‘Why should I worry, since I have healthy feet?’ A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia
Identifieur interne : 003B79 ( Pmc/Curation ); précédent : 003B78; suivant : 003B80‘Why should I worry, since I have healthy feet?’ A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia
Auteurs : Abebe Kelemework [Éthiopie] ; Abebayehu Tora [Éthiopie] ; Tsigie Amberbir [Éthiopie] ; Getnet Agedew [Éthiopie] ; Abiyu Asmamaw [Éthiopie] ; Kebede Deribe [Royaume-Uni, Éthiopie] ; Gail Davey [Royaume-Uni]Source :
- BMJ Open [ 2044-6055 ] ; 2016.
Abstract
To explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia.
A qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides.
The study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia.
A total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including
Participants perceived a range of health benefits from donning footwear, including protection against injury and cold. Various types of shoes are available within the community, and their use varied depending on the nature of activities and the season. Personal and socioeconomic barriers hindered the desire to consistently use footwear. Widely established barefoot traditions and beliefs that footwear is uncomfortable, heavy and may weaken the feet have made the regular use of footwear uncommon. Economic constraints were also mentioned as hindering ownership and use of footwear. Distance from places where shoes could be bought also contributed to limited access. Cultural influences promoting gender inequality resulted in women being least able to access shoes.
We identified several individual, cultural and socioeconomic barriers that influence individuals’ decisions about and use of footwear in rural northern Ethiopia. Promoting education on the health benefits of footwear, curbing podoconiosis-related misconceptions and integrating these with economic empowerment programmes, may all improve the use of footwear.
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DOI: 10.1136/bmjopen-2015-010354
PubMed: 27006343
PubMed Central: 4809094
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strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Department of Ethiopian Languages and Literature</addr-line>,<institution>Debre Markos University</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Deribe, Kebede" sort="Deribe, Kebede" uniqKey="Deribe K" first="Kebede" last="Deribe">Kebede Deribe</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Wellcome Trust Brighton and Sussex Centre for Global Health Research</institution>,<addr-line>Brighton</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><institution>School of Public Health, Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Wellcome Trust Brighton and Sussex Centre for Global Health Research</institution>,<addr-line>Brighton</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27006343</idno><idno type="pmc">4809094</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809094</idno><idno type="RBID">PMC:4809094</idno><idno type="doi">10.1136/bmjopen-2015-010354</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">003B80</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003B80</idno><idno type="wicri:Area/Pmc/Curation">003B79</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003B79</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">‘Why should I worry, since I have healthy feet?’ A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia</title><author><name sortKey="Kelemework, Abebe" sort="Kelemework, Abebe" uniqKey="Kelemework A" first="Abebe" last="Kelemework">Abebe Kelemework</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>International Orthodox Christian Charities (IOCC)</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Tora, Abebayehu" sort="Tora, Abebayehu" uniqKey="Tora A" first="Abebayehu" last="Tora">Abebayehu Tora</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Sociology</addr-line>,<institution>Wolaita Sodo University</institution>,<addr-line>Sodo</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Sociology</addr-line>,<institution>Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Amberbir, Tsigie" sort="Amberbir, Tsigie" uniqKey="Amberbir T" first="Tsigie" last="Amberbir">Tsigie Amberbir</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>International Orthodox Christian Charities (IOCC)</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Agedew, Getnet" sort="Agedew, Getnet" uniqKey="Agedew G" first="Getnet" last="Agedew">Getnet Agedew</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>International Orthodox Christian Charities (IOCC)</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Asmamaw, Abiyu" sort="Asmamaw, Abiyu" uniqKey="Asmamaw