness of the environment), and (iv) marketing, and price (including the reasonable price of accommodation and services, the existence of marketing of tourism-related organizations, and the attendance of active representatives to attract wellness tourists in this area.

Fig. 2: The conceptual model of WT.
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The figure is extracted from previous literature and concepts. It shows factors affecting WT and wellness dimensions.

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Methods

Research design

This study serves its intended goal since a variety of stakeholders, including managers of tourism sites, rural development, managers of health organizations, and visitors, may use the findings and recommendations. This study adheres to the positivist paradigm and is quantitative in nature, employing a survey and cross-sectional design to collect data. The data analysis method is both descriptive and causal-relational. Additionally, the study is considered a field study, as it examines all variables under natural conditions while surveying and controlling for relevant factors.

Study area

East Azerbaijan province can be considered one of the important tourism capacities in Iran because of the annual and desired climate conditions. Sarab City is the third largest city in East Azerbaijan province. With an area of 3452 km2, it is one of 20 cities that occupy 7.59% of the entire area of the province. Sarab County is 134 km away from Tabriz, the capital of East Azerbaijan province. Due to its ideal geographic and climatic circumstances, proximity to the Sabalan and Bozqush Mountains, and appealing natural surroundings, the county has a strong potential to draw visitors (MPO, 2015). Despite the natural, historical, and cultural attractions, unique climate, healthy foods, and pristine nature of Sarab County, its rural areas are facing depopulation due to a lack of employment opportunities. Based on the data (Fig. 3), due to rising unemployment, and poor income in these areas, the rural population of Sarab County fell from 131,366 people in 1986 to 66,033 people in 2016 (Statistics Center of Iran, 2019). Sarab, in terms of its very pleasant and mountainous climate, as well as its ancient historical background, has many historical and natural attractions, such as the Urartian inscription (near the village of Qirkhoghizlar in the northeast of Sarab), Qirkhoghizlar inscriptions, Razliq inscription, Sarab Mosque (related to the ninth century AH), the ancient hill of Qala-e-Jooq (2.5 km north of Sarab along the road from Razliq to Sarab), the Sassanid chamber of Aghmion, the Mongolian tomb of Esfestan (6 km east of Sarab attributed to the Mongol period), “Gavdoshabad Oghan” Bridge, “Allah-hagh”, and “Asb-frooshan” waterfall.

Fig. 3
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The trend of population declines in rural districts of Sarab County from 1981 to 2016.

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The establishment of a health area and water treatment facility in the “Asb-frooshan” area of Sarab County could serve as a promising opportunity for the expansion of WT in the East Azerbaijan province. The area’s mineral spa, which is derived from the volcanic activity of Mount Sabalan and Mount Bozghush, boasts sulfur mineral waters. Feasibility studies have been conducted in the past to develop a location focused on hydrotherapy and health tourism. Asb-frooshan Sarab tourist model area has significant potential for the growth of outdoor recreation, sports, hydrotherapy, and mountain sports. Furthermore, there are plans to build low-cost accommodation centers, cable cars, and hydrotherapy (East Azerbaijan Cultural Heritage and Tourism Development Organization, 2021).

Besides, the unemployment rate has sharply risen in the rural areas of the studied city since 2006 (Fig. 4). Based on official statistics, unemployment has increased from 2006 to 2016 (2.69–6.90%, respectively), while this issue is considered insignificant.

Fig. 4
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The unemployment rate in the rural areas of Sarab County from 1986 to 2016, showed a sharp increase in unemployment rate from 2006 to 2016.

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East Azerbaijan province is home to 26 mineral and hot springs, with the most well-known being the six springs located in Sarab County (Asem Asl, 2008). The area is rich in natural resources and features meadows with a diverse range of plant species and medicinal herbs. Additionally, the region produces significant quantities of agricultural and animal products. Hot mineral springs and the spectacular views of Sabalan and Bozgoosh have made this region a potential destination for health tourists. Figures 5 and 6 show a map of East Azerbaijan province and its 21 counties. Sarab County is located in the east of the province.

Fig. 5
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Map of East Azerbaijan, Sarab County, indicating the location of Sarab County in Iran.

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Fig. 6
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Theoretical framework showing the procedure of current research.

