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Community engagement strategies provide tools for sustainable vector-borne disease control
A previous cluster randomized control trial engaged nine intervention communities in seven participatory activities to promote management of the domestic and peri-domestic environment to reduce risk factors for vector-borne Chagas disease
This study aims to assess the adoption of this innovative community-based strategy
using concepts from the Diffusion of Innovations Theory
We used questionnaires and semi-structured interviews to understand perceptions of knowledge gained
and limiting or facilitating factors for adoption
The analysis process focused on five innovation attributes proposed by the Diffusion of Innovations Theory: relative advantage
Rodent management was highly adopted by participants
as it had a relative advantage regarding the use of poison and was compatible with local practices
The higher complexity was reduced by offering several types of trapping systems and having practical workshops allowed trialability
Observability was limited because the traps were indoors
but information and traps were shared with neighbors
Chicken management was not as widely adopted due to the higher complexity of the method
and lower compatibility with local practices
Using the concepts proposed by the Diffusion of Innovations Theory helped us to identify the enablers and constraints in the implementation of the Chagas vector control strategy
community engagement and intersectoral collaboration improve the acceptance and adoption of novel and integrated strategies to improve the prevention and control of neglected diseases
We focus on the attributes of each of the activities proposed (“innovations”) to understand its influence on the level of acceptance by study participants
Our objective is to better understand community engagement practices and innovation characteristics that enabled or hindered the adoption of vector and parasite reservoir control interventions
Our findings provide insights regarding community engagement for local vector control programs to improve their sustainability and acceptance in other regions
and innovation characteristics that need to be considered when planning community-based health interventions in rural settings
and activities performed in the overall project
This manuscript is solely focusing on reporting the results of the interim evaluation
which aimed to understand the adoption process of the intervention
The activities in the meetings were based on interpersonal communication
with the members of our team taking the lead
and using questions to create a two-way communication
In each meeting we used supporting material
The meetings took place in each of the intervention communities
in different venues proposed and offered by the participants (i.e.
From the seven meetings, we held three directly targeting the risk factors: one introducing Chagas disease, one regarding rodents’ ecology and biology for its control, and one regarding chicken management and composting (Table 1)
The rodents’ meetings proposed the use of traps for rodent control and was accompanied by a practical workshop
We set the traps in a volunteer house and picked them up the following day
and the killing and handling of rodent process
we promoted the use of chicken coops with an integrated compost
These meetings also included a practical activity
where we built four sample chicken coops in four different communities
aiming to serve as an example for participants and neighbors
Examples of the calendars that were used as a tool for the participants to track the activities they were adopting
We conducted an interim evaluation using mixed methods, mainly targeting the participants from the 9 communities in the Intervention Group (Fig. 2)
We used questionnaires to assess the adoption rate
and semi-structured interviews to gain a deeper understanding of perceptions regarding the intervention itself
Both instruments addressed perceptions of knowledge gained via the education component of the intervention
and factors that facilitated and limited the adoption of practices
We considered the following conditions: range of communities (all nine intervention communities); age groups (child
and seniors); gender (female and male); and different levels of participation (high
Although this checklist was designed to report the essential items of qualitative research
we also included information about the questionnaire process when relevant and applicable
Several study participants that played key roles in their communities or that participated regularly in initiatives from other institutions (i.e.
municipal offices) attended meetings regularly
This inherent leadership was also shown during our intervention
or volunteered to support the organization of our monthly meetings
The main barriers that interviewees identified to attending the PAR meetings were health- or family-related responsibilities (i.e.
or because they were not informed about the activities)
and men’s absences because of agricultural work
The primary motivations to participate mentioned were the possibility to tackle multiple problems (i.e.
