Travel behaviour among inbound medical tourists in Kuala Lumpur

Despite recording the highest growth among tourism sub-sectors [Dhesi, D. (2009, March 25). Medical tourism rises in Malaysia despite economic downturn. The Star Online. Retrieved from http://www.malaysiahealthcare.com/; Leonard, T. (2009, July 24). Medical tourists to bring in RM 540 million by 2010. Retrieved from http://www.malaysiahealthcare.com/; Tourism Malaysia. (2008). Profile of tourist by selected markets 2008. Kuala Lumpur: Tourism Malaysia], little is known empirically with regard to travel behaviour among inbound medical tourists in Malaysia. This study examined the demographic profile, travel motivation, healthcare consumption, and expenditure behaviour among them in Kuala Lumpur. Using the combination of purposeful and convenience sampling, a total of 138 questionnaires were completed, returned, and analysed. The majority of the respondents were female, middle aged, travelling with two others and Indonesians. Their main travel motivation factors were ‘value for money’, ‘excellent medical services’, ‘supporting services’, ‘cultural similarity’, and ‘religious factor’ in descending order of importance. Medical treatment, cosmetic procedure, surgical procedure, and medical check-up were important healthcare services sought after by the respondents. On average, medical tourists spent MYR 26,844.19 per visit, with females and tourists of European descent contributing significantly more. Tourists from ASEAN had stronger motivation of ‘cultural similarity’ compared with other tourists. This paper is unique in providing the empirical evidence of the city's unique selling points (pull factors) in attracting inbound medical tourists. It also highlights the potential economic contribution and some managerial implications in terms of marketing and product development.     

The influence of attitudes towards healthy eating on food consumption when travelling

This study explores tourists' attitude towards healthy eating and its influence on their travel eating behaviour. Based on focus group interviews and literature review, two instruments were developed to measure healthy eating attitude and travel eating behaviour. Factor analysis results revealed two healthy eating attitude factors (‘food content and nutrients’ and ‘balanced diet and eating habit’), and five travel eating behaviour factors (‘novelty’, ‘risk avoidance’, ‘health steadfastness’, ‘familiarity’, and ‘food supplement and medicine’). The relationships among the factors were examined using structural equation modelling. The findings revealed that respondents who had a stronger attitude towards ‘balanced diet and eating habit’ tended to be more motivated by the ‘novelty’ factor; whereas ‘risk avoidance’, ‘health steadfastness’ and ‘familiarity’ were found to be associated with a stronger attitude towards ‘food content and nutrient’. The findings suggest that the healthy eating attitude construct is multidimensional and healthy eating conscious tourists should not be treated as a homogeneous group.     

More than medical tourism: lessons from Indonesia and Malaysia on South–South intra-regional medical travel

While scholars increasingly acknowledge that most contemporary international medical travel comprises South–South flows, these have gone curiously unexamined. Rather, policy, scholarly and media attention focuses predominantly on North–South flows of ‘medical tourists’. However, this focus diverts attention from the actual and potential impacts of South–South intra-regional medical travel flows on both their source and receiving contexts. As such, we present findings from a study examining South–South intra-regional medical travellers' motivations, preparations and practices to better understand the social, economic and political situations that condition them and their effects on the destinations that receive them. Our study of Indonesian medical travellers pursuing health care in Malaysia draws on 35 semi-structured interviews with Indonesian patients, their companions, medical staff and agents in both countries. From this, we suggest that South–South medical travellers' diverse socio-economic conditions shape decision-making and spending behaviour relative to treatment, accommodation and transport choices as well as length of stay. We identify ways in which informal economies and social care networks sustain the formal medical travel industry. Finally, we observe how medical travel increasingly serves as a means through which chronic and everyday health needs are met through temporary, visa-free intra-regional movement.     

‘Mobility work’: Older adults' experiences using public transportation

This paper contributes to research on public transport accessibility, disabling spaces, and older adult's mobility by highlighting the ‘mobility work’ older adults complete to meet their daily travel needs. Drawing on a systematic and inductive analysis of semi-structured interviews with older adult (65+ years of age) public transit users in Hamilton, Canada, we argue that older adults are faced with mobility work that younger and/or more able-bodied people do not routinely encounter as they meet (or attempt to meet) their daily travel needs using public transportation. Key components of older adults' trips that involve mobility work include walking to and from the bus stop, trip planning, stepping onto/ off of the bus, finding a seat, carrying items on the bus, calling a stop, and travelling in winter conditions. This mobility work can be categorized as physical (e.g., struggling to board the bus), emotional (e.g., worrying about getting a seat), or spatiotemporal (e.g., staying home when the weather is bad). Taken together, this paper puts forward a multidimensional concept of ‘mobility work’ to aid in considering accessibility at the scale of both the individual and the built environment. Further, by highlighting mobility work, this paper demonstrates the ways in which public transport spaces can be disabling for aging bodies and outlines concrete measures public transit agencies can take to make services more accessible to older adult riders.     

