Understanding the barriers and facilitators of COVID-19 risk mitigation strategy adoption and COVID-19 vaccination in refugee settlements in Uganda: a qualitative study

BMC Public Health

Research

Kelli N. O’Laughlin¹  Robin E. Klabbers¹  Monisha Sharma²  Connie Celum³  Andrew Mujugira⁴  Phuong Pham⁵  Patrick Vinck⁵  Scovia Ajidiru⁶  Timothy R. Muwonge⁶  Rosalind Parkes-Ratanshi⁷  Sukanya Borthakur⁸ 

[1] Department of Emergency Medicine, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Epidemiology, University of Washington, Seattle, WA, USA;Department of Medicine, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Infectious Diseases Institute, Makerere University, Kampala, Uganda;Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA;Infectious Diseases Institute, Makerere University, Kampala, Uganda;Infectious Diseases Institute, Makerere University, Kampala, Uganda;Department of Psychiatry, University of Cambridge, Cambridge, UK;Medical Teams International, Kampala, Uganda;

关键词: COVID-19;    Refugee;    Vaccination;    Risk mitigation;    Uganda;   

DOI  :  10.1186/s12889-023-16320-4

 received in 2022-10-06, accepted in 2023-07-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPerspectives on COVID-19 risk and the willingness and ability of persons living in refugee settlements to adopt COVID-19 prevention strategies have not been rigorously evaluated. The realities of living conditions in Ugandan refugee settlements may limit the extent to which refugees can uptake strategies to mitigate COVID-19 risk.MethodsIn-depth qualitative interviews were conducted between April 2021 and April 2022 to assess COVID-19 knowledge, risk perception, prevention strategy adoption including COVID-19 vaccination, and COVID-19 impact on living conditions in refugee settlements in Uganda. Interview participants included 28 purposively selected refugees who called into “Dial-COVID”, a free telephone COVID-19 information collection and dissemination platform that was advertised in refugee settlements by community health workers. Interviews were analyzed using a combination of deductive and inductive content analysis. Emerging themes were mapped onto the Theoretical Domains Framework to identify domains influencing prevention behavior. Results were synthesized to provide intervention and policy recommendations for risk mitigation in refugee settlements for COVID-19 and future infectious disease outbreaks.ResultsThe COVID-19 pandemic detrimentally impacted economic and food security as well as social interactions in refugee settlements. Youth were considered especially impacted, and participants reported incidents of child marriage and teenage pregnancy following school closures. Participants displayed general knowledge of COVID-19 and expressed willingness to protect themselves and others from contracting COVID-19. Risk mitigation strategy uptake including COVID-19 vaccination was influenced by COVID-19 knowledge, emotions surrounding COVID-19, the environmental context and resources, personal goals, beliefs about the consequences of (non)adoption, social influences, and behavior reinforcement. Resource constraints, housing conditions, and competing survival needs challenged the adoption of prevention strategies and compliance decreased over time.ConclusionsContextual challenges impact the feasibility of COVID-19 risk mitigation strategy uptake in refugee settlements. Pre-existing hardships in this setting were amplified by the COVID-19 pandemic and related lockdowns. Targeted dispelling of myths, alignment of information across communication mediums, supporting survival needs and leveraging of respected role models are strategies that may hold potential to mitigate risk of infectious diseases in this setting.Registration detailsWorld Pandemic Research Network – 490,652.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 5