Abstract This study aimed to to 1) examine customer satisfaction and safety associated with spa massage intervention and 2) explore customer perceptions of health and hygiene practices. Thirty spa users who met the eligibility criteria were recruited from a wellness spa operating under the WellHotel^® Establishment standard in southern Thailand. Quantitative data were analyzed using descriptive statistics. Intervention safety was defined as the absence of major adverse events and a minor adverse event rate of less than 3%. Qualitative data from in-depth interviews were analyzed using content analysis. Results indicated that participants reported high overall satisfaction with spa experience massage, and no adverse events were observed. Qualitative findings revealed that customers highly valued the spa’s strong commitment to safety, professionalism, and exceptional service quality. These findings provide practical insights for wellness spa operators and destinations seeking to strengthen their position in special-interest wellness tourism market. Nurses play an essential role in safeguarding the health and safety of both clients and staff in wellness spa settings during and beyond pandemic situations. Further research with larger samples is warranted.

Keywords: Wellness SPA, Satisfaction, COVID-19, Pandemics

Funding: This study was supported by Program Management Unit for Competitiveness (PMU-C), Office of Higher Education, Science, Research, and Innovation Policy Council via Chiang Mai University under [C10F640040].

Citation:  Klunklin, A., Uppor, W., Thana, K., and Chareonpakdee, P. 2026.  Safety and Perception of spa experience during COVID-19 pandemic: A study from Thailand. Natural and Life Sciences Communications. 25(3): e2026065.

Graphical Abstract:

INTRODUCTION

The Thailand government deployed a strategy to make Thailand a hub for medical and wellness tourism activities (Ministry of Tourism and Sport of Thailand, 2024; Thailand Board of Investment, 2024) unfortunately Thailand has been dealing with the COVID-19 pandemic in late 2019 through 2022. During the outbreak of COVID-19, several policies and measures that aimed to relieve the pandemic were implemented by the Thai government. Various restrictions seemed unbeatable challenges for the travel, tourism, and hospitality businesses (Thailand Board of Investment, 2024).  Effectively managing the pandemic crisis is a part of the government’s strategy to ensure that Thailand’s economy will continuously develop.

As the changes in modern lifestyles and increased sedentary work during pandemics (Alonso et al., 2021) the motivation by desire to use wellness services related to health promotion, disease prevention, and/or rehabilitation on physical and mental states such as holistic health is gradually increasing (Alonso et al. 2021; Thailand Board of Investment, 2024). According to Global Wellness Institute (Global Wellness Institute, 2024), Thailand’s wellness tourism marketplaces as a top five in Asia-Pacific with a 36% annual growth during 2020-2022. Thailand’s wellness tourism is estimated to be worth 7.8 billion US dollars in 2022 (Global Wellness Institute, 2024). Currently, Thailand is actively promoting itself as a leading destination for wellness tourism, including wellness spa and sports, to increase national incomes. Wellness spas are often incorporated traditional Thai therapies and herbal remedies for services’ regimes, then a major challenge in the wellness spa industry is ensuring consistent quality standards. The influx of new entrepreneurs can make it difficult for wellness clients to identify high-quality providers that meet expected health and well-being standards (Baker et al., 2020; Alonso et al., 2021; Global Wellness Institute, 2024).

The wellness spa owners were working very hard to find a way to deliver their products and maintain a high standard of services (Alonso et al., 2021; Huang et al., 2023). They recognized changes in safety and hygiene requirements, focusing on generating alternative revenue while operating the services (Baker et al., 2020).  Hence, the provision conditions for wellness tourism destinations and wellness spa establishments to make their customers feel safer on the service provided were health and hygiene. Whenever health and hygiene conditions meet high standards, the level of customers satisfaction is increased, and then tourists will become more comfortable spending time and money on wellness products and services (Luo et al., 2018; Baker et al., 2020; Huang et al., 2023). Customers’ safety is the priority for the owners of wellness spa and wellness hotel businesses that are reopening and providing travel services to inbound and outbound customers (Luo et al., 2018; Thailand Board of Investment, 2024). Measures to ensure safety, such as temperature checks upon arrival, sanitizing with disinfection, social distancing, contactless service options, and personal protective equipment, may not be enough to convince existing and new customers.