Millennials’ travel motivations and desired activities within destinations: A comparative study of the US and the UK

Millennials are one of the largest groups to be targeted by tourism companies. This paper compares the travel motivations of Millennials from both the United States and the United Kingdom by ratings, rankings and perceptual structures of both push and pull factors. This exploratory study used a questionnaire to examine the inner motivations (e.g. push factors) and preferred destination activities (e.g. pull factors) of American and British Millennials (n?=?322). Data analysis included the non-parametric Mann–Whitney U test, Kendall’s coefficient of concordance, an alternating least-squares algorithm (ALSCAL) model and ordinal regression. The results reveal that American and British Millennials are quite homogeneous in their push travel motivations and destination activity preferences. The most important motivational factors for both are ‘to relax’ and ‘to escape from the ordinary’. Both nationalities also agree that the most attractive destination activities are ‘to try local food’ and ‘to go sightseeing’. The findings indicate that the US and UK samples are similar and that there is room for segmentation according to demographics.     

The travel behaviour intentions of young people in the context of climate change

This article examines the factors influencing the future travel behaviour intentions of young people (aged 11–18), with specific attention given to how climate change considerations affect these. Overall it is found that the participants’ travel behaviour intentions are dominated by a desire to drive and that their values relating to identity, self-image, and social recognition (at the expense of their environmental values), as well as their affective attitudes towards transport modes, are key influences on this. Although they are aware of climate change, the participants’ understanding of the link between transport and climate change was weak. At the same time, they illustrated an apathy towards climate change – in part due to the timing and intangibility of its associated impacts and their lack of self-efficacy with respect to tackling this issue. However, despite claiming that their current environmentally friendly travel behaviours (such as walking or cycling to school) are not influenced by the issue of climate change, a number are accepting of the idea of enforced travel behaviour change – away from use of the car, towards more ‘environmentally friendly’ modes. This acceptance was in part due to their belief that such action would remove the influence of the ‘social dilemma’, where their own efforts to tackle climate change may be rendered worthless by the inaction of others.     

Mobility in different generations of older persons: The development of daily travel in different cohorts in Denmark,Norway and Sweden

In the Scandinavian countries Denmark, Norway and Sweden, the proportion of older people in the total population is expected to reach about 25% in 2060. The ageing of the population has a variety of social implications. One aspect of population ageing that has relatively little attention in the Scandinavian countries is the question of everyday mobility. The purpose of this paper is to get a better understanding of the activity and travel patterns of different groups of older people, examine how travel- and activity patterns are developing during the life course, study the changes over time and how the “new” generations of older people behave compared to the older ones. The method used is cohort analysis of National Travel Surveys from the three countries in a 20 years perspective. Results show a significant period effect in car ownership and use among older people in Denmark, Norway and Sweden with a clear increase during the past 20 years. This is especially true for women. The increase in the number of driver’s licence-holders and car availability is reflected in travel mode choice among older people: both men and women maintain their car-use habits at old age. Another clear finding is that older people today travel more than the comparable age groups 20–25 years ago: everyday trip rates are higher and activities outside home are more common. While commuting and work-related trips decline after retirement, shopping and leisure trips do not start to decline before high age. From the cohort analysis we see that leisure and shopping trips are maintained in the period after retirement, and the car is important to reach shopping malls, health service, leisure activities, visit relatives and other social company.     

Cycling in multimodal transport behaviours: Exploring modality styles in the Danish population

Multimodality is important for achieving less car dependent lifestyles and more sustainable transport behaviours. It is widely recognised that cycling plays a prominent role in sustainable transport. However, research has largely focused on cycling substituting motorised transport. This study explores how cycling forms part of multimodal transport behaviour based on survey data on transport modes and travel purposes and the weekly frequency of out-of-home activities and travel mode use in a representative sample of adult Danes (n = 1957). The following five distinct multimodal travel segments or ‘modality styles’ are identified: ‘education transport’; ‘public-based transport’; ‘limited transport’; ‘bicycle-based transport’; and ‘car-based transport’. Travel behaviour is predominantly multimodal with few unimodal car-drivers being identified. Substantial cycling takes place in all modality styles, and is embedded in a multimodal behaviour as the modality style combined cycling with several other modes. Furthermore, the study demonstrates that cycling serves many purposes that transgress the division of utility cycling and recreational cycling, and that cycling takes place in both dense urban settings and small towns. Thus, the way in which travel modes relate to the urban environment and variations in modality styles must serve as the starting point for policies aiming to fulfil the potential of multimodal transport behaviour and promote cycling.     

