{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T09:13:20Z","timestamp":1769937200256,"version":"3.49.0"},"reference-count":33,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019418","name":"NIHR Maudsley Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR203318"],"award-info":[{"award-number":["NIHR203318"]}],"id":[{"id":"10.13039\/100019418","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001923","name":"Health Services Research Programme","doi-asserted-by":"publisher","award":["DRF2017-10-132"],"award-info":[{"award-number":["DRF2017-10-132"]}],"id":[{"id":"10.13039\/501100001923","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001923","name":"Health Services Research Programme","doi-asserted-by":"publisher","award":["NIHR7\/1004"],"award-info":[{"award-number":["NIHR7\/1004"]}],"id":[{"id":"10.13039\/501100001923","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019734","name":"Kenya Medical Research Institute","doi-asserted-by":"publisher","award":["KEMRI\/COV\/SPEC\/002"],"award-info":[{"award-number":["KEMRI\/COV\/SPEC\/002"]}],"id":[{"id":"10.13039\/501100019734","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","award":["MR\/N015959\/1"],"award-info":[{"award-number":["MR\/N015959\/1"]}],"id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","award":["MR\/R022739\/1"],"award-info":[{"award-number":["MR\/R022739\/1"]}],"id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","award":["MR\/S009035\/1"],"award-info":[{"award-number":["MR\/S009035\/1"]}],"id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,2]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities\u2019 trust and maintaining essential economic and social activities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-062686","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T10:00:16Z","timestamp":1684231216000},"page":"e062686","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Contextually appropriate communication strategies for COVID-19 prevention in Kenya border regions: evidence from a mixed methods observational study in Busia and Mandera counties"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-0533","authenticated-orcid":false,"given":"Lydia","family":"Kaduka","sequence":"first","affiliation":[{"name":"Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya"},{"name":"Faculty of Life Sciences & Medicine, School of Life Course Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Olale","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Karamanos","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences & Medicine, School of Life Course Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Mutai","sequence":"additional","affiliation":[{"name":"Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Coultas","sequence":"additional","affiliation":[{"name":"School of Medical Education, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismail","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veline","family":"L'Esperance","sequence":"additional","affiliation":[{"name":"School of Population Health and Environmental Sciences, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursula","family":"Read","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Dazzan","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Kennedy","family":"Cruickshank","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences & Medicine, School of Life Course Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erastus","family":"Muniu","sequence":"additional","affiliation":[{"name":"Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seeromanie","family":"Harding","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences & Medicine, School of Life Course Science, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"2025121400555520000_13.5.e062686.1","unstructured":"World Health Organization . WHO Coronavirus (COVID-19) dashboard | WHO Coronavirus (COVID-19) dashboard with vaccination data. Available: https:\/\/covid19.who.int\/region\/afro\/country\/ke [Accessed 20 Jan 2022]."},{"key":"2025121400555520000_13.5.e062686.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-042749","article-title":"Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: Evidence from a prospective cohort survey in Nairobi informal settlements","volume":"11","author":"Pinchoff","year":"2021","journal-title":"BMJ Open"},{"key":"2025121400555520000_13.5.e062686.3","doi-asserted-by":"publisher","DOI":"10.1126\/science.abk0414"},{"key":"2025121400555520000_13.5.e062686.4","unstructured":"World Bank poverty and equity data. Available: http:\/\/povertydata.worldbank.org\/poverty\/country\/KEN [Accessed May 2020]."