Applying mental model methods to characterize understanding of gene-environment influences: the case of podoconiosis in Ethiopia

• Type of Material: Article
• Authors: Caitlin G. Allen, Emory University; Colleen McBride, Emory University; Kibur Engdawork, Addis Ababa University; Desta Ayode, Addis Ababa University; Getnet Tadele, Addis Ababa University
• Language: English
• Date: 2019-01-01
• Publisher: Taylor and Francis LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.
• Final Published Version (URL): http://dx.doi.org/10.1080/09581596.2017.1409885
• Title of Journal or Parent Work: Critical Public Health
• Volume: 29
• Issue: 1
• Start Page: 84
• End Page: 99
• Grant/Funding Information: This work was supported by National Institutes of Health Funding Opportunity Announcement, “Human Heredity and Health in Africa (H3Africa): Ethical, Legal, and Societal Issues (ELSI) Research Program (U01). Grant number: 5U01HG007628 – 03.
• Keywords: Biomedical Social Sciences; LITERACY; podoconiosis; Life Sciences & Biomedicine; BELIEFS; COMMUNICATION STRATEGIES; expert and lay knowledge; Public, Environmental & Occupational Health; mental model; HEALTH-PROMOTION; Social Sciences; MEDICINE; ASSOCIATION; FRAMEWORK; low and middle income countries; Science & Technology; WOLAITA ZONE; Genomics; RISK; gene-environment; Social Sciences, Biomedical; health literacy; Ethiopia; DISEASE
• Research Categories: Health Sciences, Public Health

Abstract

The rapid pace of genomic discovery has raised public expectation and concerns about the utility of new discoveries and their potential to exacerbate health disparities. Improving literacy concerning gene and environmental (GxE) contributors to disease is needed to avoid commonly observed deterministic misconceptions about genomics. Mental models approaches that incorporate community engagement processes could be used to inform GxE literacy-building interventions. We used a mental models approach to describe and systematically compare expert and lay understanding of GxE interactions, using the example of podoconiosis, a non-infectious lymphedema endemic in highland Ethiopia. Methods included: (1) specifying elicitation questions for a literature review, (2) eliciting an expert model, (3) eliciting a lay model, and (4) comparing the two models. We used a coding scheme to identify lay participants’ knowledge gaps, misunderstandings, and extra knowledge relative to the expert standard. Results indicated that lay participants’ viewed poverty as an important susceptibility factor and considered heredity and contagion to have a joint causal influence. Experts did not endorse either of these viewpoints. Conventional expert-based interventions aimed to correct misconceptions about behaviors important for prevention may be stymied by lay views that social environmental factors have more important influences on health outcomes. GxE literacy interventions that consider multiple levels of influence including social determinants of health and personal resilience to augment health education strategies are needed in diverse settings. Novel communication approaches will be needed to help target audiences disentangle long-held conceptions of heredity and contagion.