Health tourism and physical literacy: a qualitative exploration of elderly visitors’ experiences after rehabilitation at Slovenian health resorts

Katja Kokot, Maja Turnšek


The promotion of physical literacy is an opportunity to multiply significant health benefits in the ageing society. In Slovenia, health resorts are one of the most common prime areas for health enhancement that offer numerous services for individuals to improve their health and form an important pillar of the social tourism and healthcare sector. The aim of this research is to explore the role of medical rehabilitation at the Slovene health resorts in the processes of increasing the physical literacy of their patients. 21 semi-structured interviews were conducted with previous guests of Slovene health resorts that have undertaken medical rehabilitation. The analysis indicates that the most common approach is providing lectures about physical activity followed by group or individual physical regimes organised for the patients with similar health concerns. These actions target two dimensions of physical literacy:  the competence and the knowledge/understanding dimension. However, the eventual omission of prescribed physical activity following the rehabilitation is an issue concerning the motivation dimension of physical literacy, which should thus be addressed more in the future. The findings contribute to understanding the role of medical rehabilitation at Slovene health resorts by applying the physical literacy model for older adults. The study provides valuable insights regarding the long-term benefits of rehabilitation at the health resorts on individuals' level of physical literacy. The results are helpful for both the tourism and medical sectors.

Full Text:



Almond, L. (2013). What is the Value of Physical Literacy and why is Physical Literacy valuable? ICSSPE Bulletin, Journal of Sport Science and Physical Education, 65(1.2), 35‒42.

Attl, P., & Čertík, M. (2011). The Financing of Czech Spas with Health Insurance funds. In A. Kocourek (Ed.), Proceedings of the 10th International Conference -Liberec Economic Forum 2011 (pp. 17‒23), Liberec, Czech Republic: Technical University of Liberec.

Beinema, T., op den Akker, H., van Velsen, L., & Hermens, H. (2021). Tailoring Coaching Strategies to Users’ Motivation in a Multi-Agent Health Coaching Application. Computers in Human Behavior, 121, Article 106787.

Blain, H., Bernard, P. L., Canovas, G., Raffort, N., Desfour, H., Soriteau, L., Noguès, M., Camuzat, T., Mercier, J., Dupeyron, A., Quéré, I., Laffont, I., Hérisson, C., Solimene, H., &

Bousquet, J. (2016). Combining balneotherapy and health promotion to promote active and healthy ageing: the Balaruc-MACVIA-LR® approach. Aging clinical and experimental research, 28(6), 1061‒1065.

Carpentier, P. H., & Satger, B. (2009). Randomised trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. Journal of vascular surgery, 49(1), 163‒170.

Chen, W. L., Zhang, C.G., Cui, Z. Y., Wang, J. Y., Zhao, J., Wang, J. W., Wang, X., & Yu, J. M. (2019). The impact of social capital on physical activity and nutrition in China: the mediating effect of health literacy. BMC public health, 19(1), 1‒10.

Dejonghe, L. A. L., Becker, J., Froboese, I., & Schaller, A. (2017). Long-term effectiveness of health coaching in rehabilitation and prevention: A systematic review. Patient education and counseling, 100(9), 1643‒1653.

Derco, J. (2014). The Slovak spas in the light of the health care system. Tourism Planning & Development, 11(2), 243‒252.

Duscha, B. D., Piner, L. W., Patel, M. P., Craig, K. P., Brady, M., McGarrah 3rd, R. W., Chen, C., & Kraus, W. E. (2018). Effects of a 12-week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: a randomised controlled trial. American heart journal, 199, 105‒114.

European Commission. (2018). Sport and physical activity - Factsheets Slovenia – EN.

Gay, C., Guiguet-Auclair, C., Coste, N., Boisseau, N., Gerbaud, L., Pereira, B., & Coudeyre, E. (2020). Limited effect of a self-management exercise program added to spa therapy for increasing physical activity in patients with knee osteoarthritis: A quasi-randomised controlled trial. Annals of Physical and Rehabilitation Medicine, 63(3), 181–188.

Gerling, K. M., & Masuch, M. (2011). Exploring the potential of gamification among frail elderly persons. In Proceedings of the CHI 2011 workshop gamification: using game design elements in non-game contexts (pp. 1‒4).

Gerling, K. M., Schild, J., & Masuch, M. (2010). Exergame design for elderly users: the case study of SilverBalance. In Proceedings of the 7th International Conference on Advances in Computer Entertainment Technology (pp. 66‒69). Association for Computing Machinery.

Giblin, S., Collins, D., & Button, C. (2014). Physical literacy: importance, assessment and future directions. Sports Medicine, 44(9), 1177‒1184.

