Development of Integrated Marketing Communication Model
for Health Tourism Entrepreneurs to Accommodate Elderly Tourists
in the World Heritage City for Elderly Tourists
(Phra Nakhon Si Ayutthaya District)
YANISA PHUANPOH*, NATTAYA KETSOMBOON
Faculty of Management Science,
Phranakhon Si Ayutthaya Rajabhat University,
96 Pratuchai, Phra Nakhon Si Ayutthaya, Phra Nakhon Si Ayutthaya, 13000,
THAILAND
*Corresponding Author
Abstract: - The goals of this article are to 1) examine the integrated marketing communication situation of
health tourism entrepreneurs to accommodate elderly tourists in the World Heritage City for elderly tourists
(Phra Nakhon Si Ayutthaya District); 2) examine the integrated marketing communication of medical tourism
entrepreneurs to accommodate elderly tourists in the World Heritage City for elderly tourists (Phra Nakhon Si
Ayutthaya District); and 3) examine health tourism entrepreneurs to accommodate elder tourists (Phra Nakhon
Si Ayutthaya District). The research design is mixed-methods research with participatory action research
(PAR). In-depth interviews, focus group discussions, and policy meetings are all used in the qualitative
research model, and employ the Snowball Sampling method of random sampling by referring people and
experts, analyzing the data using content analysis, and composing a descriptive narrative. 400 senior tourists
were sampled using the purposive selection method for the quantitative research method. Then, descriptive
statistics and the Structural Equation Model (SEM) were used to analyze the data. The study's findings indicate
that the "SILVER D Model," which consists of the seven strategies under the models S-Standard, I-Integrated,
L-Lifestyle, V-Value Proposition, E-Entrepreneurial, R-Responsibility, and D-Digital Marketing, is the
integrated marketing communication model employed by health tourism entrepreneurs to accommodate elderly
tourists in the Phra Nakhon Si Ayutthaya District, a World Heritage Site. 3. The "SILVER D Model," a
participatory action research (PAR) framework and strategies falling under the aforementioned 7 strategies The
information gained from this study can be used to create an integrated marketing communication strategy for
health tourism business owners to assist senior tourists in the Phra Nakhon Si Ayutthaya District, a World
Heritage City for elderly tourists, for the benefit of the stakeholders involved in both economics and policy.
Key-Words: Integrated Marketing Communication, Entrepreneurship, Health Tourism, Elderly Tourists,
World Heritage City.
Received: January 7, 2023. Revised: May 27, 2023. Accepted: June 5, 2023. Published: June 15, 2023.
1 Introduction
Currently, the number of elderly people is steadily
rising in all nations. According to the United
Nations, there will be 1.968 million elderly people
in 2050, up from 687.9 million in 2006, [1].
Thailand has been an aging society for more than
ten years, which means that the percentage of
people 60 or older has increased by more than 10%
of the total population, requiring the organization
of a long-term care system for the elderly to have a
good quality of life in terms of allocating scarce
resources, enhancing the retirement system,
providing essential welfare for the elderly, setting
up public transportation systems for the elderly,
and getting ready for the Universal Design
architecture or the idea of environmental design,
which entails building structures and gadgets that
the elderly can access, use, and facilitate, [2].
Furthermore, the aging of developed-country
populations poses new challenges not only to the
healthcare system but also to tourism and leisure,
[3]. It has been discovered that the growing elderly
population worldwide presents a business
opportunity for the tourism industry and that
business owners in the industry must deal with
sociodemographic factors like age, gender, income,
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cultural values, and marketing strategies to promote
elderly tourism. The study also discovered that the
needs and motivations of the elderly in elderly
tourism are influenced by socio-demographic
factors.
Medical tourism is one of the most important
and rapidly growing industries, as well as one of
the most distinctive global phenomena of the
twenty-first century. Tourism promotes growth,
economic development, cultural heritage
restoration, and national reunification, [4]. The
elderly are particularly interested in health tourism,
which emphasizes the importance of stress
management through the use of relaxation
techniques like spa massage, Thai massage, herbal
steam baths, and massages with herbal compresses,
etc., [5]. Entrepreneurs and pertinent organizations
must adjust to accommodate aging tourists and
develop strategies to address the competitive
tourism situation by attempting to reach and meet
tourist needs as much as possible, particularly those
of elderly visitors who do not focus on haste but
rather focus on tourism to experience, absorb,
learn, and admire tourism for relaxation and
genuine learning, [6]. To accommodate this
particular demographic of tourists, the service
sector and tourism activities must be developed in
accordance with their needs.
World Heritage cities such as Phra Nakhon
Si Ayutthaya Province and surrounding areas are
regarded as tourist attractions and Thailand's
cultural heritage, with distinct characteristics and
cultural heritage that have been passed down for a
long time. The historical tour of Thailand's World
Heritage City remains a popular tourist destination
for visitors from all over the world. Even though
tourism in Phra Nakhon Si Ayutthaya Province is
consistently popular with tourists, it is discovered
that most efforts to promote tourism in Phra
Nakhon Si Ayutthaya Province focus on offering
tourism to existing historical sites and only
promote and revitalizing certain traditions and
cultures. However, it was discovered that the
tourism resources presented could still be
developed further to create new tourist attractions
to attract tourists, [7]. Additionally, enhancing
customer service, investing in information and
communication technologies to increase their
attractiveness in the tourism market, and
communicating ideas, images, and new
technologies to facilitate tourism services by
providing customer-friendly services are frequently
what drive innovative processes in the tourism
industry. Although tourism is regarded as a
forerunner in the adoption of new technologies,
studies show that new technologies are frequently
insufficient, and impact assessments are
inconsistent, [8].
IMC (Integrated Marketing
Communications) is a new paradigm for managing
marketing communications to generate and
leverage consumer interests and relationships. By
integrating, measuring, and aligning traditional and
new interactive marketing approaches, IMC can be
linked to customer relationship management. Few
studies have specifically addressed IMC and its
application in the hospitality and tourism sectors,
according to this extensive literature review. The
use of the IMC concept in the tourism and
hospitality industries, therefore, requires further
study, [9]. Furthermore, there has been an argument
that the use of digital technologies in marketing
communications for tourism and hospitality
businesses has not been sufficiently developed in
terms of marketing communications specifics, and
that digital technology has not been fully applied in
practice, affecting the tourism industry's long-term
purposeful development, [10].
