Development Perspectives on Wellness and Spa Tourism in the Context of Tourism Business Sustainability

Abstract

The main objective of this research was to present Serbia as a destination for wellness and spa tourism, bearing in mind the fact that there are about 1000 springs in this area with a potential for tourism. Then again, since there are only about 40 active spas in Serbia, the aim of this paper is to show the positive aspects of the development of this form of tourism. For this, the example of good practice of the Bad Gastein Spa (Austria) was used, considering the similarities in the quality and medicinal properties of the water, which was analyzed and compared back in the 19th century. We wanted to use this example of good practice to show all the advantages of the development of wellness and spa tourism. A total of 462 respondents participated, of which 227 were residents of Sokobanja (Serbia), while 235 were from the Bad Gastein Spa (Austria). The authors surveyed the local population by staying in these spas, using a random sample system, and then compared the respondents’ answers. The results showed the positive impacts of the development of wellness and spa tourism in Austria, but also the willingness of the local population of Serbia to develop a modern spa concept related to wellness and spa tourism. It can be concluded that Sokobanja should position itself on the tourist market by creating its own identity through the development of wellness and spa tourism. Wellness and spa tourism in Serbia must be recognized as a priority sustainable form of tourism by decision makers at the highest level. The authors believe that the positive experiences of the development of wellness and spa tourism in Sokobanja will have a domino effect for the activation, transformation and development of all other potential spas in Serbia.

1. Introduction

Wellness and spa tourism has emerged as a popular trend in the tourism industry, offering tourists the opportunity to rejuvenate their physical and mental well-being through various activities and services. It is actually a response to the contemporary problems of a society that is in search of financial gain and faced with stress, obesity and other problems [1,2]. Regardless of a person’s physical resilience, the result is inevitably stress, fatigue, chronic anxiety and a compromised immune system [3]. However, there is the concept of wellness, which aims to restore balance between the physical and the spiritual. This concept is rapidly becoming popular worldwide, leading to the establishment of numerous independent wellness centers in cities, spas, hotels and beauty salons. It aims to achieve complete psychophysical relaxation by stimulating all the senses, promoting total regeneration and regulation of metabolism [4]. It encompasses the holistic well-being of the body, health, vitality, harmony, beauty, serenity and a sense of fulfillment in the balance of mind, body and spirit [5], as well as various aspects of health, including physical activity, nutrition, stress management, self-care, emotional well-being and spirituality [4]. Despite its modern terminology, the concept of wellness is deeply rooted in ancient practices. The term wellness, as a modern concept, made its debut in the professional literature in 1961 in Dr. Halbert L. Dunn’s book, High Level Wellness [6]. In this publication, Dunn brought together the ideas of wellness and fitness, emphasizing the importance of optimal physical condition. Wellness means more than just good health; it includes both happiness and general well-being [6].

Serbia, with its many spa and climatic locations with natural healing resources, such as thermo-mineral springs, should expand its offerings and include wellness services in accordance with modern trends in the tourism industry [7]. The progress of spa tourism in Serbia requires the adoption of a fresh approach that is in line with modern trends, especially wellness tourism. However, the triumph of this new development concept depends primarily on the management of the spa destination and its managers’ determination to direct all available tourist resources towards the creation of an attractive healthcare and tourism product that can compete on a global level [8,9]. Accordingly, the management of the spa destination plays a key role, as they have to follow the latest changes in the tourism market and adjust their policies [9,10,11]. A key management task is to formulate a business strategy that incorporates these requirements [3]. The goal of this paper is to transform the outdated perception of the operation of spas in Serbia by highlighting their modern and attractive wellness content and offerings, in addition to their provision of exceptional services. This approach implies a clear distinction between medical programs for patients and wellness programs for healthy guests, both in terms of physical appearance and program content. As the transition from one way of doing business to another is quite challenging, it is necessary to learn from examples. Serbia has one such example in its neighborhood. It is Hungary. It is necessary to highlight the fact that the management of this country realized the advantage of the wellness and spa concept in time, and then all the spas in the country were privatized [12]. Another good example of the transformation of traditional spa tourism into a wellness and spa concept comes from Slovenia, where spas have also been privatized [13]. Today, these destinations represent excellently positioned wellness and spa destinations with a pronounced competitive advantage that should be a “guide for the transformation” that Serbia needs.

An example of a representative spa that has excellent potential to develop this concept is Sokobanja (Serbia). After many years of studying the similarities and differences with other spas in Europe, the authors singled out the Bad Gastein Spa (Austria), given its similar characteristics, and decided to conduct research on the impact of wellness and spa tourism on the lives of the local population, and then, by comparing the answers, influence the process of transforming an outdated spa into a place of modern wellness and spa tourism in Sokobanja.

The initial hypothesis of this paper, H, is that only a sustainable spa destination tourism business has the possibility of competitive business and enables better positioning on the tourist market. The results showed numerous positive impacts of wellness and spa tourism on the tourist destination of Sokobanja, but in order to become competitive in the tourism industry, it is crucial that this spa adapts to modern trends, especially wellness tourism. By shifting the focus from patients to guests or clients, a new approach can be established that is in line with market demands. Spas that quickly recognize and embrace this change will have a distinct advantage in the highly competitive tourism market.

2. Theoretical Background

The origins of wellness can be traced back to ancient healing practices and medical traditions that have existed for millennia. The term wellness, though contemporary in its usage, possesses deep historical origins. Furthermore, the principles of wellness can be linked to the historical traditions of ancient civilizations such as Greece, Rome and Asia, which have profoundly shaped the contemporary wellness movement [14]. Ayurveda began as an oral tradition, while Traditional Chinese Medicine (TCM), recognized as one of the oldest medical systems globally, evolved over time. Hippocrates is regarded as potentially the first physician to emphasize the prevention of illness rather than merely addressing diseases. The practice of medicine in ancient Rome placed a significant focus on the prevention of disease, embracing the Greek notion that health issues stemmed from one’s diet and lifestyle choices [15].

