Understanding international travelers' intentions to adopt protective behaviors against malaria during staying abroad: insights from a study of Chinese international travelers.

Background: Imported malaria cases from endemic regions pose significant challenges for malaria-free countries, leading to diagnostic delays, high treatment costs, and the potential for secondary local transmissions. There is a lack of understanding regarding the cognitive decision-making processes that influence travelers' intentions to engage in protective behaviors against malaria. This study aims to fill this gap by examining the factors that impact the willingness of travelers from China to adopt protective measures against malaria.

Methods: In a cross-sectional study conducted between March and October 2023, we utilized an online survey based on the malaria knowledge and Protection Motivation Theory (PMT) scales in Nanjing and Suzhou of Jiangsu Province, China. The survey was distributed by staff from the Centers for Disease Control and Prevention to Chinese international travelers after their returning from abroad. We analyzed the intentions to engage in malaria protective behaviors by multiple linear regression and structural equation modeling.

Results: In total, 252 international travelers from Jiangsu Province provided valid responses. Approximately 127 (50.4%) reported that their destination was a malaria-endemic area when they had traveled abroad. All seven PMT subconstructs were significantly affected by the malaria knowledge (all P < 0.05). Of all seven PMT subconstructs, two (severity and vulnerability) were strongly associated with intentions to engage in protective behavior. Notably, the level of malaria knowledge was insufficient for motivating protective behavior intention.

Conclusions: The intention to engage in antimalarial behaviors is closely linked to travelers' evaluation of malaria-related risks and their perceived ability to manage these threats. It is essential to enhance general knowledge on the risk of malaria and to provide robust pre- and post-travel healthcare for international travelers heading to malaria-endemic regions. This approach will empower travelers to adopt protective measures and reduce the incidence of imported malaria cases.