|Year : 2022 | Volume
| Issue : 1 | Page : 50
Pretravelling health-seeking behavior, knowledge of vaccines, and attitudes toward travel health among malaysian travelers
Zulkhairul Naim B. Sidek Ahmad1, Khairul Anwar Zarkasi2, Nur Zuliani Ramli2, Farrah Ilyani Che Jamaludin3, Muhammad Kamil Che Hasan4
1 Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
2 Department of Biomedical Sciences and Therapeutics, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
3 Department of Professional Nursing Studies, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, Kuantan, Malaysia
4 Department of Medical-Surgical Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, Kuantan, Malaysia
|Date of Submission||29-Jun-2020|
|Date of Acceptance||01-Oct-2020|
|Date of Web Publication||05-Apr-2022|
Muhammad Kamil Che Hasan
Kulliyyah of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan, Pahang 25200
Source of Support: None, Conflict of Interest: None
Background: Travelers are at higher risk of developing health-related problems, especially travel-related diseases, and this remains a major public health burden. Aims: To assess pretravel health behavior-seeking factors, knowledge of vaccine, and travel health attitudes. A cross-sectional design among Malaysian travelers. Methods: An online survey was conducted from December 2017 till March 2018 among 226 participants. Demographic data, pretraveling health behaviors, knowledge of vaccine-preventable diseases, and travel health were asked. Independent t-test and ANOVA were performed using SPSS version 20. Results: Among travelers, 51.3% and 63.7% used health-related information on their destination before departure and collected information on possible travel hazards at their destination. Participant age (P = 0.02), monthly income (P = 0.01), predeparture health information (P = 0.03), information on possible hazards (P = 0.04), and travel health advice from medical professionals (P = 0.03) have been reported as a major predictor of knowledge of vaccine-preventable disease. Travelers' gender (P = 0.01), household income (P = 0.01), and travel health advice from professionals (P = 0.002) were significantly associated with travel health attitude. Conclusions: Sociodemographic and pretravel health-seeking behavior influence knowledge of vaccine-preventable disease and attitudes towards travel health which requires a public health need for community outreach programs targeting this group.
Keywords: Attitude to health, communicable diseases, information-seeking behavior, travel-related illness, vaccine-preventable diseases
|How to cite this article:|
B. Sidek Ahmad ZN, Zarkasi KA, Ramli NZ, Che Jamaludin FI, Che Hasan MK. Pretravelling health-seeking behavior, knowledge of vaccines, and attitudes toward travel health among malaysian travelers. Int J Prev Med 2022;13:50
|How to cite this URL:|
B. Sidek Ahmad ZN, Zarkasi KA, Ramli NZ, Che Jamaludin FI, Che Hasan MK. Pretravelling health-seeking behavior, knowledge of vaccines, and attitudes toward travel health among malaysian travelers. Int J Prev Med [serial online] 2022 [cited 2022 May 25];13:50. Available from: https://www.ijpvmjournal.net/text.asp?2022/13/1/50/342572
| Introduction|| |
The risk of adverse health conditions caused by different forms of infectious diseases may depend upon the countries of destination. Travelers to/from and within Europe with travel-related diseases from 2008 to 2012 were mainly affected by malaria, with most cases (86%) of malaria acquired while traveling to sub- Saharan Africa. It was also reported that the highest infection rate among 6086 travelers who had gastrointestinal infections traveled to tropical regions such as sub-Saharan Africa, South America, and South Asia.
Preventing these travel-related infections has also been neglected by most travelers. For instance, the uptake of the rabies vaccine was very low despite being recommended by health practitioners in a pretravel clinic. Of the 13,235 travelers attending the clinic, only 2% registered previous rabies vaccination and only 3% received vaccination at the end of the consultation. Moreover, just over half (59%) of 27,386 travelers from seven western countries had some form of hepatitis vaccination, either monovalent hepatitis A or combined hepatitis A and B vaccines. Overall, the pretravel immunizations were very small for meager 1–5% (1% for rabies and cholera; 2% for influenza, meningococcal meningitis, polio, and yellow fever; 3% for typhoid; and 5% for hepatitis A and B).