According to the survey for the Marketeer (Marketeer, 2024) Thai wellness spa have been recognized as the most preferred destination for wellness tourists (Global Wellness Institute, 2024; Thailand Board of Investment, 2024). This health trend was divided into two generations: those over 40 years and the younger generation stressed out from work. Office syndrome is usually discovered in people who spend time in front of a computer at their office (Jaromi et al., 2012; Bontrup et al., 2019). With the work-from-home regulation during the pandemic, people are now spending most of their time in front of a computer screen at home. Office syndrome is pain or soreness in the neck, back and shoulder muscles often caused by sitting in the same position for too long (Jaromi et al., 2012; Kong, 2013; Bontrup et al., 2019). A new prototype of wellness spa treatment for people with office syndrome was established to sustain the customers who are seeking good health with high-purchasing-power customers and whose attracted by premium treatments and services. A prototype of wellness spa treatment for individuals with office syndrome, known as Princeville Experience Massage, was created by professional nurses using the combination of unique Thai Traditional massage with hot Thai herbal compress ball, and essential oil extraction from local southern Thai herbs. The wellness spa treatment can manipulate soft tissue in the neck and shoulder, and back muscle for therapeutic purposes using components of image, taste, scent, sound, and touch (Klunklin et al., 2021) and then, ensuring the principle of holistic wellness, including physical, mental, emotional, intellectual, and occupational domains (Klunklin et al., 2021).

With global competition for products and services, the overall quality of wellness treatment must be concerned about customers' satisfaction and loyalty. The satisfaction of customers is imperative for wellness spa experiences in health establishments for customers' engagement and repeated purchases (Sangpikul, 2022). Wellness spa establishments involve mostly experiential products, which mainly depends on the quality of the service delivered (Sangpikul, 2022). Customers' satisfaction depends on the gap between customers' pre-purchase expectations and perceived after-purchase service quality (Parasuraman et al., 1988). If the delivered service meets or exceeds expected service quality, consumers are likely to be satisfied; conversely, if the delivered service fails to meet expectations, consumers tend to be dissatisfied (Parasuraman et al., 1988; Sangpikul, 2022). Achieving customer satisfaction is significant in facilitating customer loyalty and improving service quality, essential for business success (Baloglu et al., 2018; Bi et al., 2019). Therefore, it was necessary to discover the customers’ satisfaction and reveal their preferences for wellness spa treatment.

This study adopted the model of service quality, customer value, and customer satisfaction by Haemoon Oh (1999). The model highlights how customers perceived service quality based on their perceptions of what is received and how service experience meets their expectations. Wellness spa is a holistic approach to health care that combines both science and art in its services (Klunklin, 2018; Klunklin et al., 2021). Currently, wellness spas are gaining significant popularity in Thailand, especially as individuals increasingly prioritize their own health and well-being. This study aimed to 1) examine level of satisfaction and safety of using spa massage and 2) explore perception of health and hygiene among customers.

MATERIALS AND METHODS

Study design

This study employed a cross-sectional design, utilizing a combined approach of both quantitative and qualitative methods to examine the perception and safety of using spa massage (Creswell, 2013). Quantitative data were collected first through a questionnaire survey. The secondary qualitative research examined customers' perceptions of health and hygiene during the COVID-19 outbreak, using interviews.

Sample and setting

A total of 30 spa clients was recruited using convenience sampling between February 1 and June 30, 2022, at the wellness spa center in WellHotel^® Southern, Thailand. Sample size was determined in consideration of pilot testing to explore nature of this study, as it is the first implementation of a nurse-led intervention integrating unique Thai Traditional massage with hot Thai herbal compress ball, and essential oil extraction from local Thai herbs into a single program.

