Overseas Visitors Research Articles

The Hostile Environment in Primary Care: Qualitative analysis of a cross sectional survey of health care professionals in primary care

Background: In 2014 the UK government rolled out the then called hostile environment as a series of punitive policies designed to disenfranchise undocumented migrants from living in Britain. As part of these measures upfront charging was introduced in 2017 which saw patients being denied treatment without prior full payment based on their immigration status. Aim: Assess the knowledge of the charging regulations in a sample of primary care practitioners. Assess the impact of the regulations on both patients and practitioners in a primary care setting. Methods: Building on a previous survey by the RCPCH, a cross sectional survey was circulated through the RCGP faculties and GP training groups within England. Demographic information and likert responses were collected from over 300 responses. Thematic analysis of over 120 white space questions was undertaken to create themes and sub-themes. ResultsResults showed an overall poor knowledge of the regulations. Thematic analysis was split into two main categories, (i) human impact of the policies and (ii) the economic and political impact of the policies. Key points were (i) lack of knowledge and awareness of the regulations, (ii) evidence of patient harm through patients’ being denied care, avoiding care or having care delayed, (iii) evidence of clinician harm through burnout, stress, a loss of faith in practice and concerns over extra work and (iv) concerns over implicit bias and structural racism within primary care and (v) concerns over lack of economic analysis. Conclusion: Charging of overseas visitors is poorly understood within primary care despite having an impact on both patients and practitioners within this setting. Recommendations to help tackle this issue and reduce harm include training of staff, systematic reporting of harm, and a system wide economic analysis.

Airline competition in Indonesian domestic market: Airline-within-airline strategies and impact of the COVID-19 pandemic

This study investigates the competition among four carriers from two major airline groups in Indonesia, namely Indonesia group (Garuda Indonesia and Citilink of Garuda), and Lion Air group (Lion Air and Batik Air). An airline route choice econometric model in the spirit of Probit model is constructed and estimated to shed light on the interactions of the four airlines of these two groups. Specifically, our empirical examination accentuates how the two groups utilize the Airline-within-Airline (AWA) strategy, which refers to operating a full-service carrier (FSC) and a low-cost carrier (LCC) at the same time, and the impact of the COVID-19 pandemic. Our estimation results suggest that the established FSC, Garuda Indonesia, used its LCC subsidiary, Citilink, as a fighting brand against its LCC rivalry, Lion Air. By contrast, Lion Air established a FSC brand, Batik, to broaden the market coverage instead of purely as a fighting brand. This competition structure was however shifted by the COVID-19 pandemic. All carriers became more aggressive to serve the routes involving those major airports in the big cities with more price-inelastic travellers. The overlapping routes between Lion Air and Batik Air have increased during the pandemic. The routes serving the tourism destinations have been cut due to the drop of inbound overseas visitors during the pandemic.

Cultural Capability in the Professional Care of Nurses for Medical Tourists in Iran: A Qualitative Study

Background: Medical tourists create an issue that needs to be investigated in different parts of the world. Increasing expectations of health tourists for health services improves the quality of nursing care services for foreign clients. Due to globalization, nurses are required to handle the increasing number of overseas visitors and immigrants. Objectives: This study was conducted to assess cultural capability in the professional care of nurses for medical tourists in Iran. Methods: We conducted 23 semi-structured interviews in 2021 - 2022 in this qualitative study. The interviewees included nurses from international wards and wards with international patients, patients, patient companions, and doctors. The interviews were conducted using a goal-oriented method. After recording, the data were analyzed using the conventional qualitative content analysis of Lundman and Graneheim. Results: In this study, a main theme called “Cultural capability in professional care” was categorized into 8 categories: “Culture-oriented language communication,” “Culture-oriented communication interactions,” "Cultural humility," "valuing cultural diversity," "context-based client training," and "respectful communication.". Conclusions: Cultural capability in the professional care of nurses is important for providing comprehensive and quality care because patients come with different cultural beliefs and from different geographical areas.

