ArticleLiterature Review

An integrated human behavioral model for mosquito-borne disease control: A scoping review of behavior change theories used to identify key behavioral determinants

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Mosquito-borne disease (MBD) control depends largely on a range of public health measures aimed at reducing the spread of infected mosquitoes and human-mosquito contact. These public health measures are generally driven by voluntary, though in few occasions obligatory (e.g., indoor residual spraying), self-protective behaviors by individuals and communities. To develop effective interventions that promote public health measures, the underlying mechanisms that contribute to self-protective behaviors should be well understood. The present scoping review aims to provide a timely overview of how behavior change theories have been applied in the context of MBD control. In addition, the review proposes an integrated model that includes identified key determinants in MBD control behavior, and identifies knowledge gaps to inform future research. A comprehensive search was performed in several databases: MEDLINE, PsycINFO, Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC, and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. References of included studies and literature reviews were screened, as well as citation tracking in Web of Science, Google Scholar and the malaria database of Behavior Change Impact. This scoping review identified a total of 28 studies. Most studies targeted personal-protective behavioral measures such as adopting, using, or maintaining insecticide-treated bed nets, and were most frequently informed by risk-related behavioral theories. Knowledge and perceived susceptibility of the risk, and related perceived efficacy were identified as key behavioral determinants in the conceptual, integrated human behavior model for MBD control. Numerous studies related to MBD control behavior, especially those focusing on knowledge-attitudes-practices (KAP), often lack a solid theoretical framework, which risks depicting an incomplete understanding of behaviors. In addition, by incorporating various behavioral disciplines into the domain of MBD control, a more comprehensive understanding of key behavioral determinants may be developed and applied in future research and MBD control efforts.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Educating communities about the risks of vectorborne diseases and preventive measures is vital 82,115 . Public health campaigns should focus on behavioral changes, such as using bed nets, eliminating standing water, and seeking timely medical attention for vector control management 116,117 . e. Research and Innovation: Investing in research to understand the complex interactions between climate change and vector-borne diseases is essential. ...
Article
Full-text available
Climate change is increasingly recognized as a significant driver of ecological and public health changes, particularly concerning vector-borne diseases. This scoping review aims to systematically map the current research on the impact of climate change on vector ecology and the subsequent effects on disease transmission dynamics. We conducted a comprehensive literature review across multiple databases to identify critical vectors, such as mosquitoes, ticks, and fleas. We examined how climate variables like temperature, precipitation, and humidity affect their populations, behaviors, and life cycles. Additionally, we explored the shifting geographic distributions of these vectors, investigating how climate change influences their spread and the emergence of diseases such as malaria, dengue, and Lyme disease in new regions. The review highlights the complex and multifaceted interactions between climate change and vector-borne diseases, emphasizing the necessity of understanding these relationships to inform effective public health strategies. Our findings indicate considerable variability in the impacts of climate change across different regions and vector species, underscoring the need for localized studies and tailored interventions. Moreover, significant research gaps were identified, particularly in predictive modeling, long-term surveillance, and the socio-economic impacts of vector-borne diseases exacerbated by climate change. We suggest directions for future research, including the development of integrated climate health models and enhanced disease surveillance systems to better anticipate and mitigate the effects of climate change on vector-borne disease transmission. This review underscores the urgency of addressing climate change as a critical component of global health initiatives and the importance of interdisciplinary approaches in tackling this complex issue
... Educating communities about the risks of vectorborne diseases and preventive measures is vital 82,115 . Public health campaigns should focus on behavioral changes, such as using bed nets, eliminating standing water, and seeking timely medical attention for vector control management 116,117 . e. Research and Innovation: Investing in research to understand the complex interactions between climate change and vector-borne diseases is essential. ...
... Educating communities about the risks of vectorborne diseases and preventive measures is vital 82,115 . Public health campaigns should focus on behavioral changes, such as using bed nets, eliminating standing water, and seeking timely medical attention for vector control management 116,117 . e. Research and Innovation: Investing in research to understand the complex interactions between climate change and vector-borne diseases is essential. ...
Preprint
Climate change is increasingly recognized as a significant driver of ecological and public health changes, particularly concerning vectorborne diseases. This scoping review aims to systematically map the current research on the impact of climate change on vector ecology and the subsequent effects on disease transmission dynamics. We conducted a comprehensive literature review across multiple databases to identify critical vectors, such as mosquitoes, ticks, and fleas. We examined how climate variables like temperature, precipitation, and humidity affect their populations, behaviors, and life cycles. Additionally, we explored the shifting geographic distributions of these vectors, investigating how climate change influences their spread and the emergence of diseases such as malaria, dengue, and Lyme disease in new regions. The review highlights the complex and multifaceted interactions between climate change and vector-borne diseases, emphasizing the necessity of understanding these relationships to inform effective public health strategies. Our findings indicate considerable variability in the impacts of climate change across different regions and vector species, underscoring the need for localized studies and tailored interventions. Moreover, significant research gaps were identified, particularly in predictive modeling, long-term surveillance, and the socio-economic impacts of vector-borne diseases exacerbated by climate change. We suggest directions for future research, including the development of integrated climate-health models and enhanced disease surveillance systems, to better anticipate and mitigate the effects of climate change on vector-borne disease transmission. This review underscores the urgency of addressing climate change as a critical component of global health initiatives and the importance of interdisciplinary approaches in tackling this complex issue.
... Pertama, teori Behavioral Change menyediakan kerangka kerja untuk memahami bagaimana individu mengubah perilaku mereka dalam merespons pesan-pesan kesadaran tentang dampak penggunaan smartphone [14]. Menurut teori ini, pendekatan yang efektif dalam mengubah perilaku melibatkan tiga elemen kunci: kepercayaan (beliefs), nilai (values), dan norma-norma sosial/social norms [15]. Dengan memperkuat kepercayaan akan pentingnya penggunaan smartphone yang bertanggung jawab, meningkatkan nilainilai sehat terkait dengan teknologi, dan menekankan norma-norma sosial yang mendukung perilaku yang diinginkan, maka akan lebih mungkin bagi siswa untuk mengadopsi perilaku yang lebih sehat [16]. ...
Article
Full-text available
Proyek ini fokus pada meningkatkan kesadaran siswa SMA NW Syaikh Zainuddin NW Anjani, Lombok Timur, NTB, mengenai dampak positif dan negatif penggunaan smartphone. Tujuannya adalah memberi pemahaman komprehensif kepada siswa tentang keuntungan dan kerugian dari penggunaan smartphone yang berlebihan melalui lokakarya, diskusi interaktif, dan kampanye kesadaran. Metode partisipatif melibatkan siswa, guru, orang tua, dan masyarakat lokal. Hasilnya adalah dapat meningkatkan kesadaran siswa tentang konsekuensi penggunaan smartphone yang berlebihan, dialog masyarakat tentang kebiasaan teknologi yang sehat, dan pengembangan strategi untuk mengurangi dampak negatif. Melalui upaya ini, kami dapat memberdayakan siswa untuk membuat keputusan yang lebih bertanggung jawab dalam penggunaan smartphone dan menciptakan lingkungan yang mendukung kesejahteraan mereka.
Article
Full-text available
Background Malaria during pregnancy and childhood is one of the major public health challenges globally. Its prevalence is huge in Africa, especially in sub-Saharan countries and Ethiopia. Insecticide-treated mosquito net (ITN) use is one of the primary malaria preventive strategies. Previous studies did not adequately address the health belief and behaviour-related correlates of ITN using health belief model (HBM), although a number of studies were conducted in this theme. Therefore, this study was aimed at assessing the prevalence and associated factors of ITN utilization among pregnant women and under five children in east Belessa district, northwest Ethiopia, 2020. Methods A community-based cross-sectional mixed study was conducted in east Belessa district from February 01–30/2020. A total of 724 eligible participants were included in the quantitative study. A multistage cluster sampling technique was used. The quantitative data were collected using an interviewer-administered structured questionnaire. Data were entered into Epi data version 4.6.0.2 and then exported to SPSS version 16 for analysis. The binary logistic regression model was fitted and the level of significance was declared based on AOR with its 95% CI and p-value ≤ 0.05. Meanwhile, the qualitative data were collected using focus group discussions and key informant interviews, and analysed using a thematic analysis approach. Results The prevalence of ITN utilization was 56.5% (95% CI 53.0, 60.2) and independently predicted by a corrugated iron roof of the house (AOR = 1.53; 95% CI 1.15, 2.22), rural residence (AOR = 1.59; 95% CI 1.11,2.28), ≥ 2 number of rooms in the house (AOR = 1.56; 95% CI 1.06, 2.30) and high level of perceived barrier (AOR = 0.53; 95% CI 0.38,0.74). In the qualitative findings, the main barrier was connected to misconceptions and misperception towards malaria and ITN. Conclusion The prevalence of ITN utilization in the study area was lower than the national target (100%). It was significantly associated with household characteristics, residence, and level of a perceived barrier. Reversing the community’s misconceptions through information, education and communication (IEC), and behavioural change communication (BCC) would enhance ITN utilization.
