The future of wellness tourism after COVID-19

Abstract

The tourism industry has drastically reduced its activity since the emergence of the COVID-19 pandemic, yet there has been an undeniable rise in demand for wellness tourism which now represents one of the fastest growing tourism market segments globally. Admittedly, while the COVID-19 pandemic has delayed the forecasted wellness tourism growth trend, this segment has stood fast at USD 4.4 trillion in 2020 while global GDP declined by 2.8%. In 2020, the wellness tourism market was valued at USD 436 billion, projected to rise to USD 816 billion by 2022 with more than 1.2 billion trips being realised and anticipated growth estimated at USD 1.0 trillion by 2025. The main purpose of this study is to ascertain the future trends of wellness tourism, and to investigate the extent to which this upward growth trend can be sustainably maintained post COVID-19. A qualitative structured interview methodology was employed using email interviews comprising six pre-determined questions with three expert wellness tourism participants. These expert interviewees were based in countries that were severely impacted by COVID-19, namely Brazil, USA, and Portugal. NVivo Nudist was used to analyse the primary data collected. In validating previous research findings, this study indicates that despite the challenges facing the sector, upward growth patterns in wellness tourism will continue beyond the COVID-19 pandemic.

Full text

EUROPEAN SPATIAL RESEARCH AND POLICY
Volume 30 2023 Number 1
https://doi.org/10.18778/1231-1952.30.1.05
Andressa PIATTO CLERICI *, Catriona MURPHY **,
Nuno Miguel CASTANHEIRA ALMEIDA *
THE FUTURE OF WELLNESS TOURISM AFTER COVID-19
Abstract. The tourism industry has drastically reduced its activity since the emergence of the
COVID-19 pandemic, yet there has been an undeniable rise in demand for wellness tourism which
now represents one of the fastest growing tourism market segments globally. Admittedly, while the
COVID-19 pandemic has delayed the forecasted wellness tourism growth trend, this segment has
stood fast at USD 4.4 trillion in 2020 while global GDP declined by 2.8%. In 2020, the wellness
tourism market was valued at USD 436 billion, projected to rise to USD 816 billion by 2022 with
more than 1.2 billion trips being realised and anticipated growth estimated at USD 1.0 trillion by
2025. The main purpose of this study is to ascertain the future trends of wellness tourism, and
to investigate the extent to which this upward growth trend can be sustainably maintained post
COVID-19. A qualitative structured interview methodology was employed using email interviews
comprising six pre-determined questions with three expert wellness tourism participants. These ex-
pert interviewees were based in countries that were severely impacted by COVID-19, namely Brazil,
USA, and Portugal. NVivo Nudist was used to analyse the primary data collected. In validating
previous research ndings, this study indicates that despite the challenges facing the sector, upward
growth patterns in wellness tourism will continue beyond the COVID-19 pandemic.
Key words: wellness, wellness tourism, trends, COVID-19 pandemic.
*Andressa PIATTO CLERICI, Nuno Miguel CASTANHEIRA ALMEIDA, Escola Superior de
Turismo e Tecnologia do Mar, Instituto Politécnico de Leiria, Santuário de Nossa Senhora dos
Remédios, Campus 4, 2520-641 Peniche, Portugal; e-mails: andressa.piatto@gmail.com, nunoal-
meida@ipleiria.pt, ORCIDs: https://orcid.org/0000-0003-1480-7246, https://orcid.org/0000-0002-
2322-0343
**Catriona MURPHY, Technological University of the Shannon: Midlands Midwest, TUS Moylish
Campus, Co. Limerick, V94 EC5T Limerick, Ireland; e-mail: catriona.murphy@tus.ie, ORCID:
https://orcid.org/0000-0002-1632-331X
© by the author, licensee Łódź University – Łódź University Press, Łódź, Poland. This article is an open
access article distributed under the terms and conditions of the Creative Commons Attribution license
CC-BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Received: 23.11.2022. Revised: 23.11.2022. Accepted: 23.11.2022.

