The effect of contextual factors on a health intervention against podoconiosis in Ethiopia

Introduction: Understanding contextual factors that influence the implementation and outcome of interventions is crucial to improving them. Outcome and process evaluation studies have to date focused on the successes and limitations of interventions with little consideration of external factors that could either facilitate or impede them. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated the effect of contextual factors on a health intervention implemented against the neglected tropical disease (NTD) podoconiosis in Ethiopia.

Method: We purposefully selected a health intervention jointly implemented by two NGOs in podoconiosis-endemic districts in Northwestern Ethiopia. We employed an exploratory mixed methods approach, and data were collected between April and July 2022. We first conducted document analysis, observations, 4 focus group discussions, 32 in-depth interviews and 19 key informant interviews. Subsequently, we administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. The qualitative data were managed with NVivo version 12 software. The quantitative data were analyzed using Stata version 15 software.

Results: Most project activities were implemented as per the initial plan and the intervention reached patients that never had access to treatment services before. Contextual factors (geographical, epidemiological, socio-economic, socio-cultural, ethical, legal and political) and lived experience of patients influenced the implementation and outcome of the intervention. Most of the contextual factors pose constraints on implementation and affected the acceptability and sustainability of project activities. On the other hand, political context such the commitment of the government to rollout national programs and set up NTD structures at district level positively influenced the implementation of the intervention.

Conclusion: Health intervention implementors should be aware of the interactive effects of contextual factors wherein interventions are put into practice. Minimizing the constraining effects of these contextual factors while utilizing opportunities presented by them might help implement optimal strategies to improve the lives of individuals affected by podoconiosis and similar NTDs.