As a concept, wellness has become increasingly prominent since the mid-20th century, particularly during the 1950s, 1960s and 1970s. This evolution was significantly influenced by the writings and guidance of an informal collective of physicians and intellectuals in the United States, who played a pivotal role in shaping our current understanding and discourse surrounding wellness. Wellness has become a global lifestyle, embodying a philosophy that promotes a positive and proactive approach to life, as opposed to a negative and reactive mindset [16]. Its primary focus is on nurturing and improving all aspects of human existence, with an emphasis on maintaining both physical and mental well-being through healthy practices [17]. Maintaining inner peace, physical fitness and mental relaxation are key elements to focus on [18].

The state of wellness includes both physical and spiritual well-being, and is achieved through self-responsibility and connection with nature and the environment. It has four basic components: physical activity, spiritual engagement, healthy and organic nutrition, and personal rejuvenation through relaxation [3]. Without any of these components, well-being cannot be achieved [3,4]. Recently, a fifth element has emerged in the form of a comprehensive skincare routine, which emphasizes the importance of self-care [3]. The term spa is often used in the professional literature as a substitute for wellness, which includes a wider range of aspects related to body and mind [19]. Wellness is a more comprehensive and complex concept than a spa. While relaxation and rejuvenation can be achieved through spa treatments, wellness encompasses a much broader scope that goes beyond mere physical rest [20].

Wellness is approached differently in different regions of Europe. In most European countries, the focus is on the rejuvenating effects of thermal–mineral waters and spas [21]. Southern Europe, on the other hand, places great importance on marine health, using the sun, sea air, thalassotherapy and the famous Mediterranean diet to promote overall well-being [20]. In Scandinavia, outdoor activities take center stage, with Nordic walking, skiing and even winter swimming in lakes being highly valued [22,23]. Meanwhile, Germany and Austria embraced the popular Kneipp therapies, which were rooted in the teachings of Sebastian Kneipp (1821–1897), a German priest [24]. These therapies revolve around five key principles: water, herbs, healthy diet, exercise and discipline, all aimed at achieving balance [25]. In Asia, wellness is often approached from a more spiritual perspective [26]. In the field of wellness, there are practices such as yoga, meditation and various forms of massage that facilitate the flow of energy within the individual, resulting in an improved sense of well-being. In contrast, countries such as America, Canada, England and Australia tend to prioritize beauty treatments, relaxation and self-care when it comes to wellness [27,28].

The acronym SPA is derived from Latin words, specifically standing for “Salus Per Aqua”, which translates to “Health from Water”. This term, originating in the era of the Roman Empire, pertains to therapeutic practices involving water, along with the use of oils and stones for massages. It provides essential physical and spiritual care tailored to the needs of the individual. A wellness center encompasses a diverse array of services grounded in medical treatments, whereas a spa serves as a quintessential venue for relaxation. Wellness predominantly provides services focused on various types of massage, in contrast to the spa, which primarily offers services centered around cosmetic treatments and body care. In certain contexts, wellness is regarded as a necessity, while spa experiences are perceived as a luxury. Consequently, the cost of wellness services is typically lower than that of spa services.

The advantage of spas becomes evident when considering their equal emphasis on medicine and therapy, nature and culture, movement and relaxation, and communication and experience. This advantage is particularly relevant when spas are compared to other destinations, as they pave the way for innovative development in wellness tourism [29]. As described in Konstantakopoulou [30], the authors employ six metrics to assess the health quality of the destination country, which have not been previously utilized in tourism research. This paper posits that health quality constitutes an integral element of the “institutional quality” of a destination country, a factor that may influence tourists’ decisions and their choice of destinations—an aspect that remains underexplored in the tourism literature. The study argues that the level of health quality has a significant impact on the competitiveness of tourist destinations; countries exhibiting higher health quality are likely to be more competitive than those with inferior health standards [30].

3. Materials and Methods

For the purposes of this research, two parallel surveys were conducted. The authors stayed in Sokobanja (Serbia) and Bad Gastein (Austria) on several occasions and conducted research using a random sample system. A total of 462 respondents participated, of which 227 were residents of Sokobanja (Serbia), while 235 were from the Austrian spa Bad Gastein. They were asked to answer questions about the impact of tourism on their environment and life.

Our approach was influenced by the research conducted by Monterrubio et al. (2020), where they aimed to gather the perspectives of the local community regarding the main effects of tourism growth in rural regions [31]. Monterrubio et al. [31] examined the influence of tourism development on sustainability indicators, including economic, sociological and ecological factors, and how these impacts affect the local population. Their findings demonstrated that all three sustainability indicators hold equal significance in the context of tourism development, and that the nature of tourism that emerges at a destination directly determines whether the impacts are positive or negative. This research includes a group of three sustainability indicators: economic, sociological and ecological. The questions related to the impact of tourism on the local population and their environment. Respondents were asked to give answers that related to economic (Standard of living, Productivity, Transportation, Employment opportunities, Women’s entrepreneurship and Tourism), sociological (Human relationships, Family conflicts, Population growth, Crime, Homelessness and Alcohol and drugs) and environmental variables (Air pollution, Water pollution, Land pollution, Noise pollution, Increase in garbage and Habitat disturbance). Respondents used a five-point Likert scale to rank their attitudes regarding the mentioned indicators, which were later compared. From the standpoint of sustainable tourism, it is important to research the views of the local population regarding tourism and observe changes in their satisfaction. The Pearson Chi-Square test of independence was used as one of the procedures for analyzing the obtained data, in order to look for a connection when it comes to the differences in answers between the respondents from Sokobanja and Bad Gastein. For statistically significant differences in answers, those with a value of p less than 0.05 were considered significant.