104 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
1. INTRODUCTION
The appearance of a new lethal disease, COVID-19, resulted in a combined health
and nancial crisis globally. This has been especially apparent in the tourism indus-
try where COVID-19 continues to be a major disruption with potential far-reach-
ing economic and psychological consequences and as the progress of the virus as
yet unknown (Lew et al., 2020; Orîndaru et al., 2021). Consequently, the tourism
industry has drastically reduced its activity and as Rahman et al. (2021) and Rokni
(2021) contend tourist behaviour and mental well-being continue to be adversely
aected by the pandemic. During such epidemics, the number of people whose
mental health is aected tends to be greater than the number of people aected by
the infection itself (Reardon, 2015; Shigemura et al., 2020). While tourism is one
of the world’s largest industries it is also one of the most fragile ones vulnerable to
crises and uncertainty. Despite such challenges, the tourism industry is preparing
for recovery post COVID-19 (Sibi et al., 2020) with wellness tourism pivotal to
this recovery (Majeed and Ramkissoon, 2020). Wellness tourism is considered
one of the most rapidly advancing tourism segments globally and is expected to
grow exponentially post COVID-19 (Mohan and Lamba, 2021).
Collectively, the tourism and wellness industries make a valuable contribution
to both the global economy and social and cultural advancement. Wellness and
wellness tourism are not new concepts with the search for self-care increasing
following the imposed lockdown periods that aected almost all countries in the
world. It is unsurprising, therefore, that wellness tourism is an expanding segment
worldwide with the Global Wellness Institute (GWI, 2021) reporting that the well-
ness industry reached pre-pandemic levels recording up to USD 4.3 trillion in 2017
and USD 4.9 trillion in 2019. Following the COVID-19 outbreak, the global well-
ness economy declined by 11% to USD 4.4 trillion in 2020, yet the GWI (2021)
predicted that global wellness will return to pre-pandemic values in 2021 and will
grow by 10% annually until 2025. In the GWI’s (2021) ‘Global Wellness Economy:
Looking Beyond COVID’ report, the wellness travel market is projected to reach
almost USD1 trillion in 2020 representing 20% of global tourism and will grow by
7.5% annually by 2022. This forecasted trend is especially impactful to the tourism
industry given that wellness tourists are typically higher spenders than most other
tourists (GWI, 2018). For example, in 2017, international wellness tourists spent
on average USD 1,528 per trip which was 53% more than the average international
tourist. The premium for domestic wellness tourists was even higher, at USD 609
per trip which was 178% more than the typical domestic tourist (Global Wellness
Institute, 2018). Overall, wellness tourism accounted for 830 million international
and domestic visits in 2017, representing 17% of all tourism trips.
The current COVID-19 pandemic has enabled every destination to reect, and as-
sess strategies and propose new approaches to strengthen their wellness tourism oer-
ings (Mohan and Lamba, 2021). This has stimulated new and emerging markets such

105
The future of wellness tourism after COVID-19
as Asia, Latin America, and North Africa which according to the Global Wellness In-
stitute (2021) will continue to experience rapid growth and expansion in this segment.
This present study contributes to the existing literature by considering the im-
pact of COVID-19 on the future of wellness tourism with a particular focus on the
extent to which the current upward trend in wellness tourism can be maintained.
By investigating future wellness tourism trends, it is anticipated that this study
will be of interest to policy makers, wellness tourism providers, tourism agencies,
developers, and academic researchers.
2. WELLNESS
Historically, the concept of wellness included the body, mind, spirit, and the en-
vironment associated with disease prevention, health well-being and happiness
(Dunn, 1959). More recently, Laing and Weiler (2008) have observed that wellness
is a holistic view of human life reecting a physical and psychological peaceful
mindset. According to Nahrstedt (2008), the denition of wellness echoes the World
Health Organization’s search for well-being with the concept of “tness.” As such,
well-being involves much more than the physical, rather it is a quest to balance dif-
ferent aspects of life with historical, cultural, and linguistic dierences inuencing
the interpretations of health and wellness. For example, in Hebrew, the term well-
ness is translated as health, yet health and wellness are not interchangeable terms.
Myers et al. (2000) dened wellness as a way of life guided by the pursuit of health
and well-being, bringing together the body, mind, and spirit. Similarly, Muller and
Kaufmann (2000) have agreed that wellness is the sum of elements merging harmo-
ny with the body, mind, spirit, self-responsibility, physical activities, beauty care,
nutritional health, relaxation, meditation, mental activity, education, sensitivity to
the environment, and social contacts. Therefore, wellness is associated with psycho-
logical (behaviour, emotional, and cognitive) aspects rather than physical aspects
alone. In agreement with Muller and Kaufmann (2000, p.7):
“Wellness tourism is the sum of all the relationships and phenomena resulting from a journey
and residence by people whose main motive is to preserve or promote their health. They stay in
a specialized hotel which provides the appropriate professional know-how and individual care.
They require a comprehensive service package comprising physical tness/ beauty care, healthy
nutrition/ diet, relaxation/ meditation, and mental activity/ education.”
Adams (2003) extended this denition in referring to four wellness principles:
a) Wellness is multi-dimensional; b) the practice of Wellness must be guided, seek-
ing the causes of wellness and not diseases; c) Wellness is about balance; d) Wellness
is relative, subjective, and perceptive. In addition, Adams (2003) has recognised that

