Corrigendum: Health-promoting behavior and its determinants towards non-communicable diseases among adult residents of the Gedeo zone, South Ethiopia: the application of the health belief model

Résumé

Non-communicable diseases (NCDs) are medical conditions that cannot be spread from person to person and are one of the major global health challenges [1]. These diseases include cardiovascular disease, cancer, diabetes, respiratory diseases (i.e., asthma and chronic obstructive pulmonary disease), arthritis, chronic kidney diseases, and mental health problems [2,3]. Among the NCDs, cardiovascular diseases, cancers, diabetes, and chronic lung diseases account for 80% of the global disease burden. These four groups of diseases account for 74% of all deaths globally and place increasing demands on health systems. Of all NCD deaths, 77% are in low-and middle-income countries, and these four groups of diseases account for over 80% of all premature NCD deaths [4].According to the World Health Organization's (WHO) projection for 2030, the disability-adjusted life years (DALYs) and deaths attributed to NCDs will be 52 million, which is three times greater than those of communicable diseases, rising from 38 million in 2012. Eighty percent of all deaths and over ninety percent of premature mortality in low-and middle-income countries, like Ethiopia, are attributable to NCDs [3]. The WHO 2018 country profile report states that non-communicable diseases are responsible for roughly 39% of fatalities in Ethiopia [5].The incidence of NCDs is rising quickly, placing a significant burden on society and the health care system in low-income nations [6]. NCDs are very common and expensive, although the majority of them can be avoided in easy and inexpensive ways. One important way to promote health and prevent disease is through health promotion [7]. Health-promoting behaviors are selfinitiated actions that enhance wellness, self-actualization, and fulfillment [8]. Encouraging these behaviors can reduce the risk of chronic diseases, improve well-being, prevent disease, and decrease healthcare costs, leading to improved quality of life, reduced asthma symptoms, and improved cardiovascular outcomes [9,10]. Among the multi-factorial causes of NCDs, behavioral factors like tobacco use, consumption of unhealthy diets, physical inactivity, overdosing on alcohol, and air pollution are identified as major shared risk factors for NCDs [11,12].According to WHO projections, by 2025, there will be 1.27 billion tobacco users worldwide, and over 14% of those over the age of 18 are expected to be obese [13,14]. A nationwide study conducted by the Ethiopian Public Health Institute shows that about 4.2% of participants were current smokers, of which 10% and 13% were second-hand smokers at home and at work, respectively. This study also shows that about 41% of study participants consumed alcohol within the past thirty days [15]. The 2030 United Nations Sustainable Development Goal (SDG) target 3.4 aims to reduce premature mortality from NCDs by one-third [16]. In addition, by 2025 , the Ethiopian government is working to reduce the overall premature mortality from NCDs by one-fourth [6]. To achieve the goals of health promotion, the strategies focus on removing the above-mentioned behavioral risk factors. There is ample evidence that links some lifestyle choices, such as a healthy diet, low tobacco use, limited alcohol consumption, and physical activity, to noncommunicable diseases [11,17]. The World Health Organization (WHO) projects that at least 80% of heart disease, stroke, and type 2 diabetes mellitus can be avoided by removing the key risk factors of non-communicable illnesses [18]. In addition, a recent study on type 2 diabetes mellitus (T2DM) shows a normalization of blood glucose levels in patients without therapeutic intervention through significant lifestyle modification, which is the best indicator of health promotion effectiveness [19].Although adopting lifestyle changes is the ideal strategy for health promotion and preventing noncommunicable diseases, health promotion behavior is not widely studied in Sub-Saharan Africa (i.e., Ethiopia), which faces a double burden of infectious and rapidly rising non-communicable diseases. The health belief model (HBM) is a best-fit framework to explain and interpret healthrelated behaviors. According to the model, individuals' likelihood of taking action is influenced by their perceptions of risk, their perceptions of disease severity, the benefits of interventions and barriers to interventions, cues to action, and their self-efficacy through a reasoning process. Hence, an individual is more likely to take action for healthy behavior in NCDs if he has a high perceived threat (perceived susceptibility ± perceived severity), if his perceived benefits of the intervention outweigh his perceived barriers, if he is capable of adopting the intervention (self-efficacy), and if he has some motivators or reminders to act (cues to action) [20]. Therefore, assuming the fitness of the model to evaluate healthy behavior practices, we used HBM to assess NCD health promotion behaviors and associated factors among adult residents of the Gedeo zone, south Ethiopia.This study was conducted among residents of the Gedeo zone. The Gedeo zone is found in the South Ethiopia region, which is the newly formed 12th regional state in Ethiopia. It extends south as a narrow strip of land along the eastern escarpment of the Ethiopian highlands into the Oromia Region, which borders the Zone on the east, south, and west; the Gedeo Zone shares its northern boundary with the Sidama Region. The total population of the study area is more than 1,226,779.The zone has eight Woreda (Bule, Gedeb, Wonago, Kochire, Dilla Zuriya, Chorso, Reppe, and Yirgachefe) and four administrative towns (Dilla town, Gedeb town, Chelelektu, and Yirgachefe town). Dilla is the zonal town of the Gedeo zone, 359 km from Addis Ababa in the south. In 2014, there were 250,363 households in the zone (source: Gedeo Zone Health Office). The research was carried out from November 01, 2023 to January 01, 2024. A community-based cross-sectional study was conducted to assess health-promoting behavior and its associated factors among adult residents of the Gedeo zone, south Ethiopia.All residents of the Gedeo zone were the source population, whereas the study population consisted of individuals from households in selected kebeles that were available during the data collection period. Members of the household in the chosen kebeles who are ≥ 18 years old and less than 65 and have resided for more than 6 months in the study area were included in the study. However, individuals with severe mental illnesses or those whose speech impediments prevented them from answering the questions were excluded.For estimating a single mean, the sample size was determined using a single population equation( □□ = (□□ □□/2 ) 2 * □□ 2 □□ 2) by considering 97% Confidence Interval (CI) (Zα/2= ± 2.17), a margin of error (d) of 3%, overall mean score of health promotion lifestyle Profile II (HPLP-II) (mean ± standard deviation (σ) (126.67 ± 21.29) was obtained from a previous similar study conducted among rural adults in Myanmar [21], with the consideration of the design effect of three (3) and a 10% nonresponse rate. Finally, the optimum sample size that was used for the current study was 782. A multi-stage sampling technique was employed to choose the study participants. In the first phase, a lottery method (simple random sampling technique) was used to randomly select two Woreda (Wonago and Bule) and one administrative town (Dilla town) out of a total of eight Woreda and four administrative towns, respectively. Nine kebeles (three from each Woreda and three from the administrative town) were chosen at random in the second phase. In the third phase, the number of households in each of the chosen kebeles was documented, and the total sample size (782) was proportionally allocated to each kebele. Then, using a systematic sampling technique (every N/n), the households in each kebele were included in the study. Finally, for households with more than one eligible participant, the interview was done by selecting a single participant using the lottery method, although in the event of a household with no eligible participants, the immediate next household was used. At least two visits were made in cases where eligible respondents were not available at the time of data collection.Dependent variable: Health-promoting behavior.Independent variables: Demographic and socioeconomic factors (age (in years), gender, occup ation, status of marriage, family size, level of education, and household wealth index). 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