younger sons or daughters of the participants would attend representing their households
“I said yes [to the project] because we wanted to see the house clean
Those animals are very bad because they bite you.” (Dolores
“What I liked the most was the way they came to teach us how to get rid of mice
According to survey results, the most adopted innovation was the use of rodent traps as 98% (n = 203/208) of intervention participants reported using them in the previous year. Most people (35%, n = 70/203) reported using the traps one or many times a week (Table 3)
From 203 cases where people had used a rodent trap at some point in the year
20% (n = 41/203) killed the trapped animals
as shown during the training for safety purposes
Participants identified a relative advantage of using traps when compared to the previous methods used (i.e.
most reported having stopped using the previous method
Participants reported that traps allow them to have more control over the disposal of rodent carcasses
as poisoned rodents tended to die in their burrows where it was difficult to track and dispose
participants acknowledged that traps represented a lower risk for human and animal health in the households (i.e.
traps represented a cheaper option than purchasing poison regularly
but it was bad because they died inside the holes we had in the walls
with the traps it is not difficult because they remain there
then we take them out and throw them away.” (Dolores
“What has helped me the most is that I no longer want mice in the house because they say that kissing bugs also depend on mice.” (Sonia
most interviewees considered that it was easy to learn (21/27) and to use (20/27) the rodent traps
as we found mixed opinions during the PAR process
Slam traps were found easy to use because they killed the rodent immediately
but more users were afraid of hurting themselves
Cage traps were identified as easier to set up but posed the challenge of handling a live rodent
Both types of traps were reported to be used by children (from 10 years old) and adults (up to 80 years old)
Only 9% (n = 19/203) of surveyed people did not use the traps
Of the listed reasons why they decided not to use the rodent traps
none seem to be related to the complexity of using it (i.e.
having lent the trap to someone else and not having it gotten back
Some of the general difficulties mentioned in the women’s interviews also referred to the installation of traps in high places
or that some rodents were too big to fit in the trap (although a participant shared the creation of their trap)
Last night my husband was telling me to set the traps again because the mice are back in here again.” (Dolores
“I told all the people I invited them to the meetings; we told them about the benefits of the traps
Only one person went to the meetings because I lent her a trap for a week and there were too many mice
Now only sometimes they ask me what the meetings are about or what I am going to learn there
but there are people who do not pay attention.” (Irma
Other practices like covering food containers
or behind the furniture and frames were adopted by only one-third or less of the participants
The major difference between the proposed innovation and the previous practices lies in the promotion of deep cleaning practices which included moving things around
the relative advantage reported by some of the participants was that they were able to notice burrows or rodent tracks and find triatomines or other insects
“What helped me the most was cleaning well inside the house so that kissing bugs and mice don’t find a breeding ground
That’s what I like the most because sometimes you put things in a corner and don’t sweep well
that’s where they find a place to breed.” (Martina
The risk factors identified were related to socioeconomic conditions
aiming for compatibility we focused on cleaning practices instead of house improvement (i.e.
Participants reported having added new activities to their usual cleaning
Reported practices included taking more time to move furniture
and other things that were close to the walls
They also paid more attention to cleaning around the house (patio)
and picking up grains that might had been left on the floor
Each participant adapted the proposed practices according to their context and capabilities
reporting that although they had put more effort in
the novel cleaning practices were not performed daily
women were in charge of cleaning the houses
sometimes they required the support of men or other members of the household to move things
I had people to help me in the house to do the chores and now I don’t
It’s up to me alone to be working here at home.” (Laura
There was no space for the trialability of these innovations during the participatory process
but the interviews showed that the innovations were adopted according to the needs and possibilities of each household
The observability attribute was challenging
Interviewees reported that they were not aware of their neighbors’ housekeeping practices
although in the meetings we suggested some specific activities
they mentioned that they observed more cleanliness and order in their own home
which was perceived as a more pleasant and healthy environment
We found mixed results regarding the relative advantage of these innovations
The most common practice in the area was to let chickens out during most of the year but to keep them caged or indoors during the sowing period
Interviews showed that some people put the compost inside the chicken coop and experienced the benefit of chickens getting fed by the compost
some people perceived that the behavior of the confined hens changed in an unproductive way
we found plenty of interest in receiving donated seeds as the participants recognized the economic benefits of growing their own vegetables
“One day I killed one [chicken] and I told my husband: “How fat is this hen that was locked up”