Although Phra Nakhon Si Ayutthaya
Province has consistently enjoyed a high level of
tourism, there are still many obstacles facing the
sector, including a growing proportion of elderly
tourists. Technology disruptions and digital
marketing transformation have resulted in tourism
entrepreneurs being empowered, revitalized, and
empowered to compete at their best, particularly in
the planning of integrated marketing
communication strategies in the digital age, a
strategy that all agencies in the province value as a
guideline for driving tourism in the same direction
and with clear goals in terms of concrete tourism
development planning. In this study, the situation
of integrated marketing communication among
medical tourism operators to support elderly
tourists in the World Heritage City was studied.
There are also inquiries from various sectors
involved, including government, the private sector,
entrepreneurs, citizens, and tourists, leading to the
development of an integrated marketing
communication model for health tourism
entrepreneurs to propose relevant agencies to plan
strategies for integrated marketing communication
of medical tourism operators to support elderly
tourists in the World Heritage City for senior
tourists to create added economic value and the
sustainability of the balance of economy, society,
culture, and environment in this tourist destination
area.
In conclusion, integrated entrepreneurial
marketing communication is critical in many ways
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for medical tourism entrepreneurs, aging tourists,
and tourism sector stakeholders. However, given
the rapid expansion of the tourism and service
industries, as well as the transformation of the
population structure into an aging society, tourism
entrepreneurs are finding that integrated marketing
communications must be modernized to improve
the quality of tourism and hotel services. As a
result, the goal of this study is to create an
integrated marketing communication model for
medical tourism entrepreneurs to assist elderly
tourists in the World Heritage City for elderly
tourists (Phra Nakhon Si Ayutthaya District) to
plan, adapt, and develop long-term integrated
marketing communications.
1.1 Research Objectives
1) To study the situation of integrated
marketing communication among health tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District).
2) To develop an integrated marketing
communication model for medical tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District).
3) To certify the integrated marketing
communication model of medical tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District).
2 Literature Review
2 . 1 Integrated Marketing Communication
(IMC)
A comprehensive marketing communications
strategy, which includes advertising, promotions,
word of mouth, direct marketing, and public
relations, is one of the core components of a
promotional marketing strategy. It is
fundamentally multifaceted communication that
employs techniques to balance differences. Each
promotional component of the marketing mix
generates and delivers more targeted value, which
can lead to greater awareness of the company's
products or services. It also includes informing
people about features and benefits to entice them to
buy, with the ultimate goal of converting potential
customers into customers. Marketing managers
must consider the 6Ms, which are market, mission,
message, media, money, and measurement, [11].
The study of the integration of social media and
digital media is a new component of integrated
marketing communications in the hospitality and
tourism industries to build brand value. In India, it
has been discovered that IMC tools integrated
through social media and digital media are more
effective than traditional IMC tools in the digital
era.
2.2 Health Tourism Entrepreneurs
It is frequently assumed that the success of small
businesses in the tourism industry is dependent on
the entrepreneur, [12]. The key characteristics are:
1) Proactiveness, or acting proactively, which
includes initiative, risk-taking, and competitive
aggression; and competitive aggression, which
refers to the extent to which an organization seeks
initiative and is willing to take a certain level of
risk in pursuit of opportunities, [13]. 2)
Innovativeness, that is, today, in a time of great
change, companies need to adopt innovative ideas
in their business. Finding and implementing novel
methods of conducting business and treating
employees is a necessary part of the innovative
process that is modern entrepreneurship. Therefore,
it is crucial to recognize entrepreneurs'
opportunities and creativity in the tourism market,
[14]. 3) Risk-taking, in which an entrepreneurial
risk-taking culture fosters a learning environment
characterized by exploration and experimentation.
Risk-taking and creative entrepreneurs are more
likely to demonstrate a higher level of commitment
to learning. They also encourage action that
deviates from the norm, admit mistakes, and
reward new ideas that lead to business
improvements, thereby increasing opportunities for
creative learning, [13]. 4) Competitiveness, which
is a crucial component of introducing new goods
and services to consumers, and of which
entrepreneurs must be aware in the early stages.
This has to be done from a competitive standpoint.
New developments won't occur if they operate in
an uncompetitive market, [15]. The entrepreneurial
viewpoint on destination development is a key
component of tourism-related entrepreneurship
research. There are, however, not many empirical
studies of health tourism using entrepreneurial
concepts, [16].
2.3 The Concept of the Elderly
Thailand is entering a society that is getting
older. To change the type of tourism to be
different from the past, also known as "New
Normal Tourism," as a tool to build confidence
for tourists as well as help drive the country's
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economy to be able to continue, one of the
missions that all parties must jointly accomplish
is managing health tourism to be safe and sterile
along with the needs and behaviors of tourists,
[17]. As for Thailand, the proportion of the
country's 68.3 million population that is over the
age of 65 is as high as 25.8%, meaning that
Thailand will officially enter an aging society in
2030, [18]. The behaviors of retired elderly
people include an interest in leisure travel or the
pursuit of lifelong wealth through travel to
destinations of their choice, typically selecting
travel in the service, health, and recreation
sectors by taking into account certification of
safety and health care services, as well as
selecting activities appropriate for their age. As a
result, this group of tourists is regarded as being
prepared and capable of spending, and since
there are typically 2 to 3 companions per trip,
spending is correspondingly higher, [19].
