Methodology

The development of the MTI was a multi-year, multi-steps and multi-stakeholder approach. We followed a rigorous 8 steps methodological, statistical and index construction procedure to develop this psychometric sound measurement.

The first step consisted of specifying the domain of the construct, namely Medical Tourism . This was done by a thorough literature search and review of the main drivers for medical tourism.

The second step consisted of generating a sample of items which should be included. We used a multi-source approach to generate items related to the MTI construct. We conducted a thorough literature search and review as well as consulted an expert focus group. Finally, we also conducted a global survey with 394 respondents, member of the Medical Tourism Association (MTA), to assess the initial list of items to assess content and face validity.

Step three and four consisted of collecting initial data and scale purification and refinement. This was achieved by conducting a survey with 801 respondents. We used a representative U.S. population sample with respect to 6‐demographic dimensions (gender, marital status, ethnicity, geographical location, age and educational attainment) as identified in the 2010 U.S. Bureau of Census. We then conducted a series of statistical tests such as sample adequacy, factor analysis and various reliability and validity tests were performed.

The five to seven consistent of collecting a new data, assess reliability and validity of the MTI construct. To achieve this, we conducted a survey with 800 respondents. Again, we used a representative U.S. population sample with respect to 6‐demographic dimensions. A series of statistical and index construction procedures and tests such as sample adequacy, confirmatory factor analysis and various reliability and validity tests (e.g., Cronbach Alpha, Average Variance Extracted, Construct Reliability) and a Structural Equation Modelling were performed.

After the development of the MTI, the final step (eight) was to apply it. The results of the MTI are based on a U.S. representative sample of 3,000 people in respect to 6‐demographic dimensions as identified in the 2010 U.S. Bureau of Census. In sum, the MTI is based on over 5,000 respondents.