Purpose This study aims to evaluate the process of value co-creation within wellness tourism by constructing a structural equation model of customer interactions with the environment, service employees and other customers relating to customer-perceived value and customer engagement. Design/methodology/approach Questionnaires, including wellness tourists’ customer-environment interaction, customer-service employee interaction, customer-customer interaction, customer-perceived value, customer engagement and demographic background, were developed and distributed at well-known wellness tourism destinations around Guangzhou City, Guangdong Province, China. This study collected 528 valid questionnaires from hot spring resorts, national forest parks, mountain parks and spa wellness facilities located in Guangdong Province, China. Structural equation modeling (SEM) was used to analyze the obtained data. Findings The results reveal that all three types of interactions, which include the customer-environment interaction (CEI), the customer-service employee interaction (CSI) and the customer-customer interaction (CCI), have positive effects on customer-perceived value (CPV) and that CPV positively affects customer engagement (CE). Based on these findings, recommendations for the management of wellness tourism service enterprises are given. Originality/value The causes and effects of CPV in wellness tourism, from the perspective of value co-creation, is a rather unexplored area of study. It contributes not only to knowledge about factors that foster CPV but also to the understanding of connections between CPV and CE.

Background and purpose Intracranial atherosclerotic stenosis (ICAS) is a major cause of stroke in Asian countries. Glucose‐6‐phosphate dehydrogenase (G6PD) deficiency, a hereditary enzyme defect prevalent in Asian countries, has been associated with atherosclerotic cardiovascular disease and worse poststroke outcomes. However, the impact of G6PD deficiency on ICAS remains unclear. We aimed to compare the risk of ICAS in stroke patients with and without G6PD deficiency in a Chinese cohort. Methods We prospectively and consecutively recruited stroke patients from four centers in China. All patients received intracranial artery assessment by magnetic resonance/computed tomography angiography or digital subtraction angiography, as well as G6PD enzyme evaluation. The prevalence, burden, and characteristics of ICAS were compared between patients with and without G6PD deficiency using multivariate regression analysis. Results Among 1593 patients, 116 (63.7%) of 182 patients with G6PD deficiency and 714 (50.6%) of 1411 patients with normal G6PD levels were identified as ICAS. Age, hypertension, diabetes, and G6PD deficiency were independent predictors of ICAS. Among patients with ICAS, G6PD‐deficient individuals were more likely to have multiple (≥2 segments) intracranial stenosis (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.25–2.81, p = 0.002). G6PD deficiency increased the risk of ICAS in patients who were male (OR = 1.82, 95% CI = 1.24–2.66, p = 0.002), aged ≥70 years (OR = 2.40, 95% CI = 1.33–4.31, p = 0.004), or hypertensive (OR = 1.88, 95% CI = 1.28–2.77, p = 0.001). Conclusions Stroke patients with G6PD deficiency have a higher prevalence and ICAS burden than those with normal G6PD, particularly those who are male, older, and hypertensive.

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