Japanese health and safety information for overseas visitors: a randomized controlled trial

IntroductionInternational travel to Japan increased steadily until the coronavirus disease 2019 (COVID-19) outbreak. Although international travel was curtailed worldwide due to the pandemic, the number of overseas visitors to Japan should increase again after the restrictions are lifted. We assessed the effect of a five-minute digital game on the knowledge of health information and the level of satisfaction with educational health resources of overseas visitors to Japan.MethodsWe conducted a randomized controlled trial among 1062 previous and potential visitors to Japan utilizing an internet portal. We recruited previous and potential visitors to Japan from the internet portal sites of the UK, the US and Australia. We randomly allocated participants to two groups: an intervention group that played an animated game and a control group that viewed an online animation. All participants answered a self-administered questionnaire online from March 16 to 19, 2021. We assessed visitors’ levels of health knowledge and satisfaction using the CSQ-8. We analyzed the data with a t test and the difference in differences test. Our RCT followed the SPIRIT guidelines.ResultsOf the 1062 previous and potential visitors recruited via the three countries’ internet portals (354 from each country), some had visited Japan previously (174 in the intervention group, 220 in the control group), while some were potential visitors to Japan (357 in the intervention group, 311 in the control group). Some had gathered health and safety information about Japan prior to this study (180 in the intervention group, 211 in the control group). Both groups improved their health information levels after the intervention. The level of satisfaction with health information in Japan was significantly increased in the intervention group (average difference of 4.5 points) compared to that in the control group (average difference of 3.9 points) (p < 0.05). Both groups’ mean CSQ-8 scores increased significantly after the intervention (p < 0.001): from 23 to 28 in the intervention group and from 23 to 24 in the control group.ConclusionsOur study introduced unique educational strategies using an online game to provide health and safety information to previous and potential visitors to Japan. The online game was a more effective way to increase satisfaction than the online animation about health information.This study was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry) as Version 1, and the trial registration data are available as UMIN000042483, 17/11/2020.Trial registrationTrials UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), UMIN000042483 (Japanese health and safety information for overseas visitors: A randomized controlled trial), 17/11/2020.

Black Water Fever Complicated by Acute Kidney Injury: A Case Report

Black water fever, also called malarial haemoglobinuria occurs exclusively with Plasmodium falciparum infection and is characterized by intravascular haemolysis with severe anaemia and intermittent passage of black coloured urine. It frequently leads to acute kidney injury (AKI) with increased morbidity and mortality. Although Sri Lanka has achieved remarkable success in eliminating malaria since 2016, still Sri Lanka gets malarial cases via overseas visitors from African countries and India. Here we report a case of black water fever complicated by AKI with a brief account of its pathophysiology.

The impact of NHS charging regulations on healthcare access and utilisation among migrants in England: a systematic review

BackgroundThe NHS Charges to Overseas Visitors Regulations 2015 outline when healthcare costs should be recuperated from overseas visitors in England. National and global stakeholders have expressed concerns that charging may exacerbate health inequalities and undermine public health efforts especially among vulnerable migrant groups. This review aims to systematically describe the evidence regarding the impact of NHS charging regulations on healthcare access and utilisation and health outcomes for migrants in England.MethodsA systematic search of scientific databases and grey literature sources was performed. Quantitative and qualitative studies, case studies and grey literature published between 1 January 2014 and 1 April 2021 were included. Screening, data extraction and quality appraisal were carried out in accordance with PRISMA guidelines.ResultsFrom the 1,459 identified studies, 10 were selected for inclusion. 6 were qualitative, 3 were mixed methods and 1 was quantitative. The evidence is lacking but suggests that fears of charging and data sharing can deter some migrants from accessing healthcare. There is also evidence to suggest a lack of knowledge of the charging regulations among patients and healthcare professionals is contributing to this deterrence.ConclusionsFurther independent research supported by strengthening of data collection is required to better understand the effects of charging on healthcare and health outcomes among vulnerable migrants. Our findings support improved training and communication about NHS Charging Regulations for patients and professionals.

The Visit Intention of New York City: The Influence of Social Media Marketing (Study on Tourist Who Wish Visit The New York City)

The largest market in the US for overseas visitors, who often stay longer and spend more, is New York City. Depending on past tourist behavior, there are two approaches that should be taken when promoting New York City (NYC) as a destination. When promoting a destination to tourists who have already been there before, the emphasis should be on updating them on new information and luring them back. The purpose of this study is to examine the effects of social media marketing initiatives, destination image, attitude, awareness, and perceived value on visit intention to New York City. The SEM-PLS approach was employed in this study's data analysis. 42 travelers who intended to visit New York City filled out a 1–5 scale questionnaire that was used to obtain the data. Ten theories pertaining to the 6 factors under investigation were put up. The study's findings indicate that Social Media Marketing Activity has no relationship with the Destination Image, Destination Attitude, Destination Awareness and Perseced Value variables. While the variables that have a relationship with Visit Intention New York City are Destination Awareness and Perceived Value. This study has consequences for giving tourists who want to visit New York City an overview and an explanation.

