Spa tourism in Spain nowadays: current state and opportunities

Cuadernos de Turismo, 54, (2024), 201-220 Cuadernos de Turismo, nº 54, (2024); pp. 201-220 Universidad de Murcia eISSN: 1989-4635 DOI: https://doi.org/10.6018/turismo.639241 Fecha de recepción: 17 de junio de 2024. Fecha de aceptación: 18 de octubre de 2024. *University of Ciego de Ávila. Carretera a Morón, km 9 ½. 65100. CIEGO DE ÁVILA (Cuba). E-mail: [email protected] **University of Jaén. Campus Las Lagunillas s/n. 23071 JAÉN, Spain. (España). E-mail: [email protected] ***University of Granada. Campus Universitario de Cartuja. 18071 GRANADA, Spain. (España). E-mail: [email protected], [email protected] SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES Edianny Carballo-Cruz* University of Ciego de Ávila https://orcid.org/0000-0001-9628-1510 Raciel Yera** University of Jaén https://orcid.org/0000-0001-9759-261X Juan Carlos Maroto-Martos *** University of Granada https://orcid.org/0000-0002-0391-5797 Aida Pinos-Navarrete*** University of Granada https://orcid.org/0000-0003-2934-9321 ABSTRACT This research aims to analyze the current state of the thermal tourism product in Spain. Although the literature has reported some research efforts in this direction, most of them are focused on providing partial analyses and, therefore, there is still a lack of works focused on a more comprehensive view and analyzed from different perspectives. Our work fills this gap by presenting a two-way methodology. First, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach is used for the identification and analysis of relevant research papers focused on Spanish thermal centers. In addition, data provided by the Spanish Association of Spas (ANBAL) are used as a base to contrast such relevant research with the information coming from the social network tool TripAdvisor. From the E. CARBALLO-CRUZ, R. YERA, J. C. MAROTO-MARTOS Y A. PINOS-NAVARRETE202 Cuadernos de Turismo, 54, (2024), 201-220 above, it is intended to provide a regional characterization of Spanish spas. A further discussion is also presented, as well as the theoretical and practical implications of the contribution. Keywords: Health tourism; wellbeing; territorial touristic resources; social networks. El turismo de balnearios en España: Estado actual y oportunidades RESUMEN Esta investigación pretende analizar el estado actual del producto turístico termal en España. Aunque la literatura ha reportado algunos esfuerzos de investigación en esta dirección, la mayoría de ellos se centran en ofrecer análisis parciales y, por tanto, aún faltan trabajos enfocados a una visión más integral y estudiada desde diferentes perspectivas. Nuestro trabajo pretende cubrir esta brecha presentando una metodología bidireccional. En primer lugar, se utiliza el enfoque Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) para la identificación y análisis de los trabajos de investigación relevantes centrados en los centros termales españoles. Por otro lado, se utilizan como base los datos proporcionados por la Asociación Española de Balnearios (ANBAL) para contrastar dichas investigaciones relevantes con la información procedente de la herramienta de red social TripAdvisor. A partir de lo anterior, se pretende ofrecer una caracterización regional de los balnearios españoles. Asimismo, se presenta una discusión adicional, así como las implicaciones teóricas y prácticas de la contribución. Palabras clave:Turismo de salud; bienestar; recursos turísticos territoriales; redes sociales. 1. INTRODUCTION The business model and geographical patterns that define thermalism in Western Europe have undergone, as an adaptive response to globalization and post-tourism, profound changes in recent decades (Pinos, Sánchez and Maroto, 2021). Some of these changes are associated with the accelerated demographic aging of societies, which has led administrations to actively promote this process as a means of reducing the health costs derived from sedentary lifestyles and to promote rural development. Spain is internationally recognized for its abundant mineral-medicinal resources, its tradition in the practice of thermalism for therapeutic purposes and more recently, for its commitment to diversify its offer to orient it to the tourist functionality. In recent decades, treatments based on mineral-medicinal waters with salutary properties have had as their main motivation the cure and/or prevention of health, recovering more recently, other purposes that they had in the 19th century among the wealthy classes that frequented the spas: rest, promoting personal/social relations, recreational and cultural character and even aesthetic improvement. Nowadays for Maroto and Pinos (2019) in Spain there are more than 100 active spas, distributed in 16 Autonomous Communities, demonstrating that the country is an important thermal destination in Europe. The spas have a large associated SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES 203 Cuadernos de Turismo, 54, (2024), 201-220 hotel offer, around 20,000 beds, which positions them as an engine of rural development as they are located, most of them, in rural municipalities. However, beyond these recognized interest over spa and thermalism in Spain as a touristic product, as far as we know there is a lack of a comprehensive analysis on the development of innovative touristic offering around spas. Herein, it is important to take into account that instead of focusing on the physical environment, in this case we are interest on studying the spa context as a proper touristic product. According to UNWTO, the touristic product is a combination of tangible and intangible