Abstract There has a growing trend of health spa services in Thailand over the past decade. However, little information is available about the effectiveness of a Lanna-styled spa for health. The propose of this qualitative study was to explore the Lanna Spa Model for health in Thailand. A qualitative method was used with six focus groups and in-depth, semi-structured interviews were held with a purposive selected staff who specialized in spa treatments in Northern Thailand between February and April 2017. Guided interviews focused on spa experiences, the main components of Lanna-style spa services, and suggestions for implementing the Lanna spa model for health. Data were analyzed using content analysis with the principles of trustworthiness. The health and wellness spa model consisted of four categories: 1) Identity of Lanna spa; 2) Lanna spa services (hydrotherapy, massage, and products); 3) Lanna culture; and 4) Lanna health wisdom. Lanna spa is beneficial for people as it can help promote their health and well-being. Training program and service delivery of Lanna-style spa for health should be integrated with Lanna culture and wisdom.

Keywords: Lanna spa Model, Qualitative research, Thailand

Funding: The authors are grateful for the research funding provided by the Chiang Mai University, Chiang Mai, Thailand. 

Citation: Areewan Klunklin, A., Sansiriphun,N., Viseskul, N., Sawasdisingha, P., Sripetchwandee, N.,Chaisang, S., Prachayaporn Charoenpakdee, P. 2021. Lanna Spa Model for Health in Thailand. CMU J. Nat. Sci. 20(4): e2021071.

INTRODUCTION

Spa is one of many important industries that can be used to promote people’s health (Lagrosen & Lagrosen, 2016). Spa treatment promotes mind and body relaxation in addition to stress reduction, and improves several health conditions (Frost, 2004). Spa treatment is often combined with complementary health promotion activities such as healthy food, proper exercise, fitness and meditation (Frost, 2004; Wozniak-Holecka, Romaniuk, Holecki, Aldona, Fraczkiewicz-Wronka, & Jaruga, 2017). Thailand is internationally known for wellness spa services, which have been rapidly growing (Khamanarong, Khamanarong, & Khamanarong, 2009; Han et al., 2018). Chiva Som Spa was established in 1995. Since then, the service has expanded considerably and Thailand has become the capital of spa services in the Asia Pacific region (Department of Health Service Support Ministry of Public Health, 2020). The growth rate of Thai health spa has been steadily increasing (Loh, 2011). Revenue from the Thai spa industry rose by nearly 50% from 2013 to 2015 (Suttikun, Chang, & Bicksler, 2018). Eighty percent of spa customers were expats who live in Thailand or seasonal tourists (Phongvivat & Panadis, 2011).

The north of Thailand or “Lanna” region, is totally different from the other parts of Thailand in terms of culture and tradition, cuisine, language and custom. Many spa businesses focusing on wellness tourism have been established particularly in Chiang Mai, which is the capital city of northern region. Based on Lanna culture, Lanna Spas offer treatments for physical, mental, social and spiritual health conditions (Page et al. 2017). Spa services are inspired by the integration of Thai culture and traditional alternative health practices such as Thai massage. (Ellis, 2011) and Thai herbs. Most of these experiences promote the health of customers by using Lanna-style components including images, taste, smell, sound and touch. This allowed customers to be satisfied with experiences gained from spa services such as massage for health, hydrotherapy, relaxation, energy-balancing session, aesthetic, art and music. Currently, the spa industry is highly competitive, in terms of not only spa service cost but also service quality (Khamanarong, Khamanarong, & Khamanarong, 2009).

According to the literature review, this is the first study to explore the basic information related to a model of Lanna Spa services. Therefore, further research is needed to develop the role of nurses in promoting clients’ health and provide good quality service in Lanna spas, as part of the Thai Spa model.

MATERIALS AND METHODS

Participants

Thirty-two of the participants were recruited through purposive sampling of spa owners, managers, staff, therapists and experts on spa treatments. These people were required to have experiences particularly with spa in Northern Thailand. Purposive sampling was used in this study due to a wide variation in the depth of experience, breadth of experiences, and perspectives of participants, which contributed to information-rich data (Holloway & Wheeler, 2017).

