03056nas a2200265   4500000000100000008004100001653001900042653003900061653004400100653003400144653003000178100002000208700001300228700001500241700001400256700001200270700002300282700001600305245012200321856007900443300001300522490000700535520223400542022001402776       2019                            d10aChagas disease10aNeglected tropical diseases (NDTs)10aHealthy Homes for Healthy Living (HHHL)10asystem-based health promotion10aHealth promotion strategy1 aNieto-Sanchez C1 aBates BR1 aGuerrero D1 aJimenez S1 aBaus EG1 aPeeters Grietens K1 aGrijalva MJ00aHome improvement and system-based health promotion for sustainable prevention of Chagas disease: A qualitative study.  uhttps://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007472  ae00074720 v133 a<p><strong>BACKGROUND: </strong>Human transmission of Chagas disease (CD) most commonly occurs in domiciliary spaces where triatomines remain hidden to feed on blood sources during inhabitants' sleep. Similar to other neglected tropical diseases (NTDs), sustainable control of CD requires attention to the structural conditions of life of populations at risk, in this case, the conditions of their living environments. Considering socio-cultural and political dynamics involved in dwellings' construction, this study aimed to explore social factors that contribute or limit sustainability of CD's prevention models focused on home improvement.</p>

<p><strong>METHODS AND MAIN FINDINGS: </strong>Using Healthy Homes for Healthy Living (HHHL)-a health promotion strategy focused on improvement of living environments and system-based health promotion-as a reference, a qualitative study was conducted. Research participants were selected from three rural communities of a CD endemic region in southern Ecuador involved in HHHL's refurbishment and reconstruction interventions between 2013 and 2016. Folowing an ethnographic approach, data were collected through interviews, participant observation, informal conversations and document analysis. Our results indicate that the HHHL model addressed risk factors for CD at the household level, while simultaneously promoting wellbeing at emotional, economic and social levels in local communities. We argue that sustainability of the CD prevention model proposed by HHHL is enhanced by the confluence of three factors: systemic improvement of families' quality of life, perceived usefulness of control measures, and flexibility to adapt to emerging dynamics of the context.</p>

<p><strong>CONCLUSION: </strong>HHHL's proposed home improvement, facilitated through system-based rather than disease specific health promotion processes, enhances agency in populations at risk and facilitates community partnerships forged around CD prevention. Although an independent analysis of cost-effectiveness is recommended, structural poverty experienced by local families is still the most important factor to consider when evaluating the sustainability and scalability of this model.</p>
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