Knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade, and wildlife consumption in Latin America: A One Health mixed-method study protocol

Knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade, and wildlife consumption in Latin America: A One Health mixed-method study protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade, and wildlife consumption in Latin America: A One Health mixed-method study protocol Caroline Kuhn, Luciana Salini Abrahão Pires, María Soledad Burrone, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5504949/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The emergence and transmission of zoonotic diseases is a critical global challenge. Deforestation, land use changes, and urbanization have led to increased human-wildlife interactions, raising the likelihood of pathogen spillover. Wildlife trade, including handling and consumption, contributes significantly to this risk. This study aims to identify knowledge, attitudes, and practices (KAP) towards zoonotic disease risks, wildlife trade, and consumption among rural and urban populations in Bolivia, Chile, Guatemala and Brazil, including indigenous communities. Using a mixed-methods approach, the study included a quantitative KAP survey with 3600 interviewees, qualitative in-depth interviews with 15 key actors and 6 focus group discussions to develop targeted educational interventions within the communities. This study's mixed-methods design provides quantitative baseline information, as well as qualitative context and depth, allowing for comprehensive insights into KAP in the communities in Latin America. To address the complex interplay of human, animal, and environmental factors, the One Health approach is applied with a focus on international and interdisciplinary collaboration. The participatory approach promotes mutual ownership and sustainability of public health interventions. Zoonoses Epidemiology One Health Zoonoses Wild Animals Interdisciplinary Research Figures Figure 1 Introduction The emergence and transmission of zoonotic diseases pose a critical global challenge. Around 60% of all emerging human infectious diseases are assigned to zoonotic origins, the majority of these has its origin in wildlife 1 . Deforestation, land use changes and growing urbanization are causes of an increasing reduction of wildlife habitats. They lead to a closer contact between humans and animals and therefore a higher probability of pathogens crossing the species boundary. One of the major threats to wildlife health and zoonotic diseases is wildlife trade 2 . On trade routes and markets, live and dead wild animals are in a closer contact than they would be in their natural habitats, which opens new pathways of pathogen exchange. Wildlife handling and the consumption of wild animals also represent possible ways of pathogen transfer 3 . Its likelihood depends on food hygiene practices and knowledge of wildlife handling which might differ considerably across local contexts. Besides, the nutritional source of wild meat 4 and the crucial role of indigenous food systems and knowledge 5 needs to be taken into account. Previous efforts to control wildlife trade practices focused primarily on conservation and have overlooked the health component when developing behavioral change programs. Likewise, some initiatives did not consider local communities' needs or characteristics 6 . Human-induced environmental changes are identified as the most critical factor contributing to zoonotic emerging infectious diseases 7 . Areas with higher biodiversity, particularly those undergoing land use changes, pose a heightened risk of pathogenic spillover 8 . Conversely, protecting biodiversity offers a high potential of zoonotic risk mitigation. In this context, Latin America, renowned for its rich biodiversity, faces significant challenges in conservation and wildlife trade. For example, the Brazilian Atlantic Forest is reduced to 7% of its original size in the 16th century. Its importance for human life is fundamental as half of the Brazilian population resides in areas influenced by the forests biome 9 . Recently, the One Health High-Level Expert Panel (OHHLEP) has highlighted the urgent need for action and prevention strategies, emphasizing the need for a holistic and interdisciplinary framework 10 , and recommendations for zoonotic disease prevention measures draw attention to the One Health approach 11 . One Health is such a holistic approach that addresses the interrelationships between human, animal, and environmental health and promotes interdisciplinary collaboration 12 . However, despite its comprehensive nature, mixed-methods research remains underrepresented in One Health studies focusing on zoonotic diseases and wildlife. A recent systematic literature review revealed that qualitative insights are often neglected, limiting the depth of understanding in these complex interaction 13 . This study aims to identify knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade and consumption in different populations living in urban and rural areas, including indigenous communities of Latin America. By identifying the main drivers of practices in different communities across Latin America, we develop tailor-made educational intervention strategies. Results of the project will provide input for the local development and implementation of policies for the regulation of wildlife trade and consumption in Latin America. The experiences and results of this project might also serve countries outside Latin America as a basis for future projects and activities. Methods Study design Multi-centered and mixed methods were applied along five work packages (WP): WP1 - Quantitative baseline assessment: KAP survey WP2 - Qualitative component: Interviews with key actors and focus groups discussions WP3 - Participatory community-based action: Joint identification of concrete actions WP4 - Pilot intervention: Development and pilot testing of training material WP5 - Dissemination: Information about and exchange on project methods and results The quantitative KAP survey (WP1) ensured the representativeness and validity of knowledge, attitudes and practices. The qualitative part of the study (WP2-3) allowed for the enrichment of background knowledge and the interaction with and participation of stakeholders and representatives. The study was designed as an international, interdisciplinary and intersectoral project. The staff was located in Bolivia, Chile, Guatemala, Brazil and Germany and is experienced in international and multilingual collaboration. The team included physicians, epidemiologists, veterinarians, environmental scientists, such as biologists and zoologists, and social scientists with experience of community-based work. The study thrives on the participation of its subjects, so the aim was to enable cross-sectoral exchange by involving the general population. Setting of the study The study was conducted in Bolivia, Brazil, Chile and Guatemala between September, 15 2022 and September 30, 2024. In each country, a geographical area was selected in order to cover a wide range of Latin American climate, biodiversity, wildlife and culture, considering rural and urban areas. In Bolivia , the project was carried out in the Department of Chuquisaca, Province of Jaime Zudañez, Municipality of Presto, which has an area of 1,444 km² and a population of 12,385 inhabitants. The municipality groups 33 communities, two neighborhood councils, and a predominantly Quechua-speaking population, and is located in the El Palmar Integrated Management Natural Area , a