‘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

Abstract

ObjectiveTo explore the influence of personal, cultural and socioeconomic factors related to footwear use and non-use in northern Ethiopia.DesignA qualitative study was conducted using focus group discussions and in-depth individual interviews. Data were collected using semistructured interview guides.SettingThe study was conducted in East and West Gojjam Zones, Amhara region, northwest Ethiopia.ParticipantsA total of 91 individuals from 4 target groups participated in individual and group interviews: (1) non-affected community leaders including Idir (a form of social insurance) leaders, school principals, kebele (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).ResultsParticipants 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.ConclusionsWe 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.

Health beliefs of school-age rural children in podoconiosis-affected families: A qualitative study in Southern Ethiopia

“…Barefoot exposure to soil was also raised by children as a cause of podoconiosis though the role of mineral particles in the soil was mentioned infrequently. This is congruent with previous studies which reported poor knowledge of adult community members about mineral particles in the soil as a causal agent of podoconiosis [ 8 – 10 , 12 , 43 , 44 ]. Regarding preventive measures, children were well aware of the importance of footwear and foot hygiene.…”

“…Others associated the risk of getting podoconiosis with bad luck or predisposition, which may also limit their motivation to engage in or maintain preventive action. Such a perception was also reported as common among adults in podoconiosis-endemic communities and acted as a barrier to preventive actions against podoconiosis [ 11 , 12 ]. As children associate their perception of susceptibility to podoconiosis with exposure to poison in the soil, and contact with and insults against affected people, they may consider their exposure to these risk factors beyond their control.…”

“…The perceptions of adults regarding their own and children’s susceptibility to the disease were also reported to be inaccurate [ 6 , 11 ]. The perceptions that footwear does not permit farm activities and other duties, is uncomfortable for walking in the mud, smells bad in the hot season, wears out too quickly, softens the feet, and should be preserved for special events have all been identified as factors discouraging optimum use of footwear among people at high risk for the disease [ 11 , 12 ]. However, most of these studies focused only on adults.…”

Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial

“…To our knowledge, studies 33 of lymphoedema management in patients with lymphatic filariasis have not disaggregated data by sex so it is difficult to contextualise this finding. Observational studies14, 36 among people with podoconiosis suggest that men have more access to shoes, and are more likely to own a pair. In the general population, men are more likely to be found wearing shoes at interview 37 .…”

Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia

“…A well-documented example is trachoma, where female caregivers come into more frequent contact with infected children than male caregivers and are thus more likely to become infected themselves [5,11]. In the case of podoconiosis, women have been found to be more at risk of acquiring the disease because they are less likely to own or wear shoes, reflecting cultural traditions and because available shoes were perceived to be more suitable for men [12,13]. Other studies have remarked on the underestimation and underreporting of NTDs in women, specifically schistosomiasis and lymphatic filariasis (LF), as diagnosis of these diseases can require women to comply with activities that are perceived as culturally inappropriate or taboo, such as providing a urine or stool sample or allowing intimate physical examination [14,15].…”