Comprehensive Travel Health Education for Tour Guides: Protocol for an Exploratory Sequential Mixed Methods Research

Background

Tourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal.

Objective

This study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists.

Methods

This is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display.

Results

The qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage.

Conclusions

A travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display.

Trial Registration

ClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983

Japanese encephalitis vaccine cost: a major reason to be vaccinated in Bali

Travellers, especially long term and repeat, are increasingly opting to receive vaccines in destination countries. This report summarizes the high cost of Japanese encephalitis vaccination in their home country as a barrier to pre-travel uptake.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study

PURPOSE

We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants.

METHODS

We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior.

RESULTS

Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols.

CONCLUSION

Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

The Impact of Tourism on the Quality of Life of Communities in Tourist Destination Areas: A Systematic Review

BACKGROUND: Tourism development can have a positive or negative impact on the lives of local communities. AIM: This systematic review aims to determine the impact of tourism on the quality of life (QoL) of people in tourist destination areas. METHODS: The search was conducted on the Science Direct database, Taylor Francis, EBSCO Host, Wiley Online Library, and Google Scholar. The keywords used were “residents’ QoL” AND impacts of tourism. Inclusion criteria were articles that focus on the QoL of people in tourist destination areas, published from 2015 to 2019 in peer-reviewed journals, in English. Articles were excluded if they were qualitative studies, literature reviews, and if full papers were unavailable. The review was conducted on 18 articles selected from 673 articles obtained in the initial search. RESULTS: Tourism has an impact on the QoL of local communities. In general, the domains that are perceived as being positively affected are the improvement of the economy, employment opportunities, community pride, cultural exchanges, and increased facilities availability. Meanwhile, the domains that are negatively affected in most of the studies are health, safety, quality of the physical environment, cost of living, accessibility to public facilities, and social relations. Apart from that, there is also dissatisfaction with the types of jobs available and the low level of community involvement in tourism development. CONCLUSIONS: Tourism can have both positive and negative impacts on the QoL of local communities. Efforts to minimize the negative impacts of tourism should be undertaken to improve community support for tourism development.

Forecasting COVID-19 Transmission and Healthcare Capacity in Bali, Indonesia

OBJECTIVES

In the current early phase of the coronavirus disease 2019 (COVID-19) outbreak, Bali needs to prepare to face the escalation of cases, with a particular focus on the readiness of healthcare services. We simulated the future trajectory of the epidemic under current conditions, projected the impact of policy interventions, and analyzed the implications for healthcare capacity.

METHODS

Our study was based on the first month of publicly accessible data on new confirmed daily cases. A susceptible, exposed, infected, recovered (SEIR) model for COVID-19 was employed to compare the current dynamics of the disease with those predicted under various scenarios.

RESULTS

The fitted model for the cumulative number of confirmed cases in Bali indicated an effective reproduction number of 1.4. Interventions have decreased the possible maximum number of cases from 71 125 on day 86 to 22 340 on day 119, and have prolonged the doubling time from about 9 days to 21 days. This corresponds to an approximately 30% reduction in transmissions from cases of mild infections. There will be 2780 available hospital beds, and at the peak (on day 132), the number of severe cases is estimated to be roughly 6105. Of these cases, 1831 will need intensive care unit (ICU) beds, whereas the number of currently available ICU beds is roughly 446.

CONCLUSIONS

The healthcare system in Bali is in danger of collapse; thus, serious efforts are needed to improve COVID-19 interventions and to prepare the healthcare system in Bali to the greatest extent possible.

Travel agent and tour guide perceptions on travel health promotion in Bali

The increasing number of travelers to Bali has been accompanied by the increased risks of travel-related health problems. Travel agents and tour guides are in a key position to inform travelers about these matters; nonetheless, little evidence was found on their role in the promotion of travel health. This article aims to assess travel agent and tour guide perceptions on their possible involvement in promoting travel health measures in Bali. A cross-sectional study was conducted between July and October 2015, involving 500 respondents (250 travel agents and 250 tour guides), who were chosen systematically from the Bali-based members of the Association of the Indonesian Tours and Travel Agencies. Data were collected using questionnaires, and perception indicators were developed using concepts from social learning theory and health belief model. Both groups have good levels of knowledge of general travel health issues, with mean percentages (SD) of 67.1 (11.9) and 66.2 (10.0) for travel agents and tour guides, respectively. Tour guides were more likely than travel agents to deliver information on health risks [PR (95%CI) = 1.31 (1.10–1.56); p = 0.003]; and on safety hazards during travel [PR (95%CI) = 1.22 (1.01–1.46), p = 0.04]. Overall, the majority of respondents (>68%) have positive and very positive perceptions of possible involvement in travel health and safety programs, although tour guides have statistically better perceptions (z = −2.2, p = 0.03). Based on perception levels, previous experiences and levels of knowledge, travel agents and tour guides have great potential to be involved in travel health promotion programs in Bali.