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. 2023 Sep 1;22(1):251.
doi: 10.1186/s12936-023-04685-1.

Applying the COM-B behaviour change model to a pilot study delivering volatile pyrethroid spatial repellents and insecticide-treated clothing to forest-exposed populations in Mondulkiri Province, Cambodia

Ingrid Chen  1 , Dyna Doum  2 , Kylie Mannion  3 , John Hustedt  4 , Siv Sovannaroth  5 , David McIver  4 , Michael Macdonald  6 , Neil Lobo  7 , Allison Tatarsky  4 , Margaret A Handley #  4 , Josselyn Neukom #  4
Affiliations

Applying the COM-B behaviour change model to a pilot study delivering volatile pyrethroid spatial repellents and insecticide-treated clothing to forest-exposed populations in Mondulkiri Province, Cambodia

Ingrid Chen et al. Malar J. .

Abstract

Background: Southeast Asia is making tremendous progress towards their 2030 malaria elimination goal but needs new interventions to stop forest malaria. This study trials two new vector control tools, a volatile pyrethroid spatial repellent (VPSR) and insecticide-treated clothing (ITC), amongst forest-exposed populations in Mondulkiri Province Cambodia to inform their potential use for eliminating forest malaria.

Methods: 21 forest-exposed individuals were given a questionnaire on their perceptions of malaria and preventive practices used, after which they trialed two products sequentially. Clothes was treated with ITC by the study team. Mixed methods were used to understand their experience, attitudes, and preferences regarding the products trialed. Quantitative data was summarized and qualitative insights were analysed using thematic analysis, applying the Capability, Opportunity, and Motivation Behaviour Change (COM-B) model and Behaviour Change Wheel Framework to identify intervention functions to support tailored product rollout amongst these populations.

Results: Study participants reported a need for protection from mosquito bites in outdoor and forest-exposed settings and perceived both products trialed to be effective for this purpose. The VPSR product was preferred when travel was not required, whereas ITC was preferred for ease of use when going to the forest, especially in rainy conditions. COM-B analysis identified that key enablers for use of both products included their perceived efficacy and ease of use, which required no skill or preparation. For barriers to use, the odour of ITC was sometimes perceived as being toxic, as well as its inability to protect uncovered skin from mosquito bites, while the perceived usefulness of the VPSR product trialed was limited by its water sensitivity in rainy forest settings. Intervention components to encourage appropriate and sustained use of these products include education about how to use these products and what to expect, persuasion to use them from community leaders and targeted channels, and enablement to facilitate convenient and affordable access.

Conclusion: The rollout of VPSRs and ITC amongst forest-exposed populations can be useful for eliminating malaria in Southeast Asia. Study findings can be applied to increase product uptake among forest exposed populations in Cambodia, while manufacturers can aim to develop products that are rainproof, easy to use in forest settings, and have favourable odour profiles to target users.

Keywords: Behaviour change theory; COM-B model; Forest malaria, Cambodia; High risk population; Insecticide treated clothing; Malaria elimination; Passive emanator; Spatial repellent; Volatile pyrethroid.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study timeline
Fig. 2
Fig. 2
Map of Cambodia, Mondulkiri Province in green
Fig. 3
Fig. 3
Locations where participants spend time
Fig. 4
Fig. 4
Perceived mosquito biting times
Fig. 5
Fig. 5
Mosquito bite prevention methods used inside and outside the house and in the forest
See this image and copyright information in PMC

Update of

References

    1. WHO . Accelerating malaria elimination in the greater mekong. Geneva: World Health Organization; 2022.
    1. WHO . World malaria report 2021. Geneva: World Health Organization; 2021.
    1. St Laurent B, Oy K, Miller B, Gasteiger EB, Lee E, Sovannaroth S, et al. Cow-baited tents are highly effective in sampling diverse Anopheles malaria vectors in Cambodia. Malar J. 2016;15:440. doi: 10.1186/s12936-016-1488-y. - DOI - PMC - PubMed
    1. Vantaux A, Riehle MM, Piv E, Farley EJ, Chy S, Kim S, et al. Anopheles ecology, genetics and malaria transmission in Northern Cambodia. Sci Rep. 2021;11:6458. doi: 10.1038/s41598-021-85628-1. - DOI - PMC - PubMed
    1. Sandfort M, Vantaux A, Kim S, Obadia T, Pepey A, Gardais S, et al. Forest malaria in Cambodia: the occupational and spatial clustering of Plasmodium vivax and Plasmodium falciparum infection risk in a cross-sectional survey in Mondulkiri province. Cambodia Malar J. 2020;19:413. doi: 10.1186/s12936-020-03482-4. - DOI - PMC - PubMed