106 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
wellness is composed of at least six components in his proposed wellness model
which includes emotional, intellectual, psychological, physical, spiritual, and social
components. More recently, GWI (2020) dened wellness as an active pursuit of
lifestyle choices that in turn leads to a state of holistic health. As with many de-
nitions of wellness, the GWI has stressed that wellness is individual given that one
person’s wellness may be another person’s stress. Evidence suggests that wellness
is much more than physical health, rather it incorporates a series of dimensions that
have the potential to work together to create harmony and happiness (Global Well-
ness Institute, 2020). Reecting Adams (2003), the GWI has recognised that
wellness includes dimensions of the physical, mental, spiritual, emotional, social,
and environmental. These dimensions suggest that wellness strives to create har-
mony through mental, physical, spiritual, and biological health and it is the GWI’s
(2020) denition of wellness which guides this study.
3. WELLNESS TOURISM
Ryan (1997) has contended that tourism has always been a process of self-regener-
ation, relaxation, education, and indulgence while Seaton and Bennett (1996) have
suggested that the psychological and physical eects of tourism are increasingly
signicant. More recently, emphasis has been placed more on the mind than on the
physical, and while people continue to travel for the purposes of physical health and
tness, the pursuit of relaxation and wellness dominates (Koncul, 2012). In response
to this growing demand, countries, medical providers, and hospitality and tourism
organisations are adapting to oer a broader set of wellness tourism experiences. Un-
surprisingly, there is consensus that wellness is not just about the physical, but rather
that wellness relates to a desire to feel complete, to take care of the mind and to feel
good about oneself, even though wellness activities are predominantly physical, such
as thermal water therapies, detoxication, yoga, and massage treatments. Thus, well-
ness as Adams (2003) has suggested is relative, subjective, perceptual, and multi-di-
mensional, and is impacting the growth of wellness tourism with the holistic concept
of wellness tourism draws together health, wellbeing, hospitality, and transportation
to deliver numerous tourists services. According to Voigt and Pforr (2013) increases
in human stress have expanded demand for more personalised services while the age-
ing of populations predisposes the further development of wellness tourism.
Lounsbury and Hoops (1986) claimed there was a positive correlation between
travel, health, and wellbeing. More specically, satisfying travel, relaxation, escape,
marriage and family, food, and accommodation needs through travel experiences can
contribute signicantly to human well-being (Lounsbury and Hoopes, 1986; Neal
et al., 2007) with such benets felt before, during, and after the travel experience.

107
The future of wellness tourism after COVID-19
The GWI (2018) has suggested that wellness tourists consist of people who
already have a healthy lifestyle and seek to maintain or improve their wellbeing
with wellness tourism understood as one of the many layers of health tourism
(Chen et al., 2007; Global Wellness Institute, 2018; Medina-Muñoz and Medi-
na-Muñoz, 2013; Voigt et al., 2011). Thus, wellness tourism is a combination of
concepts encompassing spirituality, hedonism, escapism, relaxation, lifestyle, in-
tellectual, socialisation, the physical, and the mind (Smith and Puczkó, 2009).
Mueller and Kaufman’s (2001) denition of wellness tourism as activities asso-
ciated with traveling to improve physical, mental and social health and promote
well-being echoes Smith and Puczkó’s (2009) understanding of wellness tourism.
Voigt et al. (2011) and Dillette et al. (2020) have included specic wellness places
and activities while Ellis (2013) referred to:
a) physical aspects: treatments and activities include massages, baths, dietary
interventions, health-focused hotels and resorts, clinics, spas, and organic/natural/
detox restaurants;
b) social aspect: tness activities at locations such as Pilates and tness cen-
tres, as well as gyms;
c) environmental aspect: might involve outdoor adventure activities such as
hiking, hillwalking, and mountaineering;
d) emotional aspects: recreational activities such as music and art classes;
e) spiritual aspects, visiting temples and churches to reect and prayer;
f) mental aspects: meditation and yoga classes and activities related to con-
necting body and mind.
4. WELLNESS TOURIST PROFILE
People searching for wellness products tend to have a higher sociocultural and
economic status than conventional tourists as observed by the GWI (2021) report
proposing there are two types of wellness tourists. Primary wellness travellers are
motivated to travel or choose their destination based on the wellness activities of-
fered (such as a wellness resort or participating in a yoga retreat), while secondary
wellness travellers are those seeking to maintain their well-being or participate
in wellness activities such as going to the gym, receiving a massage, and prioritising
healthy eating when traveling.
As indicated in Fig. 1, the secondary tourist comprised 89% of wellness tour-
ism trips and 86% of tourist spending in 2020 with greatest growth anticipated in
this tourist prole. The domestic traveller accounts for 82% of wellness tourism
and 65% of tourist spending with an expected growth of 9% per year. Given the
increased transport and accommodation costs for international travel, the highest

