New Approaches in Management and Marketing

Abstract The aim of this research is to present a marketing model for health tourism with an emphasis on medical equipment. The present research is applicable-fundamental in terms of its purpose and exploratory-survey in terms of its nature and method. The statistical population of the present study includes 15,000 employees and faculty members of Mazandaran University of Medical Sciences. The Cochran formula was used to determine the sample size, and 375 people were selected as a sample using simple random sampling. The collection tool in the present study includes a questionnaire. SPSS and PLS software were used to analyze the findings. The findings showed that economic and policy factors indirectly affect marketing development through infrastructure and service quality. Infrastructure conditions have a positive and significant effect on service quality, patient experience, and marketing development, but its direct effect on destination image was not significant. Service quality indirectly affects marketing development through patient experience, and destination marketing and image directly enhance the development of health tourism. After confirmatory factor analysis, the GoF criterion method was used to fit the overall model, and the value obtained was 0.617. Therefore, the model has a good fit.
Introduction
In the present era, the increasing spread of technology and the accelerated effort for industrialization and rapid urbanization and machine life in most countries of the world, especially in third world and developing countries, bring with them problems. A person tired of today's society who has taken a marginal role next to industry must work like a machine to make a living and live more comfortably and not show his fatigue. Although he looks very satisfied and happy on the outside, he suffers from boredom and depression more than any other time in history. It is obvious that a society benefits from dynamism and vitality when its citizens enjoy optimal physical and mental health. But the present century, which is rooted in technology and industry and has been called the century of anxiety, stress, and nervous disorders among different centuries and eras, has always had an adverse effect on human health and has brought about new social, health, and medical issues (Omidi et al., 2022). Since the second half of the twentieth century, numerous factors such as globalization, development and progress, modern means of transportation, and communications have taken steps towards the development and progress of the tourism industry, so that this industry is known as the third economic industry (Saeedbakhsh et al., 2021). Tourism is one of the expanding industries in the world, and its added value and income play a major role in the gross national product and the provision of citizens with a sustainable livelihood (Godovykh et al., 2020). The significant importance of tourism, especially in the nature tourism sector, has become apparent to everyone globally and from various aspects, especially health tourism. In addition, with the optimal planning that has been carried out in some countries, treatment costs have been reduced to a high extent and the field for the recovery and rehabilitation of patients has been provided (Soliman et al., 2023).
Today, although various factors affect tourism attraction and return visits, the nature of health tourism destinations has not been seriously considered by researchers (Zakavoti et al., 2023). This issue is of great importance, especially in health tourism destinations. Every health tourism destination, including health camps, has an image that can distinguish it from other tourism destinations. (Kovalchuk et al., 2021). In order to develop the competitive position of health tourism destinations, it is necessary to present a favorable image centered on designing appropriate and up-to-date marketing strategies, because it has a positive effect on the motivations for visiting and tourist satisfaction (Pashaeifar et al., 2021). Today, health tourism has not only found diverse formats and diverse goals, but in many marketing strategies in this field, the construction and operation of complexes such as health camps has gained considerable importance: (Zarei et al., 2019).
Research on designing a marketing model for health tourism with a focus on medical equipment is of great importance. Because in the field of health, tourism-related businesses focus on items such as medical services, medical equipment, and health services, which play a very important role in attracting tourists. Considering the above issues, the main question of the present study is: what is the marketing model for health tourism with an emphasis on medical equipment?
Theoretical Framework
Marketing
Marketing is defined as a social management process in which individuals and groups satisfy their needs and desires through the production and exchange of goods. This basic definition has gained new color and spirit today, and researchers' research has made it richer and broader than before (Zekavoti et al., 2023).
Tourism Industry
The tourism industry is one of the industries that play a significant role in the economic development of countries and the creation of job opportunities. Marketing is very important in this industry, and implementing effective marketing strategies can help the growth and development of this industry.
