Abstract
Introduction:
Tropical forests under increasing pressure from land-use change, tourism expansion, and climate stress require management strategies that simultaneously support conservation objectives and sustain human-nature interactions. While ecosystem service research has extensively documented the ecological and health functions of tropical forests, limited attention has been given to how visitors cognitively perceive these functions and how such perceptions shape ecotourists’ health-driven visitation intentions.
Methods:
Addressing this gap, this study applies the Health Belief Model (HBM) to examine how health risk appraisal, motivational evaluations, perceived barriers, and self-efficacy influence ecotourists’ perceived health benefits and their health-driven intention to visit tropical forest environments. Survey data were collected from 650 adult visitors to tropical forest destinations in Hainan Province, China, and analyzed using structural equation modeling.
Results:
The results show that perceived susceptibility and perceived severity significantly enhance perceived health benefits, while perceived benefits exert the strongest positive influence and perceived barriers have a significant negative effect. Perceived health benefits and self-efficacy emerge as the primary predictors of visitation intention, with cues to action providing additional activation. The model explains 42.4% of the variance in perceived health benefits and 49.0% of the variance in intention to visit forests.
Discussion:
By conceptualizing perceived health benefits as a distinct cognitive mechanism, this study extends the application of HBM to tropical forest contexts characterized by conservation pressures. The findings highlight the importance of integrating health-oriented perceptions into forest management and ecotourism strategies, so that maintaining and promoting health-motivated visitation can indirectly strengthen conservation support while sustaining human well-being in vulnerable tropical forest systems.
1 Introduction
Tropical forests are increasingly recognized not only for their ecological and economic functions but also for their capacity to promote human health and wellbeing (Campbell, 2005; Zheng et al., 2025). Beyond provisioning ecosystem services, forest environments offer restorative settings that can alleviate psychological stress, support physical activity, and enhance overall quality of life (Sun et al., 2024). In recent decades, these health-related benefits have gained prominence in policy discussions surrounding sustainable tourism, public health, and nature-based recreation (Zhao et al., 2025). Existing research has demonstrated that exposure to forest environments can generate multiple health outcomes, including stress reduction, mental restoration, improved mood, and enhanced physical health (Korpilo et al., 2024). Parallel research in ecotourism has highlighted the role of nature-based experiences in fostering satisfaction, place attachment, and pro-environmental attitudes among tourists (Chen et al., 2024; Maleknia and Korcz, 2025). However, much of the current literature treats health benefits as either objectively measurable outcomes or secondary by-products of nature-based recreation (Maleknia, 2025b). Fewer studies explicitly examine perceived health benefits from the perspective of ecotourists themselves. Moreover, existing ecotourism research tends to emphasize environmental attitudes, conservation support, or economic impacts, while health-related perceptions remain conceptually underdeveloped and empirically underexplored (Latifinia et al., 2025; Rahman et al., 2025). Where health perceptions are considered, they are often addressed descriptively rather than through structured behavioral models that explain why individuals recognize, value, or act to visit forests upon these perceived benefits.
Despite growing scientific and policy interest in forest-based health promotion (Liu et al., 2024; Zhou et al., 2025), there remains limited empirical understanding of how ecotourists perceive the health benefits of forest environments and how such perceptions influence their intentions to participate in forest-based tourism activities. While ecotourism is often promoted as inherently beneficial for both environmental conservation and human wellbeing (Bachi et al., 2020; Maleknia and Zamani, 2025), this assumption is rarely examined through systematic behavioral or perceptual analysis. As a result, tourism planning and forest management strategies may overlook critical cognitive and perceptual factors that shape ecotourists’ health-related motivations, expectations, and visitation intentions in forest settings. A critical gap therefore exists at the intersection of forest-based ecotourism, health perception, and forest visitation decision-making. Specifically, there is insufficient knowledge about how ecotourists cognitively evaluate the health benefits of forests, what factors shape these evaluations, and how such perceptions may influence their intentions to visit forest destinations in ecotourism. The absence of a systematic, theory-driven investigation limits the ability of researchers and practitioners to design effective ecotourism experiences that explicitly integrate health promotion goals alongside ecotourism-based conservation objectives.
In response to these gaps, the present study aims to investigate how ecotourists perceive the health benefits associated with forest environments. The specific objectives are to (1) examine ecotourists’ perceptions of physical and psychological health benefits derived from forest-based ecotourism experiences, (2) identify key perceptual and cognitive factors associated with these health-related perceptions; and (3) provide empirical insights that can inform the integration of health considerations into forest ecotourism visitation intentions.
The focus of this study is the health-driven intention to visit tropical forests as the primary behavioral outcome. While visitation intention is not, in itself, a direct conservation action, it is a key form of human–nature engagement that can underpin conservation support by sustaining public exposure to forest environments, increasing appreciation of forest ecosystem services, and providing a social and economic basis for conservation-oriented management in ecotourism destinations (Chen et al., 2024; Maleknia and Korcz, 2025). Accordingly, the empirical model is specified around visitation intention, and the study’s contribution to conservation is framed in terms of how health-motivated visitation can create conditions that indirectly support conservation objectives in tropical forest landscapes. This study is also expected to make several important contributions. Conceptually, it advances the ecotourism literature by foregrounding health benefit perceptions as a distinct and meaningful dimension of forest-based tourism experiences. Empirically, it provides evidence on how ecotourists interpret and value the health-promoting functions of forests, addressing a notable gap in existing research. From a practical perspective, the findings can support forest managers, tourism planners, and policymakers in designing ecotourism strategies that simultaneously promote human health, visitor satisfaction, and forest conservation. By linking perceived health benefits to ecotourism contexts, the study also contributes to broader discussions on the role of natural ecosystems in preventive health and sustainable development.
1.1 Theoretical framework
This study employs the Health Belief Model (HBM) (Rosenstock, 1966) to explain how ecotourists cognitively evaluate the health benefits of forest environments and how these evaluations shape their intentions to visit forest-based ecotourism areas. HBM is particularly appropriate in this context because forest visitation can be conceptualized as preventive and self-regulatory health behavior, rather than a response to acute illness. By focusing on individual perceptions, the model enables an examination of why ecotourists recognize forests as health-promoting environments and how these perceptions translate into visitation intentions.
Perceived susceptibility refers to individuals’ beliefs about their likelihood of experiencing health-related problems, such as stress, mental fatigue, or reduced physical wellbeing (Taflinger and Sattler, 2024). In contemporary societies characterized by urbanization, sedentary lifestyles, and chronic stress, individuals increasingly perceive themselves as vulnerable to psychological and lifestyle-related health risks (Adli and Schöndorf, 2020). Empirical studies in environmental psychology suggest that individuals who feel susceptible to stress or mental exhaustion are more likely to seek restorative environments, particularly natural settings such as forests (Xu et al., 2024). Research on nature-based recreation has shown that perceived vulnerability to stress heightens awareness of the potential restorative functions of green environments (Wu et al., 2024). In tourism contexts, visitors who perceive themselves as mentally or physically strained tend to value destinations that offer relaxation, tranquility, and psychological recovery. Therefore, perceived susceptibility is hypothesized as a relevant antecedent of how ecotourists interpret forest environments as beneficial for health.
