社区范围内大规模驱虫治疗期间不良反应对后续参与度的影响——计划行为理论分析。
Impact of adverse events during community-wide mass drug administration for soil-transmitted helminths on subsequent participation-a Theory of Planned Behaviour analysis.
机构信息
The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America.
出版信息
PLoS Negl Trop Dis. 2023 Mar 14;17(3):e0011148. doi: 10.1371/journal.pntd.0011148. eCollection 2023 Mar.
BACKGROUND
Experiencing adverse events (AEs) during mass drug administration (MDA) could affect participation in future MDAs. This study aims to understand the potential influence of AEs during a community-wide MDA (cMDA) trial for soil-transmitted helminths (STH) in India on intention to participate in future cMDAs.
METHODS
This study was conducted using a multi-method quantitative and qualitative approach among 74 participants who experienced an AE during STH cMDA and the 12 participants who subsequently refused cMDA treatment of the ongoing DeWorm3 trial. Path analysis and thematic analysis guided by the Theory of Planned Behaviour, was used.
PRINCIPAL FINDINGS
Among 74 individuals who reported an AE, 12% refused treatment in the cMDA immediately subsequent to their AE and 4% refused in all subsequent cMDAs. Of these 74 individuals, 59 (80%) completed a survey and eight participated in in-depth interviews. A positive attitude towards deworming and perceived ability to participate in cMDA (perceived behavioural control) were significant predictors of intention to participate in cMDA (p<0.05). A positive attitude towards cMDA was associated with caste (χ2 = 3.83, P = 0.05), particularly among the scheduled caste/scheduled tribe (SC/ST) (62%). Perceived behavioural control in cMDA participation was associated with occupation (χ2 = 5.02, P<0.05), with higher perceived control among those engaged in skilled occupations (78%). Intention to participate in subsequent cMDAs was associated with caste and family type (χ2 = 3.83, P = 0.05 and χ2 = 7.50, P<0.05 respectively) and was higher among SC/ST (62%) and those with extended families (67%). In-depth interviews demonstrated that perceived severe AEs may lead to treatment refusal in future, particularly if children were affected.
CONCLUSIONS
Intention to participate in future STH cMDAs was associated with caste (SC/ST) and family type (extended families). Therefore, community mobilization messages about potential AEs and their management may need to intentionally target non-SC/ST households, nuclear families, and those engaged in unskilled occupations to increase cMDA participation given the possibility of AEs occurring.
TRIAL REGISTRATION
NCT03014167, ClinicalTrials.gov.
背景
在大规模药物治疗（MDA）期间经历不良事件（AE）可能会影响未来 MDA 的参与。本研究旨在了解印度社区范围内土壤传播蠕虫（STH） MDA 试验期间 AE 对未来社区 MDA 治疗意愿的潜在影响。
方法
本研究采用定量和定性的多方法，对 74 名在 STH MDA 期间经历 AE 的参与者和随后拒绝参加正在进行的 Deworm3 试验 cMDA 治疗的 12 名参与者进行了研究。使用计划行为理论进行路径分析和主题分析。
主要发现
在报告 AE 的 74 人中，12%的人在 AE 后立即拒绝接受 cMDA 治疗，4%的人拒绝所有后续的 cMDA 治疗。在这 74 人中，59 人（80%）完成了一项调查，8 人参加了深入访谈。对驱虫的积极态度和参与 cMDA 的感知能力（感知行为控制）是参与 cMDA 的意愿的重要预测因素（p<0.05）。对 cMDA 的积极态度与种姓（χ2 = 3.83，P = 0.05）相关，尤其是在 scheduled caste/scheduled tribe（SC/ST）中（62%）。cMDA 参与中感知行为控制与职业（χ2 = 5.02，P<0.05）相关，技能型职业者的感知控制更高（78%）。未来参与 cMDA 的意愿与种姓和家庭类型（χ2 = 3.83，P = 0.05 和 χ2 = 7.50，P<0.05）相关，SC/ST（62%）和大家庭（67%）的意愿更高。深入访谈表明，感知严重 AE 可能导致未来拒绝治疗，特别是如果儿童受到影响。
结论
未来 STH cMDA 治疗意愿与种姓（SC/ST）和家庭类型（大家庭）相关。因此，鉴于可能发生 AE，针对非 SC/ST 家庭、核心家庭和从事非技术职业者的关于潜在 AE 及其管理的社区动员信息可能需要有针对性地提高 cMDA 的参与度。
试验注册
NCT03014167，ClinicalTrials.gov。
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