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Australian Chinese Travellers Visiting Friends and Relatives: New Approaches to Understanding and Reducing Infectious Disease Risks

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Australian Chinese Travellers Visiting Friends and Relatives: New Approaches to Understanding and Reducing Infectious Disease Risks Australian Chinese travellers visiting friends and relatives: new approaches to understanding and reducing infectious disease risks Tara Elaina Chun Hin Ma Submitted for the degree of Doctor of Philosophy School of Public Health and Community Medicine Faculty of Medicine University of New South Wales, Sydney, Australia April 2016 PLEASE TYPE THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: Ma First name: Tara Other name/s: Elaina Chun Hin Abbreviation for degree as given in the University calendar: PhD School: School of Public Health and Community Medicine Faculty: Medicine Title: Australian Chinese travellers visiting friends and relatives: new approaches to understanding and reducing infectious disease risks Abstract 350 words maximum: (PLEASE TYPE) 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 ma ny 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 internationa l 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-Aust ra lian VFR travellers from t he 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 Austra lian 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 t ravel advice. Simi lar findings were identified amongst international students, with additional unique findings including common use of social media for healt h information. Chinese VFR travellers and international stud ents 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-ri sk travellers. Declaration relating to disposition of project thesis/dissertation I hereby grant to the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or in part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all property rights, such as patent rights. I also retain the right to use in future works (s uch as articles or books) all or part of th is thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstracts International (this is applicable to doctoral theses onlv). l The University recognises that there may be exceptional circumstances requiring restrictions on copying or conditions on use Requests for restriction for a period of up to 2 years must be made in writing. Requests for a longer period of restriction may be considered in exceptional circumstances and req uire the approval of the Dean of Graduate Research. FOR OFFICE USE ONLY Date of completion of requirements for Award: THIS SHEET IS TO BE GLUED TO THE INSIDE FRONT COVER OF THE THESIS ORIGINALITY STATEMENT I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgment is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project’s design and conception or in style, presentation and linguistic expression is acknowledged. Tara Ma 15 April 2016 COPYRIGHT STATEMENT ‘I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International (this is applicable to doctoral theses only). I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation.' Signed ……………………………………………........................... Date ……………………………………………........................... AUTHENTICITY STATEMENT ‘I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format.’ Signed ……………………………………………........................... Date ……………………………………………........................... This thesis is dedicated to my mother and father. iv Acknowledgements I would like to thank my supervisors Dr Anita Heywood and Professor Raina MacIntyre for their continued supervision and assistance over the course of conducting this research and writing this thesis. Your ongoing comments and critiques and the discussions we had during our regular meetings were very helpful. I have learnt so much from both of you, and for this I am very grateful. I would like to thank the wonderful staff at the School of Public Health and Community Medicine, UNSW Australia. Your assistance was of great help in photocopying materials for the focus groups, and arranging various administrative matters with the School. I would like to thank the UNSW library and its dedicated librarians for the help they provided me during the literature reviews, and for their assistance in locating several books I had wanted to borrow over the years but could not find on the shelf. I would also like to thank Willoughby City Council and Ashfield City Council for providing the venues for the community focus groups. Having access to convenient venues located in suburbs with substantial Chinese-speaking populations was vital to the success of recruiting participants for the focus groups. Professional editor, Donna Armstrong, provided copyediting and proofreading services, according to the guidelines laid out in the university-endorsed national Guidelines for editing research theses. Finally, I would like to thank my family for their continued emotional support and encouragement throughout the course of writing this thesis. v Ethics clearance Approval for conducting the focus groups was granted by the Medical and Community Human Research Ethics Advisory Panel of UNSW Australia, in November 2012 (Reference number: 2012- 7-40). The approval was granted for 12 months, covering the period in which all focus groups were conducted. vi Publication arising from this thesis Ma T, Heywood A, MacIntyre CR. Chinese travellers visiting friends and relatives: a review of infectious risks. Travel Medicine and Infectious Disease 2015;13(4):285-94. This article is provided in Appendix 3. vii Contents Acknowledgements ............................................................................................................................. v Ethics clearance .................................................................................................................................. vi Publication arising from this thesis ................................................................................................... vii Abbreviations ...................................................................................................................................... x Abstract .............................................................................................................................................
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