Protocol for a qualitative study exploring the experiences and perceptions of dolutegravir/lamivudine dual antiretroviral therapy (the PEDAL Study) in people living with HIV

INTRODUCTION Antiretroviral treatment turned HIV infection into a chronic disease and improved quality of life for people living with HIV. Dual-drug combinations can potentially reduce long-term drug-associated toxicities. We aim to investigate patients' perceptions and experiences on the safety, effectiveness, tolerability, and unmet needs of the dual-drug combination dolutegravir/lamivudine focusing on patients receiving care in Brighton, United Kingdom. In addition, we will conduct a comparative analysis between patients on dolutegravir/lamivudine and patients on other dual-drug and three-drug combinations. Lastly, the study aims to provide recommendations to improve doctor-patient communication, knowledge and understanding of the treatment plan, and additional care that ought to be considered in patient-centred, holistic care plans. METHODS AND ANALYSIS Our qualitative methodological framework is based on three main methods: cultural domain analysis, focus group discussions, and in-depth interviews. Cultural domain analysis employs a range of techniques (free listing, pile sorts, and rankings) to elicit terms from informants regarding specific cultural domains (i.e., groups of items that are perceived to be of the same kind). This framework has been co-designed with a patient representative to ensure relevance, suitability, and co-production of knowledge. All methods have been tested to take place online via Zoom®, Skype®, or Microsoft Teams® should participants prefer to participate digitally rather than in person. Padlet®, an application to create online boards, will be used during the cultural domain analysis session. Data collected will be analysed following the completion of each method embracing an iterative approach through applied thematic analysis. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority (Reference 21/NW/0070). Findings will be used to produce recommendations to improve doctor and patient communication by identifying patients' fears, worries, misconceptions, and general concerns of their drug regimen. Conclusions will be disseminated via journal articles, conference papers, and discussions through public engagement events.

An Ethnomedical Perspective: Understanding Young Child Illness in Sri Lanka Using Cultural Domain Analysis

Objectives To understand how community perspectives toward young child nutritional illness compare to biomedical perspectives in Sri Lanka. Methods This ethnographic sub-study was embedded in a multi-phase, mixed methods formative research design to understand infant and young child feeding practices in urban, rural, and estate sectors of Sri Lanka. Data were collected among caregivers of young children to understand nutritional illness using free lists (n = 150), pile sorts (n = 84), semi-structured interviews with caregivers (n = 21) and community leaders (n = 24). Data were collected in Sinhalese and Tamil languages and translated into English for analysis. Free list and pile sort data were analyzed using cultural domain analysis with Anthropac. Textual data were analyzed thematically using Dedoose. Data sets were combined for methodological triangulation. Results During interviews, caregivers described a combination of biomedical and traditional medicine approaches for treating common childhood illness, a reflection of the continued importance of traditional medical belief systems. Beliefs grounded in Ayurvedic medicine remain important drivers of health and nutrition-seeking behaviors. Consumption of ‘cold’ foods was frequently cited as an important cause of child illness. Some caregivers did explain that promoted foods such as eggs, leafy green vegetables, fruits, and green grams are appropriate dietary choices for good child health and nutrition. Cultural domain analysis revealed nutrition-related illnesses were less salient than other common young child illnesses such as fever, common cold, and cough. Low weight was the only nutritional illness that appeared in the top 15 most salient illnesses among participants. Despite a 17% average child stunting prevalence across all sectors of Sri Lanka, chronic malnutrition and stunting were not mentioned by nearly all participants, suggesting that a local understanding of this condition may not align with the biomedical importance placed on it by health professionals. Overweight/obesity did not appear to be a concern despite a growing national prevalence. Conclusions Policies and programs aimed at improving infant and young child feeding practices in Sri Lanka may benefit from understanding and incorporating community perspectives toward nutrition-related illnesses. Funding Sources UNICEF

Using Cultural Domain Analysis to Understand Community Perceptions of Infant and Young Child Foods in Sri Lanka

Objectives 1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children Methods Design: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. Results 1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. Conclusions Understanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. Funding Sources UNICEF.

