Background: Dengue prevention for U.S. travelers focuses on compliance with mosquito avoidance practices (MAP) and passive surveillance. Understanding determinants of MAP among high-risk travelers can improve Dengue prevention strategies. In travel medicine, a risk assessment framework of social determinants of health and travel purpose of visiting friends and relatives (VFR) determines risk of travel-associated diseases. This risk assessment framework is subject to bias and inaccuracy because it fails to account for factors of influence on travel behaviors from a social-ecological perspective. A mixed methods approach identified and characterized determinants of MAP in U.S. West-Indian American VFR travelers. Two pilot studies revealed travelers' decision-making processes for MAP and outlined determinants of intended MAP through a qualitative interview and cross-sectional survey. Survey analyses included an exploratory factor analysis, Chi-squared/ Fisher's exact test, logistic regression and qualitative coding for development of an `Intended MAP International Travel Behavior' (IMAP-ITB) model.
Methods: To expand the IMAP-ITB model and describe factors of influence on actual MAP, 2 subsequent qualitative studies were conducted. A multi-case ethnographic study of travel cohorts to Trinidad, Brazil and Thailand identified social/physical environmental influences on actual MAP in a cross-case content analysis of field observations data. An interpretive phenomenological analysis of semi-structured interviews yielded similarities and differences in MAP by revealing the meaning of `going home' in VFR travelers versus another travel destination.
Results: A 'Cultural Embeddedness and MAP' model extends the IMAP-ITB, using a social-ecological perspective, including factors of influence on intended and actual MAP. MAP during international travel was associated with travel logistics, social interactions, risk perceptions and cues to action. The concept of 'Cultural Embeddedness' may explain compliance behaviors with MAP, irrespective of VFR status.
Discussion: Prevention strategies at each level of influence within a social-ecological framework would address Dengue emergence because individual level prevention using MAP is capricious by individual, type of travel and social/physical environmental influences. Findings demonstrate that VFR terminology does not accurately depict high-risk travelers. Next steps should include more research on the concept of 'Cultural Embeddedness ' and CEMAP. Furthermore, improvements to current Dengue surveillance are needed to prevent to prevent and monitor imported Dengue.
|School:||Kent State University|
|School Location:||United States -- Ohio|
|Source:||DAI-B 75/08(E), Dissertation Abstracts International|
|Subjects:||Behavioral psychology, Social psychology, Public health, Epidemiology|
|Keywords:||Dengue fever, International travel behavior, Mosquito avoidance practices|
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