He told me: “That happened because the compost is already there and it [the chicken] is eating little animals”.” (Dolores
The three activities proposed had compatibility with the local context
Some participants had worked with organic compost and chicken coop as separate projects
The greatest motivation to start the orchard was to take advantage of the seeds that were donated
Interviews suggested that few people had chickens
Most people in the locality worked in agriculture
the seeds provided for the orchard were different from traditional crops
These innovations were perceived as the most difficult ones among what was proposed. Complexity was due to the fact that for its implementation there was a need to have space, buy the necessary materials, and invest time in construction and maintenance. Only 28% (n = 28/100) of them still had an orchard at the time the questionnaire was conducted (Table 5)
Some of the reasons to abandon the orchard were lack of seeds
About 48% (n = 45/93) of participants had already stopped composting before the survey was conducted
Other reasons that interrupted having an orchard included plagues or animals that had eaten the garden (roosters
Some of the factors listed as reasons to abandon the composting were not having enough water
Other reasons listed were having it been destroyed by animals (pigs
cows) or that the project had come to an end
when you have this organic fertilizer that you take from the compost bin
you can mix it and with that you get a softer and more nutritious soil so that the plant grows well
although now it hasn’t grown much because sometimes too much water doesn’t let anything grow.” (Rafael
For the trialability attribute of this innovation
we relied on the four pilot chicken coops in the intervention communities
since some participants already had chicken coops at home
as well as a structure for the garden and the compost bin
Many of the participants affirmed that our intervention triggered their will to implement one or more activities in their houses
Given that these innovations were located outside the houses
there was some opportunity for observability among neighbors
participants reported that they did not know about their neighbors’ chicken and outdoor management practices
“I used to have them [the chickens] all over the house and now I keep them in one place
I vaccinate them and take care of them more.” (Laura
Using a qualitative approach allowed us to better understand the factors that enabled and hindered the process of adoption
Using the SWOT analysis and reflective approach in the intervention process helped us engage and jointly develop the intervention activities with the communities while tackling the risk factors identified
community engagement served as a transversal enabler of implementation and adoption
Rodent traps were the most adopted innovation and participants showed consensus that both traps were easy to use
we found mixed results in the difficulty perceived for indoor cleaning and environmental management
as they demanded more physical effort and resources investment
and could be influenced by external factors (i.e.
The fact that the project provided traps to the participants served to mitigate the complexity
as for environmental management the investment of economic resources was a strong limitation
It is fundamental to understand the socioeconomic context where the innovations are proposed
to foresee and mitigate external factors that can constrain adoption
even if our objective was focused on halting Chagas disease transmission
for most of the participants’ rodents’ presence in their houses was a more tangible problem and the traps became an instant solution
The trialability activity held through the practical workshop was key to facilitating the adoption of rodent traps
as most of the participants learned there how to use them and how to manage the rodent
Although we held a few trialability activities to show the environmental management innovations
the adoption was constrained by other factors
Environmental management practices are sustainable over time
participants associated the innovations with strategies for a more general well-being and healthy household
a barrier to evaluating long-term adoption was that the follow-up process was limited by the resources of the project
This had an impact on each of the DOI attributes as the changes proposed by the project had been designed to respond to context-specific factors and enabled the adoption of each innovation
the random sampling also limited the participation of others who were interested in the intervention
Institutionalizing integrated vector control strategies could strengthen current efforts and the sustainability of novel interventions
as it would assure the allocation of funds and resources within the national framework
and especially with activities that can be implemented by the individuals and the community itself
we believe that implementing different strategies of community engagement serves to facilitate the adoption process and to sustain the activities through time
Although this experience was focused at the community level
horizontal approaches could also benefit institutional-level interventions through intersectoral coalitions and partnerships
One of the initial challenges in the study was the design itself
combining a randomized control trial with the PAR methodology
The random probabilistic selection allowed us to have a diverse group of participants
since the initial home visits and the meetings took place during weekdays and daytime (our working hours) we had an overall higher participation of women
as they were the ones available at that time
although the objective was to be able to compare the control and intervention groups
we acknowledge that there could have been external factors (personal
political) outside the scope of the project
that could have influenced the results obtained (i.e.
