Ilhan Sağ, Ferhat Devrim Zengul and Keziban Avcı
This paper aims to explore the public’s attitude toward medical tourism activities by developing a measurement instrument in Turkey, an emerging medical tourism destination.
Abstract
Purpose
This paper aims to explore the public’s attitude toward medical tourism activities by developing a measurement instrument in Turkey, an emerging medical tourism destination.
Design/methodology/approach
During the development phase of the scale, 24 question pools were created. After the pilot study, data from a 20-question survey were collected from a study group consisting of Turkish citizens who received services from hospitals in the city of Ankara. Data were collected through convenience sampling of 221 study participants as they were walking in the Square of Kızılay, one of the most important centers and junction points in Turkey, between November 25, 2017, and December 27, 2017.
Findings
The content validity of the scale was assessed by expert opinion. The scale reliability is high with Cronbach’s α (0.908). A factor analysis was performed to assess the factor structure of the scale. The Kaiser–Meyer–Olkin measure of sampling adequacy (0.895) and Bartlett’s test (χ2 = 2,020.967; p = 0.001) were applied to determine the conformity of the scale of factor analysis. Exploratory factor analysis with Varimax rotation was performed to determine the factor structure of the scale. The 20 questions loaded under three factors: “contribution to the country,” “anxiety in getting services” and “service justice”. These factors explained approximately 55% of the total variance. Confirmatory factor analysis was performed with goodness-of-fit index (0.877), Bentler comparative fit index (0.909) and root mean square error of approximation index (0.069) to determine the validity of the factor structure, and the results indicated that the three-factor model is an acceptable level. All the results show that this new scale is valid and reliable in measuring the public’s attitude toward the development of medical tourism in Turkey.
Originality/value
The public’s attitudes on the medical tourism scale show that, as a measurement tool, it can be used validly and reliably in determining the public’s attitudes toward medical tourism.
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Ilhan Sag and Ferhat Devrim Zengul
The purpose of this paper is to determine the relationships between the health tourists’ perceptions on decisive factors (i.e. experience, technological infrastructure, flight…
Abstract
Purpose
The purpose of this paper is to determine the relationships between the health tourists’ perceptions on decisive factors (i.e. experience, technological infrastructure, flight distance, legal and moral restrictions, touristic attractions, religious similarity, waiting time and price of health tourism) and Turkey as their choice of healthcare tourism destination.
Design/methodology/approach
The data for this empirical study were collected from 288 patients in Turkey, all of whom being health tourists from various countries. Descriptive statistics and Kruskal–Wallis difference tests were utilized for analyses.
Findings
Statistically significant differences were found among health tourists in regards to the geographical regions of their residence. These finding suggest that differences among health tourists in regards to the geographical regions of their residence contributed to the healthcare tourists’ behaviors and health tourism market segmentations in Turkey.
Research limitations/implications
Among the constraints of the study are the time and funding limitations coupled with the limitations on the scale development attempts in the health tourism literature and limitation and biases related to primary data collection. Despite all these limitations, by being the first study exploring the health tourism market segmentations in Turkey, this study contributes to the literature about the perceptions of health tourists and their reasons in choosing Turkey as a health tourism destination.
Practical implications
Determining the Turkey’s health tourism market segmentations will generate the positive effect on the target market which is currently heterogeneous for health tourism operators and intermediary institutions. Moreover, this knowledge would allow the target market to be divided into homogeneous groups, with different marketing mixes for each group. Homogenized groups exhibit unified purchasing behaviors for their needs. Therefore, it is very important for health tourism operators and intermediary institutions to know how the preferences of health tourists from different geographical regions vary.
Originality/value
The paper fulfills a need for advancing the knowledge on the decisive factors in determining Turkey as the health tourism destination by revealing perceptions of health tourists from various geographical regions. This information is very valuable for the Turkey’s healthcare tourism marketing managers who desire to implement the strategies to achieve competitive advantage in the global health tourism market.
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Ferhat Devrim Zengul, Justin Lord, Ganisher Davlyatov, Akbar Ghiasi, Gregory Orewa and Robert Weech-Maldonado
Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may…
Abstract
Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.
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Robert Weech-Maldonado, Akbar Ghiasi, Justin Lord, Ganisher Davlyatov, Larry Hearld, Ferhat Devrim Zengul and Kent Rondeau
Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed…
Abstract
Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse assistants (CNAs). The relationship between human resource management (HRM)practices, organizational culture, and nursing staff turnover is examined in underresourced (high Medicaid) nursing homes. Survey data from 348 nursing home administrators (NHAs) of USA high Medicaid (85% or higher) facilities were merged with secondary data sources for 2017–2018. The dependent variables (nursing staff turnover rates) consisted of the percentages of RNs, LPNs, and CNAs that had voluntarily quit the organization during the past year. The independent variables were: (1) HRM practices (employee-centered and high involvement practices); and (2) organizational culture: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show high involvement HRM practices and having a clan culture are associated with lower RN, LPN, and CNA staffing turnover. Study findings suggest that organizational culture and HRM practices may be instrumental in reducing nursing turnover in underresourced nursing homes.