3.1. Sokobanja

Serbia is a country of warm, healing springs and spas. Spa tourism is one of the ways of returning to natural healing factors, for which there has been an increased interest in our country and abroad [32]. Sokobanja is the main tourist center of Pomoravlje, as a place centered on balneotherapy and climate therapy [33]. There are six thermal springs in Sokobanja, whose temperatures range from 28 to 45 °C; the water is suitable for the treatment of bronchitis, asthma, rheumatism, heart problems, allergies, skin diseases and chronic stress. It is the first ecological municipality; there are no air or water pollutants in the area, and the wind rose, which forms above the basin, contributes to the clean air. The richness of the air with negative ions contributes to the general well-being and quick recovery from various illnesses, primarily respiratory diseases and stress, which are common today [34]. Sokobanja is located next to the Moravica river, between the Rtanj, Ozren and Devica mountains. The healing springs of this spa were used by the Romans and Turks. The history of the development of tourism dates back to 1837, when the first patient was sent to Sokobanja for treatment. Some of the famous writers who wrote about Sokobanja were Branislav Nušić, Ivo Andrić and Isidora Sekulić. Sokobanja is a spa center with a 187-year tradition of tourism in Serbia. On the order of Prince Miloš, in 1835, the healing water of Sokobanja was sent to Vienna for analysis. Due to its healing properties, it has been compared to the waters of Bad Gastein and Pfäfers spa [35]. The Viennese chemist Franz Hruschauer (1805–1858) performed the first analysis of the medicinal waters of Sokobanja and compared them with the water sources in Gastein. Water quality was very similar. Modern research has shown that it is radon water that shows indications of being able to treat many diseases. The water in Sokobanja is rich in potassium, sodium, magnesium, lithium, iron, iodine, manganese sulfur and radon gas. Very similar to Bad Gastein, the presence of radon gas in the water is about 40 kBq/m³. The tourism development so far has been based on natural potentials, vacation and health tourism, and cultural heritage, with a noticeable lack of accompanying activities, as well as an insufficiently developed concept of wellness tourism. This approach does not ensure competitiveness in relation to other spa destinations.

Table 1. Sokobanja.

Sokobanja, Number of Overnight Stays
2018	498,463
2019	588,422
2020	648,820
2021	756,089
2022	767,725
2023	656,489

Source: https://www.tosokobanja.rs/ (accessed on 22 June 2024), [36].

shows the number of overnight stays from 2018 to 2023, where we notice an increase in the number of tourists during and after the Coronavirus pandemic. The number of overnight stays in 2023 was 656,489, so we can conclude that Sokobanja has a stable business, without major fluctuations in the number of tourists. The current situation shows that Sokobanja is an attractive destination and has great potential for further investment and development.

Table 2. Tourist attractions.

Five Reasons Why Tourists Visit Sokobanja
1.	Activities in nature and sports and recreational activities
2.	Relaxation, spa and rehabilitation
3.	Sports grounds and activities
4.	Events
5.	Traditional food and specialties

Source: Mihajlović, Novović, [37].

shows the reasons why tourists visit Sokobanja, where we can see that it is because of active vacation and wellness tourism.

3.2. Bad Gastein

According to Lettner et al. [38], Bad Gastein, or as it is also called, “the mother of all thermal baths”, is located at the southern end of the Gastein valley, in the federal state of Salzburg [29]. Today it has about 4000 inhabitants. In 1968, the thermal baths were tapped into the rock and were the first public baths in Austria. Bad Gastein is located at 1100 m above sea level. In addition to healing water, it is characterized by clean air. The thermal water of Bad Gastein springs forth at the foot of the Graukogel and is rich in minerals and radon [35]. The presence of radon gas in the water is 44 kBq/m³ [38]. It has been used for the treatment of chronic diseases for more than 60 years. The water in Bad Gastein is rich in calcium, magnesium, sodium, iron and potassium. The oldest sources testifying to the use of this water date back to the 14th century. Among the famous people who visited Bad Gastein were Emperor Franz Joseph and Empress Elisabeth. A study conducted in 2016 showed that 90% of users have a better quality of life after therapy in Bad Gastein. Bad Gastein offers its visitors packages that include not only treatment, but also hiking, cycling, summer family packages, meditation and nature walks. What particularly attracts attention is the tunnel in Bad Gastein, created for gold mining in 1940, today turned into a therapeutic center for the treatment of serious diseases [35,38,39]. In this way, Bad Gastein further developed spa and wellness tourism. In 2019, Bad Gastein recorded about a million overnight stays, which significantly decreased after the Coronavirus pandemic.

Table 3. Bad Gastein.

Bad Gastein, Number of Overnight Stays
2018	1,125,383
2019	1,116,735
2020	809,564
2021	433,778
2022	855,881
2023	<1,000,000

Source: https://www.bad-gastein.at/ (accessed on 13 July 2024), [40].

shows the number of overnight stays from 2018 to 2023. A large decrease is noticeable in 2021. The report from 2023 shows that the number of tourists exceeded a million, and it can be concluded that Bad Gastein has successfully recovered from the crisis brought by the Coronavirus pandemic.

Table 4. Tourist attractions.

Five Reasons Why Tourists Visit Bad Gastein
1.	Activities in nature and hiking
2.	Relaxation, spa and rehabilitation
3.	More favorable climate during the summer
4.	Traditional food and specialties
5.	Events

Source: Bacsi et al. [41].

shows the reasons why tourists visit Bad Gastein. Things that attract tourists are activities in nature and wellness tourism.

