Lancet Global Health: Understanding lung health beliefs in low-resource settings

17 December, 2021

Interesting paper suggesting that (lack of) basic healthcare information is at least partly to blame for the rising prevalence of smoking in low- and middle-income countries.

CITATION: Lancet Global Health: Comment| volume 10, issue 1, e6-e7, january 01, 2022

Understanding lung health beliefs in low-resource settings

Jennifer M Wang et al.

Published: January, 2022



Two common preventable risk factors for chronic respiratory diseases (CRDs) are tobacco use and household air pollution (HAP). However, many middle-income and low-income countries continue to face rising smoking epidemics despite increasing legislation of WHO tobacco control policy recommendations... understanding local health beliefs and practices remains central to the effective introduction and long-term adoption of any health intervention.

Through an observational mixed-method study5 published in The Lancet Global Health, Brakema and colleagues examined health beliefs and behaviours related to CRDs in six low-resource settings in Uganda, Vietnam, Kyrgyzstan, and Greece. ... Three main themes were identified.

The first theme involved perceived disease identity. Community members frequently attributed chronic respiratory symptoms to acute communicable diseases, predominantly tuberculosis. Most community members had not heard the term chronic obstructive pulmonary disease and did not understand the chronic and non-communicable nature of asthma and chronic bronchitis...

The second theme centred around beliefs regarding the causes of CRDs. Tobacco smoking topped this list, which also included HAP, witchcraft in Uganda, the evil eye in Kyrgyzstan, a hot–cold disbalance in Vietnam, and humidity in Greece.

The third theme focused on norms and social structures. Most smokers in this study were men and smoking behaviour was associated with masculinity in Vietnam and Kyrgyzstan...

The factors behind incomplete medical knowledge of CRDs among health-care providers were not systematically examined in this study...

LINKED PAPER: Brakema et al.

'In conclusion, to facilitate a successful implementation process of CRD-related interventions in low-resource settings, implementers should address the locally perceived identity of CRD, local beliefs about causes, and local social values and structures that influence health behaviour. Therefore, we recommend these beliefs and behaviours be mapped before every intervention to design tailored implementation strategies.'

COMMENT (NPW): We often take it for granted in high-income countries that 'everyone' knows the links between lifestyle factors such a smoking and smoking, obesity and diabetes, and so on. The picture in low- and middle-income countries is much less clear and we need to know more. It seems likely that many millions of people worldwide are unaware of the impact of their behaviour on health. This is an issue that HIFA stands ready to explore: contact us if you would like to collaborate.

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator,