An Anxiety Management Model in Medical Tourism Patients: A Meta-Synthesis Study

Iman  Akhbarati; Vahid Nasehifar

Authors

Iman Akhbarati Postdoctoral Researcher, Department of Business Administration, Allameh Tabataba'i University, Tehran, Iran Author https://orcid.org/0009-0003-4861-9304
Vahid Nasehifar Professor, Department of Business Administration, Allameh Tabataba'i University, Tehran, Iran https://orcid.org/0000-0002-7117-1152

Keywords:

Anxiety management, medical tourism, continuity of tourism-treatment services, intercultural communication

Abstract

The present study was conducted with the aim of presenting an anxiety management model for patients in medical tourism. In this research, the meta-synthesis method was employed based on the approach proposed by Sandelowski and Barroso (2007). Accordingly, a broad collection of articles related to patient anxiety, medical tourism, patient experience, facilitating technologies, and factors influencing patients’ attitudes and perceptions published between 2000 and 2025 was extracted and reviewed. Based on the obtained findings, the final research model consisted of six main themes and 23 sub-themes, including communicative governance and therapeutic trust-building (transparency of treatment information and costs, professional honesty of medical staff toward patients, continuous responsiveness and accessibility of the treating physician); management of the patient’s psychological experience (prior assessment of patient anxiety before admission, supportive psychological interventions during treatment, follow-up of the patient’s psychological condition after treatment); cultural competence and intercultural communication (alignment of healthcare services with the patient’s cultural beliefs, familiarity of medical staff with patients’ cultural differences, respect for the patient’s values, language, and lifestyle); cognitive and informational empowerment of the patient (education about the treatment process in understandable language, enhancement of health literacy among international patients, reduction of therapeutic ambiguity and uncertainty); management of the physical environment and hospital services (creating a calm and stress-reducing environment, quality of patient admission and discharge services, orderliness); social and family support for the patient (possibility of accompaniment by family members or therapeutic companions, communication with patients with similar experiences, emotional support from hospital staff); and continuity of tourism-treatment services (coordination of treatment services with accommodation and transportation, reduction of stress related to administrative and travel processes).

References

[1] B. Singh, C. Kaunert, B. A. Riswandi, M. K. Arora, and S. Lal, "Medical tourism and health gateways in international health market places: Stimulating sustainability and technological advancements," in Intersections of Law and Computational Intelligence in Health Governance: IGI Global, 2024, pp. 174-196.

[2] M. J. Farsayad, M. Ameli, and A. Mozdgir, "A robust mathematical model for medical tourism facility location and specialties allocation under hybrid uncertainty," Journal of Modelling in Management, vol. 21, no. 2, pp. 641-670, 2026.

[3] M. Rahmati, "Identification of key factors in the development of medical tourism in Ardabil city," Tourism and Development, vol. 14, no. 1, pp. 199-212, 2025.

[4] M. Goudarzi, "A meta-analysis of barriers to the development of medical tourism in Iran," Tourism and Development, vol. 14, no. 1, pp. 54-71, 2025.

[5] B. S. Al-Romeedy, M. E. Emam, H. Hussein, A. Singh, and P. K. Tyagi, "Digital passports to wellness: How technology is shaping medical tourism," in Revolutionizing Healthcare Experience With Digital Medical Tourism: IGI Global Scientific Publishing, 2025, pp. 111-136.

[6] A. Garad, A. M. Al-Ansi, M. Jaboob, and R. Kusumawati, "Digital innovations in medical tourism: A PRISMA review in the Arab region," in Revolutionizing Healthcare Experience With Digital Medical Tourism, 2025, pp. 53-78.

[7] J. Wang et al., "Prevalence and network structure of depression, anxiety and adverse doctor-patient relationship risks among patients with physical diseases: A cross-sectional study," Journal of Affective Disorders, vol. 376, pp. 122-130, 2025.

[8] J. S. Lebovidge and L. C. Schneider, "Depression and anxiety in patients with atopic dermatitis: Recognizing and addressing mental health burden," Annals of Allergy, Asthma & Immunology, 2025.

[9] F. Hu, J. Wen, and M. Kozak, "Mental health research in tourism and hospitality: A horizon 2050 paper," Tourism Review, vol. 80, no. 1, pp. 90-107, 2025.

[10] H. P. To, "Medical tourism experiences, perceived value and tourists' happiness and word of mouth in Ho Chi Minh City: A qualitative exploration," Ho Chi Minh City Open University Journal of Science: Economics and Business Administration, vol. 16, no. 2, 2026.

