Discussion
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REGRESSION, ALBERT
This study implemented and evaluated the effectiveness of a peer-led training program aimed at improving lifejacket wear to prevent drowning among occupational boaters on Lake Albert, western Uganda. At endline, the results showed a significant increase in both self-reported and observed lifejacket wear. The test of differences in proportions of lifejacket wear showed that self-reported and observed wear significantly increased in the intervention arm. These differences were too big to have occurred by chance. Using the As Treated (AT) analysis demonstrated that the prevalence of self-reported lifejacket wear among the boaters who received the peer-led training was nearly two times higher than that among the boaters who did not receive the training (Adj. PR 1.78, 95% CI 1.38–2.30). It was interesting to note that the effect of the intervention arm was not significant. This means that being in either study arm was not important in this study. The results therefore demonstrate that the peer-led training is effective independent of the study arm, meaning that training implemented in the non-intervention group was effective in improving lifejacket wear. However, the main objective of this study was to test the effectiveness of the peer-led training on improving lifejacket wear.Based on these results, contamination in this study was not necessarily a bad thing because the results show that the intervention can be effective even in the non-intervention arm. Whereas a systematic review of drowning prevention interventions argued that education alone is not effective [It is important to note that there was a significant increase in lifejacket wear even in the non-intervention arm. There are some postulates to this increase. To begin with, during the study period, the Police and Army Marine units intensified surveillance on the lake to fight the use of illegal fishing gear and rebel invasion into the country from the DRC. These operations may have had a positive non-intended effect on the use of safety equipment, including lifejacket wear as demonstrated to be effective elsewhere [The results also show that the majority of the respondents reported to have received training on lifejacket wear from their peers at their respective landing sites. We believe that this peer-led training, which may have been augmented by positive peer pressure, increased lifejacket wear. These results therefore provide sufficient evidence to reject the null hypothesis that the peer-led training and routine marine community policing program has the same effect on lifejacket wear among the occupational boaters on Lake Albert, Uganda. A systematic review of drowning prevention interventions argued that education alone is not effective and there is need to integrate interventions [There was borderline significance in lifejacket wear among people who knew how to swim. This was not different from other studies in the same area and elsewhere that found that swimming expertise did not seem to have any effect on lifejacket wear [This study has some limitations. We relied on the self-reported lifejacket wear in the multiple regression model. We recognize that this may be subject to information bias, especially the expectation bias which might have made the participants report what they felt was acceptable to hear. However, we tried to validate this through covert observation of lifejacket wear as the boaters disembarked. The covert approach was chosen because it reduces the hawthorne effect whereby study participants may modify their behavior by putting on their lifejackets if they knew that they were being observed [While it is possible that police and army marines’ operations against illegal fishing may have had a non-intended impact on lifejacket wear, this should have affected both study arms equally. Our interviews started at 7:30 am and therefore possible that we may have missed out on the boaters who returned earlier than that time. In addition, a qualitative process evaluation leaning on critical realism would be helpful to explain how the intervention worked, for whom it worked and why. Lastly, due to the diverse cultural orientations among the different fishing communities in Uganda, this study cannot be generalized to all boaters in the country because it was conducted among boaters on only one lake. We however believe that our sample was powered enough to represent the occupational boaters in the districts around Lake Albert.