How Sri Lankan Farm Households Intend to Reduce the Risk of Developing the Chronic Kidney Disease of Unknown Cause Prevalent in Their Communities

Abstract

A chronic kidney disease (CKDu), independent of known causes, such as diabetes and hypertension, is emerging as an epidemic in certain agrarian regions of the developing world. Given the unprecedented incidence of the disease among farm households, in the North Central Province (NCP) of Sri Lanka, CKDu is considered a public health emergency. Ever since the disease was first reported over two and a half decades ago, both local and international research communities have taken significant efforts to reveal the aetiology of the disease. Although the causes of the disease still remain unrevealed, much of the research findings supports a set of environmental and behavioural risk factors that are deemed to be associated with the occurrence and progression of the disease. To encourage healthy behaviours such as consumption of safe, uncontaminated water that minimise the deemed risk factors, several health extension programs have been launched in the high-risk areas of the NCP. However, according to reports, the programs have not achieved the expected success due to non-compliance of the people of the target population. Under a context of uncertainty of proven facts, the effectiveness of such programs and compliance of people to risk reduction behaviour is brought into question by two interrelated socio-cognitive concerns. One concern raises the importance of knowing how the people living in epidemic areas perceive and interpret the disease in terms of causes and risk preventive methods. The second concern being the socio-cognitive determinants that may prevent people from adopting the expected risk reduction behaviour. Highlighting the importance of the above knowledge gap, this study attempts to understand how an agrarian population in Sri Lanka, vulnerable to CKDu, perceive the disease as a health risk. The study further explores, how their psycho-social beliefs structure preventive behaviour against the unknown disease under a context of uncertainty. To achieve the latter objective, the study refers to a theoretical framework based on an extended Protection Motivation Theory.