protected area of 595 km², characterized by its integrative approach to conservation and protection. It was established with the aim of protecting flora and fauna and preserving the inter-Andean mesothermal semi-arid valleys. At the same time, the area emphasizes the protection of its rich cultural and archaeological heritage 14 . In Brazil , the project was developed in the state of Paraná, which is situated in the Atlantic Forest. This biome plays a key role as a corridor for species migration between humid and semi-deciduous forests, as well as between Atlantic Forest and Cerrado habitats 15 . Three distinct areas inhabited by traditional community groups were considered for the study: The municipality of Paranaguá is located in the coastal region of the state of Paraná in southeastern Brazil. The city has several rural villages inhabited by Caiçaras communities, composed of a mixture of indigenous, Portuguese and black people 16 . Its agricultural, fishing and food preparation activities have a strong indigenous influence. The project was carried out in the village of Maria Luiza, one of the Caiçara settlements farthest from the sea and located in a densely forested area. The differentiated mesoregion of Vale do Ribeira/Guaraqueçaba includes 16 municipalities in the State of Paraná. This region is characterized by its quilombo lands and conservation units. The quilombolas, descendants and remnants of communities formed by escaped slaves, are mainly engaged in agriculture, extractive industries, fishing and cattle raising 17 . There are 7,113 quilombola inhabitants in Paraná. The project was carried out in Adrianópolis, the municipality with the largest number of quilombola communities in the state 18 . Colônia Castelhanos is a peri-urban community located in the Serra do Mar, belonging to the municipality of São José dos Pinhais, in the state of Paraná. The area is completely embedded in the Atlantic Forest biome, about 70 km from the central area of the municipality and 80 km from the capital of Paraná. The population is composed of mixed descendants of indigenous, Ukrainian and Polish immigrants, organized in cooperatives and living mainly from the cultivation of bananas and other fruits of the region 19 . In Chile , the project was carried out in the O'Higgins region, located in the central part of the country, with a population of 914,555 inhabitants, near the Paredones river basin. The region, wich includes the municipalities of Navidad, Doñihue (Lo Miranda), and Machalí (Coya), is characterized by a Mediterranean climate with significant topographic variations. The climate in the coastal areas is humid and mild, while in the mountainous areas temperatures fall below 0°C during the winter months. In this region, conflicts between livestock farming and wildlife, as well as drought-related environmental problems, pose a threat to wildlife health. The area selected for the project encompasses a diversity of climates, biodiversity, wildlife, and culture, including both rural and urban areas. In Guatemala , the project was carried out in the Lachua Ecoregion, a vast tropical wetland with a population of around 12,500 inhabitants. It is one of the most biodiverse regions in Guatemala and is home to many endangered species. 49 indigenous communities are located in the area, belonging to the Maya-Q´eqchi´. Traditionally self-sufficient, the Maya-Q´eqchi´ have an economy based primarily on agriculture and the use of wildlife and other forest products 20 . Methodology of the work packages Work package 1: KAP survey A cross-sectional study was carried out using standardized questionnaires. KAP surveys are widely used in public health to collect information on the public’s understanding of a phenomenon (knowledge), evaluative responses to a situation (attitudes), and observed actions or behaviors (practices) among a target population. KAP research is often used to assess the development, implementation, and evaluation of public health interventions, given the linear relationship between knowledge, attitude, and behavior change 21 – 23 . It also allows for the exploration of potential barriers to health behavior change. The questionnaire (Supplementary file 1) is based on two previous questionnaires 24 , 25 and includes open and closed questions on demographic information, education, occupation, medical history, knowledge, attitudes, and practices related to the risk of zoonotic diseases, wildlife trade, and wildlife consumption. The language of the questionnaire is English with translations into Spanish, Portuguese, Quechua and Q’Eqchi. The validity of the translations was checked by bilingual experts. It was also ensured that the interviewers spoke the language of the respondents. Prior to implementation, the questionnaire was piloted with a minimum of 30 people, evaluating whether the questions are clear and understandable. The questionnaire was then adapted taking into account all suggestions and observations. Each interview took approximately 30 minutes. All interviewers were trained prior to conducting the interviews to minimize bias between the different locations and to coordinate feasibility. The questionnaire was standardized and coded to allow data entry into the Epi Info™ form or Open Data Kit (ODK). Quantitative data analysis will be performed using SPSS and R. Work package 2: key actor interviews and focus group discussions In this work package, face-to-face interviews with key actors and focus group discussions were conducted. In the interviews, the respondents were considered as experts in their field, providing new information, explaining and classifying previously developed content. Most of the questions were open-ended and based on a literature review on zoonotic diseases and wildlife trade. Supplementary file 2 presents a priori dimensions, categories and examples of questions, adapted from previous studies 24 , 25 . WP2 also included focus groups to complement the information from the key actors and adopt a multi-stakeholder approach. Focus group discussions are a common method in conservation biology and social sciences. In contrast to interviews, they allow not only for knowledge gathering, but also for the exchange of perspectives and arguments between participants 26 . One or more trained facilitators, fluent in the participants' language, moderated the discussions. To prevent major disputes and foster mutual understanding, they received comprehensive training beforehand. We employed a purposive sampling approach to identify and invite key informants who represent each group of participants. Rather than conducting a formal power calculation, we used non-probability purposive sampling to achieve data saturation, a critical factor in ensuring sample size adequacy 27 . Work package 3: roundtable discussions Based on the initial results of the previous work packages, roundtables were convened to jointly analyze the current situation of wildlife trade and consumption and to propose strategies promoting the human-coexistence, while considering the local context. These discussions ensured equal participation in developing solutions, with facilitators responsible for coordinating, moderating and managing polarized debates. All key actor interviews, focus group discussions and roundtable discussion were audio recorded and transcribed with participant’s informed consent. Constant Comparative Analysis 28 will be developed for data analysis. First, the units of meaning (words, sentences and paragraphs) will be encoded, secondly, the codes will be integrated into categories based on their common