Crafting Strategies for Developing Health Tourism in Coastal Areas with a Holistic Approach (Case Study: Guilan Province)

The current study takes up a holistic approach to health tourism and suggests strategies for developing health tourism in coastal areas. Guilan provience has been selected as the case of study. The contributions of this study are two foleded. First, it contributes to the literature by suggesting an all-encompassing definition of health tourism (including both medical and wellness attractions), which is compatible with the structure of health tourism providers in I.R. Iran. Second, it recruits the proposed definition as a basis for examining the existing situation of health tourism in Guilan province. A SWOT analysis is conducted to formulate strategies. Strengths, weaknesses, opportunities and threats have been identified based on a through literature review and a range of semi-structured exploratory interviews with experts (n=9). Based on the SWOT assessments (n=6), 12 strategies were suggested which were ranked by experts in a QSPM procedure (n=3), in the next step. 1) Investment in infrastructures, 2) development of hotel hospitals and medical SPAs (in particular thalassotherapies), 3) development of SPA hotel with the collaboration of out-of-provinces hotel chains, 4) collaboration with neighbor countries’ tourism and leisure industry to co-produce health tourism packages, and 5) providing virtual or online medical services, have been recognized as the five top-ranked strategies.
1. Introduction
The contributions of the current research are two folded. First, this study attempts to offer an encompassing definition of health tourism which includes both medical and wellness attractions, and at the same time, is compatible with the health system in I.R. Iran. The definition, which is based on the concept of “health” offered by WHO, considers medical and wellness attractions as the elements of the same tourism product and is open to the inclusion of new innovations in health-related services. This definition sets the ground for conducting a more all-inclusive analysis of the existing situation and accordingly, strategic planning of health tourism destinations.
Second, it focuses on health tourism in coastal destinations (Guilan province as the case study). The current research conducts a SWOT analysis to investigate the existing situation of health tourism in Guilan province in order to craft marketing and product development strategies. The coastal regions of Iran enjoy a distinct advantage due to their access to the sea, sandy shores, and oceanic climate, which create excellent opportunities for the growth of health tourism. Additionally, their proximity to neighboring countries enhances their strategic geopolitical status, allowing for the collaborative development of health tourism packages.
Scant research has been conducted on strategic planning for health tourism in Guilan. The present research takes into account the natural, geopolitical, and man-made potential of Guilan province when investigating the existing situation. A combination of SWOT and QSPM analysis is recruited to suggest and rank health tourism marketing and development strategies.

2. Literature Review
The meaning and components of health tourism have remained vague, with no consensus among academics in the field (Connell, 2013). The extant definitions can be divided into two overarching categories: 1) those that encompass a partial range of services and 2) those that embrace a more holistic approach. For instance, Hall (2011) argues that health tourism can be categorized into three areas: medical tourism, wellness tourism, and SPA tourism. Each of these three categories presents tourism products designed for specific tourists. Medical tourists are ill and looking for treatment of their diseases. Wellness tourists are healthy and searching for services that enhance their overall well-being. Finally, SPA tourists seek out SPA services for either medical or wellness purposes.
However, holistic definitions draw on an experience-based approach and define health tourism as a total experience that can improve individuals’ health, whatever it takes in terms of medical or wellness-related services (e.g., Dini & Pencarelli, 2022). Relying on WHO’s definition of health, as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, holistic definitions put more emphasis on the multidimensional nature of the health tourism experience. It is noteworthy that the scope of the definition, whether it is comprehensive or limited, fundamentally affects the choice of service providers that will be integrated into the strategic planning framework for health tourism.
The current research adopts a holistic view and defines health tourism as an integrated experience that improves tourists’ health, no matter which medical, wellness, or rehabilitation care s/he has received. This study divides services into two major sections (i.e., medical and wellness), depending on the necessity of the presence of a doctor of medicine over the course of treatment. Medical services include, but are not limited to, surgical and nonsurgical treatments, handicap rehabilitation, traditional medicine and pharmacology, elderly nursing homes, addiction treatments, etc. Wellness services include water-based and non-water-based services which can have active and passive forms. This study relies on this definition when analysing the existing situation of health tourism in Guilan province.