Article
Full-text available
Background School-based behaviour change communication interventions could help to achieve behavioural changes in the school and enhance the enrollment of the students and teachers as health messengers to local communities. Evidence on the impacts of the school-engaged malaria preventive interventions are limited as far as the social and behaviour change communication (SBCC) is concerned. This study examined the effectiveness of the school-based SBCC approach on insecticide-treated nets (ITNs) utilization among primary school students in malaria-endemic settings of Ethiopia. Methods Various participatory, educational, and communication interventions were implemented from 2017 to 2019 in 75 primary schools and respective villages in Jimma to promote malaria preventive practices. A quasi-experimental design was conducted with randomly selected 798 students (i.e. 399 intervention and 399 control groups). Data were collected by trained interviewers using structured questionnaires. The SPSS version 26 software was used to analyse the data. Propensity score matching analysis was performed to control for possible confounding biases. The average effects of the intervention were estimated using multivariate general linear modelling to estimate for mean differences and odds ratio based on the nature of data. Results The result showed that the ITNs utilization was 6.857 folds in the intervention groups compared to the counterpart; (OR = 6.857; 95% CI: (4.636, 10.1430); effect size = 39%). A mean differences (MD) of self-efficacy (MD = 15.34; 95% CI: 13.73 to 16.95), knowledge (MD = 5.83; 95% CI: 5.12 to 6.55), attitude (MD = 6.01; 95% CI: 5.26 to 6.77), perceived malaria risk (MD = 2.14; 95% CI: 1.53 to 2.76), and perceived family supports (MD = 6.39; 95% CI: 5.57 to 7.22) were observed favoring the intervention. Multivariable logistic regression modelling results showed that knowledge (β = 0.194, 95% CI: 1.09 to 1.35) and perceived family supports (β = 0.165, 95% CI: 1.11 to 1.25) and self-efficacy (β = 0.10, 95% CI: 1.22 to 2.32) predicted the ITN utilization among the school children. Conclusions The finding of this study suggested that the school-based SBCC approach combined with peer education activities advanced the malaria-related knowledge, attitude, self-efficacy, risk perceptions, and family supports and ultimately improved the sustained use of ITNs among school-going children. Further research should be conducted to understand the mechanism of these effects given the influences of social, health services, and school systems are considered.
Article
Full-text available
Objective: The objective of this paper is to describe the updated methodological guidance for conducting a JBI scoping review, with a focus on new updates to the approach and development of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (the PRISMA-ScR). Introduction: Scoping reviews are an increasingly common approach to informing decision-making and research based on the identification and examination of the literature on a given topic or issue. Scoping reviews draw on evidence from any research methodology and may also include evidence from non-research sources, such as policy. In this manner, scoping reviews provide a comprehensive overview to address broader review questions than traditionally more specific systematic reviews of effectiveness or qualitative evidence. The increasing popularity of scoping reviews has been accompanied by the development of a reporting guideline: the PRISMA-ScR. In 2014, the JBI Scoping Review Methodology Group developed guidance for scoping reviews that received minor updates in 2017 and was most recently updated in 2020. The updates reflect ongoing and substantial developments in approaches to scoping review conduct and reporting. As such, the JBI Scoping Review Methodology Group recognized the need to revise the guidance to align with the current state of knowledge and reporting standards in evidence synthesis. Methods: Between 2015 and 2020, the JBI Scoping Review Methodology Group expanded its membership; extensively reviewed the literature; engaged via annual face-to-face meetings, regular teleconferences, and email correspondence; sought advice from methodological experts; facilitated workshops; and presented at scientific conferences. This process led to updated guidance for scoping reviews published in the JBI Manual for Evidence Synthesis. The updated chapter was endorsed by JBI's International Scientific Committee in 2020. Results: The updated JBI guidance for scoping reviews includes additional guidance on several methodological issues, such as when a scoping review is (or is not) appropriate, and how to extract, analyze, and present results, and provides clarification for implications for practice and research. Furthermore, it is aligned with the PRISMA-ScR to ensure consistent reporting. Conclusions: The latest JBI guidance for scoping reviews provides up-to-date guidance that can be used by authors when conducting a scoping review. Furthermore, it aligns with the PRISMA-ScR, which can be used to report the conduct of a scoping review. A series of ongoing and future methodological projects identified by the JBI Scoping Review Methodology Group to further refine the methodology are planned.
Article
Full-text available
Background: Behavioural science can play a critical role in combatting the effects of an infectious disease outbreak or public health emergency, such as the COVID-19 pandemic. The current paper presents a synthesis of review literature discussing the application of behaviour change theories within an infectious disease and emergency response context, with a view to informing infectious disease modelling, research and public health practice. Methods: A scoping review procedure was adopted for the searches. Searches were run on PubMed, PsychInfo and Medline with search terms covering four major categories: behaviour, emergency response (e.g., infectious disease, preparedness, mass emergency), theoretical models, and reviews. Three further top-up reviews was also conducted using Google Scholar. Papers were included if they presented a review of theoretical models as applied to understanding preventative health behaviours in the context of emergency preparedness and response, and/or infectious disease outbreaks. Results: Thirteen papers were included in the final synthesis. Across the reviews, several theories of behaviour change were identified as more commonly cited within this context, specifically, Health Belief Model, Theory of Planned Behaviour, and Protection Motivation Theory, with support (although not universal) for their effectiveness in this context. Furthermore, the application of these theories in previous primary research within this context was found to be patchy, and so further work is required to systematically incorporate and test behaviour change models within public health emergency research and interventions. Conclusion: Overall, this review identifies a range of more commonly applied theories with broad support for their use within an infectious disease and emergency response context. The Discussion section details several key recommendations to help researchers, practitioners, and infectious disease modellers to incorporate these theories into their work. Specifically, researchers and practitioners should base future research and practice on a systematic application of theories, beginning with those reported herein. Furthermore, infectious disease modellers should consult the theories reported herein to ensure that the full range of relevant constructs (cognitive, emotional and social) are incorporated into their models. In all cases, consultation with behavioural scientists throughout these processes is strongly recommended to ensure the appropriate application of theory.