[11] M. H. Shoukat, I. Elgammal, S. Aziz, H. Olya, and K. M. Selem, "Medical tourism index and travel willingness via travel anxiety: PLS-NCA approach," Tourism Recreation Research, vol. 50, no. 2, pp. 369-384, 2025.

[12] S. Malodia, T. Otterbring, B. Taheri, and A. Dhir, "How negative framing affects VR tourism adoption: Exploring the role of travel anxiety during crisis events," Journal of Travel Research, vol. 64, no. 5, pp. 1121-1140, 2025.

[13] T. D. M. Putra, N. L. Romadhona, and T. M. K. Abdullah, "Enhancing patient revisit intention and positive word of mouth: An empirical study of medical tourism," J Manaj dan Kewirausahaan, vol. 12, no. 1, pp. 100-109, 2024.

[14] S. Majeed, W. G. Kim, and K. Ryu, "Medical tourism and cognitive dissonance: Exploring tourist choice behavior, post-choice pre-outcome regret, and visit intention," Journal of Quality Assurance in Hospitality & Tourism, vol. 25, no. 3, pp. 514-544, 2024.

[15] E. N. Anar and I. Kirtil, "Relationship between preoperative surgical fear, anxiety, and satisfaction levels in individuals choosing bariatric surgery tourism: A descriptive, cross-sectional study," Obesity Surgery, pp. 1-11, 2025.

[16] X. L. F. Kok, F. S. Ryan, J. Gwilliam, M. Sayers, and S. J. Cunningham, "A qualitative study of preoperative anxiety in orthognathic patients: The patient perspective," American Journal of Orthodontics and Dentofacial Orthopedics, vol. 167, no. 1, pp. 17-28, 2025.

[17] M. Sahin, M. Gurbuz, M. Savun, Y. C. Filtekin, O. Can, and H. L. Canat, "Effect of supplementary video information on patient anxiety before urodynamic testing: A randomized controlled study," International Neurourology Journal, vol. 29, no. 2, pp. 135-141, 2025.

[18] M. Kiali, N. Zarifsanaiey, and M. Amini, "Comparing video-enhanced face-to-face training and traditional verbal instruction for anxiety management in angiography patients: A quasi-experimental study," Health Science Reports, vol. 8, no. 10, p. e71214, 2025.

[19] J. I. Gold, K. M. Akbar, S. Avila, N. H. Ngo, and M. J. Klein, "Exploring relations between unique patient characteristics and virtual reality immersion level on anxiety and pain in patients undergoing venipuncture: Secondary analysis of a randomized control trial," Journal of Medical Internet Research, vol. 26, p. e53196, 2024.

[20] G. K. Kyei, E. F. Kyei, and R. Ansong, "The efficacy and patient experience of virtual reality in labor: An integrative review of pain and anxiety management," Pain Management Nursing, vol. 26, no. 1, pp. 65-74, 2025.

[21] B. R. McDonald, S. Vogrin, and C. M. Said, "Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: A retrospective audit," BMC Geriatrics, vol. 24, no. 1, p. 334, 2024.

[22] S. Vanoli, E. Grobet-Jeandin, O. Windisch, M. Valerio, and D. Benamran, "Evolution of anxiety management in prostate biopsy under local anesthesia: A narrative review," World Journal of Urology, vol. 42, no. 1, p. 43, 2024.

[23] K. Lewis et al., "Executive summary of a focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU," Critical Care Medicine, vol. 53, no. 3, pp. e701-e710, 2025.

[24] C. Hart et al., "Examining the psychometric properties of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 among young urban South African women," Journal of Affective Disorders, vol. 369, pp. 61-70, 2025.

[25] T. Arthur, G. J. Melendez-Torres, D. Harris, S. Robinson, M. Wilson, and S. Vine, "Extended reality interventions for health and procedural anxiety: Panoramic meta-analysis based on overviews of reviews," Journal of Medical Internet Research, vol. 27, p. e58086, 2025.

[26] J. Kim et al., "Optimizing large language models for detecting symptoms of comorbid depression or anxiety in chronic diseases: Insights from patient messages," 2025.

[27] M. A. Hossain, M. K. Rahman, M. M. Haque, M. A. Jalil, and K. C. Hussin, "Do quality halal healthcare services promote well-being toward medical tourists?," International Journal of Quality & Reliability Management, pp. 1-33, 2026.

[28] W. Li and X. Liu, "Anxiety about artificial intelligence from patient and doctor-physician," Patient Education and Counseling, vol. 133, p. 108619, 2025.