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The purpose of this article is through a systematic literature review (SLR) to present a conceptual approach to the importance of communication for thermalism. An in-depth analysis of scientific publications provides a conceptual understanding about the definition of thermalism and the importance of communication in the thermal sector. The intention is also to identify the major challenges for communication in thermalism in times of crisis. The literature on conceptual approaches in the field of thermalism is almost non-existent, and this is an important contribution of the research presented.

To achieve the objectives, an SLR was carried out, through the Preferred Reporting Items Systematic Reviews and Meta-Analysis (PRISMA) Statement method, using the Web of Science and Scopus databases. A total of 139 articles were found, of which only 26 were used for the qualitative analysis. EndNote 20 and Nvivo software were used to identify the articles for the study, their analysis and systematization of the collected information.

The results, among others, through an in-depth analysis of scientific publications, clarified the definition of thermalism and provided relevant results for better understanding of the importance of the dimensions of communication for thermalism.

The research addresses the current scarcity of academic work on the importance of communication applied to a thermal destination and the lack of relevant strategic models for the diffusion/promotion of a destination. Finally, a limitation was the fact that only 2 databases were considered and only journal articles were included. As a future line of research the authors propose extending the theme to thermal tourism experiences. In addition, scientific studies focusing on water-based experiences connected with thermalism are almost non-existent and very relevant for the future of the sector, as well as studies in the area of communication with the following research questions: where do tourists consult information when choosing a travel destination? and what are the appropriate communication channels to reach the thermal market?; We close this reflection by concluding that the thermal tradition, through the know-how of the medical class, the properties of thermal waters and the cultural history associated with its early days, stimulated more recently by implementing innovations, will regain its role in preserving health and well-being through thermal water and the exploitation of territories' endogenous resources. These factors are the basis through which communication sciences can create strategies adapted to each country to promote a thermal destination brand.

Research in tourism destination management has provided solutions, through communication, to problems that are faced daily by countries, and the authors hope this research also contributes to the recovery of thermal tourism destinations in times of crisis. It is also from this perspective that based on the main themes and dimensions of communication identified in the SLR that the authors propose the Corporate, Organisational, Skills, Management and Online (COSMO) model to help promote resilient thermal destinations prepared for future crises. The diversity and originality of this research model will be useful for destination promoters, spa managers and communication professionals.

This study contributes to the literature by providing a theoretical framework of excellence in thermalism. One possible way to solve the ambiguity of terms related to thermalism is to consider another more comprehensive term as a combination of different approaches. The aim is not to create an academic division, but rather to contribute to better conceptual understanding, from a theoretical and paradigmatic perspective, of what thermalism is. Here, a new targeted and more comprehensive concept emerges, which from the academic perspective of communication sciences will lead to prevention for a new way of feeling good with life, contributing to promoting thermal destinations in the world with a greater understanding.

For better understanding of the concepts, this study proposes a new definition of thermalism. As research related to thermal destinations, through communication management contributes to attract tourists, promote experiences, provide the human capital of the sector with skills and create authentic and resilient place brands. It is from this perspective that the model was proposed, based on the dimensions of communication related to the main themes obtained through the SLR. This model supports a plurality of communication strategies, with different characteristics and objectives but which meet a collective purpose: to disseminate information about thermalism, in order to build collective knowledge to promote thermal destinations. The analysis highlights the need for further research into thermalism, with special focus on communication.

Satisfaction in the tourism sector is a highly sensitive subject, and customer satisfaction (CS) has a significant impact on the choice of destinations made by tourists and on the decision to recommend them to friends or acquaintances. The purpose of this paper is to give empirical evidence of the dimensions of service quality (technical, functional and company image (CI)) and their connections in the sector of thermal tourism. It also aims at investigating the CI, seeking to understand whether some of the technical and functional service quality variables play a role in determining it.

An empirical survey was conducted by administering a structured research questionnaire in order to collect all necessary data, which was then elaborated to test the hypotheses using factor and multiple regression analyses.

The results of the survey confirm the direct impact of service quality dimensions (technical, functional and CI) on CS also in the thermal sector when considered individually. Moreover, when the CI was analyzed further, relational quality was found to be dependent on thermal employees’ capabilities, abilities, trustworthiness, availability, etc. Finally, when considered together, functional service quality and CI have a stronger effect on CS than technical service quality.