Perceived severity captures beliefs about the seriousness of health problems and their potential consequences for quality of life, productivity, and emotional wellbeing (Taflinger and Sattler, 2024). Individuals who believe that stress, anxiety, or physical inactivity can have serious long-term impacts are more likely to prioritize behaviors that mitigate these risks. In the context of forest-based ecotourism, perceived severity strengthens the motivation to engage with environments perceived as health-enhancing. Prior studies indicate that individuals who acknowledge the seriousness of mental fatigue, burnout, or declining wellbeing are more receptive to nature-based interventions. Forest environments, often associated with calmness, fresh air, and physical activity, are thus more likely to be perceived as valuable when health threats are considered severe. Including perceived severity allows the study to capture how the seriousness attributed to health risks intensifies ecotourists’ valuation of forest health benefits.
Perceived benefits refer to ecotourists’ beliefs about the general advantages and functional value of engaging in forest-based ecotourism activities, beyond narrowly defined health outcomes (Reza et al., 2025). Within the HBM, this construct captures individuals’ cognitive assessments of whether a particular behavior or environment is worthwhile and effective in delivering desired outcomes (Rosenstock, 1966). In the context of forest ecotourism, perceived benefits may include expectations related to relaxation, enjoyment, aesthetic appreciation, opportunities for recreation, learning about nature, and temporary escape from urban routines (Zhao et al., 2026). Prior tourism research indicates that such perceived benefits play a critical role in shaping participation in nature-based and wellness-oriented tourism by increasing the perceived utility and attractiveness of destinations (Zhou et al., 2025). Importantly, these benefits are not limited to health improvement but reflect a broader motivational evaluation of forest environments as valuable leisure and experiential settings. Incorporating perceived benefits allows the study to capture the instrumental and motivational logic through which ecotourists evaluate forest-based ecotourism as a desirable activity.
Perceived barriers refer to factors that inhibit engagement in health-promoting behaviors, even when benefits are recognized (Chow and Chen, 2022). In forest ecotourism contexts, barriers may include financial costs, limited accessibility, lack of time, inadequate infrastructure, safety concerns, or physical limitations (Hassan et al., 2026). Previous research demonstrates that perceived barriers often weaken the translation of positive attitudes into actual behavior in both health and tourism domains (Adeleke, 2015; Suhartanto et al., 2025). In nature-based tourism, logistical and structural constraints can significantly reduce visitation and participation, despite strong motivations or positive perceptions. By including perceived barriers, the study acknowledges that favorable health perceptions alone may not be sufficient to drive engagement with forest environments. This construct allows for a more realistic understanding of the constraints that shape ecotourists’ health benefits of forest-based ecotourism.
Perceived health benefits represent ecotourists’ specific and holistic evaluations of forest environments as promoters of physical and psychological wellbeing (Zhou et al., 2025). Unlike general perceived benefits, this construct focuses explicitly on health-related outcomes, such as stress reduction, mental restoration, emotional balance, improved mood, and perceived physical vitality derived from forest exposure. Drawing from environmental health and restorative environment literature, perceived health benefits reflect subjective appraisals rather than objectively measured health effects, yet these perceptions are often more influential in guiding behavioral intention (Zhang et al., 2025). In forest-based ecotourism contexts, individuals may interpret sensory experiences, tranquility, fresh air, and opportunities for gentle physical activity as indicators of health enhancement (Cheng et al., 2021). Positioning perceived health benefits as a distinct construct enables the study to isolate health-specific cognitive evaluations from broader recreational motivations, thereby strengthening the explanatory power of the model in linking forest ecosystems to tourism decision-making.
Self-efficacy refers to individuals’ confidence in their ability to perform a behavior successfully (Egele et al., 2025). In forest ecotourism, this includes confidence in engaging in activities such as walking, hiking, or spending time in forest environments for health-related purposes (Erfanian et al., 2024b). Research across health psychology and recreation studies demonstrates that self-efficacy is a strong predictor of participation in physical and nature-based activities (Surjanti et al., 2020). Individuals with higher self-efficacy are more likely to perceive fewer constraints, persist in activities, and derive greater benefits from their experiences (Zhang, 2025). In ecotourism contexts, self-efficacy may influence whether visitors feel capable of using forest environments for health enhancement, particularly among older adults or less physically active individuals. Its inclusion strengthens the explanatory power of the model by accounting for individual capability perceptions.
Cues to action represent triggers that activate health-related decision-making (Straub and Leahy, 2014). These cues can be internal, such as feelings of stress or fatigue, or external, such as media messages (Awan et al., 2022), social influence (Maleknia et al., 2025), or promotional campaigns emphasizing health benefits. In ecotourism research, cues to action have received limited attention, despite evidence that information exposure and social recommendations play a critical role in destination choice. Studies on wellness and nature-based tourism indicate that messaging highlighting relaxation, mental recovery, and health improvement can significantly influence tourists’ motivations (Straub and Leahy, 2014). Including cues to action enables the study to capture how informational and experiential triggers stimulate ecotourists’ awareness of forest health benefits and prompt their intentions to visit forest-based tourism areas.
Based on the HBM and its application to forest-based ecotourism, the following hypotheses are proposed:
H1: Perceived susceptibility to health problems positively influences ecotourists’ perceived health benefits of forest environments.
H2: Perceived severity of health problems positively influences ecotourists’ perceived health benefits of forest environments.
H3: Perceived benefits of forest-based ecotourism positively influences ecotourists’ perceived health benefits of forest environments.
H4: Perceived barriers negatively influence ecotourists’ perceived health benefits of forest environments.
H5: Ecotourists’ perceived health benefits of forest environments positively influence their intention to visit forest ecotourism destinations.
H6: Self-efficacy positively influences their intention to visit forest ecotourism destinations.
H7: Cues to action positively influence their intention to visit forest ecotourism destinations.
The theoretical framework of research with directions of influence and hypotheses is illustrated in Figure 1.
FIGURE 1
2 Materials and methods
2.1 Study area
The study was conducted in tropical forests in Hainan Province. Hainan province, situated in the South China Sea, serves as an exemplary case study for examining the role of health issues in attracting visitors to tropical rainforests (Wu et al., 2025). This province stands out due to its unique geographical characteristics, including pristine beaches, tropical climate, and diverse ecosystems, which are critical for promoting wellness and nature-based tourism. Hainan’s tropical rainforests, particularly in areas such as the Hainan Tropical Rainforest National Park and the Yalong Bay National Forest Park, offer a distinctive environment that combines natural beauty with opportunities for health and wellness activities (Gao et al., 2025). These parks are not only rich in biodiversity but also provide therapeutic experiences through activities like trekking, meditation, and herbal treatments derived from local flora. Additionally, Hainan has embraced the development of a health tourism industry, supported by government initiatives aimed at promoting wellness retreats and eco-tourism (Zheng et al., 2025). The province’s strategic focus on sustainability and conservation positions it as a model for balancing tourism growth with environmental preservation, making it an ideal location for studying the intersection between health tourism and ecological conservation. As such, Hainan’s unique combination of natural resources, institutional support for health-focused tourism, and its commitment to ecological sustainability offers a compelling context for exploring how health tourism influences visitor attraction to tropical rainforests, contributing valuable insights into sustainable tourism practices.