Inclusion criteria: 1) being age 20 years or older; 2) able to speak and understand Thai; 3) able to hear normal conversation; 4) able to participate in an interview; 5) cognitively oriented to person, place, and time; and 6) willing to participate in the study. Exclusion criteria: having allergic history for example such as aromatherapy oils, herbs or hot compresses conjunction with massage.

Intervention

The spa experience massage was a nurse-designed intervention developed to alleviate symptoms of office syndrome. The protocol combined traditional Thai massage techniques with using hot herbal compresses and essential oils extracted from local southern Thai herbs. This 90-minute session focused on stimulating soft tissues of neck and shoulder areas. Such targeted stimulation may enhance tissue function and promote overall health and healing (Weerapong et al., 2005; Crane et al., 2012).

Certified spa therapists received training in the spa experience massage protocol conducted by principal investigator and research team. The training session lasted approximately three hours and included both theoretical instruction and practical application. During training session, spa therapists were instructed on how to communicate the intervention procedure to participants and accurately identify anatomical landmarks for massage and hot compress applications. Correct techniques were verified through return-demonstration and structured feedback.

Instruments

Quantitative part

The quantitative questionnaire consisted of three questionnaires. The reliability of questionnaires was tested among 15 convenient participants who met the same criteria and had characteristics similar to study participants.

Sociodemographic data sheet was pecifically developed by the research team to collect demographic information from participants, including age, gender, and medical history such as past injuries and illnesses.

Customer satisfaction for spa experience was designed by the research team, this questionnaire aimed to evaluate participants’ satisfaction with thier spa experience and massage intervention. The questionnaire consisted of 15 items rated on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The items were organized into three subscales: health and hygiene, safety, and personnel and service quality. To establish content validity, six independent experts in spa and traditional Thai treatment reviewed the instrument. The content validity indices demonstrated strong results, with a Scale-level Content Validity Index, Averaging (S-CVI/Ave) of 0.82, and Item-level Content Validity Index values ranging from 0.80 to 1.00. Crucially, all 15 items achieved I-CVI values exceeding the recommended threshold of 0.78, indicating excellent item-level content validity. Furthermore, the instrument exhibited good internal consistency, with Cronbach's alpha coefficients ranging from 0.80 for the Health and Hygiene subscale to 0.84 for the Personnel and Service Quality subscale. Adverse Events after wellness spa treatment assessment were determined and document any adverse events occurring within 24 hours following wellness spa treatment. Adverse events were defined as any untoward medical occurrence affecting a participant after treatment, regardless of whether it was related to the wellness spa treatment itself. Assessment specifically looked for local and/or systematic reaction. If unexpected responses related to wellness spa treatment occurred, the type, severity and frequency were reported. The severity of each adverse was graded 1 (mild) to 3 (severe) according to Spilker’s AE classification (Spilker, 1991; Raisch et al., 2001). Inaddition, any burn wounds were identified and classified according to their degree, between first to third degree Wasiak et al. (2009).

Qualitative part

The qualitative data collection was guided by a semi-structured interview protocol. Prior to its implementation, interview guideline underwent expert review and was pilot tested with a small sample group to identify any potential shortcomings and facilitate necessary improvements. The guideline included two primary questions: (1) Do you think our hygiene standards meet your expectations? and (2) What did you enjoy most about your experience with this spa service?  Additional probing questions were employed to encourage participants to provide richer and more detailed, such as "Can you elaborate on that?" and "Could you give more detail?"

