6
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Impact of adverse events during community-wide mass drug administration for soil-transmitted helminths on subsequent participation–a Theory of Planned Behaviour analysis

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Experiencing adverse events (AEs) during mass drug administration (MDA) could affect participation in future MDAs. This study aims to understand the potential influence of AEs during a community-wide MDA (cMDA) trial for soil-transmitted helminths (STH) in India on intention to participate in future cMDAs.

          Methods

          This study was conducted using a multi-method quantitative and qualitative approach among 74 participants who experienced an AE during STH cMDA and the 12 participants who subsequently refused cMDA treatment of the ongoing DeWorm3 trial. Path analysis and thematic analysis guided by the Theory of Planned Behaviour, was used.

          Principal findings

          Among 74 individuals who reported an AE, 12% refused treatment in the cMDA immediately subsequent to their AE and 4% refused in all subsequent cMDAs. Of these 74 individuals, 59 (80%) completed a survey and eight participated in in-depth interviews. A positive attitude towards deworming and perceived ability to participate in cMDA (perceived behavioural control) were significant predictors of intention to participate in cMDA (p<0.05). A positive attitude towards cMDA was associated with caste (χ 2 = 3.83, P = 0.05), particularly among the scheduled caste/scheduled tribe (SC/ST) (62%). Perceived behavioural control in cMDA participation was associated with occupation (χ 2 = 5.02, P<0.05), with higher perceived control among those engaged in skilled occupations (78%). Intention to participate in subsequent cMDAs was associated with caste and family type (χ 2 = 3.83, P = 0.05 and χ 2 = 7.50, P<0.05 respectively) and was higher among SC/ST (62%) and those with extended families (67%). In-depth interviews demonstrated that perceived severe AEs may lead to treatment refusal in future, particularly if children were affected.

          Conclusions

          Intention to participate in future STH cMDAs was associated with caste (SC/ST) and family type (extended families). Therefore, community mobilization messages about potential AEs and their management may need to intentionally target non-SC/ST households, nuclear families, and those engaged in unskilled occupations to increase cMDA participation given the possibility of AEs occurring.

          Trial registration

          NCT03014167, ClinicalTrials.gov.

          Author summary

          This paper sampled individuals who experienced an AE during community-wide MDA (cMDA) with albendazole for soil-transmitted helminths in the DeWorm3 trial in India to understand their intention to participate in future cMDAs. This study utilized the theory of planned behaviour, which postulates that an individual’s intention to change a behaviour depends on their attitude, perceived expectations of people around them (social norms), and their perceived behavioural control to adopt the behaviour (self-efficacy). This study indicated that positive attitude towards cMDA and their perceived behavioural control in cMDA participation positively influences their intention to participate in future cMDAs. Other factors associated with intention to participate in cMDA were caste, family structure, occupation, and participation in community sensitisation activities. In-depth interviews revealed that while many individuals participate in subsequent cMDAs after an AE because of the presumed health benefits of deworming, some are likely to refuse treatment due to fear of AEs, particularly fears of AEs among children. To increase participation rates in cMDA programs where AEs undoubtably do occur, targeted counselling of groups at risk of non-participation and assuring care and support during AEs may be important strategies to improve coverage.

          Related collections

          Most cited references45

          • Record: found
          • Abstract: found
          • Article: not found

          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
            Bookmark
            • Record: found
            • Abstract: found
            • Book: not found

            Statistical Power Analysis for the Behavioral Sciences

            <i>Statistical Power Analysis</i> is a nontechnical guide to power analysis in research planning that provides users of applied statistics with the tools they need for more effective analysis. The Second Edition includes: <br> * a chapter covering power analysis in set correlation and multivariate methods;<br> * a chapter considering effect size, psychometric reliability, and the efficacy of "qualifying" dependent variables and;<br> * expanded power and sample size tables for multiple regression/correlation.<br>
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Making sense of Cronbach's alpha

