How Wellness Tourism Destinations Retain Tourists: The Influence of Therapeutic Landscape and Perceived Value

This study provided a mediation-moderation model to explore how therapeutic landscape may enhance tourist retention through perceived value. Data from 572 tourists were collected, revealing that the perceived value of tourists is a key mechanism linking therapeutic landscapes to tourist retention. The research indicates a significant positive impact of therapeutic landscapes on perceived value. Specifically, the physical and social landscapes within therapeutic environments positively influence tourist retention, whereas the impact of symbolic landscapes on retention is not significant. Perceived value plays an intermediary role between therapeutic landscapes and tourist retention. Moreover, this study also finds that self-assessment of health status is a critical moderator, which offers evidence that tourist retention will be enhanced when tourists have a higher level of social landscapes and self-assessment of health status.

• Therapeutic Landscape
• Perceived Value
• Tourist Retention
• Self-Assessment of Health Status
• Wellness Tourism

1. Introduction

With increasing public health awareness and evolving travel preferences, wellness has become a widely discussed topic, with wellness tourism gaining prominence. Particularly in the post-pandemic era, heightened public health consciousness has led to a greater focus on lifestyles, consumption habits, and views on healthy living. This has positioned the wellness tourism industry for rapid growth ( Gong et al., 2023 ). However, many destinations branding themselves as “wellness” lack substantial offerings, hindering their ability to attract or retain visitors. Unlike tourists at other destinations, visitors to wellness tourism spots often stay longer and return more frequently, resembling “migratory birds” ( Huang & Xu, 2018 ). Therefore, actively and effectively retaining visitors is crucial for enhancing the competitiveness of wellness tourism destinations.

In wellness tourism destinations, visitors’ behaviors are greatly influenced by the therapeutic landscapes offered, encompassing natural ecology, social culture, and interpersonal dynamics. Scholars suggest that such landscapes, as healing environments, can foster feelings of safety, relaxation, and recovery, thus enhancing physical and mental well-being ( Oeljeklaus et al., 2022 ; Zhang et al., 2021 ). Indeed, individuals’ psychological and physical health are intertwined with their perception of landscapes. When tourists resonate with the natural scenery, social interactions, and cultural elements of a destination, they tend to have positive experiences conducive to recovery, encouraging return visits or cherishing memories of the place ( Backman et al., 2023 ). Perceived value, reflecting tourists’ feelings and attitudes towards a destination, helps comprehend their purchase decisions and potential retention behaviors. While research has commenced on the characteristics of wellness tourism spots and recognized the destination itself as a crucial source of health and well-being, perceptions of destinations’ therapeutic attributes vary among individuals. It remains unclear how people derive physical and mental health benefits from relaxation and recovery at specific destinations. Research investigating the mechanisms by which environments of wellness tourism destinations influence individual behavior is still relatively scarce. Moreover, there is limited evidence regarding the connection between the environment of wellness tourism destinations and individual perceptions and behaviors ( Backman et al., 2023 ; Wang et al., 2022 ).

This study explores the influence of therapeutic landscapes on tourist retention at wellness tourism destinations, utilizing tourist perceived value as the mediating variable and tourist self-assessment of health status as the moderating variable. It sheds light on how these landscapes enhance tourist retention and refines our understanding of the mechanisms driving individual behavior. Moreover, the study offers practical insights for the operational management of wellness tourism destinations, thereby fostering their sustainable development.

2. Theory and Hypothesis

2.1. The Theory of Therapeutic Landscapes

Therapeutic landscapes encompass environments that promote healing and rehabilitation ( Huang & Xu, 2018 ; Oeljeklaus et al., 2022 ; Zhang et al., 2021 ), emphasizing both their therapeutic impact and the concept of landscapes. This term highlights experiences that evoke feelings of safety, relaxation, and restoration, contributing to physical and mental well-being. “Landscape” encompasses both tangible elements “scape” that engage individuals and their subjective perceptions “view” in response to these elements, representing an individual’s psychological interpretation of the environment.

The analytical framework developed by scholars for assessing therapeutic landscapes integrates internal dimensions and external contexts across diverse settings, including nursing homes, temples, villages, and yoga retreat centers. Internal dimensions comprise natural environments, built environments, sense of place, symbolic landscapes, and daily activities, deriving theoretical foundations from landscape studies and humanistic approaches. External contexts encompass belief systems, social relationships, and territoriality, grounded in structuralist paradigms. Consequently, therapeutic landscapes emerge as socially constructed psycho-physiological outcomes resulting from individuals’ interactions within integrated social, natural, and physical environments. The rehabilitative attributes of a place are not singular or absolute but diverse and relative, stemming from the combined effects of multiple factors. Expanding on this, the theoretical framework of therapeutic landscapes has provided a systematic analysis of three fundamental aspects of landscapes: physical environment, social landscape, and symbolic landscape, as depicted in Table 1 . These three dimensions elucidate how tourists derive therapeutic experiences from tourism destinations ( Huang & Xu, 2018 ; Zhang et al., 2021 ) and serve as the primary measurement dimensions of current therapeutic landscapes.

Table 1

Table 1. The components of therapeutic landscapes.