spillover information between communities) and the participation of the people involved (i.e.
political disagreements between participants)
we are mainly presenting the perspective of participants from the intervention group
It would be ideal to conduct a similar study in a mid- and/or long-term period
being able to include longitudinal data on the adoption of innovations
and the experiences from people in neighboring communities
to better understand the sustainability of the adoption and to what extent it diffused
We consider relying on community engagement and having built rapport with the participants to be a strength of the study
we acknowledge that the results could present a social desirability bias
as what is presented is based on perceptions and opinions of what the participants reported
and they were aware of the purpose of the study
The results of the overall study are complemented with entomological survey data
there are not many studies that have applied the attributes of the innovation from DOI to the type of study we were analyzing
therefore it was challenging to define how to “measure” the attributes of the innovations proposed
we consider that the results presented in this manuscript provide information that can be beneficial and transferable for the implementation of integrated vector control strategies at different scales and diverse contexts
placing people and communities as the key players in improving their health and welfare to achieve long-term sustainability and continuity of programs
which shows that the paradigm is evolving towards more horizontal approaches
the participatory strategies applied for community engagement facilitated the adoption and sustainability of our innovation for vector and parasite reservoir control
and compatibility were key to the adoption of rodent control and environmental management strategies
Future community-based interventions should be designed with these considerations to improve adoption
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Data are available in aggregated form due to identifiable characteristics of participants. The IRB confidentiality agreement does not allow individual disclosure of data. A version in Spanish of this article is available in the UVG repository (link: https://repositorio.uvg.edu.gt/handle/123456789/4671)
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We would like to thank the research participants in Jutiapa and the collaborators from the Ministry of Health
We thank World Vision and the Ministry of Agriculture and Livestock for having supported the orchard and compost production
We thank Jorge Sincal and Hugo Perdomo for their contribution as part of our team
and Tatiana Paz Lemus for her advice through the research process
This project had financial support from the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) with the aid of a grant from the International Development Research Centre (IDRC)
The funding source had no role in the study design
De Urioste-Stone & Pamela Marie Pennington
Present Address: School of Forest Resources
Ministerio de Salud Pública y Asistencia Social
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we used pseudonyms to ensure confidentiality
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Taylor is a general assignment reporter for Newsweek where he writes about U.S
the Slovenian Marxist Slavoj Žižek and whatever else interests him
Recently he slept in a barn while reporting a story from Cuba
either observed and verified firsthand by the reporter
or reported and verified from knowledgeable sources
Translations may contain inaccuracies—please refer to the original content
As I watched what was perhaps my hundredth bullet jelly a Nazi's eyeball
carom off his eye socket and tunnel through his gray matter before exiting his skull in a cornucopia of bone fragments and gore
I had a thought: maybe this is not healthy
Since at least the Columbine school shooting in 1999—when both researchers and the media speculated that Eric Harris and Dylan Klebold went on a killing spree because they were denied access to the violent computer games—we have been studying and arguing about whether violent video games create violent urges in players
the American Psychological Association (APA) announced the creation of the Task Force on Violent Media
The seven-member task force was charged with conducting a "meta-analysis," or review of existing literature
to determine whether video game violence can and does lead to real-world violence
The task force released its findings last Thursday. It found "a consistent relation" between violent game use and aggressive behavior, it said in a statement
"While there is some variation among the individual studies
a strong and consistent general pattern has emerged from many years of research that provides confidence in our general conclusions," wrote Mark Appelbaum
the APA drafted a resolution at its August 7 meeting in Toronto encouraging the Entertainment Software Rating Board to refine its video game rating system "to reflect the levels and characteristics of violence in games." The APA also called on video game developers to "design games that are appropriate to users' age and psychological development."