Health Tourism
Health tourism is a growing trend in the tourism industry that focuses on improving and maintaining the physical and mental health of individuals. This type of tourism includes trips that people take to improve and promote their health and usually includes staying in places with beautiful nature, recreational facilities, and various health and medical centers. One of the characteristics of health tourism is attention to spirituality and spirituality along with maintaining physical health (Osman et al., 2021. (
Chowdhary & Majumdar (2025), using a mixed qualitative and quantitative approach, showed that health tourism acts as a driver of economic growth in developing countries and contributes to economic development through foreign exchange, job creation, and strengthening healthcare infrastructure; while effective policymaking, public-private partnerships, and targeted marketing play a key role in exploiting this potential.
Afradi (2025) in a review study aimed at examining the importance of health tourism marketing in Iran, it was shown that principled marketing and successful strategies in this area improve the quality of services, attract health tourists, develop infrastructure, and ultimately national economic growth.
Research Methodology
The present study is applicable-fundamental in terms of purpose and exploratory-survey in terms of nature and method. The statistical population of the present study includes 15,000 employees and faculty members of Mazandaran University of Medical Sciences. The Cochran formula was used to determine the sample size, and 375 people were selected as a sample using simple random sampling. The collection tool in the present study includes a questionnaire.
Research findings
SPSS and PLS software were used to analyze the findings. The findings showed that economic and policy factors indirectly affect marketing development through infrastructure and service quality. Infrastructure conditions have a positive and significant effect on service quality, patient experience, and marketing development, but its direct effect on destination image was not significant. Service quality indirectly affects marketing development through patient experience, and marketing and destination image directly strengthen the development of health tourism. After confirmatory factor analysis, the GoF criterion method was used to fit the overall model, and the value obtained was equal to 0.617. Therefore, the model has a good fit.
Conclusion
The present study aimed to present a marketing model for health tourism with an emphasis on medical equipment. These results are in line with the studies of Chowdhary & Majumdar (2025), Afradi (2025), Sayadi et al. (2025), Monroy-Rodriguez, & Caro-Carretero (2025), Shabankareh et al. (2025), Shahabadi et al. (2025), Khodayi et al. (2024), Mesgari & Mehrabi Bahar (2024), Kabak & Sevim (2024), Cha et al. (2024), Connell (2021), Fernando & Long (2023), Alsharif et al. (2023), which emphasize the importance of advanced infrastructure, service quality, and branding in attracting international patients. For the sustainable development of health tourism, Iran should focus on technology-driven branding, experience-driven marketing, and integrating infrastructure and policies with digital campaigns to establish its position as a top global destination. Shabankareh et al. (2025) showed that government support has the greatest impact on improving the quality and reducing the cost of healthcare services, using advanced medical technologies, and on economic, infrastructural, and cultural factors related to health tourism. Based on the above results, the following suggestions are made: integrating health policy, economics, and marketing, national health branding with a technological core, designing treatment packages with advanced technologies, creating a narrative ecosystem to record and disseminate patient experiences with an emphasis on medical technologies, using medical equipment in health diplomacy to enhance the destination image, converting modern equipment (MRI, smart operating room) into marketing content, creating a cooperation network with the Persian Gulf, Central Asia, and Caucasus countries, developing multilingual applications to provide information on equipment, treatment stages, and follow-up. Acknowledgments The authors gratefully acknowledge all individuals, institutions, and organizations that provided scientific, technical, administrative, or advisory support throughout this research and the preparation of this manuscript. Conflicts of Interest The authors declare that they have no financial or non-financial, personal, professional, or institutional conflicts of interest relevant to this work. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. AI Use Statement The authors declare that no generative artificial intelligence (AI) or AI-assisted technologies were used in the preparation, writing, or editing of this manuscript. Funding The authors declare that no funds, grants, or other financial support were received during the conduct of this research or the preparation of this manuscript. Ethics Approval All procedures performed in this study were conducted in accordance with the ethical standards of the responsible institutional and national research committee.