properties. Furthermore, overlapping categories will be integrated (sub-categories are generated), establishing for categorization, generating theoretical concepts from the data, using the Atlas.ti software. Work package 4: pilot intervention The supposed training materials includes e-learning materials, educational short videos, flyers and community radio segments, and may be extended according to the participants’ suggestions. The study team is experienced in designing educational material, such as Massive Open Online Courses (MOOC), virtual patient e-learning (CASUS), podcasts, and regular webinars 29 . The design of these programs will seek to encourage the active participation of the participants. For this purpose, the competency-based approach, active learning model ARIPE (adjust, reactivate, inform, process, evaluate) 30 will be applied. The Kirkpatrik evaluation model 31 will be used to evaluate these interventions. A pre- and post-intervention questionnaire will be conducted to measure whether the participants experience positive changes, considering content, instructional design, technical design, and social dimensions. Work package 5: dissemination The project results will be shared with the scientific community through various channels, such as webinars and peer-reviewed publications. Additionally, the evaluated and reviewed materials will be provided to the participating communities. Dissemination efforts will also target the general public, organizations, activists, policymakers, and other relevant stakeholders. This comprehensive strategy aims to highlight the importance of the subject matter and demonstrate the value of this research and ints interventions at both local and global scales. To further enhance impact, forums for exchange and dialogue with policymakers will be promoted, ensuring that the project's findings inform the development and implementation of strategies to regulate wildlife trade and consumption in Latin America. Study participants and sampling methods For the quantitative KAP survey (WP1), the sampling frame was derived from the National Population and Housing Census (PHC), available from the National Statistical Institute of each country. It contained a list of all enumeration areas (EA), which are geographical areas covering a group of households. It included information on the location of the EA, the type of residence (urban or rural), and the estimated number of resident households. All residents of the selected households who were 10 years of age or older were eligible to be interviewed. To achieve age representation, three age groups were considered: adolescents (10–17 years), adults (18–60 years), and elderly (61 + years). These age groups, of 100 persons each, form the subpopulations of three different household locations (rural, urban, indigenous). In this way, we aimed for 900 people in each country, and for a total of 3600 people in the four countries. Figure 1 illustrates the organization of the sampling design. In each household, trained interviewers conducted face-to-face interviews with each household member aged 10 years or older. Prior to the fieldwork, the study was socialized with local authorities and local media (e.g. community radio stations) to inform people about the study and encourage participation. Community representatives helped facilitate access to the target population. Figure 1 Sample design organization of the KAP-Survey, exemplary for Bolivia. For the qualitative part , 15 key actor interviews were conducted in each country with the following stakeholders: local authorities and community representatives; health personnel (doctors, nurses or auxiliaries) from primary health care centers and representatives of the zoonosis program in the area; traditional healers; academic staff from universities or public institutions in the fields related to human and veterinary medicine, public health, wildlife, biodiversity and social/cultural studies; representatives of non-governmental organizations. Six focus group discussions were held in each country with users of forest services (hunting, rangers), representatives of Indigenous communities, residents of the communities, vendors or artisans. To ensure representativeness, the events were distributed by age (< 30 years; ≥30 years) and area (urban, rural and indigenous). Each focus group consisted of 6 to 10 people, with equal representation of women and men. Time and travel expenses were reimbursed, and participation was voluntary. Open invitations were sent out to the communities for the roundtable discussion . Interested participants from previous work packages, were reinvited, ensuring representation of area (urban, rural, indigenous), age and gender. Additionally, individuals from other sectors such as education, environmental institutions and academics, and local authorities, were included, resulting in interdisciplinary and intersectoral roundtables. To encourage active participation, each roundtable was limited to a maximum of 20 participants. Data management Data were stored at each local university. The original paper questionnaires were kept in locked boxes and will be deleted ten years after the end of the project. Digital data were pseudonymized by using a unique participant ID and stored on a privacy-compliant storage- and collaboration platform. A data management plan for the handling of research data is available in Supplementary file 3. Data confidentiality requirements of each country and state were respected. Ethics approval and consent to participate Ethical approval was obtained from the Ethics Committees at the Ludwigs-Maximilians-University in Munich, Germany; the Universidad Mayor de Simon in Cochabamba, Bolivia; the Universidad O’Higgins, Rancagua, Chile; the Universidade Federal do Paraná, Curitiba, Brazil; and the Comite Independiente de Etica K’awil, Guatemala. Written informed consent was obtained from all participants. For minors between the ages of 10 and 17, both the participant and their legal guardian(s) were asked to provide written informed consent. Discussion This study aims to identify knowledge, attitudes, and practices regarding the risk of zoonotic diseases, wildlife trade and consumption among different populations living in urban and rural areas, including indigenous communities in Latin America. By understanding the main drivers of behavior in local communities, the study will develop tailored educational intervention strategies through a participatory approach. To our knowledge this is a unique study protocol in the field of zoonotic diseases and wildlife, that combines the One Health approach, international and interdisciplinary collaboration, mixed-methods data collection, and intervention strategies. The One Health approach is particularly relevant because the determinants of infectious diseases originate in all One Health domains - human, animal and environmental 32 ; recently, the OHHLEP has underscored the importance of adopting a holistic and interdisciplinary approach to effectively address these complex interrelationships 10 . In this study, international and interdisciplinary collaboration, represented by the composition of the study team from diverse countries and disciplines, as well as the choice of mixed-methodology, facilitates a comprehensive examination of the zoonotic disease risks by considering various perspectives and fields of knowledge. The integration of quantitative and qualitative methods is still underrepresented in One Health research designs, and although challenging to implement, it broadens perspectives within the field