Travelers’ (in)Resilience to Environmental Risks Emphasized in the Media and Their Redirecting to Medical Destinations: Enhancing Sustainability

Round 1

Reviewer 1 Report

The paper is hard to understand for several reasons:

1. The literature is "comprehensive" and includes a lot of references that are irrelevant to the work. Previous work by at least one of the authors is cited 5 times with at least two of them not seeming to contribute to the work. 

2. The empirical models are not defined. For example, what is the logistic model that is used? For research completeness, this model needs to be defined with the dependent and independent variables stated.

3. The survey instrument is not well described in the study. For example, in line 465 it states "49.3%... "medical locations". What is the difference between a medical location and a medical destination? How does this influence the respondents if this is the case.

4. The authors do not clearly state how the moderator "media" is measured. They attempt to explain this in lines 424 - 427 but it is not clear enough for readers to understand how this factor is modeled. This puts into question the results and conclusions of the study.  

5. The authors should have accounted for country effects given the surveys were from two different countries; or at minimum, explain why they did not think this was important. 

6. The discussion of findings and concluding remarks contain a lot of information that should be in different sections. It is a mini literature review for example which confuses its content. Additionally, the first time "environmental risks" (which has a subsection in the paper) is succinctly defined is in the conclusion this section in lines 619-623. Thus reading the paper, the reader is left to assume what environmental risks are. This is just one issue that plagues the clarity of the paper throughout. My suggestion will be to take out everything in this section before line 650. 

English was okay, but there definitely some improvements that need to be done. For example, the second sentence of Line 226 stats with "And this is about 50 million people in the UK" which was confusing. 

Author Response

We would like to thank the reviewers for their patience and understanding, and for their suggestions to improve the quality of the manuscript. I ask the reviewers to keep in mind that everyone gave a different opinion, where some do not match, but we tried to accept the suggestions of all the reviewers. We hope that we were able to meet all expectations and improve the manuscript.

We shortened the literature and harmonized it with the research problem, we also reduced the number of repetitions of references in the text.

We defined empirical research, explained the models used in data processing and analysis, and highlighted the items for each of the factors. The independent variables and the dependent variable are defined.
We tried to uniformly use the word medical destination, not location, throughout the text.

The variables that belong to the media as a moderator are explained. Moderation is explained for readers to understand better.

The research was done in two countries, but the surveys were combined during the analysis, because we wanted to reach some result independent of the origin of the respondents. In the methodology part, it is explained why those two countries, as destinations of developed medical tourism

The discussion has been modified, so that the parts requested by the reviewers have been added, which relate to theoretical, practical and managerial implications and future research.
The English translation has been corrected

 

Author Response File: Author Response.docx

Reviewer 2 Report

1.     The research question is not clear. Make strong discussions about why the research is important, what motivations are required to complete the research and what gaps you want to search.

2. I could not understand what are the gaps or contributions of this research. In gap and contribution part makes the case more strongly by depending on the recent literature review about the topic and what is the needed gaps. What was the key contribution(s) of this study that would not have been known from existing research? The arguments should go beyond "few studies investigated these effects, and therefore we wanted to investigate it" Given These arguments are not sufficient. Even without the evidence from this research, the relationships among study constructs were straightforward and intuitive. The authors should make salient and strengthen this study's unique contributions in the introduction and discussion sections.
3. The literature review section is bulky and contains some irrelevant information. It should be summarized within two to three pages. A well-summarized review of the related literature would reveal the existing gap and provide relevance to the intended study. Make a stronger case in the literature review as to why you are conducting this research. It could be much stronger by emphasizing truthfulness as an important construct. The paper could benefit from that. Strengthen this section with literature references based on recently published articles to convince readers.
4. The current version of the discussion section does not adequately highlight the contributions of the study.
5. The practical implications provided are not actionable and are speculative at best.

6.     I would recommend structuring your discussion in a standard fashion:
1) Brief summary of findings,
2) Theoretical implications,
3) Practical implications,
4) Limitations and avenues for future research

7.  The findings of a large-scale poll conducted among 18 the people of the Russian Federation and the Republic of Serbia are presented in the article, why just two countries? why you choose two countries not the other?
8. The abstract briefly mentions a "large-scale poll," but it would be helpful to provide more details about the research methodology employed, such as sample size and data collection methods.
9. The abstract should be more concise and clearly state the main objectives and findings of the study. It currently includes some redundant phrases and vague statements that could be streamlined.

 

 

Extensive editing of English language required

Author Response

We would like to thank the reviewers for their patience and understanding, and for their suggestions to improve the quality of the manuscript. I ask the reviewers to keep in mind that everyone gave a different opinion, where some do not match, but we tried to accept the suggestions of all the reviewers. We hope that we were able to meet all expectations and improve the manuscript.

We explained the research question a little better. Point out the importance of research and results, both in the introduction and in the conclusion.

