Design, Explanation, and Validation of a Comprehensive Customer Experience Model in Health Tourism of Mazandaran Province Using a Mixed Approach

Abstract

The purpose of this study was to design, explain, and validate a localized and comprehensive customer experience model in health tourism of Mazandaran Province using an exploratory mixed-methods approach in order to identify and model the dimensions, components, and influential relationships affecting domestic and international patients’ experiences. This applied study employed an exploratory sequential mixed-methods design. In the qualitative phase, data were collected through semi-structured interviews with 15 health experts, medical center managers, and tourism practitioners until theoretical saturation was achieved. The data were analyzed using Strauss and Corbin’s grounded theory approach with NVivo software. In the quantitative phase, the statistical population included domestic and international health tourists visiting hospitals and medical centers in Mazandaran Province. A sample of 384 participants was selected using Cochran’s formula through convenience and purposive sampling methods. Data were collected using a researcher-made questionnaire derived from qualitative findings and the research literature. Structural equation modeling based on partial least squares (PLS-SEM) along with validity and reliability tests was used for data analysis. The findings indicated that customer experience in Mazandaran health tourism was influenced by five major dimensions, including cultural and linguistic adaptation, accommodation and welfare services, information technology, administrative responsiveness, and treatment service quality. Path analysis revealed that cultural and temporal adaptation was the strongest predictor of customer experience (β=0.652, T=12.43). Accommodation and welfare services (β=0.541) and information technology (β=0.390) also showed significant positive effects. In contrast, treatment service quality had a non-significant effect (β=0.081, T=0.917). The coefficient of determination for the health tourism construct was R²=0.993, while the predictive relevance index was Q²=0.557, indicating very strong explanatory and predictive power of the model. Furthermore, model fit indices including SRMR=0.045 and NFI=0.935 confirmed the excellent fit of the proposed model. The results demonstrated that customer experience in health tourism depends not only on medical treatment quality but also on cultural, communicational, welfare, administrative, and digital infrastructure factors, which play more decisive roles in patient satisfaction and loyalty. Accordingly, the final model was developed in four levels, including core medical excellence, integrated travel-treatment management, intercultural and linguistic standardization, and digital infrastructure with support services. Establishing an integrated international patient experience management system, improving coordinated services, and strengthening intercultural interactions can significantly enhance patient experience quality, competitive advantage, and Mazandaran Province’s position in the health tourism market.