108 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
spending is most likely for the international wellness tourist with an anticipated
growth rate of 12%. Collectively, therefore, wellness travellers spend more than
traditional tourists, both domestically and internationally. In 2020, international
wellness tourists spent an average of USD 1,601.00 per trip, 35% more than the tra-
ditional tourist while the domestic tourists’ average spending was USD 609.00 per
trip. As such, wellness travellers are typically more auent and educated, tend to
be early adopters, and they frequently engage in new and more novel experiences
(Global Wellness Institute, 2021). Interestingly, Deesilatham (2016) has observed
that women are the most likely wellness tourists supporting Puczkó and Bach-
varov’s (2006) previous study which contended that women under 30 years of age
dominated in this segment. Similarly, both Smith and Puczkó’s (2014) study and an
extensive report undertaken by Spander Wellness Travel (2015) commented that
Gen x (36–45) and baby boomers (46–65) were the top two consumer groups most
likely to book wellness holidays. Both studies agreed that wellness tourists were
typically consumers under the age 49, had high-incomes, were well-educated and
sought new experiences, pampering, lifestyle, and luxury wellness services.
Fig. 1. Wellness Tourism Spending Premiums (2020)
Source: adapted from The Global Wellness Economy: Looking Beyond COVID (Global Wellness
Institute, 2021).
Studies indicate that the COVID-19 pandemic has negatively impacted quality
of life for younger people in particular citing connement during lockdown lead-
ing to a signicant rise in mental illness including anxiety, irritability, depression,
and other mood disorders (Anseret al., 2021; Sahoo et al., 2020; Wang et al.,
2020; Ahorsu et al., 2020; Õri et al., 2021). While young people engaged with

109
The future of wellness tourism after COVID-19
digital technologies for long periods pre-COVID-19, isolation and imposed con-
nement resulting from COVID-19 intensied young people’s tendency to con-
sume social media. This has exacerbated anxiety and unhappy mood levels among
young people (Gudiño et al., 2022; Mustafa et al., 2020). In addition, Duan et al.
(2020) have suggested that during the COVID-19 pandemic young people were
typically engaging in physical exercise less than once a week while their intake of
soft drinks and junk food increased signicantly.
According to the GWI (2021) the top ve wellness countries include the United
States, Germany, China, France, and Japan. In addition, destinations with a long
association with traditional wellness lifestyles are gaining signicant momentum
in attracting wellness tourists as illustrated in Table 1.
Table 1. Wellness Tourism: Top Twenty Destination Markets in 2020
Country Rank
in 2020
Wellness Tourism Expenditures
(USD billions)
Number of trips
(millions)
2017 2019 2020 2020
United States 1 226 263.5 162.1 114.8
Germany 265.7 73.5 59.0 57.4
France 3 30.7 34.7 21.3 21.8
China 4 26.4 34.4 19.5 67.5
Japan 5 23.9 26.6 19.1 33.8
Austria 6 16.5 18.9 11.9 13.1
Switzerland 7 13.4 15.5 10.8 8.4
Italy 8 13.4 14.5 9.0 8.6
United Kingdom 9 13.5 15.1 9.0 16.4
Australia 10 12.3 14.0 8.5 8.6
Canada 11 12.5 13.9 8.4 10.0
India 12 11.4 13.3 7.2 48.2
Mexico 13 9.7 12.5 6.2 11.9
Spain 14 9.9 10.8 5.2 12.7
Thailand 15 12.0 16.9 4.7 6.5
South Korea 16 6.8 8.3 4.3 16.8
Malaysia 17 5.0 6.1 3.5 7.5
Portugal 18 3.4 4.4 2.8 4.0
Denmark 19 3.2 3.8 2.8 6.6
Turkey 20 4.5 5.7 2.7 6.7
Source: adapted from The Global Wellness Economy: Looking Beyond COVID (Global Wellness
Institute, 2021).