Article
Full-text available
This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies. Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components. Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap. None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health. Plain language summary Community‐based approaches are most effective in promoting changes in hygiene practices, but sustainability is a challenge Community‐based approaches to promote handwashing and sanitation efforts seem to work better than social marketing, messaging and interventions based on psychosocial theory. Programs combining hygiene and sanitation measures appears to have a larger impact than either one alone. What is this review about? Diarrhoeal diseases are very common causes of death in low and middle‐income countries. Improved sanitation and hygiene reduce diarrhoea, but adoption remains a challenge. This review assesses the evidence for two questions: (1) how effective are different approaches to promote handwashing and sanitation behaviour change; and (2) what factors influence the implementation of these approaches? What is the aim of this review? This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies. What studies are included? Studies of effectiveness had to be impact evaluations using an experimental or quasi‐experimental design and analytical observational studies. Implementation studies used qualitative designs. Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa. What are the main findings of this review? Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components. Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap. None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health. What factors affect implementation? Implementation is affected by length of the intervention; visit frequency; use of short communication messages; availability of training materials; kindness, respect, status and accessibility of the implementer; recipient awareness about costs and benefits and their access to infrastructure and social capital. For community‐based approaches, involvement of the community, enthusiasm of community leaders, having a sense of ownership, the implementer being part of the community, gender of the implementer, trust, income generating activities, clear communication and developing a culture of cooperation facilitated implementation. For sanitation and hygiene messaging, text messages should be short and culturally appropriate, passive teaching methods in schools and reminders should be frequent and over a long period. Barriers include illiteracy and a lack of interest and involvement from the family in case of a school intervention. For the social marketing approach barriers were mainly about the use of sanitation loans such as lack of communication to latrine business owners about which area to cover, loan processing times and sanitation loans not reaching poor people. What do the findings of this review mean? Promotional approaches aimed at handwashing and sanitation behaviour change can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. A combination of different promotional elements is probably the most effective strategy. Identifying and tackling the different barriers and facilitators that influence the implementation of these promotional approaches can increase effectiveness. An important implication for research is that there is a need for a more uniform method of measuring and reporting on handwashing, latrine use, safe faeces disposal, and open defecation. How up‐to‐date is this review? The review authors searched for studies published until March 2016; this Campbell Systematic Review was published in May 2017. Executive summary/Abstract BACKGROUND Water and sanitation are at the very core of sustainable development, critical to the survival of people and the planet. The Sustainable Development Goal 6 (i.e. ‘ensure availability and sustainable management of water and sanitation for all’) addresses the issues relating to drinking water, sanitation and hygiene. It is unclear which Water, Sanitation and Hygiene (WASH) promotional approach is the most effective for sanitation and hygiene behaviour change, and other outcomes leading to behaviour change (e.g. learning outcomes) or longer term outcomes that follow from behaviour change (e.g. mortality, morbidity). OBJECTIVES The overall goal of this systematic review is to show which promotional approaches are effective in changing handwashing and sanitation behaviour, and which implementation factors affect the success or failure of such interventions. This goal is achieved by answering two different review questions. Question 1: What is the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, in communities in low‐ and middle‐income countries? Question 2: What factors influence the implementation of approaches to promote handwashing and sanitation behaviour change, in communities in low‐ and middle‐income countries? SEARCH METHODS A comprehensive search was conducted to identify both published and unpublished studies. Using a sensitive search strategy, we searched the following databases from 1980 to March 2016: Medline (PubMed), Cochrane CENTRAL Issue 2, Applied Social Sciences index and abstracts (ASSIA, ProQuest), Global Health (CABI), EMBASE (OVID), PsycInfo (EBSCOHost), ERIC (EBSCOHost), Global Index Medicus, 3ie Impact Evaluation Database, International bibliography of the Social Sciences (IBSS, ProQuest), Sociological abstracts (ProQuest) and Social Sciences citation index (SSCI, Web of Science). To find unpublished material and relevant programme documents, we contacted various research groups and organizations and/or checked the relevant websites. SELECTION CRITERIA Participants included both children and adults from low‐ and middle‐income countries (LMICs), as defined by the World Bank, at the time the intervention was implemented. Studies performed at an individual, household, school or community level were included, whereas studies conducted in institutional settings (e.g. hospitals) were excluded. The following promotional approaches or elements to promote handwashing, latrine use, safe faeces disposal, and to discourage open defecation (primary outcomes), were included: community‐based approaches, social marketing approaches, sanitation and hygiene messaging and elements of psychosocial theory. Secondary outcomes of interest were behavioural factors (knowledge, skills, attitude, norms, self‐regulation) and health outcomes (morbidity, mortality). For Question 1 (effectiveness of promotional approaches), we included impact evaluations using an experimental, quasi‐experimental design and observational analytical studies. To answer Question 2 (implementation aspects), all qualitative study designs addressing factors influencing implementation of the promotional approaches were considered for inclusion. This included, for example, grounded theory, case studies, phenomenological studies, ethnographic research, action research and thematic approaches to qualitative data analysis. DATA COLLECTION AND ANALYSIS Study selection and data extraction (including risk of bias assessment) were performed independently by two reviewers, using EPPI‐Reviewer software. Study authors of all included papers were contacted by email (in July 2016) to ask for any relevant information, related to the population, intervention or outcomes, that was missing or not reported in the paper. Any disagreements between the two data extractors were resolved through discussion, or by consulting another review co‐author. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the overall quality/certainty of evidence from quantitative studies included in this review. The qualitative studies were assessed using the CASP (Critical Appraisal Skills Program) checklist. Evidence relating to Question 1 (effectiveness of promotional approaches) was synthesized in a quantitative way (meta‐analysis), where possible. RESULTS Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa. Most quantitative studies (69%) were performed in a rural setting and only 14% of the studies took place in an urban setting (with an additional 10% in an “informal‐rural setting”). The effect of a promotional approach versus not using a promotional approach on sanitation and handwashing behaviour change, behavioural factors (knowledge, skills, attitude, norms and self‐regulation) and health‐related outcomes (morbidity and mortality), was studied in 34 different studies. In addition, 7 studies compared specific promotional approaches versus other promotional approaches, and one study compared two different communication strategies. All studies showed substantial variability in programme content, study types, outcome types, methods of outcome measurement and timing of measurement. Risk of bias assessments of included studies were influenced by unclear reporting or lack of reporting of key methodological aspects of the study design and process. Five percent of the experimental studies (n=2) had a high risk of selection bias, 40% had a high risk of detection bias (n=17), 28% had a high risk of attrition bias (n=12) and 48% had a high risk of reporting bias (n=20). Most quasi‐experimental and observational studies had bias in the selection of participants, some were at high risk of confounding, methods of outcome assessment were not comparable across intervention groups, and outcome assessors were aware of the interventions that the groups received. For the body of evidence, in most assessments, the certainty of evidence was considered as ‘low’ and in some cases ‘moderate’ or ‘very low’. For the qualitative studies, an overall CASP score was given to the studies, and only 21% of the studies had a score less than 8/10. In studies with a lower score the relationship between researcher and participants was not adequately considered or ethical issues were not explicitly reported. We categorised the studies into 4 categories of promotional approaches or elements: (1) community‐based approaches, a promotional approach where there is typically community involvement and engagement, and shared decision‐making is part of the approach. All but one study in this category implemented a sanitation intervention, in some cases combined with a handwashing with soap and/or water supply/water quality component. (2) social marketing approaches, a promotional approach combining enterprise approaches with demand stimulation, and assuming that people both want and are able to change their behaviour. All but two studies in this category implemented a handwashing with soap intervention, in some cases combined with a sanitation and/or water supply/water quality component. (3) sanitation and hygiene messaging, is a predominantly directive educational approach, consisting mainly of one‐way communication, designed to help individuals and communities improve their health, by increasing their knowledge and/or skills. All but one study in this category implemented a handwashing with soap intervention, in some cases combined with a sanitation and/or water supply/water quality component. (4) elements of psychosocial theory, which are derived from a formal psychosocial theory and form the basis of the intervention. All but one study in this category implemented a handwashing‐only intervention, and one study implemented a combined handwashing and sanitation intervention. The most consistent results were obtained within the category of community‐based approaches, where at least a sanitation component was part of the programme. Working in a community‐based way may be effective in terms of handwashing with soap, and sanitation outcomes (latrine use, safe faeces disposal, and open defecation). Limited positive results on the knowledge of key handwashing times were found. Influencing factors that could play a specific role in the implementation of community‐based interventions are: a facilitator (e.g. health promoter, community leader) that is part of and representative of the community, the attitude of the implementer/facilitator, providing enough information, and creating a culture of cooperation. In addition, the gender of the facilitator seems to play an important role, since women prefer to discuss private issues with somebody of the same sex. The use of social marketing approaches seems to be less uniformly applicable, and mainly show an effect on sanitation outcomes when interventions have a combined handwashing and sanitation component. A specific barrier that could play a role in the implementation of social marketing interventions was the use of sanitation loans (slow and expensive process, not reaching the poor and people with lack of financial knowledge). Additional income generation would be an important facilitator for this type of approach. Sanitation and hygiene messaging, with a focus on handwashing with soap, seem to have an effect on handwashing programmes immediately after the intervention has ended. However, these effects are not sustainable in the long term. This type of promotional approach may make little or no difference to sanitation outcomes. With this approach it seems key that messages are delivered using active teaching methods and that messaging is innovative and culturally sensitive. In case of school level interventions with children, the duration of the intervention and involving the children's parents seem to be positive influencing factors. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seems promising for handwashing with soap. Finally, the methods used for communicating the content of a certain promotional approach, also play a role, and use of interpersonal communication was shown to be effective in certain circumstances. We only found a limited number of studies that incorporated a range of incentives (from soap bars to food or subsidies) into the promotional approach. One study reported promising results when using subsidies as part of the community‐based approach, but more research on the use of subsidies and incentives would be valuable. None of the promotional approaches described in the review showed consistent effects on behavioural factors such as knowledge, skills and attitude. Also no consistent effects on health were demonstrated. Facilitators which were relevant across different promotional approaches were: length of the approach, visit frequency, using short communication messages, availability of training materials, funding/resources and partnerships, kindness and respect of the implementer, accessibility of the implementer, and the implementer's authority/status; as well as, on the side of the recipient, awareness about costs and benefits, social capital, access to infrastructure and availability of space, and others showing the behaviour. AUTHORS’ CONCLUSIONS Implications for policy and practice. Based on our findings, promotional approaches aimed at handwashing and sanitation behaviour change can be effective in terms of handwashing with soap, latrine use, safe faeces disposal and open defecation. Findings from experimental, quasi‐experimental design and observational analytical studies show that a combination of different promotional elements is probably the most effective strategy. The recognition of different barriers and facilitators that influence the implementation of these promotional approaches may have a triggering effect on its effectiveness. Implications for research. An important implication of our work is that there is an urgent need to use a more uniform method of outcome measurement (type of outcomes, way of assessment, timing of assessment). This will facilitate making conclusions on the effects of promotional approaches in the future. In addition, it is important to further assess barriers and facilitators, identified in this review, alongside quantitative analyses of promotional approaches.
