Acceptability and feasibility of strategies to shield the vulnerable during the COVID-19 outbreak: a qualitative study in six Sudanese communities

  1. Nada Abdelmagid
  2. Salma A. E. Ahmed
  3. Nazik Nurelhuda
  4. Israa Zainalabdeen
  5. Aljaile Ahmed
  6. Mahmoud Ali Fadlallah
  7. Maysoon Dahab

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Abstract

Background

Shielding of high-risk groups from coronavirus disease (COVID-19) has been suggested as a realistic alternative to severe movement restrictions during the COVID-19 epidemic in low-income countries. The intervention entails the establishment of ‘green zones’ for high-risk persons to live in, either within their homes or in communal structures, in a safe and dignified manner, for extended periods of time during the epidemic. To our knowledge, this concept has not been tested or evaluated in resource-poor settings. This study aimed to explore the acceptability and feasibility of strategies to shield persons at higher risk of severe COVID-19 outcomes, during the COVID-19 epidemic in six communities in Sudan.

Methods

We purposively sampled participants from six communities, illustrative of urban, rural and forcibly-displaced settings. In-depth telephone interviews were held with 59 members of households with one or more members at higher risk of severe COVID-19 outcomes. Follow-up interviews were held with 30 community members after movement restrictions were eased across the country. All interviews were audio-recorded, transcribed verbatim, and analysed using a two-stage deductive and inductive thematic analysis.

Results

Most participants were aware that some people are at higher risk of severe COVID-19 outcomes but were unaware of the concept of shielding. Most participants found shielding acceptable and consistent with cultural inclinations to respect elders and protect the vulnerable. However, extra-household shielding arrangements were mostly seen as socially unacceptable. Participants reported feasibility concerns related to the reduced socialisation of shielded persons and loss of income for shielding families. The acceptability and feasibility of shielding strategies were reduced after movement restrictions were eased, as participants reported lower perception of risk in their communities and increased pressure to comply with social commitments outside the house.

Conclusion

Shielding is generally acceptable in the study communities. Acceptability is influenced by feasibility, and by contextual changes in the epidemic and associated policy response. The promotion of shielding should capitalise on the cultural and moral sense of duty towards elders and vulnerable groups. Communities and households should be provided with practical guidance to implement feasible shielding options. Households must be socially, psychologically and financially supported to adopt and sustain shielding effectively.

Article activity feed

  1. Version published to 10.1186/s12889-021-11187-9
  2. ScreenIT

    SciScore for 10.1101/2020.12.14.20248160: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Youth peers were trained remotely, through pre-recorded video and audio training sessions on qualitative research, shielding strategies, informed consent and study procedures, developed and delivered by the first author (NA).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. Firstly, in this study, we used interviews to explore the acceptability and feasibility of shielding. In acceptability research, focus group discussions are preferred over interviews as they have the advantage of allowing group members to collectively brainstorm and debate ideas, opinions, and recommendations [36]. However, given the movement restrictions posed by COVID-19, remote interviews were the appropriate choice for our study, and we are confident that we reached data saturation, as no additional themes emerged in the final interviews at any of the study sites. Secondly, we conducted the interviews remotely by telephone, which is subject to challenges including challenges to establishing rapport, absence of visual cues and contextual data, and the relatively short time of the interview to avoid respondent fatigue [37-39]. Thirdly, in this study, we inquired about the acceptability of a new concept of which the majority of study participants had no prior knowledge. It is possible that some participants provided their opinion without considering the implications of shielding on all aspects of their lives. However, given that reasons for and against acceptance were recurrent across participants and study sites, we are confident that this limitation had a minimal effect on the findings, probably in the direction of acceptance. Finally, given our study design, findings cannot be generalised to all Sudanese communities. Shielding promotion in the s...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.12.14.20248160v1 on medRxiv