Procedure

Participants were identified and approached by a research coordinator who invited them to take part in the study. Informed consent was obtained once the participants agreed to participate in the study. The first author contacted Thai Lanna Spa association in order to explain the objectives of the study and to obtain the permission. All of the participants who volunteered to participate would take part in one to three in-depth interviews and 6 focus groups. These participants were individually interviewed in-depth and in focus groups in the private and quiet environment. One interview or one focus group lasted from 45 to 90 minutes, and was audio-taped to ensure that all of the given information was recorded.

Interview

Qualitative data were collected using in-depth, semi-structured individual interviews and focus groups. The broad questions used to guide individual interviews and focus groups for all of the participants were developed by the researchers and approved by three experts on spa services. The sample questions used to guide both individual interviews and focus groups were “Can you please tell me about your experiences of providing spa services?”, “What do you think are the main components of spa services based on Lanna context?”, and “How do you apply Lanna context to your spa services for health?” The interviews and focus groups were conducted from February to April, 2017, and ended when data saturation was achieved, meaning when there was no new information to be obtained (Holloway & Wheeler, 2017).

Data Analysis

Individual interviews and focus groups were audio-recorded, transcribed verbatim into Thai, and subsequently translated into English by the bilingual researchers for accuracy. Data were analyzed using content analysis based on Morse and Fields (1996) consisting of four cognitive processes; comprehending, synthesizing, theorizing, and re-contextualizing. Firstly, during the comprehending stage, all data from digital recordings were listened to several times and the transcripts were read several times to ensure the researcher’s full understanding of the data. Subsequently, such data were checked whether they covered all of the research questions and aims. During the synthesizing stage, the data were sifted into patterns to extract various ideas, which were interpreted line-by-line to discover the available phenomena and to verify the findings. During the theorizing stage, sub-categories were collapsed into broad categories. Data inter-relationships were compared to validate the obtained categories. During the final stage of re-contextualization, the knowledge was re-formed according to the three previous analytical processes (Morse and Fields 1996).

Rigors and trustworthiness

The principles of trustworthiness based on Lincoln & Guba (1985) were obtained for this study through dependability, credibility and confirmability. The interviews and focus groups were conducted using an interview guide and focus group guideline. The researcher listened carefully to recorded interviews and transcribed them simultaneously. The researcher followed systematic data collection and analytical processes as Morse & Fields (1996). Transcripts were then given to some participants for content confirmation.

Ethical consideration

The study was approved by the Research Ethics Review Committee of the Faculty of Nursing, Chiang Mai University. The names of all participants were concealed to protect their confidentiality and anonymity. Before the interview and focus group, written consent was obtained. Participants had the rights to refuse to participate any time during the interview or focus group.

RESULTS

Thirty-two of the participants agreed to take part in this qualitative study. The participants included 25-female (78.13%) and 7-male (21.87%) whose ages ranged from 36 to 51 years. Based on the interviews and focus groups, the categories of health and wellness spa model were generated through transcript analysis. Figure 1 illustrates the four categories of Lanna Spa Model for health in Thailand. These four categories are in a non-linear format, including 1) identity of Lanna spa, 2) Lanna spa services, 3) Lanna culture, and 4) Lanna health wisdom.

Category I: Identity of Lanna spa

The topic of spa identity was discussed in both individual in-depth interviews and focus groups. The participants described their experiences and agreed that the identity of spa must consist of five components including image, taste, smell, sound, and touch.  Each Spa should have its own identity based on Lanna style. Also, its own signature spa services should be designed and created. Sample quotes are as follows.

“We apply all components of Lanna spa identity, which includes image, taste, smell, sound and touch to provide Lanna-style services to our customers.” (P2)

“Each spa should create its own courses of service with unique Lanna style.” (P5)

Image

Spa image is concerned with environment and place, which is very important for creating a positive impression. Lanna-style model is integrated into the design of each spa. Moreover, the interviews result in the identification of two sub-components as follows.  

1) External spa image is the external architecture such as the building, place and roof. Sample quotes are as follows.