Article
Full-text available
As the threat of arboviral diseases continues to escalate worldwide, the question of, “What types of human communities are at the greatest risk of infection?” persists as a key gap in the existing knowledge of arboviral diseases transmission dynamics. Here, we comprehensively review the existing literature on the socioeconomic drivers of the most common Aedes mosquito-borne diseases and Aedes mosquito presence/abundance. We reviewed a total of 182 studies on dengue viruses (DENV), chikungunya virus (CHIKV), yellow fever virus (YFVV), and Zika virus (ZIKV), and presence of Aedes mosquito vectors. In general, associations between socioeconomic conditions and both Aedes-borne diseases and Aedes mosquitoes are highly variable and often location-specific. Although 50% to 60% of studies found greater presence or prevalence of disease or vectors in areas with lower socioeconomic status, approximately half of the remaining studies found either positive or null associations. We discuss the possible causes of this lack of conclusiveness as well as the implications it holds for future research and prevention efforts.
Article
Full-text available
Background: Incidents of vector-borne disease have recently tripled in the United States. Chikungunya disease is a particularly common disease in the Caribbean, posing a threat to international tourists. However, the relationship between psychological variables derived from the protection motivation theory (PMT), and adoption of protective behaviors against the disease, is uncertain. This study sought to identify the psychological predictors of travelers’ protective health behaviors, specifically (1) appropriate clothing use, and (2) indoor spatial repellent use. Methods: An online, retrospective survey of U.S. international travelers to Caribbean destinations measured the five constructs of the PMT in the context of Chikungunya disease: Perceived severity, perceived vulnerability, perceived response efficacy, perceived self-efficacy, and knowledge. Hierarchical logistic regression analyzed whether these five theoretical constructs predicted the two protective behaviors in respondents who met study criteria (n = 184). Results: Results suggest that the interaction between chikungunya knowledge and perceived chikungunya severity predicts both appropriate clothing use (odds ratio [OR]: 1.95, CI: 1.18-3.25, P =0.010) and indoor spatial repellent use (OR: 1.55, CI: 1.05-2.29, P =0.029). In the cases of appropriate clothing use, the interaction between perceived chikungunya severity and perceived vulnerability was also a significant predictor (OR: 9.67, CI:1.23-75.80, P =0.031). Additionally, indoor spatial repellent use was also predicted by the interaction of chikungunya knowledge and perceived vulnerability (OR: 1.88, CI:1.18-3.02, P =0.009). Conclusion: Two-pronged educational approaches may be most efficacious in increasing protective health behaviors. Such efforts could reduce incidents of chikungunya disease and other vectorborne diseases in travel destinations featuring high exposure risks.
Article
Full-text available
Background: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014-2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. Methods: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. Results: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too 'experimental', and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. Conclusions: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations.
Article
Full-text available
Vector-borne diseases (VBDs) such as malaria, dengue, and leishmaniasis exert a huge burden of morbidity and mortality worldwide, particularly affecting the poorest of the poor. The principal method by which these diseases are controlled is through vector control, which has a long and distinguished history. Vector control, to a greater extent than drugs or vaccines, has been responsible for shrinking the map of many VBDs. Here, we describe the history of vector control programmes worldwide from the late 1800s to date. Pre 1940, vector control relied on a thorough understanding of vector ecology and epidemiology, and implementation of environmental management tailored to the ecology and behaviour of local vector species. This complex understanding was replaced by a simplified dependency on a handful of insecticide-based tools, particularly for malaria control, without an adequate understanding of entomology and epidemiology and without proper monitoring and evaluation. With the rising threat from insecticide-resistant vectors, global environmental change, and the need to incorporate more vector control interventions to eliminate these diseases, we advocate for continued investment in evidence-based vector control. There is a need to return to vector control approaches based on a thorough knowledge of the determinants of pathogen transmission, which utilise a range of insecticide and non–insecticide-based approaches in a locally tailored manner for more effective and sustainable vector control.
Article
Full-text available
Background: Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are effective for malaria prevention and are designed to provide nearly 5 years of mosquito protection. However, many ITNs and LLINs become damaged and ineffective for mosquito bite prevention within 1 to 2 years in field conditions. Non-adherence to recommended bed net care and repair practices may partially explain this shortened net longevity. Methods: Using data from a cross-sectional study, a net care adherence score was developed and adherence to net care practices described from two regions of western Kenya. Relationships between attitudes and environmental factors that influence net longevity were measured with adherence to bed net care practices. Results: While overall care practices are highly adherent particularly in the highlands, practices related to daily storage, washing frequency, and drying location need improvement in the lowlands. Seventy-seven percent of nets in the lowlands were washed < 3 months prior to the survey compared to 23% of nets in the highlands. More nets were dried in the sun in the lowlands (32% of nets) compared to the highlands (4% of nets). Different elements of care are influenced by various malaria attitudes and environmental factors, highlighting the complexity of factors associated with net care. For example, households that learned about net care from community events, that share a sleeping structure with animals, and that have nets used by adult males tend to adhere to washing frequency recommendations. Conclusions: In western Kenya, many nets are cared for in accordance to recommended practices, particularly in the highlands sites. In the lowlands, demonstrating methods at community events to tie nets up during the day coupled with messaging to emphasize infrequent washing and drying nets in the shade may be an appropriate intervention. As illustrated by differences between the highlands and lowlands sites in the present study, should interventions to improve adherence to bed net care practices be necessary, they should be context-specific.
Article
Full-text available
Background: Malaria preventive measures, including long-lasting insecticide-treated bet nets (LLINs), indoor residual spraying (IRS), and controlling mosquito breeding sites, are key measures to achieve malaria elimination. Still, compliance with these recommended measures remains a major challenge. By applying a novel and comprehensive model for determinants of malaria prevention behaviour, this study tests how individual perceptions influence the intentions to use malaria preventive measures and explores strategies that stimulate their consistent use. Methods: The study was carried out in the sectors of Ruhuha and Busoro, Rwanda during October and November 2017, and these were conducted into two phases. Phase one involved a questionnaire survey (N = 742), whereas Phase two employed a qualitative approach that included nine focus group discussions, seven key informant interviews, and three in-depth interviews. Results: The findings of the quantitative study showed that participants very often use LLINs (66.6%), accept IRS (73.9%), and drain stagnant water in case of presence (62%). The intentions to use malaria preventive measures were consistently driven by perceived severity, perceived self-efficacy, perceived response efficacy, and subjective norms, and hindered by perceived barriers. The intentions were also positively associated with the actual use of LLINs, acceptance of IRS, and drainage of stagnant water. There is no evidence that either not having enough LLINs (ownership of at least one bed net in the household, here referred to as availability) or having sufficient LLINs (having one LLIN per two people in the household, here referred to as accessibility) moderated the relationship between behavioural intentions and actual use of LLINs. The qualitative study indicated that participants believed malaria risk to be high and perceived a high mosquito density. They also believed that repetitive malaria episodes are caused by the perceived low effectiveness of anti-malaria medications. Lack of LLINs increased the perceived added value of LLINs, and together with the increased malaria burden increased the perceived response efficacy. Participants highlighted the need to continuously mobilize and engage community members especially those who do not use LLINs when having one, and those who do not accept the spraying activities. Conclusion: Malaria prevention interventions should target individual perceptions to enhance consistent use of malaria preventive measures. Three strategies to improve consistent use and acceptance of these measures are highlighted: (1) ensure access to LLINs and regular spraying activities, (2) community mobilization and (3) citizen engagement in malaria prevention activities.