Transport mode choice in South East Asia: Investigating the relationship between transport users’ perception and travel behaviour in Johor Bahru,Malaysia

The worldwide increase in private car dependency poses a set of significant environmental, economic and social sustainability challenges that continue to undermine the urban quality of life. Rapid motorisation, particularly in South East Asia (SEA), has emerged as a global concern given the region’s cumulative population, rate of industrialisation, and large-scale urbanisation. Thus, there is a compelling need to enhance our understanding of the underlying dynamics of how people perceive and use transportation such that transport planning is better placed to address the current, unsustainable travel patterns in SEA. Despite this need, there has been relatively limited SEA-based research that has endeavoured to examine travel perceptions and transport mode choice from a non-instrumental perspective. This research redresses this deficit by investigating the relationship between transport users’ perceptions and travel behaviours within SEA, with a particular focus on psychosocial drivers of transport mode choice interfaced with more traditional instrumental measures.Spatially stratified survey data have been collected in a case study area, Johor Bahru, Malaysia, comprising users from different transport user groups. Employing regression modelling, drivers of individual’s travel behaviour are examined. Results highlight the merit in recognising the role of non-instrumental motives alongside instrumental motives to explain transport mode choice. We conclude by highlighting that transport mode choices are motivated by a range of locational, socio-demographic, psychological and cultural determinants. The current research has contributed to a better understanding of transport mode choice in Johor Bahru and provides a foundation for future SEA-based travel behaviour research. Studies in this area can inform more sustainable travel behaviour in the SEA region.     

Being passionate about the mobile while travelling

People interpret the availability of their mobile phone similar to their personal (social) relationships (friends, family, and pets). Hence, mobile phones are appliances that provide continuous functional and emotional support. Also, in the field of tourism, the integrated use of mobile phones is indicated by words such as ‘catalyst’ and ‘travel buddies’, enhancing tourists’ experiences. This study goes one step further by incorporating the concept of passion and affective outcomes of using the mobile phone while travelling. Perceived socialness of the mobile phone significantly effects passionate behaviour and affective outcomes. For practitioners aiming for digital innovation in the field of tourism, these findings provide insight into the development of tailor-made travel-related applications. Furthermore, affective feelings derived from mobile phone usage will be enhanced by effective travel-related applications encouraging the modern tourists while travelling.     

Exploring transport to arts and cultural activities as a facilitator of social inclusion

This paper explores the relationship between travel and social inclusion in relation to a relatively rarely examined group of travel destinations—arts and cultural activities. This paper examines travel behaviour to arts and cultural activities and how this relates to social inclusion. Research literature associated with these issues is examined and then an analysis of a household travel survey in Melbourne, Australia, is undertaken to explore how travel to arts and cultural activities varies by income, car ownership and location. The paper outlines a range of evidence linking participation in arts and cultural activities and positive outcomes for social inclusion. Arts and cultural activities do not fit well into traditional household travel survey definitions of trip purposes. There is also no definitional difference between travel to activities and ‘participation’ or ‘attendance’ in arts and cultural activities. This is unfortunate since social outcomes may vary by participation or attendance. Travel survey analysis shows that like other activities trip rates to arts and cultural activities increase with income. However higher participation is demonstrated for zero- and one-car households, which contrasts with previous research of work, education and social travel. Higher participation is also demonstrated for those living in inner parts of the city. The paper suggests that most travel to arts and cultural activity is quite localised and hence much travel may be led by the diversity and range of local opportunities provided. These are particularly high in inner parts of the city. A high share of travel is also demonstrated for older people, who are thought to have the time and desire for greater participation in arts and cultural activities.     

Residential self-selection and travel behaviour: What are the effects of attitudes,reasons for location choice and the built environment?