Many of these studies were conducted in developed countries and there is still a shortage of data on health-seeking behavior among Malaysian travelers. Recent years have seen a growing number of Malaysians traveling overseas, partly due to increased median household income as well as more fair and affordable air tickets offered by low-cost airlines. Given the importance of pretravel health consultation and vaccination in the prevention of travel-related illnesses, this study is focused on the analysis of health-seeking practices among Malaysian travelers.
| Methods|| |
A cross-sectional online survey of Malaysian travelers was conducted between December 2017 and March 2018. Participants were recruited through various online platforms such as social media, peer referral methods, and direct email. To be eligible for this study, participants had to be Malaysian travelers aged 18 years or older, able to understand and give consent in English. The sample size was calculated using EpidStat to estimate the number of Malaysian travelers, where at least 220 participants are sufficient.
The administration of the questionnaire was scheduled to take less than 10 min to complete and prepared in English. The questionnaire consists of three main sections including basic demographic information (7 questions), trip characteristics (6 questions), and pretravel health behavior and vaccination by travelers (8 questions). Participants were also tested on their knowledge of vaccines for preventable diseases (9 questions) and attitudes towards travelers' health (10 questions).
Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 20. Categorical data were presented as numbers and percentages. Independent t-test and analysis of variance (ANOVA) were performed to compare the mean of two groups and more than two groups, respectively. A P value 0.05 was considered to be statistically significant. For the knowledge of vaccines, preventable disease, and attitudes toward traveler health, the participants had to respond “true” or “false.” The correct answer gave a score of 1 while the incorrect answer gave a score of 0. The correct answers were calculated and summed up to give the total score. The minimum score for knowledge and attitude is “0” while the maximum score for knowledge and attitude is “'10.”
All participants were informed of the aims and purpose of this study. Participants who completed the consent page were eligible to participate in this study. For anonymity, no individual was disclosed, and all personal details remained fully confidential. The study protocol and additional documents were reviewed and approved (JKEtika 4/16 (3)). No incentive has been provided to the participants.
| Results|| |
Overall, 226 participants were included in the study. The demographic data for the participants are shown in [Table 1]. Many participants in the 26–35 age group are 49.6%. Female participants (57.5%) were slightly higher than male participants (42.4%). More than 70% of the participants come from Malay ethnicity. Half of the participants are single. Most of the participants have upper middle income per month (38.9%).
The characteristics of the trip are shown in [Table 2]. Most participants identified themselves as tourists (80.5%), with small numbers traveling for business (12.4%) or visiting friends (7.1%). Almost 80% traveled for less than 2 weeks. A total of 134 participants (59.3%) were traveling with groups, 26.5% traveling alone and 14.2% were traveling with groups and children. Travel destinations were almost evenly divided between South East Asia (32.2%) and Europe (31.9%) while America was the least frequent destination. More than half of the participants visited two–four countries per year.
Many participants seek health-related information about their destination before departure, provide travel health advice from nonmedical sources, and ask about possible travel hazards at their destination. Only 13.7% of the participants receive travel advice from doctors and 26.5% of participants receive the vaccine before traveling. For travel insurance, 53.1% of the participants paid for it.
The overall mean score for knowledge of vaccine-preventable diseases was 6.14 ± 1.9 and ranged from 2 to 10. As regards to the individual items, more than half of the participants answered correctly in six out of ten questions, namely, hepatitis B (70.8%), influenza (69.9%), meningitis (59.7%), hepatitis A (57.1%), thyroid (52.7%), and yellow fever (52.2%).
Attitude towards travel health is shown in [Table 3]. The overall mean score for attitude was 3.17 ± 1.8. As regards the individual items, 52.2% of the participants responded correctly in question number four. The correct answer to the remaining questions was below 50% (range from 12.8% to 41.2%).
