Explaining the Comprehensive Human-To-Human Marketig System in the Health Tourism Industry

Abstract One of the most important concerns of the trustees of any tourist destination is to create a coherent identity that is proportionate to the existing capacities and convey it to international tourists. In this regard, it seems necessary to apply the latest findings and marketing models and localize them in accordance with the conditions of the tourist destination in order to develop this industry. The new marketing paradigm, which is called human-to-human marketing, with its human-centricity and customer participation in the process of designing and presenting the value proposition, along with the use of new digital technologies in the context of a service-oriented economy, can address the concerns of developing a comprehensive marketing system for tourist destinations. The aim of this research is to explain a comprehensive human-to-human marketing system in the health tourism industry in line with Iran's cultural identity and legal and institutional conditions. In this research, using the multi-grounded research strategy, a comprehensive human-to-human marketing system in health tourism was explained and presented. To this end, the researchers studied the human-to-human marketing model through qualitative content analysis, developed a general framework and concepts corresponding to each of the components of this model, and then, by conducting semi-structured interviews with 11 experts in the field of marketing and health tourism, presented a comprehensive human-to-human marketing system at three levels (macro, intermediate, and operational) and explained the functions corresponding to the categories crystallized in this model. Sampling was carried out theoretically using the snowball method, and the sample size was determined based on theoretical saturation logic. The proposed system includes all stages from formulating the vision and mission of industry and organizations to operational measures at the lowest levels and at the front of the service in a comprehensive military format. Keywords: H2H Marketing, Human-To-Human Marketing, Health Tourism, Comprehensive Marketing System, Multi-Grounded 1. Introduction The health tourism industry, an emerging and rapidly expanding sector, integrates medical, wellness, and preventive services to enhance physical and mental well-being, often in destinations outside tourists’ places of residence. As global competition intensifies among destinations to attract health tourists, establishing a coherent destination identity aligned with cultural, legal, and institutional frameworks becomes critical. Traditional marketing paradigms, often product-centric, are increasingly inadequate in addressing the nuanced demands of health tourism, which thrives on personalized, human-centric experiences. The human-to-human (H2H) marketing paradigm, as proposed by Kotler et al. (2021), shifts the focus from transactional exchanges to fostering meaningful human connections, leveraging digital technologies and service-dominant logic to co-create value with stakeholders. This study aims to elucidate a comprehensive H2H marketing system tailored to Iran’s health tourism industry, aligning with its cultural identity and regulatory environment. By addressing the research question, “What is the structure of an integrated H2H marketing system in health tourism?” this study offers a multi-level framework to enhance destination branding, stakeholder collaboration, and sustainable industry growth. Health tourism, encompassing medical, wellness, and preventive tourism, has gained significant attention as a multifaceted phenomenon with social, cultural, and economic dimensions (Figueiredo et al., 2024). Governments worldwide are increasingly investing in this sector due to its economic potential and ability to enhance destination competitiveness (Kim & Hyun, 2022). In Iran, the health tourism industry holds strategic importance, yet it faces challenges in developing a cohesive marketing system that reflects its cultural and institutional context. The H2H marketing paradigm, with its emphasis on human-centricity, empathy, and digitalization, provides a promising approach to address these challenges. This study employs a multi-grounded theory strategy to develop a comprehensive H2H marketing system, integrating theoretical insights with empirical data from expert interviews to ensure practical applicability and theoretical robustness. 