Acceptability and adherence to antiseptic gargling among Malaysian umrah pilgrims: A mixed-methods quasi-experimental pilot study.

BACKGROUND

Respiratory tract infections are common among Umrah pilgrims due to crowding, close interpersonal contact, shared accommodation, and prolonged exposure to respiratory pathogens. Gargling has been proposed as a simple non-pharmaceutical respiratory hygiene intervention, but evidence on its feasibility, adherence, and acceptability during pilgrimage remains limited.

METHODS

A mixed-methods, quasi-experimental pilot-controlled study was conducted among 90 Malaysian Umrah pilgrims from two travel batches, allocated by batch to an intervention group (n=46) or control group (n=44). The intervention group received mouthwash and was instructed to gargle with 20 mL twice daily. Quantitative outcomes included self-reported respiratory symptoms, coughing frequency, impact on Umrah activities, and adherence. Open-ended responses explored perceived benefits, facilitators, barriers, and user experiences.

RESULTS

Most participants were female (65.6%) and aged 40-59 years. Cough and sore throat were the most commonly reported symptoms in both groups. No statistically significant differences were observed between groups for individual respiratory symptoms, number of symptoms, coughing frequency, or impact on Umrah activities (all p > 0.05). The intervention group showed non-significant trends towards lower prevalence of runny nose and less disruption of activities. Among respondents, 68.2% reported gargling twice daily almost every day. However, only 22/46 intervention participants completed the post-pilgrimage adherence assessment, representing 52.2% loss to follow-up. Participants generally perceived gargling as beneficial for respiratory and oral health, while forgetfulness and busy schedules were the main barriers.

CONCLUSION

Significant reductions in respiratory symptoms were not observed, but antiseptic gargling was acceptable, feasible, and generally well received. Larger multicentre studies incorporating objective microbiological outcomes and adherence-enhancing strategies are warranted.