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Model specification

We emphasized the study’s goals when defining theoretical models. The study’s first objective was to examine the effect of the COVID-19 pandemic on tourism. The second goal was to identify the most important factor affecting the choice of WT selection.

Sampling and data collection

The current study is a descriptive survey in nature and data collection methodology. Since it was conducted at a specific time, it is a cross-sectional study. Furthermore, the concern about common method variance is a problem that may cause an unrealistic increase in the relationship between key variables in cross-sectional designs. The solutions offered by Podsakoff et al. (2012) and Lee and Podsakoff (2003) were used to address this issue. The study questionnaire was designed to be as simple as possible for respondents. Participants were informed that their responses and personal information would be kept confidential. They were also notified that there were no right or wrong answers to the questions posed in the survey. Thus, the present research attempted to reduce the possibility of social desirability which was controlled with some negative items (Podsakoff et al., 2012). Further, Harman’s one single-factor analysis was used to evaluate the common method bias (CMB) problem (Khaola and Coldwell, 2019). Based on this test, the first factor only explains 16.92% of the total variance (<50%). Thus, based on Harman’s test, common method error (CME) was not a threat to the results of this research (Harman, 1976). To strengthen this result, another method was used. The results of CFA in which all components were loaded into one single factor (χ2 = 93.443; NFI = 0.886; RMSEA = 0.117; PNFI = 0.633; CMIN/DF = 6.230) indicated an inadequate fit, implying that one factor could not interpret all of the variances of data (Bou-Llusar et al., 2009). Besides, AVE for a single factor was calculated to be 0.345. Since it was smaller than 0.5, it could not provide evidence for common method bias (Kock, 2021). Therefore, Gaski (2017) and Serrano Archimi et al. (2018) proposed using a common latent factor (CLF) to calculate the standardized regression weights of all components for models with and without a common latent factor. The differences in the standardized regression weights were <0.2, reflecting the fact that CMB was not significant in the present data.

Regarding the goal of this study was to further human knowledge, the research tool, a questionnaire (Table 2), was of the applied kind. 237,415 tourists who planned to visit Sarab County’s "natural attractions" from 2018 to 2019 made up the statistical population of the study (East Azerbaijan Tourism Department, 2019). Based on Krejcie and Morgan’s (1970) table, the sample size was determined 384 people. Data were collected via a questionnaire in five months from January 2021. A multi-stage random sampling method was utilized for data collection. The unit of analysis was the wellness tourists. The coordinator appoints a mapper and lister. They should work jointly and in group work. The mapper set the maps, and the lister collected information about the corresponding tourists’ accommodations. The mapping team identified the number of accommodation units in the study area and marked them on a map, while the data collection team gathered information about the corresponding tourists based on the marked locations. The study began at a landmark in the center of Sarab city, such as a school, and continued in a clockwise direction to neighboring areas until 384 questionnaires were completed. To prevent redundant data collecting, this job was completed. Remind that the respondents agreed to take part in the study willingly. If the respondent was not eligible (for example, if their purpose of travel was not related to wellness), the sampling was continued by referring to the neighboring room positioned on the right side of the location until the required number of samples (384) was completed. The required data were collected via a structured questionnaire, and they were completed face-to-face. An informed consent form was filled out by all contributors. Participation in completing the questionnaire was completely voluntary.

Table 2 Scale items, reliability, and validity of the dependent variable.
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Reliability and validity

The validity of the research instrument was checked by a panel of experts from the Iranian Health Tourism Association. To assess the reliability of the questionnaire, a pilot test was carried out and Cronbach’s alpha coefficient was calculated using SPSS 23 software. Cronbach’s alpha method is used to examine the degree of internal coherence, and the level of coordination between items on a scale, while composite reliability (CR) is an evaluation criterion of the interior fit of the model which can be estimated based on the degree of the concurrence of questions associated to the measurement of each component. The parameters required to calculate convergent validity and composite reliability (CR) are similar. The measure of convergent validity was developed by Fornell and Larcker in 1981. As all parts of the questionnaire had Cronbach’s alpha values of 0.7 or higher, the results indicated that the questionnaire was highly reliable. Based on Tables 2 and 3, CR was greater than 0.6. Thus, an average variance extracted (AVE) of more than 0.5 was used to establish diagnostic validity (Cheraghi et al., 2019; Bagozzi et al., 1998). It is checked based on the external model by calculating AVE. AVE criterion shows the average variance distributed between each factor and its items. In simpler terms, AVE reveals the degree of correlation of a factor with its items so that the higher the correlation is, the greater the fit will be. Fornell and Larker believe that convergent validity (CV) is obtained when AVE is >0.5 (Kalantari, 2013; Fornell and Larcker, 1981).

