Journal of Travel Medicine
Volume 26, Issue 2, 2019

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

Walz E.J.* , Volkman H.R. , Adedimeji A.A. , Abella J. , Scott L.A. , Angelo K.M. , Gaines J. , Coyle C.M. , Dunlop S.J. , Wilson D. , Biah A.P. , Wanduragala D. , Stauffer W.M.
  • a Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, United States
  • b Department of Medicine, University of Minnesota, Minneapolis, MN, United States
  • c Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, United States
  • d Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
  • e Minnesota Department of Health, St. Paul, MN, United States
  • f Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, United States
  • g Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, United States
  • h Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
  • i Hennepin County Medical Center, Minneapolis, MN, United States
  • j African Career and Education Resources, Inc., Brooklyn Park, MN, United States
  • k Minnesota Department of Health, St. Paul, MN, United States, Liberian Health Initiative, Minneapolis, MN, United States
  • l Minnesota Department of Health, St. Paul, MN, United States
  • m Department of Medicine, University of Minnesota, Minneapolis, MN, United States

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. © International Society of Travel Medicine 2019. All rights reserved.

Author Keywords

West Africa Malaria Chemoprophylaxis VFR travellers

Index Keywords

information processing male female immigrant malaria control chemoprophylaxis travel barrier tropical disease medical information qualitative research Article West African United States human adult grounded theory Planning travel
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85062165276&doi=10.1093%2fjtm%2ftay163&partnerID=40&md5=db2258654b3cfb9034ba6a470363f427
DOI: 10.1093/jtm/tay163
ISSN: 11951982
Original Language: English