Abstract The present study sought to investigate the role of entrepreneurial marketing in the development of the tourism industry. The research method is applicable in terms of its purpose, quantitative in terms of its implementation method, and descriptive-correlational in terms of its nature and method. A standard questionnaire based on a 5-point Likert scale was used to collect research data. The content validity of the tool was confirmed by specialists and experts, and Cronbach's alpha and composite reliability were used to measure the reliability of the tool. By distributing the questionnaire, the validity of the tool was measured with three methods: construct validity (external model), convergent validity (AVE), and divergent validity. The AVE value for all variables should be greater than 0.5. SPSS and PLS software were used to analyze the data. The results of structural equation modeling with SmartPL software showed that entrepreneurial marketing of health tourism is influenced by human factors, innovation, and government support, and has a significant impact on economic and social strategies and outcomes. Implementing innovative strategies improves the tourist experience and develops cooperation between healthcare and tourism centers. This study shows the importance of innovative management and the use of new technologies for the sustainable development of health tourism. In addition, the overall model fitting results showed that the obtained model had appropriate validity, reliability, and credibility.
Introduction
The tourism industry is one of the most important economic and cultural resources of countries and plays a key role in sustainable development, job creation, and increasing foreign exchange earnings (Rajabi et al., 2024). Tourism can contribute to economic and social growth by creating direct and indirect job opportunities, strengthening infrastructure, and developing less-developed areas (Lovafan et al., 2022). In Iran, despite its natural, historical, and cultural diversity, there are potential capacities for tourism development, the use of which requires careful planning and targeted policymaking (qiu et al., 2021).
Health tourism, as one of the booming and growing branches of tourism, has gained special importance. The combination of medical services with natural and cultural attractions has made Iran one of the potential health tourism destinations in the region. In addition to generating income, this type of tourism improves the quality of medical services, creates jobs, and promotes balanced development of different regions, and provides new economic opportunities for the private and public sectors (Tash & Amiri Sardari, 2023).
Entrepreneurial marketing, as a new approach to marketing management, is a combination of entrepreneurial thinking and traditional marketing principles. This approach emphasizes creativity, innovation, risk-taking, and opportunism and helps organizations remain competitive in dynamic markets. In the tourism industry, entrepreneurial marketing provides the opportunity to provide differentiated services and products, attract tourists, and create new experiences (Salami et al., 2023). Entrepreneurial marketing, relying on innovation, creativity, and the use of new market opportunities, can play a key role in the development of the health tourism industry (Mansoori et al., 2024). By focusing on accurately understanding the needs of the target market and utilizing new advertising and digital techniques, this type of marketing can help identify and introduce unique health services in health tourism destinations. In addition, entrepreneurial marketing leads to the formation of a coordinated and integrated ecosystem to attract health tourists by encouraging cooperation between different sectors such as medical centers, travel agencies, and governments. Also, by using innovative approaches, entrepreneurial marketing can help identify new markets and develop unique strategies to attract target audiences globally (Darwazeh, Clarke & Wilson, 2021). In countries like Iran, which have good medical infrastructure in many areas such as dentistry, cosmetic surgery, infertility treatment, and traditional medicine, health tourism can be considered a valuable economic opportunity to attract foreign exchange earnings and create employment. However, to exploit these opportunities, there is a need for precise and entrepreneurial marketing strategies that are specifically dedicated to this industry (Jabari Nezhad esfahlan, Divsalar & Hoseini Ghoncheh, 2022). Currently, despite the high therapeutic capacities, the marketing of the health tourism industry in Iran is still in its infancy, and many private medical centers and hospitals have not been able to effectively use this potential. This is especially noticeable compared to competing countries that use advanced marketing strategies to attract health tourists. Another challenge is the lack of accurate knowledge of the characteristics of the target market in the health tourism industry. This market, unlike traditional tourism markets, pays special attention to the specific needs of individuals and health services tailored to those needs. Therefore, designing a marketing model that can accurately identify the needs and preferences of the target market is of particular importance (Tash & Amiri Sardari, 2023). Therefore, the main question of the present research is: what is the role of entrepreneurial marketing in the development of the tourism industry?
