52THE IMPACT OF COMPLEMENTARY MEDICINE ON SUSTAINABLE TOURISM DEVELOPMENT THROUGH EVENT AND
NATURE-BASED TOURISM
Vesna Krstic1, Marijana Duradevic2, Igor Trisic3 Corresponding author E-mail: vesnak16@hotmail.com
ARTICLEINFO ABSTRACT
The subject of this research is to look at the attitudes of spa tourists towards complementary medicine and the possibilities of its application within spa services. The aim of the research is to identify certain scientific results that can contribute to the creation of an adequate tourism product. In the research, a prospective study is used and it was done by applying a standardized questionnaire. Testing the correlation of the answers given was examined and shown by the Analysis The Pearson Correlation method. The obtained results confirmed the hypotheses: complementary medicine is a significant component of the sustainable development of health tourism in spa destinations in Serbia, and that the organization of an adequate complementary medicine tourism event can increase tourists' motivation for visits and their significant relation to nature-based tourism, which would significantly affect on sustainable tourism development of spa tourism. The intensification of the growth of awareness among the respondents about the importance of complementary medicine in tourism planning and development is evident, and by providing socio-cultural, economic and environmental benefits, the basic postulates of sustainable tourism development are directly fulfilled.
© 2020 EA. All rights reserved.
1 Vesna Krstic, PhD candidate, University of Kragujevac, Faculty of Hotel Management and Tourism, Vojvodanska N°5a, 36210 Vrnjacka Banja; Republic of Serbia, Phone: +38162552893, E-mail: vesnak16@hotmail.com, ORCID ID (https://orcid.org/0000-0003-2541-5440)
2 Marijana Djuradjevic, PhD candidate, University of Kragujevac, Faculty of Hotel Management and Tourism, Vojvodanska №5a, 36210 Vrnjacka Banja; Republic of Serbia, Phone: +38166334872, E-mail: mdjuradjevic@gmail.com, ORCID ID (https://orcid. org/0000-0001-9989-7900)
3 Igor Trisic, PhD candidate, University ofKragujevac, Faculty ofHotel Management and Tourism, Vojvodanska №5a, 36210 Vrnjacka Banja; Republic of Serbia, Phone: +381641431375, E-mail: trisici@hotmail.com, ORCID ID (https://orcid.org/0000-0002-6497-9276)
Original Article Received: 02 February 2020 Accepted: 25 April 2020 doi:10.5937/ekoPolj2002377K UDC 61:[502.131.1:338.48 Keywords:
complementary medicine, sustainable tourism, event, nature-based tourism
JEL: I15, Z32, Q57
Introduction
Health tourism, as one of the most widespread types of travel, is influenced by many factors (Tucki & Hadzik, 2013). Some of these are new products and technologies in contemporary rehabilitation and prevention treatments that can be implemented within the health tourism destination (Hadzik, 2009). The use of medicinal herbs for health purposes is a significant form of complementary medicine dating back to the early stages of human development. In addition to nature-based tourism, complementary medicine can be promoted through various ethno-social events (Yoo, Lee & Lee, 2015; Wisnom & Gallagher, 2018). Nature-based tourism makes a significant link in health tourism, because the ways of access to medicinal plant raw materials and the relation to nature sometimes represent the traditions of a particular people and a model for the realization of tourism needs in nature (Wardle et al., 2018).
Within the global health tourism, wellness tourism has specific opportunities for growth (Global Wellness Institute, 2015). Medical and health tourism are forms of tourism that comprise the therapeutic and wellness segment (Smith & Puczkó, 2015; Pan et al., 2019), linked to the movement of tourists on their own initiative (Connell, 2013) to special resorts that have all the necessary resources (Suess, Baloglu & Busser, 2018). The main motive of these trips is, at the same time, any form of health promotion combined with recreation and entertainment (Vetitnev & Kuskov, 2010). Wellness tourism (as an example of innovation) has the largest share in medical tourism, and is characterized by the largest increase in value in recent years (Euromonitor International, 2012). These motives to go to spas influence the choice of leisure activities and forms, and are an inspiration for creating a new concept of health tourism products, meeting the needs of tourists (Dryglas, 2009). On the other hand, they are constantly increasing competition, changing markets and technologies, forcing companies and health resorts to implement innovations, especially product innovations. A new approach to life that includes health, based on the "wellness" paradigm, results in visible changes in health tourism in spas (Kim et al., 2019). It is focused on "extending life while maintaining health, physical and mental abilities, youthful appearance, well-being and social activity" (Sallmann, 2010).
