From Service and Destination Stimuli to Well-Being: Cognitive and Affective Pathways in Domestic Medical Tourism

Although the Stimulus-Organism-Response (SOR) theory is widely applied in tourism, its use in medical tourism remains underdeveloped, particularly regarding how different stimuli activate distinct psychological mechanisms. Addressing this gap, this study develops and tests an extended SOR framework distinguishing cognitive (perceived values) and affective (place attachment) organismic pathways. Survey data from 454 Vietnamese domestic medical tourists recruited via purposive sampling across medical and accommodation settings in Ho Chi Minh City were analyzed using Partial Least Squares Structural Equation Modeling. Results show that medical service quality, perceived affordability (expenses), destination attractiveness, and destination culture are positively associated with perceived values, whereas only medical service quality and destination attractiveness are associated with place attachment. Both organismic states positively relate to subjective well-being. Mediation analysis reveals an asymmetrical pattern of indirect relationships in these cross-sectional data: perceived values operate as a broad cognitive mechanism across all stimuli, whereas place attachment functions as a selective affective pathway linked to experiential cues. These findings refine SOR theory by clarifying contextual variations in affective bonding within treatment-oriented contexts. Managerially, healthcare providers and destination marketers should prioritize responsiveness among healthcare staff, transparent pricing structures, and recovery-friendly destination features to enhance patient well-being.