The problem, though, is that many experts think the APA's findings are junk science. In 2013, a large group of researchers—more than 230, including academics from Harvard, Yale and Columbia universities—took issue with the APA, the task force and its research methodology. In an open letter
the group called the APA's policy statements on violent video games "misleading and alarmist" and said they "delineated several strong conclusions on the basis of inconsistent or weak evidence."
Thursday's announcement is confirmation that the APA has it in for video games
"The literature is beset with methodology flaws and I don't think this report addresses those flaws," says Dr
a psychiatrist at Massachusetts General Hospital who signed the 2013 letter
Existing research on violent video games has "vague and inconsistent" definitions of aggression and violence
While the APA's report acknowledges this problem ("The violent video game literature uses a variety of concepts
and definitions in considering aggression and aggressive outcomes...")
Ceranoglu also takes issue with how some past researchers (not neccesarily affiliated with the APA) have tested for aggression. One experiment
asked some participants to play violent video games
then complete a list of words with one or more letters missing
such as "_ill" and "explo_e." Other participants did not play violent video games before completing the words
Participants who had spent time playing violent video games were more likely to write kill and explode than fill and explore
But there is no evidence that writing the word kill on a piece of paper means one is more likely to commit actual acts of violence
"I think it's causing us to miss a bigger picture," he says
"These violent video games are played all around the world
but we have a much higher violence rate in the U.S
and we can't explain why that difference is."
None of which means young kids should be allowed to play violent video games
"Even a kid who is well aware of what is fantasy and what is real would be shocked" by some of the violence in today's games
"But is that kid going to grow to be a violent person
We can't determine anything beyond a correlation."
What correlation there is between exposure to violent video games and aggression is "very small," according to Peter Gray
a child psychologist and research professor at Boston College who also signed the 2013 letter to the APA
"The only correlational studies looking at real-world violence generally present very little if any evidence of correlation," he says
Appelbaum concedes the correlation is "not very big," but compares regulating violent video games to taking aspirin to avoid heart disease
The effect of taking aspiring to prevent heart disease is " incredibly small," he says
But if you're going to prevent a heart attack
big outcome and the cost of taking the aspirin is very small
Effect size alone doesn't really tell you whether something is important."
But the outcome of over-regulating violent video games could be just as significant
"I think that there's harm in controlling children's choices and behavior," he says
"Unless we can show that children are doing something harmful
we need to allow children to make their own choices."
may be indicative of overall good mental health
"There's a general correlation between play of all types and peacefulness," he says
"If you look at the kind of person you would call a psychopath
these are by and large people who don't play
including not playing violent video games."
what is being tested is not "real-world violence," he says
but "something that the experimenter is choosing to call aggression," such as hitting a toy
"There's a long history in psychology of trying to prove that exposure to violent depictions of one sort or another increases violence in people
Appelbaum says: No such experiment is ethically possible
"I'm not about to do a study where I sit you down and make you watch video games for five hours and then give you a handgun and say
'Go out and have fun.' That kind of study is unethical and immoral." But Applebaum disagrees aggression cannot be measured
department chair of psychology at Stetson University
thinks the APA intentionally stacked the deck against video games
"It felt right from the start that the task force wasn't really designed to be an objective review," he says
"I'm not saying the individual task force members were acting in bad faith," he adds
"but I think they were selected because their opinions were pretty clear going in."
the APA notes that prospective task force members "spent significant time disclosing and discussing potential conflicts of interest," including "any research or publication activity or commitment to a fixed position through public statement or publication or through other personal or professional activity related to the current task."