In studies of the effect of built environment on travel behaviour, residential self-selection is an increasingly important issue. Self-selection implies that households locate in places that provide them with conducive conditions for their preferred way of travelling. In these studies, it is assumed that attitudes toward different travel modes are an important factor in location choice, and that households are unconstrained in choosing their preferred residential location. This paper challenges these assumptions, by distinguishing between the more passive travel attitude and travel considerations as a deliberate reason to locate in a certain place. Based on a survey among 355 recently relocated households in Dutch TOD locations, we find that the association between travel attitude and residential environment is weak, and that the association between travel attitude and travel as a factor in location choice is moderate at best. Multivariate models show that both travel attitude and travel being a reason for location choice influence travel mode use, suggesting that travel attitude is insufficient to fully reflect self-selection processes. In comparison to other travel modes, train travel is most influenced by the fact whether residents deliberately chose to live in an environment conducive to using this mode.     

An assessment of air passenger confidence a year into the COVID-19 crisis: A segmentation analysis of passengers in Norway

The COVID-19 crisis has become the most intense and long-lasting in the history of aviation. There is already a significant literature on the immediate impact of the outbreak, as well as on speculation on the future evolution of the industry. This paper seeks to contribute to this discussion by assessing a year into the crisis the demand related aspects and passenger behavioural impacts of the pandemic. Specifically, the paper aims to identify discrete market segments of air passengers according to their shared attitudes and preferences about air travel in light of the COVID-19 crisis, as well as past behaviour and future travel intentions. To achieve this, we analyse data from a large (n = 2096) online questionnaire survey of air passengers in Norway. The cluster analysis identifies four distinct passenger segments, with each displaying varying attitudes, behaviours, and levels of concern about air travel. One of these groups, described as the ‘Apprehensive Elders’, were identified as having the highest level of concern about flying, and subsequently showed a sharp decline in their intention to travel in the future. Another group, termed the ‘Cautious Commuters’, showed similarly enhanced levels of concerns about flying, but maintained a high propensity to fly following the pandemic despite these concerns. Regarding possible interventions to increase confidence in flying in the future, across all segments the data shows a clear preference for more ‘traditional’ active interventions, including wearing of face masks and enforcement of physical distancing, over and above passive or technological interventions. Norway represents a valuable case as a possible signal for future policy and practice in relation to the recovery of air travel following the pandemic. The findings have important implications for air transport managers and decision makers in terms of managing the perceptions and expectations of different passenger groups as air travel begins to return.     

Nostalgia,Identity and Tourism: Bollywood in the Indian Diaspora

In today's global world of movement our personal identities are changing. So, ‘where is my “home”?’ and ‘what is my “identity”?’ have become essential questions in one's life. In recent times, more and more diasporic communities visit their homelands, perhaps to reroot their identities. This study explored the influence of Bollywood movies in the Indian diaspora's identity construction and notions of home and tourism behaviour to India. Findings revealed that the Indian diaspora's imagination of India is strongly informed by Bollywood movies. Yet, different generations of the Indian diaspora have different reasons for travelling to India. The first generation's nostalgia arises from watching Bollywood movies, and as a result, creates a motivation to travel to India. The second generation's main to travel behaviour to India is to experience the new ‘modern’ country, portrayed in the affluent surroundings of contemporary Bollywood movies. And, for those first generations, who have never seen India before, Bollywood movies enable them to romanticise their homeland and create an urge to visit India. Thus, Bollywood movies have immense importance in the Indian diaspora's identity construction, promote diaspora tourism and constitute a huge opportunity for economic development.     

Housing mobility and travel behaviour: A process-oriented approach to spatial mobility: Evidence from a new research field in Germany

During recent years, some effort has been made to understand the location changes in the life course underlying travel demand in Germany. Such studies have presented travel behaviour and long-term housing mobility as intertwined decision flows within the life course. This perspective calls for new methods, for example comparisons of travel behaviour before and after relocation, or comparisons between different ‘relocation types’. A number of studies have taken on this new perspective. Although there are certain methodological problems arising, notable progress has already been achieved towards a more precise understanding of travel demand. This includes the investigation of the use of transport modes as well as travelled distances and activity spaces. This contribution provides an overview on these studies. Theoretical groundwork, empirically validated aspects, and deficits and blind spots of research are being discussed.     

International university students’ travel risk perceptions: an exploratory study

Tourism researchers have identified the impact of perceived risk on destination choice and travel behaviour, and differences in general traveller risk perceptions based on both traveller and trip characteristics. However, such research has neglected the travel of international university students, despite the expansion and economic importance of this market. This paper outlines an exploratory study conducted on international university students studying at an Australian university. A total of 407 valid responses from the sample were achieved. Factor analysis identified four main risk factors which were labelled ‘human-induced risk’, ‘social–psychological risk’, ‘financial risk’, and ‘health risk’. Student origins were found to influence risk perceptions. In particular, Asian students perceived higher levels of human-induced and social–psychological risks compared with students primarily from America and Europe. Travel experience and repeat visitation significantly reduced risk factors apart from health risks. Financial risks were higher for students planning to travel in Australia compared with Asia and America. The implications for destination marketing are considered, and future research avenues based on the results are outlined.     

