Modeling of Health Tourism Development in Rural Areas of Iran (Hot Springs)

Urban sprawl leads to increased physical and psychological problems of human beings in the world. This has resulted in significant growth in wellness tourism industry (Mullholland, 2005) especially spa tourism. Although in recent decades, the globe is currently embraced in a boom of spa tourism, arguably, this is one of the oldest forms of tourism especially in Rome and Greece (Stevens & Associates, 2008) and Iran (Moshiri & Fathallahi, 2009). Spa tourism is the trip to spa destination for relaxation or healing of the body using mainly hot spring (Smith & Puczkó, 2011). Hot spring is a spring of naturally hot water that is its temperature is at least 5°C or 6°C higher than its environment temperature (Moshiri & Fathollahi, 2009). Hot spring industry is in the early stages of growth (Cohen & Bodeker, 2008). Iran, with its numerous hot springs, has an opportunity for growing this industry (Ebrahimzade, 2007). Many of these springs located in rural areas that require planning for optimal utilization and provide jobs for residents of rural areas. In the first step, identifying the pattern of development of spa tourism in rural areas is needed. Village with hot spring as the tourism destination itself is comprised of numerous parts including attractions, facilities, infrastructure, transportation, and hospitality (Mill & Morrison, 1985). Each part is dependent upon the others for attracting, servicing, and satisfying the tourists. The spa destination is the result of the combined activities of all its component parts. Successful spa destination development therefore necessitates all these parts to operate in harmony, providing a value added integrated system (Liu, 1994; Machiavelli, 2001). Therefore, to understand the processes of change in tourism destination, an approach is needed to contain all the internal and external factors. The systems theory was selected for this study. In the framework of tourism system theory, one of the most commonly theories for studying the change and developing process of tourism destination is tourism area life-cycle (Breakey, 2006). Butler by applying product life cycle concept, considered 6 stages for tourism area life-cycle: exploration, involvement, development, consolidation, stagnation (or rejuvenation or decline) (Khademi & Rezvani, 2012). In this study, by accepting this assumption that hot spring industry is in the early stages of growth and using the stages of Butler's life cycle; indigenous model for health tourism development was expressed only in four stages hat were initially defined by their characteristics: 1. Exploration: around the Hot spring there is minimum physical substructure and there are no tourism facilities in the destination. There is no change in hot spring environment influenced by tourism industry. 2. Involvement: the trip to the destination is mainly by road. In addition of all physical substructure and public facilities in the exploration stage, there are separated pools and some market around the hot spring. Accommodation and welfare facilities were developed. And there is a pressure on public sector to provide infrastructure. 3. Development: using of the hot spring is completely planned in the framework of resort buildings with high tourism services and facilities. 4. Consolidation: there are various cure services in this stage and use more new medical technologies than pervious stage. All of services are proficiently provided to tourists. The five indicators of physical facilities, public facilities, health care facilities and services, staffing and location of the site spa, was considered by systematic analysis of spa resorts, hotels and hospitals ranking variables in the world (EHSA, 2014, HowStuffWorks, 2014, INTDA, no date) and Iran (Ghadami et al., 2011; Rouhparvar et al., 2012). The set of five indicators consists of 9, 22, 38 and 13 variables for the stages of exploration, involvement, development, consolidation, respectively. Then, the score of stages and their indicators were determined by applying Delphi method and pair comparing. The score of spa destination will be 100, if it has all of the studied variables. To investigate the development pattern of hot springs, the country was divided into eight geographic areas. More than 20 percent of Hot spring (16 springs) from 66 hot springs identified in villages across the country was selected by cluster sampling. The findings showed that 40 percent of the studied springs are in the exploration stage. Most of these spring located in the South East of the country where there are many hot springs (around 30 percent of total hot spring in Iran). The main reason is; these hot springs are very far from big cities. Also, findings showed that most spa investing is in the North of Iran (having less than 14 percent of total hot springs) cause of being near to Tehran with more than 14 million populations. The other reason is the low distance between cities and villages in that region. The rural destination lifecycle stages in the North West region of Iran are not homogenous. “Mot’alagh Hot Spring” located in Eastern Azerbaijan Province is in consolidation stage because it is near to metropolitan city; Tabriz. There are many hot springs in Ardabil province, despite the high potential, spa destinations are still in the involvement and development stage that one reason for this is; the low distance between the hot springs. Furthermore, Sareyn city, have many hot springs with national reputation, located in Ardabil province. This is leading to a concentration of investments in this city so investing opportunities for other hot springs in restricted. According to the findings is suggested that the feasibility study for the hot springs development in order to coordinate developing of spa tourism in Iran and then plan regionally. In South-East region of Iran, the Government should provide special financial support to attract private investors.