elements, such as natural, cultural and man-made resources, attractions, facilities, services and activities around a specific center of interest which represents the core of the destination marketing mix and creates an overall visitor experience including emotional aspects for the potential customers1. Over the last years, some authors have attempted to perform a global characterization of spa and thermal tourism and touristic products in Spain. Formerly, Piquilmán (2013) discussed new horizons for the spa tourism in Spain and their implications for the rural world, indicating that the current demand and the public-private collaboration have led to the reactivation of the spa tourism as a way for boosting the rural world in Spain. More recently, Sánchez (2021) was focused on the online reputation in the Spanish spa tourism inside the Covid-19 context. Furthermore, Pinos and Shaw (2021) examine the function and potential that spas have as health agents, identifying the opportunities for boosting this activity in the tourism dynamics in the case of Spain. Taking into account the lack of a comprehensive analysis on the spa and thermalism touristic product in Spain, the first aim of the current work is to provide a literature review in this direction. Subsequently, the ultimate objective of this work is to contrast this analysis performed by the literature, with the actual status of thermalism and spa in Spain as represented as recognized national-related associations and the overall opinions in TripAdvisor, in order to propose improvement directions. The novelty of our work is then three-fold: – Overall, as far as we know it is the first literature review focused on screening the research done around the spa and thermal tourist product in Spain. – An analysis of the regional distribution of the spa and thermal offering across Spain, built over the performed literature review. – The processing of information coming from reviews in social media, as a way for contrasting the findings identified in the performed literature review. The paper is structured as follows. Section 2 presents a general background required for the proposal’s understanding. Section 3 illustrates the mentioned methodology centered on exploring Spanish spas. Section 4 develops the results of this methodology by at first discussing the literature review obtained as output of the PRISMA-supported systematic review, the characterization of the Spanish thermal product in the frame of the Spanish National Association of Spas, and the territorial characterization of Spanish thermal centers according to TripAdvisor reviews. A further discussion and the theoretical and practical implications are also provided (Section 5). Finally, conclusions and future works are pointed out (Section 6). 1 https://www.unwto.org/tourism-development-products E. CARBALLO-CRUZ, R. YERA, J. C. MAROTO-MARTOS Y A. PINOS-NAVARRETE204 Cuadernos de Turismo, 54, (2024), 201-220 2. BACKGROUND Geographical studies and health tourism studies are those that have dealt most profusely with the importance of spas for the socioeconomic development of territories. These studies include research in countries such as Portugal, Argentina, the United States, Ecuador and Brazil (Rodrigues et al., 2022; Patiño and Cabanilla, 2022; Kumar and Sharma, 2020; Gambarota and Lorda, 2019). In other Latin American countries such as Peru and Mexico, some inventories on their thermal resources have been developed (Coyopol et al., 2020; Ministerio del Ambiente, 2024). In Spain, geographical studies predominate and these are focused on rural areas, mainly in those with demographic problems and tend to depopulation (Maroto and Pinos, 2019). Thermal tourism in Spain has had different stages. At the end of the 80s of the last century, a reactivation of the same took place, to a large extent, related to the promotion of social thermalism by the IMSERSO (Pilquimán-Vera, 2014). This public institution has implemented social tourism programs, mainly oriented to older adults and has set guidelines in the establishment of collaborative relationships between the public and private sector for the reactivation of thermal tourism. According to Maroto and Pinos (2019), there are more than 100 active spas in Spain, distributed in 16 Autonomous Communities, demonstrating that the country is an important thermal destination in Europe. The spas have a large associated hotel offer, around 20,000 beds, which positions them as an engine of rural development as they are located, most of them, in rural municipalities. These centers use mineral-medicinal waters to combat different pathologies, to which are added contemporary health and beauty techniques. Their main demand is made up of different user profiles (Pinos, Shaw and Martos, 2020). With the emergence and expansion of COVID-19, the thermal sector in Spain suffered a significant stagnation, like tourism in general; however, the pandemic evidenced the importance of innovation in tourism companies to stay in the market and generated opportunities for them to show their commitment to social and health responsibility (Pinos and Shaw, 2021). Herein, the renovation of these establishments, the diversification of supply and demand, the new modalities of thermalism and the consideration of the territory as a space for endogenous development; evidence the necessary reactivation of thermal tourism through tourism innovation. This paper focuses on characterizing the thermal tourism product in Spain, based on the review of the literature, its mineral-medicinal resources and from the point of view of travelers and tourists on TripAdvisor. In this way, it is important to remark that while we will use the spa term for characterizing several research works and scenarios, in our case it will be referring to places that make use of thermal/mineral waters. We think that this quotation is important in order to differentiate the scope of our work in relation to those related to the common spa (Pinos and Maroto, 2023). 