Physical landscapes	Symbolic landscapes	Social landscapes
Remote and tranquil	Longevity symbol	Equal social relations
Immersed in nature	Unique culture	Harmonious neighborhood relations
Scenic beauty	Important rituals	Friendly tourist interactions
Aesthetic pleasure	Health significance	Good social support
Natural healing effects	Cultural artifacts	Rehabilitation communities

Note: Compiled based on relevant literature such as Gesler (1993) , Huang & Xu (2018) , etc.

The physical landscape functions as a space where individuals encounter therapeutic effects through their interaction with both natural and constructed surroundings. Often, people perceive the impact of the physical landscape on health through access to nutritious food, fresh air and water, and picturesque views ( Huang & Xu, 2018 ). In contrast, the symbolic landscape refers to an individual’s interpretation of a place and the symbolic significance attached to it. This concept is embodied in the cultural values and beliefs that tourists perceive while undergoing the healing process, reflecting personal cultural values, social behaviors, and practices within a specific context over time. It encompasses cultural artifacts, rituals, meanings, and more. The symbolic landscape often evolves through long-term accumulation and sedimentation, shaped by people’s observations, interpretations, and experiences of the landscape ( Huang & Xu, 2018 ). Acting as a bridge between the tangible environment and the social milieu, the symbolic landscape imparts healing attributes derived from the interpretation and expression of the destination. Conversely, the social landscape pertains to the interactions among individuals, with increased levels of social engagement proving beneficial for individual health improvement. This aspect fosters opportunities for interaction and offers a degree of social support to individuals, such as through positive community environments and interpersonal engagements in unconventional settings. Numerous studies have demonstrated that these environments contribute to sustaining individuals’ physical and mental well-being ( Zhang et al., 2021 ). This is evident in the form of harmonious neighborhood atmospheres, amicable tourist interactions, mutual encouragement for recovery, and other facets.

Existing research suggests that the theory of therapeutic landscapes is evolving beyond its origins in health geography, extending into diverse fields such as anthropology and kinesiology. An increasing body of literature is concentrating on the intricate relationship between landscapes and human health, recognizing the environment as a pivotal factor in both individual and societal well-being, and exerting a discernible influence on physical and psychological development. Within the realm of tourism, therapeutic landscapes are primarily examined in terms of their impact on tourists’ experiences. For instance, Backman et al. (2023) contend that restorative environments constitute a vital aspect of health experiences, fostering positive emotions, life satisfaction, and influencing individuals’ loyalty and intentions to revisit. Employing the framework of therapeutic landscapes, Zhang et al. (2021) have established connections between individuals’ perceptions of therapeutic landscapes, their experiences of restoration, and their personal characteristics, suggesting that such perceptions positively influence restoration experiences. Additionally, Wang et al. (2018) have investigated the characteristics of desert health resorts and their correlation with health recovery. Collectively, these studies underscore the foundational role of the theory of therapeutic landscapes in elucidating the nexus between environmental settings and individual processes of physical and psychological recuperation, thereby laying a robust theoretical groundwork for the research outlined in this paper.

2.2. Therapeutic Landscape and Perceived Value

The theory of therapeutic landscapes underscores the pivotal role of individuals’ self-perception in health, highlighting its profound impact on physical well-being. Functioning as “third places,” tourist destinations serve as havens from daily pressures, captivating visitors with unique tourism offerings and instilling a profound sense of relaxation that directly shapes their experiences. In recent years, there has been a surge in attention towards the sensory components of therapeutic spaces and the significance of personal practices and sensory experiences in promoting health. Therapeutic landscapes regard therapeutic functions as intrinsic attributes of destinations, intricately linked to visitor perception ( Yan & He, 2020 ). As individuals immerse themselves in these landscapes, they reap the benefits of their therapeutic effects, leading to a diverse range of perceived values associated with the landscape.

Perceived value encompasses consumers’ cost-benefit evaluations in tourism contexts, specifically measuring health enhancement, psycho-physiological restoration, and social enrichment. This health-focused valuation is theoretically grounded in the biophilia hypothesis and attention restoration theory, which demonstrate how therapeutic destination environments facilitate emotional upliftment, stress reduction, and holistic well-being through nature immersion and social engagement. Furthermore, the theory of therapeutic landscapes posits that therapeutic attributes are intrinsic to destinations and pivotal for individual health. When individuals immerse themselves in specific landscape environments, they are influenced by the therapeutic qualities inherent in the landscape. These influences lead to varying perceptions of its value, which directly shape their recovery experiences ( Huang & Xu, 2018 ). Hanna et al. (2019) , employing grounded theory, discovered that during tourism, emotional connections with nature can aid in alleviating tension and fostering psychological well-being. Hence, therapeutic landscapes can exert specific psychological health effects on individuals, including cognitive enhancement, mood elevation, fulfillment of social needs, and provision of healing benefits. Thus, Hypothesis 1 is proposed in this study.

H1: Therapeutic landscapes have a significantly positive impact on tourists’ perceived value.

H1a: Physical landscapes have a significant positive impact on tourists’ perceived value.

H1b: Symbolic landscapes have a significantly positive impact on tourists’ perceived value.

H1c: Social landscapes have a significantly positive impact on tourists’ perceived value.

