Interpretations of education about gene-environment influences on health in rural Ethiopia: the context of a neglected tropical disease.
Misunderstandings of the role of genetics in disease development are associated with stigmatizing behaviors and fatalistic attitudes about prevention. This report describes an evaluation of community understanding of an educational module about genetic and environmental influences on the development of podoconiosis, a neglected tropical disease endemic in highland Ethiopia.



A qualitative process assessment was conducted as part of a large prospective intervention trial in August 2013, in Wolaita Zone, southern Ethiopia. Sixty five participants were purposively selected from 600 households randomized to receive the inherited susceptibility module. The educational module used pictorial representations and oral explanations of the interaction of inherited sensitivity and soil exposure and was delivered by lay health educators in participants' homes. Data were collected using semi-structured individual interviews (IDIs) or focus group discussions (FGDs).



Qualitative analyses showed that most participants improved their understanding of inherited soil sensitivity and susceptibility to podoconiosis. Participants linked their new understanding to decreased stigma-related attitudes. The module also corrected misconceptions that the condition was contagious, again diminishing stigmatizing attitudes. Lastly, these improvements in understanding increased the perceived value of foot protection.



Taken together, these improvements support the acceptability, feasibility and potential benefits of implementing gene-environment education in low and middle income countries.
Addis Ababa University, College of Social Sciences, P.O. Box 180505, Addis Ababa, Ethiopia.
Abebayehu
A
Tora
Addis Ababa University, College of Social Sciences, P.O. Box 180505, Addis Ababa, Ethiopia.
Desta
D
Ayode
Addis Ababa University, College of Social Sciences, P.O. Box 180505, Addis Ababa, Ethiopia.
Getnet
G
Tadele
People Designs Inc., 1304 Broad St, Durham NC, 27705, USA.
David
D
Farrell
Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer, Brighton BN19PX, UK.
Gail
G
Davey
Emory Rollins School of Public Health, 1518 Clifton Rd NE, GCR 564, Atlanta GA 30322, USA cmmcbri@emory.edu.
Colleen M
CM
McBride
D000328:Adult; D004604:Elephantiasis / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D059647:Gene-Environment Interaction; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000235:genetics* / Q000517:prevention & control*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014330:Tropical Medicine
Ethiopia; Gene-environment; Health education; Podoconiosis