Promoting Footwear in Rural Ethiopia

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Phase 1 qualitative data collection has been completed in the four selected villages. Periodic review of procedures indicated the need for some small changes in the interview schedules to shorten the length of the focus groups and structured interviews. All data has been compiled, translated, back-translated and is being analyzed by the NIH team using N-Vivo software. Initial findings were presented at the Society of Behavioral Medicine in April 2011. Two manuscripts based on the qualitative data are in preparation. Briefly, results indicated that community members have diverse beliefs about the role of genetics as a cause of podoconiosis. Some individuals believe that genetics is the sole cause of the disease and nothing can be done to prevent it, others see that protective footwear can prevent podoconiosis even among those at genetic risk, and others believe the disease is both genetic and contagious. The next steps will be to develop a prototype intervention that is based in church and neighborhood settings involving role models from the community (e.g., teachers) who will educate about the causes of podoconiosis and encourage consistent footwear. We expect that the prototype intervention will be developed by the team by the end of the 2011. Pilot testing using rapid assessment and evaluation methods will be conducted in early 2012 to assess the feasibility and acceptability of the intervention to promote footwear. Fall 2012 a formal evaluation of the final intervention will be initiated. A second round of pilot activities were completed in March, 2012. These results indicated the feasibility of our genetics education intervention. The community-based intervention trial commenced in January 2013. Six communities have been assigned to one of three intervention conditions: (1) Usual health education about footwear, (2) public health campaign and household-based health education and (3) public health campaign, household based health education that includes information about inherited soil sensitivity. The primary outcome is consistent shoe wearing by an index child who has received shoes from a local NGO. Four survey assessments are conducted: (1) baseline (2) 3 months after the intervention, (3) 10 mos and (4) 15 mos after the intervention. A total of 1800 households have been enrolled, completed the baseline and 3 month follow-up surveys. We have completed 2 manuscripts that are now published. Data analysis on the initial surveys will begin in October 2013.