2Objective(s): Health tourism is a branch of the tourism industry that is of interest to many countries of the world due to its high demand and good income. Therefore, considering the importance of Health tourism and the existing potential in Mazandaran province, this study was conducted with the aim of identifying and analyzing the factors affecting the development of the Health tourism industry in Mazandaran province. Methods: The present study was conducted using a qualitative method with a content analysis approach. For this purpose, 17 Health tourism industry experts and Health tourists were selected using the purposeful sampling method. Semi-structured interviews were used to collect data. The interviews were conducted until we reached a point of theoretical data saturation. Results: The findings showed that the Health tourism industry in Mazandaran province is affected by structural, process and contextual factors. The structural factors included issues related to infrastructures, potentials/attractions, institutional factors, and expert human resources for Health tourism destination. The process factor included issues related to drivers of Health tourism, provision of Health services and destination situational factors. The contextual-field factor included issues related to sociocultural contexts, potentials and attractiveness of tourism, and economic capacity. Conclusion: Despite the importance of services related to Health tourism and considering the increasing demand of this industry, travelers who travel to Mazandaran province need a variety of services, and the need to pay attention to quality service development in tourism destinations is evident. Therefore, the provision of other essentials for Health tourists such as infrastructure, destination attractions, financial capacities, sociocultural conditions, human resources, situational factors are  the requirements for the development of this industry.

Purpose: Due to the great damage that Corona has inflicted on the tourism industry, neglecting the future of tourism marketing can pose a serious challenge to this industry and economy and have irreparable consequences. The purpose of this study is to identify key factors, drivers and future scenarios of the tourism marketing.Method: The present study is applied-developmental in terms of purpose, descriptive-analytical in nature and mixed (qualitative-quantitative) in terms of methodology. The method of this research is scenario writing using MicMac software to identify key drivers and scenarios with Wizard scenario software.Findings: First, the future trends and meta-trends of post-corona tourism marketing were identified, of which 41 key trends and 8 meta-trends were identified. According to experts, 19 key factors in the future of tourism marketing in post- corona were identified using the cross-impact analysis and questionnaire completion. Then, using the cross-impact analysis questionnaire and with the help of the Wizard scenario software, two groups of favorable and unfavorable scenarios were identified.Conclusion: Based on the research results, there are two favorable scenarios and two unfavorable scenarios that can help marketing and tourism policy-makers and decision-makers to take into account the effective factors and scenarios proposed for proper planning of industry in the post-Corona era.

Dear Editor-in-Chief: Some countries in Africa and the Middle East, such as Iran, have potential advantages in medical tourism industry, including low-cost and high-quality services, competent physicians and marginal natural and historical attractions.

The present study was conducted with the aim of developing a model to promote the Health tourism industry. The qualitative part of the research was based on grounded theory. Semi-structured interviews were used to collect data, and the data were analyzed using the Strauss and Corbin method and the paradigmatic model. The sampling was done using theoretical sampling and through purposive (judgmental) techniques. According to the systematic model of grounded theory, experts and managers in the field of Health tourism, as well as tourists within the tourism industry, were selected as the study population. The results of the data analysis, obtained from interviews during the process of open, axial, and selective coding, led to the creation of a model for promoting the Health tourism industry based on grounded theory. Finally, a pattern was identified to provide a model for promoting the Health tourism industry. In the quantitative section, due to the unknown population size, the Morgan sampling table was used to select the sample size. Therefore, the sample size was estimated to be 384, and the same number of questionnaires was distributed among tourists using Health services in Tehran. Ultimately, 310 completed and valid questionnaires were received. In the quantitative part of the study, in terms of purpose, the research was applied, and in terms of data collection method, it was descriptive and survey-based. Additionally, structural equation modeling (SEM) using Smart PLS software was employed to analyze the data. The quantitative findings of the research show that market attractiveness positively affects the structure and services of Health tourism. Furthermore, Health tourism services and the structure of Health tourism have had a significant impact on value creation. On the other hand, Health tourism services and value creation have had a positive effect on Health development. Moreover, the results indicated that environmental factors moderate the effect of market attractiveness and structure on the structure of Health tourism. The qualitative findings of this study suggest that to promote the Health tourism industry, managers should pay close attention to all identified categories and subcategories in this study and possess adequate and sufficient information on each. In addition, this research highlights the need to focus on promoting the Health tourism industry. This study contributes to the literature on various aspects and approaches of Health tourism and provides future guidelines for researchers. Ultimately, this study leads to implications for the promotion of the Health tourism industry and the optimization of this platform.