A" first="Abiyu" last="Asmamaw">Abiyu Asmamaw</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Department of Amharic Language, Literature Folklore</addr-line>,<institution>Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Department of Ethiopian Languages and Literature</addr-line>,<institution>Debre Markos University</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Deribe, Kebede" sort="Deribe, Kebede" uniqKey="Deribe K" first="Kebede" last="Deribe">Kebede Deribe</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Wellcome Trust Brighton and Sussex Centre for Global Health Research</institution>,<addr-line>Brighton</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><institution>School of Public Health, Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="af6"><institution>Wellcome Trust Brighton and Sussex Centre for Global Health Research</institution>,<addr-line>Brighton</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia.</p></sec><sec><title>Design</title><p>A qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides.</p></sec><sec><title>Setting</title><p>The study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia.</p></sec><sec><title>Participants</title><p>A total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including <italic>Idir</italic> (a form of social insurance) leaders, school principals, <italic>kebele</italic> (the lowest administrative unit) officials, health professionals, teachers, merchants and religious leaders; (2) affected men and women; (3) non-affected men and women not in leadership positions; and (4) school children (both male and female).</p></sec><sec><title>Results</title><p>Participants perceived a range of health benefits from donning footwear, including protection against injury and cold. Various types of shoes are available within the community, and their use varied depending on the nature of activities and the season. Personal and socioeconomic barriers hindered the desire to consistently use footwear. Widely established barefoot traditions and beliefs that footwear is uncomfortable, heavy and may weaken the feet have made the regular use of footwear uncommon. Economic constraints were also mentioned as hindering ownership and use of footwear. Distance from places where shoes could be bought also contributed to limited access. Cultural influences promoting gender inequality resulted in women being least able to access shoes.</p></sec><sec><title>Conclusions</title><p>We identified several individual, cultural and socioeconomic barriers that influence individuals’ decisions about and use of footwear in rural northern Ethiopia. Promoting education on the health benefits of footwear, curbing podoconiosis-related misconceptions and integrating these with economic empowerment programmes, may all improve the use of footwear.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Tomczyk, S" uniqKey="Tomczyk S">S Tomczyk</name></author><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Brooker, Sj" uniqKey="Brooker S">SJ Brooker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Price, E" uniqKey="Price E">E Price</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tekola, F" uniqKey="Tekola F">F Tekola</name></author><author><name sortKey="Mariam, Dh" uniqKey="Mariam D">DH Mariam</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yakob, B" uniqKey="Yakob B">B Yakob</name></author><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ayode, D" uniqKey="Ayode D">D Ayode</name></author><author><name sortKey="Mcbride, Cm" uniqKey="Mcbride C">CM McBride</name></author><author><name sortKey="De Heer, Hd" uniqKey="De Heer H">HD de Heer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcbride, Cm" uniqKey="Mcbride C">CM McBride</name></author><author><name sortKey="Price, Cs" uniqKey="Price C">CS Price</name></author><author><name sortKey="Ayode, D" uniqKey="Ayode D">D Ayode</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Molla, Yb" uniqKey="Molla Y">YB Molla</name></author><author><name sortKey="Le Blond, Js" uniqKey="Le Blond J">JS Le Blond</name></author><author><name sortKey="Wardrop, N" uniqKey="Wardrop N">N Wardrop</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Watanabe, E" uniqKey="Watanabe E">E Watanabe</name></author><author><name sortKey="Mcbride, Cm" uniqKey="Mcbride C">CM McBride</name></author><author><name sortKey="Tora, A" uniqKey="Tora A">A Tora</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Suma, Tk" uniqKey="Suma T">TK Suma</name></author><author><name sortKey="Shenoy, Rk" uniqKey="Shenoy R">RK Shenoy</name></author><author><name sortKey="Kumaraswami, V" uniqKey="Kumaraswami