%0 Journal Article
%T Interventions to maximize facial cleanliness and achieve environmental improvement for trachoma elimination: A review of the grey literature
%A Anthony W. Solomon
%A Hiwote Solomon
%A Maryann G. Delea
%A Matthew C. Freeman
%J -
%D 2018
%R 10.1371/journal.pntd.0006178
%X Background Efforts are underway to scale-up the facial cleanliness and environmental improvement (F&E) components of the World Health Organization¡¯s SAFE strategy for elimination of trachoma as a public health problem. Improving understanding of the F&E intervention landscape could inform advancements prior to scale-up, and lead to more effective and sustained behavior change.   Methods/findings 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&E in the context of trachoma elimination programs. Subsequent to screening, we mapped attributes of F&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&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&E practices. No reviewed documents endorsed inclusion of intervention components related to behavioral maintenance or resilience¨Cfactors critical for sustaining improved behaviors.   Conclusions If left unaddressed, identified gaps in intervention content may continue to challenge uptake and sustainability of improved F&E behaviors. Stakeholders designing and implementing trachoma elimination programs should review their F&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
%K Trachoma
%K Sanitation
%K Behavior
%K Preventive medicine
%K Hygiene
%K Face
%K Global health
%K Health services administration and management
%U https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006178