4. Results and Discussion

Male and female responses were equally represented in the survey (in Sokobanja, 47.4% were male and 50.4% were female, while in Bad Gastein 52.6% were male and 49.6% were female). The age structures of Sokobanja and Bad Gastein were dominated by respondents between the ages of 36 and 49 (58.3% Sokobanja and 41.7% Bad Gastein), while the same percentage of respondents were between the ages of 19 and 35 (50.0%). The difference can be seen in those under 18 and over 66. In Sokobanja, 68% of respondents were under 18, while in Bad Gastein that percentage was 31.4%. There were 25.3% of respondents over the age of 66 in Sokobanja, and 74.7% in Bad Gastein.

The first question was related to the impact of tourism on the standard of living in Sokobanja and Bad Gastein. In

Table 5. Standard of living.

			Place		Total
			Sokobanja	Bad Gastein
Standard of living	No change	Count	50	5	55
		% within Standard of living	90.9%	9.1%	100.0%
	Better	Count	87	72	159
		% within Standard of living	54.7%	45.3%	100.0%
	Much better	Count	90	158	248
		% within Standard of living	36.3%	63.7%	100.0%
Total		Count	227	235	462
		% within Standard of living	49.1%	50.9%	100.0%

, the analysis of the responses showed that the local population of Sokobanja largely believed that the development of tourism did not significantly improve their standard of living. Comparing with the answers of local residents of Bad Gastein, we can see that they are of the opinion that their standard of living was directly affected by the development of tourism. Comparing these two spas, the biggest difference is visible in the opinions that there were no changes in economic status. The local population of Bad Gastein believes that their standard of living depends on tourism and that the development of tourism has a positive effect on their economic status. These results indicate the economic aspects of development, i.e., the improvement of the standard of living and the quality of life of the local population with the development of tourism in their milieu. The employment of the local population is directly related to the standard of living [42].

The Pearson Chi-Square test (

Table 6. Pearson Chi-Square for Standard of living.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	56,757 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

) shows that there are significant differences in the answers between the respondents of Sokobanja and Bad Gastein Spa.

The goal of every tourist destination is to support artisans and artists in recognizing the tourist and commercial potential of the traditional handicrafts they make, as well as the development of tourist offerings through new tourist products that reflect the local cultural and historical heritage [43].

Table 7. Productivity.

			Place		Total
			Sokobanja	Bad Gastein
Productivity	No change	Count	50	4	54
		% within Productivity	92.6%	7.4%	100.0%
	Better	Count	64	38	102
		% within Productivity	62.7%	37.3%	100.0%
	Much better	Count	113	193	306
		% within Productivity	36.9%	63.1%	100.0%
Total		Count	227	235	462
		% within Productivity	49.1%	50.9%	100.0%

shows the respondents’ responses related to the impact of tourism on the increase in those engaged in arts and crafts. Bad Gastein is dominant when it comes to the answers regarding the positive progress when it comes to the productivity of those who choose to create new tourism products. In total, 98.3% of them believe that with the development of tourism in Bad Gastein, the potential of those engaged in arts and crafts has been preserved. The policy of local self-government can play a big role, as well as the incentive funds of states that recognize the potential of preserving cultural and historical heritage. Analysis of the responses of respondents from Sokobanja showed that 78% are of the same opinion as the local population of Bad Gastein. The Pearson Chi-Square test in

Table 8. Pearson Chi-Square for Productivity.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	66,609 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

shows significant differences in the answers of the respondents of both spas.

Transportation infrastructure is an integral part of a tourist destination and one of the conditions for carrying out activities at the destination. The development of infrastructure is directly conditioned by the development of tourism. The analysis of the results shows that the local population of Sokobanja has a divided opinion on the improvement of infrastructure, and that 92% of respondents from Bad Gastein believe that tourism has had a great impact on the development of infrastructure in their locale (

Table 9. Transportation.

			Place		Total
			Sokobanja	Bad Gastein
Transportation	No change	Count	8	1	9
		% within Transportation	88.9%	11.1%	100.0%
	Better	Count	86	19	105
		% within Transportation	81.9%	18.1%	100.0%
	Much better	Count	133	215	348
		% within Transportation	38.2%	61.8%	100.0%
Total		Count	227	235	462
		% within Transportation	49.1%	50.9%	100.0%

). The local population believes that local infrastructure has been much better since tourism began to develop. The Pearson Chi-Square test shows a significant difference in respondents’ answers (

Table 10. Pearson Chi-Square for Transportation.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	67,400 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

). The development of transportation infrastructure is an important prerequisite for the development of tourism. Destinations with better transportation infrastructure are more attractive for tourists.

Based on the analysis of the answers related to the impact of tourism on the employment of the local population, we can conclude that the majority of respondents believe that the development of tourism creates new opportunities for employment; that is, in locations where tourism is the main activity, new jobs are created (

Table 11. Employment opportunities.

			Place		Total
			Sokobanja	Bad Gastein
Employment opportunities	No change	Count	71	28	99
		% within Employment opportunities	71.7%	28.3%	100.0%
	Better	Count	75	103	178
		% within Employment opportunities	42.1%	57.9%	100.0%
	Much better	Count	81	104	185
		% within Employment opportunities	43.8%	56.2%	100.0%
Total		Count	227	235	462
		% within Employment opportunities	49.1%	50.9%	100.0%

). The inhabitants of Bad Gastein dominate when it comes to this attitude; 88% of them think that the development of tourism opens up new opportunities for employment, compared to 31.3% of the local population of Sokobanja, whose opinion is that there are no changes when it comes to new jobs, based on the development of tourism. This difference can also be seen in

Table 12. Pearson Chi-Square for Employment opportunities.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	25,810 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

. When we look at the total number of respondents from both spas, we come to the conclusion that the development of tourism affects the employment of the local population. The respondents believe that in the future the development of tourism will provide greater opportunities for employment.

