Travel agent and tour guide perceptions on travel health promotion in Bali

The increasing number of travelers to Bali has been accompanied by the increased risks of travel-related health problems. Travel agents and tour guides are in a key position to inform travelers about these matters; nonetheless, little evidence was found on their role in the promotion of travel health. This article aims to assess travel agent and tour guide perceptions on their possible involvement in promoting travel health measures in Bali. A cross-sectional study was conducted between July and October 2015, involving 500 respondents (250 travel agents and 250 tour guides), who were chosen systematically from the Bali-based members of the Association of the Indonesian Tours and Travel Agencies. Data were collected using questionnaires, and perception indicators were developed using concepts from social learning theory and health belief model. Both groups have good levels of knowledge of general travel health issues, with mean percentages (SD) of 67.1 (11.9) and 66.2 (10.0) for travel agents and tour guides, respectively. Tour guides were more likely than travel agents to deliver information on health risks [PR (95%CI) = 1.31 (1.10-1.56); p = 0.003]; and on safety hazards during travel [PR (95%CI) = 1.22 (1.01-1.46), p = 0.04]. Overall, the majority of respondents (>68%) have positive and very positive perceptions of possible involvement in travel health and safety programs, although tour guides have statistically better perceptions (z = -2.2, p = 0.03). Based on perception levels, previous experiences and levels of knowledge, travel agents and tour guides have great potential to be involved in travel health promotion programs in Bali.