Data collection

Data were collected after the IRB approval (approval number: 2564-EXP104). The research team explained the purpose of the study and obtained informed consent, including voice record consent. After obtaining permission, the research coordinator collected quantitative data from wellness spa customers using paper-pencil questionnaires. After finishing collecting the quantitative data. An interesting issue emerged from the open question in the qualitative research about health and hygiene during the COVID-19 outbreak. Each participant was interviewed for about 15-30 minutes. All in-depth interviews were held in a private meeting room of spa. The participants and answers remained anonymous. The safety and health of the study team and participants was our primary concern during the COVID-19 pandemic. Throughout the collection time, researchers and participants were required to wear surgical facemask and perform hand hygiene using hand sanitizer or hand washing with soap and water.

Statistical analysis

All quantitative data were exported into Excel and descriptive analysis (mean, standard deviation, range) was conducted to characterize the sample and pain survey data. Analysis of qualitative data focused on usability analysis. Research staff (WU and AK) listened to and corrected transcriptions. Each text unit yielded a unique usability statement that was coded for health and hygiene protocols, safety and professionalism, and service quality & experience. The findings of the in-depth interview were content analyzed with ATLAS.ti software to gather and organize the code into categories and interpret to answer the research questions (Spilker, 1991). Data triangulation was achieved using the same focus group discussion and in-depth interview guide to improve credibility.

Ethical consideration

This study was approved by the Faculty of Nursing, Chiang Mai University Ethic Committee Review Board (Approval Number: 2564-EXP104). The research statement described the detailed explanation of the study’s purposes, methodology, and time requirements. Participants were informed that participation in this study is voluntary, so they could refuse to participate and withdraw from the study at any time without adverse effects or repercussions. All questionnaires were kept confidential, and that data were analyzed and reported anonymously, according to the rules of good clinical practice and the Declaration of Helsinki.

RESULTS

Quantitative part

Participant characteristics

A total of 30 study participants completed data collection and were included in this study analysis. The majority of sample were female (n=26, 86.67%). Mean age of the participants in the sample was 45.37 ± 14.61 years old (range 20-59 years). All participants experienced muscle pain in the neck, shoulders and back. The average pain score was 3.24 (SD=2.1).

Table 1. Socio-demographic characteristics.

Customer satisfaction with spa experience massage

Analysis of customer satisfaction revealed high overall satisfaction with spa experience massage. Participants reported the highest mean score in the personnel and service subscale (x = 4.86, SD = 0.35), indicating strong satisfaction with staff performance and service quality. Similarly, high mean scores were observed in safety subscale (x = 4.85, SD = 0.36) and health and hygiene subscale (x = 4.68, SD = 0.82), reflecting positive perceptions across all domains.

Evaluation of safety on using spa experience massage

All participants successfully completed the spa experience massage intervention without experiencing any adverse events. No cases of muscle soreness, skin burns, bruising, or pain were reported during or after the sessions. Likewise, there were no reports of unrelated adverse events, such as postural hypotension, dizziness, or falls.

Qualitative part

The content analysis follows the Krippendorff approach (Krippendorff, 2013). The first step, utilizing the data segment by reading the texts that were transcribed and highlighting excerpts in the text every time a spa service was mentioned. Then, limited our observations to the segments of text that related the customer satisfaction, safety, and service quality. Second, coded data emerged about health and hygiene standards in the spa, and the coding category. Finally, the steps of inferring and narrating represent data analysis and interpretation of findings, which customer satisfaction data revealed three key themes driving spa success: comprehensive wellness measures, a strong commitment to safety and professionalism, and an exceptional service experience, presented in carefully selected quotes (Table 2).

Table 2. Overview of coding of spa customers’ perceptions and experiences of the feasibility and safety of using Princeville massage.

(1) Health and Hygiene Protocols

First, under the theme of health and hygiene protocols, customer satisfaction is rooted in visible and systematic cleanliness. This is not limited to a single action but is a comprehensive approach. Key codes identified include staff hygiene & presentation, noting that customers value the personal cleanliness of therapists, such as appropriate attire, hand washing (Figure 1), and extending this to sanitary food service, service area sanitization between clients (Figure 2), and a clear surface disinfection protocol for common areas. Finally, a structured approach to infection control & waste management further solidifies customer confidence in the spa's commitment to hygiene.

