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Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†.
J Travel Med. 2019 Feb 01; 26(2)JT

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.

Authors+Show Affiliations

Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA.Department of Medicine, University of Minnesota, Minneapolis, MN, USA.Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.Minnesota Department of Health, St. Paul, MN, USA.Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.Hennepin County Medical Center, Minneapolis, MN, USA.African Career and Education Resources, Inc., Brooklyn Park, MN, USA.Minnesota Department of Health, St. Paul, MN, USA. Liberian Health Initiative, Minneapolis, MN, USA.Minnesota Department of Health, St. Paul, MN, USA.Department of Medicine, University of Minnesota, Minneapolis, MN, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30602033

Citation

Walz, Emily J., et al. "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, 2019.
Walz EJ, Volkman HR, Adedimeji AA, et al. Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†. J Travel Med. 2019;26(2).
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. (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, 26(2). https://doi.org/10.1093/jtm/tay163
Walz EJ, et al. Barriers to Malaria Prevention in US-based Travellers Visiting Friends and Relatives Abroad: a Qualitative Study of West African Immigrant Travellers†. J Travel Med. 2019 Feb 1;26(2) PubMed PMID: 30602033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†. AU - Walz,Emily J, 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,William M, PY - 2018/11/08/received PY - 2018/12/26/revised PY - 2018/12/29/accepted PY - 2019/1/3/pubmed PY - 2020/6/9/medline PY - 2019/1/3/entrez KW - Malaria KW - VFR travellers KW - West Africa KW - chemoprophylaxis JF - Journal of travel medicine JO - J Travel Med VL - 26 IS - 2 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. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/30602033/Barriers_to_malaria_prevention_in_US_based_travellers_visiting_friends_and_relatives_abroad:_a_qualitative_study_of_West_African_immigrant_travellers†_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/tay163 DB - PRIME DP - Unbound Medicine ER -