Article
Full-text available
Understanding factors affecting decisions by people to protect themselves, or not, is critical to designing supportive communications. Here, threat, protective‐action, and stakeholder perceptions were evaluated for effects on mainland Americans’ behavioral intentions regarding Zika in April 2017, as postulated by the Protective Action Decision Model. Although all three perception types (including a novel resource sufficiency measure) affected intentions, these relationships varied widely depending upon the method used to measure adoption of actions (e.g., total count of all behaviors adopted vs. behavior‐specific analyses), the behaviors involved, and whether analysis focused on the full sample or only on people who had a reasonable opportunity to enact the behavior or who believed it relevant to their lives. There was a general contrast between mosquito control actions (removal of mosquito breeding areas and pesticide spraying) and travel‐related behaviors (avoiding travel to areas of local transmission of the virus, protecting oneself from mosquito bites after potential exposure, and practicing safe sex after potential exposure). Reported action or inaction during the 2016 mosquito season, and stages of behavior change, were both elicited in January–February 2017; both drove intentions in April 2017 for the upcoming season, although direct and indirect effects varied widely. Collectively these findings present theoretical, measurement, and practical implications for understanding, tracking, and promoting voluntary protective actions against hazards.
Article
Full-text available
Background: Sleeping under a long-lasting insecticidal net (LLIN) is recommended for all pregnant women in sub-Saharan Africa, due to the high prevalence of malaria infection and its associated complications in the region. Despite this, LLIN use has still remained sub-optimal among pregnant women in Maiduguri, Nigeria. Understanding the interplay of factors influencing this important health behaviour would guide the development of interventions to promote its adoption. Methods: Data was collected from 380 randomly selected antenatal care attendees of a hospital in Maiduguri, using structured questionnaires. This data was then used to test the Information-Motivation-Behavioural Skills (IMB) model, for model fit, and interrelations among the constructs, using the structural equation modelling analysis with Smart-PLS. Results: Information and motivation were significantly related to behavioural skills (r = 0.29, p < 0.001 and r = 0.37, p < 0.001, respectively); and also to behaviour (r = 0.22, p < 0.001 and r = 0.11, p = 0.033 respectively). Behavioural skills however, did not significantly relate to behaviour (r = 0.03, p = 0.278). Conclusion: These findings highlight the potential usefulness of the IMB model in guiding interventions for promoting LLIN use among this group. More emphasis should also be laid on boosting levels of information and motivation among the target group.
Article
Full-text available
Background: Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others' behaviours. Methods: Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals' perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors. Results: Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09-4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors. Conclusions: Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.
Article
Full-text available
Vector-borne diseases account for a significant amount of the global infectious disease burden, including morbidity and mortality. In particular, mosquito-borne infectious diseases (MBIDs) have the greatest burden in number of cases, mortality, and disability-adjusted life years and their prevention and control is critical. However, prevention efforts are hindered by the absence of vaccines and failure of long-term mosquito vector control for these MBIDs. Thus, personal protective behaviors (PPBs) may offer the most promising and effective mode of prevention. This study examines the impact of awareness, perceived susceptibility, and perceived severity for five MBIDs (e.g., Malaria, Dengue, Zika, Chikungunya and West Nile) on the adoption of PPBs. Study participants (n = 1043) were recruited from a probability-based internet panel of adult United States residents with a history of traveling outside of the country in the past year. Data were collected in the U.S. between June 7, 2017 and June 12, 2017. Our findings show that awareness of Zika disease among respondents was consistently associated with adoption of all three PPBs. Respondents that reported high-perceived severity for all five MBIDs were also more likely to report adopting the PPBs of wearing covering clothing and use of mosquito repellent spray. Our findings indicate that U.S. travelers are largely more concerned about Zika, Chikungunya, and Dengue than Malaria and West Nile and that these concerns drive their adoption of the three recommended PPBs. This information should inform the development and design of future public health campaigns for behavior modification to prevent MBIDs.
Article
Full-text available
Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
Article
Full-text available
Background: Zika virus (ZIKV) spread rapidly in the Americas in 2015. Targeting effective public health interventions for inhabitants of, and travellers to and from, affected countries depends on understanding the risk of ZIKV emergence (and re-emergence) at the local scale. We explore the extent to which environmental, social and neighbourhood disease intensity variables influenced emergence dynamics. Our objective was to characterise population vulnerability given the potential for sustained autochthonous ZIKV transmission and the timing of emergence. Logistic regression models estimated the probability of reporting at least one case of ZIKV in a given municipality over the course of the study period as an indicator for sustained transmission; while accelerated failure time (AFT) survival models estimated the time to a first reported case of ZIKV in week t for a given municipality as an indicator for timing of emergence. Results: Sustained autochthonous ZIKV transmission was best described at the temporal scale of the study period (almost one year), such that high levels of study period precipitation and low mean study period temperature reduced the probability. Timing of ZIKV emergence was best described at the weekly scale for precipitation in that high precipitation in the current week delayed reporting. Both modelling approaches detected an effect of high poverty on reducing/slowing case detection, especially when inter-municipal road connectivity was low. We also found that proximity to municipalities reporting ZIKV had an effect to reduce timing of emergence when located, on average, less than 100 km away. Conclusions: The different modelling approaches help distinguish between large temporal scale factors driving vector habitat suitability and short temporal scale factors affecting the speed of spread. We find evidence for inter-municipal movements of infected people as a local-scale driver of spatial spread. The negative association with poverty suggests reduced case reporting in poorer areas. Overall, relatively simplistic models may be able to predict the vulnerability of populations to autochthonous ZIKV transmission at the local scale.
Article
Full-text available
Background: The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014-2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts. Methods: Sampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use. Results: In all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative). Conclusion: This research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.
Article
Full-text available
Background Globally there are an estimated 390 million dengue infections per year, of which 96 million are clinically apparent. In Cambodia, estimates suggest as many as 185,850 cases annually. The World Health Organization global strategy for dengue prevention aims to reduce mortality rates by 50% and morbidity by 25% by 2020. The adoption of integrated vector management approach using community-based methods tailored to the local context is one of the recommended strategies to achieve these objectives. Understanding local knowledge, attitudes and practices is therefore essential to designing suitable strategies to fit each local context. Methods and findings A Knowledge, Attitudes and Practices survey in 600 randomly chosen households was administered in 30 villages in Kampong Cham which is one of the most populated provinces of Cambodia. KAP surveys were administered to a sub-sample of households where an entomology survey was conducted (1200 households), during which Aedes larval/pupae and adult female Aedes mosquito densities were recorded. Participants had high levels of knowledge regarding the transmission of dengue, Aedes breeding, and biting prevention methods; the majority of participants believed they were at risk and that dengue transmission is preventable. However, self-reported vector control practices did not match observed practices recorded in our surveys. No correlation was found between knowledge and observed practices either. Conclusion An education campaign regarding dengue prevention in this setting with high knowledge levels is unlikely to have any significant effect on practices unless it is incorporated in a more comprehensive strategy for behavioural change, such a COMBI method, which includes behavioural models as well as communication and marketing theory and practice. Trial registration ISRCTN85307778.
Article
Full-text available
This study documents an investigation into the adoption and diffusion of eave tubes, a novel mosquito vector control, during a large-scale scientific field trial in West Africa. The diffusion of innovations (DOI) and the integrated model of behavior (IMB) were integrated (i.e., innovation attributes with attitudes and social pressures with norms) to predict participants’ (N = 329) diffusion intentions. The findings showed that positive attitudes about the innovation’s attributes were a consistent positive predictor of diffusion intentions: adopting it, maintaining it, and talking with others about it. As expected by the DOI and the IMB, the social pressure created by a descriptive norm positively predicted intentions to adopt and maintain the innovation. Drawing upon sharing research, we argued that the descriptive norm may dampen future talk about the innovation, because it may no longer be seen as a novel, useful topic to discuss. As predicted, the results showed that as the descriptive norm increased, the intention to talk about the innovation decreased. These results provide broad support for integrating the DOI and the IMB to predict diffusion and for efforts to draw on other research to understand motivations for social diffusion.
