The development of the MTI was a multi-year, multi-step, 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; we also consulted an expert focus group. Finally, we conducted a global survey with 394 respondents, all members of the Medical Tourism Association (MTA), to assess the initial list of items for content and face validity.

Steps three and four consisted of collecting initial data, as well as 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 six demographic dimensions (gender, marital status, ethnicity, geographic location inside the U.S., age, and educational background) as identified in the 2010 U.S. Census. We then conducted a series of statistical tests such as sample adequacy and factor analysis. 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 six 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) were all performed. We also completed Structural Equation Modelling.

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