However, because this group of tourists has more
travel restrictions than other groups, it is critical
to study and prepare thoroughly before
supporting this market to maximize efficiency
and tourist satisfaction, [20]. This is consistent
with a study of health tourism activities to
accommodate elderly tourists in Phra Nakhon Si
Ayutthaya District, Phra Nakhon Si Ayutthaya
Province, which discovered that tourism behavior
was leisure with a frequency of three times a
year. This group of tourists was primarily
interested in historical and religious tourist sites
and had a thorough understanding of the various
types of health tourism activities. The
comparison of activity patterns classified by
personal factors was different with a statistical
significance of 0.05, and there were also different
activity patterns classified by health tourism
behavior in all aspects with a statistical
significance of 0.05. And there are proposals for
ways to develop a form of health tourism
focusing on tour activities and Thai traditional
medicine, such as spa massage. And there is also
a need for public relations, tourist and travel
information, as well as convenience and safety in
tourist destinations.
3 Research Methodology
This research is a mixed method research with
participatory action research (PAR). The research’s
conceptual framework is presented in Figure 1. The
details are as follows.
Fig. 1: Research’s Conceptual Framework (Source: prepared by the authors)
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This research is a Mixed-Methods Research in
conjunction with Participatory Action Research
(PAR), and the research area is Phra Nakhon Si
Ayutthaya District. The research process is divided
into three steps, as follows:
Step 1 study an integrated marketing
communication situation of medical tourism
entrepreneurs to accommodate elderly tourists in
World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District).
Snowball sampling methods were used to
select 29 key informants from tourism stakeholders
(government agencies and private sectors: 5 people,
elderly tourists: 3 people, and 21 health tourism
entrepreneurs). There were also 40 people taking
part in group discussions. Semi-structured, in-depth
interviews and document synthesis analyses were
used as research tools. In-depth interviews, focus
group discussions, and document synthesis were
used to collect data, which included data analysis
using content analysis and writing a descriptive
narrative.
Step 2 Develop integrated marketing
communication of medical tourism entrepreneurs to
accommodate elderly tourists in World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District)
Step 2.1 Strategic analysis using SWOT
Analysis with TOWS Matrix to analyze the
elements of integrated marketing communication of
health tourism entrepreneurs to accommodate
elderly tourists in the World Heritage City for
elderly tourists (Phra Nakhon Si Ayutthaya
District).
Through a process known as snowball sampling, 21
entrepreneurs in the field of health tourism were
selected as key individuals. Semi-structured, in-
depth interviews and document synthesis analysis
were the main research tools, and they also
included data collection through in-depth
interviews and document synthesis. Content
analysis was used to analyze the data, after which a
descriptive account was written.
Step 2.2 Structural Equation Model (SEM)
analysis in which The sample group was made up
of tourists who came to travel in Phra Nakhon Si
Ayutthaya province. The number of samples used
was 400, which the researcher calculated from 19
observational variables. A reasonable and adequate
sample size should therefore be at least 10 times
19. And the observed variable equals 190 samples,
which is 20 times 19, so, the observed variable
equals 380 samples. The researcher chose to collect
data from a sample of 400 samples to be used to
analyze the tools used to collect data and use the
questionnaire to develop an integrated marketing
communication model for health tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District). The quality of the
instrument was examined by analyzing the alpha
coefficient (α) using purposive sampling. Data
were analyzed using descriptive statistics
consisting of frequency, percentage, mean, standard
deviation, and structural equation modeling (SEM).
Step 3 Certifying models and integrated
marketing communication strategies of medical
tourism entrepreneurs to accommodate elderly
tourists in World Heritage City for elderly tourists
(Phra Nakhon Si Ayutthaya District)
Step 3.1 Try out the Silver D Model to
organize an integrated marketing communication
exhibition of medical tourism entrepreneurs to
accommodate elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District) with Participatory action research (PAR).
There were 40 participants. The instrument used
was an evaluation form for organizing an integrated
marketing communication exhibition of health
tourism entrepreneurs to accommodate elderly
tourists in the World Heritage City for elderly
tourists (Phra Nakhon Si Ayutthaya District). Data
were analyzed using content analysis, then a
descriptive narration was written.
Step 3.2 There was a Policy Meeting to
certify the model by comprising the tourism-related
stakeholders in Phra Nakhon Si Ayutthaya
Province, consisting of expert groups, stakeholder
groups, strategy makers, beneficiary groups, and
academic groups, totaling 21 people. The
instrument used was an integrated marketing
communication model assessment form for health
tourism entrepreneurs to accommodate elderly
tourists in the World Heritage City for elderly
tourists (Phra Nakhon Si Ayutthaya District) and
provide recommendations. Data were analyzed
using content analysis, and descriptive writing was
done.
4 Results
1) An integrated marketing communication
situation of medical tourism entrepreneurs to
accommodate elderly tourists in World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District)
The following was discovered: 1.1 Marketing
content used by business owners in marketing
communications. Integrated health tourism
entrepreneurs to accommodate elderly tourists in
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the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District) are: 1. Tourism
Product The former capital's prosperous and joyous
past. Physical prominence has an impact on the
waterfront lifestyle, which impacts stress-relieving
health tourism and local medicinal plants from the
central region that can be used as a component of
tourism goods. Additionally, it can be developed as
a route for travel and for numerous inventive
tourism activities. 2. Price (Tourism Price), which
presents price content on the value that must be
paid each time for the use of a business's goods or
services, such as service fees for lodging, meals,
guides, and admission tickets, which offer a range
of prices depending on particular circumstances. 3.
Tourist attraction presentation channels: the use of
presentation channels that respond to a variety of
social media platforms, including websites, Line,
Facebook, and Instagram. Because of the variety of
channels, frequency of presentations, and
interesting content available, tourists nowadays
search for information through social media channels.
4. Tourism Promotion: At the moment, tourism
agencies and entrepreneurs are collaborating to
promote the provincial tourism market by
emphasizing the organization of traditional festival
activities to stimulate and invite tourists to travel
indefinitely. In addition, an aggressive marketing
strategy is used to promote marketing to reach
people through online social channels, such as
organizing a tourism program (Tourism Product)
by collaborating with other health attractions that
attract tourists. Furthermore, membership cards are
issued to groups of tourists who visit health tourism
destinations in the historical city area to receive a
discount or special privileges, etc. 5. In the process
of providing services, emphasis is placed on issues
of assisting to make the service users comfortable,
happy, and satisfied. Each stage of service delivery
involves unique products and services, as well as
the process of providing customers with intangible
services. 6. Tourism People who can present the
knowledge of personnel who also know tourist
attractions, who have a passion for service, can
advise tourists, are resourceful, and can solve
problems in an emergency. 7. Tourism Physical
Environment, which displays the identity of the
tourist attraction. New educational and public
relations materials in the form of multimedia have
been created to tell the story of the location and to
serve tourists in a friendly and thorough manner,
which is related to the subject of medical tourism.
