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BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Malaria | Research

Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study

Authors: Tinashe A. Tizifa, Alinune N. Kabaghe, Robert S. McCann, Steven Gowelo, Tumaini Malenga, Richard M. Nkhata, Yankho Chapeta, William Nkhono, Asante Kadama, Willem Takken, Kamija S. Phiri, Michele van Vugt, Henk van den Berg, Lucinda Manda-Taylor

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi.

Methods

The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility.

Results

The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018–19. In 2016–17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018–19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers’ poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges.

Conclusion

Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention’s fidelity, feasibility, and sustainability.
Appendix
Available only for authorised users
Footnotes
1
A community epicentre is a building constructed by the Hunger Project (THP) and managed by the local communities. It houses a health clinic, microcredit bank, food bank, lecture room, library and sanitary facilities.
 
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Metadata
Title
Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study
Authors
Tinashe A. Tizifa
Alinune N. Kabaghe
Robert S. McCann
Steven Gowelo
Tumaini Malenga
Richard M. Nkhata
Yankho Chapeta
William Nkhono
Asante Kadama
Willem Takken
Kamija S. Phiri
Michele van Vugt
Henk van den Berg
Lucinda Manda-Taylor
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Malaria
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18401-4

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“That was one of my most difficult and biggest challenges”: experiences, preconditions and preventive measures of health-oriented leadership in virtual teams – A qualitative study with virtual leaders