Do rural older adults take fewer trips than their urban counterparts for lack of a ride?

Aging and the presence of one or more illnesses result in limited travel for many adults age 65 and over. Yet, the need to get to essential, social, and non-emergency medical destinations endures. At some point in their life, older adults become dependent on family/friends, or rely on for-profit/not-for-profit transportation services for their mobility needs, while some do not go on certain trips. Researchers have studied out-of-home activity and mobility of older adults using data on trips taken. There is a gap, however, in understanding trips not taken in the older adult population in rural versus urban locations. Our objectives in this paper are: (i) to investigate unmet travel needs of older adults by relying on responses for trips not taken; (ii) to examine how personal abilities, living situation, and socio-demographic factors are associated with trips not taken to various destinations; and (iii) to compare the likelihood of trips not taken due to lack of a ride in urban versus rural locations across the age and income spectrum. Our data come from a phone survey conducted across the province of Alberta, Canada, in 2017–18 (n = 1390). We specify ordinal logistic models where the dependent variable is how often a respondent did not undertake a trip due to not having a ride to various trip destinations. We find that rural seniors are more likely to not take trips compared to older adults in cities, holding all else equal including driving cessation, worsening health, and disability. Rural seniors who live alone or in low-density housing are also more likely to not take trips compared to urban older adults. Household income, however, tempers these location preferences. Our findings suggest that rural older adults can be supported through income transfers, community-based low-cost travel, and moving to higher-density residential locations.     

The self‐presentation and self‐development of serious wildlife tourists

The notion of self‐concept and choice of tourism products has yet to be applied to wildlife tourism. The question of how consumers perceive themselves is considered fundamental to understanding purchase and consumption behaviours. This ethnographic study is based upon ‘serious’ wildlife tourism participants, for whom studying fauna and flora is the primary motivation for travel. The findings demonstrate how the ‘culture’ of ‘serious’ wildlife tourism is made up of individuals who differentiate themselves from other tourists in terms of dress, behaviour, development of skills, equipment and intellectual capital, illustrated by their desire to scope, identify and photograph wildlife. Copyright © 2009 John Wiley & Sons, Ltd.     

The safe mobility of older drivers: a challenge for urban road designers

For many older adults in most of the Western world, continued mobility (with associated health, well-being, independence and quality of life) means access to a private vehicle, either as a driver or as a passenger. However older driver serious injury and fatality rates per distance travelled are higher than middle-aged drivers, and crash and injury rates are likely to increase in the coming decades as a result of the ageing population, increased car ownership and overall travel amongst older people. Evidence suggests that contributory factors to this high risk are (for most) frailty, (for some) the high proportion of driving in urban areas, and (for a few) reduced fitness to drive as a result of medical conditions and associated functional limitations. Australasia has recently adopted the ‘Safe System’ approach which aims to manage vehicles, the road infrastructure, speeds, and the interactions between these components, to ensure that when crashes do occur, crash energies will remain at levels that minimize the probability of death and serious injury. A system which aspires to achieving Safe System objectives cannot ignore the challenges that older road users pose – and will pose – to the transport system. This paper discusses the so-called ‘older driver problem’, presents crash data and evidence of the impacts of driving location and reduced fitness to drive on crash risk, and recommends countermeasures within the ‘Safe System’ context, with particular reference to urban road design and operation.     

An explanation of the relationship between adults’ work trip mode and children’s school trip mode through the Heckman approach

Most studies on children’s travel hypothesize that the characteristics of children, households, schools, and neighborhoods exogenously affect their travel mode to school. This study makes an additional assumption that children’s mode to school and household adults’ travel mode to work are interrelated because of a lifestyle choice made by parents and caregivers. With this assumption, Heckman probit models were used with data from the 2009 US National Household Travel Survey to predict household adults’ travel mode to work and children’s travel mode to school jointly. It found strong evidence that household adults’ decision to drive to work significantly increases the probability of children being dropped off at school and decreases their likelihood of walking and bicycling, but not vice versa. As adults’ mode choice is more fundamental in the household decision-making process, the study suggests that children’s mode choice studies should not ignore how parents or caregivers travel to work.