3. METHODOLOGY The current research work will be based on a mixed methodology combining a qualitative and a quantitative approach (Tashakkori and Teddlie, 1998; Hernández-Samp- SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES 205 Cuadernos de Turismo, 54, (2024), 201-220 ieri, R, 2018) for characterizing the thermal touristic product in Spain. The qualitative approach is developed through the literature review of research works on thermalism in Spain. On the other hand, the quantitative approach is carried out through the analysis of the distribution of spa and thermal sources built over these reviews, and through the processing of information from social media for contrasting the findings obtained in the previous steps. In this article a systematic bibliographic analysis is carried out. With this purpose in mind, it is taken as base the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) (Page et al. 2021). Specifically, it will be adopted the first stages of this methodology, in a similar way to several reviews, previously identified and focused across diverse domains such as construction (Chung et al., 2023), financial risks (Akomea-Frimpong, I. et al. 2023), or education (Leles et al., 2024). These first stages are focused on a more general purpose, and that helps us on conducting the systematic review on thermalism in Spain. Section 4.1 will screen the methodology used for performing this review. Furthermore, Section 5 will analyse the obtained results. Figure 1 introduces the steps accomplished for performing the systematic review on thermalism in Spain, based on the initial stage of the PRISMA methodology. These steps are eligibility criteria, information sources and search strategy, the studies selection, data extraction and data items, quality evaluation, and finally the analysis of the obtained results. Below we provide some details on how each of these steps was developed, for obtaining the final results. Figure 1 SEARCH PROCESS FOR SUPPORTING THE SYSTEMATIC LITERATURE REVIEW E. CARBALLO-CRUZ, R. YERA, J. C. MAROTO-MARTOS Y A. PINOS-NAVARRETE206 Cuadernos de Turismo, 54, (2024), 201-220 Research objective: The objective of the search process is to obtain a set of representative research works characterizing the thermal touristic product in Spain. Eligibility criteria: Our search process will be driven by the following eligibility criteria: Inclusion criteria: – Papers discussing touristic products that are contextualized into thermalism and spa-related features. – Papers exploring perceptions and opinions of users about thermal centers, regarding it can lead to a direct characterization of such centers. Exclusion criteria: – Papers that characterize thermal centers, but mainly focused on the physical characteristics and not focused on presenting it as touristic product. – Papers focused on other countries, different from Spain. – Paper focused on past thermal facilities and historical issues, but not focused in the present. Information sources and search strategy. Selecting the correct information source for literature analysis is always a challenge task. In this case we choose the Web of Science Core Collection dataset, that in addition to be composed of traditional sources such as Science Citation Index, Social Science Citation Index, Arts and Humanities Citation Index, etc; it also covers the Emerging Source Citation Index, which is a source composed of high-quality emerging journals and with an inclusive nature. We use the following search queries: – tourism AND thermal AND spain – tourism AND spa AND spain Studies selection: Based on these search queries, Figure 2 illustrates the PRISMA-based methodology used for selecting the studies for developing a detailed analysis according to the initial goal. At first, the referred search queries lead to the reaching of 291 results from Web of Science Core Collection. 61 duplicated results were removed, being screened in more detail 230 registers. After analysing title, abstract, and keywords, 192 papers were discarded. Finally, 38 papers, all of them successfully retrieved, were checked in more detail. After discarding some papers due to their main focus on physical issues of the thermal installations and processes, on historical issues, or on other countries different from Spain, it is obtained a final set of 17 representative papers used for characterizing the thermal tourism and spas in Spain. Data extraction and data items: In this stage, several data were extracted from the selected papers, including title, authors, year, journal/conference, keywords, and main-referred Spanish territory. This information is used later in the step related to Analysis of the Results. Quality evaluation: The quality evaluation of the identified manuscripts was performed through a specific checklist formerly developed by Ataei and Litchfield (2022), used across diverse research fields, in the frame of the PRISMA methodology. The checklist is developed through a set of criteria made up of 7 elements, and informed by those proposed SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES 207 Cuadernos de Turismo, 54, (2024), 201-220 by CASP for assessing qualitative research (Programme CAS, 2018). The quality was agreed if at least 75% of the responses were positive