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towards adopting destination choice behavior. The
hypothesis developed as following:
H1: There is a positive significant relationship
between attitude and intention to adopt destination
choice behavior.
human behavior theories of reasoned action and
planned behavior respectively. The study revealed
that destination image and subjective norm posi-
tively impact behavioral intentions. However, the
literature does not cover attitude and perceived
behavior control as predictor.
Meanwhile, Reza Jalilvand et al. (2012) also
found that the relationship of destination image
that positively affects tourists' attitude. If the des-
tination country of medical tourism has a posi-
tive image, it will lead to positive attitude towards
developing behavioral intention in medical tour-
ism. Since Malaysia has gain a positive destination
image (Mohamad, et al., 2012), it is believed that
perceived destination image will become one of
the most important predictors in medical tourism.
As such, this study proposes the role of destina-
tion image in towards perceived behavioral control
respectively, hence the following hypotheses:
H3: There is a positive significant relationship
between perceived destination image and perceived
behavioral control.
3.2
Subjective norm
Subjective norm (SN) or social norms deals with a
consumer's motivation to perform a behavior, and
is constructed to incorporate the expectations of
what the important people in their life (e.g., fam-
ily, friends, and significant others) think about per-
forming that particular behavior (Ajzen, 1991).
Taylor and Todd (1995a) decompose subjective
norms into two aspects, that is, societal and social
norms. Societal norms refer to adherence to the
larger, societal fashions involving social community
or mass media. Jalilvand et al. (2012) emphasized
on the socio-demographics characteristics influ-
ence using electronic word of mouth in assessing
the travel intention. The role of social community
such as the doctor, nurses and the club plays vital
role in develop the intention in medical tourism.
On the other hand, social norms reflects adher-
ence to opinions from family, friends, and peers
(Taylor & Todd, 1995). In medical tourism, social
norm plays an important role towards developing
behavioral intention of medical tourists. The medi-
cal tourists normally tend to travel along with fam-
ily or friends in seeking for medical treatment. It
is thus posited here subjective norm significantly
affects intention to adopt destination choice behav-
ior; hence the following hypothesis:
H2: There is a positive significant relationship
between subjective norm and intention to adopt des-
tination choice behavior.
3.4
Perceived value towards perceived behavior
control
Kotler and Keller (2006, p. 133) defined perceived
value as “the difference between the prospective
customer's evaluation of all the benefits and all the
costs of an offering and the perceived alternatives.
Perceived value is a context-specific construct that
may drive customers' attitudes and behaviors. In
particular, little empirical research has been car-
ried out to examine the perceived value of medical
tourism services.
The major driving force of medical tourism
industry is the provision of cost effective private
medical care combined with the attraction of vis-
iting exotic sites in the destination countries (Sen
Gupta, 2004).
Han and Hwang (2013) indicated that perceived
benefits were generally associated with perceived
value and behavioral intentions, that value had a
significant mediating impact, and that national
culture had a significant moderating role in the
proposed relationships. Alternatively, the perceived
medical quality, service quality and enjoyment
were critical components that significantly influ-
enced the perception of value. Regarding sacrifice,
the effects of perceived risk on perceived value
were significant. Therefore, in this context, this
proposed study aims to investigate the relationship
between perceived values towards perceived behav-
ioral control. Hypothesis developed as following:
Hypothesis 4: There is a positive significant relation-
ship between perceived value and perceived behavio-
ral control.
3.3
Perceived destination image towards perceived
behavioral control
Perceived Destination Image refers to a sum total
of the images of individual element or attributes
that make up the tourism experience (Milman &
Pizam, 1995). The destination image could be con-
ceptualized as a formation of multi-dimensional
impression from tourist's perception of the func-
tional and psychological attributes of a destina-
tion. They also develop a conceptual model that
explain destination image holistically by integrat-
ing three levels of image such as country image,
island image and resort image.
If travelers are highly familiar with a destination,
they may not collect any additional information
from external sources (Snepenger & Snepenger,
1993). Previous study by Huang (2009) attempted
to explain travelers' behavioral intentions, by using
a model which was developed based on existing
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