              Medical educators attempt to create reliable and valid tests and questionnaires in order to enhance the accuracy of their assessment and evaluations. Validity and reliability are two fundamental elements in the evaluation of a measurement instrument. Instruments can be conventional knowledge, skill or attitude tests, clinical simulations or survey questionnaires. Instruments can measure concepts, psychomotor skills or affective values. Validity is concerned with the extent to which an instrument measures what it is intended to measure. Reliability is concerned with the ability of an instrument to measure consistently. 1 It should be noted that the reliability of an instrument is closely associated with its validity. An instrument cannot be valid unless it is reliable. However, the reliability of an instrument does not depend on its validity. 2 It is possible to objectively measure the reliability of an instrument and in this paper we explain the meaning of Cronbach’s alpha, the most widely used objective measure of reliability. Calculating alpha has become common practice in medical education research when multiple-item measures of a concept or construct are employed. This is because it is easier to use in comparison to other estimates (e.g. test-retest reliability estimates) 3 as it only requires one test administration. However, in spite of the widespread use of alpha in the literature the meaning, proper use and interpretation of alpha is not clearly understood. 2 , 4 , 5 We feel it is important, therefore, to further explain the underlying assumptions behind alpha in order to promote its more effective use. It should be emphasised that the purpose of this brief overview is just to focus on Cronbach’s alpha as an index of reliability. Alternative methods of measuring reliability based on other psychometric methods, such as generalisability theory or item-response theory, can be used for monitoring and improving the quality of OSCE examinations 6 - 10 , but will not be discussed here. What is Cronbach alpha? Alpha was developed by Lee Cronbach in 1951 11 to provide a measure of the internal consistency of a test or scale; it is expressed as a number between 0 and 1. Internal consistency describes the extent to which all the items in a test measure the same concept or construct and hence it is connected to the inter-relatedness of the items within the test. Internal consistency should be determined before a test can be employed for research or examination purposes to ensure validity. In addition, reliability estimates show the amount of measurement error in a test. Put simply, this interpretation of reliability is the correlation of test with itself. Squaring this correlation and subtracting from 1.00 produces the index of measurement error. For example, if a test has a reliability of 0.80, there is 0.36 error variance (random error) in the scores (0.80×0.80 = 0.64; 1.00 – 0.64 = 0.36). 12 As the estimate of reliability increases, the fraction of a test score that is attributable to error will decrease. 2 It is of note that the reliability of a test reveals the effect of measurement error on the observed score of a student cohort rather than on an individual student. To calculate the effect of measurement error on the observed score of an individual student, the standard error of measurement must be calculated (SEM). 13 If the items in a test are correlated to each other, the value of alpha is increased. However, a high coefficient alpha does not always mean a high degree of internal consistency. This is because alpha is also affected by the length of the test. If the test length is too short, the value of alpha is reduced. 2 , 14 Thus, to increase alpha, more related items testing the same concept should be added to the test. It is also important to note that alpha is a property of the scores on a test from a specific sample of testees. Therefore investigators should not rely on published alpha estimates and should measure alpha each time the test is administered. 14 Use of Cronbach’s alpha Improper use of alpha can lead to situations in which either a test or scale is wrongly discarded or the test is criticised for not generating trustworthy results. To avoid this situation an understanding of the associated concepts of internal consistency, homogeneity or unidimensionality can help to improve the use of alpha. Internal consistency is concerned with the interrelatedness of a sample of test items, whereas homogeneity refers to unidimensionality. A measure is said to be unidimensional if its items measure a single latent trait or construct. Internal consistency is a necessary but not sufficient condition for measuring homogeneity or unidimensionality in a sample of test items. 5 , 15 Fundamentally, the concept of reliability assumes that unidimensionality exists in a sample of test items 16 and if this assumption is violated it does cause a major underestimate of reliability. It has been well documented that a multidimensional test does not necessary have a lower alpha than a unidimensional test. Thus a more rigorous view of alpha is that it cannot simply be interpreted as an index for the internal consistency of a test. 5 , 15 , 17 Factor Analysis can be used to identify the dimensions of a test. 18 Other reliable techniques have been used and we encourage the reader to consult the paper “Applied Dimensionality and Test Structure Assessment with the START-M Mathematics Test” and to compare methods for assessing the dimensionality and underlying structure of a test. 19 Alpha, therefore, does not simply measure the unidimensionality of a set of items, but can be used to confirm whether or not a sample of items is actually unidimensional. 5 On the other hand if a test has more than one concept or construct, it may not make sense to report alpha for the test as a whole as the larger number of questions will inevitable inflate the value of alpha. In principle therefore, alpha should be calculated for each of the concepts rather than for the entire test or scale. 2 , 3 The implication for a summative examination containing heterogeneous, case-based questions is that alpha should be calculated for each case. More importantly, alpha is grounded in the ‘tau equivalent model’ which assumes that each test item measures the same latent trait on the same scale. Therefore, if multiple factors/traits underlie the items on a scale, as revealed by Factor Analysis, this assumption is violated and alpha underestimates the reliability of the test. 17 If the number of test items is too small it will also violate the assumption of tau-equivalence and will underestimate reliability. 20 When test items meet the assumptions of the tau-equivalent model, alpha approaches a better estimate of reliability. In practice, Cronbach’s alpha is a lower-bound estimate of reliability because heterogeneous test items would violate the assumptions of the tau-equivalent model. 5 If the calculation of “standardised item alpha” in SPSS is higher than “Cronbach’s alpha”, a further examination of the tau-equivalent measurement in the data may be essential. Numerical values of alpha As pointed out earlier, the number of test items, item inter-relatedness and dimensionality affect the value of alpha. 5 There are different reports about the acceptable values of alpha, ranging from 0.70 to 0.95. 2 , 21 , 22 A low value of alpha could be due to a low number of questions, poor inter-relatedness between items or heterogeneous constructs. For example if a low alpha is due to poor correlation between items then some should be revised or discarded. The easiest method to find them is to compute the correlation of each test item with the total score test; items with low correlations (approaching zero) are deleted. If alpha is too high it may suggest that some items are redundant as they are testing the same question but in a different guise. A maximum alpha value of 0.90 has been recommended. 14 Summary High quality tests are important to evaluate the reliability of data supplied in an examination or a research study. Alpha is a commonly employed index of test reliability. Alpha is affected by the test length and dimensionality. Alpha as an index of reliability should follow the assumptions of the essentially tau-equivalent approach. A low alpha appears if these assumptions are not meet. Alpha does not simply measure test homogeneity or unidimensionality as test reliability is a function of test length. A longer test increases the reliability of a test regardless of whether the test is homogenous or not. A high value of alpha (> 0.90) may suggest redundancies and show that the test length should be shortened. Conclusions Alpha is an important concept in the evaluation of assessments and questionnaires. It is mandatory that assessors and researchers should estimate this quantity to add validity and accuracy to the interpretation of their data. Nevertheless alpha has frequently been reported in an uncritical way and without adequate understanding and interpretation. In this editorial we have attempted to explain the assumptions underlying the calculation of alpha, the factors influencing its magnitude and the ways in which its value can be interpreted. We hope that investigators in future will be more critical when reporting values of alpha in their studies.
                Bookmark