The age of participants (P = 0.02), the monthly income (P = 0.01), seeking information on health before departure (P = 0.03), acquire information about potential hazard (P = 0.04), and seek travel health advice from medical professionals (P = 0.03) were found to be significantly associated with knowledge about vaccine [Table 4].
|Table 4: Knowledge about vaccine and attitude towards travel health and demographic factors, trip characteristics,and pre-traveler health-seeking behavior|
Click here to view
Gender (P = 0.01), job (P = 0.03), monthly income (P = 0.01) of the participants, and seeking advice from medical personnel (P = 0.002) were found to be significantly associated with attitude towards travel health [Table 4].
| Discussion|| |
This study is believed to be the first to assess the general level of knowledge and attitude regarding travel safety through a web-based survey in Malaysia. Most participants were female, married, 26–35-year-old rage range, Malay ethnicity, completed tertiary education, and upper middle income per month, while tourism the main purpose of traveling. This is similar to other studies conducted in three international airports in London Heathrow, Paris Charles de Gaulle, and Munich, Saudi Arabia, and the United Arab Emirates.
Pretravel health-seeking behavior is important for the prevention of measures and healthy behaviors towards global population health and well-being. This study found that only less than 20% of participants received medical advice from medical professionals before travel. This is considered low as compared to the study reported in Canada, Australia, Spain, South Africa, and the United States of America. It is a disturbing trend and should be handled properly. This also means that medical professionals need to refresh their travel health management skills. Many tend to get advice from nonmedical sources, and this is more popular by Malaysians. This will leave them for internet disinformation, similar to a study conducted among US travelers.
Once traveling to the destination case, travelers are more vulnerable to preventable health risks and accidents and may also pose a risk of introducing travel-related disease to the home country. Half of the participants are aware of this issue and have pretrip protection and bough travel insurance. Ironically, only 26.5% of participants took pretrip vaccines. This may be due to most of the participants' travel to countries in South East Asia and Europe, considered low-risk nations and the vaccine is not mandatory. However, the vaccine needed depends on the destination and planned activities although it should not be taken lightly.
Most participants showed good knowledge about vaccine-preventable diseases indicated their acceptance. Younger age is associated with poor perception, while older participants had more knowledge of vaccinable diseases. This result is similar to the study conducted in Nigeria, where the mean score was highest among participants aged 34–41 and above relative to other younger groups.
In this study, high-income participants proved to be the highest knowledge compared to low-income, similar to many reported studies.,, They may have more access to information than the lower income. It shows that searching for correct information is an important factor. Healthcare professionals were ranked among the most sought-after for information. Expectedly, participants seeking health information from the medical professionals' team scored significantly higher on skills before departure and health advice. Therefore, the public needs to be educated about vaccine-preventable diseases to enable them to identify these abnormalities and seek help early if appropriate.
For attitude towards travel health, more than 70% of participants in this study could not identify travel health hazards, which could be described as minimal and similar to a study conducted in Oman.
Males also scored higher than females, showing a good attitude. Data are not directly available on gender-related differences in attitudes. However, when we look at motivational aspects, women were a predictor of being active, well informed, and involved in health-related information. Participants' ' work and income roles play vital roles in travel health literacy in fostering positive travel health attitudes. In this study, self-employed and high income associated with good travel health attitudes. This is probably because self-employed people have more time to get details, as they do not have set working hours.
| Conclusions|| |
Wide differences in awareness and attitudes towards travel health suggest that there is a great deal of room for improvement in global health. It is important to increase awareness about the information on travel health, vaccinations, and services among travelers. Pretravel health information could be promoted among travelers as one of the checklists before traveling using social media, travelers, and global health groups.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schlagenhauf P, Weld L, Goorhuis A, Gautret P, Weber R, von Sonnenburg F, et al
. Travel-associated infection presenting in Europe (2008-12): An analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. Lancet Infect Dis 2015;15:55-64.
Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, et al
. Gastrointestinal infection among international travelers globally. J Travel Med 2008;15:221-8.