Article
Full-text available
Introduction: This study examined the relationship between specific psychosocial variables and the use of insect repellents on skin or clothing as a preventive behavior for Chikungunya fever among US travelers to Caribbean destinations. Methods: A cross-sectional retrospective online survey method was adopted. US residents who travelled to one of 34 Caribbean destinations within the past 12 months and expressed an awareness of Chikungunya fever were invited to participate in this study. Sociodemographic variables, perceived response efficacy, perceived self-efficacy, perceived Chikungunya severity and susceptibility, and self-reported use of insect repellents were investigated. Results: Results of direct logistic regression analysis revealed a significant association between higher levels of education and the odds of self-reported use of insect repellent on skin or clothing among study participants. Among the proximal Chikungunya-related variables, hierarchical binary logistic regression revealed a significant association between scores on perceived response efficacy, perceived self- efficacy, and perceived severity of self-reported use of insect repellents. These results support the existence of a hierarchical relationship between the more proximal Chikungunya-related variables and self-reported use of insect repellents as a personal protective measure (PPM). Conclusion: The findings of the current study have important implications for health communication messaging aimed at reducing the spread of Chikungunya among US travelers to Caribbean destinations. It seems essential to establish the use of insect repellent on skin and clothing as a personal preventive measure against Chikungunya disease within an educational context, framed along the lines of Chikungunya severity, response efficacy, and self-efficacy, for US travelers to destinations with a high risk of exposure to Chikungunya disease-carrying mosquitoes.
Article
Full-text available
Background As the arboviral diseases dengue, chikungunya and Zika emerge in the Americas, so does the need for sustainable vector control policies. To successfully achieve mosquito control, joint efforts of both communities and governments are essential. This study investigates this important, but by-and-large neglected topic. Methods In June and July 2015, a cross-sectional mixed methods study applying a survey questionnaire (response rate of 82.5%; n = 339), in-depth interviews (n = 20) and focus group discussions (n = 7; 50 participants) was performed in Curaçao. The study was designed based on an integrated theoretical framework of the Health Belief Model and the Theory of Planned Behaviour. ResultsParticipants showed a good knowledge of, and a high-level performance of mosquito breeding site control (MBSC) practices. Personal protection against mosquitoes (e.g. topical repellents) was perceived as relatively less effective thus practiced to lower extent compared to MBSC practices (i.e. larval source management). A lower intention to perform MBSC was independently associated with: (i) satisfaction on governmental MBSC (P = 0.012); (ii) barriers to perform MBSC practices, i.e. ‘Government doesn’t control other breeding sites’ (P = 0.005), ‘Don’t know how to control breeding sites’ (P = 0.041), and ‘a mosquito does not transmit dengue’ (P = 0.016), (iii) attitudes towards MBSC (P = 0.001) and self-efficacy (person’s perceived ability to act) to perform MBSC (P = 0.002). Mixed-methods evidence highlights three possible ways of improving community participation in MBSC. First, it highlights the need for ongoing media coverage, targeting (i) communities’ perceptions on transmission routes of dengue and chikungunya, and (ii) presence of car tires in yards. Secondly, it shows that promotion of governmental activities in MBSC can enhance MBSC of communities, if people develop a sense of responsibility to perform MBSC at their own properties. Thirdly, this study describes the presence of key persons in communities, who could be engaged in mosquito control policies to improve MBSC in neighbourhoods. Conclusion This study reveals gaps between policy and communities’ lived realities. These gaps might be overcome with the proposed interventions, resulting in a higher performance of MBSC in the community in Curaçao. Furthermore, this study shows how interdisciplinary mixed methods research can provide important, comprehensive, and in-depth insights to inform mosquito control policies.
Article
Full-text available
Background A modified theory of planned behaviour (acronym CASCADA) proposes that Conscious knowledge precedes a change in Attitude, which in turn precedes positive deviations from negative Subjective norms, intention to Change, perception of Agency to change, Discussion of possible action, and Action itself. We used this as a results chain to investigate gender-specific behaviour dynamics in chemical-free dengue prevention. Methods Secondary analysis of the Mexican arm of a cluster randomised controlled trial used household survey data on intermediate outcomes of dengue prevention behaviour. We used a matrix of odds ratios between outcomes, transformed to a symmetrical range (−1, 1), to compute fuzzy transitive closure of the results chain for control and intervention clusters, then for male and female respondents separately in each group. Transitive closure of a map computes the influence of each factor on each other factor, taking account of all influences in the system. Cumulative net influence was the sum of influences across the results chain. Results Responses of 5042 women and 1143 men in 45 intervention clusters contrasted with those of 5025 women and 1179 men in 45 control clusters. Control clusters showed a distal block (negative influence) in the results chain with a cumulative net influence of 0.88; intervention clusters showed no such block and a cumulative net influence of 1.92. Female control respondents, like the overall control picture, showed a distal block, whereas female intervention responses showed no such blocks (cumulative net influence 0.78 and 1.73 respectively). Male control respondents showed weak distal blocks. Male intervention responses showed several new negative influences and a reduction of cumulative net influence (1.38 in control and 1.11 in intervention clusters). Conclusions The overall influence of the intervention across the results chain fits with the trial findings, but is different for women and men. Among women, the intervention overcame blocks and increased the cumulative net influence of knowledge on action. Among men, the intervention did not reinforce prevention behaviour. This might be related to emphasis, during the intervention, on women’s participation and empowerment. The fuzzy transitive closure of the CASCADA map usefully highlights the differences between gender-specific results chains. Trial registration ISRCTN27581154.
Article
Full-text available
Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014-15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region (N = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.
Article
Full-text available
The aims of this study were to explore the differences in (1) the perception of severity towards ZIKV infection and dengue fever, and (2) mosquito control practices before and after the ZIKV outbreak were declared a Public Health Emergency of International Concern (PHEIC). Data were collected between February 2015 and May 2016 using a computer-assisted telephone interviewing system. The median scale score for perceived severity of ZIKV was 3 (interquartile range [IQR] 1-5) versus 4 (IQR 3-5) for dengue (P < 0.001). The scores for mosquito control practices before and after ZIKV was declared a PHEIC were similar, at 4 (IQR 3-5). Multivariate analysis revealed that participants with a higher score for perception of severity of ZIKV were more likely to report greater mosquito control practices after the declaration of the PHEIC (OR 1.822 [95% CI 1.107-2.998]). The emerging ZIKV pandemic requires concerted efforts to enhance mosquito control practices among the Malaysian public. Efforts to improve public mosquito control practices should focus on enhancing the perception of the severity of ZIKV.
Article
Full-text available
Background There is renewed interest in effective measures to control Zika and dengue vectors. A synthesis of published literature with a focus on the quality of evidence is warranted to determine the effectiveness of vector control strategies. Methodology We conducted a meta-review assessing the effectiveness of any Aedes control measure. We searched Scopus and Medline for relevant reviews through to May 2016. Titles, abstracts and full texts were assessed independently for inclusion by two authors. Data extraction was performed in duplicate and validity of the evidence was assessed using GRADE criteria. Findings 13 systematic reviews that investigated the effect of control measures on entomological parameters or disease incidence were included. Biological controls seem to achieve better reduction of entomological indices than chemical controls, while educational campaigns can reduce breeding habitats. Integrated vector control strategies may not always increase effectiveness. The efficacy of any control programme is dependent on local settings, intervention type, resources and study duration, which may partly explain the varying degree of success between studies. Nevertheless, the quality of evidence was mostly low to very low due to poor reporting of study design, observational methodologies, heterogeneity, and indirect outcomes, thus hindering an evidence-based recommendation. Conclusions The evidence for the effectiveness of Aedes control measures is mixed. Chemical control, which is commonly used, does not appear to be associated with sustainable reductions of mosquito populations over time. Indeed, by contributing to a false sense of security, chemical control may reduce the effectiveness of educational interventions aimed at encouraging local people to remove mosquito breeding sites. Better quality studies of the impact of vector control interventions on the incidence of human infections with Dengue or Zika are still needed.
Article
Full-text available
Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the global malaria control strategy. LLIN ownership, however, does not necessarily guarantee use. Thus, even in the ideal setting in which universal coverage with LLINs has been achieved, maximal malaria protection will only be achieved if LLINs are used both correctly and consistently. This study investigated the factors associated with net use, independent of net ownership. Data were collected during a household survey conducted in Ebonyi State in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based social behavior change (SBC) intervention. Logistic regression analyses, controlling for household bed net ownership, were conducted to examine the association between individual net use and various demographic, environmental, behavioral and social factors. The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit (OR = 17.11; 95% CI 4.45-65.79) or who received greater degrees of social support from friends and family (ptrend < 0.001). Factors associated with decreased odds of net use included: increasing education level (ptrend = 0.020), increasing malaria knowledge level (ptrend = 0.022), and reporting any disadvantage of bed nets (OR = 0.39; 95% CI 0.23-0.78). The findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit. The malaria community should thus further consider the importance of community outreach, interpersonal communication and social support on adoption of net use behaviors when designing future research and interventions.
Article
Full-text available
Dengue is prevalent among Malaysia's indigenous peoples, known as the Orang Asli, and it poses a serious health threat to them. The study aims to look at the socio-demographic factors, health beliefs, and knowledge about dengue and its association to dengue prevention practices among Orang Asli communities in Peninsular Malaysia. A cross-sectional survey was conducted in 16 randomly selected Orang Asli villages from eight states in Peninsular Malaysia from April 2012 until February 2013. A total of 560 Orang Asli were interviewed and 505 completed the survey. Slightly above half of the participants (n = 280, 55.4%) had a total dengue prevention score of 51-100 (of a possible score of 0-100). Multivariate analysis findings showed dengue knowledge, perceived barriers to perform dengue prevention, fogging frequency, and perceived susceptibility to dengue fever as significant factors associated to dengue prevention practices. Participants with a lower dengue knowledge score (score 0-18) were less likely (OR = 0.63, 95%CI = 0.44-0.92 vs. score 19-36, P = 0.015) to practice dengue prevention. Participants with low perceived barriers to prevent dengue (score of 1-5) were more likely (OR = 2.06, 95%CI = 1.21-3.53, vs. score of 6-10, P = 0.008) to practice dengue prevention. Villages that were not fogged (OR = 0.49, 95%CI = 0.24-0.99, P = 0.045) or rarely fogged (OR = 0.40, 95%CI = 0.22-0.75, P = 0.004) had lower dengue prevention practices than villages that were fogged often. Participants with low perceived susceptibility of acquiring dengue (score of 1-5) were less likely (OR = 0.54, 95%CI = 0.33-0.89 vs. score of 6-10, P = 0.018) to practice dengue prevention measures. Findings imply that educational and health programmes should focus on enhancing dengue knowledge and perceived susceptibility of acquiring dengue and reducing perceived barriers to performing dengue prevention practices among the Orang Asli. More outreach on mosquito control campaigns should be carried out especially in villages where mosquito fogging is frequent.
Article
Full-text available
The endemic state of West Nile virus (WNv) in North America underscores the need to examine mechanisms influencing human self-protective behavior. Based on previous findings and theory, this study is designed to achieve two specific aims. First, the study will examine self-protective behavior for WNv through a hybridized treatment of the Health Belief Model that includes cognitive, affective, ecological, and proximity risk perception measures. Second, within the resulting hybridized model explore the role of ethnicity in self-protective behavior for WNv. Data were collected in Greeley, Colorado, using a self-administered mail survey. 384 completed surveys were returned (49 % completion rate). The questionnaire used items on cognitive-affective risk perception, ecological and proximity risk perception constructs, the Health Belief Model and demographics. Analysis revealed that newer risk perception models (ecological and proximity) provide some power to explain protective behavior. The psychometric measures of risk perception (cognitive and affective components) provided the best explanatory power. Self-protective behavior was further enhanced by the perception of benefits associated with such actions and the exposure to information cues to action. Hispanic/Latinos demonstrate greater perception of risk/susceptibility and greater exposure to information cues to action, and were more likely to practice self-protective behavior. The findings in this study point to several useful openings for effective public health communication and intervention for WNv based on affective response, information exposure, and ethnicity. The results also have relevance for vectored diseases generally. It is becoming clear that changes in global climate will bring increased threat from mosquito vectored diseases. Mosquito protection will be an increasingly salient topic for public health communicators in the coming years.
Article
Full-text available
A growing number of recent reports have implicated Rickettsia felis as a human pathogen, paralleling the increasing detection of R. felis in arthropod hosts across the globe, primarily in fleas. Here Anopheles gambiae mosquitoes, the primary malarial vectors in sub- Saharan Africa, were fed with either blood meal infected with R. felis or infected cellular media administered in membrane feeding systems. In addition, a group of mosquitoes was fed on R. felisinfected BALB/c mice. The acquisition and persistence of R. felis in mosquitoes was demonstrated by quantitative PCR detection of the bacteria up to day 15 postinfection. R. felis was detected in mosquito feces up to day 14. Furthermore, R. felis was visualized by immunofluorescence in salivary glands, in and around the gut, and in the ovaries, although no vertical transmission was observed. R. felis was also found in the cotton used for sucrose feeding after the mosquitoes were fed infected blood. Natural bites from R. felisinfected An. gambiae were able to cause transient rickettsemias in mice, indicating that this mosquito species has the potential to be a vector of R. felis infection. This is particularly important given the recent report of high prevalence of R. felis infection in patients with “fever of unknown origin” in malaria-endemic areas.
Article
Full-text available
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural science journals. Of secondary interest we developed a list of agreed criteria for judging the quality of the theories. We identified 82 theories and 9 criteria for assessing theory quality. The potential relevance of this wide-ranging number of theories to public health interventions and the ease and usefulness of evaluating the theories in terms of the quality criteria are however yet to be determined.
Article
Full-text available
Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision-making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance. We completed a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organization of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesized. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH). We identified 15 WASH-specific theoretical models, behaviour change frameworks, or programmatic models, of which 9 addressed our review questions. Existing models under-represented the potential role of technology in influencing behavioural outcomes, focused on individual-level behavioural determinants, and had largely ignored the role of the physical and natural environment. IBM-WASH attempts to correct this by acknowledging three dimensions (Contextual Factors, Psychosocial Factors, and Technology Factors) that operate on five-levels (structural, community, household, individual, and habitual). A number of WASH-specific models and frameworks exist, yet with some limitations. The IBM-WASH model aims to provide both a conceptual and practical tool for improving our understanding and evaluation of the multi-level multi-dimensional factors that influence water, sanitation, and hygiene practices in infrastructure-constrained settings. We outline future applications of our proposed model as well as future research priorities needed to advance our understanding of the sustained adoption of water, sanitation, and hygiene technologies and practices.
Article
Full-text available
Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.
Article
Full-text available
Background: Malaria-related knowledge, preventative methods and treatment-seeking behaviours were investigated in a post-conflict district of Sri Lanka in order to guide the development of components of malaria interventions and to support future programme evaluation. Methods: A structured questionnaire was used to collect data from a random sample of 300 households in four Divisional Secretariat Divisions (DSD) of the district where internally displaced populations were being resettled after a 30-year civil war. Results: The surveyed community had a good overall level of knowledge of malaria. There was high bednet ownership (94.0%), although only 48.0% of households in the study had long-lasting insecticide-treated nets (LLIN). Most respondents reported rapid treatment-seeking behaviour (71.0%) and easy access to malaria diagnostic facilities (67.0%). The Tamil population living in Manthai West and Madhu DSDs who were displaced to refugee camps had better malaria-related knowledge and practices, probably due to the malaria control activities focused on these camps by the government. Conclusions: Although knowledge and practices regarding malaria amongst resettled populations in Mannar District were high, continued malaria surveillance, case management, vector control including distribution of LLINs, education and information campaigns are important not only amongst the communities affected by the conflict but the entire district.
Article
Full-text available
Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
Article
Full-text available
While policies often target malaria prevention and treatment - proximal causes of malaria and related health outcomes - too little attention has been given to the role of household- and individual-level socio-economic status (SES) as a fundamental cause of disease risk in developing countries. This paper presents a conceptual model outlining ways in which SES may influence malaria-related outcomes. Building on this conceptual model, we use household data from rural Mvomero, Tanzania, to examine empirical relationships among multiple measures of household and individual SES and demographics, on the one hand, and malaria prevention, illness, and diagnosis and treatment behaviours, on the other. We find that access to prevention and treatment is significantly associated with indicators of households' wealth; education-based disparities do not emerge in this context. Meanwhile, reported malaria illness shows a stronger association with demographic variables than with SES (controlling for prevention). Greater understanding of the mechanisms through which SES and malaria policies interact to influence disease risk can help to reduce health disparities and reduce the malaria burden in an equitable manner.
Article
Full-text available
Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency). The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours.Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.
Article
Full-text available
Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
Article
Full-text available
We investigated personal protective behaviors against West Nile virus infection. Barriers to adopting these behaviors were identified, including the perception that DEET (N,N-diethyl-m-toluamide and related compounds) is a health and environmental hazard. Televised public health messages and knowing that family or friends practiced protective behaviors were important cues to action.
