Watanabe Noriko, Kaneko Akira, Yamar Sam, Leodoro Hope, Taleo George, Tanihata Takeo, Lum J Koji, Larson Peter S
Department of Parasitology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Malar J. 2014 Nov 20;13:441. doi: 10.1186/1475-2875-13-441.
Insecticide-treated nets (ITNs) are an integral piece of any malaria elimination strategy, but compliance remains a challenge and determinants of use vary by location and context. The Health Belief Model (HBM) is a tool to explore perceptions and beliefs about malaria and ITN use. Insights from the model can be used to increase coverage to control malaria transmission in island contexts.
A mixed methods study consisting of a questionnaire and interviews was carried out in July 2012 on two islands of Vanuatu: Ambae Island where malaria transmission continues to occur at low levels, and Aneityum Island, where an elimination programme initiated in 1991 has halted transmission for several years.
For most HBM constructs, no significant difference was found in the findings between the two islands: the fear of malaria (99%), severity of malaria (55%), malaria-prevention benefits of ITN use (79%) and willingness to use ITNs (93%). ITN use the previous night on Aneityum (73%) was higher than that on Ambae (68%) though not statistically significant. Results from interviews and group discussions showed that participants on Ambae tended to believe that risk was low due to the perceived absence of malaria, while participants on Aneityum believed that they were still at risk despite the long absence of malaria. On both islands, seasonal variation in perceived risk, thermal discomfort, costs of replacing nets, a lack of money, a lack of nets, nets in poor condition and the inconvenience of hanging had negative influences, while free mass distribution with awareness campaigns and the malaria-prevention benefits had positive influences on ITN use.
The results on Ambae highlight the challenges of motivating communities to engage in elimination efforts when transmission continues to occur, while the results from Aneityum suggest the possibility of continued compliance to malaria elimination efforts given the threat of resurgence. Where a high degree of community engagement is possible, malaria elimination programmes may prove successful.
经杀虫剂处理的蚊帐（ITNs）是任何疟疾消除策略的一个重要组成部分，但蚊帐的使用依从性仍然是一个挑战，而且其使用的决定因素因地点和环境而异。健康信念模型（HBM）是一种用于探索对疟疾和ITN使用的认知与信念的工具。该模型的见解可用于提高覆盖率，以控制岛屿环境中的疟疾传播。
2012年7月，在瓦努阿图的两个岛屿上开展了一项混合方法研究，包括问卷调查和访谈：安巴岛仍有低水平的疟疾传播，阿内蒂乌姆岛于1991年启动了消除计划，疟疾传播已停止数年。
对于大多数健康信念模型的构建因素，两个岛屿的调查结果没有显著差异：对疟疾的恐惧（99%）、疟疾的严重性（55%）、使用ITN预防疟疾的益处（79%）以及使用ITN的意愿（93%）。阿内蒂乌姆岛前一晚ITN的使用率（73%）高于安巴岛（68%），但无统计学意义。访谈和小组讨论的结果表明，安巴岛的参与者倾向于认为由于感觉没有疟疾，风险较低，而阿内蒂乌姆岛的参与者认为尽管长期没有疟疾，他们仍然面临风险。在两个岛屿上，感知风险的季节性变化、热不适、更换蚊帐的成本、缺钱、蚊帐短缺、蚊帐状况差以及悬挂不便都有负面影响，而免费大规模分发并开展宣传活动以及预防疟疾的益处对ITN的使用有积极影响。
安巴岛的结果凸显了在疟疾传播仍在继续的情况下，激励社区参与消除努力所面临的挑战，而阿内蒂乌姆岛的结果表明，鉴于疟疾复发的威胁，持续遵守疟疾消除努力是有可能的。在社区参与度较高的地方，疟疾消除计划可能会取得成功。