110 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
5. WELLNESS TOURISM TRENDS BEYOND COVID-19
Wellness tourism research focuses on beneting community development, rural
places, and green areas such as national parks (Bell et al., 2015) which is reec-
tive of the market segment. For example, airports and airlines are promoting well-
ness programmes such as Fly Healthy and Fly Well, while the provision of such
services as spas at airports and gyms, meditations on the ights, healthy catering,
and clean design at airports are evident. Such a partnership between wellness
companies and travel brands seeks to harness routine consumer wellness habits
while travelling to leverage wellness trends, as the collaboration between Peloton
and Westin Hotels, Intrepid travel and tours oering, and the birth of micro trips
(Law, 2022) demonstrate. According to Smith and Puczkó (2009), the tourism
industry is harnessing what Law (2022) declared as a ‘wellness boom’ in several
ways including:
a) Hotels (clean and healthy hotels) incorporating clean aesthetics, healthy,
natural, and organic foods, and activities to provide a calm and relaxing atmos-
phere for the guests through biophilic design. Such design is a philosophy that
encourages the use of natural systems and processes in the process to build the
environment (Kellert et al., 2008) based on the Biophilia hypothesis. This hy-
pothesis proposes that humans have an innate connection with the natural world
(Wilson, 1984) and that exposure to the natural world is, therefore, important for
human wellbeing.
b) Building the connection between travel, work, and wellness with cowork-
ing becoming very common because of the COVID-19 pandemic. People are trav-
elling more and working at the same time demonstrating that a person can live,
work and experience new cultures while maintaining wellness in any location.
c) Blending traditional hospitals with spas to oer medical treatments and spa
services for a more holistic experience. As Smith and Puczkó (2009) have argued,
Wellpitals and Medhotels oer the blended services and qualities of hospitals, ho-
tels and spas without the hospital, clinic or standard hotel image or feel becoming
either an extended spa, adapted hospital or cruise ship which is a blend between
hospitals and spas, that oers medical treatments and spa services (Wellness Tour-
ism Worldwide WTW, 2020).
d) Oering Spa Living Environments (Navarrete and Shaw, 2021) and EcoFit
Resorts/Eco-Friendly Resorts (Smith and Puczkó,2009) to provide spaces to relax
and improve physical and physiological health through comfortable pet-friendly
or natural surroundings. Such places include outdoor activities, massages, yoga,
natural and organic foods, and physical activity facilities.
e) Developing dreamscapes, which are luxury products targeted at younger
age groups, oering futuristic experience, like a cinema in a spa, with music, and
games to induce another world feeling.

111
The future of wellness tourism after COVID-19
f) Designing well-working environments to create a calm and relaxed space
for employees through the provision of workplace gyms, healthy food options and
medical incentive travel opportunities.
In agreement with Law (2022) this study recognises that there is a wide range
of available wellness tourism assets reected in the diverse and creative oerings
available across the world. However, while diverse wellness tourism services and
products are available across the globe reecting increasing consumer demand,
such services and products are not universally consumed or accessed in the same
way. Therefore, this study contends that new wellness tourism strategies are re-
quired to assist in the recovery of the global tourism industry post the COVID-19
outbreak. Given that 56% of people prioritise their well-being while 42% will
seek wellness travel options following the COVID-19 pandemic according to
GWI (2021), a new era of wellness tourism is unfolding. However, as noted by the
WTW (2020, p. 41) a major threat to this upward growth trend is the anticipated
‘globalization of standardized and uniform products and services which can only
serve to undermine uniqueness and competitiveness.’
Existing literature suggests that customising the wellness tourist’s experience
is necessary due to the standard protocols imposed to curb the spread of the virus
and to full consumers’ need for a more bespoke consumer experience. Indica-
tions suggest that a combination of maintaining the availability of wellness as-
sets and enhancing product diversication through the creation of new luxury and
more personalised wellness services to ensure sustainable future growth is the key
to the future development of wellness tourism.
6. METHODOLOGICAL PROCEDURE
To extend this line of enquiry, primary research was conducted using a qualitative
research approach employing three structured email interviews with represent-
ative experts to further discovery of anticipated wellness tourism trends. Email
interviews were considered an appropriate data collection instrument based on an
assessment of the research aim, condence of credible ndings, ease of accessi-
bility, and the subject population’s familiarisation with the technology. Notwith-
standing the small sample size this approach can produce a substantial amount of
data (Jones and Gratton, 2010), promotes a deeper investigation, and allows the
researchers to focus on the context of the information gathered whilst also gaining
a broad understanding of it (Pechlaner and Volgger, 2012). As Meho (2006) has
agreed, email interviews give respondents time to answer questions at their own
pace over an extended period while Ratislavová and Ratislav (2014) have ad-
vised that email interviewing provides extended access to participants compared

