Skip to main content

Structural Equation Modelling with Second-Order Confirmatory Factor Analysis: Critical Factors Influencing Consumer Behavior in Medical Tourism

  • Chapter
  • First Online:
Quantitative Tourism Research in Asia

Part of the book series: Perspectives on Asian Tourism ((PAT))

Abstract

The chapter demonstrates an application of structural equation modelling (SEM) with latent variables in tourism research, and the associated statistics are described. First, we discuss the basic concepts of SEM, followed by an explanation of the key statistics and terms associated with this procedure. Then we describe the procedure for conducting SEM, including second-order confirmatory factor analysis (CFA). Finally, we describe the related technique of SEM analysis. In doing so, the chapter provides an application of structural equation modelling with latent variables, of which latent variables are hypothetical constructs that are invoked to explain observed covariation in behavior. The study aims to identify critical factors of consumer acceptance of medical tourism in Asia. The study employs factor analysis (i.e., exploratory factor analysis, confirmatory factor analysis, and internal consistency reliability tests) and structural equation modelling analysis and path analysis (i.e., the analysis of moment structures and regression analysis) using the survey data collected from a sample of 486 international tourists who visited South Korea in 2014.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adams, S. A. (2011). Sourcing the crowd for health services improvement: The reflexive patient and “share-your-experience” websites. Social Science & Medicine, 72(7), 1069–1076.

    Article  Google Scholar 

  • Bartholomew, D. J. (1996). The statistical approach to environmental measurement. San Diego: Academic.

    Google Scholar 

  • Basilevsky, A. (1994). Statistical factor analysis and related methods. New York: Wiley.

    Book  Google Scholar 

  • Chang, G., & Caneday, L. (2011). Web-based GIS in tourism information search: Perceptions, tasks, and trip attributes. Tourism Management, 32, 1435–1437.

    Article  Google Scholar 

  • Chomvilailuk, R., & Srisomyong, N. (2014). Three dimensional perceptions of medical/health travelers and destination brand choices: Cases of Thailand. Procedia-Social and Behavioral Sciences, 175, 376–383.

    Article  Google Scholar 

  • Connell, J. (2006). Medical tourism: Sea, sun, sand and surgery. Tourism Management, 27(6), 1093–1100.

    Article  Google Scholar 

  • Connell, J. (2013). Contemporary medical tourism: Conceptualization, culture and commodification. Tourism Management, 34, 1–13.

    Article  Google Scholar 

  • Cormany, D., & Baloglu, S. (2011). Medical travel facilitator websites: An exploratory study of web page contents and services offered to the prospective medical tourist. Tourism Management, 32, 709–716.

    Article  Google Scholar 

  • Crooks, V. A., Turner, L., Snyder, J., Johnston, R., & Kingsbury, P. (2011). Promoting medical tourism to India: Messages, images, and the marketing of international patient travel. Social Science & Medicine, 72(5), 726–732.

    Article  Google Scholar 

  • Dudensing, R., Hughes, D. W., & Shields, M. (2011). Perceptions of tourism promotion and business challenges: A survey-based comparison of tourism businesses and promotion organizations. Tourism Management, 32(6), 1453–1462.

    Article  Google Scholar 

  • Dunn, G. (1989). Design and analysis of reliability studies: The statistical evaluation of measurement errors. London: Edward Arnold Publishers.

    Google Scholar 

  • Edmonds, A. (2011). “Almost invisible scars”: Medical tourism to Brazil. Signs: Journal of Women in Culture and Society, 36(2), 297–302.

    Article  Google Scholar 

  • El-Gohary, H. (2012). Factors affecting e-marketing adoption and implementation in tourism firms: An empirical investigation of Egyptian small tourism organisations. Tourism Management, 33(5), 1256–1269.

    Article  Google Scholar 

  • Enderwick, P., & Nagar, S. (2011). The competitive challenge of emerging markets: The case of medical tourism. International Journal of Emerging Markets, 6(4), 329–350.

    Article  Google Scholar 

  • García-Altés, A. (2005). The development of health tourism services. Annals of Tourism Research, 32(1), 262–266.

    Article  Google Scholar 

  • Heung, V. C. S., Kucukusta, D., & Song, H. (2011). Medical tourism development in Hong Kong: An assessment of the barriers. Tourism Management, 32(5), 995–1005.

    Article  Google Scholar 

  • Horng, J. S., & Tsai, C. T. (2010). Government websites for promoting East Asian culinary tourism: A cross-national analysis. Tourism Management, 31(1), 74–85.

    Article  Google Scholar 

  • Hung, K., & Law, R. (2011). An overview of Internet-based surveys in hospitality and tourism journals. Tourism Management, 32(4), 717–724.

    Article  Google Scholar 

  • Johnson, T. J., & Garman, A. N. (2010). Impact of medical travel on imports and exports of medical services. Health Policy, 98(2–3), 171–177.

    Article  Google Scholar 

  • Kline, R. B. (2005). Principles and practices of structural equation modeling (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Labonté, R., Runnels, V., Packer, C., & Deonandan, R. (Eds.). (2013). Travelling well: Essays in medical tourism. (Transdisciplinary Studies in Population Health Series, 4(1)). Ottawa: Institute of Population Health, University of Ottawa.

