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

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INTRODUCTION: Understanding barriers to seeking and following pre-travel advice in Visiting Friends and Relatives (VFR) travelers might enhance preventive behaviors before and during travel. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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