Theoretical foundations
Health tourism
Health tourism is a set of activities in which people travel to a destination other than their place of residence to improve their physical and mental health, receive medical, rehabilitation, prevention or health care services. This type of tourism is a combination of medical, care and recreational services and, due to its overlap with other tourism sectors such as nature tourism, cultural and accommodation, has extensive economic and social potential (Shafiei & et al, 2021).
Research background
Khakzadian (2025) studied “Explanation of local and cultural characteristics of Mazandaran province on the formation and continuation of hybrid entrepreneurship”. The qualitative and phenomenological research approach was chosen using the Claise method. The results show that the combination of cultural, geographical and climatic characteristics of the region, as well as the role of local networks and support structures, provides a suitable platform for the formation and continuation of hybrid entrepreneurship in Mazandaran.
Yahyazadeh et al. (2023) studied “Presenting a tourism industry development model with an emphasis on the role of media management with a mixed approach”, in this study a mixed approach (qualitative-quantitative) was used. The results showed that advertising, service quality, policy-making, participation of local people, tourism culture, appropriate exploitation of the environment, income generation in the tourism destination and infrastructure facilities were identified as the main components that affect the tourism industry.
Research methodology
This research is applicable in terms of purpose and descriptive-correlational in terms of method. The population of the present study includes all hospital visitors (including patients and their companions). Given the unlimited size of the population, the sample size was determined to be 384 people and four cities including Shiraz, Rasht, Tehran, and Isfahan were selected. The researcher was assigned to Milad and Pars hospitals in Tehran, Namaz and Dr. Shariati hospitals in Shiraz, Fayyaz Bakhsh, Imam Khomeini hospitals in Isfahan, and Ghaem (A.J.) and Golsar hospitals in Rasht. An equal number of 48 questionnaires were distributed to each hospital. The findings from the Cronbach's alpha test and composite reliability to measure the reliability of the research instrument are reported in Table 2. To examine the validity of the instrument, content validity (expert opinion) was used and its validity was confirmed. Then, by distributing the questionnaire, the validity of the instrument was measured with three methods: construct validity (external model), convergent validity (AVE), and divergent validity. The AVE value for all research variables must be greater than 0.5. In order to test the research hypotheses, structural equation modeling was used in the context of smart pls2 statistical software.
Research findings
The findings showed that human factors and skills, innovation in services, infrastructure and government support play an important role in the formation of entrepreneurial marketing in health tourism, and this phenomenon has a significant impact on development strategies and economic, social and cultural consequences of the industry. Also, strategies based on entrepreneurial marketing improve customer experience, attract investment and strengthen cooperation between medical centers and tourism. These results are in line with previous domestic and international research and emphasize the importance of innovative management and the use of new technologies in the development of health tourism.
Discussion and Conclusion
The research findings showed that a set of human and specialized factors play the greatest role in the formation of entrepreneurial marketing in health tourism. The expertise and experience of doctors, the communication skills of employees, the quality of customer-oriented services, and innovation in providing medical services strengthen the understanding and trust of health tourists and provide a suitable platform for entrepreneurial marketing. These results are in line with the studies of Shafei et al. (2021), who emphasized that human resource capabilities and service quality are the most important factors in attracting health tourists in Iran. Also, the studies of Kaewman et al. (2018) show that innovation and expertise are the determining factors for tourists. Therefore, it can be concluded that human factors and innovation are the basis for the development of entrepreneurial marketing in the health tourism industry and their importance has been confirmed globally.
The results show that entrepreneurial marketing, as the main phenomenon of the research, is the main driver of the success of health tourism attraction strategies. The use of creativity, digital technologies, social networks and distinctive branding increases the attractiveness of health services and differentiates the destination in the competitive health tourism market. These findings are consistent with the research of Daraie et al. (2023) which shows that innovative and digital marketing increases the effectiveness of health tourism programs. Also, the studies of Mansoori et al. (2024) emphasize that the application of new technologies and entrepreneurial marketing increases competitiveness and international market development. As a result, entrepreneurial marketing plays a key role in creating value, developing the market and attracting health tourists and can create a sustainable competitive advantage for medical destinations. The findings showed that cultural and social factors play an important intervening role in the implementation of entrepreneurial marketing strategies. The attitude of the host community, the level of public awareness towards health tourism and the level of acceptance of new treatment methods can facilitate or limit the implementation of marketing programs. The study of Hosseini et al in Iran also emphasizes that a positive attitude and community awareness are prerequisites for the success of health tourism. Studies by Kaewman et al. (2018) show that cultural differences and social acceptance are determining factors for the success of health tourism destinations. Therefore, it can be concluded that without cultural support and community awareness, marketing strategies, even if innovative, will not achieve the desired results.
