Association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by podoconiosis in rural Ethiopia

Public health applications of genomic discovery will be challenged by the difficulties of conveying information to lay audiences about complex gene-by-environment influences. This will be especially true in global contexts characterized by low literacy and diverse cultural norms. Commonsense beliefs about the role of heredity in health conditions may have an important influence on preventive and interpersonal behaviors, yet little research has been conducted in the developing world. We explored beliefs about the causes of podoconiosis, a hereditary tropical disease endemic in south Ethiopia. While the condition clusters in families, it can be prevented if individuals wear shoes consistently. This qualitative study involved 307 participants including affected adults, unaffected adults, children and community leaders, in four of 13 rural communities served by a local NGO. A total of 38 individual interviews, 28 focus group discussions and seven case studies were conducted. Three themes emerged in beliefs about the causes of podoconiosis: (1) heredity is the sole cause; (2) environment is the sole cause; and (3) multi-factorial causes. Individuals who believed heredity to be the sole cause tended to downplay the importance of taking preventive actions such as shoe wearing. However, beliefs that heredity had no role in the condition fostered concerns about contagion, which increased the perceived importance of increasing social distance from affected families. Educational programs designed for low literacy audiences that illustrate how hereditary health conditions can be overcome by taking preventive actions to reduce key environmental exposures could increase preventive behaviors and social acceptance of affected individuals.