Barriers to Uptake and Adherence with Malaria Prophylaxis by the African Community in London, England: Focus Group Study
Bibliographic record
Abstract
BACKGROUND: Rates of imported malaria in the UK and other European countries are increasing, and particularly the more serious Plasmodium falciparum malaria. This study investigated beliefs about malaria and barriers to the uptake and adherence to malaria prophylaxis experienced by African descent individuals in inner London who have low rates of use of malaria prophylaxis and high risks of P. falciparum malaria. DESIGN: Five focus groups conducted with 44 volunteers of African origin living in south London. Transcripts were analysed qualitatively. RESULTS: Failure to access the drugs prior to travel was influenced by perceptions of malaria as a low threat, non-serious and easily treatable, and a belief that they were vaccinated or somehow not at personal risk, together with concerns about side effects of the drugs, dislike of the taste and disbelief by some participants of the drugs effectiveness. Health service barriers included the cost of drugs, waiting times for appointments and uncertainty regarding appropriate medication. Adherence to the prophylaxis was hindered by difficulties in remembering complex regimes, a lack of understanding of the rationale for continuing the drugs after return to the UK and the practice of leaving drugs for relatives in Africa. However, there was some variability in beliefs and practices that appeared to be associated with socio-economic status, prior experience of malaria and the local organisation and delivery of primary care travel services. CONCLUSIONS: Much non-adherence is 'intentional' and reflects both beliefs common to all travellers and the particular circumstances and experiences of migrants of African descent. However, there was considerable variability in beliefs and practices among participants that reflects the heterogeneity within the West African community in their socio-economic position and circumstances. Changing behaviours requires a multi-dimensional approach involving community-based health promotion that targets the beliefs of this ethnic group and health service measures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".