1.2 Integrated marketing communication tools for
medical tourism entrepreneurs to accommodate
elderly tourists in the World Heritage City for
elderly tourists (Phra Nakhon Si Ayutthaya
District) are: 1. Advertising, which places a strong
emphasis on selecting the best media and
completely contacting the target audience through
social media channels like Facebook, Instagram,
and websites. 2. The ability of targeted tourists to
personally negotiate with salespeople or service
providers through online media like Line, Inbox,
and Facebook impresses tourists and encourages
them to use the service frequently. 3. Public
relations, ongoing news updates, and public
relations work together to promote healthy tourism
destinations and show how ready tourist
destinations are to host senior citizens. 4. Sales
promotion, offering a variety of promotions on
social networking sites can encourage users to use
the service more quickly. 5. Direct communication
through digital channels can foster intimacy with
local businesses and delight visitors, especially if
benefits are provided. Additionally, today's
developments in customer databases are also taken
into account. Entrepreneurs frequently employ
multiple marketing tools while keeping in mind
their target markets and marketing goals. For
instance, applying social media to the elderly
market involves taking into account psychological
and behavioral science factors, particularly
lifestyle, and focusing on building positive
perceptions of products and services to foster
loyalty to those goods and services. To achieve the
use of all marketing communication tools in the
same direction, all marketing communication plans,
whether branded or entrepreneurial, have a
comprehensive, integrated marketing
communication plan. They only differ in terms of
the particulars of the tool, such as in advertising
campaigns on television, radio, in newspapers, or in
magazines, where the content should be the same
but needs to be tailored to the tool.
2) The Development of an Integrated
Marketing Communication Model for Medical
Tourism Entrepreneurs to Accommodate Elderly
Tourists in the World Heritage City for Elderly
Tourists (Phra Nakhon Si Ayutthaya District)
2.1 Strategic analysis using SWOT analysis
with the TOWS Matrix to analyze the elements of
integrated marketing communication of health
tourism entrepreneurs to accommodate elderly
tourists in the World Heritage City for elderly
tourists (Phra Nakhon Si Ayutthaya District) found
that there are seven proactive strategies: 1.
Strategies to encourage elderly tourists to use
integrated marketing communications that highlight
the region's identity and key businesses: 2. Strategy
to promote the development of products and
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services to create specific values suitable for
elderly tourists: 3. Strategy to allocate resources
with social responsibility in response to elderly
customers: 4. Strategy to promote and support
tourists: 5. Strategy to promote entrepreneurs by
offering routes and activities that are suitable for
elderly tourists according to their behaviors and
modern lifestyles: 6. Strategy to encourage tourism
stakeholders to integrate cooperation to promote
health tourism for more elderly tourists and 7.
Strategy to promote the development of
entrepreneurial skills to always be ready for
changes in the digital age.
2 . 2 Structural Equation Model (SEM)
Analysing: The integrated marketing
communication of medical tourism entrepreneurs to
accommodate elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District) found that the hypothetical model was
well consistent with the empirical data. In other
words, the model is highly accurate. It can be
considered from the chi-square value (𝑥2) which
equals 65.01 with statistical significance at the
level 0.42 (p-value equal to 0.42). The chi-square
value (𝑥2/𝑑𝑓) equals 1.17 Comparative Fit Index
(CFI) equal to 1.00, Goodness of Fit Index (GFI)
equal to 0.95, Adjusted Goodness of Fit Index
(AGFI) equal to 0.92 and Root Mean Square Error
of Approximation (RMSEA) equal to 0.01, all
criteria passed. Therefore, it can be concluded that
the hypothetical model is consistent with the
empirical data as shown in Table 1.
Table 1. Structural Harmony Index
of Integrated Marketing Communication Model
Development of Medical Tourism Entrepreneurs to
Accommodate Elderly Tourists in World Heritage
City for Elderly Tourists (Phra Nakhon Si
Ayutthaya District)
Source: prepared by the authors
The structural model analysis results of integrated
marketing communication model development of
medical tourism entrepreneurs to accommodate
elderly tourists in the world heritage city for elderly
tourists is presented in Figure 2.
Fig. 2: Structural Model Analysis Results of
Integrated Marketing Communication Model
Development of Medical Tourism Entrepreneurs to
Accommodate Elderly Tourists in the World
Heritage City for Elderly Tourists (Phra Nakhon Si
Ayutthaya District) (Source: prepared by the
authors)
When considering the structural model for the
development of an integrated marketing
communication model of health tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District), it was found that
the causal variables had a statistical influence.
Influence coefficients were 0.59 and 0.73,
respectively. Furthermore, the causal factor directly
influencing the image of health tourism
destinations, namely integrated marketing
communication via digital media, was discovered
to have a coefficient of influence of 0.68.
