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Health tourism is recognised as a recent new pattern of taking a break while accessing health-care services overseas. Past studies have explored this research area, but few have focussed on the theoretical perspective. Applying an appropriate theoretical model to guide interventions in planning and programme development is crucial, particularly when the focus of the study is on the cognitive mediation processes of change in individual behaviour. This study aims to examine the effectiveness of the protection motivation theory with the influence of threat appraisal and coping appraisal. The purpose is to trigger the behavioural intention to engage in international health tourism.

A total of 299 international tourists participated in the survey. The partial least squares structural equation modelling technique was used to test the research framework. Both the measurement model and the structural model were assessed as adequate.

The empirical results demonstrate that tourists’ high risk perception must be complemented by coping ability to produce a motivational response. Further, the adaptive behaviours of international tourists are focussed more on perceived efficacy than on the perception of threats related to behavioural intentions towards health tourism.

The study presents an effective theoretical model intervention applicable to health tourism. Future studies should conduct a more comprehensive assessment to generate strong decision-making effectiveness from the theoretical model.

共有299名国际游客参加了此次调查。使用偏最小二乘结构方程建模技术来测试研究框架。测量模型和结构模型均被评估为足够。

健康旅游业被公认为是最近在海外获得医疗服务时休息的新模式。过去的研究已经探索了这个研究领域, 但是很少有人关注理论观点。应用适当的理论模型来指导计划和程序开发的干预措施至关重要, 特别是当研究的重点是个人行为改变的认知中介过程时。本研究在威胁评估和应对评估的影响下检验了保护动机理论（PMT）的有效性。目的是激发从事国际健康旅游的行为意图。

实证结果表明, 游客的高风险感知必须通过应对能力来补充, 以产生激励反应。此外, 国际游客的适应行为更多地集中在感知的效能上, 而不是感知与针对健康旅游的行为意图有关的威胁。

该研究提出了一种适用于健康旅游的有效理论模型干预措施。未来的研究应进行更全面的评估, 以从理论模型中产生强大的决策效力。

关键词 健康旅游, 行为意图, 保护动机理论, 国际游客, 马来西亚

文章类型： 研究型论文

Un total de 299 turistas internacionales participaron en la encuesta. Se utilizó la técnica de modelización de ecuaciones estructurales por mínimos cuadrados parciales para probar el marco de investigación. Tanto el modelo de medición como el modelo estructural se consideraron adecuados.

El turismo de salud se reconoce como un nuevo modelo reciente de descanso para acceder a los servicios sanitarios en el extranjero. Estudios anteriores han explorado esta área de investigación, pero pocos se han centrado en la perspectiva teórica. La aplicación de un modelo teórico adecuado para guiar las intervenciones en la planificación y el desarrollo de programas es crucial, especialmente cuando el estudio se centra en los procesos de mediación cognitiva del cambio en el comportamiento individual. Este estudio examina la eficacia de la teoría de la motivación de la protección (PMT) con la influencia de la valoración de la amenaza y la valoración del afrontamiento. El objetivo es activar la intención conductual de realizar turismo sanitario internacional.

Los resultados empíricos demuestran que la percepción de alto riesgo de los turistas debe complementarse con la capacidad de afrontamiento para producir una respuesta motivacional. Además, los comportamientos adaptativos de los turistas internacionales se centran más en la eficacia percibida, que en la percepción de las amenazas relacionadas con las intenciones de comportamiento hacia el turismo de salud.

El estudio presenta un modelo teórico de intervención eficaz aplicable al turismo de salud. Futuros estudios deberían realizar una evaluación más exhaustiva para generar mayor eficacia en la toma de decisiones a partir del modelo teórico.

Turismo de salud; Intención de comportamiento; Teoría de la motivación de la protección; Turistas internacionales; Malasia

Trabajo de investigación

Medical tourism has grown to become a formidable multinational industry to generate revenue. This phenomenon has also increased impact on the healthcare sector as well as strategies development opportunities. The present study emphases on the international tourists' behavioural intention for medical tourism in Malaysia. A research framework is derived from the exceptional component of fear appeal in protection motivation theory (PMT).

Data were collected with a sample of 501 respondents and analysed via structural equation modelling approach. Both measurement model and structural model were assessed to generate the result.

The outcomes have shown a good backing on the use of adapted PMT theoretical model. There is a higher predictive power on health coping than health threats. Coping alternatives can be served as the linkage between the PMT appraisals and behavioural intention.

The study confirmed the effectiveness of using a theoretical framework in predicting international tourists' behavioural intention for medical tourism. It is suggesting that risk adaptive behaviour does offer a valuable proposition in contributing to the reception of medical tourism.