Changes in the social, economic and political system in Serbia at the beginning of the new millennium marked the beginning of another new stage in the development of female entrepreneurship [44]. However, the road to gender equality in the business world is still long. The obtained results should be taken into account because in the future in the business world, the equality of women will have multiple benefits for the economy. All respondents from Bad Gastein believe that tourism has influenced female entrepreneurship (

Table 13. Women’s entrepreneurship.

			Place		Total
			Sokobanja	Bad Gastein
Women’s entrepreneurship	No change	Count	6	0	6
		% within Women’s entrepreneurship	100.0%	0%	100.0%
	Better	Count	82	44	126
		% within Women’s entrepreneurship	65.1%	34.9%	100.0%
	Much Better	Count	139	191	330
		% within Women’s entrepreneurship	42.1%	57.9%	100.0%
Total		Count	227	235	462
		% within Women’s entrepreneurship	49.1%	50.9%	100.0%

). It is evident that 97.4% of those surveyed from Sokobanja are of a similar opinion. In

Table 14. Pearson Chi-Square for Women’s entrepreneurship.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	25,523 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

, the Pearson Chi-Square test showed that there are statistical significances in the responses between the surveyed population.

Table 15. Tourism.

			Place		Total
			Sokobanja	Bad Gastein
Tourism	No change	Count	1	0	1
		% within Tourism	100.0%	0%	100.0%
	Better	Count	48	63	111
		% within Tourism	43.2%	56.8%	100.0%
	Much better	Count	178	172	350
		% within Tourism	50.9%	49.1%	100.0%
Total		Count	227	235	462
		% within Tourism	49.1%	50.9%	100.0%

shows the views of the local population on the decision of young people to engage in tourism. A job in tourism comes with a lot of negative connotations, especially because it is considered a seasonal job, which is sometimes poorly paid, with overtime, and the presence of unskilled labor. The choice of young people to engage in tourism was confirmed by the respondents in both spas; 78.4% of respondents from Sokobanja were of the opinion that young people opt for this job. Respondents from Bad Gastein also agreed with this statement. There was no statistically significant difference in the answers, which is also visible in

Table 16. Pearson Chi-Square for Tourism.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	2992 a	2	0.224

^a. 2 cells (10.0%) have expected count less than 5.

, because p = 0.224. An important aspect of tourism development is the employment of young people.

The quality of life of the local population can be threatened by the development of tourism, and the consequences may be reflected in various conflicts between the residents themselves. When asked about the impact of tourism on interpersonal relationships, the respondents had different opinions. About 80% of respondents from Bad Gastein believed that relations are much better, with 60% of respondents from Sokobanja sharing the same view (

Table 17. Human relationships.

			Place		Total
			Sokobanja	Bad Gastein
Human relationships	No change	Count	8	3	11
		% within Human relationships	72.7%	27.3%	100.0%
	Better	Count	82	46	128
		% within Human relationships	64.1%	35.9%	100.0%
	Much better	Count	137	186	323
		% within Human relationships	42.4%	57.6%	100.0%
Total		Count	227	235	462
		% within Human relationships	49.1%	50.9%	100.0%

). Some of them did not have a positive opinion when it came to interpersonal relations.

Table 18. Pearson Chi-Square for Human relationships.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	19,699 a	2	0.000

^a. 2 cells (10.0%) have expected count less than 5.

shows that there are statistically significant differences in the answers between the respondents. Based on the analysis of the answers to the question about the impact of tourism on family relations (

Table 19. Family conflicts.

			Place		Total
			Sokobanja	Bad Gastein
Family conflicts	No change	Count	2	3	5
		% within Family conflicts	40.0%	60.0%	100.0%
	Increasing	Count	52	54	106
		% within Family conflicts	49.1%	50.9%	100.0%
	Greatly increasing	Count	173	178	351
		% within Family conflicts	49.3%	50.7%	100.0%
Total		Count	227	235	462
		% within Family conflicts	49.1%	50.9%	100.0%

), 76.2% of the respondents from Sokobanja believe that family relations have worsened, while 75.7% of respondents from Bad Gastein think the same.

Table 20. Pearson Chi-Square for Family conflicts.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	0.170 a	2	0.918

^a. 2 cells (10.0%) have expected count less than 5.

shows the results, and since p = 0.918, it can be concluded that there is no statistical significance; that is, the respondents from both spas agreed about the negative impact that tourism has on their family relationships.

The increase in the number of inhabitants is linked to the development of tourism in many ways. Population growth is conditioned by the power of tourism and depends on the location of the tourist place, the way it develops and the infrastructure itself. Tourism enables the survival of settlements with a smaller number of inhabitants, triggering migration and tourist movements. When asked about the impact of tourism on the birth rate and the number of inhabitants, 76.6% of respondents from Bad Gastein believe that there has been an increase in the population. On the other hand, 42.7% of respondents from Sokobanja were of the same opinion (

Table 21. Population growth.

			Place		Total
			Sokobanja	Bad Gastein
Population growth	Decreasing	Count	4	17	21
		% within Population growth	19.0%	81.0%	100.0%
	No change	Count	126	38	164
		% within Population growth	76.8%	23.2%	100.0%
	Increasing	Count	45	77	122
		% within Population growth	36.9%	63.1%	100.0%
	Greatly increasing	Count	52	103	155
		% within Population growth	33.5%	66.5%	100.0%
Total		Count	227	235	462
		% within Population growth	49.1%	50.9%	100.0%

). The Pearson Chi-Square Test in

Table 22. Pearson Chi-Square for Population growth.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	80,327 a	3	0.000

^a. 2 cells (10.0%) have expected count less than 5.

shows this statistically significant difference between respondents’ responses.

