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Kim W, Chang K, Lee SY, Ju YJ. Area-level deprivation and handwashing behavior during the COVID-19 pandemic: A multilevel analysis on a nationwide survey in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2088-2103. [PMID: 37204032 DOI: 10.1080/09603123.2023.2212600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
This study investigated the association between area deprivation level and performance of handwashing behavior during the COVID-19 pandemic in Korean adults. This study used data from the 2015 Population and Housing Census data to measure area deprivation level. The 2020 Korea Community Health Survey was used for all other variables, including hand hygiene behavior (August through November 2020). The association between area deprivation level and practice of handwashing behavior was examined using multilevel logistic regression analysis. The study population comprised 215,676 adults aged 19 years or above. Compared to the least area deprived group, the most deprived group was more likely to not wash hands after using the restroom (OR 1.43, 95% CI 1.13-1.82), after coming home (OR 1.85, 95% CI 1.43-2.39), and using soap (OR 1.55, 95% CI 1.29-1.84). The findings suggest the importance of considering area deprivation in implementing policies that promote handwashing, particularly during a pandemic.
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Affiliation(s)
- Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kyujin Chang
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
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Tamene A, Habte A, Tagesse M, Endale F, Melis T, Wale Sewalem Z, Afework A. Exploring associations between household environmental factors and handwashing with essential agents in sub-Saharan Africa. PLoS One 2023; 18:e0286735. [PMID: 37384738 PMCID: PMC10310012 DOI: 10.1371/journal.pone.0286735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND 3 billion people lack proper home hand hygiene facilities globally. Of these, 1.4 billion (18%) lack soap or water, while 1.6 billion (22%) have neither. This analysis explores the link between living conditions and the use of essential agents in sub-Saharan Africa. This secondary data analysis examines potential associations between the domiciliary environment and the use of essential agents in sub-Saharan Africa. METHODS Eighteen demographic and health surveys were used to analyze the association between household environmental factors and handwashing with essential agents. STATA version 16 was used to analyze data from 203,311 households across weighted samples. Using a multivariable multilevel mixed effect logistic regression analysis, it was possible to determine how each independent factor affected the outcome while taking the data clustering into account. The adjusted odds ratio and its associated 95% confidence interval were used to assess the independent factors' statistical significance. RESULT Only one in three households 34.84%, practiced handwashing with essential agents, with the highest prevalence in Angola (70.2%) and the lowest in Malawi (6.5%). Educational status [aOR = 1.77; 95%(CI = 1.68-1.86)], female headship[aOR = 1.09; 95%(CI = 1.06-1.2)], household wealth[aOR = 4.08; 95%(CI = 3.84-4.33)], not sharing toilets with other homes[aOR = 1.13; 95%(CI = 1.10-1.17)], having a fixed place for hand washing[aOR = 1.49; 95%(CI = 1.45-1.54)], not having regular access to water [aOR = 0.09; 95%(CI = 0.095-0.10)]and being a rural resident [aOR = 0.85; 95%(CI = 0.82-0.88)] were associated with handwashing. CONCLUSION sub-Saharan nations are failing to demonstrate advancements in handwashing practices. There are still a lot of homes without access to basic infrastructure for handwashing and household water sources. For essential agent adoption programs to be successful in an environment with limited resources, Water, Sanitation, and Hygiene measures must be implemented. Furthermore, it is critical to include contextual factors from the current study as well as socio-cultural and psychological characteristics that dissuade people from using essential agents in intervention strategies.
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Affiliation(s)
- Aiggan Tamene
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Mihretu Tagesse
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Fitsum Endale
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Zablon Wale Sewalem
- Department of Clinical and Psychosocial Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Abel Afework
- Department of Environmental Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Luetke Lanfer H, Rossmann C, Kargbo SI. Exploring the Contextual Factors of Religious Leader Participation in Health Communication: Evidence from a Qualitative Study in Sierra Leone. JOURNAL OF RELIGION AND HEALTH 2023; 62:1695-1715. [PMID: 35987844 PMCID: PMC9392582 DOI: 10.1007/s10943-022-01632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
As there are many and sometimes ambivalent intersections of health and religion, strategic collaborations with religious opinion leaders in health campaigns have been increasingly explored. Despite the known influence of distinct contextual factors within emergency and non-emergency settings, existing research seldom distinguishes between those different factors and their impact on the inclusion of religious leaders as health messengers. To compare the contextual factors of religious leaders as health messengers during emergency and non-emergency situations in a setting with high religious affiliations, this study used a qualitative approach and triangulated the perspectives of three different samples, including (religious) opinion leaders, members of religious communities, and developers of health communication strategies in Sierra Leone. The results provide multifaceted insights into contextual factors applicable to emergency and non-emergency settings as well as the risks and opportunities. Recommendations for the incorporation of religious leaders in health promotion activities in consideration of different contextual factors are provided.
