Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide‑treated net use in Ghana

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dc.contributor.author Ahorlu, C.S.
dc.contributor.author Adongo, P.
dc.contributor.author Koenker, H.
dc.contributor.author Zigirumugabe, S.
dc.contributor.author Sika‑Bright, S.
dc.contributor.author Koka, E.
dc.contributor.author Tabong, P.T-N.
dc.date.accessioned 2020-01-17T09:37:53Z
dc.date.available 2020-01-17T09:37:53Z
dc.date.issued 2019-12-12
dc.identifier.other https://doi.org/10.1186/s12936-019-3051-0
dc.identifier.uri http://ugspace.ug.edu.gh/handle/123456789/34421
dc.description Research Article en_US
dc.description.abstract Background: Mass and continuous distribution channels have significantly increased access to insecticide-treated nets (ITNs) in Ghana since 2000. Despite these gains, a large gap remains between ITN access and use. Methods: A qualitative research study was carried out to explore the individual and contextual factors influencing ITN use among those with access in three sites in Ghana. Eighteen focus group discussions, and free listing and ranking activities were carried out with 174 participants; seven of those participants were selected for in-depth case study. Focus group discussions and case study interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results: ITN use, as described by study participants, was not binary; it varied throughout the night, across seasons, and over time. Heat was the most commonly cited barrier to consistent ITN use and contributed to low reported ITN use during the dry season. Barriers to ITN use throughout the year included skin irritation; lack of airflow in the sleeping space; and, in some cases, a lack of information on the connection between the use of ITNs and malaria prevention. Falling ill or losing a loved one to malaria was the most powerful motivator for consistent ITN use. Participants also discussed developing a habit of ITN use and the economic benefit of prevention over treatment as facilitating factors. Participants reported gender differences in ITN use, noting that men were more likely than women and children to stay outdoors late at night and more likely to sleep outdoors without an ITN. Conclusion: The study results suggest the greatest gains in ITN use among those with access could be made by promoting consistent use throughout the year among occasional and seasonal users. Opportunities for improving communication messages, such as increasing the time ITNs are aired before first use, as well as structural approaches to enhance the usability of ITNs in challenging contexts, such as promoting solutions for outdoor ITN use, were identified from this work. The information from this study can be used to inform social and behaviour change messaging and innovative approaches to closing the ITN use gap in Ghana. en_US
dc.description.sponsorship American people through the United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) under the terms of USAID/JHU Cooperative Agreement No. AID-OAA-A-14-00057 (VectorWorks Project). en_US
dc.language.iso en en_US
dc.publisher Malaria Journal en_US
dc.relation.ispartofseries 18;417
dc.subject Malaria en_US
dc.subject Ghana en_US
dc.subject Insecticide-treated mosquito net en_US
dc.subject Prevention en_US
dc.title Understanding the gap between access and use: a qualitative study on barriers and facilitators to insecticide‑treated net use in Ghana en_US
dc.type Article en_US


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  • Epidemiology Department [240]
    The Epidemiology Department contributes to the mission of the institute through basic and applied epidemiological research on, but not limited to, malaria and other diseases of public health importance. It is also home to the Social Science Unit of the Institute, including the Health Support Centre for HIV/AIDS and other communicable and noncommunicable health problems.

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