The development of tourism can cause occurrences that are undesirable for the local population. There are frequent changes in the social environment due to the development of crime, drug addiction, gambling and alcoholism, or with the presence of homeless people and begging. Based on the analysis of the answers to the question about the increase in crime and the increase in the homeless, respondents from Bad Gastein and Sokobanja believed that there have been no major changes and that there has been a decrease (

Table 23. Crime.

			Place		Total
			Sokobanja	Bad Gastein
Crime	Greatly decreasing	Count	0	25	25
		% within Crime	0%	100.0%	100.0%
	Decreasing	Count	47	55	102
		% within Crime	46.1%	53.9%	100.0%
	No change	Count	139	58	197
		% within Crime	70.6%	29.4%	100.0%
	Increasing	Count	41	58	99
		% within Crime	41.4%	58.6%	100.0%
	Greatly increasing	Count	0	39	39
		% within Crime	0%	100.0%	100.0%
Total		Count	227	235	462
		% within Crime	49.1%	50.9%	100.0%

and

Table 24. Pearson Chi-Square for Crime.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	100,743 a	4	0.000

^a. 2 cells (10.0%) have expected count less than 5.

). When we asked about an increase in addiction to gambling, alcohol and drugs, the responses were approximately the same among respondents from both spas. A statistically significant difference in the answers was shown by the Pearson Chi-Square test (

Table 25. Homelessness and begging.

			Place		Total
			Sokobanja	Bad Gastein
Homelessness and begging	Greatly decreasing	Count	1	7	8
		% within Homelessness and begging	12.5%	87.5%	100.0%
	Decreasing	Count	23	43	66
		% within Homelessness and begging	34.8%	65.2%	100.0%
	No change	Count	169	140	309
		% within Homelessness and begging	54.7%	45.3%	100.0%
	Increasing	Count	34	45	79
		% within Homelessness and begging	43.0%	57.0%	100.0%
Total		Count	227	235	462
		% within Homelessness and begging	49.1%	50.9%	100.0%

and

Table 26. Pearson Chi-Square for Homelessness and begging.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	14,680 a	3	0.002

^a. 2 cells (10.0%) have expected count less than 5.

). Most of them, around 70%, believed that there were no changes. We should not ignore the number of those who indicated a change in the behavior of the local population, especially among the inhabitants of Bad Gastein (

Table 27. Alcohol and drugs.

			Place		Total
			Sokobanja	Bad Gastein
Alcohol and drugs	Decreasing	Count	16	30	46
		% within Alcohol and drugs	34.8%	65.2%	100.0%
	No change	Count	168	161	329
		% within Alcohol and drugs	51.1%	48.9%	100.0%
	Greatly increasing	Count	43	44	87
		% within Alcohol and drugs	49.4%	50.6%	100.0%
Total		Count	227	235	462
		% within Alcohol and drugs	49.1%	50.9%	100.0%

). Given that the residents of these places gave similar answers, the results in

Table 28. Pearson Chi-Square for Alcohol and drugs.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	4284 a	2	0.117

^a. 2 cells (10.0%) have expected count less than 5.

show that there were no statistically significant differences in the answers, p = 0.117. The local population is a key aspect of any destination; therefore, their safety and health must be a priority. The destination is, after all, home to local residents.

Sokobanja is known as a healthy environment, due to the clean air that is reflected in the high concentration of negative ions. That is how it acquired the status of an air spa. Preservation of this status is a prerequisite for the development of tourism in the future. By analyzing the obtained results, it can be concluded that the local population in both places does not feel the negative consequences caused by the development of tourism. It can be concluded that 68% of respondents believe that the development of tourism does not affect air pollution in their place, which is shown in

Table 29. Air pollution.

			Place		Total
			Sokobanja	Bad Gastein
Air pollution	No change	Count	16	19	35
		% within Air pollution	45.7%	54.3%	100.0%
	Better	Count	49	64	113
		% within Air pollution	43.4%	56.6%	100.0%
	Much better	Count	162	152	314
		% within Air pollution	51.6%	48.4%	100.0%
Total		Count	227	235	462
		% within Air pollution	49.1%	50.9%	100.0%

. Pearson Chi-Square test showed the similarity in the respondents’ answers in

Table 30. Pearson Chi-Square for Air pollution.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	2429 a	2	0.297

^a. 2 cells (10.0%) have expected count less than 5.

, and that there are no statistically significant differences.

One of the negative examples of the impact on the ecosystem is the contamination of groundwater and soil with large amounts of wastewater. In addition, excessive tourism-related use of resources such as water may lead to reduced access for members of local communities. The development of tourism should not deny the local population access to a preserved environment. The results of those surveyed from Sokobanja and Bad Gastein show that 72% of them believe that tourism does not have a negative impact on the state of water in their places (

Table 31. Water pollution.

			Place		Total
			Sokobanja	Bad Gastein
Water pollution	No change	Count	10	9	19
		% within Water pollution	52.6%	47.4%	100.0%
	Better	Count	58	53	111
		% within Water pollution	52.3%	47.7%	100.0%
	Much better	Count	159	173	332
		% within Water pollution	47.9%	52.1%	100.0%
Total		Count	227	235	462
		% within Water pollution	49.1%	50.9%	100.0%

).

Table 32. Pearson Chi-Square for Water pollution.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	0.730 a	2	0.694

^a. 2 cells (10.0%) have expected count less than 5.

shows that there is no statistically significant difference in the answers of respondents of both spas.

