Contents lists available at ScienceDirect Journal of Destination Marketing & Management journal homepage: www.elsevier.com/locate/jdmm Research Paper Segmentation by push motives in health tourism destinations: A case study of Polish spa resorts Diana Dryglas a, ⁎ , Marcin Salamaga b a AGH University of Science and Technology, Department of General Geology and Geotourism, al. Mickiewicza 30, 30-059 Krakow, Poland b Cracow University of Economics, Department of Statistics, Rakowicka 27, 31-510 Krakow, Poland ARTICLE INFO Keywords: Push motive Segmentation Health tourism destination Spa resort Poland ABSTRACT The aim of the paper is to segment tourists visiting medical (traditional) spa resorts and examine the underlying factors that motivate them. Survey data were collected from 2050 tourists to spa resorts in Poland, using a self- administered questionnaire. A factor-clustering method used in the study identified three groups of push mo- tives: treatment, prevention and tourism, as well as three distinct segments of tourists to Polish spa resorts: treatment seekers, wellness and treatment seekers, and tourism, treatment and wellness seekers. The results indicated that the segments differ from each other with respect to socio-demographic, behavioural and psy- chographic factors. The segments delineated have important implications for scholars, allowing them to un- derstand the socio-demographic profile of tourists visiting spa resorts, their behaviours and the way they evaluate services, infrastructure and attractiveness of spa resorts, as well as for local governments and en- terprises engaged in marketing and development in European medical spa resorts. 1. Introduction Despite increasing globalization and hybridization of health tourism (Smith & Puczkó, 2009), one of its forms (therapeutic tourism) is mainly to be found in European medical spa resorts, which constitute an example of therapeutic tourism destinations. According to the Eur- opean Spas Association (ESPA) spa resorts are defined as health resorts of the highest status, recognized as such by the state legal regulations on health treatment based on their natural healing assets proved by scientific evidence and being part of scientific medicine (Kirschner, 2005). Spa resorts understood in the medical (traditional) sense are to be found in German-speaking countries, some parts of France, the Baltic States (Estonia, Latvia and Lithuania), Central and Eastern Europe and Russia. Poland is one of the European countries where one still can meet the traditional therapeutic architecture (e.g. sanatorium, pump room, graduation tower) together with classical therapeutic treatments (e.g. balneotherapy, climatotherapy). Poland therefore seems to be a good example of a medical spa resort with a healing potential. The operation of European medical spa resorts in the 20th century was based on the public financial system (e.g. Derco, 2014; Kotikowa & Schwartzhoffova, 2013; Pforr & Locher, 2013). The reduction of sub- sidies for medical spa resorts in many European countries since 1990s on the one hand (Minghetti & Furlan, 2006; Nahrstedt, 2004), and the desire to live a healthier life (Douglas, 2001; Gustavo, 2010), on the other, have led to a change in the proportions of non-commercial (i.e. financed by the public insurer) and commercial (i.e. self-financed) stays (Dryglas & Różycki, 2017). The share of commercial tourists increased (Szromek & Romaniuk, 2014). As the market of recipients of services offered by European spa resorts is not a unified whole, it is crucial that local governments and therapeutic destination managers distinguish its segments based on push motive segmentation and target their products at a specific type of consumers in order to make European spa resorts more competitive on the world health-related market (Frochot & Morrison, 2000; Prideaux, Berbigier, & Thompson, 2014). According to Buhalis (2000), each type of destination can only match certain types of demand. For that reason spa resorts do not endeavor to cater for the entire market, seeing the futility of such efforts. Furthermore, a thorough examination of health tourism push mo- tive (i.e. psychological benefits sought) segmentation in health tourism literature has shown that while push motive segmentation in medical and wellness tourism destinations has been extensively examined (see Table 1) there is no push motive segmentation of tourists visiting therapeutic destinations other than pull motive segmentation (Dryglas & Salamaga, 2017). All of the previous studies on push motives of tourists visiting medical and wellness and wellbeing tourism destina- tions displayed a local or regional character. In addition, the segmen- tation by push motives in medical and wellness and wellbeing tourism destinations did not include the socio-demographic, behavioural and https://doi.org/10.1016/j.jdmm.2018.01.008 Received 12 April 2017; Received in revised form 20 December 2017; Accepted 21 January 2018 ⁎ Corresponding author. E-mail addresses: ddryglas@agh.edu.pl (D. Dryglas), salamaga@uek.krakow.pl (M. Salamaga). Journal of Destination Marketing & Management xxx (xxxx) xxx–xxx 2212-571X/ © 2018 Elsevier Ltd. All rights reserved. Please cite this article as: Dryglas, D., Journal of Destination Marketing & Management (2018), https://doi.org/10.1016/j.jdmm.2018.01.008