Journal Article

Insights into barriers and adherence to pre-travel advice among West African travelers in Spain: A prospective mixed-methods evaluation

Soriano-Pérez, Manuel Jesús, Milán-Gutiérrez, Silvia, Luzón-García, María Pilar, Salas-Coronas, Joaquín, Gálvez-Cano, María Isabel, del Moral-Hernández, Begoña, Lozano-Serrano, Ana B., Fernández-López, Martina Lucía, Castillo-Fernández, Nerea, Vázquez-Villegas, José, Cabeza-Barrera, María Isabel, Zevallos-Delgado, Jaime, Pumares-Fernández, Pablo, del Mar Lozano-Martínez, María, Borrego-Jiménez, Jaime

2025

Overview

Understanding barriers to seeking and following pre-travel advice in Visiting Friends and Relatives (VFR) travelers might enhance preventive behaviors before and during travel. A mixed-method research with an explanatory sequential design among West African VFR travelers was conducted between 2019 and 2022 in an area with a high number of immigrants. Firstly, all travelers were advised to seek pre-travel advice and prospectively followed after the trip. Secondly, focus groups and individual semi-structured interviews were conducted to explain results in more depth. Finally, quantitative and qualitative data were integrated. Eighty-eight travelers, mostly men (92 %), were prospectively followed. Main countries of origin were Mali (29.5 %) and Senegal (29.5 %). Fifty-three percent of travelers did not seek pre-travel advice at the vaccination center. Only 29.5 % took malaria chemoprophylaxis properly. Travelers visiting their home country for the first time, among others, were more likely to attend pre-travel advice (p < 0.005). No differences in risk activities and preventive measures were found between those who sought pre-travel advice and those who did not. Upon returning, 25 travelers (28.7 %) presented with some infectious diseases such as malaria (n = 10; 11.4 %). In the qualitative phase, most VFR travelers did not perceive returning home as a health risk and deemed pre-travel advice unnecessary and culturally inappropriate. Social and family pressure were significant barriers to follow preventive measures, perceiving them as an act of rejection towards their community. Redesigning pre-travel counseling programs from a holistic approach is needed to improve communication and overcome barriers and cultural gaps. Community health workers, facilitated appointments and interventions through primary care may be helpful. •Despite efforts in promoting pre-travel advice, VFRs showed poor adherence to such advice and to malaria prophylaxis.•First-time travelers were more likely to attend official travel counseling.•Pre-travel advice did not significantly change risk behaviors during the trip.•Fatalism, social pressure and cultural beliefs limit effectiveness of educational actions.•Culturally tailored counseling is crucial for improving VFR travel health.

• Publisher: Elsevier Ltd,Elsevier Limited,Elsevier
• Subject: Adult / Africa, Western - ethnology / Community health care / Counseling / Disease prevention / Female / Focus Groups / Health Knowledge, Attitudes, Practice / Health risks / Hospitals / Human diseases / Humans / Immigrants / Immunization / Infectious Disease / Infectious diseases / Malaria / Malaria - prevention & control / Male / Middle Aged / Nonprofit organizations / Pre-travel advice / Pre-travel counseling / Primary care / Prospective Studies / Public health / Qualitative research / Spain / Sub-Saharan Africa / Travel / Travelers / Tropical diseases / Vaccines / Vector-borne diseases / Visiting friends and relatives / Young Adult