Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Negl Trop Dis. 2018 Jan 25;12(1):e0006178. doi: 10.1371/journal.pntd.0006178. eCollection 2018 Jan.
Efforts are underway to scale-up the facial cleanliness and environmental improvement (F&E) components of the World Health Organization's SAFE strategy for elimination of trachoma as a public health problem. Improving understanding of the F&E intervention landscape could inform advancements prior to scale-up, and lead to more effective and sustained behavior change.
METHODS/FINDINGS: We systematically searched for relevant grey literature published from January 1965 through August 2016. Publications were eligible for review if they described interventions addressing F&E in the context of trachoma elimination programs. Subsequent to screening, we mapped attributes of F&E interventions. We then employed three behavior change frameworks to synthesize mapped data and identify potential intervention gaps. We identified 27 documents meeting inclusion criteria. With the exception of some recent programming, F&E interventions have largely focused on intermediate and distal antecedents of behavior change. Evidence from our analyses suggests many interventions are not designed to address documented determinants of improved F&E practices. No reviewed documents endorsed inclusion of intervention components related to behavioral maintenance or resilience-factors critical for sustaining improved behaviors.
If left unaddressed, identified gaps in intervention content may continue to challenge uptake and sustainability of improved F&E behaviors. Stakeholders designing and implementing trachoma elimination programs should review their F&E intervention content and delivery approaches with an eye toward improvement, including better alignment with established behavior change theories and empirical evidence. Implementation should move beyond information dissemination, and appropriately employ a variety of behavior change techniques to address more proximal influencers of change.
目前正在努力扩大世界卫生组织 SAFE 消除致盲性沙眼公共卫生问题战略中的面部清洁和环境卫生改善（F&E）部分。增进对 F&E 干预措施的了解，可以在扩大规模之前为其提供信息，并促成更有效和可持续的行为改变。
方法/发现：我们系统地搜索了 1965 年 1 月至 2016 年 8 月期间发表的相关灰色文献。如果出版物描述了在消除沙眼规划中针对 F&E 的干预措施，则有资格进行审查。筛选后，我们绘制了 F&E 干预措施的属性图。然后，我们运用了三个行为改变框架来综合映射数据并确定潜在的干预差距。我们确定了符合纳入标准的 27 份文件。除了一些最近的规划，F&E 干预措施主要集中在行为改变的中间和远因上。我们的分析结果表明，许多干预措施并非旨在解决已记录的改善 F&E 实践的决定因素。没有审查过的文件认可将与行为维持或弹性相关的干预因素纳入进来，这些因素对维持改善的行为至关重要。
如果不加以解决，干预内容中的差距可能会继续对改善的 F&E 行为的采纳和可持续性构成挑战。设计和实施沙眼消除规划的利益攸关方应审查其 F&E 干预内容和实施方法，以寻求改进，包括更好地与既定的行为改变理论和经验证据保持一致。实施应超越信息传播，并适当采用各种行为改变技术来解决更接近变革的影响因素。