of study 33-35 . Thus, the quantitative KAP survey provides baseline information and patterns of knowledge, attitudes, and practices, that are essential for developing targeted public health interventions and policies. The qualitative data, then enriches the quantitative part by providing context and depth. For example, if the KAP survey identifies high rates of wildlife consumption in a particular region, qualitative interviews can reveal the underlying reasons, such as economic dependence or cultural practices, and thus inform more nuanced and effective public health strategies. In addition, a participatory approach is essential to ensure that the diverse perspectives of different stakeholders, including local communities, are taken into account 36 . This is particularly important in regions with high biodiversity and significant human-wildlife interactions, such as Latin America. Engaging community members through interviews, focus groups, and roundtable discussions ensures that the interventions and recommendations developed are culturally sensitive, contextually relevant, and more likely to be maintained by the communities. Here, the coordination of these events by local experts with long experience of working with the communities at all sites is essential. This participatory element is consistent with the principles of transdisciplinarity, where knowledge generation is a collaborative process involving academic and non-academic stakeholders, thus promoting mutual ownership and sustainability of health interventions 37 . In conclusion, the holistic study design is critical to understanding and mitigating the complex and interrelated risks of zoonotic diseases associated with wildlife trade and consumption in Latin America. The findings of this study may not only inform local policies and interventions but also contribute to the global understanding of zoonotic disease dynamics and prevention. The approaches and methods introduced in this study protocol aim to provide a more comprehensive understanding of complex health issues, and to promote robust and effective solutions. Declarations Acknowledgements We would like to acknowledge and thank all members of the KAP wildlife study group: Adler, Marcia; da Costa-Ribeiro, Magda Clara Vieira; de Almeida, Gustavo Araújo; de Carvalho, Denise Siqueira; de Tarso Pires, Paulo; Encina Zamorra, Veronica; Garrido, Marie Astrid; Guzmán-Quilo, Maria Carolina; Magalhães Buffon, Marilene da Cruz; Mansilla Vivar, Pilar Macarena; Mendez Heredia, Dennis Martin; Perez Morales, Fabiana Marcela; Pinto Navia, Carlos Fernando; Ribeiro de Almeida, Tatjana Queiroz References Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL et al (2008) Global trends in emerging infectious diseases. Nature 451(7181):990–993 Smith KF, Behrens M, Schloegel LM, Marano N, Burgiel S, Daszak P (2009) Ecology. Reducing the risks of the wildlife trade. Science 324(5927):594–595 Milbank C, Vira B (2022) Wildmeat consumption and zoonotic spillover: contextualising disease emergence and policy responses. 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One Health 3:44–50 Kuhn C, Hayibor KM, Acheampong AT, Abrahão Pires LS, Vieira Costa-Ribeiro MC, Burrone MS et al (eds) (2024) How studies on zoonotic risks in wildlife implement the One Health approach – A Systematic Review. International One Health Symposium; ; Berlin. One Health Platform Kelly TR, Karesh WB, Johnson CK, Gilardi KV, Anthony SJ, Goldstein T et al (2017) One Health proof of concept: Bringing a transdisciplinary approach to surveillance for zoonotic viruses at the human-wild animal interface. Prev Vet Med 137(Pt B):112–118 Wright MT, Roche B, Von Unger H, Block M, Gardner B (2010) A call for an International Collaboration on Participatory Research for Health. Health Promot Int 25(1):115–122 Additional Declarations The authors declare no competing interests. Supplementary Files S1Text.QuestionnaireKAPSurvey.pdf S2Text.InterviewGuide.pdf S3Text.DataManagementPlan.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5504949","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":381431771,"identity":"b28515c1-6ab8-46f3-9104-2e18f9b0e11c","order_by":0,"name":"Caroline Kuhn","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-6381-2055","institution":"Center for International Health, Ludwig-Maximilian-University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Caroline","middleName":"","lastName":"Kuhn","suffix":""},{"id":381431772,"identity":"e62e2268-150c-4bd6-b360-1e6b923eefe9","order_by":1,"name":"Luciana Salini Abrahão Pires","email":"","orcid":"https://orcid.org/0000-0002-6963-4875","institution":"Federal University of Paraná","correspondingAuthor":false,"prefix":"","firstName":"Luciana","middleName":"Salini Abrahão","lastName":"Pires","suffix":""},{"id":381431773,"identity":"c26ddc38-74b4-41c5-810a-f5075f8411ee","order_by":2,"name":"María Soledad Burrone","email":"","orcid":"https://orcid.org/0000-0002-9641-8350","institution":"Institute of Health Sciences, Universidad de O'Higgins","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Soledad","lastName":"Burrone","suffix":""},{"id":381431774,"identity":"5a17023d-0140-4c1b-a178-00e847f10d24","order_by":3,"name":"Carlos Roberto Vásquez-Almazán","email":"","orcid":"https://orcid.org/0000-0002-9574-5536","institution":"Museo de Historia Natural - Escuela de Biología, Universidad San Carlos de Guatemala","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Roberto","lastName":"Vásquez-Almazán","suffix":""},{"id":381431775,"identity":"d58a52b6-b8bb-4a91-984c-3b1a8fc8a763","order_by":4,"name":"Katja Radon","email":"","orcid":"https://orcid.org/0000-0002-5271-3972","institution":"Center for International Health, Ludwig-Maximilian-University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Katja","middleName":"","lastName":"Radon","suffix":""},{"id":381431776,"identity":"1bef19c7-5ee8-49d3-85a2-03a28e38d131","order_by":5,"name":"María Teresa Solis Soto","email":"","orcid":"https://orcid.org/0000-0003-4787-3688","institution":"CIH-LMU OH TARGET Competence Center, Universidad San Francisco Xavier de Chuquisaca","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Teresa Solis","lastName":"Soto","suffix":""}],"badges":[],"createdAt":"2024-11-22 13:37:32","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5504949/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5504949/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69809753,"identity":"e2b77b6e-a977-4712-aead-15d3b7b46c79","added_by":"auto","created_at":"2024-11-25 12:34:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28882,"visible":true,"origin":"","legend":"\u003cp\u003eSample design organization of the KAP-Survey, exemplary for Bolivia.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5504949/v1/982b1e6a8f1e3a759e40d032.png"},{"id":69811340,"identity":"7d0261cc-65e7-47bc-aefa-e3bc3ce4b0bf","added_by":"auto","created_at":"2024-11-25 12:42:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":408831,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5504949/v1/178a8c21-ebe5-432d-bb5e-02ea998313ff.pdf"},{"id":69809755,"identity":"549f199d-3664-4cbc-bc29-35682a28a29c","added_by":"auto","created_at":"2024-11-25 12:34:32","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":472783,"visible":true,"origin":"","legend":"","description":"","filename":"S1Text.QuestionnaireKAPSurvey.