2. Literature Review Health tourism, as defined by the World Tourism Organization, involves travel to access services that improve health and well-being, often leveraging natural resources, medical interventions, or wellness activities (Asadi et al., 2019). The academic literature on health tourism is diverse, covering multiple perspectives: Conceptual Studies: Clarify distinctions between medical and wellness tourism (Connell, 2013; Hall, 2011). Motivational Analyses: Highlight factors such as cost savings and access to superior care (Lunt & Carrera, 2010). Economic Studies: Emphasize positive impacts on destination economies (NaRanong & NaRanong, 2011). Ethical Inquiries: Address issues like organ transplant tourism (Budiani-Saberi & Delmonico, 2008). Geographical Analyses: Explore regional variations in health tourism practices (Bookman & Bookman, 2007). Technological Perspectives: Focus on the role of digital marketing in attracting patients (Cormany & Baloglu, 2011). Policy Studies: Examine governmental influences on industry development (Chee, 2010). Marketing Research: Identify strategies for attracting international patients (Heung et al., 2010). In Iran, health tourism research emerged in the mid-2000s, initially focusing on development factors and descriptive analyses (Shalbafian, 2007; Jabbari, 2008). Recent studies have explored marketing strategies, but a comprehensive marketing system remains underexplored (Zakavati et al., 2022; Bagheri et al., 2022). The H2H marketing paradigm, introduced by Kotler et al. (2021), provides a robust theoretical foundation for this study. H2H marketing integrates design thinking, service-dominant logic, and digitalization to prioritize human-centric interactions. It comprises two layers: Conceptual Framework: Emphasizes human-centricity, empathy, and collaboration, drawing on design thinking, service-dominant logic, and digitalization. Operational Framework: Focuses on strategic brand management and process execution, ensuring practical implementation of human-centric principles. This paradigm aligns with health tourism’s need for trust, personalization, and stakeholder engagement, making it suitable for developing a comprehensive marketing system. The H2H approach emphasizes co-creation of value, where customers are active participants in designing and delivering value propositions, supported by digital technologies that enhance efficiency and personalization. 3. Methodology This study adopts a qualitative, non-experimental approach with a fundamental theoretical orientation, employing a multi-grounded theory strategy to develop a comprehensive H2H marketing system for health tourism. The methodology unfolds in two phases: Qualitative Content Analysis: The H2H marketing model was analyzed to extract core concepts and develop an initial framework. This involved identifying key components of the H2H paradigm, such as human-centricity, trust, and digitalization, and mapping their relevance to health tourism. Semi-Structured Interviews: Eleven experts in marketing, tourism, and health tourism were interviewed to refine and validate the framework. Experts were selected via snowball sampling until theoretical saturation was achieved, ensuring a diverse sample with at least 15 years of experience and advanced degrees, holding senior roles in academia, government, or service provision. Data collection combined library research (to establish theoretical foundations) and field methods (interviews). Interview transcripts were analyzed using Glaser’s grounded theory approach, involving: Open Coding: Generating 247 initial codes from interview data. Axial Coding: Grouping codes into 24 main categories based on common themes. Selective Coding: Organizing categories into three levels—macro (national/international), meso (regional/local), and micro (service providers)—to form the comprehensive system. Theoretical saturation was confirmed when no new concepts emerged in the final two interviews. To ensure trustworthiness, the study employed continuous data review, simultaneous data collection and analysis, participant code validation, and triangulation with secondary sources. The resulting framework was validated by experts, ensuring robustness and applicability to Iran’s health tourism context. 4. Results The study’s findings articulate a comprehensive H2H marketing system for health tourism, structured across three levels: macro, meso, and micro. The system integrates 24 main categories, each associated with specific functions, ensuring a holistic approach to marketing that aligns with human-centric principles and Iran’s cultural and institutional context. Macro-Level Management At the macro level, the system focuses on national and international strategies to build trust, establish a cohesive brand identity, and develop supportive infrastructure. Key functions include: Trust and National Branding: Defining human dignity and human-centricity in the national brand identity, using research to analyze customer perceptions, and fostering trust in private investments to encourage industry growth. Coordination and Integration: Strengthening inter-institutional communication, establishing a unified health tourism authority, and promoting a systemic perspective among stakeholders to ensure cohesive policy implementation. Guidance and Goal Setting: Designing foresight systems, innovation frameworks, and customer journey maps to enhance sustainability and expand market reach. Infrastructure Development: Enhancing internet