Abstract
BackgroundMelioidosis, an often fatal infectious disease in Northeast Thailand, is caused by skin inoculation, inhalation or ingestion of the environmental bacterium, Burkholderia pseudomallei. The major underlying risk factor for melioidosis is diabetes mellitus. Recommendations for melioidosis prevention include using protective gear such as rubber boots and gloves when in direct contact with soil and environmental water, and consuming bottled or boiled water. Only a small proportion of people follow such recommendations.MethodsNine focus group discussions were conducted to evaluate barriers to adopting recommended preventive behaviours. A total of 76 diabetic patients from northeast Thailand participated in focus group sessions. Barriers to adopting the recommended preventive behaviours and future intervention strategies were identified using two frameworks: the Theoretical Domains Framework and the Behaviour Change Wheel.ResultsBarriers were identified in the following five domains: (i) knowledge, (ii) beliefs about consequences, (iii) intention and goals, (iv) environmental context and resources, and (v) social influence. Of 76 participants, 72 (95%) had never heard of melioidosis. Most participants saw no harm in not adopting recommended preventive behaviours, and perceived rubber boots and gloves to be hot and uncomfortable while working in muddy rice fields. Participants reported that they normally followed the behaviour of friends, family and their community, the majority of whom did not wear boots while working in rice fields and did not boil water before drinking. Eight intervention functions were identified as relevant for the intervention: (i) education, (ii) persuasion, (iii) incentivisation, (iv) coercion, (v) modeling, (vi) environmental restructuring, (vii) training, and (viii) enablement. Participants noted that input from role models in the form of physicians, diabetic clinics, friends and families, and from the government via mass media would be required for them to change their behaviours.ConclusionThere are numerous barriers to the adoption of behaviours recommended for melioidosis prevention. We recommend that a multifaceted intervention at community and government level is required to achieve the desired behaviour changes.
Highlights
There are numerous barriers to the adoption of behaviours recommended for melioidosis prevention
Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, which is present in soil and water in many tropical countries in Central and South America, sub-Saharan Africa, South Asia, Southeast Asia and northern Australia [1, 2]
After informing participants about behaviours recommended for melioidosis prevention, we found that participants reported no problems in terms of skills and beliefs about their capabilities to perform such behaviours
Summary
Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, which is present in soil and water in many tropical countries in Central and South America, sub-Saharan Africa, South Asia, Southeast Asia and northern Australia [1, 2]. Diabetes mellitus is the major underlying risk factor for melioidosis, and is present in more than 50% of all melioidosis cases [3]. The risk of people with diabetes acquiring melioidosis is about 12 times higher than the rest of the population [6, 7]. People with diabetes are the major target population for melioidosis preventive measures [8]. Melioidosis, an often fatal infectious disease in Northeast Thailand, is caused by skin inoculation, inhalation or ingestion of the environmental bacterium, Burkholderia pseudomallei. The major underlying risk factor for melioidosis is diabetes mellitus.
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