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5504949/v1/7093f56f214d78f6eefa0d91.pdf"},{"id":69809757,"identity":"9bbae87c-e1f6-4ae9-81dc-fa6a8f0241aa","added_by":"auto","created_at":"2024-11-25 12:34:32","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":222952,"visible":true,"origin":"","legend":"","description":"","filename":"S2Text.InterviewGuide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5504949/v1/71b46392d3309f97c91cac38.pdf"},{"id":69811338,"identity":"06d943c8-cf74-46e9-b7de-0ffb1a7f9214","added_by":"auto","created_at":"2024-11-25 12:42:32","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":52760,"visible":true,"origin":"","legend":"","description":"","filename":"S3Text.DataManagementPlan.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5504949/v1/9abebc966adb89c61cd4f7eb.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eKnowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade, and wildlife consumption in Latin America: A One Health mixed-method study protocol\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe emergence and transmission of zoonotic diseases pose a critical global challenge. Around 60% of all emerging human infectious diseases are assigned to zoonotic origins, the majority of these has its origin in wildlife\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Deforestation, land use changes and growing urbanization are causes of an increasing reduction of wildlife habitats. They lead to a closer contact between humans and animals and therefore a higher probability of pathogens crossing the species boundary. One of the major threats to wildlife health and zoonotic diseases is wildlife trade\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. On trade routes and markets, live and dead wild animals are in a closer contact than they would be in their natural habitats, which opens new pathways of pathogen exchange. Wildlife handling and the consumption of wild animals also represent possible ways of pathogen transfer\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Its likelihood depends on food hygiene practices and knowledge of wildlife handling which might differ considerably across local contexts. Besides, the nutritional source of wild meat \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e and the crucial role of indigenous food systems and knowledge \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e needs to be taken into account. Previous efforts to control wildlife trade practices focused primarily on conservation and have overlooked the health component when developing behavioral change programs. Likewise, some initiatives did not consider local communities' needs or characteristics\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHuman-induced environmental changes are identified as the most critical factor contributing to zoonotic emerging infectious diseases\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Areas with higher biodiversity, particularly those undergoing land use changes, pose a heightened risk of pathogenic spillover\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Conversely, protecting biodiversity offers a high potential of zoonotic risk mitigation. In this context, Latin America, renowned for its rich biodiversity, faces significant challenges in conservation and wildlife trade. For example, the Brazilian Atlantic Forest is reduced to 7% of its original size in the 16th century. Its importance for human life is fundamental as half of the Brazilian population resides in areas influenced by the forests biome\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecently, the One Health High-Level Expert Panel (OHHLEP) has highlighted the urgent need for action and prevention strategies, emphasizing the need for a holistic and interdisciplinary framework\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, and recommendations for zoonotic disease prevention measures draw attention to the One Health approach\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. One Health is such a holistic approach that addresses the interrelationships between human, animal, and environmental health and promotes interdisciplinary collaboration\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, despite its comprehensive nature, mixed-methods research remains underrepresented in One Health studies focusing on zoonotic diseases and wildlife. A recent systematic literature review revealed that qualitative insights are often neglected, limiting the depth of understanding in these complex interaction\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study aims to identify knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade and consumption in different populations living in urban and rural areas, including indigenous communities of Latin America. By identifying the main drivers of practices in different communities across Latin America, we develop tailor-made educational intervention strategies. Results of the project will provide input for the local development and implementation of policies for the regulation of wildlife trade and consumption in Latin America. The experiences and results of this project might also serve countries outside Latin America as a basis for future projects and activities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eMulti-centered and mixed methods were applied along five work packages (WP):\u003c/p\u003e \u003cp\u003e \u003cb\u003eWP1\u003c/b\u003e - Quantitative baseline assessment: KAP survey\u003c/p\u003e \u003cp\u003e \u003cb\u003eWP2\u003c/b\u003e - Qualitative component: Interviews with key actors and focus groups discussions\u003c/p\u003e \u003cp\u003e \u003cb\u003eWP3\u003c/b\u003e - Participatory community-based action: Joint identification of concrete actions\u003c/p\u003e \u003cp\u003e \u003cb\u003eWP4\u003c/b\u003e - Pilot intervention: Development and pilot testing of training material\u003c/p\u003e \u003cp\u003e \u003cb\u003eWP5 -\u003c/b\u003e Dissemination: Information about and exchange on project methods and results\u003c/p\u003e \u003cp\u003eThe quantitative KAP survey (WP1) ensured the representativeness and validity of knowledge, attitudes and practices. The qualitative part of the study (WP2-3) allowed for the enrichment of background knowledge and the interaction with and participation of stakeholders and representatives. The study was designed as an international, interdisciplinary and intersectoral project. The staff was located in Bolivia, Chile, Guatemala, Brazil and Germany and is experienced in international and multilingual collaboration. The team included physicians, epidemiologists, veterinarians, environmental scientists, such as biologists and zoologists, and social scientists with experience of community-based work. The study thrives on the participation of its subjects, so the aim was to enable cross-sectoral exchange by involving the general population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting of the study\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in Bolivia, Brazil, Chile and Guatemala between September, 15 2022 and September 30, 2024. In each country, a geographical area was selected in order to cover a wide range of Latin American climate, biodiversity, wildlife and culture, considering rural and urban areas.