Today, tourism and its types are considered as one of the most dynamic and growing industries in the world And countries around the world have recognized it as one of the most important tools for the development of human society in all aspects, and are working to develop comprehensive programs to achieve its benefits. In order to prepare and formulate this plan, especially in today's turbulent and changing environment, which is full of uncertainties and ambiguities, it is necessary to adopt the most attentive approaches and methods so that all the influential aspects of this industry can be learned so as to act with aristocracy. Scenario planning as an appropriate approach in the current environment can be identified by identifying the factors, trends, Driving Force and future scenarios of the industry in order to be prepared and prevent passive events in the field under consideration. The present study is applied in terms of purpose, and is descriptive-analytic in terms of method. According to the research findings, the two main drivers of the development of the Iranian Health tourism industry in the 1414 horizon are the political variables and the infrastructural variables and accordingly, four scenarios are in the 1414 horizon ahead of the country's Health tourism industry. The findings of this study can provide a good guide for Health tourism policy makers and policy makers in adopting appropriate policies and strategies for facing different future scenarios as well as threats and challenges of this industry in Horizon 1414.

tourism will be one of the fast growing industries. Unlike many other industries that are affected by the advancement of technology, they can completely change, tourism will have a larger share of the economy of countries and cities. But the potential contribution of tourism in urban economics, such as Tehran, is fraught with uncertainties, which should be used for future prospecting to understand its future. In this regard, the present study tries to address the tourism industry's future prospects in Tehran. The focus of this article is on foreign tourists. From the perspective of the research method, this research is applied and descriptive-analytic, and uses the methods of the future workshop, panel of experts and scenario planning. Six key drivers were identified with increasing demand for travel throughout the world, foreign relations, innovative businesses, tourism freedoms, government economic and infrastructures in Tehran, with two adventurers with titles of state economics and foreign relations as uncertainty. By identifying two key uncertainties, namely, the planned economy and foreign relations, the present study was divided into four independent scenarios for the future of tourism in Tehran, respectively: The firs "scenario scary Tehran", the second "Tehran: hosting unwanted guests", the third "Awaited Tehran" and the last one "Tehran: free visit to the public". The findings of the research show that Tehran's tourism situation is not good except in free visit to the public scenario, and this industry cannot contribute to Tehran's urban economy.

Background and Aim: Ethics in marketing and the use of up-to-date technologies are considered as two strategic factors in today's Health tourism industry,therefore, the current research was conducted with the aim of designing a model of digital transformation of ethical marketing in the tourism industry. Methods: The current research method is qualitative and using the foundation data method. The data of this research was obtained through semi-structured interviews with the snowball technique, which reached theoretical saturation for interviews with eight expert university professors in ethical digital marketing and eight expert managers of the Health tourism industry. After performing three stages of open, central and selective coding, the paradigm model of the research was developed. Ethical Considerations: In the different stages of design, collection and analysis of data and research findings, the principles and standards of ethics in research such as faithfulness to the text, referring to sources and observing the principles of scientific writing have been followed. Results: This research provides a comprehensive model regarding the digital evolution in ethical marketing in the Health tourism industry and according to the goal of the Ministry of Health, Treatment and Medical Education regarding digital services, the Health tourism industry as an industry based on international information and communication and the interior will be affected by digital technology very quickly. Conclusion: This research provides a comprehensive model regarding the digital evolution in ethical marketing in the Health tourism industry and according to the goal of the Ministry of Health, Treatment and Medical Education regarding digital services, the Health tourism industry as an industry based on international information and communication and the interior will be affected by digital technology very quickly.