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Table 2. Direct Influence (DE), Indirect influence (IE), Total Influence (TE), and R-Squared Values (R2) of the
Integrated Marketing Communication Model Development Structure Model of Health Tourism Entrepreneurs
to Accommodate Elderly Tourists in the World Heritage City for Elderly Tourists (Phra Nakhon Si Ayutthaya
District)
Causal Variables
Result Variable
Digital Integrated Marketing
(DIM)
DE
IE
TE
DE
IE
TE
Tourism Fundamentals (INF)
0.59*
-
0.59*
-
0.43*
0.43*
Health Tourism Entrepreneurs (ENT)
0.73*
-
0.73*
-
0.49*
0.49*
Digital Integrated Marketing (DIM)
-
-
-
0.68*
-
0.68*
From the analysis of strategic analysis with
SWOT analysis and the TOWS matrix table, seven
proactive strategies were obtained, as were the
results of the structure model of integrated
marketing communication model development for
medical tourism entrepreneurs to accommodate
elderly tourists in the World Heritage City for
elderly tourists (Phra Nakhon Si Ayutthaya
District), where the hypothetical model was in good
agreement with the empirical data. In other words,
the model is highly accurate. The researcher
synthesized data and developed an integrated
marketing communication model for health tourism
entrepreneurs to accommodate elderly tourists in
the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District) is the "SILVER D
Model" consisting of: S-Standard is the standard of
quality service. As older tourist are now tourists
with specific needs and high purchasing power,
there is a demand for quality service standards that
can impress them; I Integrated, integrating
cooperation with stakeholders, including upstream,
midstream, and downstream, including creating
cooperation between entrepreneurs and government
stakeholders; L-Lifestyle, that is, studying and
analyzing the behavior of elderly tourists, is very
important for designing integrated marketing
communications to meet the needs of creating a
competitive advantage; V-Value proposition is to
deliver differentiated value to older tourists, as this
group of tourists has relatively high travel
experience, and delivering exceptional value and
experience will be able to attract tourists; E
Entrepreneurial, that is, developing entrepreneurial
skills that are always ready for change; R
Responsibility that is, social responsibility to take
into account the sustainability of society, economy,
and environment, which will lead to sustainable
tourism that can affect the tourism industry in Phra
Nakhon Si Ayutthaya Province; DDigital
Marketing, that is, to encourage entrepreneurs to
use digital marketing with maximum efficiency in
order to meet the needs of target tourists who have
behaviors that use more technology nowadays.
3) Certifying Models and Integrated
Marketing Communication Strategies of Medical
Tourism Entrepreneurs to Accommodate Elderly
Tourists in World Heritage City for Elderly
Tourists (Phra Nakhon Si Ayutthaya District)
3.1 Creation of a participatory process by
bringing the “SILVER D Model” model to
organizing the exhibition research results on the
study of the Integrated Marketing Innovation
Exhibition "Wai Kao Mai Chao" with participatory
action research (PAR). There were 40 participants.
The evaluation results of the trial use of organizing
an integrated marketing communication exhibition
of medical tourism entrepreneurs to accommodate
elderly tourists in the World Heritage City for
elderly tourists (Phra Nakhon Si Ayutthaya
District) through an adaptation of the “SILVER D
Model.” Furthermore, a study of evaluation results
from five tourism experts discovered that the
overall picture of the integrated marketing
communication model of health tourism operators
to support elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District) is appropriate and can be used in the
future to transfer and exchange knowledge with
health tourism entrepreneurs. Furthermore, it was
discovered that there was a joint learning creation
among tourism operators, community members,
and the government and private sectors in tourism
in terms of integrated marketing communication,
both offline and online marketing, which aims to
go in the same direction, including creating a
learning process to create concrete practices that
take into account all sectors in a balanced way,
which will be an important factor in the success of
integrated marketing communications for medical
tourism operators.
3.2 The model and strategy in the policy
meeting were endorsed by Ayutthaya tourism-
related stakeholders, including experts,
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stakeholders, strategists, beneficiaries, and
academics. It was found that the consensus of the
policy meeting was that such a strategy is
appropriate and feasible to use as a provincial
policy plan to develop integrated marketing
communications for medical tourism entrepreneurs
to support elderly tourists in World Heritage Cities
for elderly tourists (Phra Nakhon Si Ayutthaya
District), and the results can also be extended to
other groups of tourism operators to support the
elderly tourist group, which is expected to grow in
the future.
5 Discussion and Conclusion
1) The results of the research were as
follows:
1) the integrated marketing communication
situation of medical tourism entrepreneurs to
accommodate elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District) found that 1.1) Marketing content that
entrepreneurs use integrated marketing
communications of health tourism entrepreneurs to
support elderly tourists in the World Heritage City
for senior tourists (Phra Nakhon Si Ayutthaya
District) are: 1. Tourism Product 2. Tourism Price
3. Tourism Place 4. Tourism Promotion 5. Service
Process 6. Tourism People 7. Tourism Physical
Environment, which these aspects should focus on
presenting the identity of the area and presenting it
from the point of view of health tourism. will be
able to attract tourists to the target group, [21]. This
is consistent with the research on marketing mix
influences on medical tourism, which found that
the 7Ps of the marketing mix can have an impact on
medical tourism. The people factor was discovered
to be the most influential factor in all marketing
mixes. It was also discovered that a tourist
attraction's physical environment was the least
influential factor in the overall marketing mix. This
study suggests developing a marketing strategy
using a marketing mix approach, particularly for
the people component. 1.2) An integrated
marketing communication tool for medical tourism
entrepreneurs to accommodate elderly tourists in
World Heritage Cities for elderly tourist (Phra
Nakhon Si Ayutthaya District) including 1. In
terms of advertising, it was found that advertising
is mainly done through social media such as FB,
IG, and Website, focusing on selecting the right
media and reaching the target customers
comprehensively. 2. The capability of targeted
tourists to haggle with salespeople or service
providers via online media enhances their
reputation and draws in more visitors. 3. In terms
of public relations, it was discovered that
consistently updating news and PR helps to build a
positive perception of health tourism destinations,
demonstrating those locations' capacity to host
elderly tourists. 4. In terms of sales promotion, it
was found that having a variety of promotions
through social network media can stimulate
decision-making to use the service faster. 5. Direct
communication via digital channels can foster
intimacy between you and the destination's
business and delight tourists if benefits are
provided. Furthermore, customer database
development is now taken into account, [22]. This
is consistent with research on integrated marketing
communication strategies for health tourism
conducted at Sai Noi Homestay in Bang Ban
District, Phra Nakhon Si Ayutthaya Province,
which discovered that event marketing, word-of-
mouth marketing, and online communication
influence decision-making motives, primarily from
merchant support, allowing for integrated
marketing communication strategies. Entrepreneurs
frequently employ multiple marketing tools while
keeping in mind their target markets and marketing
goals. For instance, applying social media to the
elderly market involves taking into account
psychological and behavioral science factors,
particularly lifestyle, and focusing on building
positive perceptions of products and services to
foster loyalty to those goods and services. To
achieve the use of all marketing communication
tools in the same direction, all marketing
communication plans, whether branded or
entrepreneurial, have a comprehensive, integrated
marketing communication plan. They only differ in
terms of the particulars of the tool, such as in
advertising campaigns on television, radio, in
newspapers, or in magazines, where the content
should be the same but needs to be tailored to the
tool, [23]. This is related to a study of the primary
driving forces behind local health spa industry
success: The ability to compete on a global scale is
made possible by Thai hospitality, skilled certified
professional staff, a wide range of options, and
interesting travel resources. Support from the
government is crucial. Training employees and
enhancing their capacity to direct the launch of
proactive marketing and integrated marketing
communication campaigns are two examples of this
support. To increase the competitiveness of the
health spa industry and make Thailand a hub for
international health tourism, government officials
should adopt a support mindset instead of a control
mindset, acting as coaches, mentors, and
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consultants. Additionally, the government must
continue to develop a brand for wellness tourism in
Thailand, and business owners must do the same
for their brands.