Gutenbrunner, C., Bender, T., Cantista, P., & Karagülle, Z. (2010). A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology. International Journal of Biometeorology, 54(5), 495‒507.

Hočevar Grom, A., Belščak Čolaković, A., Rehberger, M., Lavtar, D., Gabrijelčič Blenkuš, M., Jeriček Klanšček, H., Fajdiga Turk, V., Gregorič, M., Šivec, N., Poličnik, R., Blaznik, U., Carli, T., & Zupančič Tisovec, N. (2021). Covid-19 Pandemic in Slovenia: Results of a panel online survey on the impact of the pandemic on life (SI-PANDA) - 7th wave. National Institite for Public Health.

Horvat, U. (2014). Razvoj turizma v zdraviliških turističnih krajih v Sloveniji. In D. Cigale, B. Lampič, I. Potočnik Slavič & B. Repe (Eds.), Geografsko raziskovanje turizma in rekreacije v Sloveniji (pp. 47‒66). Znanstvena založba Filozofske fakultete Univerze v Ljubljani.

Johnson, D., Deterding, S., Kuhn, K. A., Staneva, A., Stoyanov, S., & Hides, L. (2016). Gamification for health and well-being: A systematic review of the literature. Internet interventions, 6, 89‒106.

Jones, G. R., Stathokostas, L., Young, B. W., Wister, A. V., Chau, S., Clark, P., Duggan, M., Mitchell, D., & Nordland, P. (2018). Development of a physical literacy model for older adults – a consensus process by the collaborative working group on physical literacy for older Canadians. BMC Geriatrics, 18(1), 1‒16.

Kamioka, H., Nakamura, Y., Okada, S., Kitayuguchi, J., Kamada, M., Honda, T., Matsui, Y., & Mutoh, Y. (2009). Effectiveness of comprehensive health education combining lifestyle education and hot spa bathing for male white-collar employees: a randomised controlled trial with 1-year follow-up. Journal of Epidemiology, 19(5), 219‒230.

Kamioka, H., Nakamura, Y., Yazaki, T., Uebaba, K., Mutoh, Y., Okada, S., & Takahashi, M. (2006). Comprehensive health education combining hot spa bathing and lifestyle education in middle-aged and elderly women: one-year follow-up on randomised controlled trial of three-and six-month interventions. Journal of Epidemiology, 16(1), 35‒44.

Kasurinen, J., & Knutas, A. (2018). Publication trends in gamification: A systematic mapping study. Computer Science Review, 27, 33‒44.

Kitsiou, S., Thomas, M., Marai, G. E., Maglaveras, N., Kondos, G., Arena, R., & Gerber, B. (2017). Development of an innovative mHealth platform for remote physical activity monitoring and health coaching of cardiac rehabilitation patients. In 2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI 2017) (pp. 133‒136). IEEE.

Kivelä, K., Elo, S., Kyngäs, H., & Kääriäinen, M. (2014). The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient education and counseling, 97(2), 147‒157.

Koh, S., Yoo, J. J. E., & Boger, C. A. (2010). Importance‐performance analysis with benefit segmentation of spa goers. International Journal of Contemporary Hospitality Management, 22(5), 718‒735.

Koivisto, J., & Malik, A. (2020). Gamification for Older Adults: A Systematic Literature Review. The Gerontologist, 20, 1‒13.

Kucukusta, D., Pang, L., & Chui, S., 2013. Inbound travelers’ selection criteria for hotel spas in Hong Kong. Journal of Travel & Tourism Marketing, 30(6), 557–576.

Lindner, S., Illing, K., Sommer, J., Krajnc-Nikolić, T., Harer, J., Kurre, C., Lautner, K., Hauser, M., Grabar, D., Graf-Stelzl, R., Korn, C., Pilz, K., Ritter, B., & Roller-Wirnsberger, R. (2021). Development of a Binational Framework for Active and Healthy Ageing (AHA) Bridging Austria and Slovenia in a Thermal Spa Region. International Journal of Environmental Research and Public Health, 18(2), Article 639.

Maitre, J., Guinhouya, B., Darrieutort, N., & Paillard, T. (2017). Physical education in a thermal spa resort to maintain an active lifestyle at home: a one-year self-controlled follow-up pilot study. Evidence-Based Complementary and Alternative Medicine, 2017, 1‒8.

Martinho, D., Carneiro, J., Corchado, J. M., & Marreiros, G. (2020). A systematic review of gamification techniques applied to elderly care. Artificial Intelligence Review, 53(7), 4863‒4901.

Masiero, S., & Maccarone, M. C. (2021). Health resort therapy interventions in the COVID-19 pandemic era: what next?. International Journal of Biometeorology, 65(4), 1‒3.