Table 3 Scale items, reliability, and validity of the independent variables.
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“WBT” was measured by examining the individual, social, and physical aspects using 10, 5, and 4 items, respectively. Besides, to determine the independent variables, 12, 7, 9, and 9 items were considered for satisfaction, place, marketing price, and quality features (items and references are listed in Tables 2 and 3). The items were scored on a five-point Likert scale including 1 = very low, 2 = low, 3 = medium, 4 = high, and 5 = very high.

Data analysis

Structural equation model (SEM) was applied to validate the model using AMOS software. This software is characterized by its capability of

  • managing data in different forms, and easily calling data in different formats either in raw form or in the form of variance–covariance or correlation matrices from other software,

  • managing multi-group data in such a way that the models can be tested for different samples and the results can be easily compared with each other,

  • verifying univariate and multivariate normality,

  • handling outlier data well,

  • estimating the parameters with different methods, including maximum likelihood, generalized least squares, non-weighted least squares, and scale-independent least squares (McCormick and Salcedo, 2017).

SEM is regarded as an efficient multivariate analytic technique that is often used in social science. SEM can be used to test straightforward relationships between variables as well as for complex analyses. It provides a flexible framework for examining complex interactions between multiple variables, allowing for model validity testing. One of its most significant advantages is its ability to handle measurement errors (Perles-Ribes et al., 2020; Valaei et al., 2021). Furthermore, there are some statistical methods applied to calculate and test the relations of variables. “Similar but more accurate than regression analysis, correlation analysis studies linear causal relationships among variables while calculating measurement error” (Civelek, 2018). A structural model was used to measure the causal relations between internal and external variables, as well as to describe the degree of variance and causal effects. The research model examines the effect of each independent variable, including place, facilities, quality and quality, and marketing and price, on the dependent variables including wellness.

Results

In general, among 384 participants, 132 were female (34.4%) and 252 (65.6%) were male. Regarding marital status, 131 participants (34.1%) were single, and 253 (65.9%) were married. (Table 4). The employment situation revealed that 176 people (45.8%) worked full-time.

Table 4 Gender, marital status, and employment category.
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Table 5 shows that based on the results, the average tourists’ age was almost 35–36 years, and most tourists were under 35 years old (54.68%). The results regarding the educational level showed that 127 people (33.07%) were studying in the timespan of 12 < X ≥ 18 years. The findings of the annual income showed that 243 respondents (63.28%) had an annual revenue of <$1500.

Table 5 Age, years of schooling, and annual income.
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The status of the wellness dimensions

Table 6 and Fig. 7 present the average social, individual, and physical dimensions of WT were 3.57, 3.63, and 4.14, respectively. Friedman’s test found significant variance (P = 0.01) in the dependent variable’s various dimensions. "Feeling refreshed and relieved of physical fatigue" and "feeling of pain relief" received the highest scores out of all the other items in the physical dimension. In the individual dimension, "resting and relaxation" and "feeling of inner peace and relief from stress" had the highest scores. Thus, in the social dimension, the highest score was assigned to "building friendly and supportive relationships" and "spending time with family/friends".

Table 6 The standing of the dimensions of the dependent variable.
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Fig. 7
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The status of the WT dimensions status.

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As shown in Fig. 7, the physical dimension plays the most important role in wellness-oriented tourism, which is a notable result.

The ranking of external factors

The dimension of satisfaction had the highest mean score (3.13) among the various influential factors. Among the items related to satisfaction, the highest-ranking item was "environmental safety", followed by "environmental cleanliness", and lastly "satisfaction with access to city buses and taxis". The mean values for the remaining three external factors, including "place," "marketing and price," and "quality of facilities," were less than 3 (2.92, 2.53, and 2.41, respectively). The lowest scores were given to the provision of leisure and wellness packages, recreation and health facilities, and airport access. The results of the Friedman test showed a notable variation (P < 0.01) between the present condition of different factors that affect WT (Table 7 and Fig. 8).

