How does health consciousness and worries affect the loyalty of medical tourism destination? A conditional process model for the intention of visiting and word of mouth marketing

Medical tourism has surged as health-conscious travellers search for trusted destinations that can offset the risks they perceive in everyday life. Drawing on Protection Motivation Theory (PMT), this study examines how health consciousness shapes two key loyalty outcomes: Revisit intention and word-of-mouth (WOM) recommendation, through the mediating role of modern health worries (MHW) and under the boundary condition of medical tourism destination image. Data were collected via face-to-face surveys from 328 volunteer medical tourists in Antalya, Türkiye. Using structural equation modelling in SmartPLS, we tested a moderated-mediation model. Results show that MHW fully and positively mediates the effect of health consciousness on both revisit intention and WOM. Moreover, a medical tourism destination image negatively moderates this indirect effect: when the image is highly positive, the motivational power of MHW weakens, in line with PMT's "risk-is-under-control" logic. The findings extend PMT by illustrating how excessive coping confidence can dampen threat-driven loyalty, and they offer managers guidance on balancing reassurance with motivation in medical tourism marketing. The paper concludes with theoretical implications for risk-based consumer research and practical recommendations for destination branding and service design.