Identification and Evaluation of Strategic Factors Affecting The Development of Health Tourism: A Mixed Approach

Aim and Introduction
Health tourism has been ever-increasing expansion in recent years, so that in some countries of the world it has become a strategic issue to increase the prestige of that country, develop new related technologies, attract investment and attract tourists from different countries of the world. The increasing importance of health tourism has made governments interested in using and benefiting from the economic benefits of this industry, and this has led to the increasing competition of countries to attract health tourists among countries. Iran also has excellent potential and actual capacities to expand the health tourism industry in the region and even the world. Low treatment costs and experienced medical doctors are among the actual existing capacities and the existences of original tourism areas such as Kish Island are among the potential capacities in this field. The purpose of this research is to identify and evaluate the strategic factors affecting the development of health tourism in Kish Island as a hub for providing various types of tourism services in Iran.

Methodology
This research was done using a mixed exploratory method. The statistical population in the qualitative section consisted of 15 health experts who were selected by purposeful and snowball sampling. In the quantitative part, the findings were evaluated by 158 health experts. To analyse the data in the qualitative part, thematic analysis method and in three general stages, was used and in the quantitative part, factor analysis and structural equations were used. The research findings were categorized into three levels of open, central, and selective coding and the necessary evaluations were performed to check the validity of the obtained results.

Findings
The results led to the identification of 144 basic themes. These basic themes were categorized into five strategic areas, including the capacity of Kish Island, economic factors, infrastructural factors, organizational and legal factors, and finally cultural factors. These strategic factors were classified into three main categories including causal factors (capacity of Kish Island, economic factors, infrastructure factors), contextual factors (organizational and legal factors) and intervening factors (cultural factors).In terms of the capacity of Kish Island, economic factors and infrastructure factors, among the identified factors, seven factors of natural attractions and pristine beaches, low tourism costs, unique recreational places, geographical and strategic location of the island, existence of favourable tourism infrastructure, the existence of well-equipped hotels with high reception capacity, the existence of numerous flight and transportation lines, no need for visas for foreign Iranians, and access to international waterways were approved by experts. In terms of economic factors, among the identified factors, six factors are government support and financial support for the development of health tourism, reforming the banking system and supporting the country's banking system for the development of the health tourism industry, insurance facilities for foreign tourists, lifting sanctions and expanding communications, foreign facilities and encouraging companies investing in health tourism and tax exemption for the development of health tourism activities were approved. In terms of cultural factors, factors of ensuring the social security of tourists, setting up health tourism agencies in public places (airports, embassies, medical centres, etc.), extensive advertising at the national and international level to introduce the opportunities of Kish Island in the field of health tourism, inviting representatives of other countries to visit the island and introduce health tourism development opportunities, advertisements using well-known and famous people from abroad, detailed and documented planning in line with the development of marketing in the target countries, preparing investment packages for investors and getting to know them with investment opportunities, a platform for dialogue with private companies through specialized platforms and virtual networks, meetings and collaboration with domestic and foreign experts and officials in line with the development of the health tourism industry were approved. In terms of organizational and legal factors using the capacity of the private sector to develop health tourism, developing private sector partnerships to improve the health tourism industry based on soft technologies, formation of expert planning team for advertising and marketing purposes, detailed plans for the development of the island's health tourism industry, determining the needs of health tourism users and prioritizing them, cooperation between health ministry organizations and embassies to develop the health tourism industry, consensus and integrity in the decisions of organizations in the field of health tourism, establishing laws approved by the Ministry of Health and the Parliament, removing cumbersome laws in the field of health tourism, Simplifying and clarifying the laws established to attract foreign tourists, facilitating the issuance of tourist visas and amending the laws governing the society and removing legal restrictions for foreign tourists were approved. In terms of infrastructure, six factors providing up-to-date and diverse services and equipment in hospitals and medical centres, equipping hospitals and hotels for the recovery period of foreign patients, taking advantage of the experiences of first-tier countries in the direction of health tourism development, use of nurses with experience working abroad, acquaintance of health tourism industry personnel with the culture and language of different countries and creating infrastructure for accommodation of non-resident doctors were approved.

Discussion and Conclusion
In various domestic and foreign researches, one or more effective factors in the formation and development of the health tourism industry have been mentioned. But in this comprehensive research, the results show a wide range of seemingly unrelated factors that should be taken into consideration by the stakeholders due to the special sensitivity of health tourism, especially by tourists who consider their health as their most important asset. It is necessary to adopt the necessary approach based on the identified effective strategic factors for the development of health tourism from the officials and managers of the country and Kish Island to tourism agencies and doctors.