2.3. Therapeutic Landscape and Tourist Retention

The Environmental Behavior Relationship Theory posits that external stimuli can trigger psychological responses in individuals, shaping their behaviors. Humans have an inherent inclination to seek physical and mental well-being by connecting with nature, finding solace in the tranquil natural environment as a counterbalance to the stressors of urban life, thus experiencing therapeutic effects. This connection between environment and health motivates individuals to adopt positive behaviors for their overall well-being. Consequently, therapeutic landscapes evoke various degrees of restorative experiences in individuals, influencing their subsequent behaviors ( Li et al., 2023 ).

Tourist retention, defined as consumers’ inclination at tourist destinations to repurchase, recommend, or endorse products or services, reflects their sustained engagement with an organization’s offerings or preference for a specific destination over time ( Fan et al., 2023 ). Across both tourism and consumer behavior research, environmental cues have been shown to enhance customers’ comfort and satisfaction during consumption experiences, which are crucial for subsequent behaviors ( Han et al., 2018 ). For instance, Mehrabian & Russell (1974) emphasized the significant impact of environmental components on post-purchase behavior, while Jang & Namkung (2009) found that the environment effectively predicts restaurant customers’ decision-making processes. Furthermore, a positive environmental ambiance fosters customers’ favorable emotional experiences post-purchase, leading to repeat consumption behavior. Empirical studies by Han et al. (2019) underscore the significant influence of environmental stimuli on customer retention, while Zhang et al. (2021) conducted empirical research on “migratory bird-type” health tourism in Hainan, revealing that such therapeutic destination environments enhance tourists’ perceptions of health benefits, consequently affecting their loyalty and driving repeat consumption behavior. Thus, Hypothesis 2 is proposed in this study.

H2: Therapeutic landscapes have a significant positive impact on tourist retention.

H2a: Physical landscapes have a significantly positive impact on tourist retention.

H2b: Symbolic landscapes have a significantly positive impact on tourist retention.

H2c: Social landscapes have a significantly positive impact on tourist retention.

2.4. Perceived Value and Tourist Retention

Consumers’ perceptions of the value associated with products or services can significantly influence their purchase intentions, as evidenced by several studies highlighting the impact of perceived value on tourists’ behavior. The value that tourists perceive in destinations affects their satisfaction, intentions to revisit, likelihood to recommend, and overall loyalty. Research indicates that tourism plays a vital role in enhancing and maintaining individuals’ well-being, with tourists’ perceptions and interactions within destination environments being crucial for their overall satisfaction. Throughout the tourism experience, tourists’ perceptions are influenced by various subjective and objective environmental factors, which can impact behaviors such as satisfaction and preferences. Huang (2022) found, in a survey of 368 shared bicycle users, that usability is key to promoting word-of-mouth communication through perceived value and brand image, thus affecting customer purchasing behavior. Eid (2015) explored the influence of perceived value on customer retention, considering quality value, price value, emotional value, social value, and attribute value perceived by Muslim tourists regarding tourism destination products. The study suggests that customers’ perceived value positively affects satisfaction and loyalty, thereby influencing customer retention. Han et al. (2019) conducted a survey among Islamic tourists visiting Korea and established a significant positive relationship between perceived return on investment and customer retention.

Perceived value emerges as a pivotal factor influencing customer retention ( Lee et al., 2007 ), acting as both a precursor to purchase intention and an indicator of product quality. Brady et al. (2001) demonstrate that the relationship between service quality evaluations and behavioral intentions is indirect, mediated by perceived service value. Consequently, perceived value gains increasing recognition as a reliable predictor of behavioral intentions. Greater perceived value is associated with higher tourist satisfaction and intention to retain ( Zeithaml, 1988 ). Berger et al. (2002) highlight perceived value as fundamental in consumer purchase decisions, a sentiment echoed by Sirakaya-Turk et al. (2015) , who emphasize its pivotal role in customer retention. Eid (2015) validates the positive impact of perceived value on customer retention among 221 Muslim religious tourists, with satisfaction and loyalty mediating this relationship. Thus, Hypothesis 3 and Hypothesis 4 are proposed in this study.

H3: Perceived value has a positive and significant impact on tourist retention.

H4: Perceived value mediates the relationship between therapeutic landscapes and tourist retention.

H4a: Perceived value mediates the relationship between symbolic landscapes and tourist retention.

H4b: Perceived value mediates the relationship between symbolic landscapes and tourist retention.

H4c: Perceived value mediates the relationship between social landscapes and tourist retention.

2.5. Self-Assessment of Health Status

Health encompasses more than just the absence of illness; it signifies complete physical, mental, and social well-being, underscored by a sense of contentment derived from positive interactions between individual potential, life necessities, and societal and environmental factors. It embodies holistic dimensions, including spiritual, psychological, and experiential aspects, beyond the purely physical realm. Consequently, determinants of health can be categorized into personal, social, and environmental factors, where individual physical status and environmental perception intertwine. While health is influenced by multifaceted factors such as socioeconomic status, social support, and physical ailments, tourists with varying self-assessed health statuses may have diverse health experiences when exposed to physical landscapes. Research suggests that older tourists often demonstrate a higher likelihood of repeat visitation compared to younger counterparts ( Kim et al., 2009 ), with age moderating the relationship between customer satisfaction and behavioral intentions.