2.2 Participants and sampling method
The study population consisted of adult visitors to forest-based ecotourism sites within Hainan Province, China, a region where tropical forest ecosystems represent a major natural asset and underpin a well-developed nature-based tourism sector. According to (Krejcie and Morgan, 1970) table, a sample size of 384 was required for this study. However, to better capture the effects of the implementation variables and to ensure broader representation across different types of tourists and demographic groups, a larger number of questionnaires were distributed. After removing questionnaires with deficiencies, a total of 650 completed responses were retained for analysis. The analytical focus on on-site forest visitors was intentional, as direct exposure to forest environments is particularly relevant for shaping perceptions of ecosystem-related health benefits and ecotourism engagement. Individuals were eligible to participate if they were at least 18 years of age and were visiting forest areas for recreational, leisure, or health-related purposes during the survey period. A spatially stratified field sampling design was employed to enhance representativeness across the province. Three counties with extensive forest coverage, public accessibility, and established roles as forest ecotourism destinations were selected as sampling strata. Collectively, these areas encompass diverse tropical forest ecosystem types, management regimes, and visitor use patterns, thereby capturing heterogeneity in forest–visitor interactions within the provincial context. Data collection was conducted at high-use forest access points, including trailheads, recreation zones, and main visitor entry areas.
The study was implemented at multiple forest-based ecotourism sites, including Hainan Tropical Rainforest National Park, Dongzhai Harbor National Nature Reserve, Nanshan Forest Reserve, and Yalong Bay Tropical Paradise Forest Park. These sites were selected to reflect variation in forest ecosystem characteristics, tourism intensity, and visitor motivations across inland rainforest and coastal forest environments. A systematic intercept sampling approach was adopted, whereby visitors were approached at regular intervals to minimize interviewer discretion and reduce selection bias. Surveys were administered across different days of the week and time periods to account for temporal variation in visitation patterns and to capture both weekday and weekend visitor profiles. Participation was strictly voluntary, and informed consent was obtained prior to questionnaire administration. To ensure data quality, each respondent was surveyed only once, and questionnaires with substantial missing or inconsistent responses were excluded from subsequent analyses. The final sample size met established methodological requirements for covariance-based structural equation modeling, providing adequate statistical power for model estimation and hypothesis testing. While the sampling strategy was designed to enhance representativeness among active forest users, the findings primarily reflect the perceptions and behavioral intentions of on-site visitors rather than those of the general population. Overall, this sampling framework enabled the collection of empirically robust and context-specific data on ecotourists’ health-related perceptions and behavioral intentions, while maintaining methodological rigor and minimizing common sources of bias associated with on-site visitor surveys.
2.3 Data collection procedures
A structured questionnaire was developed to empirically operationalize the constructs derived from HBM within the ecological context of tropical forest environments. Scale development followed a rigorous multi-stage process to ensure conceptual precision, contextual relevance, and psychometric robustness. Measurement items were adapted from established and validated instruments in public health, environmental psychology, and pro-environmental behavior research. Items were carefully contextualized to reflect the specific health services provided by tropical forests. All latent variables were measured using multi-item indicators on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree) (Likert, 1932). Behavioral variables included both self-reported visitation frequency and engagement in specific forest-based activities.
To establish content validity and contextual appropriateness, the preliminary questionnaire was evaluated by an interdisciplinary expert panel comprising specialists in forestry, tropical ecology, environmental health, public health, and social psychology. Panel members possessed substantial experience in ecosystem service research and community-based survey methodology within tropical regions of China, particularly in Hainan Province. Experts independently assessed each item in terms of relevance, clarity, representativeness, and theoretical alignment with HBM constructs. Based on their recommendations, several items were rephrased to improve semantic clarity and eliminate ambiguity. Redundant indicators were removed, and wording adjustments were made to better reflect the ecological characteristics of tropical forests. This iterative refinement process ensured both theoretical coherence and disciplinary alignment with forestry research standards. A pilot study was conducted to assess reliability, feasibility, and preliminary construct validity. The pre-test involved 30 samples. Preliminary reliability analysis indicated satisfactory internal consistency across constructs, with Cronbach’s alpha values exceeding the recommended threshold of 0.70 (Cronbach, 1951).
The main survey was conducted using a structured, face-to-face administration approach to enhance response quality and reduce non-response bias. A standardized protocol was implemented to ensure procedural consistency. Field researchers received comprehensive training covering study objectives, ethical procedures, standardized explanation scripts, neutral response clarification techniques, and quality control measures. After providing a standardized explanation of the study purpose, voluntary nature of participation, and confidentiality assurances, informed consent was obtained. Respondents completed the questionnaire independently. For participants with limited literacy, investigators provided clarification without influencing responses. Participation was entirely voluntary, with the right to withdraw at any time without consequence. Participants were fully informed of the study’s academic purpose, procedures, and confidentiality protections prior to participation. No personally identifiable information was collected. Data were anonymized and securely stored.
2.4 Data analysis
Data analysis was conducted through a systematic and sequential procedure to ensure statistical rigor, measurement validity, and robust hypothesis testing. The analytical strategy followed Partial Least Squares Structural Equation Modeling (PLS-SEM). The first stage involved comprehensive data screening and preparation. Descriptive statistics were subsequently calculated to characterize the samples’ characteristics. Frequencies and percentages were reported for categorical demographic variables. The measurement model was then evaluated to assess reliability and construct validity of the latent variables derived from model. Internal consistency reliability was examined using Cronbach’s alpha and composite reliability, with values above 0.70 considered acceptable (Cronbach, 1951). Convergent validity was assessed through standardized factor loadings and Average Variance Extracted (AVE), ensuring that items adequately represented their respective constructs (Hair et al., 2019). Discriminant validity was evaluated using the Fornell–Larcker criterion and the heterotrait–monotrait ratio (HTMT), confirming that constructs were empirically distinct from one another. After establishing a satisfactory measurement model, the structural model was tested to examine the hypothesized relationships among constructs. To further examine indirect effects within the model, mediation analysis was conducted using bootstrapping procedures with a large number of resamples (e.g., 5,000). The explanatory power of the model was assessed through coefficients of determination (R2) for endogenous constructs, indicating the proportion of variance explained by predictor variables. Through this structured and rigorous analytical approach, the study ensured reliable measurement validation and robust testing of the theoretical model linking tropical forest ecosystem perceptions to health-related engagement among migrant populations. For the analysis of participants’ demographic characteristics, SPSS24 was used. The structural equation modeling analysis was conducted using SmartPLS3.