3. Methodology
A SWOT procedure has been conducted to investigate the existing situation of health tourism in Guilan province. Experts in health tourism were interviewed and surveyed for the purpose of this study. Snowball sampling has been recruited to identify experts. The research took place over eighteen months, spanning from February 2023 to September 2025. The sequence of steps involved in the study is detailed below:

Strengths, weaknesses, opportunities, and threats have been identified through a thorough literature review and a range of interviews (n=9) with health tourism experts.
SWOT questionnaires were designed and sent to experts (effective sample of 6 respondents).
External Factor evaluation matrix (EFE) and internal Factor Evaluation matrix (IFE) have been produced.
Competitors Profile Matrix has been produced.
SWOT Matrix has been produced and strategies have been suggested for the four categories.
The strategic position of health tourism has been indicated using a variety of tools including, Internal-External matrix (IE), Strategic Position and Action Evaluation (SPACE), and Grand Strategy Matrix (GSM)
QSPM questionnaire has been designed and sent to the experts to rank the suggested strategies (effective sample of 3 respondents).
QSPM analysis has been conducted and strategies have been ranked based on their attractiveness scores.

4. Results
The results of IE, SPACE, and GSM analysis showed that health tourism in Guilan Province is in the area of harvest and divest strategies (VI area), but very close to the area of hold and maintain (V area). Therefore, WO and WT strategies have been recognized as suitable strategies for health tourism in Guilan province. Although, as the position of medical attractions (when it has been investigated separately) in the IE matrix was somewhere in the middle of the V area, three other strategies (two SO and one ST) have also been included in the strategy ranking phase. 12 strategies in total have been chosen to be ranked using the QSPM. The results of the QSPM analysis indicated that the improvement of infrastructure, including increasing the number of direct flights, and transport vehicles, investment in seawater purification that makes it suitable for wellness and medical purposes, and improvement of internet connection speed, is the most attractive health tourism development strategy in Guilan province. The second most attractive strategy was the establishment of hotel-hospitals and medical SPAs (specifically thalassotherapy) in collaboration with hospitals outside the Guilan province. Establishment of SPA hotels with collaboration of hotel chains outside the province has been recognized as the third attractive strategy. Partnership with Azerbaijani tourism companies to develop joint products (cure in Iran, entertainment in Azerbaijan) has been identified as the fourth strategy. Providing virtual medical care using distance monitoring tools for patients with chronic disease has been ranked as the fifth strategy. The sixth compelling strategy was upgrading the health tourism steering committee of Guilan province to a level higher than the organization of tourism and Guilan medical university for coordination and controlling purposes. Formation of R&D and education partnerships with medical schools in the markets (e.g., Azerbaijan), and promoting investments in active wellness resorts with a focus on halal and expensive sports and entertainment for Persian Gulf Arab Muslim markets, were ranked as the 7th and 8th strategies. The next four strategies consist of “improvement of specialist dentistry and ophthalmology clinics,” “outsourcing marketing and branding affairs to specialist companies,” “improvement of the distribution system of health tourism in Gulian province via the formation of partnerships between hospitals and local as well as international tourism distributors,” and “promoting investment in the establishment of luxury nursing homes and home care services for the elderly who possess second homes in Gulian province”.
5. Conclusion
The present research is one of the first attempts related to strategic planning of health tourism in Guilan province. However, the results of this study go in line with the findings of previous research works on health tourism in Gulan Province (e.g., Amin-Tahmasbi and Malekzade, 1401; Hassanzadeh et al, 1400). Finally, the small sample size in the QSPM phase that might have influenced the ranking of strategies was one of the limitations of the current research.