For tourists to wellness tourism destinations, their self-assessment of health also plays a crucial role in their length of stay. Conradson (2005) introduced the concept of relational selves, highlighting individual differences in perceiving therapeutic environments. Research by Yan & He (2020) among seasonal health migration tourists in Bama revealed varying perceptions of therapeutic landscapes between those with serious illnesses and those who are relatively healthy. Some tourists view magnetic caves as having healing properties due to their strong magnetic fields, often spending extended periods there. However, others, especially older individuals and chronic disease patients, find the caves’ damp and cold conditions detrimental to health. Studies typically concentrate on specific demographics, such as youth, seniors, and individuals with mental health issues, demonstrating the stress-reducing benefits of natural environments. Consequently, the impact of therapeutic landscapes on tourist retention varies depending on their self-assessed health status, leading to the formulation of hypothesis 5.

H5: Tourists’ self-assessment of their health status moderates the relationship between therapeutic landscapes and tourist retention.

H5a: Tourists’ self-assessment of their health status moderates the relationship between physical landscapes and tourist retention.

H5b: Tourists’ self-assessment of their health status moderates the relationship between symbolic landscapes and tourist retention.

H5c: Tourists’ self-assessment of their health status moderates the relationship between social landscapes and tourist retention.

On the basis of the above discussion of the literature, in health tourism destinations, therapeutic landscapes influence tourists’ perceived value, leading to tourist retention behavior. Therefore, this study proposes the following hypothetical model (as shown in Figure 1 ).

Figure 1

Figure 1. Conceptual framework of the study.

3. Research Methods

3.1. Research Setting

This research centers on Bama, Guangxi, as its primary case study location. Bama stands out as a natural haven for health preservation, boasting exceptional therapeutic landscapes. Moreover, globally recognized as a longevity village and a hub for health tourism, Bama’s strides in health and wellness tourism have become a focal point in academic discourse. Scholars such as Huang & Xu (2018) , Yan & He (2020) , and Wang et al. (2020) have conducted comprehensive research from diverse angles, covering therapeutic landscapes, wellness culture, health tourism, and spatial stigmatization. The extensive interviews conducted by Huang & Xu (2018) , integrating therapeutic landscape theory, provide a robust foundation for the quantitative research in this study. Thus, the selection of Bama as a focal point for health and wellness tourism not only demonstrates feasibility but also holds considerable academic research value.

In particular, this study opted to collect data from three distinct locales in Bama: Baimo Cave, Longevity Island, and Renshouyuan. This approach aims to mitigate potential biases that might arise from relying solely on one sampling location. Baimo Cave, nestled near the outlet of the Panyang River, attracts numerous visitors who seek water and engage in magnetic therapy meditation. Longevity Island hosts regular performances of “Dream of Bama,” a significant event that showcases Bama’s rich culture of longevity. Lastly, Renshouyuan serves as the cradle of Bama’s longevity culture, offering insights into Bama’s traditions of health preservation, filial piety, and dietary practices.

3.2. Measurement Instrument

To validate the hypotheses, this study employed a quantitative approach, gathering data through questionnaire distribution. The questionnaire was structured into three sections: screening questions, assessing the impact of therapeutic landscapes on tourist retention, and capturing basic visitor demographics. The screening questions ensured that respondents were indeed health and wellness tourists. The section on landscape impact evaluated its influence on tourist retention, while the demographics section gathered relevant data.

In measuring variables, existing validated scales were utilized, with adjustments made for contextual relevance during translation. Professional translators were involved, and adjustments were further refined by three tourism experts to ensure questionnaire effectiveness. The scales were primarily drawn from established studies: therapeutic landscapes from Zhang et al. (2021) and Huang & Xu (2018) ; perceived value from Kim et al. (2009) ; tourist retention from Han et al. (2019) and Fan et al. (2023) ; and self-health assessment from Zhang et al. (2021) and Dai et al. (2021) . All measurement items used a 7-point Likert scale.

3.3. Sampling and Data Collection

Due to constraints in time, resources, manpower, and finances, this study will utilize convenience sampling to survey the research subjects. Convenience sampling involves selecting readily available samples from all research subjects as respondents and is characterized by its non-comprehensive and non-probabilistic nature. While convenience sampling may exhibit notable differences in demographic characteristics compared to probability sampling, both methods typically yield similar statistical significance in most experimental and observational studies. Despite the demographic variations among samples, the unknown overall population of research subjects makes simple random sampling challenging. Thus, convenience sampling is the chosen approach for this study, allowing for practical and efficient data collection within the given constraints.

This study conducted on-site surveys daily from February 12 to 20, 2024, spanning from 7:00 to 18:00, at Baimo Cave, Longevity Island, and Renshouyuan. Recognizing the predominant elderly demographic among Bama’s tourists, three tourism management students were enlisted as research assistants to elucidate survey objectives and administer questionnaires. This proactive approach aimed to ensure respondents’ thorough understanding of the survey’s purpose and questions, thereby enhancing the reliability of the questionnaire responses. The data collection process comprised three essential steps: initially, research assistants communicated study objectives and screening questions to tourists, proceeding with the survey if respondents agreed to participate and met screening criteria. Subsequently, research assistants actively facilitated tourists in completing questionnaires, providing clarifications and ensuring questionnaire completeness. Finally, upon completion, research assistants meticulously collected and sequentially numbered each questionnaire or recorded pertinent details.

