Contextual factors (WP4) - FACE-UP CONSORTIUM

RESEARCH

Contextual factors influencing uptake of exposure reduction practices (WP4)

We investigated, from the community perspective, the contextual factors influencing uptake of the exposure reduction practices tested in WP2. Data were collected from children (aged 5-12), their carers (parents/guardians and teachers) and other key in-formants (agency practitioners) in regions of varying socioeconomic status within each city.

1) Mask preferences and learning behaviours: Focus group discussions (FGDs) were conducted in each city to explore children’s preferences for different styles of facemasks. Feeding into WP7, the FGDs were also used to ask from whom the children learn from at different ages; preferred media (e.g. booklets, internet, videos, plays); ages at which children have agency in different domains; and what guidance they have already received from NGO/GOs (if any) and perceptions of the usefulness of received information.

2) Children’s mask donning skills: Children were asked to put on respirators and their untutored ability to do so was assessed, therefore highlighting common mistakes which then formed the focus of learning in the information products developed for WP7.

3) Cultural drivers influencing behaviour change: The contextual drivers for child use of respiratory protection were investigated, to gain a depth of understanding of influences on uptake, using a mixed methods approach combining both qualitative and quantitative data from interviews with caregivers and their children. The two types of data were used to validate each other and create a solid foundation for informing the design of the uptake interventions that were evaluated in WP7.

The ‘Behaviour Change Wheel’ (BCW) [Michie et al. 2011], implemented in many studies, formed the analytical framework for the interviews. At its hub, the BCW has a model of behaviour, known as COM-B, which describes behaviour as consisting of Capability (e.g., knowledge, skills), Opportunity (e.g., sociocultural influences, environmental context, resources), and Motivation (e.g., goals and intentions, beliefs about consequences). The model is used to identify how to best achieve behaviour change. For example, if lack of capability is a barrier to uptake of a practice then a different type of uptake intervention (e.g., education, training) would be needed compared to if the barrier is lack of opportunity (e.g., enablement, environmental restructuring) or motivation (e.g., persuasion, incentivisation).

Our contextually-sensitive approaches to data analysis included thematic analysis of the interview data to identify patterns of meaning across different contexts, from a descriptive and exploratory orientation. To complement these qualitative insights, the quantitative survey analysis adopted statistical approaches underpinned by regression analysis (e.g. structural equation modelling (SEM)), to quantify the contributions of contextual factors in shaping the determinants of behaviour change.

The Behaviour Change Wheel. Michie et al. 2011, Implementation Sci. 6:42.