Home improvement and system-based health promotion for sustainable prevention of Chagas disease: A qualitative study

Abstract

Background Human transmission of Chagas disease (CD) most commonly occurs in domiciliary spaces where triatomines remain hidden to feed on blood sources during inhabitants’ sleep. Similar to other neglected tropical diseases (NTDs), sustainable control of CD requires attention to the structural conditions of life of populations at risk, in this case, the conditions of their living environments. Considering socio-cultural and political dynamics involved in dwellings’ construction, this study aimed to explore social factors that contribute or limit sustainability of CD’s prevention models focused on home improvement. Methods and main findings Using Healthy Homes for Healthy Living (HHHL)—a health promotion strategy focused on improvement of living environments and system-based health promotion—as a reference, a qualitative study was conducted. Research participants were selected from three rural communities of a CD endemic region in southern Ecuador involved in HHHL’s refurbishment and reconstruction interventions between 2013 and 2016. Folowing an ethnographic approach, data were collected through interviews, participant observation, informal conversations and document analysis. Our results indicate that the HHHL model addressed risk factors for CD at the household level, while simultaneously promoting wellbeing at emotional, economic and social levels in local communities. We argue that sustainability of the CD prevention model proposed by HHHL is enhanced by the confluence of three factors: systemic improvement of families’ quality of life, perceived usefulness of control measures, and flexibility to adapt to emerging dynamics of the context. Conclusion HHHL’s proposed home improvement, facilitated through system-based rather than disease specific health promotion processes, enhances agency in populations at risk and facilitates community partnerships forged around CD prevention. Although an independent analysis of cost-effectiveness is recommended, structural poverty experienced by local families is still the most important factor to consider when evaluating the sustainability and scalability of this model.

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

“…Most of the homes in these communities have structural, behavioral, and/or peridomiciliary conditions that place them at greater risk of triatomine infestation. Structurally, most of the homes in these communities are adobe constructions, with dirt floors, walls raised on found stone foundations, ceilings made of bamboo, and roofs made of loosely fitted tiles [24]. Many of the families enact behaviors that attract hosts for triatomines, such as cohabitation of these homes with domestic animals and the accumulation of grain and produce in the home (which attracts mice, rats, and squirrels) [25].…”

“…The present data was collected in the context of a nearly 20-year long research and servicelearning collaboration between Ohio University's Infectious and Tropical Disease Institute (ITDI),the Pontificia Universidad del Ecuador's "Centro de Investigación para la Salud en America Latina" (CISeAL), and their partner communities in Loja, Ecuador. The center of this large participatory research intervention is the Healthy Living Initiative (HLI), an ongoing, multidisciplinary research initiative that supports sustainable community education, socioeconomic development, and housing (re)construction in rural communities as its main tools for the control of CD (see, for example, [11,15,16,24,[26][27][28]. In this ongoing engagement with communities in Loja, our project team has adopted the principle that constructs of health and healthy living are best articulated by members of the community so that culture-centered, community-appropriate interventions can be designed [27].…”

Housing Risk Factors of Four Tropical Neglected Diseases: A Brief Review of the Recent Literature

“…Even though indoor control of vector density based on systematic spraying seems to be the most effective intervention regarding the above-mentioned diseases, there needs to be a long-term strategy that includes housing improvement as suggested by various researchers and international organizations [ 4 , 58 , 59 ]. Indeed, housing structures can have an impact on the overall health, be it physical or mental, of their inhabitants [ 4 , 46 ].…”

“…Furthermore, housing structures may affect the socio-economic conditions of their inhabitants, which in turn impacts their health [ 5 , 60 ]. Such considerations gave rise to projects such as the Healthy Homes for Healthy Living Model, which proposes “a strategy focused on building and promoting living environments designed to deter presence of vectors in domestic and peridomestic areas ” through the structural improvement of homes, health promotion activities and community involvement [ 59 ]. However, the structural improvement of homes may face logistic challenges, such as access to appropriate technical expertise, lack of construction materials and high costs that could compromise the efficacy of this approach [ 59 ].…”

Key criteria of sustainable hospital refurbishment

“…Nurses mainly man these stations by providing prescriptive and emotional support until the patient is discharged. This is the typical patient flow in a hospital that forms the process of healing within hospital environments [2]. Medicine, physician and nursing care forms a pivotal part of the healing process and is a major part of the healing process.…”