Participants were required to have either completed or been actively engaged in their trip before completing the questionnaire to enable a comprehensive understanding and evaluation of the study variables. Furthermore, participation was restricted to tourists aged 18 and above, with those under 18 excluded on ethical grounds. Out of the 604 questionnaires distributed and collected, 572 valid responses were obtained after excluding 32 invalid submissions, yielding an impressive effective response rate of 94.7%.

4. Results

SmartPLS stands out for its efficacy in exploratory research models due to its robust statistical analysis capabilities, adeptness in managing smaller sample sizes, and handling of non-normal distribution data ( Hair et al., 2012 ). Widely embraced across diverse social science domains, such as marketing and tourism ( Hair et al., 2019 ), SmartPLS 4.0 was the cornerstone of this study, facilitating comprehensive measurement model analysis and structural equation model analysis to rigorously validate the proposed hypothesis relationships within the framework.

4.1. Sample Profile

Among the 572 respondents, males predominated at 61%, while females accounted for 39%. The age distribution skewed towards older demographics, with the 56 to 65 age group representing over half of the sample, demonstrating a “small at both ends, large in the middle” trend. High school education, including vocational training, was most prevalent, with 48.3% of respondents holding this level of attainment. This educational profile mirrored the age distribution, particularly among those aged 56 to 65, indicating a prevalence of lower educational levels, typically high school or below. Retirees constituted the largest occupational group at 77.6%. Regarding monthly income, the majority fell within the 6001 to 10,000 yuan range, accounting for 68.0% of respondents. This income distribution reflected a pattern of “small at both ends, large in the middle,” indicating a generally stable economic status among Bama tourists.

4.2. Measurement Model

Item factor loadings range from 0.700 to 0.916 (shown in Table 2 ), all exceeding the 0.7 threshold set by Barclay et al. (1995) , indicating robust item reliability. Cronbach’s alpha is above 0.7 for all items, while composite reliability is below 0.95, demonstrating a strong level of reliability in the measurement model. The average variance extracted (AVE) ranges from 0.599 to 0.749, surpassing the 0.5 benchmark suggested by Hair et al. (2014) , indicating excellent convergent validity. Additionally, the square root of AVE for each variable exceeds its correlations with other variables ( Fornell & Larcker, 1981 ), confirming significant discriminant validity, as shown in Table 3 .

Table 2

Table 2. Reliability and validity

Construct/Items	Factor loading	Cronbach’s α	CR	AVE
Physical landscapes		0.921	0.935	0.707
PYL1	0.843
PYL2	0.831
PYL3	0.916
PYL4	0.797
PYL5	0.812
PYL6	0.841
Symbolic landscapes		0.797	0.856	0.599
SYL1	0.840
SYL2	0.810
SYL3	0.700
SYL4	0.738
Social landscapes		0.849	0.893	0.736
SOL1	0.912
SOL2	0.893
SOL3	0.761
Perceived value		0.834	0.899	0.749
PEV1	0.893
PEV2	0.810
PEV3	0.890
Tourist retention		0.859	0.903	0.699
TR1	0.833
TR2	0.847
TR3	0.818
TR4	0.845
Self-health assessment		0.925	0.915	0.644
PHC1	0.819
PHC2	0.812
PHC3	0.766
PHC4	0.790
PHC5	0.756
PHC6	0.867

Table 3

Table 3. Correlation matrix of all variables.

	PYL	SYL	SOL	PEV	TR	PHC
PYL	0.834
SYL	0.362	0.774
SOL	0.533	0.344	0.848
PEV	0.473	0.343	0.430	0.845
TR	0.525	0.230	0.527	0.509	0.836
PHC	0.021	0.133	0.430	0.136	0.122	0.802

4.3. Structural Model

Bootstrapping (5000 subsamples) was performed to analyze the research models. When the p-value is less than 0.05 and the t-value exceeds 1.96 ( Hair et al., 2019 ), the path relationships between variables are significant, supporting the hypotheses. As shown in Table 4 , the three dimensions of therapeutic landscapes significantly influence perceived value (βPLY → PEV = 0.300, T = 4.664, P < 0.05; βSOY → PEV = 0.160, T = 3.377, P < 0.05; βSYL → PEV = 0.215, T = 3.752, P < 0.05), supporting hypotheses 1a, 1b, and 1c. The physical and social environments positively impact tourist retention (βPLY → TR = 0.231, T = 4.843, P < 0.05; βSOL → TR = 0.260, T = 6.709, P < 0.05), while the symbolic environment does not (βSLY → TR = −0.040, T = 1.109, P > 0.05), supporting hypotheses 2a and 2c but not 2b. Perceived value significantly influences tourist retention (βPEV → TR = 0.269, T = 5.662, P < 0.05), supporting hypothesis 3.