Different events represent a significant model for promoting this form of tourism. Whether it is local herbal fairs and its application in wellness and spa tourism, or are events of an international nature, health and nature-based forms of tourism can initiate various tourism activities (Whittle, Stewart & Fisher, 2015; Doran, Hanss & Larsen, 2017). The common link between these forms of tourism is nature, and the right attitude of man towards it. Properly integrated into the tourism offer, health, events and nature-based forms of tourism can contribute to significant tourism revenue. With proper planning and development, these forms of tourism can contribute to increasing socio-cultural, economic (Cvijanovic, Pantic & Ignjatijevic, 2020) and environmental benefits in tourist destinations (Kostic, Ratkovic & Forlani, 2019).
Achieving these positive results is also the basic postulate of sustainable tourism development (Trisic, Stetic & Krstic, 2018). Innovations in spa health tourism primarily
relate to offers connected to health services. Innovations in spa health tourism are recognized in dimensions as: functional (as they relate to others), useful (as value carrier - patient benefit), technical (as a process in the process of diagnosis and therapy), and relational (as a specific recipient-donor dialogue) service) (Sawicki, 2014). Innovations play a key role in tourism (Aldebert et al., 2011), one of the essential elements of consumer satisfaction with the tourism service that enables the producer to differentiate himself from the competition (Zivkovic, 2009). The modern tourist, a man of today, in order to recover, rest, recover energy, rejuvenate, or heal, visits spa complexes relatively frequently (Manic, 2018). His motives can be classified as "rejuvenation", "socialization", "hedonism", "obsession with health and beauty", "relaxation" and "escape from routine". Tourism offers products and services designed to improve the quality of life (Dimitrovski & Todorovic, 2015). Event tourism allows tourists to relax, enhance relatives or other social relationships, experience something unusual and have fun (Senic & Senic, 2016). Visitors can attend the event either for substantially primary reasons, that is, their primary reason for visiting the destination, or for incidental reasons (Getz & Page, 2016). Event management goes through a number of stages: initiation, planning, implementation, event and closure (Event Management Body of Knowledge, 1999). With changes in consumer preferences in the tourism market towards adherence to sustainability criteria, the process of adapting tourism destinations in terms of competitive advantage and sustainable development will last (Popesku, 2011), which entails three pillars of sustainability: economic, socio-cultural and environmental (Vujovic, Cvijanovic, & Stetic, 2012; Golob et al., 2015). Events are crucial in promoting the destination and attracting visitors who will spend their money in the destination (Getz & Page, 2016) and contribute to the huge profits of the destination (Giampiccoli et al., 2015). Event tourism plays an important role in the modern economy and can have a significant impact, where sustainability-oriented tourism has become an important component of tourism destination development and planning (Golob et al., 2015; Vujovic, Curcic, & Miletic, 2016; Cvijanovic, Simic & Vukotic, 2018).
The subject of this research is to look at the attitudes of spa tourists towards complementary medicine and the possibilities of its application within spa services. The hypotheses of the research are: complementary medicine is a significant component of the sustainable development of health tourism in spa destinations in Serbia (H1) and the organization of an adequate complementary medicine tourism event would increase tourists' motivation for visits and their significant relation to nature-based tourism (through traditional plant picking and nature stay), which would have a significant impact on the sustainable tourism development of spa tourism (H2).