Before estimating the structural model, preliminary nonparametric analyses were conducted to determine whether the constructs of model and intention differed across age and gender groups. Using the Kruskal–Wallis test for six age categories (Table 1) and the Mann–Whitney U test for gender (Table 2), no significant differences were found, indicating that neither demographic factor was associated with variations in the variables of model. Because these variables showed no significant differences, and to preserve model parsimony and avoid unnecessary complexity, age and gender were not included as control variables in the structural equation model. This approach aligns with PLS-SEM guidelines, which recommend incorporating control variables only when supported by theory or empirical evidence.
TABLE 1
| Tests | Intention | PS | PV | PB | PBR | CA | SE | PHB |
|---|---|---|---|---|---|---|---|---|
| Chi-square | 1.721 | 2.361 | 2.266 | 1.887 | 1.855 | 4.312 | 3.418 | 1.681 |
| df | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 |
| Asymp. Sig. | 0.886ns | 0.797ns | 0.811ns | 0.865ns | 0.869ns | 0.505ns | 0.636ns | 0.891ns |
Results of Kruskal Wallis test for comparison constructs of model between age groups*.
*: PS; perceived susceptibility, PV; perceived severity, PB; perceived benefits, PBR; perceived barriers, CA; cues to action, SE; self-efficacy, PHB; perceived health benefits, ns: not significant.
TABLE 2
| Tests | Intention | PS | PV | PB | PBR | CA | SE | PHB |
|---|---|---|---|---|---|---|---|---|
| Mann-Whitney U | 49489.5 | 50824.0 | 52335.0 | 50956.0 | 50960.5 | 50942.0 | 51678.5 | 52027.0 |
| Wilcoxon W | 105434.5 | 100910.0 | 108280.0 | 101042.0 | 101046.5 | 106887.0 | 107623.5 | 102113.0 |
| Z | -1.387 | -0.821 | -0.184 | -0.766 | -0.765 | -0.772 | -0.461 | -0.314 |
| Asymp. Sig. (2-tailed) | 0.165 | 0.412 | 0.854 | 0.443 | 0.445 | 0.440 | 0.645 | 0.753 |
Results of Mann-Whitney test for comparison constructs of model between gender groups*.
*: PS; perceived susceptibility, PV; perceived severity, PB; perceived benefits, PBR; perceived barriers, CA; cues to action, SE; self-efficacy, PHB; perceived health benefits, ns: not significant.
3 Results
3.1 Characteristics of participants
The characteristics of research participants are shown in Table 3. Participants of study were approximately evenly distributed by gender (320 males, 49%; 330 females, 51%) and comprised a greater proportion of single participants (n = 381, 59%) than married participants (n = 269, 41%). Age was distributed across six bands, with the largest groups in the 51–60 (n = 148, 23%) and 41–50 (n = 139, 22%) ranges, followed by 31–40 (n = 137, 21%), > 61 (n = 94, 14%), 21–30 (n = 93, 14%), and < 20 (n = 39, 6%). Educational attainment was relatively high: 37% (n = 240) held university degrees, 36% (n = 235) had completed diploma-level education, and 27% (n = 175) had a school-level education. Overall, the sample exhibits balanced gender representation, a predominance of single respondents, an age distribution skewed toward middle and older adults, and substantial tertiary or diploma-level educational attainment.
TABLE 3
| Characteristic | Categories | Frequency | Percentage |
|---|---|---|---|
| Gender | Male | 320 | 49 |
| Female | 330 | 51 | |
| Marital Status | Single | 381 | 59 |
| Married | 269 | 41 | |
| Age | <20 | 39 | 6 |
| 21–30 | 93 | 14 | |
| 31–40 | 137 | 21 | |
| 41–50 | 139 | 22 | |
| 51–60 | 148 | 23 | |
| >61 | 94 | 14 | |
| Educational level | School | 175 | 27 |
| Diploma | 235 | 36 | |
| University degrees | 240 | 37 |
The characteristics of research participants.
3.2 Measurement model assessment
The reliability and convergent validity of the latent constructs were evaluated prior to testing the structural relationships. Internal consistency reliability was satisfactory across all constructs, as indicated by Cronbach’s alpha and rho_A values exceeding commonly accepted thresholds (Cronbach, 1951; Table 4). These results confirm that the measurement items consistently captured their intended theoretical dimensions.
TABLE 4
| Constructs | Code | Statements | Reliability and validity | References |
|---|---|---|---|---|
| Intention to visit forest | INV1 | I intend to visit forest-based ecotourism destinations in the near future. | αα = = 0.834 rho_A = = 0.835 CR: 0.889 AVE: 0.667 | (Urbanovich and Bevan, 2020; Ataei et al., 2021, 2024; Le et al., 2021; Chow and Chen, 2022; Erfanian et al., 2024b; Maleknia, 2025b) |
| INV2 | I am likely to choose forest destinations for my future trips. | |||
| INV3 | Visiting forests will be a priority in my future leisure plans. | |||
| INV4 | I am willing to make an effort to visit forest environments. | |||
| Perceived susceptibility | PS1 | I believe that my current lifestyle makes me vulnerable to physical or mental health problems. | αα = = 0.826 rho_A = = 0.828 CR: 0.884 AVE: 0.657 | |
| PS2 | I often feel that stress or fatigue could negatively affect my health. | |||
| PS3 | Without regular contact with nature, my wellbeing may decline. | |||
| PS4 | I feel at risk of experiencing mental exhaustion in my everyday life. | |||
| Perceived severity | PV1 | Long-term stress can seriously reduce my quality of life. | αα = = 0.788 rho_A = = 0.797 CR: 0.862 AVE: 0.610 | |
| PV2 | Mental fatigue can have serious consequences for my overall wellbeing. | |||
| PV3 | Health problems caused by stress are difficult to recover from. | |||
| PV4 | Declining physical or mental health would seriously affect my life satisfaction. | |||
| Perceived benefits | PB1 | Visiting forests is an enjoyable and valuable leisure activity for me. | αα = = 0.795 rho_A = = 0.797 CR: 0.866 AVE: 0.679 | |
| PB2 | Spending time in forests enhances my overall travel experience. | |||
| PB3 | Forest visits allow me to reconnect with nature in meaningful ways. | |||
| PB4 | I consider forest visits worthwhile use of my time and resources. | |||
| Perceived barriers | PBR1 | I do not have enough time to visit forest areas regularly. | αα = = 0.817 rho_A = = 0.824 CR: 0.879 AVE: 0.644 | |
| PBR2 | The cost of visiting forest areas is a limitation for me. | |||
| PBR3 | Lack of suitable facilities reduces my interest in forest visits. | |||
| PBR4 | I have concerns about safety when visiting forest environments. | |||
| Perceived health benefits | PHB1 | I believe protecting nature is important even if it does not directly benefit people. | αα = = 0.852 rho_A = = 0.855 CR: 0.900 AVE: 0.693 | |
| PHB2 | I think all living things have a right to exist. | |||
| PHB3 | I care deeply about damage done to the natural environment. | |||
| PHB4 | I feel personally responsible for minimizing harm to nature. | |||
| Self-efficacy | SE1 | I am confident in my ability to visit forest environments regularly. | αα = = 0.844 rho_A = = 0.845 CR: 0.895 AVE: 0.681 | |
| SE2 | I feel capable of engaging in activities such as walking or hiking in forests. | |||
| SE3 | I can manage the physical demands of visiting forest areas. | |||
| SE4 | Even if challenges arise, I am confident I can still visit forests | |||
| Cues to action | CA1 | Feeling stressed motivates me to consider visiting forests. | αα = = 0.793 rho_A = = 0.808 CR: 0.865 AVE: 0.615 | |
| CA2 | Information about health benefits encourages me to visit forest areas. | |||
| CA3 | Recommendations from others motivate me to visit forests. | |||
| CA4 | Experiencing fatigue reminds me to seek forest environments. |
The constructs of model with their statements, reliability, and validity.