Mayring, P. (2014). Qualitative content analysis: theoretical foundation, basic procedures and software solution.

Mueller, H., & Kaufmann, E. L. (2001). Wellness tourism: Market analysis of a special health tourism segment and implications for the hotel industry. Journal of vacation marketing, 7(1), 5‒17.

Odprti podatki Slovenije. (2014). Dolgotrajna oviranost po spolu in starosti, Slovenija, leto 2014.

Odprti podatki Slovenije. (2019). Število obravnav na rehabilitaciji, bolniških dni in povprečno trajanje hospitalizacij na obravnavah na rehabilitaciji, Slovenija, letno.

Olsen, J. M., & Nesbitt, B. J. (2010). Health coaching to improve healthy lifestyle behaviors: an integrative review. American Journal of Health Promotion, 25(1), e1‒e12.

Palmer, S., Tubbs, I., & Whybrow, A. (2003). Health coaching to facilitate the promotion of healthy behaviour and achievement of health-related goals. International Journal of Health Promotion and Education, 41(3), 91‒93.

Pforr, C., & Locher, C. (2013). Impacts of health policy on medical tourism in Germany. In C. M. Hall (Ed.), Medical tourism: The ethics, regulation, and marketing of health mobility (pp. 77‒94). Routledge.

Roetert, E. P., & Ortega, C. (2019). Physical Literacy for the Older Adult. Strength & Conditioning Journal, 41(2), 89‒99.

Rulle, M. (2004). Der Gesundheitstourismus in Europa: Entwicklungstendenzen und Diversifikationsstrategien. Profil Verlag GmbH.

Sibson, R., Scherrer, P., Ryan, M. M., Henley, N., & Sheridan, L. (2010). Is physical activity leisure or work? Exploring the leisure‐tourism‒physical activity relationship with holidaymakers on Rottnest Island, Western Australia. Annals of Leisure Research, 13(4), 652‒678.

Skupnost slovenskih naravnih zdravilišč. (2018). Poročilo o poslovanju skupnosti slovenskih naravnih zdravilišč v letu 2017.

Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC public health, 12(1), 1‒13.

Stevens, Z., Barlow, C., Kendrick, D., Masud. D., Skelton, D.A., Dinan-Young, S., & Iliffe, S. (2014). Effectiveness of general practice-based physical activity promotion for older adults: systematic review. Primary health care research & development, 15(2), 190‒201.

Surugiu, C., Surugiu, M. R., & Mazilescu, R. (2020). Social insurance system influence on spa tourism: evidence for Romania. Anatolia, 32(1), 1‒11.

Thermana Laško. (2020). Letno poročilo 2019. Retrieved April 24, 2021, from:

Turnšek, M., Brumen, B., Rangus, M., Gorenak, M., Mekinc, J., & Štuhec, T. L. (2020). Perceived threat of COVID-19 and future travel avoidance: Results from an early convenient sample in Slovenia. Academica Turistica-Tourism and Innovation Journal, 13(1). 3‒19.

Young, L., O’Connor, J., & Alfrey, L. (2020). Physical literacy: a concept analysis. Sport, Education and Society, 25(8), 946‒959.

Wang, F., McDonald, T., Reffitt, B., & Edington, D. W. (2005). BMI, physical activity, and health care utilisation/costs among Medicare retirees. Obesity Research, 13(8), 1450‒1457.

Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Cmaj, 174(6), 801‒809.

Ward, K., Pousette, A., & Pelletier, C. A. (2020). “Not Everybody’s an Athlete, But They Certainly Can Move”: Facilitators of Physical Activity Maintenance in Older Adults in a Northern and Rural Setting. Journal of Aging and Physical Activity, 28(6), 854‒863.

Whitehead, M. (2010). Physical Literacy: Throughout the lifecourse. Routledge.

Whitehead, M. (2013). Definition of physical literacy and clarification of related issues. ICSSPE Bulletin, Journal of Sport Science and Physical Education 65(1.2), 29‒34.

World Health Organization. (2021). Rehabilitation.

Woźniak-Holecka, J., Romaniuk, P., Holecki, T., Frączkiewicz-Wronka, A., & Jaruga, S. (2017). Health promotion development in the spa treatment. Perspectives for the European countries learned from Poland’s experiences. Frontiers in pharmacology, 8(29), 1‒4.

UNECE/European Commission. (2015). Active Ageing Index 2014: Analytical Report.

Zijlstra, T. R., van de Laar, M. A., Bernelot Moens, H. J., Taal, E., Zakraoui, L., & Rasker, J. J. (2005). Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatology, 44(4), 539‒546.


  • There are currently no refbacks.