(2) Safety and Professionalism

The second theme, safety and professionalism, highlights that trust is built upon the expertise of the staff and the quality of the products. A crucial element here is the client risk assessment. The spa actively screens for health conditions to ensure client safety. This is complemented by high ratings for staff competence & professionalism during treatments. Satisfaction is further enhanced by the use of high-quality natural products, specifically local essential oils, which signal authenticity and quality to the customer. The application of the treatment itself is also coded as being safe and comfortable.

(3) Service Quality & Client Experience

Finally, the service quality & client experience theme demonstrates excellence in the customer journey from start to finish. The single highest-rated item, coded as accredited staff training, shows that customers place immense value on certified expertise. The experience is supported by practical elements like service accessibility through easy booking and clear policies. The spa also focuses on the sensory experience through ambiance curation with relaxing music. The process is made seamless with transparent & modern transactions, including clear pricing and cashless options. Ultimately, these elements combine to produce the desired holistic relaxation outcome, fulfilling the core promise of a wellness spa.

DISCUSSION

This study examines level of satisfaction and safety of using spa massage; and explore perception of health and hygiene among customers during the COVID-19 pandemic at a wellness spa within a WellHotel^® Establishment in southern Thailand.  The findings suggest that the spa experience massage is a safe and well-tolerated intervention for spa customers. Further, the new prototype of SPA treatment for people with office syndrome is known as the spa Experience Massage, was utilized with all the participants. The findings demonstrated that health spa customers were satisfied with the new treatment and the steps to protect their health and safety.

 For the three subscales of wellness customers’ satisfaction reported high satisfaction with services from wellness spa personnel and the safety subscale. These findings were similar to the previous study by Klunklin et al. (2021), that spa staff mainly performed the services, and massage, which are core components of positive spa services, creating relaxation and comfort for customers. Furthermore, Vryoni et al. (2017) found that comfort was associated with spa staff ability and capability. The new types of spa services and innovations should be further developed to compete with the wellness of spa services.

However, the COVID-19 pandemic has brought unprecedented challenges to the wellness spa establishment. Although the wellness spa businesses have gradually recovered under the guidelines and protocols of the Thailand government, the pandemics continues to influence service and treatment in wellness spas within health establishments because customers’ satisfaction dimensions have changed (Chuenyindee et al., 2022). The fundamental determinants for consumers’ satisfaction after pandemics are the value of health and hygiene; the safety of the prototype of wellness spa treatment for office syndrome played an increasingly dominant role in achieving customer satisfaction. Higher customer satisfaction leads to higher brand loyalty (Klunklin, 2018; Matsuoka, 2022). On the contrary, for example, when COVID-19 safety guidelines were not implemented well in the wellness spa business, customers are likely to feel bad and unsatisfied with the service. As a result, they are less likely to return to the same wellness spa establishments even if they had good experiences before the pandemic (Kostromitina et al., 2021).

Previous studies have extensively explored customer satisfaction, and several gaps still exist. First, evidence suggests that pandemics and epidemics have an impact on customers’ level and valued determinants of satisfaction (Zibarzani et al., 2021). Most studies focused on understanding major attributes before the pandemic; how customer preferences change in the face of COVID-19 pandemic is still unknown (Smith et al., 2020; Zibarzani et al., 2021). Second, according to a systematic review of customer satisfaction in the hospitality and tourism industry, customer satisfaction in spas was under-explored (Prayag et al., 2018). Satisfied customers may transit to loyal customers, who would provide positive comments, repurchase the product or service, or recommend the brand to others. Furthermore, satisfied customers are less likely to switch to competing firms (Vildová et al., 2015; Chikazhe et al., 2021). Conversely, unsatisfied customers may hesitate to return to the product/service or spread negative comments, which would cause damage to the brand’s reputation and image (Chikazhe et al., 2021; Sangsri et al., 2021). Building consumer brand loyalty and fidelity has become increasingly crucial for business success, especially when remaining customers is more economically effective than attracting new customers (Vildová et al., 2015; Kotler et al., 2022). Maintaining high customer satisfaction is vital to increasing customers’ brand loyalty (Kostromitina et al., 2021; Sangpikul, 2022).