The aim of the research in this paper is to identify certain scientific results that can contribute to the creation of an adequate tourism product. This significant tourism product would integrate complementary medicine with events and nature-based forms of tourism into a single unity, thus meeting the expressed needs of spa tourists. In addition to directly meeting the need to improve and upgrade their health status, tourists also expressed interest in learning about the available herbal medicinal resources of Vrnjacka Banja and its natural environment. Organizing an adequate tourism event in
the field of complementary medicine would increase tourists' motivation to visit, which would significantly influence the sustainable development of spa tourism.
The expected results of the research are that complementary medicine is a significant component of health tourism, and that in addition to nature-based tourism and events, it can contribute to the sustainable tourism development of Serbia.
Materials and methods
A prospective study was conducted using a questionnaire containing four groups of variables: demographic characteristics, knowledge of properties and use of medicinal herbs, initiation of treatment, and respondents' attitudes toward phytotherapy and complementary (traditional) medicine. Within this paper, three groups of variables are presented: demographic characteristics, treatment initiation, and respondents' attitudes toward phytotherapy and complementary medicine. The research instrument is a standardized questionnaire, prepared according to WHO guidelines for assessing the availability, use, coordination and comprehensiveness of health care used in the WHO survey in the Republic of Serbia in 2009, which is thematically tailored to the research needs. The survey of 62 Vrnjacka Banja tourists was conducted in the period July - September 2019. Respondents were selected by random selection method and completed questionnaires in the presence of interviewers. Respondents were asked a total of 15 questions, of which 13 questions were used for research and analysis. The questions were assigned numbers n1, n2, n3, n4, n5, n6, n7 ... n13. The questionnaire was prepared using a structured interview method, composed of two parts. In the first part, consisting of questions 1 and 2, the respondents presented their answers by writing the answer that is related to a certain offered number (1, 2, 3 or 4), depending on its meaning and truthfulness. In the second part of the questionnaire, from the third question, three-level Likert scale answers were given: Yes - I agree (number 1 offered); Partially agree (2) and Disagree (3). The Likert scale allows respondents to adequately express their level of agreement with certain statements in the questionnaire (Joshi et al., 2015). The data were described by descriptive statistical methods and analyzed by appropriate statistical-analytical method using SPSS (Statistical Package for the Social Sciences) software. Testing the correlation of the answers given was examined and shown by the Analysis The Pearson Correlation method, to determine whether the model of differences obtained was relevant to the analysis of the results. The number of 62 randomly selected respondents represents a small but significant sample for analyzing the current state of the spa and event tourism market in Vrnjacka Banja, which is a significant tourist destination in the Republic of Serbia and in the region. Analyzing the answers from the questionnaire can contribute to the construction of scientific conclusions regarding sustainable tourism development, ie whether events, spa and nature-based tourism can be significant for sustainable tourism development. The results may also point to further research related to these areas of tourism planning and development.
Results and Discussions
The sample consisted of 62 respondents, 59.7% female and 40.3% male. The observed difference in gender distribution is not at the level of statistical significance. The average age of the respondents was 55.48 ± 15.18 years, with the average age of the female being 8 years. Half of the respondents have a high school diploma and a third have a college/faculty diploma. Every tenth respondent evaluates his financial status as very good. Of the total number of respondents, 43.5% live in the city, 32.3% in the suburbs and 24.2% in the village. The largest number of respondents came from Central Serbia, 43.5%, and the smallest from Eastern Serbia, 11.3%. The analysis by gender shows that there is no statistically significant difference in the level of education, the assessment of the material situation, the part of Serbia where the respondents come from and the places of residence between the male and female persons.The structure of the respondents can be summarized in Table 1.
Table 1. Structure of respondents
Gender Frequency Percent Mean Std. dev.
Male 25 40.3 1.4 .495
Female 37 59.7
Total 62 100
Education frequency Percent Mean Std. dev.
Unfinished school 2 3.2 3.15 .721
primary education 6 9.7
secondary education 35 56.5
Tertiary and faculty education 19 30.6
Total 62 100
age structure N Min Max Mean Std. dev.
