THE IMPACT OF COMPLEMENTARY MEDICINE ON SUSTAINABLE TOURISM DEVELOPMENT THROUGH EVENT AND NATURE-BASED TOURISM

The subject of this research is to look at the attitudes of spa tourists towards complementary medicine and the possibilities of its application within spa services. The aim of the research is to identify certain scientific results that can contribute to the creation of an adequate tourism product. In the research, a prospective study is used and it was done by applying a standardized questionnaire. Testing the correlation of the answers given was examined and shown by the Analysis The Pearson Correlation method. The obtained results confirmed the hypotheses: complementary medicine is a significant component of the sustainable development of health tourism in spa destinations in Serbia, and that the organization of an adequate complementary medicine tourism event can increase tourists’ motivation for visits and their significant relation to nature-based tourism, which would significantly affect on sustainable tourism development of spa tourism. The intensification of the growth of awareness among the respondents about the importance of complementary medicine in tourism planning and development is evident, and by providing socio-cultural, economic and environmental benefits, the basic postulates of sustainable tourism development are directly fulfilled. © 2020 EA. All rights reserved.


Introduction
Health tourism, as one of the most widespread types of travel, is influenced by many factors (Tucki & Hadzik, 2013). Some of these are new products and technologies in contemporary rehabilitation and prevention treatments that can be implemented within the health tourism destination (Hadzik, 2009). The use of medicinal herbs for health purposes is a significant form of complementary medicine dating back to the early stages of human development. In addition to nature-based tourism, complementary medicine can be promoted through various ethno-social events (Yoo, Lee & Lee, 2015; Wisnom & Gallagher, 2018). Nature-based tourism makes a significant link in health tourism, because the ways of access to medicinal plant raw materials and the relation to nature sometimes represent the traditions of a particular people and a model for the realization of tourism needs in nature (Wardle et al., 2018).
Within the global health tourism, wellness tourism has specific opportunities for growth (Global Wellness Institute, 2015). Medical and health tourism are forms of tourism that comprise the therapeutic and wellness segment (Smith & Puczkó, 2015;Pan et al., 2019), linked to the movement of tourists on their own initiative (Connell, 2013) to special resorts that have all the necessary resources (Suess, Baloglu & Busser, 2018). The main motive of these trips is, at the same time, any form of health promotion combined with recreation and entertainment (Vetitnev & Kuskov, 2010). Wellness tourism (as an example of innovation) has the largest share in medical tourism, and is characterized by the largest increase in value in recent years (Euromonitor International, 2012). These motives to go to spas influence the choice of leisure activities and forms, and are an inspiration for creating a new concept of health tourism products, meeting the needs of tourists (Dryglas, 2009). On the other hand, they are constantly increasing competition, changing markets and technologies, forcing companies and health resorts to implement innovations, especially product innovations. A new approach to life that includes health, based on the "wellness" paradigm, results in visible changes in health tourism in spas (Kim et al., 2019). It is focused on "extending life while maintaining health, physical and mental abilities, youthful appearance, well-being and social activity" (Sallmann, 2010).
Different events represent a significant model for promoting this form of tourism. Whether it is local herbal fairs and its application in wellness and spa tourism, or are events of an international nature, health and nature-based forms of tourism can initiate various tourism activities (Whittle, Stewart & Fisher, 2015;Doran, Hanss & Larsen, 2017). The common link between these forms of tourism is nature, and the right attitude of man towards it. Properly integrated into the tourism offer, health, events and nature-based forms of tourism can contribute to significant tourism revenue. With proper planning and development, these forms of tourism can contribute to increasing socio-cultural, economic (Cvijanović, Pantić & Ignjatijević, 2020) and environmental benefits in tourist destinations (Kostić, Ratković & Forlani, 2019).
Achieving these positive results is also the basic postulate of sustainable tourism development (Trisić, Štetić & Krstić, 2018). Innovations in spa health tourism primarily Economics of Agriculture, Year 67, No. 2, 2020, (pp. 377-390), Belgrade relate to offers connected to health services. Innovations in spa health tourism are recognized in dimensions as: functional (as they relate to others), useful (as value carrier -patient benefit), technical (as a process in the process of diagnosis and therapy), and relational (as a specific recipient-donor dialogue) service) (Sawicki, 2014). Innovations play a key role in tourism (Aldebert et al., 2011), one of the essential elements of consumer satisfaction with the tourism service that enables the producer to differentiate himself from the competition (Živković, 2009). The modern tourist, a man of today, in order to recover, rest, recover energy, rejuvenate, or heal, visits spa complexes relatively frequently (Manić, 2018). His motives can be classified as "rejuvenation", "socialization", "hedonism", "obsession with health and beauty", "relaxation" and "escape from routine". Tourism offers products and services designed to improve the quality of life (Dimitrovski & Todorović, 2015). Event tourism allows tourists to relax, enhance relatives or other social relationships, experience something unusual and have fun (Senić & Senić, 2016). Visitors can attend the event either for substantially primary reasons, that is, their primary reason for visiting the destination, or for incidental reasons (Getz & Page, 2016). Event management goes through a number of stages: initiation, planning, implementation, event and closure (Event Management Body of Knowledge, 1999). With changes in consumer preferences in the tourism market towards adherence to sustainability criteria, the process of adapting tourism destinations in terms of competitive advantage and sustainable development will last (Popesku, 2011), which entails three pillars of sustainability: economic, socio-cultural and environmental (Vujović, Cvijanović, & Štetić, 2012;Golob et al., 2015). Events are crucial in promoting the destination and attracting visitors who will spend their money in the destination (Getz & Page, 2016)  The aim of the research in this paper is to identify certain scientific results that can contribute to the creation of an adequate tourism product. This significant tourism product would integrate complementary medicine with events and nature-based forms of tourism into a single unity, thus meeting the expressed needs of spa tourists. In addition to directly meeting the need to improve and upgrade their health status, tourists also expressed interest in learning about the available herbal medicinal resources of Vrnjačka Banja and its natural environment. Organizing an adequate tourism event in the field of complementary medicine would increase tourists' motivation to visit, which would significantly influence the sustainable development of spa tourism.
The expected results of the research are that complementary medicine is a significant component of health tourism, and that in addition to nature-based tourism and events, it can contribute to the sustainable tourism development of Serbia.

Materials and methods
A prospective study was conducted using a questionnaire containing four groups of variables: demographic characteristics, knowledge of properties and use of medicinal herbs, initiation of treatment, and respondents' attitudes toward phytotherapy and complementary (traditional) medicine. Within this paper, three groups of variables are presented: demographic characteristics, treatment initiation, and respondents' attitudes toward phytotherapy and complementary medicine. The research instrument is a standardized questionnaire, prepared according to WHO guidelines for assessing the availability, use, coordination and comprehensiveness of health care used in the WHO survey in the Republic of Serbia in 2009, which is thematically tailored to the research needs. The survey of 62 Vrnjačka Banja tourists was conducted in the period July -September 2019. Respondents were selected by random selection method and completed questionnaires in the presence of interviewers. Respondents were asked a total of 15 questions, of which 13 questions were used for research and analysis. The questions were assigned numbers n 1 , n 2 , n 3 , n 4 , n 5 , n 6 , n 7 ... n 13 . The questionnaire was prepared using a structured interview method, composed of two parts. In the first part, consisting of questions 1 and 2, the respondents presented their answers by writing the answer that is related to a certain offered number (1, 2, 3 or 4), depending on its meaning and truthfulness. In the second part of the questionnaire, from the third question, three-level Likert scale answers were given: Yes -I agree (number 1 offered); Partially agree (2) and Disagree (3). The Likert scale allows respondents to adequately express their level of agreement with certain statements in the questionnaire (Joshi et al., 2015). The data were described by descriptive statistical methods and analyzed by appropriate statistical-analytical method using SPSS (Statistical Package for the Social Sciences) software. Testing the correlation of the answers given was examined and shown by the Analysis The Pearson Correlation method, to determine whether the model of differences obtained was relevant to the analysis of the results. The number of 62 randomly selected respondents represents a small but significant sample for analyzing the current state of the spa and event tourism market in Vrnjačka Banja, which is a significant tourist destination in the Republic of Serbia and in the region. Analyzing the answers from the questionnaire can contribute to the construction of scientific conclusions regarding sustainable tourism development, ie whether events, spa and nature-based tourism can be significant for sustainable tourism development. The results may also point to further research related to these areas of tourism planning and development.