One of the most important concerns of the trustees of any tourist destination is to create a coherent identity that is proportionate to the existing capacities and convey it to international tourists. In this regard, it seems necessary to apply the latest findings and marketing models and localize them in accordance with the conditions of the tourist destination in order to develop this industry. The new marketing paradigm, which is called human-to-human marketing, with its human-centricity and customer participation in the process of designing and presenting the value proposition, along with the use of new digital technologies in the context of a service-oriented economy, can address the concerns of developing a comprehensive marketing system for tourist destinations. The aim of this research is to explain a comprehensive human-to-human marketing system in the Health tourism industry in line with Iran's cultural identity and legal and institutional conditions. In this research, using the multi-grounded research strategy, a comprehensive human-to-human marketing system in Health tourism was explained and presented. To this end, the researchers studied the human-to-human marketing model through qualitative content analysis, developed a general framework and concepts corresponding to each of the components of this model, and then, by conducting semi-structured interviews with 11 experts in the field of marketing and Health tourism, presented a comprehensive human-to-human marketing system at three levels (macro, intermediate, and operational) and explained the functions corresponding to the categories crystallized in this model. Sampling was carried out theoretically using the snowball method, and the sample size was determined based on theoretical saturation logic. The proposed system includes all stages from formulating the vision and mission of industry and organizations to operational measures at the lowest levels and at the front of the service in a comprehensive military format. Keywords:  H2H Marketing, Human-To-Human Marketing, Health tourism, Comprehensive Marketing System, Multi-Grounded 1. IntroductionThe Health tourism industry, an emerging and rapidly expanding sector, integrates medical, wellness, and preventive services to enhance physical and mental well-being, often in destinations outside tourists’ places of residence. As global competition intensifies among destinations to attract Health tourists, establishing a coherent destination identity aligned with cultural, legal, and institutional frameworks becomes critical. Traditional marketing paradigms, often product-centric, are increasingly inadequate in addressing the nuanced demands of Health tourism, which thrives on personalized, human-centric experiences. The human-to-human (H2H) marketing paradigm, as proposed by Kotler et al. (2021), shifts the focus from transactional exchanges to fostering meaningful human connections, leveraging digital technologies and service-dominant logic to co-create value with stakeholders. This study aims to elucidate a comprehensive H2H marketing system tailored to Iran’s Health tourism industry, aligning with its cultural identity and regulatory environment. By addressing the research question, “What is the structure of an integrated H2H marketing system in Health tourism?” this study offers a multi-level framework to enhance destination branding, stakeholder collaboration, and sustainable industry growth.Health tourism, encompassing medical, wellness, and preventive tourism, has gained significant attention as a multifaceted phenomenon with social, cultural, and economic dimensions (Figueiredo et al., 2024). Governments worldwide are increasingly investing in this sector due to its economic potential and ability to enhance destination competitiveness (Kim & Hyun, 2022). In Iran, the Health tourism industry holds strategic importance, yet it faces challenges in developing a cohesive marketing system that reflects its cultural and institutional context. The H2H marketing paradigm, with its emphasis on human-centricity, empathy, and digitalization, provides a promising approach to address these challenges. This study employs a multi-grounded theory strategy to develop a comprehensive H2H marketing system, integrating theoretical insights with empirical data from expert interviews to ensure practical applicability and theoretical robustness. 2. Literature ReviewHealth tourism, as defined by the World tourism Organization, involves travel to access services that improve Health and well-being, often leveraging natural resources, medical interventions, or wellness activities (Asadi et al., 2019). The academic literature on Health tourism is diverse, covering multiple perspectives:Conceptual Studies: Clarify distinctions between medical and wellness tourism (Connell, 2013; Hall, 2011).Motivational Analyses: Highlight factors such as cost savings and access to superior care (Lunt & Carrera, 2010).Economic Studies: Emphasize positive impacts on destination economies (NaRanong & NaRanong, 2011).Ethical Inquiries: Address issues like organ transplant tourism (Budiani-Saberi & Delmonico, 2008).Geographical Analyses: Explore regional variations in Health tourism practices (Bookman & Bookman, 2007).Technological Perspectives: Focus on the role of digital marketing in attracting patients (Cormany & Baloglu, 2011).Policy Studies: Examine governmental influences on industry development (Chee, 2010).Marketing Research: Identify strategies for attracting international patients (Heung et al., 2010).In Iran, Health tourism research emerged in the mid-2000s, initially focusing on development factors and descriptive analyses (Shalbafian, 2007; Jabbari, 2008). Recent studies have explored marketing strategies, but a comprehensive marketing system remains