title: Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.
abstract: BACKGROUND
  Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity.
  
  
  METHODS
  A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention.
  
  
  RESULTS
  A small improvement in travel agents  overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores.
  
  
  CONCLUSIONS
  Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: MacDougall
authors.forename: T W
authors.initials: TW
authors.lastname: Gyorkos
authors.forename: K
authors.initials: K
authors.lastname: Leffondré
authors.forename: M
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: D
authors.initials: D
authors.lastname: Tessier
authors.forename: B J
authors.initials: BJ
authors.lastname: Ward
authors.forename: J D
authors.initials: JD
authors.lastname: MacLean
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002170:Canada; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012044:Regression Analysis; D012306:Risk; D014195:Travel