4.4. The Mediating Effects

This study employs bootstrapping to evaluate the significance of indirect effects and determine the presence of mediation effects. Initially, the significance of the indirect effects between variables is assessed. If these effects are not significant, mediation does not exist. If the indirect effects are significant, the direct effects are analyzed to determine whether the mediation is partial or full. Significant direct effects indicate partial mediation, while non-significant direct effects indicate full mediation. As shown in Table 5 , perceived value partially mediates the relationship between the physical and social environments and tourist retention, and fully mediates the relationship between the symbolic environment and tourist retention. These findings support hypotheses 4a, 4b, and 4c.

Table 4

Table 4. Results of hypothesis testing.

Hypothesis	Path	β-Value	t-Value	P-Value	f2	Support
H1a	PYL → PEV	0.300	4.664	0.000	0.086	Yes
H1b	SYL → PEV	0.160	3.377	0.001	0.030	Yes
H1c	SOL → PEV	0.215	3.752	0.000	0.045	Yes
H2a	PYL → TR	0.231	4.843	0.000	0.062	Yes
H2b	SYL → TR	-0.040	1.109	0.267	0.003	No
H2c	SOL → TR	0.260	6.709	0.000	0.083	Yes
H3	PEV → TR	0.269	5.662	0.000	0.090	Yes

Table 5

Table 5. Mediating effects.

Hypothesis	Path	Indirect			Direct			Support
		β-Value	P-Value	T-Value	β-Value	P-Value	T-Value
H4a	PYL → PEV → TR	0.081	0.000	3.539	0.231	0.000	4.843	Yes
H4b	SYL → PEV → TR	0.043	0.003	2.932	−0.040	0.267	1.109	Yes
H4c	SOL → PEV → TR	0.058	0.003	3.008	0.260	0.000	6.709	Yes

4.5. The Moderating Effects

To analyze moderation effects using SmartPLS, the significance of the moderation effect is first determined through bootstrapping path analysis. If significant, a simple slopes analysis is conducted to examine the direction of the moderation effect by analyzing the mean of the moderating variable at −1 and +1 standard deviations. This study employs bootstrapping with 5000 samples and a significance level of 0.05 to test the moderation paths. As shown in Table 6 , tourists’ self-assessment of health status significantly moderates the relationship between the social environment and tourist retention (β = 0.105, P = 0.007, T = 2.717; P < 0.05, T > 1.96). However, it does not moderate the relationship between the physical environment (β = 0.064, P = 0.221, T = 1.224; P > 0.05, T < 1.96) or the symbolic environment (β = -0.030, P = 0.456, T = 0.746; P > 0.05, T < 1.96). Therefore, hypotheses 5a and 5b are not supported, while hypothesis 5c is supported.

Table 6

Table 6. Moderating effects.

Hypothesis	Path	β-Value	Mean	t-Value	P-Value	Support
H5a	PHC × PYL → TR	0.064	0.080	1.224	0.221	No
H5b	PHC × SYL → TR	−0.030	0.030	0.746	0.456	No
H5c	PHC × SOL → TR	0.105	0.101	2.717	0.007	Yes

Based on the simple slopes analysis presented in Figure 2 , the slope for tourists with higher self-assessed health status (PHC +1 standard deviation) significantly exceeds that for tourists with lower self-assessed health status (PHC −1 standard deviation). This suggests that as tourists perceive their health more favorably, the social environment exerts a stronger influence on tourist retention. Consequently, tourists’ self-assessment of health status positively moderates the relationship between the social environment and tourist retention.

Figure 2

Figure 2. Moderating effect of tourists’ self-assessed health status on the relationship between social environment and tourist retention.

5. Discussion and Conclusion

5.1. Conclusion

This study proposes that physical, symbolic, and social therapeutic landscape dimensions enhance perceived value, whereby heightened restorative perceptions prompt tourist recovery experiences, value recognition, and ultimately foster destination loyalty. The outcomes of Hypotheses 1a, 1b, and 1c further corroborate the significant positive influence of therapeutic landscapes on perceived value, aligning with existing empirical research ( Hanna et al., 2019 ; Wang et al., 2022 ; Zhang et al., 2022 ). Wang et al. (2022) revealed through a survey of tourists in Dujiangyan, Sichuan, that the restorative environment of a health tourism destination significantly influences perceived value. Hanna et al. (2019) demonstrated through grounded theory research that emotional connections with nature during travel alleviate tourist stress and promote mental well-being. Moreover, therapeutic landscapes positively impact psychological health, enhancing cognitive functions, improving mood, and fulfilling social needs, thereby providing therapeutic value. Thus, a critical condition for tourists perceiving their experience as worthwhile is the landscape’s ability to facilitate physical and mental recovery, positively influencing health. In this study, tourists perceive Bama’s unique restorative landscape as having a therapeutic effect, directly enhancing perceived value and crucially promoting tourist retention.