at least four appear to have previously expressed opinions about the link between exposure to violent video games and aggression
which critics say amount to conflicts of interest
The brief Hamby and Dodge endorsed argued there is "a significant relationship" between exposure to violent video games and violent behavior
"[P]laying violent video games causes an increase in the likelihood of physically aggressive behavior
and desensitization/low empathy," and "the industry
caregivers and educational organizations [have] a responsibility to intercede in this epidemic," the brief states
Appelbaum disagrees that signing an amicus brief presents a conflict of interest
"No one on the task force was involved in writing the amicus brief
It's hard to imagine you'd find someone with expertise some of these areas that wouldn't be approached," to sign an amicus brief
my professional reputation is not based on violent video game research and I have no financial stake in selling violent video games
My main area of specialty is family violence research." She added that she has never received any money connected to video games or video game research
Dodge said his participation does not constitute a significant conflict of interest
"I do not conduct research on violent video games and have nothing financially or reputationally to gain or lose by the outcome," he wrote
"Signing an amicus or authoring a conclusion at one point in time does not
place that individual in conflict of interest
If it were common practice to exclude all scientists after they render one conclusion
the field would be void of qualified experts."
video games) can increase the likelihood of physically and verbally aggressive behavior
and aggressive emotions." The statement concludes the current "research speaks to a strong need to revise policies on youth exposure to violence in the media."
Graham did not respond to a request for comment
"If someone had a paper that directly looked at the relationship between playing violent media and this class of behaviors that are the outcome
they were not even eligible to be on the task force," Appelbaum says
However, in a 1994 paper published in the Journal of Applied Development Psychology
task force member Sandra Calvert of Georgetown University appeared to argue violent video games teach aggressive behavior
video games and virtual reality require direct action for a game to continue
In the case of aggressive content in the virtual reality game used in this study
a person must kill or be killed in this life-like
aggressive action is incorporated directly into a person's behavioral repertoire when virtual reality games are played," she wrote
In another paper co-authored by Calvert
currently in press for publication by American Psychologist in 2015
youth who commit such crimes should be affected by media aggression in the same ways that other youth have been shown to be affected: through arousal
the development of aggressive schemas including schemas about males being aggressive
and social learning of antisocial behaviors that are rewarded in game play."
"My background in the children's media area provided expertise that was valuable to the APA Task Force," wrote Calvert in an email to Newsweek
"I disclosed all of my activities in the video game and aggression area at the beginning of the APA Task Force work
and I kept Task Force members appraised of any related activities on my end."
as has always been my way of conducting research
Ferguson argues that the 2015 report "should have disqualified her from the task force." Ferguson also believes the task force was inconsistent in the papers it selected for meta-analysis
the APA lists six criteria for inclusion of studies in its analysis
the task force ended up identifying 31 as meeting their criteria
there are many studies that have been done on the subject over the years which appear to meet all six criteria
but were not deemed "of sufficient utility" by the task force
"Of those they actually looked at very closely, it looks like they almost systematically excluded most null studies," meaning studies that found no association, positive or negative, between violent video game exposure and violent actions. For example, a 2011 study published in Psychology of Violence concludes that competition
is actually what drives aggressive behavior in video game players
saying that "the conclusion of the paper was not part of the rating that moved them ahead into the meta-analysis
"We're all seeing incredibly similar results and just drawing different conclusions," he adds
"People have to remember that groups like the American Psychological Association—of which I'm a fellow
They do not exist to provide people with objective facts
It's to their advantage to identify problems that psychologists can run in and fix
It is not to their advantage to say 'we don't know' or 'the evidence is all over the place' or 'there's nothing we can do to help you.'"
"This seems to be a pattern with the APA," he adds
"We're talking about an organization that was caught colluding in the real torture of real people in real life and now they're turning around and wagging their hand about people playing video games?"
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APA format is the standard writing style used for psychology research papers
Creating an outline using APA format can help you develop and organize your paper's structure
also keeping you on task as you sit down to write the content
If you need further subheadings within the initial subheadings
then Arabic numerals inside parentheses [(1)
Whether you are creating your outline according to your instructor's guidelines or following your own organizational preferences
the most important thing is that you are consistent
If you are required to turn in your outline before you begin working on your paper
keep in mind that you may need to include a list of references that you plan to use
American Psychological Association. About APA Style
Purdue University Online Writing Lab. Types of outlines and samples
Mississippi College. Writing Center: Outlines
American Psychological Association. APA style: Style and Grammar Guidelines