for any considered work. Analysis of the results: A detailed analysis of the 17 obtained papers is presented in the following section. Figure 2 PRISMA METHODOLOGY USED FOR STUDIES SELECTION Second, in this research information from social media, such as TripAdvisor. The selection of TripAdvisor is justified due to its overall use as the leading platform for reviews of hotels, restaurants, attractions and travel experiences, highlighted by several E. CARBALLO-CRUZ, R. YERA, J. C. MAROTO-MARTOS Y A. PINOS-NAVARRETE208 Cuadernos de Turismo, 54, (2024), 201-220 authors (Gretzel and Yoo, 2008; Banerjee and Chua, 2016; Sangkaew and Zhu, 2022; Mokgehle and Fitchett, 2024). Therefore, TripAdvisor is analyzed to contrast the conclusions obtained in the previous steps from the point of view of tourists or travelers. To accomplish this task, the following steps are followed (done at June 2024). At first, they are identified in TripAdvisor the hotels associated to a group of thermal centers registered at the National Association of Spas (ANBAL) in Spain. In the cases where there is not a direct associated hotel, then it is analyzed the profile of the thermal center itself. We also point out that there were some eventual cases we did not find a reference in TripAdvisor of ANBAL’s referred centers. For each scenario, it is retrieved the amount of reviews and the average rating. Furthermore, it is retrieved the amount of reviews with their associated rating in each of the values of the rating scale Excellent (5), Very Good (4), Good (3), OK (2), Awful (1). Afterwards, for presenting synthesized results, for each autonomous community we average all the values associated to each thermal center. 4. RESULTS This section is focused on developing the methodology presented at the previous section. Herein, Section 4.1 presents the literature review focused on thermalism in Spain. Section 4.2 develops a territorial characterization of thermal centers in Spain according to TripAdvisor reviews. 4.1. A literature review of research works focused on thermalism in Spain When analyzing the final sample of articles identified using the PRISMA methodology, it is concluded that most of the papers are linked to Galicia and Andalucía, although there are also some references to Aragón, the Islas Canarias and Cataluña. Finally, some papers focused on global analysis and not centered on a specific region were also detected. In the case of Galicia, an initial work was developed by Henn-Bonfada et al. (2011), focused on identifying the importance of thermal cosmetic in Galician spas, as well as the marketing issues related to these centers. It is used a structured questionnaire as data gathering tool. It is obtained as main conclusions that the thermal cosmetic is the main resource of such spas as a new business unit, strengthening the image and creating a competitive advantage in relation to other competitors. Alén et al. (2014) focused on the use of quantitative techniques for exploring the level of well-defined differentiation strategies across Galician thermal establishments, including health resorts, spa, and thalassotherapy centers. Here the authors synthesize an analysis of 15 thermal centers, 4 thalassotherapy centers, and 7 hotels with spas. Their specific goal is to determine which services were offered with greater or lesser frequency in these establishments. Furthermore, it develops an analytic procedure for measuring the differences between these centers using a Euclidean distance matrix and clustering procedures. The results indicate that thalassotherapy centers and spas offer on average a lower number of services among the different analysed categories. This difference in relation to thermal centers, become larger regarding therapeutic indications, but is lower in the case SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES 209 Cuadernos de Turismo, 54, (2024), 201-220 of techniques. The authors suggest that Thalassotherapy centres and spas should decide carefully whether to increase the number and quality of techniques offered. Amboage et al. (2015) are centered on the study of the most representative Spa of Galicia in Facebook, using the Fanpage Karma tool, which provide data on the situation of such centers according to social media. Herein, the analysis focused on characterizing these establishments is driven by the following indicators: content, engagement, channel updating for each week, and publicity values. The selected spas where Guitiriz, Caldaria, Compostela, and Mondariz, being appreciated for each case, specific strengths and weaknesses according to each indicator. Other work focused on the same direction, was the developed by Rodríguez-Fernández et al. (2017). In a different direction, Barros et al. (2021) attempt to explore the relationship with thermal tourism consumers, suggesting a conceptual model that relates relational marketing and the result of innovation in tourism, boosting trust, commitment, quality of service, satisfaction and loyalty. Specifically, they point out the proposal of a model that would connect the relationship marketing dimensions (i.e. commitment, trust and cooperation) with the consequent satisfaction with the thermal tourist and the behavioural intention of repeating the experience or reinforcing the experience with a euroregion marketing and niche tourism perspective. The necessity of this model is screened from the context of the Galicia and Northern Portugal euroregion. In Andalucía, Anaya-Aguilar et al. (2021a) develop a usability analysis of their spa websites, by conducting an exploratory investigation of the associated content. With this aim in