112 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
to other types of interviews so interviewees can better formulate answers without
disruption. Access during the pandemic was particularly relevant in this study.
The interviewees included a Vice President of a Wellness Association in Portugal,
a Chair of a Wellness Institute in the United States, and a Wellness Hotel Market-
ing Supervisor in Brazil. These interview exchanges occurred between May and
July 2021, a time when the impact of COVID-19 on the tourism industry was se-
vere in all three destinations. The back-and-forth email conversations allowed for
prolonged engagement with participants to connect and establish relationships,
enabled the researchers to clarify descriptive data, pursue further discovery, and
ensure accuracy in describing wellness tourism trends from the perspective of the
interviewees. To maintain discretion respondents’ names were coded. A content
analysis approach was employed to systematically describe the content of each
email message as advised by Bardin (1977), and Franco (2008). Data input and
analysis was conducted using the NVivo Nudist software to code and categorise
the email content as recommended by Zamawe (2015) before generating Word
Clouds based on the frequency of emerging themes. Word Clouds are useful
visual depictions of text data (Cappelli et al., 2017) and such pictorial representa-
tion of data was deemed appropriate to organise and summarise the research data
in this study.
7. RESULTS AND DISCUSSION
Six pre-determined questions were posed to three expert wellness tourism parti-
cipants to uncover their perceptions of wellness tourism, assessment of the chal-
lenges facing the sector, and to ascertain the extent to which, if any, the upward
growth in wellness tourism will be realised post COVID-19. As such, the results
of this study reect the perceptions of three prominent tourism wellness repre-
sentatives in three dierent destinations during the COVID-19 outbreak. While
the small sample size will evidently restrain the generalisability of the results,
the deeply reective answers arising from across three geographically diverse
samples have resulted in ndings that may have application outside of these re-
search settings. The results oer insights and understanding with wider relevance
to wellness tourism to stimulate further research that will assist researchers, policy
makers and industry stakeholders to move forward as destinations embrace the
wellness boom.
In articulating the meaning of wellness tourism, expert (A) considered:
‘Wellness Tourism is travel that seeks physical, mental, and spiritual well-being, associated
with the infrastructure that tourism oers, such as transportation and lodging. Although there
is a wide dissemination of tourism and health, the population still has little understanding of

113
The future of wellness tourism after COVID-19
the relationship and interdependence between the two areas. There is a certain rejection by the
medical segment of the term tourism or other health-related terms, thus failing to recognize the
importance and relationship of the two areas that would be a major stimulus to the development
of health and wellness tourism in the world. If health and medical authorities publicly
recognized that travel related to wellness in all segments brings benets to society and were
more encouraged, we would have a greater acceptance by the whole society.’ (Expert A).
Expert B contended that wellness tourism ‘is a trip to create, to maintain
well-being, whether mental, physical, or social’ (Expert B), while Expert (C) de-
ned Wellness Tourism as ‘a kind of tourism focused on maintaining or improving
the well-being of the tourist who enjoys it’ (Expert C).
In assessing the value and importance of wellness tourism to the economy,
Expert A noted that:
‘The Tourism and Health Industries move trillions in the world economy separately, and together
they end up generating much more income, and jobs, in virtually every country around the
globe. These are two segments that are always investing in innovations, equipment, structure
improvements, hiring and qualication of new professionals, among others, which make it
possible for many places to be positively aected by Wellness Tourism.’ (Expert A).
In the context of the industry post COVID-19, Expert A claimed that:
‘Thinking about the activity in the post-pandemic future will only grow this activity and always
increase the economy. Due to the Covid-19 pandemic travel has been restricted, but this has
not diminished people’s desire and needs to travel. Now there are many more people who
want to take better care of themselves and their health. This concern with well-being often
includes places other than one’s own home, such as clinics, hotels, and spas. And many of
these establishments are preparing for the increase in this damned and potential demand for the
coming years. An important detail that was mentioned is that only the places that suered travel
restrictions had a signicant drop in the volume of visitors to Wellness-related establishments.
Where they were allowed to operate, the impact was minimal, showing that the activity, which
was already growing, only tends to increase after this pandemic period. It will be a time when
people will take much more care of themselves, whether physical or mental, and these places
will be increasingly sought out to meet these needs.’ (Expert A).
In continuing this discussion, Expert A noted that:
‘Concerning the challenges that Wellness Tourism will face after the Covid19 Pandemic,
it is believed that convincing public authorities of the high importance of people’s physical,
mental, and psychological well-being will be the most dicult. This type of service needs to be
considered essential since during the pandemic most places were closed. It has been found that
due to the restrictions imposed by the Covid19 Pandemics many people’s health has worsened,
such as high rates of suicide, depression, and anxiety, so depriving people of using Wellness
services is making them sick early. We believe that strengthening safety protocols is paramount,
since institutions that work with Wellness already have strict protocols to avoid infection and
contamination, and a broad campaign publicizing the benets that outweigh the risks will be of
great importance to stimulate Wellness in the coming years.’ (Expert A).