Composite reliability values further supported the robustness of the measurement model, demonstrating adequate construct reliability and indicating that the indicators jointly explained a substantial proportion of variance in their respective latent variables. None of the constructs exhibited signs of under- or over-reliability, suggesting a balanced measurement structure appropriate for structural equation modeling. Convergent validity was confirmed through AVE values that surpassed the recommended minimum criterion (Hair et al., 2017). This indicates that, for each construct, the latent variable accounted for more than half of the variance observed in its indicators, providing evidence that the items meaningfully represented their underlying theoretical concepts. In particular, constructs related to health cognition and behavioral intention demonstrated strong explanatory capacity, supporting their conceptual relevance within the HBM framework applied to forest-based ecotourism. Overall, the measurement model exhibited satisfactory psychometric properties, confirming the adequacy of the latent constructs for subsequent structural model estimation. These results establish a sound empirical foundation for examining the hypothesized relationships among health perceptions, motivational factors, and intention to engage in forest ecotourism.
3.3 Discriminant validity
Discriminant validity was assessed using both the Fornell–Larcker criterion and the heterotrait–monotrait ratio (HTMT) to ensure robust evaluation of construct distinctiveness. The Fornell–Larcker (Table 5) results indicated that each construct shared greater variance with its own indicators than with other latent variables, confirming that the square roots of the AVE values exceeded all corresponding inter-construct correlations (Fornell and Larcker, 1981). Complementary HTMT analysis further supported these findings (Table 6), as all construct pair ratios remained below established threshold levels, providing stronger evidence against construct redundancy. Although conceptually related variables—particularly perceived health benefits, self-efficacy, and intention to visit forests—exhibited moderate associations, these relationships remained within acceptable bounds and reflected theoretical coherence rather than empirical overlap (Sarstedt et al., 2021). Importantly, inhibitory factors such as perceived barriers remained clearly distinguishable from benefit- and intention-oriented constructs, consistent with the HBM’s conceptual structure. Taken together, the convergence of evidence from both discriminant validity assessments confirms that the latent constructs represent empirically distinct psychological dimensions, thereby supporting the adequacy of the measurement model and justifying progression to structural model estimation.
TABLE 5
| Constructs | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
| Cues to action | 0.784 | 0.817 | 0.803 | 0.786 | 0.832 | 0.781 |
| Intention to visit forest | 0.273 | |||||
| Perceived barriers | -0.032 | -0.409 | ||||
| Perceived benefits | 0.082 | 0.308 | -0.23 | |||
| Perceived health benefits | 0.334 | 0.637 | -0.36 | 0.504 | ||
| Perceived severity | 0.065 | 0.204 | -0.132 | 0.161 | 0.32 | |
| Perceived susceptibility | 0.036 | 0.247 | -0.160 | 0.204 | 0.38 | 0.100 |
| Self-efficacy | 0.114 | 0.548 | -0.171 | 0.165 | 0.477 | 0.136 |
The discriminant validity by Fornell and Larcker criterion.
TABLE 6
| Constructs | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|---|---|---|---|---|---|---|---|
| Cues to action | 0.327 | 0.490 | 0.281 | 0.609 | 0.384 | 0.122 | 0.242 |
| Intention to visit forest | |||||||
| Perceived barriers | 0.068 | ||||||
| Perceived benefits | 0.099 | 0.378 | |||||
| Perceived health benefits | 0.399 | 0.753 | 0.422 | ||||
| Perceived severity | 0.084 | 0.252 | 0.154 | 0.200 | |||
| Perceived susceptibility | 0.053 | 0.296 | 0.190 | 0.249 | 0.450 | ||
| Self-efficacy | 0.133 | 0.652 | 0.200 | 0.201 | 0.562 | 0.164 |
The results of HTMT criterion.
3.4 Structural model results and hypothesis testing
The SEM presented illustrates the relationships between key constructs, including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, cues to action, perceived health benefits, and intention to visit the forest. The model (Figure 2) explains 42.4% of the variance (R20.424) in perceived health benefits, which is influenced by perceived susceptibility (β = 0.251), perceived severity (β = 0.207), perceived benefits (β = 0.372), and perceived barriers (-0.207). Furthermore, the model accounts for 49.0% of the variance (R20.490) in the intention to visit the forest, which is strongly predicted by perceived health benefits (β = 0.456) and self-efficacy (β = 0.321), with a weaker contribution from cues to action (β = 0.085). Factor loadings for indicator variables and path coefficients highlight the strength of these relationships, providing a comprehensive understanding of the constructs and their interconnectedness in the model. All path coefficients were found to be statistically significant, providing full empirical support for the proposed framework. Path significance was assessed using t-values and corresponding p-values obtained through bootstrapping procedures.
FIGURE 2
Health risk appraisal variables exhibited strong effects on perceived health benefits (Table 7). Perceived susceptibility (H1) showed a positive and significant influence perceived on health benefits (t = 8.083, p < 0.001), indicating that individuals who perceive themselves as vulnerable to health problems are more likely to recognize forests as health-enhancing environments. Similarly, perceived severity (H2) exerted a significant positive effect (t = 7.667, p < 0.001), confirming that greater concern about the seriousness of health issues strengthens the perceived health value of forest ecosystems. These findings support the role of risk perception as a foundational cognitive driver of health-related evaluations in forest-based ecotourism. Evaluative and constraint-related factors also significantly shaped perceived health benefits. Perceived benefits (H3) demonstrated the strongest positive influence among antecedent variables (t = 13.240, p < 0.001), highlighting the importance of broader experiential and recreational evaluations in reinforcing health-related perceptions. In contrast, perceived barriers (H4) showed a significant negative effect on perceived health benefits (t = 6.776, p < 0.001), suggesting that practical and psychological constraints reduce the extent to which forest environments are interpreted as beneficial for health. Together, these paths confirm that perceived health benefits are formed through a balance of motivational appraisal and perceived constraints.