Table 7 The ranking of factors influencing the wellness-based destination selection.
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Fig. 8
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The status of external factors affecting destination selection.

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As can be seen in Fig. 8, the factors of “satisfaction” and “place” were ranked first, followed by factors of “marketing, and price” and “quality and facilities”. So, these factors should be prioritized in decision-making.

Correlation coefficients between variables

The results of the Pearson correlation test showed a positive and significant relationship between “wellness” and “marketing and price”, “place”, “quality and facilities”, and “satisfaction”. The results revealed a positive and significant correlation between the independent variables, and the dependent variable (wellness) (Table 8).

Table 8 The results of correlation coefficients.
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Table 9 presents the results of the correlation matrix, which shows good discriminant validity of constructs/factors as the values in brackets are larger than the correlations (Roldán and Sánchez Franco, 2012).

Table 9 Correlation matrix and discriminant validity.
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Structural equation model (SEM)

The results of fit indices confirmed that the values of CFI, GFI, NFI, and TLI for the model were greater than the desirable level of 0.9 (Asadi et al., 2013). The root means square error of approximation (RMSEA) index indicated that the model had a good fit, with a score of <0.08. Regarding the amount of variance and fit indices obtained by the independent variables, wellness variance for the four external latent variables, including price, quality, satisfaction, and location, was 62% (see Table 10 and Fig. 9). Physical, individual, and societal elements are used to quantify well-being based on the measurement model. The measurement model validation findings showed a strong match for the wellness model, and the physical dimension had the largest factor load and relative relevance when compared to other aspects (Table 10).

Table 10 Fit indices.
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Fig. 9: The structural model of the research.
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The coefficients show the relative importance of factors and dimensions.

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The overall effects of the independent variables on wellness are reported in Table 11. Based on the results, the maximum effects were 0.825 for place and 0.579 for satisfaction. Other characteristics affecting destination choice were marketing and pricing, with a value of 0.545, and quality and amenities, with a value of 0.391. The following regression equation lists the factors that have an effect on the choice of a wellness location as well as their path coefficients. Wellness = 28.21 + 1.113* Place + 0.281* Satisfaction + 0.222* Marketing & Price + 0.212* Quality & Facilities.

Table 11 The overall effect of the factors on wellness.
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Based on the results, 62% of the changes to choose a health destination are affected by the four factors identified in this research.

Furthermore, the results of this section are consistent with the outcomes of the Friedman test, indicating that the physical dimension was the most critical aspect of wellness and played a significant role in explaining wellness-based tourism. However, the priority of the physical dimension of wellness-oriented travelers was identified in the order of “feeling refreshed”, “feeling relief from physical pain”, “using fresh, healthy, and local food”, and “physical activity”. The location was identified as the most significant element affecting WBT. It comprises, among other things, (1) the proximity of the spa complexes to the hotel, (2) the availability of good roads and railroads, (3) the location’s lack of traffic, (4) the beauty of the surrounding terrain, (5) the local cultural attractions, and (6) the building views of the hot spring complexes, respectively.

Discussion

The findings showed that the most important, and prominent dimension of wellness was the physical dimension. Then, the issues of individual, and interactive wellness were discussed. As can be seen, the most significant aspect of this group of visitors is to protect “physical wellness”, which is more important under current COVID-19 conditions. Regarding the factors affecting the tourists’ destination selection, the geographical location of the place was the most effective factor followed by the variable of satisfaction with the received services. In terms of importance, the variables of marketing and pricing were ranked second and third, respectively, while facilities and service quality were placed fourth. Collectively, these variables influenced 62% of travelers’ intentions to choose a wellness tourism destination. However, 38% of factors affecting WT destination selection were left unaccounted for, which warrants further studies in this regard. Research has been done on the factors affecting the tourism destination selection, some of which were not WT destinations.