“The structure of building and roof of each spa is designed with Lanna style or integrated with Lanna style. Most spas are not in a complete Lanna style as their design is mixed with modern style.” (P1)

“The external buildings of some spas are made of wood and include wood craving in Lanna-style and decorated with Lanna plants and trees.” (P3)

 2) Internal spa image includes Lanna-style design inside the spa building such as treatment rooms, furniture, equipment, as well as uniforms of therapists, receptionists, and attendants. Sample quotes are as follows.

“We decorate the wall with Lanna-style paintings, and also put up Lanna-style cotton cloth on some parts of the wall” (P11)

“We use cotton material such as Lanna woven cloth to make uniforms for spa therapists, receptionists, and attendants.” (P25)

“The inside of each spa is decorated with images and ceramics such as containers of spa products and incent burners. We also use ceramic glasses to provide drinks to customers. Most of spa equipment is locally made in Chiang Mai” (P21)

 “Regarding furniture in spa, we use wooden beds and chairs designed in Lanna style. They are very beautiful.” (P14)

Taste

Taste comes from local plants or herbs, which are made into beverages such as herbal tea without sugar. These herbal drinks are very good for health. Taste also includes any kind of seasonal fruits that can be found locally in the north such as strawberry. Sample quotes are as follows.

“Our spa welcomes customers with herbal drinks, which are very good for health, such as lemongrass juice and Makiang (Cleistocalyx nervosum var. paniala) juice. Makiang is a local fruit full of antioxidants.” (P23)

“After providing spa service to our customers, we provide them with fresh locally-grown fruit such as strawberry or mango.” (P30)

Smell

The smell of spa comes from aromatic plants found in northern Thailand. These plants are used in order to show the unique and valuable characteristics of Lanna style. Each spa will use fresh flowers to make the place smell good and fill it with a natural scent. Some spas decorate their places with Lanna flowery plants such as gardenias. These fragrant plants can be used to develop the spa products. Some spas use flowers to make aromatherapy incense and candles, which can be used during the massage or to create good atmosphere in the spa. Sample quotes are as follows.

"There are many smells of Lanna herbs, including  fragrant northern flowers such as Indian cork flower and  other herbs, which can be used to create our spa products” (P15)

“Our spa plants gardenia trees (Lanna Flower) to create good smell. Also, Lanna people believe that gardenia flower is a sacred flower that can bring good fortune to us” (P1)

“We use burners that are made from Lanna herbs” (P30) 

Sound

The sound in spa comes from several kinds of sounds that are unique to Lanna style. Composed by Lanna music specialists, instrumental music is played inside the spa. Sounds also comes from nature such as the sound of a waterfall, crickets or birds. It makes the customers feel relaxed. Sample quotes are as follows.

“The sound of music is very important in the spa. Each spa normally uses a different sound. Most spas use Lanna instrumental music. Every spa needs to provide sound as it cannot be without sound. This might be a natural sound from waterfalls or birds.” (P 28)

“The sound in spas is sometimes the natural sound as the sound of waterfalls or the sounds from birds or crickets” (P3)

Touch

Services in the spa primarily involve touch. The service will begin with a greeting in the Lanna language. This is a way to show that spa services will be delivered with delicacy and modesty, as part of Lanna style. The spa menu includes massages for health, which are integrated into Lanna-style massage. Occasionally, the massage service is accompanied with some kinds of ritual such as a devotion ritual.  Sample quotes are as follows.

“We deliver spa service with Lanna-style touch, which is gentle and delicate, from the first stage of the service. We use Lanna language to greet our customers to create warm atmosphere” (P11)

“The sense of touch in Lanna massage is very important for spa services. Each spa in the north will offer different services based on their massage therapists’ expertise and the spa’s specific focus.” (P3)

Category II: Lanna spa services

The study results show that spa services have three sub-categories, namely hydrotherapy, massage, and spa product. The core services in spa are hydrotherapy and massage for health, both of which are usually accompanied with spa products. 

Hydrotherapy

The hydrotherapy is the core service in spas, as it has been mentioned in the statute of Ministry of Public health in Thailand.  Many types of services employ water such as baths or steam baths. These treatments help the clients to feel relaxed. Herbal steam allows the clients to inhale aromatherapy, which helps balance both physical and mental health of the body. Sample quotes are as follows.

