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

Abstract

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. MethodsThis 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 SETTINGtool. 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.

Prevention, diagnosis and treatment of chronic respiratory diseases in Primary Health Care settings

“…While 67.5% strongly agreed that smoking causes respiratory symptoms, the respective percentage for HAP was 8.5%. Compared to the other low-resource settings of FRESH AIR, Greek participants more strongly attributed long-term respiratory symptoms to a respiratory illness, rather than an infection (160). Despite the presence of relative awareness regarding smoking, 73.5% of the sample were current smokers, a result that agrees with the general figures for Greece (27).…”

“…This study was part of a comparative FRESH AIR study whose detailed methods and results have been presented in a Lancet Global Health publication, co-authored by the PhD candidate (160). Additional information on the context-mapping tool used in this study are also presented in a BMJ Global Health publication of the FRESH AIR group (161).…”

“…The theoretical framework used to guide this study was constructed by the FRESH AIR team of Leiden University Medical Center and was based on a combination of three health behaviour models: the Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behaviour (160). The framework consisted of elements including perceptions of CRD identity, susceptibility, barriers towards behavioural change and risk reduction and help seeking behaviour (Figure 5).…”

“…The framework consisted of elements including perceptions of CRD identity, susceptibility, barriers towards behavioural change and risk reduction and help seeking behaviour (Figure 5). Detailed information on the framework has been published elsewhere (160). The vignette and the questionnaire can be found in Appendix 4.…”

“…(5). The results of this observational study are presented in a structured format below, while part of the Greek data has been published by our group in Lancet Global Health (160).…”