Research on well-being has long sought to promote trips for the improvement of spiritual, and physical health (Esfandiari and Choobchian, 2020; Buckley, 2020; Hanna et al., 2019). It is recognized that wellness trips should be flexible to maintain, and mentally rehabilitate tourists. These issues have led to a favorable reassessment of tourism travel satisfaction. This study adds to studies that generally concentrate on the advantages of travel, such as raising mental well-being, boosting health, lowering weariness and stress, and promoting life satisfaction (Esfandiari and Choobchian, 2020; de Bloom et al., 2017; Sirgy et al., 2011; Kühnel and Sonnentag, 2011). Current research on well-being discusses how negative events may disrupt the travel sector. These studies address various aspects of the tourism sector and are replete with promising prospects that may occur in the field of tourism.

In conclusion, sustainable development represents the most appropriate approach to tourism development. This approach emphasizes the integration of ecological and socio-economic factors within a community. In many advanced countries, tourism is considered a vital resource in the economy, and as such, it holds a special place in these countries. Sustainable development is all-round development. Future generations have the right to live and enjoy the future, in addition to me, you, and them. The economic, social, and environmental advantages, as well as the drawbacks of tourism, should all be taken into account for the growth of the industry, and its sustainable evaluation. WBT development is not possible without considering environmental development. It is impossible to discuss tourism destinations, which are known to be influenced most significantly by location, without considering environmental sustainability concerns (Ozturk et al., 2023; Zhao et al., 2022). In addition to causing destruction and pollution of the environment, this may reduce the attractiveness of the region for tourists. Therefore, it will hurt the prosperity of the tourism industry. Thus, this issue may cause damage to the preservation of the history, and culture of the region, which hurts the satisfaction of tourists (Koval et al., 2019; Singh et al., 2021). Thus, preserving and improving the environment is of special importance in the tourism industry.

Significant developments in the tourism industry in recent times have raised questions regarding the role of tourism in economic growth. The ability of service providers and residents to offer tourists the best possible travel experience is hindered by potential risks that could negatively impact public health and raise concerns about resource limitations. Furthermore, the world did not experience such a wide-ranging impact on the economy before the COVID-19 outbreak, with influential outcomes for socio-economic dimensions of the society (such as SARS, MERS, and H1N1). In the tourism industry, responsible post-COVID-19 recovery is the building block of resilience to deal with long-term welfare crises, especially in a world with a new order, rebuilt after the pandemic. As Gössling et al. (2021) state, epidemics create vulnerabilities that are devastating for the tourism industry.

Therefore, sustainable tourism aims to meet the needs of current tourists and host communities while preserving and increasing opportunities for future generations. It seeks to find promising ways to enhance tourists’ well-being and ensure long-term sustainability. However, the COVID-19 pandemic has had an unexpected impact on the tourism industry’s economy. This inevitably leads to increased physical and mental problems, which causes a loss of well-being after the trip.

The findings of this research will help government authorities, tourist sector administrators, and politicians make better preparations for upcoming issues. To provide prompt assistance and sincere support, doctors should complete specialized training in health crises and crisis management.

Limitations and further studies

Tourists’ lack of knowledge of the idea of WT was one of the limitations of the current study as people without knowledge in this field chose this type of tourism. These issues should be taken into consideration by the Iranian Ministry of Cultural Heritage, Tourism, and Handicrafts and other relevant organizations. Additionally, researchers are encouraged to explore the concept of wellness tourism in a broader context in their future studies. It is proposed to test this model in another statistical population for its cross-validation. Besides, the data of the current study were gathered before the COVID-19 pandemic, so future research needs to examine WT during the COVID-19 outbreak and provide the protocols required to combat the disease during travel. Future research should look at how other variables may be affecting this kind of tourism. For instance, it is important to take into account how political and legal aspects influence the attraction of such visitors, particularly those from outside. Moreover, it is recommended that future research examines the impact of wellness tourism on the development of rural areas. It is important to note that this study was designed as a cross-sectional study, which is an observational method that analyzes data from a population at a particular point in time. Unlike other kinds of observational research, cross-sectional studies do not track samples over time. These studies are usually economical and simple to conduct which are suitable for generating initial evidence to design a future expanded study. These limitations apply to our research, which was conducted as a cross-sectional study owing to time and resource constraints. Future research can attempt to get around this restriction. Furthermore, this study did not incorporate control variables, which should be considered in future research. Additionally, the use of structural equation modeling in this study had limitations, as it is more applicable to specific cases. Therefore, it is recommended that future tourism studies utilize Bayesian networks, as suggested by Norouzi et al. (2022). We face the uncertainties that justify Bayesian networks. Bayesian network-based approach overcomes many limitations of classical safety and reliability analysis approaches (Kabir and Papadopoulos, 2019). In a Bayesian paradigm, the model is derived from quantitative data so that the data drive the study rather than a predefined model (Manthiou et al., 2022). As recently emphasized (Assaf et al., 2016), one of the main motivations to use the Bayesian perspective is its flexibility in managing very complex models or data structures. By taking into account the relationships among variables in the network structure, uncertainties in the model can be addressed, resulting in model results that are more consistent with real-world scenarios (Watthayu and Peng, 2004). The model used in this study met all of the fit criteria and provided effective explanations for the predictor factors of health-oriented tourism. The predictive strength of the model might be improved by expanding it to include new factors including revisit intention, perceived quality, place attachment, and readiness to suggest.

