Abstract
Effectiveness of health programmes can be undermined when the implementation misaligns with local beliefs and behaviours. To design context-driven implementation strategies, we explored beliefs and behaviours regarding chronic respiratory disease (CRD) in diverse low-resource settings. This observational mixed-method study was conducted in Africa (Uganda), Asia (Kyrgyzstan and Vietnam) and Europe (rural Greece and a Roma camp). We systematically mapped beliefs and behaviours using the SETTING-tool. Multiple qualitative methods among purposively selected community members, health-care professionals, and key informants were triangulated with a quantitative survey among a representative group of community members and health-care professionals. We used thematic analysis and descriptive statistics. We included qualitative data from 340 informants (77 interviews, 45 focus group discussions, 83 observations of community members' households and health-care professionals' consultations) and quantitative data from 1037 community members and 204 health-care professionals. We identified three key themes across the settings; namely, (1) perceived CRD identity (community members in all settings except the rural Greek strongly attributed long-lasting respiratory symptoms to infection, predominantly tuberculosis); (2) beliefs about causes (682 [65·8%] of 1037 community members strongly agreed that tobacco smoking causes symptoms, this number was 198 [19·1%] for household air pollution; typical perceived causes ranged from witchcraft [Uganda] to a hot-cold disbalance [Vietnam]); and (3) norms and social structures (eg, real men smoke [Kyrgyzstan and Vietnam]). When designing context-driven implementation strategies for CRD-related interventions across these global settings, three consistent themes should be addressed, each with common and context-specific beliefs and behaviours. Context-driven strategies can reduce the risk of implementation failure, thereby optimising resource use to benefit health outcomes. European Commission Horizon 2020. For the Greek, Russian and Vietnamese translations of the abstract see Supplementary Materials section.
Highlights
WHO, global health funders, and other institutions have urged for more and better implementation research.[1,2,3,4] Implementation failure can drain scarce resources and seriously undermine the effect of health programmes.[5]
We identified three key themes across the settings; namely, (1) perceived chronic respiratory disease (CRD) identity; (2) beliefs about causes (682 [65·8%] of 1037 community members strongly agreed that tobacco smoking causes symptoms, this number was 198 [19·1%] for household air pollution; typical perceived causes ranged from witchcraft [Uganda] to a hot–cold disbalance [Vietnam]); and (3) norms and social structures
Across slums in Uganda, highland and lowland Kyrgyzstan, rapidly developing Vietnam, austerity-impacted Greece, and an off-the-grid Roma camp we identified three common themes: (1) perceived disease identity; (2) beliefs about causes; and (3) norms and social structures
Summary
WHO, global health funders, and other institutions have urged for more and better implementation research.[1,2,3,4] Implementation failure can drain scarce resources and seriously undermine the effect of health programmes.[5]. Critical is the compatibility between the programme, implementation strategy, and the local context, of which local health beliefs and behaviours are key dimensions.[2,7,8] Leading theoretical models are built on the concept that health behaviour is shaped by health beliefs.[9,10,11] To illustrate, three billion people still burn solid fuels (eg, wood or animal dung) daily. Failure to understand the households’ beliefs and needs, and failure of the stoves to meet those beliefs and needs has been a major barrier to successful implementation of the stove programmes. Discrepancy between the perceived and actual harm of HAP is another common barrier.[13] Implementation research must explore such local beliefs and related behaviours to optimise uptake of promising interventions and enable those to enter routine practice
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