Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.
Department of Social and Behavioral Science, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
Malar J. 2019 Dec 12;18(1):417. doi: 10.1186/s12936-019-3051-0.
Mass and continuous distribution channels have significantly increased access to insecticide-treated nets (ITNs) in Ghana since 2000. Despite these gains, a large gap remains between ITN access and use.
A qualitative research study was carried out to explore the individual and contextual factors influencing ITN use among those with access in three sites in Ghana. Eighteen focus group discussions, and free listing and ranking activities were carried out with 174 participants; seven of those participants were selected for in-depth case study. Focus group discussions and case study interviews were audio-recorded, transcribed verbatim, and analysed thematically.
ITN use, as described by study participants, was not binary; it varied throughout the night, across seasons, and over time. Heat was the most commonly cited barrier to consistent ITN use and contributed to low reported ITN use during the dry season. Barriers to ITN use throughout the year included skin irritation; lack of airflow in the sleeping space; and, in some cases, a lack of information on the connection between the use of ITNs and malaria prevention. Falling ill or losing a loved one to malaria was the most powerful motivator for consistent ITN use. Participants also discussed developing a habit of ITN use and the economic benefit of prevention over treatment as facilitating factors. Participants reported gender differences in ITN use, noting that men were more likely than women and children to stay outdoors late at night and more likely to sleep outdoors without an ITN.
The study results suggest the greatest gains in ITN use among those with access could be made by promoting consistent use throughout the year among occasional and seasonal users. Opportunities for improving communication messages, such as increasing the time ITNs are aired before first use, as well as structural approaches to enhance the usability of ITNs in challenging contexts, such as promoting solutions for outdoor ITN use, were identified from this work. The information from this study can be used to inform social and behaviour change messaging and innovative approaches to closing the ITN use gap in Ghana.
自 2000 年以来，大规模和连续的分销渠道极大地增加了加纳驱虫蚊帐（ITN）的可及性。尽管取得了这些进展，但 ITN 的可及性和使用率之间仍存在很大差距。
本研究开展了一项定性研究，以探索在加纳三个地点具有 ITN 可及性的人群中，影响 ITN 使用的个人和环境因素。共进行了 18 次焦点小组讨论，以及自由列举和排序活动，参与者共有 174 人；其中 7 人被选为深入案例研究对象。对焦点小组讨论和案例研究访谈进行了录音、逐字转录，并进行了主题分析。
正如研究参与者所描述的那样，ITN 使用并不是二元的；它会在整个晚上、不同季节和不同时间发生变化。热是导致 ITN 使用率低的最常见障碍，也是导致旱季 ITN 使用率低的原因。全年使用 ITN 的障碍包括皮肤刺激；睡眠空间内空气流通不畅；在某些情况下，缺乏关于使用 ITN 与疟疾预防之间联系的信息。生病或因疟疾失去亲人是坚持使用 ITN 的最有力动机。参与者还讨论了养成使用 ITN 的习惯以及预防胜于治疗的经济效益作为促进因素。参与者报告了 ITN 使用中的性别差异，指出男性比女性和儿童更有可能在深夜在户外逗留，更有可能在户外睡觉而不使用 ITN。
研究结果表明，促进偶尔和季节性使用者全年持续使用 ITN，可能会使那些有 ITN 可及性的人最大程度地提高 ITN 使用量。本研究工作中确定了一些改进沟通信息的机会，例如增加 ITN 在首次使用前的通风时间，以及在具有挑战性的环境中提高 ITN 可用性的结构方法，例如推广户外使用 ITN 的解决方案。这项研究的信息可用于为加纳缩小 ITN 使用差距提供社会和行为改变信息以及创新方法。