underexplored (Zakavati et al., 2022; Bagheri et al., 2022). The H2H marketing paradigm, introduced by Kotler et al. (2021), provides a robust theoretical foundation for this study. H2H marketing integrates design thinking, service-dominant logic, and digitalization to prioritize human-centric interactions. It comprises two layers:Conceptual Framework: Emphasizes human-centricity, empathy, and collaboration, drawing on design thinking, service-dominant logic, and digitalization.Operational Framework: Focuses on strategic brand management and process execution, ensuring practical implementation of human-centric principles.This paradigm aligns with Health tourism’s need for trust, personalization, and stakeholder engagement, making it suitable for developing a comprehensive marketing system. The H2H approach emphasizes co-creation of value, where customers are active participants in designing and delivering value propositions, supported by digital technologies that enhance efficiency and personalization. 3. MethodologyThis study adopts a qualitative, non-experimental approach with a fundamental theoretical orientation, employing a multi-grounded theory strategy to develop a comprehensive H2H marketing system for Health tourism. The methodology unfolds in two phases:Qualitative Content Analysis: The H2H marketing model was analyzed to extract core concepts and develop an initial framework. This involved identifying key components of the H2H paradigm, such as human-centricity, trust, and digitalization, and mapping their relevance to Health tourism.Semi-Structured Interviews: Eleven experts in marketing, tourism, and Health tourism were interviewed to refine and validate the framework. Experts were selected via snowball sampling until theoretical saturation was achieved, ensuring a diverse sample with at least 15 years of experience and advanced degrees, holding senior roles in academia, government, or service provision.Data collection combined library research (to establish theoretical foundations) and field methods (interviews). Interview transcripts were analyzed using Glaser’s grounded theory approach, involving:Open Coding: Generating 247 initial codes from interview data.Axial Coding: Grouping codes into 24 main categories based on common themes.Selective Coding: Organizing categories into three levels—macro (national/international), meso (regional/local), and micro (service providers)—to form the comprehensive system.Theoretical saturation was confirmed when no new concepts emerged in the final two interviews. To ensure trustworthiness, the study employed continuous data review, simultaneous data collection and analysis, participant code validation, and triangulation with secondary sources. The resulting framework was validated by experts, ensuring robustness and applicability to Iran’s Health tourism context. 4. ResultsThe study’s findings articulate a comprehensive H2H marketing system for Health tourism, structured across three levels: macro, meso, and micro. The system integrates 24 main categories, each associated with specific functions, ensuring a holistic approach to marketing that aligns with human-centric principles and Iran’s cultural and institutional context.Macro-Level ManagementAt the macro level, the system focuses on national and international strategies to build trust, establish a cohesive brand identity, and develop supportive infrastructure. Key functions include:Trust and National Branding: Defining human dignity and human-centricity in the national brand identity, using research to analyze customer perceptions, and fostering trust in private investments to encourage industry growth.Coordination and Integration: Strengthening inter-institutional communication, establishing a unified Health tourism authority, and promoting a systemic perspective among stakeholders to ensure cohesive policy implementation.Guidance and Goal Setting: Designing foresight systems, innovation frameworks, and customer journey maps to enhance sustainability and expand market reach.Infrastructure Development: Enhancing internet penetration, facilitating international interactions, and fostering entrepreneurial ecosystems to support Health tourism growth.Evaluation and Oversight: Implementing transparent monitoring of institutional performance and agile policy enforcement to maintain accountability.Regulatory Development: Formulating laws for sustainable development, data privacy, and shared economy principles to create a supportive legal environment.These functions ensure that national policies align with human-centric principles, fostering trust and collaboration across stakeholders.Meso-Level ManagementThe meso level emphasizes regional and local coordination, destination branding, and infrastructure enhancement. Key functions include:Culture Building: Promoting co-creation, sustainability, and customer-centricity among regional stakeholders to foster a collaborative environment.Destination Branding: Co-creating destination brands through stakeholder collaboration, international events, and digital media to enhance regional competitiveness.Infrastructure Development: Advancing digital infrastructure (e.g., blockchain, IoT), transportation networks, and accommodation facilities to support seamless tourist experiences.Monitoring and Evaluation: Tracking tourist satisfaction, environmental protection, and industry issues to ensure quality and sustainability.Coordination: Facilitating stakeholder collaboration and data sharing through regional customer databases to enhance operational efficiency.Planning: Conducting territorial planning, reviving traditional medicine, and optimizing digitalization to align regional strategies with national goals.Distributive Justice: Addressing power imbalances, leveraging technology for equitable resource allocation, and