The originality of the present research relies on the following: a further contribution to the so-called “European perspective” of service quality; the study of service quality dimensions (technical, functional and CI) in the thermal sector; and evidencing the link between thermal employee characteristics and the relational quality factor of the CI, demonstrating that many aspects of this construct need further empirical investigation, in the wellness sector.

Thermal Tour As had been identified in the Second Report on Italian Tourism (1), the market for “thermal tourism” has developed its trends with further characterizations and differentiations:

Human life has been unfavourably impacted by COVID-19, which has impacted the entire planet. Contrastingly, it is now crucial to discern the significance of health in human life and pay more attention to protecting health. Owing to COVID-19's influence on lifestyle, it is evident that the pandemic contributes to the development of health tourism and that wellness tourism, which was in the pre-pandemic growth trend, is favoured more often. Therefore, it is indisputable that stakeholders in the health and tourism industries view the rising demand for health-focused holidays as a potential. However, on the opposite hand, it is meaningful to broaden the number of products made available within the context of wellness tourism, to pinpoint areas that are conducive to health-related activities, to generate the infrastructure and superstructure required in these areas and to step up marketing initiatives in order to make the most of this opportunity. To address these concerns, it is deemed crucial that the parties involved in the tourism and health sectors coordinate their efforts.

The purpose of this article is to describe the characteristics and the consumption behaviour of tourists coming from different countries and choosing different holiday typologies (cultural, seaside, mountains, etc.), by evaluating their expenditure in terms of consumption functions and productive sectors. The analysis — which uses the results of the survey on tourist expenditure carried out in the Veneto region, with particular reference to international tourism, from May 1994 to April 1995 —, can be suitably extended over the local scale. A multisectoral‐biregional input output model (VERDITOUR) has been implemented to measure the economic role of each segment and the plot of interactions going from tourist expenditure habits to the tourism industry.

As an alternative way of tourism, disabled tourism has its own characteristics due to the fact that disabled tourists are likely to have different needs and expectations throughout their vacations at a destination. Therefore, this chapter aims to provide a generic overview of disabled tourism and identify if there would be any requirements for developing training programs and examine their contexts. The discussion of results is based on undertaking an interview survey among the executive managers of travel agencies and hotel businesses operating in a resort town of Turkey. Although the respondents emphasize the importance of training programs, unfortunately there is much less improvement in terms of facilities for disabled visitors.

The Geography of Tourism in Spain is now at a par in terms of its scientific production with other European countries. Since the middle of the '80s the quality and volume of contributions is analogous to the rest of the European Union, although as a part of University Geography in Spain it has not achieved the level of dedication reached by other subjects considering the importance of tourist activities to the economy, the society and the territory of Spain. It could be said that the Geography of Tourism in Spain is in the international vanguard in dealing with Mediterranean coastal tourism, with the relationships between the residential real estate and tourism sectors and with aspects related to tourism and leisure in rural and protected areas.

Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA).

Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996).

The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped.

The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency.

Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

The purpose of this paper is to assess the competitiveness of the Uruguayan rural tourism sector against its main competitors from Argentina and Brazil, as perceived by Uruguayan stakeholders on the supply side. The paper will also evaluate the potential of Uruguay as a rural tourism destination in attracting German tourists.

Two different questionnaires were administered, one to Uruguayan rural tourism stakeholders and another one to potential German tourists in Germany.

The findings indicate that the main strengths of Uruguayan rural tourism offer, compared to Argentina and Brazil, are the hospitality and friendliness of local people, the natural and cultural attractions and the country’s security and safety. Main weaknesses identified were the poor management of several destination components that are key to create a successful tourism destination and poor management of the “demand conditions” component of Dwyer and Kim’s (2003) integrated model.

There is very limited research done on the competitiveness of Uruguay as a rural tourist destination in attracting foreign tourists (Mackinnon et al., 2009). The objective of this study is to partially fill this gap by assessing how competitive Uruguayan rural tourism is and evaluating whether Uruguay represents an attractive market for German tourists looking for agro tourism and farm holiday destinations. The German market was chosen because it is one of the top tourist-generating countries and one of the biggest spenders in international tourism (The World Tourism organization, 2010). Moreover, most tourists – from outside South America – selecting Uruguay as a tourist destination come from Germany, USA and Australia (Peralta, 2012).