title: The impact of injection anxiety on education of travelers about common travel risks.
abstract: BACKGROUND
  Despite many travelers receiving at least one vaccination during the pre-travel consultation, little is known about travelers' fear of injections and the impact this may have on educating travelers about health risks associated with their trip. This study aimed to investigate: (1) the prevalence of injection anxiety in travelers attending a pre-travel consultation, (2) whether anxiety due to anticipating a vaccination adversely affects recall of information and advice, and (3) whether clinicians can recognize travelers' anxiety, and how they respond to anxious travelers.
  
  
  METHODS
  Consecutive adult travelers (N = 105) attending one of two inner-city travel clinics completed self-report measures of state anxiety, injection anxiety, and symptoms of needle phobia immediately before and after their pre-travel consultation. Clinicians were also asked to rate travelers' anxiety and report any anxiety management strategies. Standardized information was presented during the consultation and recall of information and advice was assessed immediately post-consultation. Delayed recall (24 hours) was assessed for a subsample (20%) of participants.
  
  
  RESULTS
  More than one third of travelers reported feeling nervous or afraid when having an injection (39%). Travelers' state anxiety was related to their psychological and physiological reactions to needles, and reduced significantly post-consultation. Recall of information and advice varied, with failure of recall ranging from 2 to 70% across 15 items, and delayed recall being significantly lower. No relationship was found between recall and anxiety. Clinician-rated anxiety moderately correlated with travelers' self-reported anxiety.
  
  
  CONCLUSIONS
  A significant proportion of travelers experienced injection anxiety when attending the pre-travel consultation, with some travelers reporting symptoms consistent with criteria for Blood Injection Injury phobia. There were important gaps in recall of information and advice about common travel risks. Although no relationship was found between recall and anxiety, this may have been due to the sample and setting.
authors.affiliation: UCL Medical School, University College London, London, UK.
authors.forename: Lorraine M
authors.initials: LM
authors.lastname: Noble
authors.forename: Lorna
authors.initials: L
authors.lastname: Farquharson
authors.forename: Niamh A
authors.initials: NA
authors.lastname: O'Dwyer
authors.forename: Ron H
authors.initials: RH
authors.lastname: Behrens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000208:ethnology*; D007267:Injections / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009339:Needles; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D014195:Travel; D006113:United Kingdom / Q000453:epidemiology; D014611:Vaccination / Q000379:methods / Q000523:psychology*; D055815:Young Adult