LIMITATIONS

There are some limitations of this study should be acknowledged. First, relatively small sample size (N = 30) may limit generalizability of findings and reduce statistical power to detect the intervention efficiency. Future studies should include larger sample sizes to more adequately evaluate effectiveness of intervention and to examine its long-term impact on relieving office syndrome symptoms. Second, intervention period was relatively short. Due to the use of convenience sampling during the COVID-19 pandemic, the duration and frequency of treatment sessions were constrained. Therefore, it remains unclear whether intervention achieved its maximal therapeutic efficacy within study timeframe. Future research with longer intervention and follow-up period is recommended to more comprehensively assess sustained effectiveness. Finally, the use of convenience sampling may have introduced selection bias, which could further limit the representativeness of sample. Subsequent studies employing randomized sampling methods are warranted to strengthen methodological rigor and enhance validity of research findings.

CONCLUSION

In overall, wellness spa customers in this study indicated the high-level satisfaction in all subscales of health and hygiene, safety, and personnel and service quality. It can be stated that the perception of using a nurse designed wellness spa treatment relieving office syndrome that greatly meet customer expectations. While the pandemics can lead to sudden change in social lifestyles, nurse-designed wellness treatment can also ensure health and hygiene safety for wellness customers. Based on the results of this study, nurses have a major role to play in protecting the public and staff in wellness spa establishments during and after pandemics. Additional research is needed to develop and test more wellness nurse-designed interventions targeting specific holistic wellness care.

ACKNOWLEDGEMENT

We thank the research participants who contributed to this research. Also, we would like to thank Yane Yan for clerical support in preparing this manuscript.

AUTHOR CONTRIBUTIONS

Areewan Klunklin: Conceptualization (Lead), Data Curation (Lead), Validation (Lead), Writing – Original Draft (Lead), Funding Acquisition (Lead); Wassana Uppor: Conceptualization(Equal), Data Curation (Equal), Formal Analysis (Equal), Validation (Equal), Writing – Review & Editing (Equal); Kanjana Thana: Data Curation (Equal), Formal Analysis (Equal), Validation (Equal), Writing – Review & Editing (Equal); Prachayaporn Chareonpakdee: Data Curation (Equal), Formal Analysis (Equal), Validation (Equal), Writing – Review & Editing (Supporting).

CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest.

REFERENCES

Alonso, J., Vilagut, G., Mortier, P., Ferrer, M., Alayo, I., Aragón-Peña, A., Aragonès, E., Campos, M., Cura-González, I.D., Emparanza, J.I., et al. 2021. Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey. Revista de Psiquiatria y Salud Mental. 14(2): 90–105. https://doi.org/10.1016/j.rpsm.2020.12.001

Baker, S.R., Farrokhnia, R.A., Meyer, S., Pagel, M., and Yannelis, C. 2020.  How does household spending respond to an epidemic? Consumption during the 2020 COVID-19 Pandemic. Review of Asset Pricing Studies. 10(4): 834-862. https://doi.org/10.1093/rapstu/raaa009

Baloglu, S., Busser, J., and Cain, L. 2018. Impact of experience on emotional well-being and loyalty. Journal of Hospitality Marketing & Management. 28(4): 427-445. https://doi.org/10.1080/19368623.2019.1527269

Bi, J-W., Liu, Y., Fan, Z-P., and Cambria, E. 2019. Modeling customer satisfaction from online reviews using ensemble neural network and effect-based Kano model. International Journal of Production Research. 57(22): 7068-7088. https://doi.org/10.1080/00207543.2019.1574989