Policy and theoretical implications

The COVID-19 epidemic has left socio-economic, psychological, and cultural effects on different tourism stakeholders, and they will suffer for a long time. The findings have some implications for COVID-19 policies as follows:

  • In addition to affecting the tourism sector, COVID-19 has a larger effect on tourism education, which has heavily influenced job opportunities around the world. As such, tourism researchers must devise new strategies and research concepts to identify organizational weaknesses while taking into account the mental health and privacy concerns of stakeholders affected by COVID-19. Furthermore, educational features should be considered, such as outlining as well as implementing "sustainable" and adaptable approaches to tourism education and the development of students with transferable and practical abilities in other business sectors.

  • After the COVID-19 era, e-tourism can modify the future of tourism by affording measurable and versatile value constructions, structural descriptions, technical tendencies, as well as tangible and technical theories. Scientific-technological innovation needs reforms in the field of e-tourism, including diversity, openness, history, equality, and reflection.

  • Crisis supervision should determine the main administration process before, during, or after the crisis. The effects and consequences of COVID-19 can impact various stakeholders, including government officials and tourism organizations. It would be equally innovative to focus on current topics and relationships while incorporating modern techniques into the research framework using contemporary perspectives and conceptual analyses. Such actions can show significant unresolved problems and complexities.

  • Social entrepreneurship has grown over the last decade because of the economic crisis in 2008. COVID-19 promotes these social tourism plans to create social influence, solve the social problems caused by COVID-19, and help those in need. The rapid growth of related social tourism businesses in COVID-19 provides numerous opportunities to practice, and correctly interpret this concept in new biodiversity, stakeholder, and post-course circumstances.

  • From now on, the goal of tourist companies should not be to increase the number of visitors, but to "easier and more convenient trips and personalized services, while sustaining an affordable price." The tourism industry must begin to rebuild hotels, improve staff quality, streamline tour group sales and customer registration, and make progress toward digital technology. To cater to families, appropriate entertainment should be provided, including suitable programs for children and youth, as well as proper food menus. It is expected that high-quality health measures be implemented in the tourism sector in future epidemics, so after the epidemic, high-quality health measures should be taken in tourism. All hotels, for example, may provide staff and tourists with health, and protection equipment against the epidemic, and customer service should be on a rotating basis to avoid overcrowding. To maintain social distance on the beaches, the place can be divided into separate blocks.

  • Besides, potentially important and effective programs should be promoted and prioritized by local tourism authorities. The service quality in quarantined hotels should be considered by the government authorities as this is one of the concerns of tourists during the epidemic. Besides, media advertisement by the government is essential to strengthen understanding during the epidemic.