2) Development of an Integrated Marketing
Communication Model for Medical Tourism
Entrepreneurs to Accommodate Elderly Tourists in
World Heritage Cities for Elderly Tourists (Phra
Nakhon Si Ayutthaya District)
2.1 Strategic analysis using SWOT analysis
with the TOWS Matrix to analyze the elements of
integrated marketing communication of health
tourism entrepreneurs to accommodate elderly
tourists in the World Heritage City for elderly
tourists (Phra Nakhon Si Ayutthaya District) found
that there are seven proactive strategies: 1.
Strategies to encourage elderly tourists to use
integrated marketing communications that highlight
the region's identity and key businesses: 2. Strategy
to promote the development of products and
services to create specific values suitable for
elderly tourists: 3. Strategy to allocate resources
with social responsibility in response to elderly
customers: 4. Strategy to promote and
support tourists: 5. Strategy to promote
entrepreneurs by offering routes and activities that
are suitable for elderly tourists according to their
behaviors and modern lifestyles: 6. Strategy to
encourage tourism stakeholders to integrate
cooperation to promote health tourism for more
elderly tourists and 7. Strategy to promote the
development of entrepreneurial skills to always be
ready for changes in the digital age. This is in line,
[24], with Research on tourist demand and
marketing strategies on the Impact of decisions to
bring Chinese tourists to medication and medical
tourism. The research results found that 1. Most
Chinese medical tourists are women aged 2630
who work in private companies. Most of them have
a bachelor's degree and earn 50,001100,000 baht
per month. Most Chinese tourists use health
services such as spas and massages. These tourists
are informed through hotel staff, friends, family,
online forums, tour entrepreneurs, magazines,
travel websites, and travel books. In addition, this
group of tourists also has high general health needs
such as check-ups, surgeries, treatments, dentistry,
plastic surgery, and health promotion using
traditional and alternative medicine, anti-aging, and
medical spas. 2. There are six variables in
marketing factors: product composition, people,
physical environment, price, and other user costs.
Promotion, education, and service processes
influenced the level of Chinese tourists in their
decision-making about medical tourism in
Thailand, with an estimated ratio of 86.7% (R2 =
0.867). 3. The market factors of product
composition, output, quality, people, promotion,
and education influenced the Chinese tourists'
loyalty to medical tourism in Thailand with a
predicted ratio of 88.3% (R2 = 0.883). In this
regard, medical entrepreneurs and the medical
tourism industry should focus on marketing
strategies that influence the decision-making and
loyalty of Chinese tourists, as well as business
planning strategies and practices that lead to
success.
2.2 Structural Equation Model (SEM)
Analysis of The integrated marketing
communication of medical tourism entrepreneurs to
accommodate elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District) found that the hypothetical model was
well consistent with the empirical data. In other
words, the model is highly accurate. This can be
considered from the chi-square value (𝑥2) which is
equal to 65.01 and statistically significant at 0.42
(p-value equal to 0.42). The chi-square value
(𝑥2/𝑑𝑓) is equal to 1.17 and Comparative Fit
Index (CFI) is equal to 1.00, the Goodness of Fit
Index (GFI) is equal to 0.95, the Adjusted
Goodness of Fit Index (AGFI) is equal to 0.92, and
the Root Mean Square Error of Approximation is
equal to 0.01 which passed all criteria. Therefore, it
can be concluded that the hypothesis model is
consistent with the empirical data. The above
conclusions are consistent with the research on
tourism fundamentals influencing integrated
marketing communications via digital media:
tourism fundamentals have a positive direct
influence on integrated marketing communications
via digital media, and tourism fundamentals have a
direct and indirect influence on the image of a
healthy tourist destination through integrated
marketing communication via digital media. It was
found that image is one of the components of
tourism products that is the main factor in the
decision-making process of tourists and has a great
influence on their motivation, which is consistent
with Middleton's (1994) idea that says Perceptual
tourism image influences repeat tourist loyalty, and
also inconsistent with [25], a sustainable, integrated
ecotourism development plan is aided by the idea
of sustainable tourism development planning, as
well as the involvement and roles of the public, the
private sector, and the government in the
development of ecotourism. This is also
inconsistent with [26], a study on tourism image,
service quality image, and tourism value affecting
attitudes towards sustainable tourism found that
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factors affecting the attitudes of Thai working-age
tourists in Bangkok with statistical significance,
namely a) the tourism image of experience and
variety of attractions; b) the service quality image
of customer response; and c) personal travel values.
Furthermore, it was discovered that the following
factors influenced the tourism values of working-
age Thai tourists in Bangkok: a) tourism image in
terms of remembering the variety of tourist
attractions and environments; and b) service quality
image in terms of touchability.
Health tourism entrepreneurs have a direct
positive influence on integrated marketing
communications via digital media, and also have a
direct positive influence on the image of wellness
tourism destinations disseminated via integrated
marketing communication via digital media.