Exploring international beachgoers’ perceptions of safety signage on Australian beaches

Background136 coastal drowning fatalities in Australia were reported in 2020–2021,almost half of which were overseas-born beachgoers. In light of these statistics, this study explores how beachgoers, including overseas-born beachgoers, see and interpret current existing beach safety signage at Bondi beach in Sydney, Australia. MethodsSurveys of beachgoers at Bondi Beach were collected over 10 days between February 8 and March 21. Surveys comprised closed responses with multiple choices. The data were analysed via SPSS for descriptive analysis for independence, and the Pearson Chi-Square test for the significance of the difference between the Australian and overseas-born beachgoers. Results167 survey responses (52 Australian citizens and 116 overseas-born beachgoers) were analysed. Of the overseas visitors and residents, 30.2% believe that swimming between the flags means only that people “perceived to be good swimmers” were allowed to be between the flags. About 50% of the Australian and international beachgoers believe that no flags = no swim means that when the flags are not displayed they cannot swim but can still go into the water. On top of these results, other terms commonly used in beach signage such as shore dump and high surf are understood by only less than 30% of overseas-born beachgoers. ConclusionThese results suggest that at least some of the beach safety signs are not interpreted correctly either by overseas-born or Australian beachgoers.Learning Outcomes: This study suggests a number of linguistic strategies to improve the clarity of nomenclature.

Cross-Cultural Information for Japanese Nurses at an International Hospital: A Controlled Before-After Intervention Study.

This study sought to evaluate the efficacy of providing health information through an ordinary travel guidebook combined with a short digital video compared with an ordinary travel guidebook alone by measuring the anxiety levels of Japanese nurses dealing with foreign patients. We conducted a controlled before–after intervention study in 2016 at a major international hospital in Japan. We created two interventions: (1) a brief piece of health information from a travel guidebook for Japan, (2) the same travel guidebook, and a four-minute digital video in English on health information in Japan, titled Mari Info Japan for nurses. After each intervention, we assessed the nurses’ levels of anxiety about caring for foreign patients. We evaluated the results through statistical testing and the State–Trait Anxiety Inventory Form Y. Of 111 nurses, 83 (74.8%) completed both interventions and the questionnaires. The second intervention (the guidebook and video) proved more effective than the first (the guidebook) for reducing anxiety related to caring for foreign patients. Japanese nurses can lower their anxiety about dealing with foreign patients by learning about the content of various forms of health care information currently accessible to overseas visitors. Using both guidebooks and digital videos can help to reduce nurses’ anxiety.

“What Blood Unites, the Sea Shall Not Divide”: Bohemian Day at the World's Columbian Exposition of 1893

“What Blood Unites, the Sea Shall Not Divide”: Bohemian Day at the World's Columbian Exposition of 1893

Charging overseas visitors

Charging overseas visitors

Overseas visitor demand for marine and coastal tourism

For many coastal regions, marine and coastal tourism is a vital contributor to their economies. However, recent COVID-19 related travel restrictions have constrained the flow of overseas tourists into these areas. As restrictions ease, coastal regions aim to restart this tourism market. Using an Irish case study, this paper explores overseas tourist’ participation and length of stay in marine and coastal areas, using a logit model and negative binomial model respectively, to inform policy development to revitalise this segment of the tourism industry. The results indicate that a myriad of attributes impact the decision to enter the market and the amount of time spent in these areas. Country of residence, composition of the travelling group as well as activities undertaken in coastal areas all affect demand. Importantly, the results also suggest that not all attributes that affect participation affect length of stay and vice-versa. This may indicate niches where appropriate policy could transform those already participating in the market to become longer stay tourists. Additionally, consumer surplus estimates indicate that the average marine and coastal tourist receives three times more value than they spend. The analysis presented here also suggests a number of future avenues for research that may be of interest. Future researchers may wish to look at the relationship between close geographic neighbours and length of stay as well as the effects of going on tours, and, possibly, eco-tours, on time spent in coastal areas.

Effect of a simplified billing form and the SARS-CoV-2 pandemic on compensable billings in an Australian metropolitan emergency department: An interrupted time series analysis.