TABLE 7
| Hypotheses | t-values | p-values | Results | |
|---|---|---|---|---|
| H1 | Perceived susceptibility - > > perceived health benefits | 8.083 | 0.00 | Supported |
| H2 | Perceived severity - > > perceived health benefits | 7.667 | 0.00 | Supported |
| H3 | Perceived benefits - > > perceived health benefits | 13.24 | 0.00 | Supported |
| H4 | Perceived barriers - > > perceived health benefits | 6.776 | 0.00 | Supported |
| H5 | Perceived health benefits - > > intention to visit forest | 15.371 | 0.00 | Supported |
| H6 | Self-efficacy - > > intention to visit forest | 11.007 | 0.00 | Supported |
| H7 | Cues to action - > > intention to visit forest | 2.806 | 0.00 | Supported |
The results of testing of study hypotheses.
Perceived health benefits (H5), in turn, had a pronounced positive effect on intention to visit forest environments (t = 15.371, p < 0.001), demonstrating its central mediating role in the model. This result indicates that health-related perceptions serve as a key psychological mechanism through which forest ecosystems motivate ecotourism engagement. Beyond health perceptions, individual capability and activation mechanisms independently influenced behavioral intention. Self-efficacy (H6) exhibited a strong positive association with intention to visit forests (t = 11.007, p < 0.001), confirming that confidence in one’s ability to engage in forest-based activities is critical for intention formation. Cues to action (H7) also showed a significant positive effect (t = 2.806, p = 0.005), indicating that internal or external triggers, such as health awareness or informational exposure, play a meaningful role in activating forest visitation intentions. The results indicate that all seven hypothesized relationships were statistically supported, demonstrating a coherent and theoretically consistent structural model. The findings validate the applicability of the HBM in explaining how health-related cognition, motivational evaluation, perceived constraints, and individual capability jointly shape ecotourists’ intentions to engage with forest environments.
4 Discussion
This study was conducted for understanding of determinants of individuals’ intention to visit forests, using a PLS-SEM approach. The findings highlighted the central role of perceived health benefits in predicting behavioral intention, explaining a substantial proportion of variance (R20.490). Perceived health benefits themselves are significantly influenced by perceived benefits, perceived susceptibility, and perceived severity, while perceived barriers exert a negative effect. The results of hypotheses of research will be discussed following.
Perceived susceptibility (H1) and perceived severity (H2) showed significant positive contributions to perceived health benefits, reflecting the relevance of health risk awareness. These results are consistent with the core premises of the HBM (Rosenstock, 1966) and findings of pervious research (Tashiro, 2022; Maleknia, 2025b) which posits that individuals are more likely to develop health intentions and behaviors when they recognize their vulnerability to health risks and perceive these risks as serious. In the context of forest visits, individuals who are aware of the health risks associated with sedentary lifestyles, urban stress, or chronic diseases may be more inclined to perceive forest visits as a valuable means to mitigate these risks. The significant positive influence of perceived benefits on perceived health benefits (H3) also supported the notion that individuals are more likely to develop health-promoting intrntions when they perceive clear and tangible outcomes. This finding not only aligns with prior research (Urbanovich and Bevan, 2020; Kim and Cooke, 2021), which has demonstrated the importance of perceived benefits in motivating preventive health behaviors but also extends its application to nature-based health interventions, such as forest visits. Forests are increasingly recognized for their capacity to promote physical and mental wellbeing, reduce stress, and enhance cognitive functioning (Korpilo et al., 2024). These benefits likely make forest visits particularly appealing to individuals who value health-enhancing behaviors, thereby strengthening their perceived health benefits.
The negative impact of perceived barriers (H4) on perceived health benefits underscored the importance of addressing obstacles that may hinder individuals from recognizing or acting on the potential benefits of forest visits. Perceived barriers have been widely recognized as critical determinants of health behavior, with prior studies identifying factors such as time constraints, financial costs, lack of accessibility, and insufficient knowledge as common barriers (Urbanovich and Bevan, 2020; Chen and Liu, 2023). For example, in urban populations, limited access to green spaces and a lack of awareness about the health benefits of forest visits may reduce their perceived feasibility (Maleknia, 2025a). This finding highlighted the need for targeted interventions to lower these barriers, such as improving access to forests, offering guided programs, or disseminating information about the health benefits of nature exposure. Addressing perceived barriers is particularly important for vulnerable populations who may face compounded challenges, such as lower socioeconomic status or physical disabilities.
The model’s high explanatory power for perceived health benefits and its strong influence on intention underscored the pivotal role of this construct in driving health-driven forest visitation intention (H5). These findings are consistent with prior studies, which have identified perceived health benefits as a significant predictor of health-promoting intention, including physical activity, dietary changes, and preventive health screenings (Tashiro, 2022; Zhou et al., 2024). The emphasis on perceived health benefits highlighted the practical implications of promoting forest visits as a health intervention. Public health campaigns could focus on emphasizing the physical, mental, and emotional benefits of forest exposure, such as reducing stress, improving cardiovascular health, and enhancing overall wellbeing. Tailored messaging that resonates with specific populations, such as urban residents or individuals with chronic health conditions, may further enhance the impact of such interventions.
Self-efficacy (H6) emerged as a critical determinant of intention to visit forests, consistent with Bandura (2004) social cognitive theory, which emphasizes the role of confidence in one’s abilities to perform a behavior. This result is supported by previous research showing that higher self-efficacy enhances an individual’s likelihood of engaging in health-promoting behaviors (Tashiro, 2022; Vasli et al., 2024). In the context of forest visitation, self-efficacy may represent individuals’ confidence in their ability to organize and execute a forest visit, including overcoming logistical challenges such as transportation or physical activity requirements (Erfanian et al., 2024a). Interventions aimed at enhancing self-efficacy may include guided forest visits, educational campaigns, or community-led initiatives that provide individuals with the skills and confidence needed to engage in nature-based activities. For instance, studies on physical activity interventions have demonstrated that improving self-efficacy through motivational techniques and behavioral modeling significantly enhances participation rates (Ferrari et al., 2021; Sarrasin et al., 2022). Applying similar strategies to promote forest visits could yield similar benefits.
The relatively modest contribution of cues to action (H7) to visit intention suggested that their influence may be indirect or context-dependent. While cues to action are widely recognized as triggers for initiating health behaviors (Tashiro, 2022; Chonsalasin et al., 2026), their effectiveness may vary depending on the strength of other constructs in the model, such as perceived health benefits or self-efficacy. For example, individuals who already perceive forest visits as highly beneficial or feel confident in their ability to engage in such activities may require fewer external triggers to act. Conversely, those with lower perceptions of benefits or lower self-efficacy may rely more heavily on explicit prompts, such as medical advice, public health campaigns, or social influences. This result suggested that internal cognitive motivations and a sense of personal capability are more powerful predictors of intention than external triggers. This finding implied that while external promotions can serve as necessary sparks, they are secondary to the individual’s internalized understanding of the forest’s health-giving properties. Rather than relying on high-volume advertising, efforts should be directed toward deep-reaching interpretive programs and health-focused communication that enhance the visitor’s perceived benefits and confidence. In this context, external cues should be viewed as complementary tools that activate a pre-existing, motivation rather than as primary drivers of visitation intent. Future research should explore the situational or contextual factors that amplify or diminish the role of cues to action in motivating forest visits.
