The impact of travel clinic consultation on travellers' health beliefs and adherence to malaria chemoprophylaxis

Background: There are approximately 2,000 cases of imported malaria in the UK every year and there is evidence that adherence to chemoprophylaxis is poor. Social cognition models have been developed in an attempt to explain a wide range of health behaviours and a previous study has demonstrated the applicability of two such models to the area of adherence to malaria prophylaxis. The communication between doctors and patients has also been shown to relate to adherence to treatment and a number of recommendations have been made for improving the consultation. Objectives: The present study examined the predictive value of cognitions specified by the Health Belief Model (Rosenstock, Stretcher and Becker, 1988) and the Theory of Planned Behaviour (Azjen and Madden, 1986), as well as how these were influenced by the travel clinic consultation. In addition, the relationship between the interaction in the consultation and adherence to prophylactic recommendations was investigated. Methods: The participants were 130 consecutive travellers attending a travel medicine clinic who were due to travel to a malarious region. Pre- and post-consultation questionnaires were administered and a follow-up telephone interview was conducted between 4 and 7 weeks after the traveller's return to the UK. The consultations were audiotaped and analysed using Roter's Interaction Analysis System, which provides a quantitative assessment of the communication. A content analysis method was also employed to examine information exchange specific to malaria and malaria prophylaxis. Results: Significant changes in travellers' health beliefs were found as a result of the consultation. Perceived susceptibility to malaria, perceived benefits of medication and intentions to adhere significantly increased. There was also a significant reduction in the perceived permanent nature of side effects of medication. No significant changes were found for perceived severity of malaria, perceived behavioural control nor the belief that side effects would reduce enjoyment of the trip. In total, 107 participants were successfully contacted at follow-up, of whom 62% reported full adherence, 26% reported partial adherence and 12% reported poor/no adherence to the recommended medication. The three groups were found to be significantly different in terms of their length of stay, beliefs and intentions as well as their communication in the consultation. A multinomial logistic regression analysis revealed that length of stay, perceived benefits of medication pre-consultation, health professional discussion about adherence and traveller questions/statements independently predicted reported adherence. Conclusions: The results suggest that there is scope for improving the consultation. It is proposed that incorporating strategies from motivational interviewing, emphasising benefits of medication and resolving potential barriers to adherence would be particularly helpful. Implications for future research are discussed and it is suggested that readiness to engage in behaviour change, perceived effort of adherence and social influences whilst in a malarious region will be important concepts to investigate