Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana
Abstract Background 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. Methods A qualitative research study was carried out to explore the individua...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12936-019-3051-0 |
| _version_ | 1831557172606009344 |
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| author | Collins Stephen Ahorlu Philip Adongo Hannah Koenker Sixte Zigirumugabe Solomon Sika-Bright Eric Koka Philip Teg-Nefaah Tabong Danielle Piccinini Sylvester Segbaya Bolanle Olapeju April Monroe |
| author_facet | Collins Stephen Ahorlu Philip Adongo Hannah Koenker Sixte Zigirumugabe Solomon Sika-Bright Eric Koka Philip Teg-Nefaah Tabong Danielle Piccinini Sylvester Segbaya Bolanle Olapeju April Monroe |
| author_sort | Collins Stephen Ahorlu |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusion 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. |
| first_indexed | 2024-12-17T04:48:05Z |
| format | Article |
| id | doaj.art-e3a5c3ff96fd42208d6ebc25dad1adce |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-17T04:48:05Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-e3a5c3ff96fd42208d6ebc25dad1adce2022-12-21T22:03:01ZengBMCMalaria Journal1475-28752019-12-0118111310.1186/s12936-019-3051-0Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in GhanaCollins Stephen Ahorlu0Philip Adongo1Hannah Koenker2Sixte Zigirumugabe3Solomon Sika-Bright4Eric Koka5Philip Teg-Nefaah Tabong6Danielle Piccinini7Sylvester Segbaya8Bolanle Olapeju9April Monroe10Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of GhanaDepartment of Social and Behavioral Science, School of Public Health, College of Health Sciences, University of GhanaPMI VectorWorks Project, Johns Hopkins Center for Communication ProgramsU.S. President’s Malaria Initiative, U.S. Agency for International DevelopmentDepartment of Sociology and Anthropology, University of Cape CoastDepartment of Sociology and Anthropology, University of Cape CoastDepartment of Social and Behavioral Science, School of Public Health, College of Health Sciences, University of GhanaPMI VectorWorks Project, Johns Hopkins Center for Communication ProgramsJohns Hopkins Center for Communication ProgramsPMI VectorWorks Project, Johns Hopkins Center for Communication ProgramsPMI VectorWorks Project, Johns Hopkins Center for Communication ProgramsAbstract Background 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. Methods 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. Results 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. Conclusion 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.https://doi.org/10.1186/s12936-019-3051-0MalariaGhanaInsecticide-treated mosquito netPrevention |
| spellingShingle | Collins Stephen Ahorlu Philip Adongo Hannah Koenker Sixte Zigirumugabe Solomon Sika-Bright Eric Koka Philip Teg-Nefaah Tabong Danielle Piccinini Sylvester Segbaya Bolanle Olapeju April Monroe Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana Malaria Journal Malaria Ghana Insecticide-treated mosquito net Prevention |
| title | Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana |
| title_full | Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana |
| title_fullStr | Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana |
| title_full_unstemmed | Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana |
| title_short | Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide-treated net use in Ghana |
| title_sort | understanding the gap between access and use a qualitative study on barriers and facilitators to insecticide treated net use in ghana |
| topic | Malaria Ghana Insecticide-treated mosquito net Prevention |
| url | https://doi.org/10.1186/s12936-019-3051-0 |
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