Table 4.

Barriers among travellers visiting friends and relatives (VFRs) to implementing mosquito protective measures while travelling reported in the travel medicine literature compared with those identified during focus groups held in Minnesota and New York with West African immigrants

Barriers reported in literature	Source	Supported in present study
Accommodations without bed-nets or screens	3a	Sometimes
Longer trips than non-VFRs	2a,3a,15a,16,17a,18a,23a	Sometimes
Approximation of risk to that of locals (‘living like locals’)	2a,3a,16–18a,23a	Sometimes
Rural exposures expose them to greater risks	6a,18a	Yes
Debilitating illness could ruin a trip, but sometimes certain activities are ‘worth the risk’	6	Yes
High-risk travel during life stages (pregnant, comorbidities, young children)	2a,15a,20	n/a
Chemoprophylaxis use negatively marks VFR travellers as different from the local population and people they visit	5	Sometimes
Don’t use mosquito bite prevention such as repellent	2a,19	No
Preference for mosquito avoidance to using drugs for malaria prevention (covering up at night, using repellents, avoiding stagnant water and using local protective products)	5,6	Yes
Previous negative experience deters bed net usage (exacerbating heat and claustrophobia) and belief that there are more modern ways to prevent mosquito bites	5,6	Yes
Non-routine insecticide in bedroom before sleeping, but this might not be done routinely	5	Yes
Lodging choices are usually not near mosquito breeding sites but acknowledge that sometimes neighbours do not maintain adequate sanitation	5	Yes
Mosquito bite avoidance is not always possible, especially if sitting outside in the evening	5	Yes
Novel barriers identified in present study
Hand hygiene and food/water sanitation are used as malaria prevention tasks to avoid foodborne or waterborne illnesses that may mimic the symptoms of malaria and confound diagnosis and treatment

^aAnecdotal barrier noted in publication which was not based on authors’ primary research results.