title: Exploring barriers to and facilitators of preventive measures against infectious diseases among Australian Hajj pilgrims: cross-sectional studies before and after Hajj.
abstract: OBJECTIVE
  For reasons that have yet to be elucidated, the uptake of preventive measures against infectious diseases by Hajj pilgrims is variable. The aim of this study was to identify the preventive advice and interventions received by Australian pilgrims before Hajj, and the barriers to and facilitators of their use during Hajj.
  
  
  METHODS
  Two cross-sectional surveys of Australians pilgrims aged ≥18 years were undertaken, one before and one after the Hajj 2014.
  
  
  RESULTS
  Of 356 pilgrims who completed the survey (response rate 94%), 80% had the influenza vaccine, 30% the pneumococcal vaccine, and 30% the pertussis vaccine. Concern about contracting disease at Hajj was the most cited reason for vaccination (73.4%), and not being aware of vaccine availability was the main reason for non-receipt (56%). Those who obtained pre-travel advice were twice as likely to be vaccinated as those who did not seek advice. Of 150 pilgrims surveyed upon return, 94% reported practicing hand hygiene during Hajj, citing ease of use (67%) and belief in its effectiveness (62.4%) as the main reasons for compliance; university education was a significant predictor of hand hygiene adherence. Fifty-three percent used facemasks, with breathing discomfort (76%) and a feeling of suffocation (40%) being the main obstacles to compliance.
  
  
  CONCLUSIONS
  This study indicates that there are significant opportunities to improve awareness among Australian Hajj pilgrims about the importance of using preventive health measures.
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: amani.alqahtani@health.nsw.gov.au.
authors.forename: Amani S
authors.initials: AS
authors.lastname: Alqahtani
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kerrie E
authors.initials: KE
authors.lastname: Wiley
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tashani
authors.affiliation: School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Harold W
authors.initials: HW
authors.lastname: Willaby
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Heywood
authors.affiliation: Health Informatics Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
authors.forename: Nasser F
authors.initials: NF
authors.lastname: BinDhim
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Booy
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia.
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003140:Communicable Disease Control; D003430:Cross-Sectional Studies; D005260:Female; D063373:Hand Hygiene; D006693:Holidays; D006801:Humans; D007252:Influenza Vaccines; D007514:Islam; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D022242:Pneumococcal Vaccines; D012529:Saudi Arabia; D011795:Surveys and Questionnaires; D014195:Travel; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines
keywords: Facemask; Hajj; Hand hygiene; Mass gathering; Pre-travel health advice