managing stakeholder conflicts to ensure fairness.These functions strengthen regional capabilities, ensuring that local efforts align with national objectives while addressing community-specific needs.Micro-Level ManagementAt the micro level, the system prioritizes operational excellence and customer experience at the service provider level. Key functions include:Value Network Transformation: Embedding human-centricity, empathy, and co-creation in organizational culture, countering dehumanization from digitalization to maintain meaningful interactions.Process Design: Developing flexible, customer-inclusive processes, green service frameworks, and omnichannel communication to enhance service delivery.Environmental Monitoring: Continuously assessing customer needs and market trends to ensure responsiveness.Process Execution and Control: Implementing agile marketing and innovative service delivery to meet customer expectations.Resource Enhancement: Upgrading physical and digital infrastructure to deliver transformative customer experiences.Reputation and Trust-Building: Enhancing organizational credibility through social responsibility and stakeholder engagement.Value Network Branding: Strengthening organizational brands within the value network to enhance competitiveness.Decision-Making: Empowering participatory decision-making and innovation to foster agility.Investment and Financing: Securing resources for sustainable growth.Innovation: Leveraging customer insights and stakeholder collaboration for service innovation.The comprehensive human-to-human (H2H) marketing system in the Health tourism industry (Figure 4) demonstrates how these functions interact and emphasizes bidirectional communication across different levels to ensure human-centricity and stakeholder alignment. The 24 categories were validated through expert consensus, with theoretical saturation confirmed via a qualitative matrix (Table 6) and frequency analysis (Table 7), ensuring comprehensive coverage of marketing activities.5. ConclusionThe proposed H2H marketing system for Health tourism offers a holistic framework to address the industry’s complexities, integrating human-centric principles, digital technologies, and service-dominant logic. By structuring marketing activities across macro, meso, and micro levels, the system ensures cohesive destination branding, stakeholder collaboration, and sustainable growth. The emphasis on human-centricity, trust, and co-creation aligns with the evolving needs of Health tourists, fostering meaningful experiences and equitable value distribution. Digitalization enhances efficiency and personalization, while robust legal and cultural infrastructures support trust and sustainability. The system’s bidirectional decision-making structure empowers stakeholders at all levels, positioning customers as co-creators of value.For practitioners, this framework provides actionable strategies to enhance Iran’s Health tourism competitiveness, including trust-building, digital infrastructure development, and stakeholder coordination. For researchers, it opens avenues for further exploration, such as institutional mapping, gap analysis, and policy refinement. Specific recommendations include:Identifying and integrating soft institutions to support the system’s functions.Conducting institutional mapping to analyze the current state of Health tourism stakeholders.Assessing the ideal state of H2H marketing and proposing solutions to address gaps.This study contributes to the academic and practical understanding of Health tourism marketing by offering a comprehensive, context-specific system that balances human-centricity with operational efficiency, paving the way for sustainable industry growth in Iran and beyond.

The present study was conducted with the aim of designing and validating an experiential marketing model in Iran’s Health tourism industry. In terms of its nature, the research is applied,in terms of method, it is qualitative,the research approach is inductive,the prevailing paradigms include theoretical foundations and interviews, and the overall research paradigm is interpretivist. The research strategy is grounded theory, and data collection was carried out through both literature review and interviews. Interviews were conducted with experts and stakeholders in the field of Health tourism to identify the factors and components shaping the experiential marketing model in the Iranian Health tourism sector, specifically in the context of hospitals and treatment centers. In this phase, most interviews were conducted in person (with 5 individuals), while a smaller portion was done by phone (with 3 individuals). Ultimately, interviews were completed with a total of 8 participants. In total, over 173 minutes of interviews were conducted across a three-month period, coordinated with relevant experts. In the quantitative phase, a message was sent via the automation system to all members of the target population—consisting of over 500 individuals—requesting their cooperation in completing the questionnaire. Following extensive follow-ups, approximately 385 of these professionals completed and returned the questionnaire. The data collected from the interviews were analyzed using MAXQDA software, while model fit evaluation was conducted using SPSS and SmartPLS software. Following a comprehensive review of all interviews and the analysis of participants’ statements and viewpoints, as well as a systematic literature review, 78 open codes were identified in the open coding phase. After further examination and categorization, approximately 6 main categories and 15 subcategories were extracted. Moreover, the obtained model demonstrated an acceptable fit, with a model fit index value of 0. 866, indicating a satisfactory overall model fit for the study.