Tourism has an impact on the entire ecosystem; the increased influx of tourists can affect the environment by endangering the habitat, increasing municipal waste, and increasing noise, soil, water and air pollution. Sometimes these environmental indicators are the invisible burden of tourism. The issue of soil quality is significant because there are many sources of pollution: agriculture (nitrites, nitrates), mining (Soko mine tailings dump in Čitluk), urban areas (tourist zone), the dilapidated sewage system and the city dump [45]. About 69% of the residents of both spas were of the opinion that tourism does not have a negative impact on the soil (

Table 33. Land pollution.

			Place		Total
			Sokobanja	Bad Gastein
Land pollution	No change	Count	9	3	12
		% within Land pollution	75.0%	25.0%	100.0%
	Better	Count	67	65	132
		% within Land pollution	50.8%	49.2%	100.0%
	Much better	Count	151	167	318
		% within Land pollution	47.5%	52.5%	100.0%
Total		Count	227	235	462
		% within Land pollution	49.1%	50.9%	100.0%

). The survey showed that the responses of the respondents in both places were similar, which was also shown by the Pearson Chi-Square test, which had a result of p = 0.157 (

Table 34. Pearson Chi-Square for Land pollution.

.	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	3698 a	2	0.157

^a. 2 cells (10.0%) have expected count less than 5.

).

One of the biggest problems that arises with the increase in the number of tourists is noise. Such a problem in Sokobanja was pointed out by a study on the acoustic zoning of Sokobanja [46]. This study confirmed that in Sokobanja during the summer there is a deviation during the day of 10–26 dB. Respondents from Sokobanja did not indicate a major worsening of this environmental indicator in their answers. As for Bad Gastein respondents, 81% believe that they are not exposed to unwanted noise levels (

Table 35. Noise pollution.

			Place		Total
			Sokobanja	Bad Gastein
Noise pollution	No change	Count	11	3	14
		% within Noise	78.6%	21.4%	100.0%
	Better	Count	59	41	100
		% within Noise	59.0%	41.0%	100.0%
	Much better	Count	157	191	348
		% within Noise	45.1%	54.9%	100.0%
Total		Count	227	235	462
		% within Noise	49.1%	50.9%	100.0%

). The Pearson Chi-Square test showed that there were significant statistical differences in the responses of respondents from both places (

Table 36. Pearson Chi-Square for Noise pollution.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	10,998 a	2	0.004

^a. 2 cells (10.0%) have expected count less than 5.

).

With the increase in the number of visitors to the tourist destination, there is also an increase in municipal waste. It is necessary to find a way in which attractive tourist destinations can fight this negative impact due to the increased number of visitors. Proper education of the local population and employees in tourism would contribute to the attainment of sustainable tourism according to the given ecological indicator. More respondents from Bad Gastein believe that this indicator has not worsened. We can also see in

Table 37. Increase in garbage.

			Place		Total
			Sokobanja	Bad Gastein
Increase in garbage	No change	Count	17	11	28
		% within Increase in garbage	60.7%	39.3%	100.0%
	Better	Count	83	79	162
		% within Increase in garbage	51.2%	48.8%	100.0%
	Much better	Count	127	145	272
		% within Increase in garbage	46.7%	53.3%	100.0%
Total		Count	227	235	462
		% within Increase in garbage	49.1%	50.9%	100.0%

the overall opinion of the respondents in relation to the worsening of the environmental indicator, where 59% believe that the destinations are successfully fighting the increase in municipal waste. Given that the residents of Sokobanja and Bad Gastein had similar answers to the question related to the increase in garbage, the Pearson Chi-Square test found that there were no statistically significant differences in the answers in relation to the place of the respondents (

Table 38. Pearson Chi-Square for Increase in garbage.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	2438 a	2	0.296

^a. 2 cells (10.0%) have expected count less than 5.

).

From the following tables, we can conclude that there are similar opinions about habitat degradation in Sokobanja and Bad Gastein, where 43% of respondents from Sokobanja believe that it has not worsened, while 46% of respondents from Bad Gastein share that opinion. When we look at the opinions of all the respondents, we come to the conclusion that 45% of them believe that the development of tourism has not affected the degradation of the ecosystem in Sokobanja and Bad Gastein (

Table 39. Habitat disturbance.

			Place		Total
			Sokobanja	Bad Gastein
Habitat disturbance	No change	Count	26	34	60
		% within Habitat disturbance	43.3%	56.7%	100.0%
	Better	Count	103	92	195
		% within Habitat disturbance	52.8%	47.2%	100.0%
	Much better	Count	98	109	207
		% within Habitat disturbance	47.3%	52.7%	100.0%
Total		Count	227	235	462
		% within Habitat disturbance	49.1%	50.9%	100.0%

). From the results obtained by the Pearson Chi-Square test, we can see that there is no statistically significant difference in the answers in relation to the place, with p = 0.344 (

Table 40. Pearson Chi-Square for Habitat disturbance.

	Value	df	Asymp. Sig. (2-Sided)
Pearson Chi-Square	2134 a	2	0.344

^a. 2 cells (10.0%) have expected count less than 5.

). The quality of the environment is one of the main factors for the development of tourism.