Bontrup, C., Taylor, W.R., Fliesser, M., Visscher, R., Green, T., Wippert, P.M., and Zemp, R. 2019. Low back pain and its relationship with sitting behaviour among sedentary office workers. Applied Ergonomics. 81: 102894. https://doi:10.1016/j.apergo.102894

Crane, J.D., Ogborn, D.I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J.M., and Tarnopolsky, M.A. 2012. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine. 4(119): 119ra13. https://doi.org/10.1126/scitranslmed.3002882

Creswell, J.W. 2013. Qualitative Inquiry & Research Design: Choosing among Five Approaches (3^rd ed.). Thousand Oaks, CA: SAGE Publications.

Chikazhe, L., Makanyeza, C., and Chigunhah, B. 2021. Understanding mediators and moderators of the effect of customer satisfaction on loyalty. Cogent Business & Management. 8(1): 1922127. https://doi.org/10.1080/23311975.2021.1922127

Chuenyindee, T., Ong, A.K.S., Ramos, J.P., Prasetyo, Y.T., Nadlifatin, R., Kurata, Y.B., and Sittiwatethanasiri, T. 2022. Public utility vehicle service quality and customer satisfaction in the Philippines during the COVID-19 pandemic. Utilities Policy. 75: 101336. https://doi.org/10.1016/j.jup.2022.101336

Global Wellness Institute. 2024. Thailand Wellness Economic Report 2023. https://globalwellnessinstitute.org/geography-of-wellness/wellness-in-thailand/

Huang, Y-H., Meyer, B., Connolly, D., and Strader, T. 2023. Preparing for a future crisis: Using DEA-based performance analysis to assess initial pandemic responses in the Taiwanese hotel industry. International Hospitality Review. 38(2): 297-316. https://doi:10.1108/IHR-01-2023-0003

Jaromi, M., Nemeth, A., Kranicz, J., Laczko, T., and Betlehem, J. 2012. Treatment and ergonomics training of work-related lower back pain and body posture problems for nurses. Journal of Clinical Nursing. 21(11-12): 1776-1784. https://doi:10.1111/j.1365-2702.2012.04089.x

Klunklin, A., Sansiriphun, N., Viseskul, N., Sawasdisingha, P., Sripetchwande, N., Chaisang, S., and Charoenpakdee, P. 2021. Lanna spa model for health in Thailand. Chaing Mai University Journal of Natural Science. 20(4): e2021071. https://doi.org/10.12982/CMUJNS.2021.071

Klunklin, A. 2018. Basic knowledge about health spa. Training documents of Lanna health spa service model. Chiang Mai: Siampimnana.

Kong, L.J., Zhan, H.S., Cheng, Y.W., Yuan, W.A., Chen, B., and Fang, M. 2013. Massage therapy for neck and shoulder pain: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2013: 613279. https://doi:10.1155/2013/613279

Kostromitina, M., Keller, D., Cavusogl, M., and Beloin, K. 2021. His lack of a mask ruined everything. Restaurant customer satisfaction during the COVID-19 outbreak: An analysis of Yelp review texts and star-ratings. International Journal of Hospitality Management. 98: 103048. https://doi.org/10.1016/j.ijhm.2021.103048

Kotler, P., Bowen, J.T., Makens, J., and Baloglu, S. 2017. Marketing for Hospitality and Tourism. Boston, MA: Pearson Education.

Krippendorff, K. 2013. Content Analysis. An Introduction to Its Methodology (3^rd ed). California CA: SAGE Publications.

