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

Perceived causes for chronic respiratory symptoms
Elsevier, The Lancet Global Health, Volume 10, January 2022
Brakema E.A., van der Kleij R.M.J.J., Poot C.C., An P.L., Anastasaki M., Crone M.R. et al.
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. Methods: This 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 SETTING-tool. 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. Funding: European Commission Horizon 2020. Translations: For the Greek, Russian and Vietnamese translations of the abstract see Supplementary Materials section.