Although the outcome examined in this study is visitors’ intention to visit tropical forests, such visitation can represent an important precursor to conservation-related outcomes. Repeated and meaningful interactions with natural environments are widely recognized as mechanisms through which individuals develop emotional and cognitive connections to specific places (Maleknia and Korcz, 2025). In tourism and environmental psychology literature, these processes are commonly conceptualized as forms of place attachment (Chen et al., 2024; Zhou et al., 2024) and nature connectedness (Barrable et al., 2024; Korpilo et al., 2024), which have been shown to increase pro-environmental intentions and behaviors, support for conservation policies, and willingness to engage in protective behaviors. From this perspective, health-driven visitation may indirectly contribute to conservation by strengthening visitors’ experiential relationships with forest landscapes. When individuals visit forests to seek psychological restoration, physical activity, or stress reduction, they experience ecosystem services firsthand. Such experiences can foster appreciation of forest functions and increase awareness of their ecological value. Over time, these repeated experiences may cultivate stronger place attachment and environmental concern, which are key predictors of conservation-supportive behaviors. Therefore, while the present model focuses on health-driven visitation intention as the primary outcome, the results suggested a broader pathway in which health-oriented motivations facilitate human–nature interactions that can ultimately reinforce public support for tropical forest conservation. Integrating health-oriented forest experiences into ecotourism management may thus not only enhance visitor wellbeing but also create social conditions that encourage long-term conservation stewardship.
4.1 Theoretical implications
This study tried to advance theory at the intersection of environmental psychology, public health, and forest-based ecotourism by reconceptualizing forest visitation as a preventive, health-oriented intention rather than a purely recreational or experiential activity. By embedding forest-based ecotourism within the HBM, the research extends the theoretical scope of HBM beyond its traditional applications in clinical, risk-avoidance, and disease-prevention contexts, demonstrating its relevance for nature-based, voluntary, and non-medical health behaviors. This extension contributes to ongoing theoretical efforts to adapt health-related intentions models to ecotourism settings. A central theoretical contribution lies in the conceptual differentiation and empirical positioning of perceived health benefits as a distinct cognitive construct, rather than treating health outcomes as implicit or secondary by-products of nature-based tourism. Prior ecotourism and recreation theories have often subsumed health under general experiential value or wellbeing outcomes. This study theoretically supports that health-related cognition operates as an intermediate psychological mechanism linking health risk appraisal and motivational evaluation to behavioral intention. By doing so, it refines existing behavioral models in tourism research, which have tended to prioritize attitudes, satisfaction, or environmental values while under-theorizing health perception as an independent driver of engagement. The findings also contribute to theoretical debates on risk appraisal in non-threatening contexts. Within classical HBM applications, perceived susceptibility and severity are typically examined in relation to explicit health threats. This study suggests that these constructs retain explanatory relevance even when the intention is not a direct response to illness but rather a self-initiated strategy for maintaining or enhancing wellbeing. Theoretically, this suggests that health risk appraisal should not be confined to pathological conditions but can be understood as a broader cognitive orientation toward lifestyle-related vulnerabilities, thereby expanding the conceptual boundaries of HBM.
The simultaneous consideration of perceived barriers and self-efficacy indicates that forest-based health intention is shaped not only by positive evaluations of nature but also by perceived feasibility and personal competence. This theoretical integration suggests that intention formation in ecotourism is best understood as the outcome of motivational appraisal, constraint negotiation, and perceived behavioral control, rather than as a linear attitudinal process. The inclusion of cues to action also helps to theoretical understanding of activation mechanisms in forest-based tourism visitation intention. While many tourism models emphasized stable dispositions such as attitudes or values, this study underscores the importance of situational and informational triggers in translating latent health motivations into intention. Theoretically, this supports a more dynamic view of ecotourism decision-making, in which behavioral readiness fluctuates in response to internal states and external stimuli rather than remaining solely value-driven.
4.2 Policy and managerial implications
The findings indicated that perceived health benefits function as the primary psychological mechanism driving intention to visit forest environments. Consequently, rather than promoting forest destinations solely through scenic beauty or biodiversity attributes, communication strategies should explicitly articulate stress reduction, mental restoration, emotional regulation, and physical vitality benefits. Interpretive materials, signage, digital campaigns, and guided programs should systematically translate ecological characteristics into clearly communicated health value propositions. The significant role of perceived susceptibility and perceived severity suggests that health risk awareness enhances recognition of forest health value. Policymakers may therefore integrate forest-based tourism within broader public health messaging that addresses lifestyle-related stress, sedentary behavior, and urban mental fatigue. Strategic alignment between environmental agencies and public health institutions could strengthen policy coherence. For example, forest visitation could be embedded within municipal wellness initiatives, stress management campaigns, or preventive healthcare communication.
Because perceived benefits exerted the strongest influence on perceived health benefits, managers should ensure that experiential quality reinforces these evaluations. This requires maintaining high environmental quality, sensory comfort, safety, and accessibility. Investments in trail design, rest areas, quiet zones, and aesthetic landscape management are not merely infrastructure improvements—they directly shape visitors’ cognitive evaluation of forests as beneficial environments. Program development should integrate structured wellness-oriented activities such as guided walking routes, mindfulness sessions, or light physical activity programs, thereby making the perceived benefits more tangible and cognitively salient. The negative influence of perceived barriers highlights the importance of reducing structural and psychological constraints that weaken health-related appraisals. Transportation accessibility, affordable entry policies, clear wayfinding systems, and safety assurances should be prioritized, as barriers do not only suppress intention directly but also diminish the extent to which forests are interpreted as health-enhancing. Managers should conduct periodic barrier assessments to identify logistical, informational, or perceptual obstacles among different visitor segments. Addressing barriers is particularly critical for populations who may recognize health value but hesitate due to practical constraints. The strong effect of self-efficacy on intention indicates that visitors’ confidence in their ability to visit forest-based ecotourism areas is decisive. Management strategies should therefore incorporate capability-enhancing mechanisms. These may include beginner-friendly trails, graded difficulty information, guided group activities, instructional signage, and pre-visit digital orientation materials. Programs targeting older adults or physically inactive populations should emphasize achievable participation and gradual engagement. Enhancing self-efficacy reduces psychological resistance and strengthens translation of positive perceptions into behavioral readiness.
