Development and Psychometric Properties of a Questionnaire to Measure Factors Affecting the Attraction of Health Tourists

Abstract

Background and purpose: Health tourism is one of the dimensions of sustainable development to help Mazandarn’s economic dynamic. A strong agreement is doubted in identifying factors influencing the attraction of health tourists. This study was implemented to design a questionnaire to measure the factors influencing the attraction of healthy tourists and investigate its psychometric properties. Materials and methods: This study was done with a combinatorial approach in three steps, including relevant literature and the opinions of experts as long as health tourists' opinions of Mazandaran province were applied to the development of the item pool. Then, content validity, face validity, construct validity, and reliability of the questionnaire were assessed for the psychometric properties of the questionnaire. The final questionnaire was approved after performing 17 interviews and applying professional expertise in the qualitative part. In the first stage of the quantitative part content validity was studied by 10 people from an expert panel, and its face validity, the questionnaire was completed by 10 participants. Finally, the construct validity of the designed instrument was calculated using exploratory factor analysis using SPSS 24 software and confirmatory factor analysis using AMOS 24 software by asking 300 people familiar with health tourism in Mazandaran province. The internal and external validity were determined using Cronbach's alpha and test-retest in 25 people. Results: The results of the literature review and interviews with experts in the first and second stages of the study led to the design of 76 items. In the next step, the changes in the qualitative stage 15 questions did not receive favorite points in Content validity ratio (CVR) and content validity index (CVI) calculation in the quantitative part of content validity. Then face validity was applied and the item effect index for 8 items was lower than 1.5 in the quantitative stage of face validity. Then the questionnaire with 53 items was entered into construct validity. In the exploratory factor analysis, the value of KMO was equal to 0.778. Furthermore, the value of Bartlett's test of significance was less than 5%. Based on the rotated matrix of components, eight factors with positive values were obtained. The results of exploratory factor analysis showed that 7 items had a factor loading of less than 0.4, which were removed from the questionnaire, and finally, 46 items remained. In the confirmatory factor analysis stage, the factor load of all dimensions was in good condition and the P-value was in the acceptable range. Cronbach alpha rate was calculated as 0.831. The external reliability was lower than 0.05 (ICC= 0.90, P<0.001). Conclusion: The designed questionnaire, due to the low number of questions, the simplicity of the sentences, as well as the acceptable validity and reliability, can be used to identify and investigate the factors affecting the attraction of health tourists. Normalization of the questionnaire in other cultures is suggested. It is hoped that the findings of this study will be utilized by researchers, healthcare and tourism system managers, and other stakeholders to inform the planning of interventions aimed at increasing medical tourism. Additionally, it is hoped that the results of this study will serve as a springboard for future research in this area.

Keywords

• mixed method
• structural equations
• psychometric properties
• questionnaire
• health tourists