Dolan SB, Jentes ES, Sotir MJ, Han P, Blanton JD, Rao SR, et al
. Pre-exposure rabies vaccination among US international travelers: Findings from the global TravEpiNet consortium. Vector Borne Zoonotic Dis 2014;14:160-7.
Heywood AE, Nothdurft H, Tessier D, Moodley M, Rombo L, Marano C, et al
. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†
. J Travel Med 2016;24:taw069.
Wilder-Smith A, Khairullah NS, Song JH, Chen CY, Torresi J. Travel health knowledge, attitudes and practices among Australasian travelers. J Travel Med 2004;11:9-15.
Department of Statistics Malaysia Press Release Report of Household Income and Basic Amenities Survey 2014. 2015 Available from: https://www.dosm.gov.my/v1
[Last accessed on 2016 Aug 15].
Herck K, Zuckerman J, Castelli F, Damme P, Walker E, Steffen R, et al
. Travelers' Knowledge, attitudes, and practices on prevention of infectious diseases: Results from a pilot study. J Travel Med 2006;10:75-8.
Alghamdi AH, Ibrahim AM, Al-Ghamdi MS, Ryan ET, Al-Raddadi R. Travel health in the Kingdom of Saudi Arabia: Perception and practice of saudi travelers. Int J Health Res Innov 2014;2:25-39.
Omer F, Hassan N, Hussain H, Mana S, Awad O. Travel health, gaps in knowledge, attitudes, and practices among Dubai travellers, Dubai UAE. Int J Prev Med Res 2015;1:126-31.
Masic I. Public health aspects of global population health and well-being in the 21st
century regarding determinants of health. Int J Prev Med 2018;9 :4.
] [Full text]
Provost S, Soto JC. Perception and knowledge about some infectious diseases among travelers from Québec, Canada. J Travel Med 2006;9:184-9.
Heywood AE, Watkins RE, Iamsirithaworn S, Nilvarangkul K, MacIntyre CR. A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC Public Health 2012;12:321.
Lopez-Velez R, Bayas J. Spanish travelers to high-risk areas in the tropics: Airport survey of travel health knowledge, attitudes, and practices in vaccination and malaria prevention. J Travel Med 2007;14:297-305.
Toovey S, Jamieson A, Holloway M. Travelers' knowledge, attitudes and practices on the prevention of infectious diseases: Results from a study at Johannesburg International Airport. J Travel Med 2004;11:16-22.
LaRocque RC, Rao SR, Tsibris A, Lawton T, Anita Barry M, Marano N, et al
. Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport. J Travel Med 2010;17:387-91.
Mohammed, Y. M. E. Determination of the Knowledge of Vaccine Preventable Diseases and Routine Immunization Among Nursing Mothers In Katagum Local Government Area Bauchi State. IOSR Journal of Nursing and Health Science, 2015;4:16-21. https://doi.org/10.9790/1959-04451621
Simon AE, Ahrens KA, Akinbami LJ. Influenza vaccination among US children with asthma, 2005-2013. Acad Pediatr 2016;16:68-74.
Barker M, O'Hanlon A, McGee HM, Hickey A, Conroy RM, Levy B, et al
. Cross-sectional validation of the Aging Perceptions Questionnaire: A multidimensional instrument for assessing self-perceptions of aging. BMC Geriatr 2007;7:9.
Brien S, Kwong JC, Charland KM, Verma AD, Brownstein JS, Buckeridge DL. Neighborhood determinants of 2009 pandemic A/H1N1 influenza vaccination in Montreal, Quebec, Canada. Am J Epidemiol 2012;176:897-908.
Al-Abri SS, Abdel-Hady DM, Al-Abaidani IS. Knowledge, attitudes, and practices regarding travel health among Muscat International Airport travelers in Oman: Identifying the gaps and addressing the challenges. J Epidemiol Glob Health 2016;6:67-75.
Chylińska J, Łazarewicz M, Rzadkiewicz M, Adamus M, Jaworski M, Haugan G, et al
. The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators. BMC Geriatr 2017;17:284.
[Table 1], [Table 2], [Table 3], [Table 4]