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.