ObjectiveTo evaluate the effect of a simplified billing form on billings recovery.MethodsAn interrupted time series analysis of weekly presentations and billings between 1 April 2019 and 14 June 2020.ResultsNotably, 3228 patients were included (2030 Overseas Visitor Agreement, 359 Transport Accident Commission and 839 Work Cover). There was a $208.34 (95% CI 155.44–261.23, P < 0.0001) increase in billings per episode, that is, 59% (95% CI 44–74, P < 0.0001), from a baseline of $351.75/episode. There was no significant change in the actual billing rate during the pandemic.ConclusionTotal billings did not change. Less patients were identified, but each generated 59% more billings.

Wines from the hinterland: comparing availability of local wines on wine lists in two New Zealand tourism destinations

PurposeThis paper aims to situate restaurant experiences and in particular the wines available on wine lists, within the wider context of wine tourism. This is done by examining the wine lists of restaurants in two New Zealand destinations, focusing in particular on the showcasing of “local wines” and the factors behind these offerings, and outlines the potential implications for hospitality managers and a wider academic audience.Design/methodology/approachThe population of restaurants in each destination was identified using online directories, from which a sample of wine lists, comprising 84 in Christchurch and 43 in Queenstown, was systematically analysed to identify number of wines, regional origin, price and other information. Following this, key informant interviews in restaurants in each destination explored decision-making factors in stocking local wines, including consumer base, existing networks and reputation and additional challenges and opportunities.FindingsRestaurants in each destination offered more New Zealand than foreign wines on their lists, though significant regional differences are apparent. Queenstown restaurants offered slightly fewer imported wines and significantly more local (Central Otago) wines than Christchurch restaurants. The global awareness of Central Otago pinot noir is a factor in this wine list representation, but there are also other influences, including the greater concentration of overseas visitors (pre-pandemic) and more significant visibility and greater opportunities for wine tourism experiences within the destination.Originality/valueThis paper represents an important addition to academic research on wine marketing in the on-premise sector of emerging wine regions. This paper also highlights the potential significance of restaurant meals – including wine choices – in overall wine destination experiences and demonstrates differences in approach between restaurants in wine regions of similar size but with different reputations, international visitation and wine tourism infrastructure.

Segmenting food festivalgoers: experiential value, emotional state and loyalty

PurposeThe primary purpose of this research is to segment food festivalgoers based upon their experiential value. Once those segments are found, it aims to examine whether the segments differ with regard to their perceived level of satisfaction, delight and loyalty.Design/methodology/approachA self-administered questionnaire was designed to assess the on-site festival experiential value, satisfaction, delight and loyalty of local and overseas visitors at the Macau International food festival. Data were analyzed by using the factor and cluster approach. To profile segments, a series of chi-square tests, ANOVAs and multivariate analysis of variance were performed.FindingsThis study uncovered three underlying dimensions of experiential value and classified four segments based on their experiential value among the food festivalgoers, which provides insightful implications for festival organizers and marketers. The segments differed in age, education level and place of residence. Furthermore, the multi-experiential value group was the most important segment, showing the highest festival satisfaction, delight and loyalty.Originality/valueExperiential value reflects a core value of festival attendees, where the experience is a determining factor in the creation of a successful festival and desirable outcomes. Limited studies, however, have been conducted to segment food festival markets according to their festival experience. This study identified experiential value, applying it as a segmentation criterion within a food festival setting.

Transmission of NDM-5-Producing and OXA-48-Producing Escherichia coli Sequence Type 648 by International Visitors without Previous Medical Exposure.

ABSTRACTCarbapenemase-producing Escherichia coli sequence type (ST) 648 strains were isolated from two international visitors without previous medical exposure from Southeast Asian countries in a hospital in Japan. One isolate, FUJ80154, carried blaNDM-5 in a complex class 1 integron on an IncFIB/FII plasmid; the other isolate, FUJ80155, carried two copies of blaOXA-48 on the chromosome flanked by IS1R on both sides. The core-genome based-phylogenetic analysis with publicly available genome data of E. coli ST648 carrying blaNDM-5 or blaOXA-48-like demonstrated high genetic similarity between FUJ80154 and NDM-5-prooducing E. coli ST648 strains isolated in South and Southeast Asian countries. On the other hand, no closely related isolates of FUJ80155 were identified. In the absence of prior hospitalization overseas, neither patient had qualified for routine screening of multidrug-resistant organisms, and the isolates were incidentally identified in cultures ordered at the discretion of the treating physician.IMPORTANCE Although patients with history of international hospitalization are often subject to screening for multidrug-resistant organisms, it is unclear whether patients who reside in countries where carbapenemase-producing Enterobacterales (CPE) is endemic but have no history of local hospitalization contribute to the transmission of CPE. In this study, NDM-5-producing and OXA-48-producing Escherichia coli sequence type (ST) 648, a recently recognized high-risk, multidrug-resistant clone, were detected from two overseas visitors without previous medical exposure. The findings of this study suggest that active surveillance culture on admission to hospital may be considered for travelers from countries with endemicity of carbapenem-resistant organisms even without history of local hospitalization and underscore the need to monitor cross-border transmission of high-risk clones, such as carbapenemase-producing E. coli ST648.