62 18 82 55.48 15.178
The environment you come from frequency Percent mean Std. dev.
City 27 43.5 1.81 .807
Suburb 20 32.3
Rural environment 15 24.2
Total 62 100
The region you come from Frequency Percent Mean Std. dev.
Vojvodina 9 14.5 2.90 1.183
Western Serbia Srbija 11 17.7
Central Srbija 27 43.5
Eastern Srbija 7 11.3
Foreign country 8 12.9
Total 62 100
Source: Author research
The level of education has an impact on how treatment is started, so that people with secondary education, as well as those with tertiary /faculty education, most often start treatment with the use of medicinal herbs. Respondents who evaluate their financial
status as good most often start treatment with medicinal plants, while those with mediocre financial status most often visit a doctor first.
Persons coming from Vojvodina usually start treatment with medicinal herbs, while respondents from Western, Central, Eastern and Southern Serbia first consult a doctor.
To the question nt - Do you use herbs, and n2 - Do the family members of the respondents use herbs, the respondents gave their answers in the following relation (Table 2).
Table 2. Respondents' answers to questions n and n2
Questions n, n2
Valid Frequency Percent Frequency Percent
Daily 14 22.6 6 9.7
Occasionally, when I'm healthy 27 43.5 29 46.8
Only in case of illness 21 33.9 27 43.5
Total 62 100 62 100
t 22.216 28.268
Sig. (2-tailed) .000 .000
df 61 61
Mean Difference 2.113 2.339
Std. Error Mean .095 .083
Source: Author research
Analyzing the answers, presented in Table 2, it is concluded that the majority of respondents use herbs occasionally, or when their current health needs to be improved. Likewise, the respondent's family, in the largest number of responses, occasionally uses herbs or, when ill. It is concluded that the respondents are competent to provide answers regarding the role of complementary medicine in sustainable tourism development through events, nature-based and spa forms of tourism, since they make significant use of medicinal herbs.
The second part of the questionnaire deals with the respondents' agreement with the offered options (they agree completely, partially agree, or disagree). The structure of questions 3 through 13 from the questionnaire is shown in Table 3.
Table 3. Question structure of the second part of the questionnaire
Questions
n3 Serbia is rich in medicinal plants that grow freely in nature
n4 Vrnjacka Banja is rich in medicinal plants important for the development of events and nature-based forms of tourism
n5 Medicinal plants are good for health
n6 Medicinal plants should be harvested for their function and tradition
n7 I would love to collect herbs while staying at the spa
n8 In many countries, traditional medicines are used in medical treatment besides medical
n9 In many countries, physicians and experts in traditional (complementary) medicine also participate in treatment
Questions
n10 I think that the same treatment principles should be applied to us through the spa form of tourism as a significant tourist offer
n11 If the same treatment principles were applied in the spa, the treatment would be more effective
n12 If traditional (complementary) medicine were part of spa tourism, as the initiator of events and nature based forms of tourism, I would visit the spa more often
n13 If the same treatment principles were applied in the spa, more tourists would be staying in the spa
Source: Author research
Respondents' answers to the questions asked can be presented and analyzed structurally in Table 4.
Table 4. Respondents' answers to the second group of questions
Statistics
n I agree Percent Partially agree Percent Disagree Pecent Mean Std. Deviation
n3 50 80.6 10 16.1 2 3.2 1.23 .493
n4 38 61.3 31 33.9 3 4.8 1.44 .590
n5 60 96.8 1 1.6 1 1.6 1.05 .282
n6 58 93.5 3 4.8 1 1.7 1.08 .329
n7 24 38.7 20 32.3 18 29 1.90 .824
ns 44 71.0 14 22.6 4 6.5 1.35 .603
n, 40 64.5 17 27.4 5 8.1 1.44 .643
n10 46 74.2 16 25.8 0 0.0 1.26 .441
n11 44 71 15 24.2 3 4.8 1.34 .571
n12 32 51.6 23 37.1 7 11.3 1.60 .689
n13 46 74.2 14 22.6 2 3.2 1.29 .524
Source: Author research
After statistically presenting the answers given in Table 4, it can be concluded that the majority of respondents agree with the question asked. The highest average values have the answers to the questions in which the respondents completely agree, in questions n5, n6, n3, n10 and n13, while the lowest average values in the answers of the agreement with the statement, recorded in questions n7, n12 and n4. An insight into the data in Table 4 reveals statistically significant differences in the outputs. These statistically significant differences can be examined with the help of Analysis The Pearson Correlations, which determines whether the model of statistically significant differences obtained is relevant for reaching conclusions, the respondents 'attitudes have a significant role in creating the research conclusions, and to what extent the respondents' attitudes may influence to draw conclusions about the impact of complementary medicine on sustainable tourism development, through spa, events and nature-based tourism, as shown in Table 5.
