Digging for care-seeking behaviour among gold miners in the Guyana hinterland: a qualitative doer non-doer analysis of social and behavioural motivations for malaria testing and treatment.

BACKGROUND: Although Guyana has made significant progress toward malaria control, limited access to malaria testing and treatment services threatens those gains. Mining activities create breeding environments for mosquitoes, and the migrant and mobile mining populations are hard to reach with information and services. The Ministry of Public Health (MoPH) has trained volunteers to test and treat malaria cases in remote regions. However, it remains unclear how miners perceive these testers, the services they provide, or what their malaria care-seeking behaviour is in general. To better address these challenges, Breakthrough ACTION Guyana and MoPH conducted qualitative research from October to November 2018 in Regions 7 and 8 in Guyana. METHODS: A total of 109 individuals, 70 miners, 17 other mining camp staff, and 22 other key stakeholders (e.g. community health workers, pharmacists, and regional leadership), participated in semi-structured interviews and focus group discussions. Results were derived using a framework analysis, with an adjusted doer and non-doer analysis, and organized using the integrated behaviour framework. RESULTS: Miners sought MoPH-approved services because of close geographic proximity to testing services, a preference for public service treatment, and a desire to correctly diagnose and cure malaria rather than just treat its symptoms. Those who chose to initiate self-treatment-using unregulated medications from the private and informal sector-did so out of convenience and the belief that self-treatment had worked before. Miners who completed the full MoPH-approved treatment understood the need to complete the treatment, while those who prematurely stopped treatment did so because of medication side effects and a desire to feel better as soon as possible. CONCLUSION: Reasons why miners do and do not pursue malaria testing and treatment services are diverse. These results can inform better MoPH programming and new solutions to improve malaria outcomes in Guyana.

Use of short message service for monitoring Zika-related behaviors in four Latin American countries: lessons learned from the field.

BACKGROUND: Effective response to widespread epidemics relies in part on rapidly changing information from affected communities as individuals react to emergency response efforts. The short message service (SMS) approach was used to monitor knowledge, prevention, and behavior during an outbreak of Zika cases in Honduras, El Salvador, the Dominican Republic, and Guatemala in 2017. SMS methods supported collection of monitoring data at a time of heightened reliance on communication via mobile phones, and when the use of phones for epidemic-related communication was amplified. SMS methods were used to collect monitoring data on knowledge of Zika risk and prevention, and behaviors to prevent Zika infection. METHODS: Serial SMS surveys were conducted over a seven-month period to capture changing community perceptions of risk and behaviors to prevent Zika during the epidemic. This article discusses the development of the SMS surveys, from planning and designing tools to collecting the data, and the unique experiences encountered during survey implementation. RESULTS: Special considerations for the effective use of SMS for data collection are described, including market penetration of mobile phones, predominant phone types in use, preparation of communities and the target audience, options for tailoring questionnaires to the available technology, relationships with telecommunication companies, and supporting participants' ability to complete questionnaires. The article discusses issues related to the development of the questionnaires, context-specific challenges before and during implementation of the surveys, and creative strategies to overcome barriers. Lessons learned, and recommendations to increase opportunities for a successful SMS survey, are included. CONCLUSIONS: Understanding the social and economic context of mobile phone use in the target area and careful crafting of SMS questionnaires can produce useful data that may rival information captured through other approaches, such as Knowledge, Attitudes and Practices (KAP) surveys. Despite the challenges experienced, there is room for more consistent and widespread use of SMS for data collection in Latin America.