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn Bolivia\u003c/b\u003e, the project was carried out in the Department of Chuquisaca, Province of Jaime Zuda\u0026ntilde;ez, Municipality of Presto, which has an area of 1,444 km\u0026sup2; and a population of 12,385 inhabitants. The municipality groups 33 communities, two neighborhood councils, and a predominantly Quechua-speaking population, and is located in the \u003cem\u003eEl Palmar Integrated Management Natural Area\u003c/em\u003e, a protected area of 595 km\u0026sup2;, characterized by its integrative approach to conservation and protection. It was established with the aim of protecting flora and fauna and preserving the inter-Andean mesothermal semi-arid valleys. At the same time, the area emphasizes the protection of its rich cultural and archaeological heritage\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn Brazil\u003c/b\u003e, the project was developed in the state of Paran\u0026aacute;, which is situated in the Atlantic Forest. This biome plays a key role as a corridor for species migration between humid and semi-deciduous forests, as well as between Atlantic Forest and Cerrado habitats\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Three distinct areas inhabited by traditional community groups were considered for the study:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe municipality of Paranagu\u0026aacute; is located in the coastal region of the state of Paran\u0026aacute; in southeastern Brazil. The city has several rural villages inhabited by Cai\u0026ccedil;aras communities, composed of a mixture of indigenous, Portuguese and black people\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Its agricultural, fishing and food preparation activities have a strong indigenous influence. The project was carried out in the village of Maria Luiza, one of the Cai\u0026ccedil;ara settlements farthest from the sea and located in a densely forested area.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe differentiated mesoregion of Vale do Ribeira/Guaraque\u0026ccedil;aba includes 16 municipalities in the State of Paran\u0026aacute;. This region is characterized by its quilombo lands and conservation units. The quilombolas, descendants and remnants of communities formed by escaped slaves, are mainly engaged in agriculture, extractive industries, fishing and cattle raising\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. There are 7,113 quilombola inhabitants in Paran\u0026aacute;. The project was carried out in Adrian\u0026oacute;polis, the municipality with the largest number of quilombola communities in the state\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCol\u0026ocirc;nia Castelhanos is a peri-urban community located in the Serra do Mar, belonging to the municipality of S\u0026atilde;o Jos\u0026eacute; dos Pinhais, in the state of Paran\u0026aacute;. The area is completely embedded in the Atlantic Forest biome, about 70 km from the central area of the municipality and 80 km from the capital of Paran\u0026aacute;. The population is composed of mixed descendants of indigenous, Ukrainian and Polish immigrants, organized in cooperatives and living mainly from the cultivation of bananas and other fruits of the region\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIn Chile\u003c/b\u003e, the project was carried out in the O'Higgins region, located in the central part of the country, with a population of 914,555 inhabitants, near the Paredones river basin. The region, wich includes the municipalities of Navidad, Do\u0026ntilde;ihue (Lo Miranda), and Machal\u0026iacute; (Coya), is characterized by a Mediterranean climate with significant topographic variations. The climate in the coastal areas is humid and mild, while in the mountainous areas temperatures fall below 0\u0026deg;C during the winter months. In this region, conflicts between livestock farming and wildlife, as well as drought-related environmental problems, pose a threat to wildlife health. The area selected for the project encompasses a diversity of climates, biodiversity, wildlife, and culture, including both rural and urban areas.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn Guatemala\u003c/b\u003e, the project was carried out in the Lachua Ecoregion, a vast tropical wetland with a population of around 12,500 inhabitants. It is one of the most biodiverse regions in Guatemala and is home to many endangered species. 49 indigenous communities are located in the area, belonging to the Maya-Q\u0026acute;eqchi\u0026acute;. Traditionally self-sufficient, the Maya-Q\u0026acute;eqchi\u0026acute; have an economy based primarily on agriculture and the use of wildlife and other forest products\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eMethodology of the work packages\u003c/h3\u003e\n\u003cp\u003eWork package 1: KAP survey\u003c/p\u003e \u003cp\u003eA cross-sectional study was carried out using standardized questionnaires. KAP surveys are widely used in public health to collect information on the public\u0026rsquo;s understanding of a phenomenon (knowledge), evaluative responses to a situation (attitudes), and observed actions or behaviors (practices) among a target population. KAP research is often used to assess the development, implementation, and evaluation of public health interventions, given the linear relationship between knowledge, attitude, and behavior change\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. It also allows for the exploration of potential barriers to health behavior change. The questionnaire (Supplementary file 1) is based on two previous questionnaires\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and includes open and closed questions on demographic information, education, occupation, medical history, knowledge, attitudes, and practices related to the risk of zoonotic diseases, wildlife trade, and wildlife consumption. The language of the questionnaire is English with translations into Spanish, Portuguese, Quechua and Q\u0026rsquo;Eqchi. The validity of the translations was checked by bilingual experts. It was also ensured that the interviewers spoke the language of the respondents. Prior to implementation, the questionnaire was piloted with a minimum of 30 people, evaluating whether the questions are clear and understandable. The questionnaire was then adapted taking into account all suggestions and observations. Each interview took approximately 30 minutes. All interviewers were trained prior to conducting the interviews to minimize bias between the different locations and to coordinate feasibility. The questionnaire was standardized and coded to allow data entry into the Epi Info\u0026trade; form or Open Data Kit (ODK). Quantitative data analysis will be performed using SPSS and R.\u003c/p\u003e \u003cp\u003eWork package 2: key actor interviews and focus group discussions\u003c/p\u003e \u003cp\u003eIn this work package, face-to-face interviews with key actors and focus group discussions were conducted. In the interviews, the respondents were considered as experts in their field, providing new information, explaining and classifying previously developed content. Most of the questions were open-ended and based on a literature review on zoonotic diseases and wildlife trade. Supplementary file 2 presents a priori dimensions, categories and examples of questions, adapted from previous studies\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. WP2 also included focus groups to complement the information from the key actors and adopt a multi-stakeholder approach. Focus group discussions are a common method in conservation biology and social sciences. In contrast to interviews, they allow not only for knowledge gathering, but also for the exchange of perspectives and arguments between participants\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. One or more trained facilitators, fluent in the participants' language, moderated the discussions. To prevent major disputes and foster mutual understanding, they received comprehensive training beforehand.