Tourism is considered an industry that can best
respond to the needs of the market in the digital
age. The digital system is regarded as a necessary
system because people nowadays tend to search for
information about hotels and attractions using
various tools. This positively affects businesses that
adopt integrated digital marketing communication
tools, which is consistent with the research in the
Academic of the Secretariat of the House of
Representatives (2018) which found that Because
the government recognizes the importance of
digital technology and the Internet system, it has
been used to support Thai tourism, which is also
consistent with research findings of [27], that has
studied the factors influencing tourist decisions
towards medical tourism in the eastern seaboard
provinces and discovered that the public relations
factor influencing the decision to travel along
Thailand's west coast the most is getting travel
information from the internet. This is also
inconsistent with [28], which has studied trends and
tourism marketing 4.0 in Thailand and discovered
that global changes and Thailand 4.0 government
policies have influenced Thailand's tourism
industry policy and tourism marketing 4.0, which
emphasizes innovation, technology, and creativity
in tourism management and marketing. Thailand
4.0 focuses on a new form of tourism marketing
that focuses on online marketing (digital
marketing), which is considered social media
marketing that is open to ideas and participation
and accepts differences. Each individual has
developed communication technology that allows
customers to contact, exchange knowledge, search
for information, and buy and sell goods and
services across borders by connecting online and
offline marketing.
A study on integrated marketing
communications via digital media has a positive
direct influence on the image of health tourism
destinations, revealing that elderly tourists in the
World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District) will continue to
travel to the health tourism destinations of Phra
Nakhon Si Ayutthaya Province when given the
opportunity. This is inconsistent with [29], which
studied foreign visitors' perceptions of the province
of Nakhon Si Thammarat's tourist attractions and
discovered that visitors who changed their travel
plans upon their return had a different perception of
the province's tourist attractions. In terms of
customer word-of-mouth public relations, it was
discovered that customers had diverse public
relations. Regarding the perception of the overall
and individual aspects of the image of the tourist
attractions in the province of Nakhon Si
Thammarat, it was consistent with [30], which
studied factors that influence Chinese tourists to
return to Thailand found that satisfaction in tourist
attractions and willingness to recommend other
places are important in returning to travel
respectively. This is consistent with [31], which
studied Factors affecting the period of returning
tourists to Chiang Khan It has been discovered that
the environment, culture, and traditional way of life
are what draw Thai tourists to Chiang Khan, while
the target group of tourists is young urbanites with
low monthly incomes. Furthermore, for tourists
who have previously visited Chiang Khan, the
duration of their subsequent visits is inversely
related to distance; that is, the longer the distance,
the more likely the tourists will return to Chiang
Khan slowly. This is consistent with [32], which
studied the influence of tourist image and
satisfaction on the return of tourists in Pathum
Thani Province, it was found that the tourist
attraction image had the most effect on the return
of tourists in Pathum Thani Province, followed by
satisfaction with environmental management and
attractions of tourist attractions at a statistical
significance level of 0.05.
3) The integrated marketing communication
model of medical tourism entrepreneurs to support
elderly tourists in World Heritage Cities for elderly
tourists (Phra Nakhon Si Ayutthaya District) is the
"SILVER D Model," consisting of S - Standard, or
the standard of quality service. As older tourists
have specific needs and high purchasing power and
they tend to demand quality service standards that
can impress them which is consistent with [33],
which studied the customer satisfaction of South
African properties at different star ratings with
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multi-cluster analysis and key performance map
analysis using PLS-SEM that enables
differentiation between service quality scores and
their influence. The two most important predictors
of satisfaction with one- and two-star properties are
customer satisfaction at properties with different
star ratings: accommodation infrastructure and staff
expertise.
I - Integrated, or integrating cooperation with
stakeholders, including upstream, midstream, and
downstream, including creating cooperation
between entrepreneurs and government
stakeholders which is consistent with [34], that
studied a governance framework with tourism
stakeholders can leverage their specific roles and
mutual benefits to promote sustainability in terms
of regulations, stringent standards, and enforceable
measures. Considering a seamless value chain that
will enable stakeholders to take part in the
advantages of sustainable tourism, where visitors
are seen as stakeholders in sustainability rather than
as customers. The new visitor experience will be
redesigned to promote adherence to regional
traditions, including patronizing local businesses
and abiding by local laws, as well as environmental
ethics, respect for local communities, and
involvement in sustainable development
diversification in the neighborhood.
L-Lifestyle, because designing integrated
marketing communications that are responsive to
the demands of establishing a competitive
advantage requires studying and analyzing the
behavior of senior tourists. This is consistent with
[35], which studied marketing strategies affecting
the satisfaction of senior Chinese tourists who use
health-promoting tourism services in Thailand.
According to the findings of this study, older
tourists have more travel restrictions than younger
tourists, so they should be well prepared to research
service marketing strategies that match their
preferences. Furthermore, the results of the
multiple regression test revealed that gender,
income, marital status, occupation, and education
level influenced marketing strategies that
influenced the satisfaction of elderly Chinese
tourists who use health tourism services in
Thailand.
V Value proposition, delivering value and
differentiation to elderly tourists is important
because they are highly experienced, and delivering
exceptional value and experience will attract them.
This is consistent with [36], which studied
accelerated process strategies to support
digitalization and customer value outcomes in
travel. The findings highlighted the role of process
capability in speeding up work in three related
ways. These include clients, partnerships, and
operations to help tourism organizations that can
leverage digital technology to produce and/or
deliver value to their customers. Travel companies
use digital technology to communicate with
customers quickly to test services, present ideas,
and draw in new clients. and support the use of
digital technologies by the travel industry to
communicate with partners, create, and/or deliver
new value. Through the use of digital technology,
this process will help operations move more
quickly and efficiently when creating and
delivering value. Moreover, the current study
presents a contextual theory of how to process
strategies to enable tourism organizations to
leverage digital technologies to create and/or
deliver customer value in tourism, based on the
tourism context.
