Mean score for knowledge domain by known-groups.

<p>*Reference group for p-value</p><p>Mean score for knowledge domain by known-groups.</p

Development and Validation of a Cross-Cultural Knowledge, Attitudes, and Practices Survey Instrument for Chronic Kidney Disease in a Swahili-Speaking Population

<div><p>Introduction</p><p>Non-communicable diseases are a growing global burden, and structured surveys can identify critical gaps to address this epidemic. In sub-Saharan Africa, there are very few well-tested survey instruments measuring population attributes related to non-communicable diseases. To meet this need, we have developed and validated the first instrument evaluating knowledge, attitudes and practices pertaining to chronic kidney disease in a Swahili-speaking population.</p><p>Methods and Results</p><p>Between December 2013 and June 2014, we conducted a four-stage, mixed-methods study among adults from the general population of northern Tanzania. In stage 1, the survey instrument was constructed in English by a group of cross-cultural experts from multiple disciplines and through content analysis of focus group discussions to ensure local significance. Following translation, in stage 2, we piloted the survey through cognitive and structured interviews, and in stage 3, in order to obtain initial evidence of reliability and construct validity, we recruited and then administered the instrument to a random sample of 606 adults. In stage 4, we conducted analyses to establish test-retest reliability and known-groups validity which was informed by thematic analysis of the qualitative data in stages 1 and 2. The final version consisted of 25 items divided into three conceptual domains: knowledge, attitudes and practices. Each item demonstrated excellent test-retest reliability with established content and construct validity.</p><p>Conclusions</p><p>We have developed a reliable and valid cross-cultural survey instrument designed to measure knowledge, attitudes and practices of chronic kidney disease in a Swahili-speaking population of Northern Tanzania. This instrument may be valuable for addressing gaps in non-communicable diseases care by understanding preferences regarding healthcare, formulating educational initiatives, and directing development of chronic disease management programs that incorporate chronic kidney disease across sub-Saharan Africa.</p></div

Demographic and social characteristics of the survey respondents.

<p>*Other Tribal Ethnicities represented in our groups include Maasai, Luguru, Kilindi, Kurya, Mziguwa, Mnyisanzu, Rangi, Jita, Nyambo and Kaguru</p><p># Includes housewives and students</p><p>† Professional includes any salaried position (e.g. nurse, teacher, government employee, etc.) and retired persons</p><p>††For comparison of urban and rural</p><p>Demographic and social characteristics of the survey respondents.</p

Inclusion criteria for survey items.

<p>Inclusion criteria for survey items.</p

Action Cycle Outlining the Iterative Process for Developing and Piloting the Cross-Cultural Survey Instrument.

<p>Action Cycle Outlining the Iterative Process for Developing and Piloting the Cross-Cultural Survey Instrument.</p

a-c, Polychoric correlation matrices for the three domains of knowledge, attitudes, and practices based on results of the 606 adults who completed the piloted survey instrument.

<p>*The response scale consisted of <i>Yes</i>, <i>No</i>, <i>Do not know</i> and <i>Unsure</i> with <i>Do not know</i> and <i>Unsure</i> coded as one response.</p><p>†The response scale consisted of <i>Yes</i> and <i>No</i></p><p>‡The response scale consisted of <i>Very Unlikely</i>, <i>Unlikely</i>, <i>Likely</i> and <i>Very Likely</i></p><p>††Item 26 was removed from the final version of the instrument</p><p>a-c, Polychoric correlation matrices for the three domains of knowledge, attitudes, and practices based on results of the 606 adults who completed the piloted survey instrument.</p

The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study

<div><p>Introduction</p><p>Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.</p><p>Methods</p><p>Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.</p><p>Results</p><p>Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.</p><p>Conclusions</p><p>In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.</p></div

Baseline characteristics of the structured survey respondents.

<p>Baseline characteristics of the structured survey respondents.</p

Determinants for the use of Traditional Medicines.

<p>The diagram illustrates the five major determinantsand their relationship to each other.</p

Baseline characteristics of the traditional healers and herbal vendors.

<p>Baseline characteristics of the traditional healers and herbal vendors.</p