The present study argues the need for greater clarity in understanding the emergent implications for health policy and healthcare delivery for future medical tourism development.

The fundamental theories and current literature do not incorporate the component of fear appeal in explaining decision making. The study findings demonstrate that protection motivation theory has provide another promising theoretical model in explaining international tourists' behaviour intention for medical tourism.

Few studies have adopted social psychology theories to understand the medical tourism decision-making process. The purpose of this study is to fill the said gap by suggesting the adoption of two social cognition models: the theory of planned behaviour (TPB) and protection motivation theory (PMT), to predict medical tourism behavioural intention, as well as compare their predictive power by integrating TBP and PMT in a single model.

A quantitative method has been adopted. There were 265 international tourists from various regions who visited Malaysia (one of the main medical tourism players in Asia), who were asked to complete the survey questionnaire. Data was analysed using the partial least squares structural equation modelling technique.

The results of this study provided support and validated the well-developed research models of TPB and PMT. Although PMT appears to be a more concrete and specific framework, the TPB model results have a slight advantage. TPB results emphasised the important roles of attitude, subjective norms and perceived behavioural control in developing behavioural intentions, and thus directly linked to the development of pull marketing strategies. PMT results emphasised the important roles of perceived threats and coping appraisal of health care in developing push strategies for medical tourism.

The research illustrates the need for rigorous examination of the ability of behavioural theories. The findings can aid in scrutinising their shortcomings and their readiness to modify, integrate and enhance in a more constructive manner when they address the health-education interventions, especially in a medical tourism context.

很少有研究采用社会心理学理论来理解医疗旅游的决策过程。这项研究的目的是通过建议采用两种社会认知模型（计划行为理论（TPB）和保护动机理论（PMT））来填补上述空白。通过将TBP和PMT集成到一个模型中, 预测医疗旅游行为意愿并比较其预测能力。

采用定量方法。样本包括265名访问了马来西亚（亚洲主要的医疗旅游公司之一）的国际游客, 他们被邀请填写调查问卷。研究使用偏最小二乘结构方程建模技术分析数据。

这项研究的结果支持并验证了TPB和PMT完善的研究模型。尽管PMT似乎是一个更具体的框架, 但TPB模型结果却有一点优势。TPB模型的结果强调了态度, 主观规范和感知的行为控制在形成行为意愿中的重要作用, 因此直接与拉动式营销策略的发展相关。 PMT结果强调了感知到的威胁和对医疗保健的应对评估在制定医疗旅游推动策略中的重要作用。

该研究阐述了严格检验行为理论能力的必要性。当研究结果针对健康教育干预措施时, 尤其是在医疗旅游领域, 这些发现可以帮助审查它们的缺点以及它们是否准备好以更具建设性的方式进行修改, 整合和改善。

医疗旅游, 游客的行为意愿, 保护动机理论, 计划行为理论, 模型比较, 马来西亚

研究论文

Pocos estudios han adoptado teorías de psicología social para comprender el proceso de toma de decisiones de turismo médico. El objetivo de esta investigación es llenar dicho vacío sugiriendo la adopción de dos modelos de cognición social: la teoría del comportamiento planificado (TPB) y la teoría de la motivación de protección (PMT), para predecir la intención conductual del turismo médico y comparar su poder predictivo integrando TBP y PMT en un solo modelo.

se ha adoptado un método cuantitativo. Hubo 265 turistas internacionales de diversas regiones que visitaron Malasia (uno de los principales actores del turismo médico en Asia) a quienes se les pidió que completaran el cuestionario de la encuesta. Los datos se analizaron utilizando la técnica de modelado de ecuaciones estructurales de mínimos cuadrados parciales.

Los resultados de este estudio brindaron apoyo y validaron los modelos de investigación bien desarrollados de TPB y PMT. Aunque PMT parece ser un marco más concreto y específico, los resultados del modelo TPB tienen una ligera ventaja. Los resultados del TPB enfatizaron los roles importantes de las actitudes, las normas subjetivas y el control conductual percibido en el desarrollo de las intenciones conductuales y, por lo tanto, directamente vinculados con el desarrollo de estrategias de marketing pull. Los resultados de PMT enfatizaron los roles importantes de las amenazas percibidas y la evaluación de la atención médica en el desarrollo de estrategias de empuje para el turismo médico.

La investigación ilustra la necesidad de un examen riguroso de la capacidad de las teorías conductuales. Los hallazgos pueden ayudar a analizar sus deficiencias y su disposición a modificar, integrar y mejorar de una manera más constructiva cuando abordan las intervenciones de educación sanitaria, especialmente en un contexto de turismo médico.

