Changes in social mixing and attitudes and practices to precautionary measures in a maturing COVID-19 pandemic in six communities in Sudan: a qualitative study

INTRODUCTION

With low COVID-19 vaccination coverage, non-pharmaceutical interventions were critical to mitigating the COVID-19 pandemic in Sudan. We explored changes in social contact patterns, risk perception, attitudes, and practices toward protective measures during an evolving COVID-19 outbreak in six illustrative communities in Sudan.

METHODS

This qualitative study took place in six communities in five Sudanese states using focus group discussions with community members and non-participant structured observations in public spaces between March 2021 and April 2021. A total of 117 participants joined 24 group discussions. We used a two-stage thematic analysis.

RESULTS

The perceived importance of compliance with individual preventative measures among those who believe in COVID-19 was higher than observed compliance with behaviors in most study sites. Adherence was consistently low and mainly driven by enforced movement restrictions. As restrictions were lifted, social contacts outside the household resumed pre-COVID-19 levels, and risk perception and individual and institutional adherence to protective measures diminished. We identified an environment that is socially and economically unsupportive of preventive practices, compounded by widespread rumours, misinformation, and mistrust in the government-led response. However, we identified new social habits that can contribute to reducing COVID-19 transmission.

CONCLUSION

The unfavourable social and economic environment, coupled with the low visibility of the pandemic and pandemic response, has likely modulated the influence of higher risk perception on adopting precautionary behaviours by individuals. Governments and non-governmental actors should increase the visibility of the pandemic and pandemic response, enforce and incentivise infection control measures in public areas, promote emerging preventive social habits, and actively track and address rumours and misinformation related to COVID-19 and COVID-19 vaccines.

Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

BACKGROUND

Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of 'green zones' for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan.

METHODS

We purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis.

RESULTS

Most participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the reduced socialisation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house.

CONCLUSION

Shielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

A multicriteria evaluation approach to set forest restoration priorities based on water ecosystem services

Forest plays an important role in keeping water ecosystem services, such as drinking water provision. Thus, payment for ecosystem services is an essential instrument to promote forest restoration in agricultural watersheds. However, funds are limited and must be well planned to ensure water resources conservation and water ecosystem services improvement. In this context, our study aimed to identify priority areas for forest restoration, based on water ecosystem services in agricultural landscapes. For this, we have developed a decision-making support model for agricultural watersheds (in the Atlantic Forest region), based on mixed approaches, that were multicriteria evaluation (MCE) and Participatory Technique. The model will help decision-makers and stakeholders to set priorities for payment for ecosystem services programs implementation. So, we evaluate its application in watersheds with different forest cover patterns to check if it can be applied to different landscape patterns. The base of the model was the following criteria, that were produced with high-resolution data and ranking in the Participatory Technique context, considering their importance for the study: proximity to spring, slope, soil erodibility, topographic index, and land-use/land-cover (LULC). The criteria were aggregated by the Weighted Linear Combination (WLC) method (an MCE method). The priorities maps showed areas classified as high priority near the rivers (at most 200 m far from rivers), on the greatest slopes (>40%), on soils associated with high potential of erosion, and predominantly in agriculture lands. However, this class presented more percentage of the area associated with native forest in the forested watershed (native forest covers 55% of its area) than in the watershed non-forested (native forest covers 25%). Another important point of the final maps was a high percentage of areas associated with the medium class, which is a characteristic of the WLC method. Thus, areas classified as high and medium priority was defined as targets for forest restoration in the watersheds. We can conclude that for small watersheds, the MCE method, with high-resolution data, supports an appropriate prioritization of areas for forest restoration, aiming at the improvement of water ecosystem services. This way, our model can be applied to various payments for ecosystem services schemes in agricultural landscapes worldwide.

Group based video-conferencing for adults with depression: findings from a user-led qualitative data analysis using participatory theme elicitation

BACKGROUND

Accessing support services for depression has been historically difficult given the societal stigma that exists regarding the condition. Recent advances in digital technologies continue to be postulated as a potential panacea yet the results from research trials have been mixed with a range of effect sizes.

METHODS

This article offers a different perspective by presenting a panel of end users (co-researchers) with qualitative interview data (n = 8) taken from a feasibility RCT of a group based video-conferencing service for depressed adults. The co-researcher panel were introduced to a new method of participatory data analysis known as Participatory Theme Elicitation (PTE). This method involves using network analysis techniques to create groupings and visual diagrams in order to support the generation of themes and minimise scientific researcher input/influence.

RESULTS

Co-researchers reported that while VC based interventions appeared convenient, accessible and relatively low cost - additional training and support should be offered to improve uptake and retention. In addition, co-researchers suggested that further exploration is needed regarding the level of self-awareness one feels in a group based VC environment and whether this facilitates disclosure (through disinhibition) or increases anxiety.

CONCLUSION

The findings presented here appear to support existing (researcher and academic-led) literature in the field as well as suggest new areas for investigation. By presenting data generated solely by co-researchers, this article also adds to the evidence surrounding participatory analysis methods - particularly the growing need for robust approaches that are accessible and less time-consuming than those currently available.

TRIAL REGISTRATION NUMBER

NCT03288506 (Clinicaltrials.gov) 20th Sept 2017 https://clinicaltrials.gov/ct2/show/NCT03288506.

Network methods to support user involvement in qualitative data analyses: an introduction to Participatory Theme Elicitation

BACKGROUND

While Patient and Public Involvement (PPI) is encouraged throughout the research process, engagement is typically limited to intervention design and post-analysis stages. There are few approaches to participatory data analyses within complex health interventions.

METHODS

Using qualitative data from a feasibility randomised controlled trial (RCT), this proof-of-concept study tests the value of a new approach to participatory data analysis called Participatory Theme Elicitation (PTE). Forty excerpts were given to eight members of a youth advisory PPI panel to sort into piles based on their perception of related thematic content. Using algorithms to detect communities in networks, excerpts were then assigned to a thematic cluster that combined the panel members' perspectives. Network analysis techniques were also used to identify key excerpts in each grouping that were then further explored qualitatively.

RESULTS

While PTE analysis was, for the most part, consistent with the researcher-led analysis, young people also identified new emerging thematic content.

CONCLUSIONS

PTE appears promising for encouraging user led identification of themes arising from qualitative data collected during complex interventions. Further work is required to validate and extend this method.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02455986 . Retrospectively Registered on 21 May 2015.