                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                PLOS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                14 March 2023
                March 2023
                : 17
                : 3
                : e0011148
                Affiliations
                [1 ] The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
                [2 ] Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
                [3 ] The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
                [4 ] Department of Global Health, University of Washington, Seattle, Washington, United States of America
                Institute of Continuing Medical Education of Ioannina, GREECE
                Author notes

                The authors have declared that no competing interests exist.

                ‡ Co-lead authors

                Author information
                https://orcid.org/0000-0003-3419-6577
                Article
                PNTD-D-22-01128
                10.1371/journal.pntd.0011148
                10013912
                36917597
                038091cc-0f8f-4997-bf67-13e5d0acb1ad
                © 2023 Aruldas et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 September 2022
                : 7 February 2023
                Page count
                Figures: 3, Tables: 1, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1129535
                Award Recipient :
                The DeWorm3 Project is funded by a grant from the Bill & Melinda Gates Foundation (OPP1129535, PI JLW). The funders had no role in study design, data collection, analysis, decision to publish, or manuscript preparation.
                Categories
                Research Article
                Social Sciences
                Sociology
                Human Families
                Medicine and Health Sciences
                Medical Conditions
                Parasitic Diseases
                Helminth Infections
                Soil-Transmitted Helminthiases
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Neglected Tropical Diseases
                Soil-Transmitted Helminthiases
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Eating
                Biology and Life Sciences
                Psychology
                Psychological Attitudes
                Social Sciences
                Psychology
                Psychological Attitudes
                Biology and Life Sciences
                Parasitology
                Intestinal Parasites
                People and Places
                Geographical Locations
                Asia
                India
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Perception
                Sensory Perception
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Social Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Biology and Life Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Stomach
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Gastrointestinal Tract
                Stomach
                Custom metadata
                Some restrictions will apply because there may be some sensitivity and potentially identifiable information where participants describe individual-level experiences. All relevant data are within the manuscript and its supporting information files.

                Infectious disease & Microbiology
                Infectious disease & Microbiology

                Comments

                Comment on this article