The aim of this paper is to explore the relationship between perception of service quality, student satisfaction, switching barriers on behavioural intentions among private higher education institutions (HEIs) with self-accreditation status in Malaysia.

A total of 388 valid questionnaires were collected via a self-administered questionnaire from the undergraduate students of private HEIs with self-accreditation status in Malaysia. PLS-SEM has been employed for hypotheses testing.

The results show that student perceived service quality is positively influence student satisfaction and student behavioural intentions, particularly the positive word-of-mouth (WOM). The relationship of student perceived service quality and student behavioural intentions is fully mediated by student satisfaction. However, there is no mediating effect found for the switching barriers on the relationship between student satisfaction and behavioural intentions.

This study's findings are only generalizable to the private HEI with self-accreditation status in Malaysia. The paper contributes to the body of knowledge in the areas of service quality, satisfaction, switching barriers and behavioural intentions. These findings provide valuable insight to the private universities management and policymakers to improve existing policies and practices in order to formulate effective strategies to attract potential new students and retain the existing students through the delivery of high-quality services.

This study's findings have reconfirmed that the causal relationship of perceived service quality-satisfaction-behavioural intentions model. Switching barriers has treated as the mediator which received less attention in the context of private higher education sector. Thus, this study broadens the exiting body of knowledge and advances the understanding of how switching barriers play a crucial role by influencing students' behavioural intention, particular WOM.

The purpose of this paper is to examine the effects of teachers’ perception on trust over their willingness to exercise organisational citizenship behaviours (OCB) using self-efficacy as a mediator.

Usable questionnaires were collected from 411 teachers in secondary schools. A two-stage analytic approach was used to analyse the data.

The results indicated that trust and teachers’ self-efficacy dimensions (general teaching and personal teaching) are positively related to OCB. Additionally, trust in the principal, colleagues and clients are predicted to have indirect influence on OCB through self-efficacy.

Teachers’ personal sense of efficacy is largely dependent on the amount of efforts devoted in their teaching, their decision-making ability and the degree of persistency in solving problematic issues. School management and policy makers are urged to develop effective human resources initiatives and programmes that can create a trusting relationship in the organisation and enhance teachers’ self-efficacy. These may include the socialisation programmes that can inculcate teachers’ inner natures, confidence and interpersonal skills when directed towards perceived abilities in given specific tasks and responsibilities to make a significant impact on OCB. Apart from this, the school administrator is advised to offer relevant training and workshops that able to enhance the efficacy level of teachers.

This study explored how teachers’ self-efficacy was related to trust and OCB. Teachers’ positive behaviours enable them to have greater belief in their capability of handling pressures and crises. The study contributes to the current body of literature and creates a comprehensive theoretical framework for teachers to be involved in OCB. Besides, these unique findings served as a reference to management of any school to better understand the importance of trust in the school and how it relates to teacher self-efficacy, which, in turn nurture the citizenship behaviour in workplace.

This study examines the mediating effect of self-efficacy between perceived organizational support (POS) and organizational citizenship behaviors (OCB) organization (OCBO); and POS and OCB individual (OCBI) in a cross-cultural context.

Data were collected from 207 full-time academics from the private universities in Malaysia and Mainland China using a questionnaire survey.

The results indicate that self-efficacy is a salient mediator linking POS with OCBI and OCBO. Additionally, ethnic dissimilarity is found to have a contextual influence on the research model as the results reveal that self-efficacy only mediates the relationship between POS and OCBO but not between POS and OCBI in a heterogeneous society. In contrast, self-efficacy is found to mediate the relationships between POS and OCBO and between POS and OCBI in a homogeneous society.

This study contributes to the literature by being one of the first studies that examine the relationship between self-efficacy and two dimensions of OCB in two different cultural contexts.

Utilizing organizational support theory, the purpose of this paper is to examine the mediation effect of perceived organizational support (POS) on the relationship between ethical leadership and citizenship behavior, and investigate the moderating effect of ethnic dissimilarity in the research model.

Using a self-administered questionnaire, data were collected from 294 academics of private universities in China, Malaysia and Thailand. The collected data were analyzed using partial least squares path modeling technique on R platform.

The study found that ethical leadership is significantly and positively related to POS, which, in turn, related to both distinct dimensions of organizational citizenship behaviors – individual and organization. However, further analysis reveals that ethnic dissimilarity does moderate the hypothesized relationships in the research model, in which POS is found to have a mediation effect in the heterogeneous sample but not in the homogeneous sample in terms of ethnic dissimilarity.

To the best knowledge of the researchers, this study is among the first few research works examining the interrelationships of ethical leadership, POS, and citizenship behavior in terms of individual and organizational. Moreover, this is one of the earliest studies to examine the concepts in two different samples in terms of ethnic dissimilarity.