NHS Apartheid: On resisting NHS charges for overseas visitor healthcare

NHS Apartheid: On resisting NHS charges for overseas visitor healthcare

Accessing Healthcare Services as an Overseas Visitor::Japanese Expatriate Experiences in Thailand

Accessing Healthcare Services as an Overseas Visitor::Japanese Expatriate Experiences in Thailand

Effect of control measures on the pattern of COVID-19 Epidemics in Japan.

BackgroundCOVID-19 has spread worldwide since its emergence in 2019. In contrast to many other countries with epidemics, Japan differed in that it avoided lockdowns and instead asked people for self-control. A travel campaign was conducted with a sizable budget, but the number of PCR tests was severely limited. These choices may have influenced the course of the epidemic.MethodsThe increase or decrease in the classes of SARS-CoV-2 variants was estimated by analyzing the published sequences with an objective multivariate analysis. This approach observes the samples in multiple directions, digesting complex differences into simpler forms. The results were compared over time with the number of confirmed cases, PCR tests, and overseas visitors. The kinetics of infection were analyzed using the logarithmic growth rate.ResultsThe declared states of emergency failed to alter the movement of the growth rate. Three epidemic peaks were caused by domestically mutated variants. In other countries, there are few cases in which multiple variants have peaked. However, due to the relaxation of immigration restrictions, several infective variants have been imported from abroad and are currently competing for expansion, creating the fourth peak. By April 2021, these foreign variants exceeded 80%. The chaotic situation in Japan will continue for some time, in part because no effort has been made to identify asymptomatic carriers, and details of the vaccination program are undecided.

Using Co-Design to Create Community Advocacy for Biosecurity Behavior Change

Background: New Zealand’s Ministry for Primary Industries (MPI) manages the “declare or dispose” biosecurity border compliance social marketing program. Its aim is to protect the country’s important horticulture and agriculture industries from imported pests and diseases, and its environment. The program encourages visitors to New Zealand to leave potential biosecurity risk items at home or dispose in specially marked bins on arrival. An important part of this is having New Zealand ethnic communities advocate on MPI’s behalf to friends and family overseas to follow the biosecurity rules. To fully engage the community to be advocates, it was felt that the community should be involved in the creation of this aspect of the program. Focus of the article: The article is a case study explaining how MPI used co-design methodology to create an advocacy program with a local community to assist behavior change in overseas visitors. The article focusses on the process and planning (including following a six-step co-design model) from a practitioners’ perspective to develop a program co-created with the target audience, rather than the final interventions developed. Program design/approach: The “declare or dispose” program had been solely “expert led” and designed by social marketers and researchers. The program is heavily influenced by a mix of quantitative and ethnographic research. These feed into customer journey mapping where interventions are inserted to influence audiences’ behavior. To assist in advocacy from the New Zealand Indian community to friends and family overseas, a customer led co-design process was developed to create community engagement and advocacy. Methods: MPI ran three co-design sessions involving members of local Indian community groups. The sessions used a mixture of card sorting and open discussion within small groups. The card sorting was used to review, and rate current interventions used in the behavior change program (including interventions both overseas direct to visitors and locally to community members). The open discussion asked participants to generate new ideas for potential new interventions to reach visitors. Results: Through the ranking of existing tools and participant suggestions of new ideas—MPI has developed an advocacy program that spans expert-led and user-led interventions. As hoped, the user-led suggestions were at a community-based level, resulting in a stronger buy-in from the community to deliver advocacy messages to overseas friends and family. Recommendations for practice: The article is useful for practitioners by detailing how to not only use co-design for creating new ideas, but also to evaluate existing ones to create a program blending both expert- and user-led interventions. MPI followed a six-step co-design process to organize its co-design program. This ensured that the right preparation was followed, sessions were effective, and the desired results of the program were achieved.