Social Norms, Misperceptions, and Mosquito Net Use: A Population‑Based, Cross‑Sectional Study in Rural Uganda
This study was supported by Friends of a Healthy Uganda and by a Roybal Center Grant through U.S. National Institutes of Health (NIH) P30AG034420. JMP acknowledges salary support from NIH K01MH115811. ST was supported by the VA Office of Academic Affiliations through the National Clinician Scholars Program. ACT acknowledges salary support from NIH K23MH096620.
Mosquito nets, Malaria -- Prevention, Public health
Background: Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others’ behaviours.
Methods: Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals’ perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors.
Results: Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09–4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors. Conclusions: Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.
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Perkins, J. M., Krezanoski, P., Takada, S., Kakuhikire, B., Batwala, V., Tsai, A. C., ... & Bangsberg, D. R. (2019). Social norms, misperceptions, and mosquito net use: a population-based, cross-sectional study in rural Uganda. Malaria journal, 18(1), 189.
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