OJ 00
in
o §
a> £
g"
o
I
a> 02 C7* Oq
n< n« nT n,,
«3 Pearson Correlation 1 .276* .038 .189 .014 .112 .150 .105 .015 .079 .186
Sig. (2-tailed) .030 .769 .141 .912 .386 .245 .419 .908 .539 .148
N 62 62 62 62 62 62 62 62 62 62 62
Pears.Correlation .276* 1 .167 .154 .223 .111 .226 .191 .285* .278* .167
Sig. (2-tailed) .030 .195 .232 .082 .389 .077 .137 .025 .029 .193
N 62 62 62 62 62 62 62 62 62 62 62
Pears.Correlation .038 .167 1 .841** .091 -.006 .153 .030 .202 .271* .458"
Sig. (2-tailed) .769 .195 .000 .482 .962 .235 .818 .116 .033 .000
N 62 62 62 62 62 62 62 62 62 62 62
"6 Pears.Correlation .189 .154 .841" 1 .090 .101 .296* .080 .201 .218 .432"
Sig. (2-tailed) .141 .232 .000 .488 .433 .019 .536 .117 .088 .000
N 62 62 62 62 62 62 62 62 62 62 62
"7 Pears.Correlation .014 .223 .091 .090 1 .169 .235 .340" .489** .306* .028
Sig. (2-tailed) .912 .082 .482 .488 .189 .065 .007 .000 .016 .828
N 62 62 62 62 62 62 62 62 62 62 62
Pears.Correlation .112 .111 -.006 .101 .169 1 .694" .574" .359** .113 .135
Sig. (2-tailed) .386 .389 .962 .433 .189 .000 .000 .004 .380 .294
N 62 62 62 62 62 62 62 62 62 62 62
Pears.Correlation .150 .226 .153 .296* .235 .694" 1 .464" .395** .440" .202
Sig. (2-tailed) .245 .077 .235 .019 .065 .000 .000 .001 .000 .115
N 62 62 62 62 62 62 62 62 62 62 62
nio Pears.Correlation .105 .191 .030 .080 .340" .574" .464" 1 .624** .132 .096
Sig. (2-tailed) .419 .137 .818 .536 .007 .000 .000 .000 .305 .458
N 62 62 62 62 62 62 62 62 62 62 62
"ll Pears. Correlation .015 .285* .202 .201 .489" .359" .395" .624" 1 .395" .268*
Sig. (2-tailed) .908 .025 .116 .117 .000 .004 .001 .000 .001 .035
N 62 62 62 62 62 62 62 62 62 62 62
"l2 Pears.Correlation .079 .278* .271* .218 .306* .113 .440" .132 .395** 1 .466"
Sig. (2-tailed) .539 .029 .033 .088 .016 .380 .000 .305 .001 .000
N 62 62 62 62 62 62 62 62 62 62 62
"l3 Pears.Correlation .186 .167 .458" .432** .028 .135 .202 .096 .268* .466" 1
Sig. (2-tailed) .148 .193 .000 .000 .828 .294 .115 .458 .035 .000
N 62 62 62 62 62 62 62 62 62 62 62
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
The correlation results indicate that the respondents tend to express the differences in the answers, which to a greater extent confirm certain claims. This result indicates that a significant number of respondents agree with the claim that complementary medicine has a significant share in the creation of the tourist offer of the destination. The smaller number of respondents, from the largest clusters of Serbia and abroad, can represent a significant sample for analyzing the impact of complementary medicine on sustainable tourism development through events, spa and nature-based tourism. The results obtained may be significant for the comparative analysis of sustainable tourism development in the Republic of Serbia. It can be concluded that understanding of the importance of the implementation of complementary medicine in the tourist offer of Serbia is present, especially through the organization of special events, because through events, spa and nature-based tourism, such sustainable tourism development provides different benefits (Traskevich & Fontanari, 2018; Trisic et al., 2020). This refers to data indicating that only a small number of respondents disagree with the statements made in the questions asked. What is significant is that there is an intense increase in awareness among the respondents about the importance of complementary medicine in tourism planning and development, precisely through events and nature-based tourism. The results obtained in this way can be of great importance in domestic and foreign tourism. Tourists from the countries of the region, such as Bosnia and Herzegovina, Croatia, Hungary, Romania, Bulgaria, as well as other European and world countries, are increasingly visiting the Republic of Serbia. Much of the tourism demands are directed specifically to events, spa and nature-based tourism. By developing such forms of tourism, it strengthens tourists' awareness of the importance of nature and environment, as an indispensable factor in tourism development (Valdivieso, Eagles & Gil, 2015; Geneletti, Scolozzi & Esmail, 2018).