There are significant differences in opinions between respondents from Sokobanja and Bad Gastein regarding several aspects of tourism’s impact, such as productivity, employment opportunities and transportation infrastructure. This indicates a lack of consensus on the benefits and drawbacks of tourism. While Bad Gastein perceives a positive impact on infrastructure development, Sokobanja has a divided opinion. This inconsistency could reflect differing levels of infrastructure investment and development, potentially affecting the overall attractiveness of the destinations. There is a notable difference in the perception of job creation due to tourism between the two locations. Sokobanja respondents are less optimistic about tourism creating new employment opportunities compared to Bad Gastein. This could be explained by the fact that tourism in Sokobanja is still not sufficiently developed. With the development of tourism, a complementary offer such as numerous outdoor activities could be included in the tourist offerings, which would increase the possibility of employment. Tourism appears to have mixed effects on interpersonal and family relationships, with some respondents feeling negatively affected. This highlights potential social tensions within the community that could be exacerbated by increased tourism. Although both locations report a decrease in crime and homelessness, there is concern about the potential for increased social issues such as drug addiction and gambling. The perception of a rise in these issues could indicate underlying social challenges that tourism might aggravate. There is a disparity in views on how tourism affects population growth, with Bad Gastein respondents generally seeing an increase, while Sokobanja respondents are more skeptical. This difference may impact planning and resource allocation. Despite high approval of tourism’s influence on female entrepreneurship, gender equality in the business world remains a concern, indicating that while tourism may provide opportunities, broader structural issues persist. The analysis of environmental issues such as air, water, land, noise pollution and garbage relies heavily on perceptions without presenting objective data or thorough analysis. This lack of detailed context and exploration of contributing factors limits the understanding of the actual environmental impacts and effectiveness of local management practices.

Bearing all this in mind, we come to the conclusion that differences in standard of living, as well as in the local population’s awareness of the importance of the development of wellness and spa tourism, directly explain the differences in responses between the local populations of these two destinations. Although these destinations have similar water quality and healing potential, the degree of utilization of that potential directly depends on the recognition of the potential by decision makers at the highest level, the positioning of the destination on the world tourist map, and understanding the importance of competition and gaining a competitive advantage. What needs to be accomplished is to integrate wellness and spa tourism in the next Development Strategy of the Republic of Serbia, as a priority sustainable form of tourism. Then, the management of the tourist destination will have access to various projects that are important for the development of the concept of wellness and spa tourism.

Pointing to certain limiting factors of the research, it can be concluded that the main limitation of the work is the sample of respondents and that some future research should have a significantly larger sample, on both sides. All these data confirm hypothesis H that the sustainable tourism business management of spa destinations has the possibility of competitive business and enables better positioning on the tourist market.

5. Conclusions

The modern tourist market is characterized by tumultuous changes, and only those destinations that offer greater value to existing and future tourists than their competitors are successful. In addition to the price, the tourist destination will be distinguished by the quality of service and offerings. At the same time, these are factors that influence tourists when choosing a destination. Spa tourism is facing great challenges, due to which it is necessary to adapt its offerings and develop new concepts of tourism. In recent years, there has been a change in the age structure of guests visiting these destinations, where the reasons for their visits are fun, sports, recreation, relaxation and enjoyment of the spa environment. The importance and awareness of personal health has been noticeable among tourists lately. Spa destinations are faced with the challenge of how to adapt their offerings, which years ago were directed towards users of social security funds, and as such were based only on healthcare and rehabilitation tourism. Today, spa tourism offers its services to self-paying tourists, who, in addition to the desire to improve their health, travel for relaxation. The goal of this offer is to merge the tradition and the modern reality of spas and to make tourists’ stays as eventful as possible.

The concept of the development of spa tourism in Serbia is still not clearly defined, although some spas have marked their significant anniversaries and scientifically confirmed their longevity [47]. Mineral water sources are the basis of the development of spa tourism. Their tourist valorization is complex because spa and wellness tourism, in addition to classic healthcare tourism, serve for the prevention and recreation of healthy people. It is a fact that other types of tourism take place in modern spa resorts. According to the Tourism Development Program in Sokobanja from 2023 to 2027, the new mission of Sokobanja as a destination is based on staying in an unpolluted environment suitable for recreation through relaxing and therapeutic wellness treatments and specific gastronomic experiences [48]. For the implementation of such a program, it is necessary to open new hotel–recreational complexes and maximally utilize tapped sources of thermal mineral water for tourist purposes. The research has pointed to several key aspects: the need to innovate the existing Tourism Development Strategy of the Republic of Serbia, given the interest of the local population in the development of wellness and spa tourism, the inclusion of various types of outdoor activities, manifestations and other activities in the tourist offer, the need for connection and networking with similar service providers with the aim of achieving the highest quality tourist offer, and the continuous need for research such as that provided by this study.

Modern spa and wellness tourism should contribute to sustainable development and be integrated into the natural, cultural and human environment. A condition for the proper management of tourism is that the sustainability of the resources on which it depends must be guaranteed [10]. Future research should be related to the analysis and constant monitoring of the impact of tourism on sustainability indicators. It is necessary to pay attention to ecology and sustainable development, because only a clean and orderly environment will significantly contribute to the development of tourism and have positive effects on the local population. Sokobanja should base further development of tourism on the principles of sustainable development.

The methods of field research, surveys and comparison of the two spas show the clearest results of the state and reality of their tourist offerings and the activities that are offered to tourists, but also the consequences that occur with the development of excessive tourism. The results of this research showed that spa tourism in Sokobanja did not affect the local population in relation to the given indicators. A comparative analysis of the two spas revealed a difference when it comes to the development of infrastructure and the employment of young people in tourism. As a result of the development of tourism in Bad Gastein, the locals have a better standard of living, unlike the residents of Sokobanja. Both surveyed spa destinations have the same goal: successful and future-oriented development of the destination with a focus on creating special offers for target groups. A clear positioning, especially in the field of wellness tourism, may lead to the attraction of clients not only domestically, but also from the foreign market, especially those who are oriented towards preventive healthcare. It is necessary to properly conceptualize and design the perspective of the balneological center of Sokobanja and focus on the development of wellness tourism, a good example of which is Bad Gastein.