Australian Chinese travellers visiting friends and relatives: new approaches to understanding and reducing infectious disease risks

Travellers are an important vector in the global spread of infections. China has been the source of multiple pandemics over the past century, spread globally via travel. Travellers visiting friends and relatives (VFR) are at an increased risk of many infectious diseases compared to other travellers. Therefore, returned Chinese VFR travellers are a potentially important source of importation of emerging infectious diseases to countries with large Chinese migrant populations, including Australia. This thesis aimed to understand the knowledge, attitudes and practices (KAP) of Australian Chinese VFR travellers around international travel, and to study travel health-related behaviours both before and during travel, to identify areas for intervention.The thesis has three components. The first study consists of five focus groups with Chinese-Australian VFR travellers from the general community. The second study consists of two focus groups involving Chinese international students. The third study focuses on KAP of infectious disease outbreaks through integrating an in-depth literature review of outbreak risks in China with data from all seven focus groups, and exploring the implications of the combined findings. In each focus group, topics relating to pre-travel health preparations, actual and intended health-related behaviour during travel and during outbreaks, and general health-related KAP were explored. The research identified low risk-perception and sub-optimal travel health behaviours, both pre-travel and during travel, among Australian Chinese VFR travellers, and identified important cultural and belief system reasons for this. They often undertook activities and consumed commercially prepared meals with family and friends in China, who were also their most important source of travel advice. Similar findings were identified amongst international students, with additional unique findings including common use of social media for health information. Chinese VFR travellers and international students were inadequately prepared for disease outbreaks experienced during past travel, and likely to be underprepared for future travel. China has been and will likely continue to be an important source of pandemics. This research highlights the importance of Chinese VFR travellers as potential vectors. Overall, this research provides new insights into Chinese VFR travellers, which can be used to tailor prevention programs for this group of at-risk travellers