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Affiliation(s)
- Hanna Luetke Lanfer
- School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Constanze Rossmann
- Division of Communication and Media Research, LMU Munich, Oettingenstr. 67, 80538 Munich, Germany
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Mavragani A, Brew-Sam N, Rossmann C. An Analysis of Power Dynamics Affecting Handwashing Interventions in Sierra Leone: Findings From a Qualitative Participatory Study. JMIR Form Res 2023; 7:e39226. [PMID: 36705952 PMCID: PMC9919519 DOI: 10.2196/39226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Handwashing is an effective and cost-efficient health behavior for preventing infectious diseases; however, its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, participatory approaches that allow a more equitable distribution of resources and the development of locally tailored interventions are increasingly used. However, social power dynamics have not been well integrated into the concept of participation, despite their known impact. OBJECTIVE We sought to investigate the role of power dynamics in participatory approaches to handwashing in Sierra Leone. METHODS From a socio-ecological perspective, this qualitative, formative interview study aimed to identify relevant actors and their power relationships before designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory, community-driven approach with that in a nonparticipatory top-down approach. RESULTS According to our formative study, in community-based projects, multiple groups and actors interact directly or indirectly with each other, located within a macro level (eg, political institutions), meso level (eg, community leaders and groups), and micro level (eg, families) of a socio-ecological model. Although distinct leadership structures were noticeable and affected intervention attendance and processes of change in nonparticipatory approaches, community-led activities and handwashing increased in the participatory approach, irrespective of the leadership structure. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action, and empower lower-ranking individuals to practice handwashing. A similar ambivalent role could be observed in relation to external researchers, especially if they come from a different cultural background than the research participants, for example, from a Western country in a non-Western project setting. Although external researchers can initiate a project or provide certain resources, distinct expectations regarding their roles and resources can impact participatory efforts and power relations. CONCLUSIONS The results highlight the advantages of participatory approaches for health promotion. Power dynamics should be a core component of continuous reflection and analysis in participatory projects.
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Affiliation(s)
| | - Nicola Brew-Sam
- Department of Health Services Research & Policy, Australian National University, Canberra, Australia
| | - Constanze Rossmann
- Department of Media and Communication, Ludwig Maximilian University of Munich, Munich, Germany
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Acosta D, Ludgate N, McKune SL, Russo S. Who Has Access to Livestock Vaccines? Using the Social-Ecological Model and Intersectionality Frameworks to Identify the Social Barriers to Peste des Petits Ruminants Vaccines in Karamoja, Uganda. Front Vet Sci 2022; 9:831752. [PMID: 35296060 PMCID: PMC8918586 DOI: 10.3389/fvets.2022.831752] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Access to veterinary services is important in Karamoja, northeastern part of Uganda, as livestock is a primary source of livelihood. Gender is often overlooked in animal health programs, let alone intersectionality. However, given the socio-cultural intricacies of Karamoja, ignoring these factors may hinder animal vaccination practices, limiting the success of programs designed to control and prevent animal diseases, such as peste des petits ruminants (PPR). The study used qualitative research methods, including focus group discussions, individual interviews, and key informant interviews in a participatory research approach to investigate the constraints faced by livestock keepers when accessing vaccines. The study was carried out in Abim, Amudat, Kotido, and Moroto, four districts in the Karamoja Subregion of Uganda. A modified version of the socio-ecological model (SEM) blended with an intersectional approach were used as frameworks to analyze underlying individual, social and structural determinants of vaccine access with intersecting factors of social inequalities. The results show there are seven intersecting factors that influence access to vaccination the most. These are: gender, ethnicity, geographic location, age, physical ability, marital status, and access to education. The impact of these intersections across the different levels of the SEM highlight that there are vast inequalities within the current system. Access to vaccines and information about animal health was most limited among women, widows, the elderly, the disabled, geographically isolated, and those with unfavorable knowledge, attitudes, and practices about vaccination. Cultural norms of communities were also important factors determining access to PPR vaccines. Norms that burden women with household chores and beliefs that women cannot manage livestock, combined with gender-based violence, leaves them unable to participate in and benefit from the livestock vaccine value chain. Trainings and sensitization on gendered intersectional approaches for those involved in the distribution and delivery of vaccines are necessary to avoid exacerbating existing inequalities in Karamoja.
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Affiliation(s)
- Daniel Acosta
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- *Correspondence: Daniel Acosta
| | - Nargiza Ludgate
- International Center, University of Florida, Gainesville, FL, United States
| | - Sarah L. McKune
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Sandra Russo
- International Center, University of Florida, Gainesville, FL, United States
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Luetke Lanfer H, Reifegerste D. Correction to: Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone. BMC Public Health 2021; 21:2273. [PMID: 34903189 PMCID: PMC8670143 DOI: 10.1186/s12889-021-12291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hanna Luetke Lanfer
- School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Doreen Reifegerste
- School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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Luetke Lanfer H, Reifegerste D, Kargbo SI. Collecting quantitative experimental data from a non-WEIRD population: challenges and practical recommendations from a field experiment in rural Sierra Leone. BMC Res Notes 2021; 14:414. [PMID: 34789341 PMCID: PMC8597296 DOI: 10.1186/s13104-021-05828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Standardized pretest–posttest experimental designs with quantitative surveys are frequently applied to evaluate the effectiveness of health programs. However, this method is strongly informed by research on samples from Western, Educated, Industralized, Rich, and Democratic (WEIRD) societies and may not produce meaningful results in a distinct cultural, educational and socioeconomic context. Results This paper reports several methodological challenges encountered along the research process of collecting quantitative survey data (i.e., during recruitment, obtaining informed consent, matching pretest–posttest data and data collection) for a mixed-methods field experiment on domestic handwashing in Sierra Leone. Ethical dilemmas of certain research practices are pointed out and potential solutions or alternatives are recommended for each challenge. Analysis of these challenges highlights the importance of reflecting on the aptness of research methodologies for non-WEIRD samples. While this is not to say that quantitative surveys are not suitable in a non-WEIRD context, their employment require considerable time for extensive pilot testing, involving local interviewers and participants in designing research projects and the modification of data collection strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05828-w.
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Affiliation(s)
- Hanna Luetke Lanfer
- School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Doreen Reifegerste
- School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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