114 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
Expert B noted that:
‘According to the research done this segment tends to grow a lot, after the coronavirus restrictions
pass. The focus on taking care of wellness had a very big increase during the pandemic, and it
will be very important for people to stay healthy afterward. It is important to stress that the
demand needs to remain strong and willing to consume, one of the challenges of the sector,
because many borders are still closed and it is necessary to train the employees well, who oer
wellness activities. The connection with nature is a major focus of the activity, along with
healthy food, good accommodations, and sta trained to provide the best service.’ (Expert B).
For Expert C:
‘Tourism tends to increase due to the pandemic because people are looking for better health,
to improve their physical and mental well-being, and these are points that Wellness can solve,
besides being the key factor to happen, the condence that the tourist’s health is being taken
care of.’ (Expert C),
and noted that:
‘The great challenge for growth and continuity to be maintained is that people still do not feel as
condent to travel, due to the restrictions imposed by the pandemic. How to get to the destination
is what worries the agents of this segment’ and reects that wellness tourism is (Expert C);
‘A type of tourism that brings foreign exchange with shopping that is a unique experience for
the users’ (Expert C).
In evaluating the potential growth of wellness tourism, Expert (A) suggested that:
‘Regarding the main trends of the segment for the future, it should be noted that there will be
a large increase in demand for health and wellness services in the coming years. People are
becoming aware of how necessary physical and mental well-being is. Studies have shown that
Covid-19 was more deadly in those who were obese, sedentary, and had comorbidities or health
problems, and much of it was preventable like hypertension, diabetes, etc. In other words, it has
only increased the awareness of how important and necessary good health linked to wellness
is in facing new diseases. There will be more options for activities within Wellness Tourism in
the coming years, even thinking about adaptation to new diseases. One increase already seen is
that of remote assistance, something that was not so common in Wellness, since physical contact
needs to be made with great caution, an alternative to this has already begun to be created.’
(Expert A).
Expert (B) identied the tourism industry as:
‘one of the great pillars of the economy, bringing many jobs, foreign exchange, and helping
other sectors as well. Tourism helps in the growth and development of local communities when
inserted into the activity. Some trends pointed out are travel with transformative experiences,
regenerative travel, the return to ancient traditions and rituals, the inclusion of pets in therapies,
physical experiences in nature, such as cycling, hiking, camping, and places that rely on biophilic
design, always integrating nature in the activities.’(Expert B),

115
The future of wellness tourism after COVID-19
while Expert (C) proposed that:
‘The main trends for the future are believed to be the search for treatments for the sequelae of
Covid-19, the search for Mind Detox, the search for weight loss, treatments for anxiety and
depression, and socialization in healthy environments.’ (Expert C).
Following the data collection phase, a detailed content analysis was under-
taken generating three Word Clouds to visually present and determine shared
perspectives and consensus arising from the data set. Keywords most frequent-
ly mentioned by respondents were captured in larger orange text with those
mentioned less often were presented in smaller black text. Figure 2 depicts
the most frequently cited words comprising a minimum of eight letters and
Figure3 illustrates words most frequently mentioned that contain at least ve
letters. Given that health was one of the most dominant words cited across all
interviews, Figure 4 presents a word cloud that concentrates on health-related
terms which was designed after interviewees’ responses were categorised. Giv-
en the proliferation of a number of key terms such as restrictions, experiences,
challenges, physical, wellness, pandemic, increase, oerings, travel, tourism,
increase, people, health, and challenge a shared perspective between the inter-
viewees is apparent.
Fig. 2. Word Cloud Content Analysis comprising words with at least 8 letters
Source: own work based on data provided by the three structured email interviews.

116 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
Fig. 3. Word Cloud Content Analysis comprising words with at least 5 letters
Source: own work based on data provided by the three structured email interviews.
Fig. 4. Word Cloud Content Analysis categorized by health-related and comprising words with at
least 5 letters
Source: own work based on data provided by the three structured email interviews.

117
The future of wellness tourism after COVID-19
The research ndings in this study reinforce and corroborate the work of other
researchers and strives to further inform academics, governments, developers, and
other decision-makers in the tourism wellness industry. As observed by Abbas et
al. (2021), the wellness tourism segment will increase exponentially. The outbreak
of COVID-19 has not dampened growth – rather the pandemic has accelerated the
growth of tourism wellness primarily due to a heightened awareness of health
and most notably mental health concerns. On the one hand, rapidly expanding
demand requires new strategies to personalise and dierentiate products and ser-
vices while on the other hand alleviating the simultaneous increase in tourists risk
perceptions and risk averse tendencies to mitigate the spread of the virus need
attention (Rahman et al., 2021) .
A recent study by Han and An (2022) assessed the perception of wellness tour-
ism before and after the COVID-19 pandemic in Korea by extracting and analysing
keywords related to wellness tourism from online social networks. Their results in-
dicated that the desire for healing of both body and mind appeared more signicant
after the outbreak and concluded that government action was needed to revitalise
and boost local wellness tourism (Han and An, 2022). In a related study, Sivananda-
moorthy (2021) evaluated the impact of the pandemic on the wellness tourism of Sri
Lanka, a traditional destination for western European travellers using semi-struc-
tured interviews. The study determined that wellness tourism in Sri Lanka has been
severely disrupted, faced signicant challenges and advocated that authorities and
hotel brands explored the potential of local nature resources and focused on ethical
strategies and regulations to assist in mitigating the eects of the pandemic.
Fontoura, Lusby and Romagosa (2020) adopted qualitative research methodo-
logies including personal communication, secondary data analysis and one-on-one
interviews with experts to analyse the tourism industry post-COVID-19 in Brazil
and USA. In the case of Brazil, the lack of consistent action from the central gov-
ernment demonstrated through examples of inadequate local public administration
and the need for private initiatives such as the provision of sanitary measures and
funding to address the tourism crisis. In the context of the USA, Fontoura et al.
(2020) have suggested the COVID-19 crisis is more negatively impactful than the
Great Depression and the September 11th attacks, and estimate that the travel indus-
try would report losses of USD 519 billion this year (US Travel Association, 2020).
According to the US Travel Association, geographical dierences were observed
with 75% of residents in the Northeast planning to halt all travel, compared to only
59% of residents in the South and 57% of residents in the Midwest. The majority
of Americans agreed that the compulsory use face masks was a positive measure
noting that American tourists preferred destinations that imposed a mask mandate
and oered local and outdoors activities which suggested that natural attractions,
national parks and smaller communities would become more popular among US
tourists (US Travel Association, 2020). Finally, Fontoura et al. (2020) noted the im-
portance of introducing sustainable initiatives was necessary to harness wellness