    Google Scholar 

  • Lee, C. G. (2010). Health care and tourism: Evidence from Singapore. Tourism Management, 31(4), 486–488.

    Article  Google Scholar 

  • Lee, S., Jeon, S., & Kim, D. (2011). The impact of tour quality and tourist satisfaction on tourist loyalty: The case of Chinese tourists in Korea. Tourism Management, 32(5), 1115–1124.

    Article  Google Scholar 

  • Lertwannawit, A., & Gulid, N. (2011). International tourists’ service quality perception and behavioral loyalty toward medical tourism in Bangkok metropolitan area. The Journal of Applied Business Research, 27(6), 1–11.

    Article  Google Scholar 

  • Li, X., Lai, C., Harrill, R., Kline, S. F., & Wang, L. (2011). When east meets west: An exploratory study on Chinese outbound tourists’ travel expectations. Tourism Management, 32(4), 741–749.

    Article  Google Scholar 

  • Lunt, N., & Carrera, P. (2010). Medical tourism: Assessing the evidence on treatment abroad. Maturitas, 66(1), 27–32.

    Article  Google Scholar 

  • Lunt, N., Hardey, M., & Mannion, R. (2010). Nip, tuck and click: Medical tourism and the emergence of web-based health information. The Open Medical Informatics Journal, 4, 1–11.

    Article  Google Scholar 

  • Luo, Q., & Zhong, D. (2015). Using social network analysis to explain communication characteristics of travel-related electronic word-of-mouth on social networking sites. Tourism Management, 46, 274–282.

    Article  Google Scholar 

  • Malhotra, N. K. (2010). Marketing research: An applied orientation (6th ed.). Upper Saddle River: Pearson.

    Book  Google Scholar 

  • Moghimehfar, F., & Nasr-Esfahani, M. H. (2011). Decisive factors in medical tourism destination choice: A case study of Isfahan, Iran and fertility treatments. Tourism Management, 32(6), 1431–1434.

    Article  Google Scholar 

  • Munar, A. M., & Jacobsen, J. K. S. (2014). Motivations for sharing tourism experiences through social media. Tourism Management, 43, 46–54.

    Article  Google Scholar 

  • Ormond, M. E., & Sothern, M. (2012). You, too, can be an international medical traveler: Reading medical travel guidebooks. Health & Place, 18(5), 935–941.

    Article  Google Scholar 

  • Penney, K., Snyder, J., Crooks, V. A., & Johnston, R. (2011). Risk communication and informed consent in the medical tourism industry: A thematic content analysis of Canadian broker websites. BMC Medical Ethics, 12(1), 17–26.

    Article  Google Scholar 

  • Runnels, V., & Carrera, P. M. (2012). Why do patients engage in medical tourism? Maturitas, 73(4), 300–304.

    Article  Google Scholar 

  • Sobo, E. J., Herlihy, E., & Bicker, M. (2011). Selling medical travel to US patient-consumers: The cultural appeal of website marketing messages. Anthropology & Medicine, 18(1), 119–136.

    Article  Google Scholar 

  • Suziedelyte, A. (2012). How does searching for health information on the Internet affect individuals’ demand for health care services? Social Science & Medicine, 75(10), 1828–1835.

    Article  Google Scholar 

  • Turner, L. (2011). Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and Health, 7, 40–56.

    Article  Google Scholar 

  • Viladrich, A., & Baron-Faust, R. (2014). Medical tourism in tango paradise: The internet branding of cosmetic surgery in Argentina. Annals of Tourism Research, 45(March), 116–131.

    Article  Google Scholar 

  • Visit Medical Korea. (2016). Visit medical Korea information. Available from: http://english.visitmedicalkorea.com. Accessed 18 Jan 2016.

  • Wang, K. C., Chou, S. H., Su, C. J., & Tsai, H. Y. (2007). More information, stronger effectiveness? Different group package tour advertising components on web page. Journal of Business Research, 60(4), 382–387.

    Article  Google Scholar 

  • Wongkit, M., & McKercher, B. (2013). Toward a typology of medical tourists: A case study of Thailand. Tourism Management, 38, 4–12.

    Article  Google Scholar 

  • Ye, B. H., Qiu, H. Z., & Yuen, P. P. (2011). Motivations and experiences of Mainland Chinese medical tourists in Hong Kong. Tourism Management, 32(5), 1125–1127.

    Article  Google Scholar 

  • Yeoh, E., Othman, K., & Ahmad, H. (2013). Understanding medical tourists: Word-of-mouth and viral marketing as potent marketing tools. Tourism Management, 34, 196–201.

    Article  Google Scholar 

  • Yu, J. Y., & Ko, T. G. (2012). A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea. Tourism Management, 33(1), 80–88.

    Article  Google Scholar 

  • Zhang, J., Seo, S., & Lee, H. (2013). The impact of psychological distance on Chinese customers when selecting an international healthcare service country. Tourism Management, 35, 32–40.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jung Wan Lee .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lee, J.W., Kwag, M. (2019). Structural Equation Modelling with Second-Order Confirmatory Factor Analysis: Critical Factors Influencing Consumer Behavior in Medical Tourism. In: Rezaei, S. (eds) Quantitative Tourism Research in Asia. Perspectives on Asian Tourism. Springer, Singapore. https://doi.org/10.1007/978-981-13-2463-5_11

Download citation

Publish with us

Policies and ethics