Conclusions
The conducted research has enabled the constitution of scientific knowledge that tourists are very happy to opt for activities of traditional medicinal herbs collection, significant in complementary medicine. Such activities are realized in nature, with which tourists came in direct contact (Bottero et al., 2019). Using these resources can encourage their renewal and improvement, which is a segment of sustainable tourism development (Schmudde, 2015; Bello, Carr & Lovelock, 2016). Herbs collection activities would form a positive collective socio-cultural impact, both on tourists and on the local community (Page et al., 2017; Buradevic & Dimitrovski, 2019). The local community plays an important role in promoting these natural values of the tourist destination. Respondents, through their questionnaire, just gave importance to events, wellness and spa forms of tourism (Buradevic, 2017), which, with the aforementioned nature-based motives, can enhance Vrnjacka Banja's importance in terms of competing tourist destinations. The research and analysis of the obtained results confirmed two sets of scientific hypotheses. These are that complementary medicine is a significant component of the sustainable development of health tourism in Serbian spa destinations and that organizing an adequate complementary medicine tourism event can increase tourists' motivation for visits and their significant relationship to nature-based tourism http://ea.bg.ac.rs 385
(through traditional plant picking and stay in nature), which would have a significant impact on the sustainable tourism development of spa tourism. Also, the results of the research in this paper showed that complementary medicine is a significant component of the development of health tourism in Serbia, and that the organization of adequate tourist events in the field of complementary medicine would increase the motivation of tourists to visit, which would significantly improve the overall sustainable tourism development of tourism. industry. The results obtained may also be significant for a comparative analysis of sustainable tourism development in the Republic of Serbia. It can be concluded that there is an understanding of the importance of implementing complementary medicine in the tourist offer of Serbia, because through events, spa and nature-based tourism, such sustainable tourism development provides different benefits. The concluding remarks made can be of great importance in domestic and international tourism. Tourists from the countries of the region, such as Bosnia and Herzegovina, Croatia, Hungary, Romania, Bulgaria, as well as other European and world countries, are increasingly visiting the Republic of Serbia. Respondents, although the number of them is not so large, represent a significant sample for correlating and comparing tourism development at local, national and regional levels. Much of the world's tourism demand is directed specifically to events, spa and nature-based tourism (Koskinen & Wilska, 2019). Complementary medicine can represent a significant link between these three important forms of tourism for Serbia, and by providing socio-cultural, economic and environmental benefits, the basic postulates of sustainable tourism development are directly fulfilled.
Conflict of interests
The authors declare no conflict of interest.
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