Purpose Health tourism is recognised as a recent new pattern of taking a break while accessing health-care services overseas. Past studies have explored this research area, but few have focussed on the theoretical perspective. Applying an appropriate theoretical model to guide interventions in planning and programme development is crucial, particularly when the focus of the study is on the cognitive mediation processes of change in individual behaviour. This study aims to examine the effectiveness of the protection motivation theory with the influence of threat appraisal and coping appraisal. The purpose is to trigger the behavioural intention to engage in international health tourism. Design/methodology/approach A total of 299 international tourists participated in the survey. The partial least squares structural equation modelling technique was used to test the research framework. Both the measurement model and the structural model were assessed as adequate. Findings The empirical results demonstrate that tourists’ high risk perception must be complemented by coping ability to produce a motivational response. Further, the adaptive behaviours of international tourists are focussed more on perceived efficacy than on the perception of threats related to behavioural intentions towards health tourism. Originality/value The study presents an effective theoretical model intervention applicable to health tourism. Future studies should conduct a more comprehensive assessment to generate strong decision-making effectiveness from the theoretical model.