美国探亲访友旅行者疟疾预防障碍：对西非移民旅行者的定性研究†。
Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†.
机构信息
Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA.
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Travel Med. 2019 Feb 1;26(2). doi: 10.1093/jtm/tay163.
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.
背景
据报道， 在美国， 超过一半的疟疾病例发生在探亲访友旅行者（VFRs）中， 这些旅行者主要前往西非。 很少有研究直接询问 VFR 旅行者寻求旅行前保健的障碍。 我们旨在描述从美国前往疟疾流行国家的 VFR 的知识、 态度和实践。 根据这些发现， 我们旨在设计干预措施， 以鼓励在旅行前和旅行期间采取预防行为。
方法
在明尼阿波利斯-圣保罗和纽约市两个美国大都市地区的 13 个非洲国家中， 共有 172 人参加了 16 个焦点小组。 焦点小组讨论进行了录音和转录，并进行了修正的扎根理论分析。 参与者审查了主题， 以验证陈述的意图。
结果
参与者描述了就诊和化学预防费用高、 在医疗保健环境中为自己辩护的挑战以及对冒犯或给主人带来不便的担忧， 这些都是预防疟疾的障碍。 获得旅行前保健的文化障碍包括旅行计划时的优先事项竞争， 例如为家人购买礼物、 旅行物流和安全问题。 当参与者寻求旅行前保健时， 大多数人咨询他们的初级保健提供者。 参与者对美国提供者关于疟疾和其他热带疾病的知识和培训缺乏信心。
结论
VFR 旅行者旅行前保健的障碍是多方面的， 并不仅仅是因为他们对疾病风险的看法。 我们的研究结果仅支持一些以前在轶事和定性文献中报道的障碍。 未来的干预措施应该针对个别社区确定的障碍， 并涉及初级保健和旅行专家保健提供者。 需要做更多的工作来解决获得保健的系统障碍， 并建立支持西非 VFR 旅行者健康的社区方案。
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