\u003c/p\u003e \u003cp\u003e We employed a purposive sampling approach to identify and invite key informants who represent each group of participants. Rather than conducting a formal power calculation, we used non-probability purposive sampling to achieve data saturation, a critical factor in ensuring sample size adequacy\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWork package 3: roundtable discussions\u003c/p\u003e \u003cp\u003eBased on the initial results of the previous work packages, roundtables were convened to jointly analyze the current situation of wildlife trade and consumption and to propose strategies promoting the human-coexistence, while considering the local context. These discussions ensured equal participation in developing solutions, with facilitators responsible for coordinating, moderating and managing polarized debates.\u003c/p\u003e \u003cp\u003e All key actor interviews, focus group discussions and roundtable discussion were audio recorded and transcribed with participant\u0026rsquo;s informed consent. Constant Comparative Analysis\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e will be developed for data analysis. First, the units of meaning (words, sentences and paragraphs) will be encoded, secondly, the codes will be integrated into categories based on their common properties. Furthermore, overlapping categories will be integrated (sub-categories are generated), establishing for categorization, generating theoretical concepts from the data, using the Atlas.ti software.\u003c/p\u003e \u003cp\u003eWork package 4: pilot intervention\u003c/p\u003e \u003cp\u003eThe supposed training materials includes e-learning materials, educational short videos, flyers and community radio segments, and may be extended according to the participants\u0026rsquo; suggestions. The study team is experienced in designing educational material, such as Massive Open Online Courses (MOOC), virtual patient e-learning (CASUS), podcasts, and regular webinars\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The design of these programs will seek to encourage the active participation of the participants. For this purpose, the competency-based approach, active learning model ARIPE (adjust, reactivate, inform, process, evaluate)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e will be applied. The Kirkpatrik evaluation model\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e will be used to evaluate these interventions. A pre- and post-intervention questionnaire will be conducted to measure whether the participants experience positive changes, considering content, instructional design, technical design, and social dimensions.\u003c/p\u003e \u003cp\u003eWork package 5: dissemination\u003c/p\u003e \u003cp\u003eThe project results will be shared with the scientific community through various channels, such as webinars and peer-reviewed publications. Additionally, the evaluated and reviewed materials will be provided to the participating communities. Dissemination efforts will also target the general public, organizations, activists, policymakers, and other relevant stakeholders. This comprehensive strategy aims to highlight the importance of the subject matter and demonstrate the value of this research and ints interventions at both local and global scales. To further enhance impact, forums for exchange and dialogue with policymakers will be promoted, ensuring that the project's findings inform the development and implementation of strategies to regulate wildlife trade and consumption in Latin America.\u003c/p\u003e\n\u003ch3\u003eStudy participants and sampling methods\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eFor the quantitative KAP survey\u003c/b\u003e (WP1), the sampling frame was derived from the National Population and Housing Census (PHC), available from the National Statistical Institute of each country. It contained a list of all enumeration areas (EA), which are geographical areas covering a group of households. It included information on the location of the EA, the type of residence (urban or rural), and the estimated number of resident households. All residents of the selected households who were 10 years of age or older were eligible to be interviewed. To achieve age representation, three age groups were considered: adolescents (10\u0026ndash;17 years), adults (18\u0026ndash;60 years), and elderly (61\u0026thinsp;+\u0026thinsp;years). These age groups, of 100 persons each, form the subpopulations of three different household locations (rural, urban, indigenous). In this way, we aimed for 900 people in each country, and for a total of 3600 people in the four countries. Figure\u0026nbsp;1 illustrates the organization of the sampling design. In each household, trained interviewers conducted face-to-face interviews with each household member aged 10 years or older. Prior to the fieldwork, the study was socialized with local authorities and local media (e.g. community radio stations) to inform people about the study and encourage participation. Community representatives helped facilitate access to the target population.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure 1\u003c/strong\u003e \u003cp\u003eSample design organization of the KAP-Survey, exemplary for Bolivia.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFor the qualitative part\u003c/b\u003e, 15 \u003cb\u003ekey actor interviews\u003c/b\u003e were conducted in each country with the following stakeholders: local authorities and community representatives; health personnel (doctors, nurses or auxiliaries) from primary health care centers and representatives of the zoonosis program in the area; traditional healers; academic staff from universities or public institutions in the fields related to human and veterinary medicine, public health, wildlife, biodiversity and social/cultural studies; representatives of non-governmental organizations. Six \u003cb\u003efocus group discussions\u003c/b\u003e were held in each country with users of forest services (hunting, rangers), representatives of Indigenous communities, residents of the communities, vendors or artisans. To ensure representativeness, the events were distributed by age (\u0026lt;\u0026thinsp;30 years; \u0026ge;30 years) and area (urban, rural and indigenous). Each focus group consisted of 6 to 10 people, with equal representation of women and men. Time and travel expenses were reimbursed, and participation was voluntary.\u003c/p\u003e \u003cp\u003eOpen invitations were sent out to the communities for the \u003cb\u003eroundtable discussion\u003c/b\u003e. Interested participants from previous work packages, were reinvited, ensuring representation of area (urban, rural, indigenous), age and gender. Additionally, individuals from other sectors such as education, environmental institutions and academics, and local authorities, were included, resulting in interdisciplinary and intersectoral roundtables. To encourage active participation, each roundtable was limited to a maximum of 20 participants.\u003c/p\u003e\n\u003ch3\u003eData management\u003c/h3\u003e\n\u003cp\u003eData were stored at each local university. The original paper questionnaires were kept in locked boxes and will be deleted ten years after the end of the project. Digital data were pseudonymized by using a unique participant ID and stored on a privacy-compliant storage- and collaboration platform. A data management plan for the handling of research data is available in Supplementary file 3. Data confidentiality requirements of each country and state were respected.