In studying the impact of therapeutic landscapes on tourist retention, both natural and social environments were found to have a significantly positive influence, consistent with existing research ( Hanna et al., 2019 ; Huang, 2022 ; Zhang et al., 2021 ). However, this study did not find a direct significant relationship between the symbolic environment and tourist retention. For the symbolic environment to directly affect tourist retention, it must do so through recovery experiences and perceived value, which contrasts with previous findings ( Wang et al., 2020 ; Zhang et al., 2021 ). Symbols, acting as conveyors of meaning, cultural markers, signs, and images, are crucial for reflecting health culture ( Huang & Xu, 2018 ). The therapeutic effect of symbolic landscapes depends on “the use, interpretation, and application of core cultural symbols in the healing process.” However, cultural attention and understanding differ based on cultural backgrounds, social environments, and motivational needs. According to cognitive appraisal theory, individuals’ perceptions of the external environment vary, which stimulates self-development and intrinsic motivation, thereby influencing behavior. Consequently, significant individual differences lead to varied perceptions and subsequent behaviors. Unlike seasonal tourists in Sanya, Hainan, as studied by Zhang et al. (2021) , many tourists in Bama are “healing” tourists dealing with cancer or other chronic illnesses ( Huang & Xu, 2023 ; Huang, 2021 ; Wang et al., 2020 ). These tourists prioritize the health-related attributes of the destination, such as water, air, food, and community recovery experiences, over cultural aspects ( Huang & Xu, 2018 ). Huang (2022) found in an IPA study of Bama’s destination image that tourists are more interested in activities like sightseeing, oxygen therapy, and water intake than in visiting centenarians or experiencing Bama’s ethnic minority culture, indicating limited cultural engagement. Therefore, in this study, the symbolic environment can significantly influence tourist retention by fostering recovery experiences and perceived value.

Tourists’ perceived value significantly impacts their retention behavior (Hypothesis 3). Specifically, the more valuable tourists find the activities at a wellness tourism destination, the more likely they are to return. The study’s results confirm that perceived value positively influences tourist retention behavior, supporting Hypothesis 3 and aligning with existing research. Studies have shown that perceived value affects tourists’ satisfaction, revisit intentions, recommendations, and loyalty ( Paulose & Shakeel, 2022 ). Han, Moon, et al. (2019) found a positive relationship between perceived return on investment and tourist retention in a survey of Islamic tourists visiting Korea. Vada et al. (2019) concluded that when tourists have a satisfactory trip and feel their time was well spent, their attachment to the destination strengthens, leading to revisit intentions. For tourists in Bama, retention behavior is attributed to the perceived value from experiencing physical and mental recovery in Bama’s unique restorative environment.

This study posits that tourists’ perceived value acts as a mediator in the relationship between therapeutic landscapes (including physical, symbolic, and social environments) and tourist retention (Hypotheses 4a, 4b, 4c). Existing literature highlights perceived value as a fundamental and influential factor in consumer decision-making: higher perceived value leads to greater tourist satisfaction and increased intention to revisit ( Zeithaml, 1988 ). Brady et al. (2001) demonstrated that customers’ assessments of service quality indirectly influence behavioral intentions through perceived value, rather than directly. Similarly, Jeong & Kim (2019) argue that the quality of destination offerings and the destination’s image impact tourist satisfaction via perceived value, subsequently shaping their behavioral intentions. Thus, perceived value serves as a mediator in the relationship between destination attributes and tourists’ behavioral intentions.

This study posits that tourists’ self-assessed health status moderates the relationship between physical and social environments and tourist retention (Hypotheses 5a, 5b, 5c), wherein heightened health perception amplifies therapeutic landscape effects, particularly among tourists with poorer health status who demonstrate intensified therapeutic responses and stronger retention behavior ( Yan & He, 2020 ; Zhang et al., 2021 ). This study’s findings diverge from prior assumptions, potentially attributable to its post-restriction timing (conducted 4 months after pandemic measures lifted). Despite lifted restrictions, persistent COVID-19/influenza prevalence amplified tourists’ risk perceptions, fundamentally altering host-guest interaction patterns through precautionary avoidance behaviors ( Jiang & Tu, 2023 ). Tourists with poorer self-assessed health status exhibited socially constrained behaviors, while those with better health engaged significantly more in targeted interactions—particularly with local elderly and experience-sharing peers. These restorative social exchanges fostered reciprocal restoration and relaxation, thereby reinforcing destination loyalty.

5.2. Theoretical Implications

Firstly, this study significantly advances the application of restorative landscape theory in tourism. While existing literature primarily investigates therapeutic landscapes in health geography, nursing, and landscape and urban planning, focusing on the relationship between landscape environments and individual well-being, research on its application in tourism remains limited ( Qiu et al., 2022 ). Addressing this gap, the study selects Bama, a globally recognized longevity village, as a case study for wellness tourism. Guided by restorative landscape theory, it conducts a detailed analysis of Bama’s landscapes—physical, symbolic, and social—contributing to broader applications in tourism studies. Moreover, while qualitative research predominates in restorative landscape theory, quantitative studies are notably lacking ( Zhang et al., 2021 ). This study fills this methodological gap by refining measurement scales through a comprehensive literature review and empirical fieldwork. Current applications of restorative landscape theory in tourism often focus narrowly on specific products and services, like hot springs, cuisine, health spas, and desert therapies ( Huang & Xu, 2018 ; Wang et al., 2018 ), overlooking comprehensive landscape assessments. By focusing on wellness tourism destinations and integrating physical, symbolic, and social dimensions, this research expands both the theoretical and practical implications of restorative landscape theory in the tourism sector.