Luo, Y., Chiang, L., Eojina, K., Liang, R.T., and Sung, M.S. 2018. Towards quality of life: The effects of the wellness tourism experience. Journal of Travel & Tourism Marketing. 35 (4): 410–424. https://doi:10.1080/10548408.2017.1358236

Marketeer. 2024. Trend for Health & Wellness in 2024. https://marketeeronline.co/archives/338462

Matsuoka, K. 2022. Effects of revenue management on perceived value, customer satisfaction, and customer loyalty. Journal of Business Research. 148: 131-148. https://doi.org/10.1016/j.jbusres.2022.04.052

Ministry of Tourism and Sport of Thailand. 2024. Sports authority of Thailand, in collaboration with Ministry of Public Health, develops and promotes Thailand to be the hub of Medical and Wellness Tourism within 10 years. https://www.mots.go.th/mots_en/news/3314

Oh, H. 1999. Service quality, customer satisfaction, and customer value: A holistic perspective. International Journal of Hospitality Management. 18(1): 67-82. https://doi.org/10.1016/S0278-4319(98)00047-4

Parasuraman, A., Zeithaml, V.A., and Berry, L.L. 1988. SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing. 64(1): 12-40. https://doi.org/10.1016/S0148-2963(99)00084-3

Prayag, G., Hassibi, S., and Nunkoo, R. 2018. A systematic review of consumer satisfaction studies in hospitality journals: Conceptual development, research approaches and future prospects. Journal of Hospitality Marketing & Management. 28(1): 51-80. https://doi.org/10.1080/19368623.2018.1504367

Raisch, D.W., Troutman, W.G., Sather, M.R., and Fudala, P.J. 2001. Variability in the assessment of adverse events in a multicenter clinical trial. Clinical Therapeutics. 23(12): 2011–2020. https://doi.org/10.1016/s0149-2918(01)80153-3

Sangpikul, A. 2022. Understanding dissatisfied customers’ expectations of spa service quality. Academica Turistica-Tourism and Innovation Journal. 15(2): 265-279. https://doi.org/10.26493/2335-4194.15.265-279

Sangsri, E., Ruanguttamanan, C., and Wongkhae, K. 2021. An assessment of service quality By Thai Sappaya spa customers: An empirical analysis. Academy of Strategic Management Journal. 20(3): 1-10. https://www.scopus.com/pages/publications/85105822659

Smith, M.K., Jancsik, A., and Puczkó, L. 2020. Customer satisfaction in post-socialist Spas: A case study of Budapest, City of Spas. International Journal of Spa and Wellness. 3(2-3): 165-186. https://doi.org/10.1080/24721735.2020.1866330

Spilker B. 1991. Interpretation of adverse reactions. In: Spilker B., editors. Guide to Clinical Trials. New York: Raven Press. 

Thailand Board of Investment. 2024. Thailand medical destination: Finding wealth in wellness. https://www.boi.go.th/upload/content/TIRMay2020.pdf

Vildová, E., Martinčik, D., Tlučhoř, J., and Jakubíková, D. 2015. Measuring customer satisfaction and loyalty in spa companies. E+M Ekonomie a Management. 18(1): 151-168. https://doi.org/10.15240/tul/001/2015-1-012

Vryoni, S., Bakirtzoglou, P., and Ioannou, P. 2017. Customers‘ satisfaction and service quality of spa centers in Greece. Acta Kinesiologica, Suppl. (1). 11(1): 12-18

Wasiak, J. and Cleland, H. 2009. Burns (minor thermal). BMJ Clinical Evidence. 2009: 1903.

Weerapong, P., Hume, P.A., and Kolt, G.S. 2005. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Medicine. 35(3): 235–256. https://doi.org/10.2165/00007256-200535030-00004

Zibarzani, M., Abumalloh, R.A., Nilashi, M., Samad, S., Alghamdi, O.A., Nayer, F.K., Ismail, M.Y., Mohd, S., and Mohammed Akib, N.A. 2022. Customer satisfaction with restaurants service quality during COVID-19 outbreak: A two-stage methodology. Technology in Society. 70: 101977. https://doi.org/10.1016/j.techsoc.2022.101977

OPEN access freely available online

Natural and Life Sciences Communications

Chiang Mai University, Thailand. https://cmuj.cmu.ac.th