mind, several criteria were considered, grouped by categories based on Home Page, Contents of Website Information, Languages, Contents of Reservation Information, Other Marketing-related Content, Position in Search Engines, and Social Network following. Ten spas were selected for this analysis, overall proving that the use of new technologies in these contexts is underdeveloped, even though they have reached good positions in search engines due to the synergistic effect of the official tourism websites. In parallel, Anaya-Aguilar et al. (2021b) screen the main challenges of spa tourism in Andalucía. Specifically, the objective of the work is to understand the structural and operational dimensions of tourism’s spa, and to assess the current situation of this sector. The authors recover information from experts through a questionnaire that using the Delphi method, explores spas in relation to the legal, natural, and heritage environments, available services such as treatments, human resources and new technologies, facilities and equipment, competitive advantages, position strategies, and new images. The results suggest in Andalucía a lack of community laws regarding spas, an inadequate protection of natural results related to spas, as well as a lack of consensus on the necessity of strategies from preventing the popular imagination from relating spas with diseases or large populations. Finally, the authors also suggest that policies designed to guide this type of tourism’s expansion are still scarce in Andalucía. Anaya-Aguilar et al (2021cc) also characterizes spa-goers in Andalucía. From 725 valid survey questionnaires, it is shown that 44.6% of users are between 65 and 88 years old, that approximately 50% of respondents are retired and 60% has a monthly income of less than 1000 euros. The authors also suggest that this kind of health tourism may be also spreading among young people with less free time and financial resources, or in individuals more affected by the recent economic crisis. E. CARBALLO-CRUZ, R. YERA, J. C. MAROTO-MARTOS Y A. PINOS-NAVARRETE216 Cuadernos de Turismo, 54, (2024), 201-220 necessarily have the best positioning in TripAdvisor. Furthermore, even though most of the regions have a larger average similar among their own spas in relation to other regions, there are some scenarios that do not verify this issue but keep a larger amount of reviews and a high rating. Overall, it can be concluded that Spanish spas are characterized by a high diversity linked to the different associated contexts. On the other hand, some current limitations of this methodology are connected to the exclusive use of TripAdvisor for analyzing the client’s preferences, that even though this platform has been recognized as the leading one in this domain (Gretzel and Yoo, 2008), it could lead to some bias in the developed analysis. Another issue is the focus on the thermal centers linked to the National Association of Spas (ANBAL), that could also limit the reached findings. These issues will be regarded as starting point for the evolution of the current research. 5.3. Practical implications The developed research also leads to several implications from the managerial and practical viewpoint. In this case, the main value is the demonstration for decision makers that it is necessary a multi-view management of the spa as touristic attraction, for working towards an overall acceptance of the final users. Furthermore, the performed analysis can be considered as a diagnosis of the former potential of each region and therefore could be used as base for drawing strategies to potentiate the strengths of the territory and mitigating their weaknesses. At second, the results obtained from the TripAdvisor analysis can be taken into account for a better promotion and positioning of the corresponding regions. Finally, the discovered relationships between the research done, the inner characteristics of spas, and the TripAdvisor analysis, can be used as reference by overall spas stakeholders across different countries in order to consolidate the presence and success of their respective centers. 6. CONCLUSIONS AND FUTURE WORKS This work have developed a two-fold analysis of Spanish spas by considering a literature analysis using the PRISMA methodology, and a characterization of their presence in social media considering TripAdvisor as source. This analysis allows the discovery of several particularities of Spanish spas across different regions, having as main conclusion the presence of a high diversity with strengths and weakness in the different territories. The theoretical and practical implications have been also discussed in this context. As future work it will be considered the following research directions: 1) Incorporating information related to facilities and additional services for analyzing the strengths and weakness of each region; 2) The use of natural language computational tools for processing the TripAdvisor reviews as extra source in addition to the currently used ratings; 3) Developing a similar study for characterizing thermal centers of other regions out of Spain, and 4) The use of previously considered tools for generating competitive touristic advantages (Carballo et al., 2023), in this scenario of thermal centers. SPA TOURISM IN SPAIN NOWADAYS: CURRENT STATE AND OPPORTUNITIES 217 Cuadernos de Turismo, 54, (2024), 201-220 Authorship statement: The authors declare no conflict of interest. Conceptualization: Edianny Carballo-Cruz and Raciel Yera. Consulting and treatment of original sources: Edianny Carballo-Cruz and Raciel Yera. 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