Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Brakema, Evelyn A; van der Kleij, Rianne M J J; Poot, Charlotte C; An, Pham Le; Anastasaki, Marilena; Crone, Matty R; Hong, Le Huynh Thi Cam; Kirenga, Bruce; Lionis, Christos; Mademilov, Maamed; Numans, Mattijs E; Oanh, Lê Thi Tu; Tsiligianni, Ioanna; Sooronbaev, Talant; Walusimbi, Simon; Williams, Siân; Chavannes, Niels H; Reis, Ria
• Is Part Of: Lancet. Volume 10:Issue 1(2022)
• Page Start: e63
• Page End: e76
• Publication Date: 2022-01
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1016/S2214-109X(21)00456-3
• Languages: English
• ISSNs: 2214-109X

Abstract

Summary: Background: 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. Methods: 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. Findings: 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]). Interpretation: 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. Funding: European Commission Horizon 2020. Translations: For the Greek, Russian and Vietnamese translations of the abstract see Supplementary Materials section.