“The core services in spa is hydrotherapy. We offer many hydrotherapy treatments such as steam bath, bath, and whirlpool. We combine Lanna herbs with our service such as herbal steam or bathing, so that our clients can feel relaxed.” (P18)

“Our spa menu includes bathing with Lanna herbs and herbal steam.” (P22)

Massage for health

Massages are effectively good for both physical and mental health. The massage for health is integrated with Lanna wisdom, which has been passed on from generation to generation. Sample quotes are as follows.

“Massage is considered the heart of the service.” (P5)

“We deliver service by applying the science of touch to muscles through massage. We also develope a new treatment of Lanna massage by cooperating with Lanna Spa Association, School of Nursing, School of Pharmacology, Chiang Mai University. This Lanna-style massage treatment is called “Lanna exotic massage”, which combines Lanna massage, culture and Lanna aromatherapy” (P24)

Spa product

Most of spa menus provide a combination of both spa services and spa products. Spa products can be made from natural materials such as the fresh herbs in herbal balls. Many northern fragrant plants can be developed into spa products. For instance, Amomum biflorum jack (a species in the ginger family) can be used to produce Lanna essential oil. Sample quotes are as follows.

“Our spa menu offers herbal balls that are made of fresh herbs. They have very good smell and can relax our clients.” (P 12)

“We develope spa products from Amomum biflorum jack into Lanna essential oil for “Lanna exotic massage” (P2)

Category III: Lanna culture

During the interviews, the participants mentioned that the services in the spa must be integrated with Lanna culture. Lanna spa culture is very popular worldwide. Each spa location designs its service by integrating Thai culture such as using a “Wai” (Thai greeting) to welcome customers and Lanna style by wearing traditional Lanna clothing (pa sin) to create a unique identity. Each spa combines Lanna culture into the process of spa services with the senses of image, taste, smell, sound and touch as detailed above. The customers who visit spa would enjoy and feel satisfied with Lanna culture. Sample quotes are as follows.

“We apply Lanna culture and tradition to create spa courses. Besides, we integrate the concept of Lanna culture into the process of services such as Wai (Thai greeting), and communicating with customers by using Lanna language. ”(P2)

“We believe the tradition and culture of Thailand and Lanna are widely popular. We use them to provide the service of spa treatment. From our evaluation, our clients enjoy and are satisfied with our Lanna-culture service” (P21)

Category IV: Lanna health wisdom

The services in the spa are integrated with Lanna health wisdom. The spa menu provides holistic health treatments that cover physical and mental health. There are many spa courses to choose from, such as Lanna massage, herbal steam, healthy food and “Fawn Jerng” for health. “Fawn Jerng” is Lanna-style dancing modified for exercise.  Sample quotes are as follows.

“We apply Lanna health wisdom with our service such as herbal ball and herbal steam in order to release muscle tension and promote blood circulation.”

“We serve traditional herbal drinks and healthy food in order to promote good health and wellbeing of our customers.”

“We also apply Lanna wisdom as part of massage service such as paying respect to our teacher who has taught us how to do massage. We would pay respect before and after doing massage”

“We offer “Fawn Jerng” for good exercise in the spa menu.”

Figure 1. Lanna Spa Model for health in Thailand.

DISCUSSION

The aim of this qualitative study was to explore the Lanna Spa Model for health in Thailand. Based on the in-depth interviews and focus groups, the data indicated that Lanna spa for health must consist of four categories including identity of Lanna spa, Lanna spa services, Lanna culture, and Lanna health wisdom. Health and wellness spa are beneficial resources for people to promote their well-being as well as for local people to share their knowledge and preserve the rich history of Thai traditions. Spa services are integrated as part of the healthcare system in Poland and other countries in Europe (Wozniak-Holecka, Romaniuk, Holecki, Aldona, Fraczkiewicz-Wronka, & Jaruga. 2017). Many customers utilize spa-related health services in order to prevent illness. For nurses, spa services including nutritional provision and exercise program can be incorporated as part of health education and health promotion programs. The Lanna spa model from this study may be useful in developing the spa business in Thailand as well as in other countries.

