TY - JOUR
T1 - A qualitative study of community perspectives surrounding cleaning practices in the context of Zika prevention in El Salvador
T2 - Implications for community-based Aedes aegypti control
AU - Leontsini, Elli
AU - Maloney, Sean
AU - Ramírez, Margarita
AU - Rodriguez, Eric
AU - Gurman, Tilly
AU - Ballard Sara, Anne
AU - Hunter, Gabrielle C.
N1 - Funding Information:
The study was made possible by the support of the American people through the United States Agency for International Development (USAID) under the Breakthrough ACTION Cooperative Agreements #AID-OAA-A-17-00017. Breakthrough ACTION is based at the Johns Hopkins Center for Communication Programs (CCP). Beyond advising on the selection of study sites, the funder did not have any role in the design of the study, the collection, analysis, and interpretation of the data, nor in writing the manuscript. The contents of this article are the sole responsibility of the authors and do not necessarily reflect the views of Breakthrough ACTION, USAID, the United States Government, or Johns Hopkins University.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/9/11
Y1 - 2020/9/11
N2 - Background: In El Salvador, Aedes aegypti mosquitoes transmitting Zika and other arboviruses use water storage containers as important oviposition sites. Promotion of water storage container cleaning is a key element of prevention programs. We explored community perceptions surrounding cleaning practices among pregnant women, male partners of pregnant women, and women likely to become pregnant. Methods: Researchers conducted 11 focus groups and 12 in-depth interviews which included individual elicitations of Zika prevention measures practiced in the community. Focus group participants rated 18 images depicting Zika-related behaviors according to effectiveness and feasibility in the community context, discussed influencing determinants, voted on community intentions to perform prevention behaviors, and performed washbasin cleaning simulations. In-depth interviews with male partners of pregnant women used projective techniques with images to explore their perceptions on a subset of Zika prevention behaviors. Results: General cleaning of the home, to ensure a healthy environment, was a strong community norm. In this context, participants gave water storage container cleaning a high rating, for both its effectiveness and feasibility. Participants were convinced that they cleaned their water storage containers effectively against Zika, but their actual skills were inadequate to destroy Aedes aegypti eggs. A further constraint was the schedule of water availability. Even during pregnancy, male partners rarely cleaned water storage containers because water became available in homes when they were at work. Furthermore, prevailing gender norms did not foster male participation in domestic cleaning activities. Despite these factors, many men were willing to provide substantial support with cleaning when their partners were pregnant, in order to protect their family. Conclusions: Behavior change programs for the prevention of Zika and other arboviruses need to improve community members' mosquito egg destruction skills rather than perpetuate the promotion of non-specific cleaning in and around the home as effective. Egg elimination must be clearly identified as the objective of water storage container maintenance and programs should highlight the effective techniques to achieve this goal. In addition, programs must build the skills of family members who support pregnant women to maintain the frequency of effective egg destruction in all water storage containers of the home.
AB - Background: In El Salvador, Aedes aegypti mosquitoes transmitting Zika and other arboviruses use water storage containers as important oviposition sites. Promotion of water storage container cleaning is a key element of prevention programs. We explored community perceptions surrounding cleaning practices among pregnant women, male partners of pregnant women, and women likely to become pregnant. Methods: Researchers conducted 11 focus groups and 12 in-depth interviews which included individual elicitations of Zika prevention measures practiced in the community. Focus group participants rated 18 images depicting Zika-related behaviors according to effectiveness and feasibility in the community context, discussed influencing determinants, voted on community intentions to perform prevention behaviors, and performed washbasin cleaning simulations. In-depth interviews with male partners of pregnant women used projective techniques with images to explore their perceptions on a subset of Zika prevention behaviors. Results: General cleaning of the home, to ensure a healthy environment, was a strong community norm. In this context, participants gave water storage container cleaning a high rating, for both its effectiveness and feasibility. Participants were convinced that they cleaned their water storage containers effectively against Zika, but their actual skills were inadequate to destroy Aedes aegypti eggs. A further constraint was the schedule of water availability. Even during pregnancy, male partners rarely cleaned water storage containers because water became available in homes when they were at work. Furthermore, prevailing gender norms did not foster male participation in domestic cleaning activities. Despite these factors, many men were willing to provide substantial support with cleaning when their partners were pregnant, in order to protect their family. Conclusions: Behavior change programs for the prevention of Zika and other arboviruses need to improve community members' mosquito egg destruction skills rather than perpetuate the promotion of non-specific cleaning in and around the home as effective. Egg elimination must be clearly identified as the objective of water storage container maintenance and programs should highlight the effective techniques to achieve this goal. In addition, programs must build the skills of family members who support pregnant women to maintain the frequency of effective egg destruction in all water storage containers of the home.
KW - Arbovirus prevention
KW - Behavioral determinants
KW - Chikungunya
KW - Community control of Aedes aegypti
KW - Dengue
KW - El Salvador
KW - Mosquito ovicidal technique
KW - Untadita
KW - Water storage containers
KW - Zika
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UR - http://www.scopus.com/inward/citedby.url?scp=85090817853&partnerID=8YFLogxK
U2 - 10.1186/s12889-020-09370-5
DO - 10.1186/s12889-020-09370-5
M3 - Article
C2 - 32912177
AN - SCOPUS:85090817853
SN - 1471-2458
VL - 20
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 1385
ER -