Exploring the affecting factors on special Brand health tourism value and its effect on health tourist's loyalty in Tabriz

Introduction
Nowadays, tourism industry is one of the main economic activity among the countries. Tourism help countries to improve their infrastructures, services, and as a result, it generates a lot of activity and job creation. One of the more recent and important branch of tourism is health tourism, in this form of tourism, tourists go to medical services. Health tourism, as a branch of tourism, has many positive economic effects, especially that it has been emphasized on job creation in Iran. Considering the position of Iran in the Middle East and the potential in health and cure system, it is necessary to pay more attention to this industry in today's competitive world. The metropolis of Tabriz, the biggest city in the north west of Iran and its close proximity to the provinces of West Azerbaijan, Kurdistan and Ardabil and the nearby Caucasian countries, has provided a good place to attract health tourists by introducing its abilities for absorbing of tourists from the above mentioned cities. The intention to revisit the tourism destinations is one of the important factors which determining the success of tourism destinations. Investigating the factors influencing the intention of tourists to visit tourism destinations can help tourism manager and planners to achieve the success of tourism destinations. Therefore, the purpose of this study is to investigate the effect of the great value of health services in Tabriz on the intention of revisiting this tourist destination among health tourists traveling to Tabriz.
this study has four hypotheses;
- The destination image of Tabriz medical services has an effect on loyalty to this tourism destination.
-The perceived quality of health services of Tabriz effects on the loyalty of visitors.
-The perceived value of health services of Tabriz has an effect on the loyalty of visitors.
-The satisfaction from health services of Tabriz effects on the loyalty of visitors.
Many researches have dealt with the health tourism in recent years but in the case of Iran and especially in Tabriz there is a few researches; this fact point out the value of study in this field.
 
Methodology 
The statistical population of this study included tourists visiting health centers and hospitals of Tabriz in the summer of 2018. About 385 of them were randomly selected as samples. Data were collected via a 45-item questionnaire. The validity of the questionnaire was evaluated by using of content validation and the reliability was assessed based on Cronbach's alpha test. SPSS software was also used to analyze the data. The questionnaire was made up from five variables such as destination brand image, effect of destination image, perceived quality of health services, perceived value of health services and satisfaction, which every variable had its own indicators. These indicators were extracted from literature review. For the first variable, eight indicators were used. The second Variable had 12 indicators and for the third, fourth and fifth variables; twelve, six and seven indicators were applied, respectively. Then the data were analyzed, at first the normality test were used based on K-S normality test. Because of the test result which showed abnormality of data in this research we applied the nonparametric statistical methods. Hence at first Spearman’s correlation method was exerted. Then multivariate linear regression was applied for analyzing.
 
Results and discussion
From 385 people which were the research sample; about 57.7 percent were male and 42.3 percent were female. Exploring of sample age showed that 40.5 percent of samples were in age 18-29 years' old which were highest frequency in the sample, and about 92.2 percent of samples were from northwest and west of country. The first analysis which was applied on the questionaries' answer, was Normality checking, in this research we used K.S method for evaluation of normality, the result of this analysis indicated that the data which gathered from questionnaires were not normal, so Spearman correlation test was used. The result of correlation analysis demonstrated that between destination image and loyalty had correlation rate about 0.657, and for perceived quality and perceived value with loyalty the rates were 0.724 and 0.753 respectively. Finally, correlation rate for satisfaction and loyalty was 0.689. All coefficients were significant at the level of 0.95. Multivariate linear regression showed a general correlation coefficient between the variables equal to 0.63. The result for F test was about 166.893.    
 
Conclusion
The main goal of this research was to investigate the effect of brand equity on the absorption of visitors and tourists in the health services field.  The Intention to revisit is one of the main factors in sustainability of tourism. Many factors could influence the intention to revisit.  The research findings showed that there is a positive and significant relationship between destination image, perceived quality, perceived value and satisfaction with tourists' loyalty. Actually these factors effect on the intention to revisit. Among the mentioned variables, satisfaction index with 31%   beta coefficient had the greatest effect on the loyalty of health tourists to Tabriz health centers. And the second more important variable had 26% beta coefficient, which was perceived value. For the third variable i.e. perceived quality, the beta coefficient was 23%. Finally, the lowest beta coefficient was related to the destination image variable. As the results revealed the main factor which could effect on the health tourism trend and brand image of Tabriz is satisfaction of health services on one hand, that means services providers must pay more attention on this factor. On the other hand, the perceived value and perceived quality are the second more important variables, beside the satisfaction for health providers. The results of this study were in line with previous research, so that satisfaction was emphasized in the research of Hutchinson et al. (2009) as well as in the studies of Williams and Sutter (2009).