Conclusions

The tourism industry, with characteristics consistent with today’s world, has features that guide the development process. Therefore, by leveraging the adaptable nature of the tourism industry and adhering to social distancing guidelines during epidemics, it is possible to harness the positive aspects and guide the development process in rural areas, which was the focus of this research. “WT” is a kind of leisure industry that can be responsive to the current conditions of modern societies which are replete with tension, stress, and pressure so it can be considered the main pillar of tourism activities in the current COVID-19 conditions, where traveling to crowded areas should be avoided. In addition, WT can enhance and enrich the financial, social, cultural, and ecological aspects of the host location by attracting attention and inspiring interest in the area. In other words, WT can serve as a useful approach for boosting employment in rural communities that are facing challenges related to income and employment. What is necessary for us in the present situation is to use the concept of WT on a small scale as a strategy for regional and local development and at an international level to save the tourism industry as well as tense human societies. On the one hand, the rural host community during a gradual change in the rural environment learns how to welcome and treat wellness tourists. On the other hand, financial and communal mechanisms are provided for the growth of the tourism industry and they can be used as a means for viable rural development. The main point here is that in COVID-19 conditions, the practice should be first prepared for domestic tourists, and then, it can be extended to foreign tourists.

WT, which seeks tranquility and travel without medical assistance or supervision to decrease everyday stress and promote mental and physical health, is one of the most underappreciated parts of Iranian tourism. Wellness tourists typically seek to experience the health-promoting benefits of nature and escape the stress and chaos of urban life. In this study, we aimed to provide a specific framework for planning and policymaking in this area by identifying the key aspects of wellness. Thus, rural areas with natural and climatic attractions are the best destinations for these tourists as the crucial dimension of wellness in this kind of tourism was identified to be the physical dimension, which included body health, using fresh and healthy foods, and feeling refreshed and relaxed. Planners and politicians need to consider this conclusion. In this respect, it is recommended that suitable procedures be established for COVID-19 conditions for WT by the current circumstances. Besides, based on the findings of the current study, some suggestions are made that can help the growth of WT:

  • Since a crucial aspect of health tourism is the physical dimension and the most important products in the study area are honey plus dairy products, policies to commercialize local goods and their brands should be considered.

  • In this region in terms of climate, positive image, and, excellent foods, is one of the most attractive destinations for wellness tourists. Moreover, in this county, investors from the private sector of the tourism industry should be encouraged to invest in activities related to wellness tourism. Furthermore, due to its strategic location, Sarab County has significant potential for strengthening its connections with neighboring countries. Furthermore, while being one of the top 10 countries in the world for greenhouse gas emissions, Iran uses renewable energy at a relatively low rate. The hot springs in this region are excellent geothermal energy sources and are promoted as health tourism locations. Considering marketing is weak in the study region, it should be on the agenda of planners via social media and TV, as well as radio programs to show tourist attractions and activities, as well as the value of WT. Further, to inform local people about the importance of activities related to WT, instruction on how to deal with wellness tourists, and the way to assist them in emergencies should be recognized in local training and development programs.

  • By taking advantage of the potential of the private sector, and the unique position of the region, investment can be motivated as it can play an important role to create job opportunities, and preventing residents’ immigration. Therefore, with the expansion of health tourism and the activation of mineral hot springs in the study site as the center of hot springs in the province, cultural heritage can be protected for future generations.

In conclusion, despite the disruption caused by the COVID-19 pandemic to the tourist sector, it is still possible for it to prosper by adhering to WT’s health guidelines. In other words, by adhering to new rules, WT may now be attained as a kind of tourism. Furthermore, this type of tourism can be a good option to reduce tension and enhance health for people who have suffered from physical and mental problems during the COVID-19 epidemic.

This study’s findings can help planners, research scholars, and practitioners to reinforce their weak points. Therefore, detecting sustainable dimensions for WT and listing them would support tourists to pick destinations tailored to their necessities. Viable dimensions include all financial, communal, and ecological ones. Therefore, identifying and listing criteria can aid in selecting tourism destinations. However, like previous studies, this research also has limitations, such as the difficulty in accessing reliable databases and the challenge of converting qualitative criteria into quantitative ones. Lastly, it should be noted that this study only focused on the perspectives of Iranians and did not take into account the views of other nationalities. Albeit very important, the current research has not addressed the relationship between health-related features and tourism, particularly in the current COVID-19 epidemic.

WT with an emphasis on untouched nature, and lightly populated regions, can be considered tourism for economic promotion and development. Moreover, it would be assumed that employment levels will be maintained given the ongoing harm to the economy of countries. An unemployment crisis will result if this problem is not resolved. It will not be possible to alleviate the loss initiated by this worldwide crisis without the cohesion of all institutions, policymakers, and administrators.