Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: A qualitative study of West African immigrant travellers

Emily J Walz, Hannah R. Volkman, Adebola A. Adedimeji, Jilliane Abella, Lauren A. Scott, Kristina M. Angelo, Joanna Gaines, Christina M. Coyle, Stephen J. Dunlop, David Wilson, Arthur P. Biah, Danushka Wanduragala, William M Stauffer III

Research output: Contribution to journalArticle

Abstract

Background: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. Methods: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. Results: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers’ knowledge and training about malaria and other tropical diseases. Conclusion: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.

Original languageEnglish (US)
Article numberY
JournalJournal of travel medicine
Volume26
Issue number2
DOIs
StatePublished - Jan 1 2019

Fingerprint

Malaria
Focus Groups
Health Knowledge, Attitudes, Practice
Gift Giving
Western Africa
Chemoprevention
Health Personnel
Primary Health Care
Delivery of Health Care
Safety
Costs and Cost Analysis
Health
Population

Keywords

  • Chemoprophylaxis
  • Malaria
  • VFR travellers
  • West Africa

PubMed: MeSH publication types

  • Journal Article

Cite this

Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad : A qualitative study of West African immigrant travellers. / Walz, Emily J; Volkman, Hannah R.; Adedimeji, Adebola A.; Abella, Jilliane; Scott, Lauren A.; Angelo, Kristina M.; Gaines, Joanna; Coyle, Christina M.; Dunlop, Stephen J.; Wilson, David; Biah, Arthur P.; Wanduragala, Danushka; Stauffer III, William M.

In: Journal of travel medicine, Vol. 26, No. 2, Y, 01.01.2019.

Research output: Contribution to journalArticle

Walz, EJ, Volkman, HR, Adedimeji, AA, Abella, J, Scott, LA, Angelo, KM, Gaines, J, Coyle, CM, Dunlop, SJ, Wilson, D, Biah, AP, Wanduragala, D & Stauffer III, WM 2019, 'Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: A qualitative study of West African immigrant travellers' Journal of travel medicine, vol. 26, no. 2, Y. https://doi.org/10.1093/jtm/tay163
Walz, Emily J ; Volkman, Hannah R. ; Adedimeji, Adebola A. ; Abella, Jilliane ; Scott, Lauren A. ; Angelo, Kristina M. ; Gaines, Joanna ; Coyle, Christina M. ; Dunlop, Stephen J. ; Wilson, David ; Biah, Arthur P. ; Wanduragala, Danushka ; Stauffer III, William M. / Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad : A qualitative study of West African immigrant travellers. In: Journal of travel medicine. 2019 ; Vol. 26, No. 2.
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abstract = "Background: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. Methods: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. Results: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers’ knowledge and training about malaria and other tropical diseases. Conclusion: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.",
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AU - Volkman, Hannah R.

AU - Adedimeji, Adebola A.

AU - Abella, Jilliane

AU - Scott, Lauren A.

AU - Angelo, Kristina M.

AU - Gaines, Joanna

AU - Coyle, Christina M.

AU - Dunlop, Stephen J.

AU - Wilson, David

AU - Biah, Arthur P.

AU - Wanduragala, Danushka

AU - Stauffer III, William M

PY - 2019/1/1

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N2 - Background: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. Methods: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. Results: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers’ knowledge and training about malaria and other tropical diseases. Conclusion: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.

AB - Background: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. Methods: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. Results: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers’ knowledge and training about malaria and other tropical diseases. Conclusion: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.

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KW - West Africa

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