Results and Discussions
The sample consisted of 62 respondents, 59.7% female and 40.3% male. The observed difference in gender distribution is not at the level of statistical significance. The average age of the respondents was 55.48 ± 15.18 years, with the average age of the female being 8 years. Half of the respondents have a high school diploma and a third have a college/faculty diploma. Every tenth respondent evaluates his financial status as very good. Of the total number of respondents, 43.5% live in the city, 32.3% in the suburbs and 24.2% in the village. The largest number of respondents came from Central Serbia, 43.5%, and the smallest from Eastern Serbia, 11.3%. The analysis by gender shows that there is no statistically significant difference in the level of education, the assessment of the material situation, the part of Serbia where the respondents come from and the places of residence between the male and female persons.The structure of the respondents can be summarized in Table 1. To the question n 1 -Do you use herbs, and n 2 -Do the family members of the respondents use herbs, the respondents gave their answers in the following relation (Table 2). Analyzing the answers, presented in Table 2, it is concluded that the majority of respondents use herbs occasionally, or when their current health needs to be improved. Likewise, the respondent's family, in the largest number of responses, occasionally uses herbs or, when ill. It is concluded that the respondents are competent to provide answers regarding the role of complementary medicine in sustainable tourism development through events, nature-based and spa forms of tourism, since they make significant use of medicinal herbs.
The second part of the questionnaire deals with the respondents' agreement with the offered options (they agree completely, partially agree, or disagree). The structure of questions 3 through 13 from the questionnaire is shown in Table 3. Questions n 10 I think that the same treatment principles should be applied to us through the spa form of tourism as a significant tourist offer n 11 If the same treatment principles were applied in the spa, the treatment would be more effective n 12 If traditional (complementary) medicine were part of spa tourism, as the initiator of events and nature based forms of tourism, I would visit the spa more often n 13 If the same treatment principles were applied in the spa, more tourists would be staying in the spa

Source: Author research
Respondents' answers to the questions asked can be presented and analyzed structurally in Table 4. After statistically presenting the answers given in Table 4, it can be concluded that the majority of respondents agree with the question asked. The highest average values have the answers to the questions in which the respondents completely agree, in questions n 5 , n 6 , n 3 , n 10 and n 13 , while the lowest average values in the answers of the agreement with the statement, recorded in questions n 7 , n 12 and n 4 . An insight into the data in Table 4 reveals statistically significant differences in the outputs. These statistically significant differences can be examined with the help of Analysis The Pearson Correlations, which determines whether the model of statistically significant differences obtained is relevant for reaching conclusions, the respondents 'attitudes have a significant role in creating the research conclusions, and to what extent the respondents' attitudes may influence to draw conclusions about the impact of complementary medicine on sustainable tourism development, through spa, events and nature-based tourism, as shown in Table 5.   The correlation results indicate that the respondents tend to express the differences in the answers, which to a greater extent confirm certain claims. This result indicates that a significant number of respondents agree with the claim that complementary medicine has a significant share in the creation of the tourist offer of the destination.  (Đurađević, 2017), which, with the aforementioned nature-based motives, can enhance Vrnjačka Banja's importance in terms of competing tourist destinations. The research and analysis of the obtained results confirmed two sets of scientific hypotheses. These are that complementary medicine is a significant component of the sustainable development of health tourism in Serbian spa destinations and that organizing an adequate complementary medicine tourism event can increase tourists' motivation for visits and their significant relationship to nature-based tourism (through traditional plant picking and stay in nature), which would have a significant impact on the sustainable tourism development of spa tourism. Also, the results of the research in this paper showed that complementary medicine is a significant component of the development of health tourism in Serbia, and that the organization of adequate tourist events in the field of complementary medicine would increase the motivation of tourists to visit, which would significantly improve the overall sustainable tourism development of tourism. industry. The results obtained may also be significant for a comparative analysis of sustainable tourism development in the Republic of Serbia. It can be concluded that there is an understanding of the importance of implementing complementary medicine in the tourist offer of Serbia, because through events, spa and nature-based tourism, such sustainable tourism development provides different benefits. The concluding remarks made can be of great importance in domestic and international tourism. Tourists from the countries of the region, such as Bosnia and Herzegovina, Croatia, Hungary, Romania, Bulgaria, as well as other European and world countries, are increasingly visiting the Republic of Serbia. Respondents, although the number of them is not so large, represent a significant sample for correlating and comparing tourism development at local, national and regional levels. Much of the world's tourism demand is directed specifically to events, spa and nature-based tourism (Koskinen & Wilska, 2019). Complementary medicine can represent a significant link between these three important forms of tourism for Serbia, and by providing socio-cultural, economic and environmental benefits, the basic postulates of sustainable tourism development are directly fulfilled.