@article{31078,
  keywords = {Trachoma, SAFE Strategy, Neglected tropical diseases (NTDs), Facial cleanliness, Environmental improvement, Elimination},
  author = {Delea M and Solomon H and Solomon A and Freeman MC},
  title = {Interventions to maximize facial cleanliness and achieve environmental improvement for trachoma elimination: A review of the grey literature.},
  abstract = {<p><strong>BACKGROUND: </strong>Efforts are underway to scale-up the facial cleanliness and environmental improvement (F&amp;E) components of the World Health Organization's SAFE strategy for elimination of trachoma as a public health problem. Improving understanding of the F&amp;E intervention landscape could inform advancements prior to scale-up, and lead to more effective and sustained behavior change.</p>

<p><strong>METHODS/FINDINGS: </strong>We systematically searched for relevant grey literature published from January 1965 through August 2016. Publications were eligible for review if they described interventions addressing F&amp;E in the context of trachoma elimination programs. Subsequent to screening, we mapped attributes of F&amp;E interventions. We then employed three behavior change frameworks to synthesize mapped data and identify potential intervention gaps. We identified 27 documents meeting inclusion criteria. With the exception of some recent programming, F&amp;E interventions have largely focused on intermediate and distal antecedents of behavior change. Evidence from our analyses suggests many interventions are not designed to address documented determinants of improved F&amp;E practices. No reviewed documents endorsed inclusion of intervention components related to behavioral maintenance or resilience-factors critical for sustaining improved behaviors.</p>

<p><strong>CONCLUSIONS: </strong>If left unaddressed, identified gaps in intervention content may continue to challenge uptake and sustainability of improved F&amp;E behaviors. Stakeholders designing and implementing trachoma elimination programs should review their F&amp;E intervention content and delivery approaches with an eye toward improvement, including better alignment with established behavior change theories and empirical evidence. Implementation should move beyond information dissemination, and appropriately employ a variety of behavior change techniques to address more proximal influencers of change.</p>
},
  year = {2018},
  journal = {PLoS neglected tropical diseases},
  volume = {12},
  pages = {e0006178},
  issn = {1935-2735},
  url = {http://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006178&type=printable},
  doi = {10.1371/journal.pntd.0006178},
  language = {eng},
}