V">V Kumaraswami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harwell, Ts" uniqKey="Harwell T">TS Harwell</name></author><author><name sortKey="Helgerson, Sd" uniqKey="Helgerson S">SD Helgerson</name></author><author><name sortKey="Gohdes, D" uniqKey="Gohdes D">D Gohdes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abera, B" uniqKey="Abera B">B Abera</name></author><author><name sortKey="Alem, G" uniqKey="Alem G">G Alem</name></author><author><name sortKey="Yimer, M" uniqKey="Yimer M">M Yimer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Meribo, K" uniqKey="Meribo K">K Meribo</name></author><author><name sortKey="Gebre, T" uniqKey="Gebre T">T Gebre</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pullan, Rl" uniqKey="Pullan R">RL Pullan</name></author><author><name sortKey="Smith, Jl" uniqKey="Smith J">JL Smith</name></author><author><name sortKey="Jasrasaria, R" uniqKey="Jasrasaria R">R Jasrasaria</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tadesse, G" uniqKey="Tadesse G">G Tadesse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Taye, B" uniqKey="Taye B">B Taye</name></author><author><name sortKey="Alemayehu, B" uniqKey="Alemayehu B">B Alemayehu</name></author><author><name sortKey="Birhanu, A" uniqKey="Birhanu A">A Birhanu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alemu, G" uniqKey="Alemu G">G Alemu</name></author><author><name sortKey="Tekola Ayele, F" uniqKey="Tekola Ayele F">F Tekola Ayele</name></author><author><name sortKey="Daniel, T" uniqKey="Daniel T">T Daniel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ayode, D" uniqKey="Ayode D">D Ayode</name></author><author><name sortKey="Mcbride, Cm" uniqKey="Mcbride C">CM McBride</name></author><author><name sortKey="De Heer, H" uniqKey="De Heer H">H de Heer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Molla, Yb" uniqKey="Molla Y">YB Molla</name></author><author><name sortKey="Tomczyk, S" uniqKey="Tomczyk S">S Tomczyk</name></author><author><name sortKey="Amberbir, T" uniqKey="Amberbir T">T Amberbir</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tamiru, A" uniqKey="Tamiru A">A Tamiru</name></author><author><name sortKey="Tsegay, G" uniqKey="Tsegay G">G Tsegay</name></author><author><name sortKey="Wubie, M" uniqKey="Wubie M">M Wubie</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Glaser, Bg" uniqKey="Glaser B">BG Glaser</name></author><author><name sortKey="Strauss, Al" uniqKey="Strauss A">AL Strauss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Araya, Gd" uniqKey="Araya G">GD Araya</name></author><author><name sortKey="Reda, Hl" uniqKey="Reda H">HL Reda</name></author><author><name sortKey="Tesema, Ag" uniqKey="Tesema A">AG Tesema</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Astatkie, A" uniqKey="Astatkie A">A Astatkie</name></author><author><name sortKey="Feleke, A" uniqKey="Feleke A">A Feleke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Brooker, Sj" uniqKey="Brooker S">SJ Brooker</name></author><author><name sortKey="Pullan, Rl" uniqKey="Pullan R">RL Pullan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id><journal-id journal-id-type="hwp">bmjopen</journal-id><journal-id journal-id-type="publisher-id">bmjopen</journal-id><journal-title-group><journal-title>BMJ Open</journal-title></journal-title-group><issn pub-type="epub">2044-6055</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27006343</article-id><article-id pub-id-type="pmc">4809094</article-id><article-id pub-id-type="publisher-id">bmjopen-2015-010354</article-id><article-id pub-id-type="doi">10.1136/bmjopen-2015-010354</article-id><article-categories><subj-group subj-group-type="heading"><subject>Qualitative Research</subject><subj-group><subject>Research</subject></subj-group></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject><subject>1725</subject><subject>1724</subject><subject>1704</subject><subject>1703</subject></subj-group></article-categories><title-group><article-title>‘Why should I worry, since I have healthy feet?’ A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kelemework</surname><given-names>Abebe</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tora</surname><given-names>Abebayehu</given-names></name><xref ref-type="aff" rid="af2">2</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Amberbir</surname><given-names>Tsigie</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Agedew</surname><given-names>Getnet</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Asmamaw</surname><given-names>Abiyu</given-names></name><xref ref-type="aff" rid="af4">4</xref><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Deribe</surname><given-names>Kebede</given-names></name><xref ref-type="aff" rid="af6">6</xref><xref ref-type="aff" rid="af7">7</xref></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-2796-7468</contrib-id><name><surname>Davey</surname><given-names>Gail</given-names></name><xref ref-type="aff" rid="af6">6</xref></contrib></contrib-group><aff id="af1"><label>1</label><institution>International Orthodox Christian Charities (IOCC)</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></aff><aff id="af2"><label>2</label><addr-line>Department of Sociology</addr-line>,<institution>Wolaita Sodo University</institution>,<addr-line>Sodo</addr-line>,<country>Ethiopia</country></aff><aff id="af3"><label>3</label><addr-line>Department of Sociology</addr-line>,<institution>Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></aff><aff id="af4"><label>4</label><addr-line>Department of Amharic Language, Literature Folklore</addr-line>,<institution>Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></aff><aff id="af5"><label>5</label><addr-line>Department of Ethiopian Languages and Literature</addr-line>,<institution>Debre Markos University</institution>,<addr-line>Debre Markos</addr-line>,<country>Ethiopia</country></aff><aff id="af6"><label>6</label><institution>Wellcome Trust Brighton and Sussex Centre for Global Health Research</institution>,<addr-line>Brighton</addr-line>,<country>UK</country></aff><aff id="af7"><label>7</label><institution>School of Public Health, Addis Ababa University</institution>,<addr-line>Addis Ababa</addr-line>,<country>Ethiopia</country></aff><author-notes><corresp><label>Correspondence to</label> Abebe Kelemework; <email>abebe1978@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>22</day><month>3</month><year>2016</year></pub-date><volume>6</volume><issue>3</issue><elocation-id>e010354</elocation-id><history><date date-type="received"><day>23</day><month>10</month><year>2015</year></date><date date-type="rev-recd"><day>5</day><month>1</month><year>2016</year></date><date date-type="accepted"><day>8</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:href="bmjopen-2015-010354.pdf"></self-uri><abstract><sec><title>Objective</title><p>To explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia.</p></sec><sec><title>Design</title><p>A qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides.</p></sec><sec><title>Setting</title><p>The study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia.</p></sec><sec><title>Participants</title><p>A total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including <italic>Idir</italic> (a form of social insurance) leaders, school principals, <italic>kebele</italic> (the lowest administrative unit) officials, health professionals, teachers, merchants and religious leaders; (2) affected men and women; (3) non-affected men and women not in leadership positions; and (4) school children (both male and female).</p></sec><sec><title>Results</title><p>Participants perceived a range of health benefits from donning footwear, including protection against injury and cold. Various types of shoes are available within the community, and their use varied depending on the nature of activities and the season. Personal and socioeconomic barriers hindered the desire to consistently use footwear. Widely established barefoot traditions and beliefs that footwear is uncomfortable, heavy and may weaken the feet have made the regular use of footwear uncommon. Economic constraints were also mentioned as hindering ownership and use of footwear. Distance from places where shoes could be bought also contributed to limited access. Cultural influences promoting gender inequality resulted in women being least able to access shoes.</p></sec><sec><title>Conclusions</title><p>We identified several individual, cultural and socioeconomic barriers that influence individuals’ decisions about and use of footwear in rural northern Ethiopia. Promoting education on the health benefits of footwear, curbing podoconiosis-related misconceptions and integrating these with economic empowerment programmes, may all improve the use of footwear.</p></sec></abstract><kwd-group><kwd>Podoconiosis</kwd><kwd>Footwear</kwd><kwd>Personal protection</kwd><kwd>Shoe wearing</kwd><kwd>Neglected tropical diseases</kwd></kwd-group><funding-group specific-use="FundRef"><award-group id="funding-1"><funding-source><institution-wrap><institution>Wellcome Trust</institution><institution-id>http://dx.doi.org/10.13039/100004440</institution-id></institution-wrap></funding-source><award-id>grant number 091956</award-id><award-id>grant number 099876</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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