118 Andressa Piatto Clerici, Catriona Murphy, Nuno Miguel Castanheira Almeida
tourism in these destinations. This is consistent with Dionísio and Rodrigue’s
(2021) study which investigated the tourism industry crisis in Portugal during the
pandemic outbreak and concluded that sustainable strategies were central to the
revival of the Portuguese tourism industry advising that the creation of initiatives
such as the ‘Clean and Safe’ stamp were necessary for the visitor experience in
the new ‘normal’.
In line with the results of previous studies, this current research study rec-
ognises that changing consumer attitudes and demands for health and wellness
requires destinations to embrace this phenomenon by investing in sustainable
wellness tourism. “Welltodo” website (2020) has declared that operators are be-
coming more competitive with new oerings disturbing traditional wellness tour-
ism players from wellness tourism to spa tourism, workplace wellness, personal
care, traditional health, complementary therapies, mindfulness, and tness. With
many borders reopened, it is now time to follow a multi-step approach for well-
ness tourism to overcome the COVID-19 crisis. It is also time for governments
and authorities to create new regulations and safety guidelines, for tourism poli-
cy-makers and practitioners to design new wellness luxury and safety strategies,
and for destinations to provide the enhanced and authentic experiences demanded
by wellness consumers post-COVID-19.
This study identied the upward trend in wellness tourism and assessed the many
signicant challenges the industry is facing from the perspective of prominent well-
ness tourism experts. Notably two of these experts represent destinations featured in
the top twenty wellness tourism places in the world, are among the countries most
aected by COVID-19 with few wellness tourism research studies specically fo-
cusing on these specic destinations. Notwithstanding its contribution, this study has
several limitations. Firstly, the small sample size restricts the generalisability of the
ndings and future research could capitalise on this research by employing a more
extensive sample to allow for greater depth of understanding across multiple wellness
tourism destinations. Secondly, perceptions of wellness tourists post COVID-19 have
not been explored and it is proposed that capturing such perceptions represent an
important research agenda to inform sustainable wellness tourism strategies. Thirdly,
some researchers argue that written responses of email interview lack the social cues
that assist the full understanding of the respondent’s experience as it is not possible to
observe or interpret visual cues, tone, silence, or hesitation (Fritz and Vandermause,
2017). However, the researchers in this study contend that even with additional writ-
ten cues, researchers cannot respond in real-time or capture emotions. Finally, the
consideration of participant characteristics is essential for determining that email in-
terviews are appropriate in terms of internet connectivity, cyber security breachers,
and discomfort with email communication. All participants in this study were well-
ness tourism experts, had computer access, have consistent internet connectivity, rou-
tinely communicated via email, and no data breach concerns were noticeable.

119
The future of wellness tourism after COVID-19
8. CONCLUDING REMARKS
The results and trends observed in this study from the perspective of wellness
tourism experts anticipate ongoing and exponential growth of wellness tourism
after the COVID-19 pandemic. The value and importance of wellness tourism des-
tinations that support physical and physiological outdoor, tness, and spiritual
activities is central to recovery which can only be achieved through sustainable,
personalised, authentic, and distinctive wellness tourism oerings.
This study aims to advance wellness tourism academic research and to inspire
new and creative future research stands in this important eld of study. The ef-
fects of the COVID-19 pandemic on the tourism industry are unquestionable and
wellness tourism is well placed to drive the industry’s recovery. This will require
planning and strategies informed by multiple stakeholders so that destinations can
sustainably embrace this declared wellness boom.
Acknowledgements. This work was funded by national funds through FCT
– Foundation for Science and Technology I.P., within the scope of reference pro-
ject no. UIDB/04470/2020.
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