title: Community participation for malaria elimination in Tafea Province, Vanuatu: Part I. Maintaining motivation for prevention practices in the context of disappearing disease.
abstract: BACKGROUND
  In the 1990s, the experience of eliminating malaria from Aneityum Island, Vanuatu is often given as evidence for the potential to eliminate malaria in the south-west Pacific. This experience, however, cannot provide a blueprint for larger islands that represent more complex social and environmental contexts. Community support was a key contributor to success in Aneityum. In the context of disappearing disease, obtaining and maintaining community participation in strategies to eliminate malaria in the rest of Tafea Province, Vanuatu will be significantly more challenging.
  
  
  METHODS
  Nine focus group discussions (FGDs), 12 key informant interviews (KIIs), three transect walks and seven participatory workshops were carried out in three villages across Tanna Island to investigate community perceptions and practices relating to malaria prevention (particularly relating to bed nets); influences on these practices including how malaria is contextualized within community health and disease priorities; and effective avenues for channelling health information.
  
  
  RESULTS
  The primary protection method identified by participants was the use of bed nets, however, the frequency and motivation for their use differed between study villages on the basis of the perceived presence of malaria. Village, household and personal cleanliness were identified by participants as important for protection against malaria. Barriers and influences on bed net use included cultural beliefs and practices, travel, gender roles, seasonality of mosquito nuisance and risk perception. Health care workers and church leaders were reported to have greatest influence on malaria prevention practices. Participants preferred receiving health information through visiting community health promotion teams, health workers, church leaders and village chiefs.
  
  
  CONCLUSIONS
  In low malaria transmission settings, a package for augmenting social capital and sustaining community participation for elimination will be essential and includes: 'sentinel sites' for qualitative monitoring of evolving local socio-cultural, behavioural and practical issues that impact malaria prevention and treatment; mobilizing social networks; intersectoral collaboration; integration of malaria interventions with activities addressing other community health and disease priorities; and targeted implementation of locally appropriate, multi-level, media campaigns that sustain motivation for community participation in malaria elimination.
authors.affiliation: Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia. joan.atkinson@uq.edu.au
authors.forename: Jo-An M
authors.initials: JA
authors.lastname: Atkinson
authors.forename: Lisa
authors.initials: L
authors.lastname: Fitzgerald
authors.forename: Hilson
authors.initials: H
authors.lastname: Toaliu
authors.forename: George
authors.initials: G
authors.lastname: Taleo
authors.forename: Anna
authors.initials: A
authors.lastname: Tynan
authors.forename: Maxine
authors.initials: M
authors.lastname: Whittaker
authors.forename: Ian
authors.initials: I
authors.lastname: Riley
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001512:Bedding and Linens / Q000706:statistics & numerical data*; D003153:Community Health Services; D003256:Community Participation; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods*; D057147:Mosquito Nets; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D009514:Vanuatu; D055815:Young Adult