},{"key":"2025121400555520000_13.5.e062686.5","unstructured":"Government of Kenya . The COVID 19 global pandemic: Impact to the economy and policy options, parliamentary budget office (PBO) special Bulletin No.1\/2020. n.d. Available: http:\/\/parliament.go.ke\/sites\/default\/files\/202004\/Special%20Bulletin%20Covid%2019%202.4.2020%20final.pdf"},{"key":"2025121400555520000_13.5.e062686.6","unstructured":"Government of Kenya . The seventh Presidential address on the Coronavirus pandemic: The 8-point economic stimulus programme. n.d. Available: https:\/\/www.president.go.ke\/2020\/05\/23\/the-seventh-presidential-address-on-the-coronavirus-pandemic-the-8-point-economic-stimulus-programme-saturday-23rd-may-2020\/"},{"key":"2025121400555520000_13.5.e062686.7","unstructured":"World Bank . Socioeconomic impacts of COVID-19 in Kenya on households: Rapid response phone survey, round 1. 2021. Available: https:\/\/openknowledge.worldbank.org\/handle\/10986\/35173 License: CC BY 3.0 IGO"},{"key":"2025121400555520000_13.5.e062686.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-01218-z"},{"key":"2025121400555520000_13.5.e062686.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-020-01779-4","article-title":"The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements","volume":"18","author":"Quaife","year":"2020","journal-title":"BMC Med"},{"key":"2025121400555520000_13.5.e062686.10","doi-asserted-by":"crossref","unstructured":"Ope M , Sonoiya S , Kariuki J , et al . Regional initiatives in support of surveillance in East Africa: The East Africa integrated disease surveillance network (Eaidsnet) experience. Emerg Health Threats J 2013;6. doi:10.3402\/ehtj.v6i0.19948","DOI":"10.3402\/ehtj.v6i0.19948"},{"key":"2025121400555520000_13.5.e062686.11","unstructured":"Okongo O . Malaria pandemic, leading cause of deaths in Busia County. 2017. Available: https:\/\/www.talkafrica.co.ke\/reports-indicate-malaria-cases-cause-deaths-busia-county\/"},{"key":"2025121400555520000_13.5.e062686.12","unstructured":"Nnnennaya A , Hagembe J . Increasing access to Healthcare services for cross-border and mobile communities in East Africa \u2013 global health innovation center. 2019. Available: https:\/\/dukeghic.org\/2019\/07\/19\/increasing-access-to-healthcare-services-for-cross-border-and-mobile-communities-in-east-africa\/"},{"key":"2025121400555520000_13.5.e062686.13","unstructured":"World Health Organisation . Horn of Africa countries in a communique to speed up polio eradication. Regional Office for Africa, 2018. Available: https:\/\/www.afro.who.int\/pt\/node\/10538"},{"key":"2025121400555520000_13.5.e062686.14","unstructured":"East African Community . Mapping of health services along major transport corridors in East Africa; 2015. East African community report"},{"key":"2025121400555520000_13.5.e062686.15","unstructured":"African Union . The COVID-19 pandemic in the IGAD region: Impact on the health and economy Vol 1. Horn economic and social policy Institute (HESPI): Pillar 2 an assessment of the health and economic impact on the Hoa countries. 2020. Available: https:\/\/media.africaportal.org\/documents\/The-COVID-19-Pandemic-in-the-IGAD-region_VOL-I.pdf"},{"key":"2025121400555520000_13.5.e062686.16","unstructured":"Kenya Ministry of Health . COVID-19 outbreak in Kenya; 2022 Jan 19."},{"key":"2025121400555520000_13.5.e062686.17","unstructured":"Kenya Harmonized health facility assessment report (KHFA) 2018\/2019 report;"},{"key":"2025121400555520000_13.5.e062686.18","unstructured":"Creswell JW , Plano Clark VL . Designing and conducting mixed methods research. Thousand Oaks, CA: Sage, 2011."},{"key":"2025121400555520000_13.5.e062686.19","unstructured":"Kenya National Bureau of Statistics . Kenya Population and Housing Census Volume IV: Distribution of Population by Socio-Economic Characteristics 2019, Available: https:\/\/www.knbs.or.ke\/?wpdmpro=2019-kenya-population-and-housing-census-volume-iv-distribution-of-population-by-socio-economic-characteristics"},{"key":"2025121400555520000_13.5.e062686.20","doi-asserted-by":"publisher","DOI":"10.1086\/203642"},{"key":"2025121400555520000_13.5.e062686.21","unstructured":"World Health Organization . Risk communication and community engagement (RCCE) action plan guidance COVID-19 preparedness and response. 2020 Available: https:\/\/www.who.int\/publications\/i\/item\/risk-communication-and-community-engagement-(rcce)-action-plan-guidance"},{"key":"2025121400555520000_13.5.e062686.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025121400555520000_13.5.e062686.23","unstructured":"StataCorp . Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC, 2019."},{"key":"2025121400555520000_13.5.e062686.24","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"2025121400555520000_13.5.e062686.25","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"2025121400555520000_13.5.e062686.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11067-2","article-title":"Knowledge, attitudes, practices, and the effects of COVID-19 among the youth in Kenya","volume":"21","author":"Karijo","year":"2021","journal-title":"BMC Public Health"},{"key":"2025121400555520000_13.5.e062686.27","doi-asserted-by":"crossref","unstructured":"Austrian K , Pinchoff J , Tidwell JB , et al . COVID-19 related knowledge, attitudes, practices and needs of households in informal settlements in Nairobi, Kenya. 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