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Table 3 Primary facilitators and barriers to indoor residual spraying acceptance in this Mozambique study and from other settings

From: Community knowledge and acceptance of indoor residual spraying for malaria prevention in Mozambique: a qualitative study

  Primary facilitators from this study Primary facilitators from other settings Primary barriers from this study Primary barriers from other settings
Education and IRS knowledge   Community education on IRS was important influence on IRS uptake in Tanzania and Uganda [15, 16, 23] and recommended by the WHO [9] Lack of information on spray schedule
Lack of information about residual efficacy
Higher education
Lack of information was a barrier in southern Mozambique [17], Tanzania [15] and Uganda [23]. In Uganda willingness was associated with higher education [16]
Refusers in Tanzania were more educated [15].
Socio-economic    Families with too many/too heavy items to remove
Families with too few items
Participants in Tanzania noted barrier of embarrassment of removal of limited and low quality household items [15] and in Uganda noted household property security concerns [23]
Middle-class individuals in Uganda were less likely to accept IRS than individuals from lower socio-economic classes [16]
Geographic location Rural areas   More urbanized areas  
Community Desire to protect neighbours
Learning from experience of neighbours
Community leader involvement in IRS promotion
Participants in Mozambique underscored role of community in facilitating acceptance and in Tanzania noted concerns about community level effect [15, 17, 18] Lack of community leader support
Community preference for ITNs
Preference for ITNs over IRS was also noted in southern Mozambique [17,18,19]
Programmatic IRS was accepted because it was believed to be effective in reducing malaria Influence of perceived effectiveness of IRS against malaria was noted across settings [15, 16, 24]
Inclusion of known spray operators was influential in southern Mozambique [18] and recommended by the WHO [9]
Selection of unknown or not trusted spray operators
Concerns that insecticide was over-diluted
Use of insecticide that left strong smell and stain on walls
Insufficient or lack of timely communication of spray calendar
The importance of local, transparent recruitment of spray operators and their correct application of insecticide has been noted across settings [15, 18, 24,25,26]
Skepticism regarding effectiveness of IRS persisted with some participants in Tanzania [15]
Participants in Tanzania and Rwanda also noted the insecticide smell [15, 24] and in Tanzania about not having sufficient awareness of spray [15] and in Zimbabwe noted concerts with stains left on walls [27]
Environmental Desire to remove other non-malaria insects from home This desire was also noted in Tanzania [15], southern Mozambique [18] and Uganda [16, 23] Belief that IRS chased away mosquitoes, but did not kill
Perceived low residual efficacy
Participants in southern Mozambique, Tanzania, Rwanda and Thailand felt that IRS attracted insects and were concerned about side effects [15, 18, 19, 24, 25]
Political Trust in government and health workers Trust was also noted in southern Mozambique [18] Engagement of only government party community leaders Some participants in Tanzania felt spray was politically motivated [15]
Historical Prior acceptance of IRS IRS demand was higher among those with prior IRS experience in Tanzania [15] and Uganda [16] Negative past experiences with IRS Individuals whose houses were not sprayed in previous campaigns were less likely to accept future IRS in Uganda [16]