E Entrepreneurial, or developing
entrepreneurial skills that are always ready for
change. This is consistent with [37], which found
that Technology and digitalization are becoming
increasingly popular topics with far-reaching
implications, the Internet of Things, big data, cloud
computing, artificial intelligence, and other
digitally enabled platforms are examples of digital
innovations. These technologies are all influencing
business operations and changing the way
entrepreneurs participate, demonstrating how
technology, entrepreneurship, and social change are
inextricably linked.
R - Responsibility, or social responsibility, to
consider the sustainability of society, economy, and
environment, which will lead to sustainable
tourism, which may have an impact on the tourism
industry in Phra Nakhon Si Ayutthaya Province.
This is consistent with [38], which stated that the
company's environmental, social, and governance
performance has an unbiased impact on its
financial success. Tourism businesses should
engage in socially responsible practices that
contribute to the SDGs. Tourism organizations
must communicate their corporate social
responsibility initiatives to raise public awareness
of their environmental, social, and governance
efforts.
D - Digital Marketing, or encouraging D -
Digital Marketing, or encouraging business owners
to use digital marketing as effectively as possible to
meet the needs of potential tourists, whose behavior
is increasingly influenced by technology. This is
consistent with [39], who studied how digital
platforms and entrepreneurs transformed during the
COVID-19 crisis as a result of their concurrent use
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and growing popularity. As a result, a new digital
platform has been created that is linked to specific
local and emerging needs. The study is based on
transformational entrepreneurship theory and
focuses on social change caused by the COVID-19
pandemic. The findings suggest that during a crisis,
farming entrepreneurs are motivated by financial,
social, and community goals, which influence their
use of digital platforms. The findings contribute to
management and policy discussions by highlighting
how digital platforms can be used to create
transformative entrepreneurial outcomes in times of
crisis.
New Research Discoveries
This research creates a body of knowledge about
the integrated marketing communication model of
health tourism entrepreneurs to accommodate
elderly tourists in the World Heritage City for
elderly tourists (Phra Nakhon Si Ayutthaya
District): the "SILVER D Model," as shown in
Figure 3.
Fig. 3: SILVER D Model (Source: prepared by the authors)
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6 Conclusion
This study investigated the model and integrated
marketing communication strategies of medical
tourism entrepreneurs to support elderly tourists in
the World Heritage City for senior tourists (Phra
Nakhon Si Ayutthaya District), namely the
"SILVER D Model," which consists of S -
Standard, I -Integrated, L -Lifestyle, V -Value
proposition, E -Entrepreneurial, R-Responsibility,
D-Digital Marketing, including 7 strategies
However, special consideration should be given to
the needs of the targeted tourists, in this case, the
elderly.
Furthermore, it should concentrate on
preserving the benefits of the identity of the world
heritage tourist attractions and fostering willing
cooperation among all sectors eager to develop
tourist attractions in the same direction.
Furthermore, government agencies can use this
research to create integrated marketing
communications for economic utilization, while
taking into account important factors such as social
and environmental impacts. Government agencies
should provide such assistance by assisting in the
understanding of medical tourism operators'
integrated marketing communications.
Furthermore, government agencies should act as
liaisons between tour operators and tourism
communities to present tourist attractions and
develop destination branding for tourist attractions
that tourists are interested in visiting.
7 Suggestions
Based on the findings of the study, the researcher
makes the following suggestion:
1) Suggestions for putting the research findings to
use According to the findings of the Objective 1
research, entrepreneurs prioritize presenting
marketing content through marketing tools that reach
all target groups. However, if integrated marketing
communications are planned holistically for specific
target groups, the efficiency of integrated marketing
communications can be increased. As a result,
relevant agencies should promote knowledge and
understanding of integrated marketing
communication planning holistically, ensuring that all
marketing communication tools are used in the same
direction and meet the needs of the target group.
According to the findings of Objective 2, Health
tourism entrepreneurs accommodating elderly tourists
in the World Heritage City for elderly tourists (Phra
Nakhon Si Ayutthaya District) have used the
"SILVER D MODEL" that consists of S-Standard, I -
Integrated, L-Lifestyle, V-Value. the proposition, E
Entrepreneurial, R and D Digital Marketing, and
seven strategies under the aforementioned model for
marketing communication. All of the above elements
can be integrated to create a positive impression and
word of mouth and to stimulate the emotions of
tourists concretely in the future. Therefore, relevant
agencies should proceed to develop a guideline for
integrated marketing communication for health
tourism operators. to support elderly tourists in the
World Heritage City and expand the results to other
target groups in the future.
According to the findings of Objective 3, the key
to the success of integrated marketing
communications will be to create a collaborative
learning environment for community members,
tourism operators, and the government and private
sectors in tourism with concrete practices. operators
of health tourism can truly As a result, relevant
agencies should collaborate to foster more
collaborative learning in the tourism sector.
2) Suggestions for Further Research
This study discovered the "SILVER D Model," a
model and integrated marketing communication
strategies of medical tourism entrepreneurs to
accommodate elderly tourists in the World Heritage
City for elderly tourists (Phra Nakhon Si Ayutthaya
District), which can be applied to tourism sector
agencies that support the development of marketing
communications for entrepreneurs targeting older
tourists. Further research should be conducted on the
topic of health tourism operators, which is a tourism
trend that groups of tourists are currently interested in.
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Contribution of Individual Authors to the
Creation of a Scientific Article (Ghostwriting
Policy)
The authors equally contributed in the present
research, at all stages from the formulation of the
problem to the final findings and solution.
Sources of Funding for Research Presented in a
Scientific Article or Scientific Article Itself
This research project is supported by Phranakhon
Si Ayutthaya Rajabhat University (Fundamental
Fund: fiscal year 2022 by National Science
Research and Innovation Fund (NSRF))
Conflict of Interest
The authors have no conflict of interest to declare.
Creative Commons Attribution License 4.0
(Attribution 4.0 International, CC BY 4.0)
This article is published under the terms of the
Creative Commons Attribution License 4.0
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n_US
WSEAS TRANSACTIONS on BUSINESS and ECONOMICS
DOI: 10.37394/23207.2023.20.118
Yanisa Phuanpoh, Nattaya Ketsomboon
E-ISSN: 2224-2899
1335
Volume 20, 2023