Secondly, this study theoretically advances tourist retention research by establishing perceived value as a psychological mediator between therapeutic landscapes and destination loyalty. While rooted in marketing, tourist retention remains underexplored in tourism studies compared to related concepts like tourist behavior and loyalty. Our findings bridge this gap by empirically demonstrating how restorative environments enhance retention through experiential value perceptions, extending beyond conventional antecedent factors, such as satisfaction and trust.

Finally, by introducing the moderating role of tourists’ self-assessed health status, this study offers a nuanced analysis of factors influencing tourist retention from the perspective of tourists’ subjective conditions, presenting a novel theoretical framework. Tourist retention is a key indicator of a destination’s competitiveness and development. Tourists with different self-assessed health statuses exhibit varied retention behaviors. While existing research has focused mainly on antecedent factors like satisfaction, loyalty, environmental ambiance, perceived value, and trust, it often overlooks moderating effects. This study empirically demonstrates that tourists’ self-assessed health status moderates the relationship between the social environment and tourist retention, providing a new theoretical perspective in the field.

5.3. Practical Implications

Firstly, it is essential to protect and enhance visitor behaviors to promote the sustainable development of natural resources. Bama, renowned as a global longevity region, attracts tourists with its physical landscapes, including water, air, geomagnetism, and local cuisine ( Huang & Xu, 2023 ; Huang, 2022 ). The natural environment is the cornerstone of Bama’s wellness tourism and, as a non-renewable resource, must be responsibly preserved and developed. Authorities should implement sound planning strategies, guide visitors’ activities, and promote environmental responsibility through awareness campaigns, waste segregation, and strategic placement of wellness facilities.

Secondly, regarding the symbolic environment, enhancing cultural export and strengthening the wellness culture brand are essential. As a unique cultural amalgamation of the destination, the symbolic environment often embodies distinct regional characteristics and cultural nuances ( Huang & Xu, 2018 ). This requires meticulous excavation and integration for effective presentation to tourists. Authorities can boost the export of Bama’s wellness culture by developing cultural and creative products and incorporating folk performances to enrich tourists’ perceptions of Bama’s longevity and wellness culture.

Thirdly, in terms of the social environment, fostering robust social interactions and nurturing a harmonious atmosphere are paramount. According to Jiang & Tu (2023) , social interactions significantly influence tourists’ experiences at a destination. This study reinforces the positive impact of the social environment on enhancing tourists’ restorative experiences. Genuine social interactions can facilitate superior restorative experiences, thereby creating memorable encounters for tourists. Positive experiences drive favorable word-of-mouth recommendations, which are crucial for the destination’s long-term sustainability. Therefore, authorities should implement interventions to enhance tourists’ perception of authentic hospitality from local hosts.

Fourth, enhancing tourists’ perceived value through high-quality, affordable wellness products is crucial. The perceived value of a destination significantly contributes to tourists’ physical and mental rejuvenation, positively impacting word-of-mouth promotion and revisitation intentions. In wellness tourism, tourists’ perceptions hinge on accessibility, facility convenience, and the quality of activities offered. Tourists assess the value of their time and expenditure based on these criteria. Authorities can enhance Bama’s accessibility by expanding high-speed rail networks and improving local infrastructure. Strengthening regulatory measures to combat counterfeit products and elevating the overall quality of tourism services will further enhance tourists’ perceived value.

Finally, targeted marketing based on tourists’ health conditions is paramount. Local destination organizations and managers should prioritize visitors with health concerns, improving perceptions and dispelling misconceptions about Bama as a “cancer village,” thereby enhancing the overall travel experience. Proactive guidance strategies and effective media campaigns should promote a positive image of local hosts and the destination. Tailored tourism experiences that cater to the unique attributes of Bama and accommodate diverse health needs will engage tourists with varying health assessments, fostering greater interest and participation.

5.4. Limitations and Future Study

In conclusion, this study provides empirical insights that advance the theoretical understanding of the relationship between environment and behavior, as well as restorative theories. It also offers practical recommendations for the sustainable development of wellness tourism destinations. However, certain limitations arise from the researcher’s expertise and objective constraints.

Firstly, this study’s generalizability is constrained by its single-site focus on Bama’s distinctive longevity-themed therapeutic landscapes and the convenience sampling of domestic tourists, limiting cross-cultural applicability. Future research should adopt multi-destination comparative designs across diverse wellness tourism contexts to address regional, categorical, and developmental heterogeneity for enhanced external validity.

Secondly, the research depth can be enhanced by exploring different contexts. This study focused on tourists’ self-assessment of physical health as a moderating variable but overlooked other aspects, such as psychological health. For wellness tourism destinations, the pursuit of physical health is significant ( Wang et al., 2022 ), especially for Bama tourists, many of whom suffer from cancer or other chronic diseases ( Huang & Xu, 2023 ; Huang, 2021 ; Wang et al., 2022 ), underscoring the need for physical health. Moreover, measuring psychological health or other health states involves complex dimensions and methods, which were beyond this study’s scope. Future research should integrate tourists’ physical health assessments with psychological health and other aspects, using different methodologies for a more comprehensive analysis.

Acknowledgements

Thanks to the support from the Zhanjiang Philosophy and Social Sciences Planning Project for the research titled “Mechanisms and Pathways of Low-Altitude Economy Driving the Reconstruction of the Value Network in Zhanjiang’s Urban Periphery Recreational Belt.”

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