\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Committees at the Ludwigs-Maximilians-University in Munich, Germany; the Universidad Mayor de Simon in Cochabamba, Bolivia; the Universidad O\u0026rsquo;Higgins, Rancagua, Chile; the Universidade Federal do Paran\u0026aacute;, Curitiba, Brazil; and the Comite Independiente de Etica K\u0026rsquo;awil, Guatemala. Written informed consent was obtained from all participants. For minors between the ages of 10 and 17, both the participant and their legal guardian(s) were asked to provide written informed consent.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aims to identify knowledge, attitudes, and practices regarding the risk of zoonotic diseases, wildlife trade and consumption among different populations living in urban and rural areas, including indigenous communities in Latin America. By understanding the main drivers of behavior in local communities, the study will develop tailored educational intervention strategies through a participatory approach.\u003c/p\u003e\n\u003cp\u003eTo our knowledge this is a unique study protocol in the field of zoonotic diseases and wildlife, that combines the One Health approach, international and interdisciplinary collaboration, mixed-methods data collection, and intervention strategies. The One Health approach is particularly relevant because the determinants of infectious diseases originate in all One Health domains - human, animal and environmental\u003csup\u003e32\u003c/sup\u003e; recently, the OHHLEP has underscored the importance of adopting a holistic and interdisciplinary approach to effectively address these complex interrelationships\u003csup\u003e10\u003c/sup\u003e. In this study, international and interdisciplinary collaboration, represented by the composition of the study team from diverse countries and disciplines, as well as the choice of mixed-methodology, facilitates a comprehensive examination of the zoonotic disease risks by considering various perspectives and fields of knowledge. The integration of quantitative and qualitative methods is still underrepresented in One Health research designs, and although challenging to implement, it broadens perspectives within the field of study\u003csup\u003e33-35\u003c/sup\u003e. Thus, the quantitative KAP survey provides baseline information and patterns of knowledge, attitudes, and practices, that are essential for developing targeted public health interventions and policies. The qualitative data, then enriches the quantitative part by providing context and depth. For example, if the KAP survey identifies high rates of wildlife consumption in a particular region, qualitative interviews can reveal the underlying reasons, such as economic dependence or cultural practices, and thus inform more nuanced and effective public health strategies. In addition, a participatory approach is essential to ensure that the diverse perspectives of different stakeholders, including local communities, are taken into account\u003csup\u003e36\u003c/sup\u003e. This is particularly important in regions with high biodiversity and significant human-wildlife interactions, such as Latin America. Engaging community members through interviews, focus groups, and roundtable discussions ensures that the interventions and recommendations developed are culturally sensitive, contextually relevant, and more likely to be maintained by the communities. Here, the coordination of these events by local experts with long experience of working with the communities at all sites is essential. This participatory element is consistent with the principles of transdisciplinarity, where knowledge generation is a collaborative process involving academic and non-academic stakeholders, thus promoting mutual ownership and sustainability of health interventions\u003csup\u003e37\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the holistic study design is critical to understanding and mitigating the complex and interrelated risks of zoonotic diseases associated with wildlife trade and consumption in Latin America. The findings of this study may not only inform local policies and interventions but also contribute to the global understanding of zoonotic disease dynamics and prevention. The approaches and methods introduced in this study protocol aim to provide a more comprehensive understanding of complex health issues, and to promote robust and effective solutions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to acknowledge and thank all members of the KAP wildlife study group:\u003c/p\u003e\n\u003cp\u003eAdler, Marcia; da Costa-Ribeiro, Magda Clara Vieira; de Almeida, Gustavo Ara\u0026uacute;jo; de Carvalho, Denise Siqueira; de Tarso Pires, Paulo; Encina Zamorra, Veronica; Garrido, Marie Astrid; Guzm\u0026aacute;n-Quilo, Maria Carolina; Magalh\u0026atilde;es Buffon, Marilene da Cruz; Mansilla Vivar, Pilar Macarena; Mendez Heredia, Dennis Martin; Perez Morales, Fabiana Marcela; Pinto Navia, Carlos Fernando; Ribeiro de Almeida, Tatjana Queiroz\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL et al (2008) Global trends in emerging infectious diseases. 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Health Promot Int 25(1):115\u0026ndash;122\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"One Health, Zoonoses, Wild Animals, Interdisciplinary Research","lastPublishedDoi":"10.21203/rs.3.rs-5504949/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5504949/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe emergence and transmission of zoonotic diseases is a critical global challenge. Deforestation, land use changes, and urbanization have led to increased human-wildlife interactions, raising the likelihood of pathogen spillover. Wildlife trade, including handling and consumption, contributes significantly to this risk. This study aims to identify knowledge, attitudes, and practices (KAP) towards zoonotic disease risks, wildlife trade, and consumption among rural and urban populations in Bolivia, Chile, Guatemala and Brazil, including indigenous communities.\u003c/p\u003e\n\u003cp\u003eUsing a mixed-methods approach, the study included a quantitative KAP survey with 3600 interviewees, qualitative in-depth interviews with 15 key actors and 6 focus group discussions to develop targeted educational interventions within the communities.\u003c/p\u003e\n\u003cp\u003eThis study's mixed-methods design provides quantitative baseline information, as well as qualitative context and depth, allowing for comprehensive insights into KAP in the communities in Latin America. To address the complex interplay of human, animal, and environmental factors, the One Health approach is applied with a focus on international and interdisciplinary collaboration. The participatory approach promotes mutual ownership and sustainability of public health interventions.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitudes, and practices towards the risk of zoonotic diseases, wildlife trade, and wildlife consumption in Latin America: A One Health mixed-method study protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 12:34:27","doi":"10.21203/rs.3.rs-5504949/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4bd4ce98-295f-4ff5-92ce-5fdd61717f7e","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40628982,"name":"Zoonoses"},{"id":40628983,"name":"Epidemiology"}],"tags":[],"updatedAt":"2024-11-25T12:34:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-25 12:34:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5504949","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5504949","identity":"rs-5504949","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}