Identity of Lanna spa

The identity of a spa is reflected from image, taste, smell, sound, and touch. All five identities have been chosen by spa entrepreneurs and providers who have extensive experiences of spa management. Image is what the customers see in the spa building, service area, and/or spa’s staff clothes and manners. Chaoprayoon et al. (2016) indicated that this image could be modified from Lanna lifestyle and art such as wood carving or painting in order to create a spa’s ambience. Taste is any type of drink or snack served to customers either before or after service has been delivered. Each spa provides healthy drinks made from herbs and vegetables found in northern regions (Chaoprayoon et al., 2016). Smell is what customers experience from inhaling aromatherapy, which is part of spa atmosphere. Sound is traditional Lanna melodies that customers hear starting from the moment they walk into the spa building until the end of the service. Touch is what customers perceive through the traditional spa massage using firm hands to press and squeeze. These findings are similar to those of the study conducted by Chaoprayoon et al., (2016), who reported that the key components of Lanna spa identity consisted of form, taste, aromatherapy, sound, and touch.

Spa services

Spa services refer to types of services that are performed by spa staff. Particularly, this study found that hydrotherapy and massage are core components of positive spa services in Lanna spa model as these two treatments can create relaxing and comfortable environments for the customers. However, these findings contradict the results of a previous study by Vryoni et al. (2017), who found that the ability of spa staff, level of comfort, or the promptness of services were considered the most important factors of positive spa services. Nonetheless, the study by Khamanarong et al. (2009) found that the customers who visited Thailand expected to receive good spa services and healthy products.  Spa products are also very important and they should be integrated into spa menu services. Spa businesses use local Lanna herbs to develop their spa products (Chaoprayoon et al., 2016). In response to a competitive market of spa services, new types of spa services and innovations should be further developed.

Lanna culture

Thailand is the well-known for spa service industries (Khamanarong et al., 2009). The uniqueness of Thai spa and its service is based on its roots in Thai culture. The Lanna region has a unique culture and has provided a warm welcome to all visitors for a long time (Chaoprayoon et al., 2016). The spa staff and providers believed that the art of Lanna culture may promote recognition and service delivery satisfactions among their customers. 

Lanna health wisdom

Thai wisdom has been applied to both hydrotherapy and massage services in the Lanna spas. In regards to nursing, Thai health wisdom and Lanna health wisdom employ herbs and traditional medicine that can be used to relive pain and promote relaxation. Thai massage with herbal balls, a technique that comes from Lanna health wisdom, may promote customers’ holistic health and well-being (Apivantanaporn & Walsh, 2012). Spa services based on Lanna wisdom can increase service value and promote products in the spa business (Chaoprayoon et al., 2016)

Implications

This sample of relatively heterogeneous participants from a small geographical region provides more understanding of the experiences of performing and providing spa services. The recruitment strategy ensured that the participants were those who had been trained by certified spa experts and institutions. The process of conducting the interviews allowed the researcher to obtain information, which was important for developing a spa model for health, particularly the experiences and perspectives of spa professionals. The contemporary nature of the information is rooted in the first-hand experience of these participants. The journey to become spa personnel requires support through appropriate training. This statement was supported and confirmed by the interview results from most of the participants.

CONCLUSION

In conclusion, the data collected from the participants reflect the value of their experiences of establishing Lanna spas for health. This qualitative study provides important insight into the spas for health services. Identity of a spa, spa services, Thai culture, and Thai health wisdom were the key categories identified. To enhance the Lanna spa for health, there is a clear need to collaborate and integrate Lanna culture and wisdom into the basis of spa training and service delivery.

ACKNOWLEDGEMENTS

Funding for this qualitative study was granted by Chiang Mai University. Authors would like to thank the dedicated participants in the study and the study teams for the fieldwork and data collection.

AUTHOR CONTRIBUTIONS

Areewan Klunklin planned the research project and approved final manuscript. Areewan Klunklin, Nantaporn Sansiriphun, Nongkran Viseskul, designed the model and verified the analytical methods. Piyawan Sawasdisingha, Noppamas, Sripetchwandee, Saranya Chaisang and Prachayaporn Charoenpakdee obtained data collection. All authors discussed the results, wrote the manuscript and contributed to the final manuscript.

CONFLICT OF INTEREST

Authors have no potential conflict of interest to report.

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