The study addresses the growing need for wellness tourism as a response to the stresses of modern life and the economic downturn caused by the COVID-19 pandemic. It highlights the potential of wellness tourism to revitalize rural areas, specifically focusing on Sarab County in Northwest Iran, a region with untapped potential due to its natural resources and cultural heritage. The research questions the most important aspects of wellness-based tourism (WBT) post-pandemic and the key determinants influencing WBT destination choice. The study argues that identifying and prioritizing these factors can contribute to sustainable rural development and economic recovery. The context includes the global shift towards wellness tourism, the significant negative impact of COVID-19 on the tourism sector in Iran, and the specific opportunities presented by Sarab County's unique characteristics, including its natural environment, medicinal plants, and mineral springs.

The literature review examines existing definitions and models of wellness tourism, highlighting the variations in terminology (wellness tourism, health tourism, medical tourism) and the diverse range of activities and services it encompasses. It explores the growing global market share of wellness tourism and its potential for rural development. The review also notes the lack of research on the specific factors influencing wellness tourism destination choice, especially in the context of the COVID-19 pandemic and sustainable rural development in areas like Sarab County. Existing studies on health tourism and its various dimensions are discussed, outlining the physical, social, and individual aspects and external factors such as marketing, price, place, and quality of facilities.

This quantitative research employs a cross-sectional survey design. The study population consisted of 237,415 tourists visiting Sarab County's natural attractions between 2018 and 2019, with a sample of 384 tourists selected using a multi-stage random sampling method. Data collection involved a structured questionnaire administered through face-to-face interviews. The questionnaire measured wellness tourism (WBT) through physical, social, and individual dimensions, and destination selection through satisfaction, place, marketing and price, and quality and facilities. To ensure reliability and validity, a pilot test was conducted, Cronbach's alpha was calculated, and expert validation was performed. The structural equation model (SEM) using AMOS software analyzed the data to assess the relationships between these variables, addressing concerns about common method bias through several techniques such as Harman's single-factor test and CFA. The analysis examined the direct and indirect effects of the independent variables on the three dimensions of wellness tourism and overall wellness.

The descriptive statistics revealed a predominantly male (65.6%), married (65.9%), and full-time employed (45.8%) sample with an average age of 35-36 years. The physical dimension of wellness tourism had the highest mean score (4.14), followed by the individual (3.63) and social (3.57) dimensions. Friedman's test confirmed significant differences between the dimensions. Among the external factors influencing destination choice, satisfaction had the highest mean score (3.13), followed by place (2.92), marketing and price (2.53), and quality and facilities (2.41). The structural equation modeling (SEM) results showed that the model had a good fit (CFI > 0.9, GFI > 0.9, NFI > 0.9, TLI > 0.9, RMSEA < 0.08). The overall model explained 62% of the variance in wellness tourism destination choice. Place had the strongest direct effect (0.825), followed by satisfaction (0.579), marketing and price (0.545), and quality and facilities (0.391). The regression equation summarizing the findings shows the relative influence of these factors on the wellness tourism decision.

The findings highlight the importance of the physical dimension of wellness tourism, particularly relevant in the context of the COVID-19 pandemic where avoiding crowded places is crucial. The strong influence of 'place' underscores the significance of natural attractions, climate, and cultural heritage in attracting wellness tourists. High levels of satisfaction further emphasizes the need for quality services and infrastructure. These findings support previous research emphasizing the positive effects of travel on mental and physical well-being. The study's contribution lies in offering a specific framework for developing wellness tourism in rural areas, considering the challenges posed by the pandemic and the need for sustainable development.

This study provides a valuable framework for developing sustainable wellness-based tourism in rural areas, specifically highlighting the importance of physical wellness, desirable location, high satisfaction, and effective marketing and pricing strategies. Future research could expand this model by including other variables such as revisit intention, perceived quality, place attachment, and recommendation intention. Furthermore, using methods like Bayesian networks might enhance the predictive strength of the model. Applying this model to other regions and exploring the long-term socioeconomic impacts of wellness tourism are important next steps.

The study's cross-sectional design limits the ability to establish causal relationships and track changes over time. The sample only includes Iranian tourists, limiting the generalizability of the findings to other nationalities. The lack of control variables might influence the results. The reliance on self-reported data through questionnaires could introduce biases like social desirability. The study's pre-pandemic data collection limits its direct applicability to the current situation, requiring further research on post-pandemic trends.