The Association of Beliefs About Heredity with Preventive and Interpersonal Behaviors in Communities Affected by Podoconiosis in Rural Ethiopia

Abstract

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.

Association Between Causal Beliefs and Shoe Wearing to Prevent Podoconiosis: A Baseline Study

“…25 We found that the caregiver's gender was significantly associated with reported shoe wearing by the index child. Female caregivers reported less regular shoe wearing among index children than male caregivers.…”

“…Consistent with our qualitative study, affected respondents were less likely to recognize heredity as a cause of podoconiosis than those who were not affected by the condition. 25 Beliefs about heredity were negatively associated with reported shoe wearing of the index child in affected households. When these beliefs were coded for accuracy, affected individuals were more accurate in their knowledge than unaffected respondents.…”

“…In our previous qualitative study, we found that affected families downplayed heredity as a cause for podoconiosis due to fear of stigma. 25 This situation calls for sensitivity in designing programs that raise awareness of hereditary susceptibility in high-risk population. Some recent studies support the usefulness of family-oriented education with messages tailored to familial risks in resourcelimited communities.…”

“…Although it is difficult to disentangle cause and effect, our earlier qualitative work suggested that shoes have social value and facilitate school attendance. 25 Alternatively, level of education might influence norms about shoe wearing and foot protection.…”

“…24 In our previous qualitative research, we identified three domains of beliefs about the causes of podoconiosis wrongly held by members of the community. 25 Some participants observed that podoconiosis tended to affect multiple family members and concluded that the disease was entirely inherited, making it inevitable. Others noted that not all family members contracted the condition-some developed the disease while *Address correspondence to Colleen M. McBride, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR 564, Atlanta, GA 30322.…”