BackgroundThe role of footwear in protection against a range of Neglected Tropical Diseases (NTDs) is gaining increasing attention. Better understanding of the behaviors that influence use of footwear will lead to improved ability to measure shoe use and will be important for those implementing footwear programs.Methodology/Principal FindingsUsing the PRECEDE-PROCEED model we assessed social, behavioral, environmental, educational and ecological needs influencing whether and when children wear shoes in a rural highland Ethiopian community endemic for podoconiosis. Information was gathered from 242 respondents using focus groups, semi-structured interviews and extended case studies. Shoe-wearing norms were said to be changing, with going barefoot increasingly seen as ‘shameful’. Shoes were thought to confer dignity as well as protection against injury and cold. However, many practical and social barriers prevented the desire to wear shoes from being translated into practice. Limited financial resources meant that people were neither able to purchase more than one pair of shoes to ensure their longevity nor afford shoes of the preferred quality. As a result of this limited access, shoes were typically preserved for special occasions and might not be provided for children until they reached a certain age. While some barriers (for example fit of shoe and fear of labeling through use of a certain type of shoe) may be applicable only to certain diseases, underlying structural level barriers related to poverty (for example price, quality, unsuitability for daily activities and low risk perception) are likely to be relevant to a range of NTDs.Conclusions/SignificanceUsing well established conceptual models of health behavior adoption, we identified several barriers to shoe wearing that are amenable to intervention and which we anticipate will be of benefit to those considering NTD prevention through shoe distribution.

Abstract. Little is known about how beliefs about heredity as a cause of health conditions might influence preventive and interpersonal behaviors among those individuals with low genetic and health literacy. We explored causal beliefs about podoconiosis, a neglected tropical disease (NTD) endemic in Ethiopia. Podoconiosis clusters in families but can be prevented if individuals at genetically high risk wear shoes consistently. Adults (N = 242) from four rural Ethiopian communities participated in qualitative assessments of beliefs about the causes of podoconiosis. Heredity was commonly mentioned, with heredity being perceived as (1) the sole cause of podoconiosis, (2) not a causal factor, or (3) one of multiple causes. These beliefs influenced the perceived controllability of podoconiosis and in turn, whether individuals endorsed preventive and interpersonal stigmatizing behaviors. Culturally informed education programs that increase the perceived controllability of stigmatized hereditary health conditions like podoconiosis have promise for increasing preventive behaviors and reducing interpersonal stigma.

The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.

BackgroundEritrean migrants in Israel, the majority of whom are seeking asylum, have limited access to institutional support. While the temporary group protection granted to Eritreans by Israel ensures that they are not deported, it does not confer permanent legal status, nor does it allow access to the formal work sector. This study qualitatively explores how political and economic marginalization increases the risk of sexual and other forms of violence as well as the exploitation of Eritrean women asylum seekers living in Israel.MethodsTwenty-five interviews with key informants, twelve individual interviews (six with men and six with women), and eight focus group discussions (four with men and four with women) were conducted among Eritreans of reproductive age in Tel Aviv, Israel. Qualitative data analysis was conducted using open, focused, and axial coding.ResultsParticipants reported that Israel’s restrictive immigration policies laid the foundation for the political and economic marginalization of asylum seekers. This manifested in limited access to institutional support during and after arrival, and hindered access to formal employment and its associated protections. The Israeli government’s decision to grant provisional status with a stipulation banning Eritreans from the formal work sector was perceived to create direct and indirect conditions for a heightened sense of structural vulnerability, particularly for women. Participants reported that this structural vulnerability increased the risk of sexual and domestic violence in addition to the risk for the exploitation of women asylum seekers.ConclusionsIsrael’s immigration policies may contribute to women asylum seekers’ vulnerability to sexual violence upon arrival in their host country. These policies shape the social realities of women asylum seekers, potentially increasing their risk of violence and exploitation during their time in Israel. This study provides an example of the effects of political and economic marginalization on violence against women, a concept that may apply to other settings globally.Electronic supplementary materialThe online version of this article (10.1186/s12905-018-0624-y) contains supplementary material, which is available to authorized users.

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