Article
Full-text available
Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.
Article
Over 80% of the global population is at risk of a vector-borne disease, with mosquito-borne diseases being the largest contributor to human disease burden. Although many global processes such as land-use and socioeconomic change are thought to influence mosquitoborne disease dynamics, research to-date has strongly focused on the role of climate change. We show, through a review of contemporary modelling studies, that there is no consensus on how future changes in climatic conditions will impact mosquito-borne diseases, possibly due to interacting effects of other global change processes which are often excluded from analyses. We conclude that research should not focus solely on the role of climate change but instead consider growing evidence for additional factors that modulate disease risk. Furthermore, future research should adopt new technologies, including developments in remote sensing and system dynamics modelling techniques, enabling a better understanding and mitigation of mosquito-borne diseases in a changing world.
Article
Background: Myanmar accounts for the greatest number of malaria cases among the Greater Mekong Sub-regions and 60% of the total populations are residing in malaria endemic area. The Myanmar National Malaria Strategic Plan (2016 to 2020) has recommended universal coverage and use of long-lasting insecticide-treated net (LLIN) as a key vector control measure in all malaria transmission areas. Objective: The present study aimed to identify LLIN use and associated factors in the high, moderate, and low transmission areas of Myawaddy District, which is a high malaria morbidity and mortality area. Materials and Methods: A cross sectional study using multistage stratified sampling was performed on 423 households in the high, moderate, and low malaria transmission areas of Myawaddy District. Structured interviews and observations of LLIN use were conducted between April and May 2017. Bivariate and multivariate logistic regressions were performed to find predictors of effective LLIN use the night before the survey. Results: Household ownership of at least one LLIN was 91.0%, 87.2%, and 96.5% in high, moderate, and low transmission areas, respectively. Among these households, those in which all household members sleeping under effective LLIN the night before the survey was lowest in high transmission area (37.8%), followed by moderate transmission area (72.4%), and low transmission area (83.8%). Knowledge of malaria was poor in high and moderate transmission areas, while perceptions towards malaria and receiving malaria information were lowest in high transmission area. Multivariate analysis showed that knowledge of malaria, perceived susceptibility and seriousness on malaria, exposure to malaria information, ethnicity of household head, family size, and number of LLIN available in the household were the important predictors of the household in which all household members sleeping under LLIN the night before the survey. Conclusion: The present study indicated that 100% use of LLIN should be achieved through effective behavioral change communication to improve malaria knowledge and perceptions. Moreover, the National Malaria Control Program should focus on households with Kayin ethnicity, low income, and large family size in high malaria transmission area.
Article
Rationale. Although greater attention has been recently given to the ecological determinants of health behaviours, we still do not know much about the behavioural changes induced by the spread of infectious diseases. Objective. In this study, we took advantage of a large epidemic of chikungunya, an emerging mosquito-borne disease, in French Guiana to examine the dynamic interaction between risk-related perceptions and behaviours that occurs in response to a disease outbreak. In particular, we tested empirically the assumption that both risk perceptions and health behaviours were elastic with respect to prevalence of chikungunya. Methods. A representative sample of French Guianan (N=434) was interviewed in January 2015 just after the peak of the epidemic, and again 2 months later. Participants were asked about their perceptions of the threat, as well as their engagement in a range of protective behaviours promoted by the regional health authorities to control the spread of the disease. Results. The surveys showed that (1) the frequency of some health behaviours – those related to visible control methods – significantly increased with the subjective and objective prevalence of the disease, (2) perceived risk of infection for oneself tended to decrease considerably over time, and (3) the risk reappraisal hypothesis failed to account for this paradoxical trend in the people’s response to the risk of contracting the disease. Conclusion. These findings suggest that people may fail to adjust their risk perceptions, and to a lesser extent their health protective behaviours, to the course of an epidemic. Notably, the prevalence elasticity of preventive action found in previous studies of behavioural response to infectious diseases differed substantially according to the type of intervention (personal versus environmental methods). This paradoxical trend may be attributed to risk habituation effects, which seem to vary significantly according to the social visibility of the preventive actions.
Article
Limiting the spread and impact of Zika was a major global priority in 2016, which required a variety of vector control measures. The success of vector control campaigns is varied and often dependent on public or political will. This paper examines the change over time in the United States population's support for vector control and the factors that predicted support for three vector control strategies (i.e., indoor spraying, outdoor spraying, and use of larvacide tablets) during the 2016 Zika outbreak in the United States. Data is from a nationally representative random digit dial sample conducted at three time points in 2016. Bivariate and multivariate regression analyses were used, treating data as a pooled cross-sectional sample. Results show public support for vector control strategies depends on both perceived risk for disease and knowledge of disease characteristics, as well is confidence in government to prevent the threat. Support varied based on vector control method: indoor spraying, aerial spraying, and use of larvacide tables. Results can aide public health officials in implementing effective vector control campaigns depending on the vector control strategy of choice. Results have implications for ways to design effective prevention campaigns in future emerging infectious disease threats.
Article
The rapid spread of mosquito resistance to currently available insecticides, and the current lack of an efficacious malaria vaccine are among many challenges that affect large-scale efforts for malaria control. As goals of malaria elimination and eradication are put forth, new vector-control paradigms and tools and/or further optimization of current vector-control products are required to meet public health demands. Vector control remains the most effective measure to prevent malaria transmission and present gains against malaria mortality and morbidity may be maintained as long as vector-intervention strategies are sustained and adapted to underlying vector-related transmission dynamics. The following provides a brief overview of vector-control strategies and tools either in use or under development and evaluation that are intended to exploit key entomological parameters toward driving down transmission.
Article
We investigated personal protective behaviors against West Nile virus infection. Barriers to adopting these behaviors were identified, including the perception that DEET (N,N-diethyl-m-toluamide and related compounds) is a health and environmental hazard. Televised public health messages and knowing that family or friends practiced protective behaviors were important cues to action.
Article
Monitoring of preventive health behaviors and their determinants at the level of households is an important component in field research for malaria control programs. Household members in 12 rural villages in south central Malawi participated in a study to show change over time in perceptions and behaviors in an area undergoing multiple malaria control interventions. Focus group interviews were used initially to elicit the major concepts villagers used to define and respond to the threat of malaria. A longitudinal household survey (T1: n = 2460; T2: n = 2149) measured biomedical or traditional knowledge about malaria causation and control attitudes toward mosquitoes barriers to taking preventive actions and preventive behaviors defined as sanitation traditional or commercial methods to control mosquitoes. While adherence to traditional beliefs and behaviors was found among some the majority of respondents also had adopted many biomedical beliefs and attitudes about malaria causation. Changes reflected both national and local initiatives to improve health status and control malaria. Behaviors changed over time and were associated with a village level intervention and with structural situational and cognitive attributes of respondents. (authors)
Article
Contemporary management of dengue fever relies on community members controlling the host mosquito's breeding and protecting themselves from direct mosquito contact. Research indicates that obtaining this vital community participation component can be difficult. The current study used the Health Belief Model as a framework to identify beliefs statistically predictive of engagement in two distinct behaviours; mosquito control and self protection. The knowledge, beliefs and behaviours of 122 James Cook University students were surveyed. Results indicated that the Health Belief Model was effective in predicting mosquito control behaviours but less effective in predicting self protective behaviours. Dengue fever awareness campaigns that target peoples' beliefs may be most effective in eliciting mosquito control behaviours.
Article
A core assumption of the standard multiple regression model is independence of residuals, the violation of which results in biased standard errors and test statistics. The structural equation model (SEM) generalizes the regression model in several key ways, but the SEM also assumes independence of residuals. The multilevel model (MLM) was developed to extend the regression model to dependent data structures. Attempts have been made to extend the SEM in similar ways, but several complications currently limit the general application of these techniques in practice. Interestingly, it is well known that under a broad set of conditions SEM and MLM longitudinal "growth curve" models are analytically and empirically identical. This is intriguing given the clear violation of independence in growth modeling that does not detrimentally affect the standard SEM. Better understanding the source and potential implications of this isomorphism is my focus here. I begin by exploring why SEM and MLM are analytically equivalent methods in the presence of nesting due to repeated observations over time. I then capitalize on this equivalency to allow for the extension of SEMs to a general class of nested data structures. I conclude with a description of potential opportunities for multilevel SEMs and directions for future developments.