Interventions to maximize facial cleanliness and achieve environmental improvement for trachoma elimination: A review of the grey literature

• Authors: Maryann G. Delea, Emory University; Hiwote Solomon, Emory University; Anthony W. Solomon, World Health Organization; Matthew Freeman, Emory University
• Journal Title: PLoS Neglected Tropical Diseases
• Volume: Volume 12, Number 1
• Publisher: Public Library of Science | 2018-01-01, Pages e0006178-e0006178
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pntd.0006178
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Parasitology; Tropical Medicine; BEHAVIOR-CHANGE; DEVELOPING-COUNTRIES; RANDOMIZED-TRIAL; HEALTH BEHAVIORS; STRATEGY; IMPACT; FACE; TANZANIA; DISEASE; WATER

Abstract

Efforts are underway to scale-up the facial cleanliness and environmental improvement (F & E) components of the World Health Organization’s SAFE strategy for elimination of trachoma as a public health problem. Improving understanding of the F & E intervention landscape could inform advancements prior to scale-up, and lead to more effective and sustained behavior change. Methods/findings: We systematically searched for relevant grey literature published from January 1965 through August 2016. Publications were eligible for review if they described interventions addressing F & E in the context of trachoma elimination programs. Subsequent to screening, we mapped attributes of F & E interventions. We then employed three behavior change frameworks to synthesize mapped data and identify potential intervention gaps. We identified 27 documents meeting inclusion criteria. With the exception of some recent programming, F & E interventions have largely focused on intermediate and distal antecedents of behavior change. Evidence from our analyses suggests many interventions are not designed to address documented determinants of improved F & E practices. No reviewed documents endorsed inclusion of intervention components related to behavioral maintenance or resilience–factors critical for sustaining improved behaviors. Conclusions: If left unaddressed, identified gaps in intervention content may continue to challenge uptake and sustainability of improved F & E behaviors. Stakeholders designing and implementing trachoma elimination programs should review their F & E intervention content and delivery approaches with an eye toward improvement, including better alignment with established behavior change theories and empirical evidence. Implementation should move beyond information dissemination, and appropriately employ a variety of behavior change techniques to address more proximal influencers of change.