{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T18:36:16Z","timestamp":1776796576629,"version":"3.51.2"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background\/Objectives<\/jats:title>\n Zimbabwe faces a protracted cholera crisis exacerbated by El Ni\u00f1o-induced droughts, transitioning from episodic outbreaks to an endemic public health emergency. While recurrent outbreaks are often attributed to poor community awareness, this study moves beyond the conventional Knowledge, Attitudes, and Practices (KAP) paradigm. Grounded in the Integrated Behavioral Model for WASH and the theory of structural violence, we investigate the structural determinants of the knowledge-practice gap to understand how infrastructural disparities constrain cholera prevention.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A quantitative cross-sectional study was conducted among 307 adult residents in rural and urban Zimbabwe using a structured online survey. To address the multidimensional nature of WASH behaviors, Exploratory Factor Analysis was performed to decompose the practice scale into two distinct dimensions: Individual Agency and Structural Access. Multiple linear regression analyses were applied to identify predictors for each dimension independently.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants demonstrated high overall knowledge of cholera prevention. However, regression analysis revealed a striking divergence: while knowledge significantly predicted individual agency behaviors, it had no statistically significant effect on structural access practices. Residence and socio-economic factors heavily dictated structural access. Additionally, women exhibited higher practice scores, reflecting the disproportionate burden of sanitation insecurity rather than mere adherence to domestic gender roles.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The persistent knowledge-practice gap in Zimbabwe\u2019s cholera endemic is not a behavioral failure but a manifestation of structural violence. Health education campaigns have reached saturation; individuals know how to protect themselves but are structurally paralyzed by decaying municipal services. Sustainable elimination requires shifting policy to climate-resilient WASH infrastructure.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0347844","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:36:21Z","timestamp":1776792981000},"page":"e0347844","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The gap between knowledge and action in Zimbabwe: The limits of individual awareness in the face of structural violence in cholera endemicity"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4193-5040","authenticated-orcid":true,"given":"Saime","family":"Ulucayli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afet","family":"Arkut","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anele","family":"Lunga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"1","key":"pone.0347844.ref001","doi-asserted-by":"crossref","first-page":"195","DOI":"10.4269\/ajtmh.22-0396","article-title":"Knowledge, Attitudes and Practices on Cholera and Water, Sanitation, and Hygiene among Internally Displaced Persons in Cabo Delgado Province, Mozambique","volume":"108","author":"F Di Gennaro","year":"2022","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pone.0347844.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e18278","article-title":"Cholera in Syria, a crisis following crises: Assessment of knowledge, attitude, and practice in a cohort of syrian population","volume":"9","author":"L Albitar","year":"2023","journal-title":"Heliyon"},{"issue":"23","key":"pone.0347844.ref003","doi-asserted-by":"crossref","first-page":"16243","DOI":"10.3390\/ijerph192316243","article-title":"Knowledge, attitude, and practice in a sample of the Lebanese population regarding cholera","volume":"19","author":"D Malaeb","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pone.0347844.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-091360","article-title":"Assessment of knowledge, attitudes and practices regarding cholera among people living in a cholera-endemic health zone in the Democratic Republic of the Congo","volume":"15","author":"HC Kayembe Ntumba","year":"2025","journal-title":"BMJ Open"},{"key":"pone.0347844.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/9781108773928.002","article-title":"Introduction: Stories and Politics of Cholera","volume-title":"The Political Life of an Epidemic: Cholera, Crisis and Citizenship in Zimbabwe","author":"S Chigudu","year":"2020"},{"issue":"10","key":"pone.0347844.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0030449","article-title":"Structural Violence and Clinical Medicine","volume":"3","author":"PE Farmer","year":"2006","journal-title":"PLoS Medicine"},{"issue":"8","key":"pone.0347844.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271726","article-title":"Barriers and facilitators to Water, Sanitation and Hygiene (WaSH) practices in Southern Africa: A scoping review","volume":"17","author":"NP Tseole","year":"2022","journal-title":"PLoS One"},{"key":"pone.0347844.ref008","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1186\/1471-2458-13-1015","article-title":"The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings","volume":"13","author":"R Dreibelbis","year":"2013","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0347844.ref009","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/1468-2427.12744","article-title":"Problematizing Urban Shit(ting): Representing Human Waste as a Problem","volume":"43","author":"A Oberg","year":"2019","journal-title":"Int J Urban Regional Res"},{"issue":"1","key":"pone.0347844.ref010","doi-asserted-by":"crossref","DOI":"10.1080\/27707571.2024.2322826","article-title":"Behavioural determinants of handwashing at critical times among mothers and care givers in Zimbabwe: implications for behaviour change interventions","volume":"11","author":"C Murendo","year":"2024","journal-title":"Cogent Public Health"},{"issue":"3","key":"pone.0347844.ref011","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.jiph.2023.12.025","article-title":"A retrospective study on cholera understanding and WASH (water, sanitation, and hygiene) behavior among adolescents in three regions of La Gon\u00e2ve, Haiti","volume":"17","author":"Y Kim","year":"2024","journal-title":"J Infect Public Health"},{"key":"pone.0347844.ref012","doi-asserted-by":"crossref","first-page":"359","DOI":"10.51584\/IJRIAS.2025.10020031","article-title":"Gendered Climate Change-Induced Domestic Water Challenges: Exploring the Plight of Women and Girls Linked to Water Challenges in Ward 32 of Buhera District, Zimbabwe","author":"MT Gomo","year":"2025","journal-title":"IJRIAS"},{"issue":"4","key":"pone.0347844.ref013","first-page":"236","article-title":"Knowledge, Attitude, and Practices of the General Population toward the Old-New Outbreak of Cholera in a Developing Country","volume":"8","author":"M Akel","year":"2023","journal-title":"Trop Med Infect Dis"},{"issue":"1","key":"pone.0347844.ref014","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s44197-025-00386-x","article-title":"Cholera in Africa: A Climate Change Crisis","volume":"15","author":"BK Bekele","year":"2025","journal-title":"J Epidemiol Glob Health"},{"key":"pone.0347844.ref015","volume-title":"Zimbabwe Humanitarian Situation Report No. 9 (End of Year)","author":"UNICEF","year":"2024"},{"key":"pone.0347844.ref016","volume-title":"Zimbabwe Humanitarian Situation Report No. 2 (March - April 2025)","author":"UNICEF","year":"2025"},{"key":"pone.0347844.ref017","article-title":"Cholera is spreading fast, yet it can be stopped. Why haven\u2019t we consigned it to history?","author":"H Hichilema","year":"2025","journal-title":"The Guardian"},{"key":"pone.0347844.ref018","article-title":"Cholera Outbreaks in Zimbabwe: An In-Depth Analysis of Drivers, Constraints and Reimagining the Use of Medicinal Plants","author":"SO Mintah","year":"2024","journal-title":"Preprints"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:36:25Z","timestamp":1776792985000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347844"}},"subtitle":[],"editor":[{"given":"Alison","family":"Parker","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347844","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}