Shortcomings and contributions are clarified in the concluding section, the contribution of the study is added and clarified with much more text and much more understandable.
The literature section has been corrected. Unnecessary text has been removed.

The discussion was written on the recommendation of:
1) Brief summary of findings,
2) Theoretical implications,
3) Practical implications,
4) Limitations and avenues for future research

The research was carried out in two countries, where the authors who carried out the research come from, as well as those who work in Russia and Serbia as professors, so it was possible to capture the real state of medical tourism in these developed countries known for their development in both. Some future research can include other countries, if the authors of other countries are paired to write real research from their countries where it comes from.

More information about the survey is provided in the methodology section.
The abstract has been modified.

 

Author Response File: Author Response.docx

Reviewer 3 Report

Dear Authors, thank you for the opportunity to read this paper and accept my gratitude for your time and effort in writing this manuscript.

Abstract

The abstract should contain one or two sentences explaining the article’s originality not just the most important findings if the number of words allows it. Also, you can add one sentence to present in abstract the methodology.

Introduction

Please, spend more time in the Introduction section (at least one phrase) to present article’s originality not just to tell what article is about.at least emphasise on the novelty.

Methodology

Figure 1. I think Medical destination is not appropriate term. I think you should rather use intention to visit MD (but as I cannot see the scales used, I am not sure my suggestion is ok).

Please indicate at least one source to support each hypothesis (lines 401-415)

Line 416 3.1. Measures. Please spend more time in here to provide content for this subtitle as there is no such content. It would help me and other readers to see the scales used in your research. Also, I think the number should be 3.2. Please check the numbers for following subtitles.

Line 446. I think your subtitle must be changed to reflect the content.

Table 1. You should provide information for MD component too. I am not finding it in table.

Please, spend more time in the Methodology section presenting information about methodology of the study e.g., sampling procedures (what type of sampling have you used, how were selected the participants and why and so on.

4.2. lines 557-575. I think this part shouldn’t be included in article as you are focusing just on MD not RD or UD. Maybe you compare the results from Russian and Serbian sample to discover differences or similarities.

Discussion of findings

 I recommend you emphasise on your results. You start to discuss your results just in line 650 and this part begins with line 576. I recommend you present your article contribution to literature not just to repeat the results obtained. Also, you should compare your results with similar studies.

You should also delimitate and present managerial implication of your study. I don’t think material between lines 718 and 742 covers my observation regarding theoretical and managerial implication.

Please specify how the article contributes to aims, themes or scopes of Sustainability Journal.

Author Response

We would like to thank the reviewers for their patience and understanding, and for their suggestions to improve the quality of the manuscript. I ask the reviewers to keep in mind that everyone gave a different opinion, where some do not match, but we tried to accept the suggestions of all the reviewers. We hope that we were able to meet all expectations and improve the manuscript.

The abstract has been modified and a section on the methodology and significance of the research has been added.

The introductory part has been changed. The originality of the manuscript and research is presented.
Medical destination was explained as intention to visit a medical destination, as a variable, where possible. Somewhere in the mentioned MD it is explained that it is a variable of the intention to choose a medical destination.

Hypotheses were designed by the author according to the model and research problem, and the items and model were taken over and modified, and this is stated in the methodology part. The items for each fact are explained, as well as the methodology and scale used. The sampling procedure is explained more clearly.
Added similar research in the discussion section. A comparative analysis was performed. The discussion is modified and theoretical, practical and managerial implications are given. Added a section on the importance of research and results in the field of sustainability.

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Authors have done a good job to try to answer previous questions and comments. Self citations of at least two instances that do not seem to be appropriate exist in the paper. #25 and 45.

Some paragraphs are very long with different themes especially in the discussions and concluding remarks. This could be separated into different paragraphs to include readability. 

Author Response

We would like to thank the reviewers for their great help in improving the quality of the manuscript.
We changed the self-reading, so that the 25 and 45 references are not the same. The first is self-citation, the second is a completely different author who expresses his views on the given issue
Paragraphs have been simplified to be clear, grammar and translation have been checked. Everything is marked in yellow.

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

Accepted

Minor editing of English language required

Author Response

We would like to thank the reviewers for their great help in improving the quality of the manuscript.
Paragraphs have been simplified to be clear, grammar and translation have been checked. Everything is marked in yellow

Author Response File: Author Response.docx

Reviewer 3 Report

I have no further observations 

Author Response

We would like to thank the reviewers for their great help in improving the quality of the manuscript.
We changed the self-reading, so that the 25 and 45 references are not the same. The first is self-citation, the second is a completely different author who expresses his views on the given issue
Paragraphs have been simplified to be clear, grammar and translation have been checked. Everything is marked in yellow.

All tables and graphs are part of the author's persistence used for the first time, there is no need to provide copyright
permissions

 

Author Response File: Author Response.docx