A Framework for Integrating Qualitative and Quantitative Data in Knowledge, Attitude, and Practice Studies: A Case Study of Pesticide Usage in Eastern Uganda.

James Muleme,Adrian Muwonge,John C Ssempebwa,Stella Mazeri,Clovice Kankya

doi:10.3389/fpubh.2017.00318

Abstract

Knowledge, attitude, and practice (KAP) studies guide the implementation of public health interventions (PHIs), and they are important tools for political persuasion. The design and implementation of PHIs assumes a linear KAP relationship, i.e., an awareness campaign results in the desirable societal behavioral change. However, there is no robust framework for testing this relationship before and after PHIs. Here, we use qualitative and quantitative data on pesticide usage to test this linear relationship, identify associated context specific factors as well as assemble a framework that could be used to guide and evaluate PHIs. We used data from a cross-sectional mixed methods study on pesticide usage. Quantitative data were collected using a structured questionnaire from 167 households representing 1,002 individuals. Qualitative data were collected from key informants and focus group discussions. Quantitative and qualitative data analysis was done in R 3.2.0 as well as qualitative thematic analysis, respectively. Our framework shows that a KAP linear relationship only existed for households with a low knowledge score, suggesting that an awareness campaign would only be effective for ~37% of the households. Context specific socioeconomic factors explain why this relationship does not hold for households with high knowledge scores. These findings are essential for developing targeted cost-effective and sustainable interventions on pesticide usage and other PHIs with context specific modifications.

Highlights

The success of public health interventions (PHIs) in resource-limited settings critically depends on our understanding of the socio-anthropological and economic aspects of the context in which these interventions are implemented [1,2,3]
The results show that respondents who thought that sunny days were the least conducive days to spray had higher probability of scoring highly on the knowledge metric odds ratio (OR) = 3.57, 95% Confidence interval (CI) (1.77–5.37) and p = 0.03
We have identified context specific factors associated with increased knowledge and proposed a framework for integrating quantitative and qualitative data for KAP studies

Summary

Introduction

The success of public health interventions (PHIs) in resource-limited settings critically depends on our understanding of the socio-anthropological and economic aspects of the context in which these interventions are implemented [1,2,3]. By taking into account the behavioral and social norms within the affected communities, public health officials were able to limit the scale of the outbreak [3] Such context-specific public health information is gathered through knowledge, attitude, and practice (KAP) studies [1]. Countries like Uganda are experiencing a rapid population growth characterized by rapid urbanization [13, 14] This comes with profound changes in food security especially in crop production which is more than ever dependent on the ubiquitous use of pesticides [13]. Such demographic shifts inherently alter societal beliefs and practices; it is important to consider these changes when designing PHIs [14]. It is important to note that there are remarkably few KAP studies that combine both qualitative and quantitative data [1]

Methods

Results

Discussion

Conclusion