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Barriers and Recommended Interventions to Prevent Melioidosis in Northeast Thailand: A Focus Group Study Using the
Pornpan Suntornsut1, Nittayasee Wongsuwan1, Mayura Malasit1
1Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Background:
Melioidosis, an often fatal infectious disease in Northeast Thailand, is caused by skin inoculation, inhalation or ingestion of the environmental bacterium, Burkholderia pseudomallei. The major underlying risk factor for melioidosis is diabetes mellitus. Recommendations for melioidosis prevention include using protective gear such as rubber boots and gloves when in direct contact with soil and environmental water, and consuming bottled or boiled water. Only a small proportion of people follow such recommendations.
Methods:
Nine focus group discussions were conducted to evaluate barriers to adopting recommended preventive behaviours. A total of 76 diabetic patients from northeast Thailand participated in focus group sessions. Barriers to adopting the recommended preventive behaviours and future intervention strategies were identified using two frameworks: the Theoretical Domains Framework and the Behaviour Change Wheel.
Results:
Barriers were identified in the following five domains: (i) knowledge, (ii) beliefs about consequences, (iii) intention and goals, (iv) environmental context and resources, and (v) social influence. Of 76 participants, 72 (95%) had never heard of melioidosis. Most participants saw no harm in not adopting recommended preventive behaviours, and perceived rubber boots and gloves to be hot and uncomfortable while working in muddy rice fields. Participants reported that they normally followed the behaviour of friends, family and their community, the majority of whom did not wear boots while working in rice fields and did not boil water before drinking. Eight intervention functions were identified as relevant for the intervention: (i) education, (ii) persuasion, (iii) incentivisation, (iv) coercion, (v) modeling, (vi) environmental restructuring, (vii) training, and (viii) enablement. Participants noted that input from role models in the form of physicians, diabetic clinics, friends and families, and from the government via mass media would be required for them to change their behaviours.
Conclusion:
There are numerous barriers to the adoption of behaviours recommended for melioidosis prevention. We recommend that a multifaceted intervention at community and government level is required to achieve the desired behaviour changes.
Insights
Melioidosis prevention is low among diabetic patients in Thailand due to lack of knowledge and perceived discomfort with protective measures. Multifaceted community and government interventions are needed to improve adoption of preventive behaviors.
Area of Science:
- Infectious Diseases
- Public Health
- Behavioral Science
Background:
- Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is prevalent in Northeast Thailand.
- Diabetes mellitus is a major risk factor for melioidosis.
- Current prevention recommendations, including protective gear and safe water consumption, are poorly adopted.
Purpose of the Study:
- To evaluate barriers to adopting recommended melioidosis preventive behaviors among diabetic patients in Northeast Thailand.
- To identify potential intervention strategies for improving melioidosis prevention.
Main Methods:
- Nine focus group discussions were conducted with 76 diabetic patients.
- The Theoretical Domains Framework and Behaviour Change Wheel were used to analyze barriers and interventions.
Main Results:
- Key barriers included lack of knowledge (95% unaware of melioidosis), low perceived risk, and discomfort with protective gear.
- Social influence from family, community, and peers significantly impacted behavior.
- Eight intervention functions were identified, emphasizing education, persuasion, and modeling by healthcare professionals and government.
Conclusions:
- Numerous barriers hinder the adoption of melioidosis preventive behaviors.
- A multifaceted intervention involving community and government efforts is essential for behavior change.
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