To our knowledge, this study was the first to assess the knowledge, attitudes and practices of general health care providers regarding the pre-travel counselling of patients with diabetes in Saudi Arabia and the Middle East at large. It has demonstrated essential findings. First, this study showed that more than half (57.9%) of the participants had poor knowledge scores. Second, more than half (52.5%) of participants had agreement attitudes, while 183 (47.5%) showed disagreement attitudes towards the importance of pre-travel counselling for patients with diabetes. Third, the majority (62.6%) of the participants had low practice scores.
Travel health advice for patients with diabetes can be complex. Understanding the demographic features and travel-associated risk factors is important in adjustments of insulin dose while travelling over multiple time zones (the compressed day when travelling eastward and the prolonged day when travelling westward can cause confusion about when to give scheduled doses of insulin).
Our study showed that the majority of participants did not know that travelling across more than five time zones and in hot or cold climates affected insulin dose and frequency. Few participants knew that patients with diabetes travelling to the east region may need to increase their insulin dose, while those travelling to the west region may need to decrease their insulin dose.
Similar to our findings, Kogelman et al.11 compared the knowledge, attitudes and practices of US primary care providers and US travel medicine specialists. They demonstrated knowledge and practice deficits among practitioners offering travel medicine advice. Furthermore, they revealed that familiarity with travel-specific vaccines and knowledge scores based on brief pre-travel scenarios were higher among travel medicine specialists. Likewise, Piotte et al.1 assessed the level of specific knowledge among primary care providers in eastern France regarding health advice, vaccinations and malaria prophylaxis. They concluded that the participants’ high level of knowledge in travel medicine was mostly linked to their motivation to practice in this specialized discipline. This finding should be considered with respect to the provision of education programmes in our society.
Al-Hajri et al.12 surveyed 76 PHC physicians in Qatar. The questionnaire included items assessing socio-demographic characteristics and knowledge and practices related to travel medicine before and after an educational symposium.12 They detected significantly increased knowledge on the post-symposium questionnaire for most questions. Such educational programmes are necessary to cover the deficiencies detected and to provide sufficient information during pre-travel counselling.
Regarding the attitudes of participants towards pre-travel counselling, our results showed that more than half of participants strongly agreed that Saudi Arabia lacks the practice of travel medicine, and two-thirds strongly agreed that our society lacks knowledge of the importance of travel medicine. As travel becomes more frequent in Saudi, pre-travel counselling and risk assessment are needed to understand travel-related risks and to better enable preparation for such activity. Therefore, our findings could promote the implementation of training programmes on travel medicine.
With regard to the practice of pre-travel counselling, our results showed that approximately two-thirds of the participants, especially general practitioners, reported that they did not feel confident about how to adjust insulin doses for patients travelling across several time zones. This may be the reason that most provider characteristics were not associated with the knowledge of guideline recommendations for travel health. Additionally, there is a lack of health travel programmes.
A comparison of the knowledge, attitudes and practices scores among the studied participants revealed a significantly higher knowledge score, followed by the attitudes score and the practice score (mean ranks were 2.54, 2.19 and 1.27, respectively). Additionally, a significant positive correlation was detected between knowledge and practice scores. Improving the level of knowledge of PHC physicians directly affects their practices. Furthermore, the structure of pre-travel consultations should address the travellers’ wishes, expectations, difficulties, experiences, and previous knowledge. Physicians should ask the traveller whether he or she understood the advice given. Finally, a booklet with additional advice and a website where patients can find health advice on their destination should be provided.13
A limitation of this study is the use of a survey tool that has not undergone prior reliability and validity testing. In addition, the result of this study cannot be generalised to other populations in the country because KAP might be greatly influenced by socio-demographic factors of the population. More studies on the travel of Saudi’s population with diabetes need to be performed, especially with the increasing affluence and diverse travel habits in the region.