Exploring the Cultural Model of Social Stress Among Andean Women in the Peruvian Highlands

We conducted research to explore how women in the highlands perceive and identify stress within the cultural context of the Andes. Using cultural domain analysis, consisting of free listing and pile sorting, we demonstrate the shared cultural model of stress among Andean women. The project describes different types of stress that impact women including economic insecurity, lack of access to education, and spousal problems. We demonstrate what this research tells us about how Andean women organize sources of stress. The practical implications of this study involve researchers and practitioners considering social factors present in the lives of Andean highland women. The research can improve discussions about how these issues influence individual social stress levels.

The Connection of French to Bayou Identity

Chapter Five illustrates how a general Bayou identity that is universal across the region underlies other divisions, and shows that this relationship is revealed via discussions of language. The chapter outlines the results of two perceptual tests: the first was a verbal guise test, during which participants were asked to guess the origins and ethnicity of speakers they listened to via short audio clips. The second asked interviewees to simply state whether they believed there were differences in the French spoken between sub-regions or between ethnic groups; the results were analyzed using a method borrowed from cultural anthropology called cultural domain analysis. The results of both tests show that all people, whether Indian or Cajun, when asked to define themselves first make their affiliation with place clear.

Perceived burden, causes and consequences of adolescent pregnancy in the rural Maharashtra: a cultural domain analysis

ObjectivesThe existing level of the early age pregnancy necessitates in-depth discussions and study. The objective of this study is to explore the perception of rural population regarding adolescent pregnancy with reference to the perceived burden, causes and consequences.MethodsA cross-sectional study through cultural domain analysis using free listing and participatory learning and action (PLA) tool of ten seed analysis was used for exploring the perceptions of the community. Cognitive salience was estimated using the Sutrop (Su) index.ResultsThe perceived burden of adolescent pregnancy was around 18%. Early marriage (Su index = 0.274), love/relationship (Su index = 0.246), pre-marital sex (Su index = 0.215), rape/incest (Su index = 0.162), and poor educational status (Su index = 0.152) were the salient causes of adolescent pregnancy. The salient consequences identified were weak baby (Su index = 0.170), social stigma (Su index = 0.124), excessive bleeding during delivery (Su index = 0.114), mother may die (Su index = 0.112) and abortion (Su index = 0.109).ConclusionsTeenage pregnancy is perceived as a problem by the community. The causes of teenage pregnancy in this setting are multi-dimensional and are deeply embedded in the system of local values, beliefs and practices.

Understanding Why Behavioral Interventions Pose Challenges - Using Cultural Domain Analysis to Compare Malnutrition Risk Perception in 6 Global Contexts

Objectives Within formative research to inform behavioral interventions since 2013, we have sought to understand community risk perceptions toward nutrition-related illnesses. This analysis compares findings from 6 countries to 1) describe the extent to which nutrition-related illnesses are salient to community members, and 2) to compare malnutrition risk perception across cultural contexts. Methods We conducted formative research in 6 countries between 2013–2018 to inform preventative nutrition interventions where behavior change was a focus. In both rural and urban sites of each country context, we used two ethnographic methods for cultural domain analysis. Free listing of ‘childhood illnesses’ was conducted in Malawi (n = 64), Mozambique (n = 115), Nigeria (n = 81), Marshall Islands (n = 86), Solomon Islands (n = 89), and Kiribati (n = 84). Smith's statistic (S) was used to assess illness term salience. The most salient terms in each setting were then pile sorted by participants who were asked to sort illness terms by perceived severity/seriousness for young child health. Data were analyzed using ANTHROPAC. Semi-structured interview data contextualized and triangulated findings. Results Across 6 global contexts, community members perceived nutrition-related illnesses to be less serious/severe than other childhood illnesses. Consistently, the most salient child illness terms identified were malaria/fever, flu/cough, and stomachache/diarrhea. Terms referring to malnutrition were mentioned in just half of the country contexts, with iron deficiency anemia (‘loss of blood’) and wasting-related terms the most salient. Local terms referring to the biomedical equivalent of stunting did not exist in most contexts. Most participants categorized nutrition-related illness terms into ‘least serious/severe’ or ‘moderately serious/severe’ rather than ‘most serious/severe’ where other more salient childhood illnesses were placed. Interview data corroborated these findings, revealing an important discrepancy between the priorities of global nutrition practitioners and the communities with whom they work, regardless of cultural or geographic context. Conclusions This study provides insight into why nutrition interventions where behavior change is needed may face challenges achieving desired effectiveness. Funding Sources Not applicable.