The results showed that the existence of appropriate physical and medical infrastructure, standard accommodation facilities, appropriate transportation and financial support and government policy play a fundamental role in the success of entrepreneurial marketing. Studies by Wang et al. (2023) have also shown that infrastructure and government support are the most important requirements for the development of health tourism. Kaewman et al. (2018) also shows that smart government policymaking and the development of standard infrastructure directly attract health tourists and increase industry productivity.
Therefore, the conclusion is that marketing strategies cannot be effective without adequate infrastructure and strengthening environmental conditions is the basis for the development of this industry.
The results show that the implementation of entrepreneurial marketing strategies has wide-ranging consequences at the economic, social and cultural levels. The use of creativity, innovative service design and correct branding, in addition to increasing tourist attraction, creates jobs, boosts related businesses and improves the quality of health services. Robina-Ramírez et al. (2022) studies have also emphasized the role of these strategies in economic development and improving the quality of services. Kaewman et al. (2018) studies also show that innovative marketing increases cultural interaction, sustainable development and improve of the quality of health services in health tourism destinations. Therefore, entrepreneurial marketing strategies act as a bridge between therapeutic capacities and international markets and play a key role in the sustainable growth of the industry. Acknowledgments The authors gratefully acknowledge all individuals, institutions, and organizations that provided scientific, technical, administrative, or advisory support throughout this research and the preparation of this manuscript. Conflicts of Interest The authors declare that they have no financial or non-financial, personal, professional, or institutional conflicts of interest relevant to this work. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. AI Use Statement The authors declare that no generative artificial intelligence (AI) or AI-assisted technologies were used in the preparation, writing, or editing of this manuscript. Funding The authors declare that no funds, grants, or other financial support were received during the conduct of this research or the preparation of this manuscript. Ethics Approval All procedures performed in this study were conducted in accordance with the ethical standards of the responsible institutional and national research committee.

Abstract The objective of the current research is destination branding for health tourism in medical centers of Yazd province. The present study is based on the pragmatism paradigm with an exploratory orientation, conducted as developmental research in a cross-sectional manner using a survey approach (interviews) through field studies; the research strategy was projective technique, and data collection was performed using semi-structured, in-depth interviews with 12 experts in health tourism and destination branding who were selected through purposive sampling; at this stage, the sample size was determined based on the theoretical saturation rule, and after three-level coding (open, axial, and selective), this concept was developed; the research findings indicate the necessity of attention to infrastructure factors, cultural factors, and economic factors as variables of health tourism destination country, tourism factors and destination branding factors of the city, advertising, sales promotions, brand communities, and public relations as communication tools variables, as well as physicians and nurses, medical center staff, and managers as human resources variables, and medical equipment/facilities and services as product/service variables.
Introduction
In today's world, health tourism is recognized as one of the most prosperous global industries, attracting millions of people annually to various destinations for medical services (Patterson & Balderas-Cejudo, 2023). Within this context, health tourism destination branding has emerged as a critical factor in attracting both domestic and international patients while creating sustainable competitive advantages for medical centers. A primary concern for health and tourism policymakers is establishing medical destinations as preferred and trustworthy options in the minds of global audiences through effective branding strategies.
Despite Iran's significant potential, particularly in Yazd province, for attracting health tourists, limited research has systematically examined the factors influencing destination branding in this context. A review of existing literature reveals that cultural perspectives and elements - themselves influenced by environmental changes - significantly impact branding. As Wijaya (2024) demonstrated, successful branding strategies can create innovative, distinctive products that foster loyalty among target audiences. Similarly, Ailawadi & Keller (2004) investigated how branding strategies create unique positions for brands across various sectors, contributing to sustainable competitive advantage.
Theoretical Framework
Branding
The rapid changes and transformations at the end of the second millennium, coupled with the emergence of new global challenges, have revealed the limitations of traditional forecasting-based planning methods (Linkon et al., 2024). This constant evolution creates an ongoing need for individuals to adapt to environmental changes (Kindström et al., 2024).
Tourism Destination Branding
Destination branding focuses on creating perceptions or reputations that attract investors and tourists. A strong destination brand serves as an effective tool for differentiation and developing emotional connections with consumers (Darwish & Burns, 2019).
Health Tourism Destination Branding
Health tourism, defined as travel for physical and mental health purposes lasting between 24 hours and one year, represents a rapidly growing sector of the tourism industry (Sattari et al., 2020).
Research Methodology
This exploratory qualitative study adopts a developmental approach within the pragmatism paradigm. Utilizing inductive reasoning and taxonomic modeling, the research employed projective techniques and expert interviews to develop the concept of health tourism destination branding. The cross-sectional field study involved purposive sampling of 12 experts (following theoretical saturation principles) from academia and healthcare management in Yazd province (Table 1).
Credibility: Verified through member checking with participating experts
Transferability: Ensured through peer review by university professors
Dependability: Established through audit trails by two external reviewers
Inter-coder reliability: Achieved >0.7 agreement between independent coders
Findings and Discussion
Analysis of 60-90 minute interviews (recorded with participant consent) yielded 60 open codes, subsequently categorized into 14 axial and 5 selective categories (Table 2). The study identifies critical success factors including:
Infrastructure, cultural, and economic considerations
Tourism and destination branding elements
Communication tools (advertising, promotions, PR)
Human resources (medical staff, administrators)
Service quality and medical facilities
Conclusion
Yazd province - and Iran more broadly - possesses the medical expertise, competitive pricing, and cultural attractions to become a regional health tourism hub. However, realizing this potential requires:
Strategic destination branding
Infrastructure development
Health diplomacy initiatives
The study provides a comprehensive framework for policymakers and healthcare administrators to enhance Iran's position in the global health tourism market through systematic destination branding approaches. Acknowledgments The authors gratefully acknowledge all individuals, institutions, and organizations that provided scientific, technical, administrative, or advisory support throughout this research and the preparation of this manuscript. Conflicts of Interest The authors declare that they have no financial or non-financial, personal, professional, or institutional conflicts of interest relevant to this work. Data Availability Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. AI Use Statement The authors declare that no generative artificial intelligence (AI) or AI-assisted technologies were used in the preparation, writing, or editing of this manuscript. Funding The authors declare that no funds, grants, or other financial support were received during the conduct of this research or the preparation of this manuscript. Ethics Approval All procedures performed in this study were conducted in accordance with the ethical standards of the responsible institutional and national research committee.

Abstract .Today, with the advancement of digital and internet, verbal marketing has found a new platform for activity. In fact, marketing in social networks has changed verbal marketing. One of the most important results of social networks is the formation of electronic verbal marketing among the members of these networks, which is considered as one of the most important applications of these networks. The phenomenon of tourism has always been important and based on the predictions made, it will become the most profitable industry in the world, and in the meantime, the field of health tourism is of great importance. Hence, the aim of this research is to investigate the role of effective factors on electronic word of mouth marketing in the growth of health tourism economy (case study: Shiraz city). Descriptive research is a survey. The statistical sample of the research included 56 health tourists from Shiraz, who were selected and interviewed non-randomly. Data and scenarios were analyzed using fuzzy cognitive mapping technique and the research model was designed using social network analysis. In this regard, several factors are involved, among which the verbal advertising factors of users, improving the experience of tourists and increasing interaction with tourists were the most important respectively; Because they were more central. Finally, based on the obtained results, suggestions were made regarding the development of electronic word of mouth marketing in the growth of health tourism economy (case study: Shiraz city).