The comparatively smaller, but statistically meaningful effect of cues to action implies that well-timed informational prompts can facilitate decision-making, particularly for individuals already inclined toward health-motivated visitation. Seasonal campaigns, social media reminders, partnerships with healthcare providers, or wellness-focused promotional events may serve as effective cues. Importantly, cues are most effective when aligned with existing health motivations and perceived benefits rather than functioning as isolated promotional stimuli.
These findings of research suggest that forest governance and management should move beyond a traditional emphasis on scenic beauty or passive recreation toward a more explicitly health-oriented strategic framework. Internationally, there is growing recognition of forests as part of the nature-based solutions portfolio in public health (Liu et al., 2024), where ecosystem services are not only conserved for biodiversity and aesthetics, but also intentionally integrated into stress reduction, mental health promotion, and non-communicable disease prevention strategies. Our results highlighting perceived health benefits as the primary psychological driver of intention, align with this global trend. For forest-based tourism destinations, this implies that forest management agencies, tourism authorities, and public health institutions should jointly conceptualize forests as everyday health infrastructure rather than as optional leisure spaces. Strategically, this entails embedding forest-based activities into formal health promotion programs, and designing governance arrangements that explicitly prioritize health outcomes alongside ecological and economic objectives. By repositioning forest visitation within broader health policy and cross-sectoral planning, managers can ensure that the health-enhancing potential of forest ecosystems is systematically realized and promoted to attract tourists.
4.3 Limitations and future research
Despite the robust measurement properties and strong explanatory power of the structural model, several limitations should be acknowledged. These considerations do not undermine the validity or reliability of the findings, but rather delineate the contextual and methodological boundaries within which the results should be interpreted. The analysis relied on self-reported perceptual measures to assess health cognitions, perceived benefits, barriers, self-efficacy, and behavioral intention. While the measurement model demonstrated satisfactory reliability, convergent validity, and discriminant validity, self-reported data may be influenced by individual response tendencies or situational factors. Nevertheless, subjective perceptions are central to the HBM and are theoretically appropriate for examining cognitive determinants of intention. Future studies may complement perceptual data with behavioral or physiological indicators to further enrich understanding of health-related outcomes. The dependent variable focused on intention to visit forest environments rather than directly observed visitation behavior. Although intention is widely recognized as a proximal predictor of behavior in health and tourism research, the intention–behavior relationship may be moderated by situational constraints or contextual factors. Incorporating objective behavioral measures or follow-up assessments of actual visitation frequency would provide additional insight into how health-related cognitions translate into sustained engagement.
This study has also limitations related to its cross-sectional design and geographical scope. Because the data were collected at a single point in time and within the specific context of Hainan, China, the findings may not fully capture temporal dynamics or regional variability in ecotourism behavior. In addition, the study focuses on intention to visit rather than actual visitation behavior, and therefore cannot account for the well-documented intention–behavior gap. Although the model includes a construct for perceived barriers, this measure does not encompass many structural constraints such as time availability, travel costs, and accessibility limitations, all of which may prevent individuals from acting on their stated health-driven intentions. Future research should therefore adopt longitudinal or experimental designs to examine causal pathways, integrate objective behavioral and health indicators, and explore moderating variables that may influence the intention–behavior relationship. Comparative and cross-cultural studies would further clarify the contextual robustness of the HBM in forest-based tourism settings. Expanding the theoretical framework to include additional psychosocial constructs such as environmental identity, place attachment, or social norms may also enhance explanatory depth and provide a more comprehensive understanding of how perceived health benefits motivate sustained interaction with forest ecosystems.
5 Conclusion
This research was conducted to explore the determinants of health-driven forest visitation intention. Grounded in the HBM, the findings demonstrated that perceived health benefits function as a central psychological mechanism linking health risk appraisal and motivational evaluation to behavioral intention. The structural model exhibited substantial explanatory power, accounting for 42.4% of the variance in perceived health benefits and 49.0% of the variance in intention to visit forest environments, thereby confirming the theoretical robustness of the proposed framework. The results indicated that perceived susceptibility and perceived severity significantly enhanced the recognition of forests as health-promoting environments, underscoring the importance of health risk awareness in shaping environmental engagement. Among all antecedents, perceived benefits exerted the strongest influence on perceived health benefits, suggesting that broader experiential and recreational evaluations reinforce health-related interpretations of forest ecosystems. Conversely, perceived barriers negatively affected perceived health benefits, highlighting the constraining role of logistical and psychological obstacles in shaping cognitive appraisals. Perceived health benefits emerged as the most influential predictor of intention to visit forests, confirming its mediating role within the model. This finding emphasized that ecotourism engagement is not driven solely by recreational motivations but is substantially informed by health-oriented cognitive evaluations. In addition, self-efficacy demonstrated a strong positive effect on intention, indicating that confidence in one’s ability to participate in forest-based activities is critical for translating positive perceptions into behavioral readiness. Although cues to action showed a comparatively smaller effect, their significance suggests that informational and experiential triggers contribute to activating forest visitation decisions.
Collectively, the findings validate the applicability of the HBM in the context of forest-based ecotourism and extend its relevance to preventive, nature-based healthintentions. By positioning perceived health benefits as a distinct and empirically supported construct, this study advanced theoretical integration between environmental psychology, tourism research, and public health. The results underscored the importance of framing forest ecosystems not only as recreational resources but also as perceived health assets that motivate sustainable engagement. From a practical perspective, the study provided guidance for policymakers and forest managers seeking to promote health-oriented ecotourism. Strategies that emphasize tangible health benefits, reduce perceived barriers, and enhance visitors’ self-efficacy may strengthen public engagement with forest environments.
Statements
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved by the Business School, Huanggang Normal University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
PW: Conceptualization, Data curation, Funding acquisition, Investigation, Resources, Supervision, Validation, Writing – original draft. SE: Conceptualization, Formal analysis, Methodology, Project administration, Software, Writing – review & editing. QQ: Conceptualization, Resources, Validation, Writing – review & editing.
Funding
The author(s) declared that financial support was received for this work and/or its publication. This study was supported by Hainan Provincial Project for Construction of Health Demands and Service Models for Seasonal Travelers in Hainan Region, HNSK(ZC)25-143.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
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Summary
Keywords
health benefits of forest, ecotourist, forest therapy, tourists well-being, self-efficacy
Citation
Weiwei P, Erfanian S and Qing Q (2026) Perceived health benefits and health-driven visitation intentions in tropical forests: applying the Health Belief Model to ecotourism behavior. Front. For. Glob. Change 9:1823185. doi: 10.3389/ffgc.2026.1823185
Received
04 March 2026
Revised
07 April 2026
Accepted
13 April 2026
Published
21 May 2026
Volume
9 - 2026
Edited by
Mohammad Imam Hasan Reza, Centre for Environment and Sustainability, Bangladesh
Reviewed by
Shandra Rama Panji Wulung, Indonesia University of Education, Indonesia
Yuan Liu, Northeast Forestry University, China
Updates
Copyright
© 2026 Weiwei, Erfanian and Qing.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sahar Erfanian, sahar_erfanian@hgnu.edu.cn
Disclaimer
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