https://orcid.org/0000-0003-2029-4934
Figures
Abstract
Studies have been conducted on migrant health during the COVID-19 pandemic. However, in-depth information is scarce regarding the barriers to preventing COVID-19 in this vulnerable population. The objective of the study is to explore the barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in Thailand. We conducted an interview-based qualitative study among 7 migrants from Myanmar, 6 Thai employers, and 9 Thai healthcare providers in the cities of Hat Yai and Pattani in Southern Thailand. We recruited participants by purposive sampling. We conducted in-depth interviews in-person or via telephone in Thai or Burmese language, transcribed the interview, and conducted thematic analysis. Regarding adherence to COVID-19 protective behaviors, two themes emerged: lifestyle and habit-related barriers, and non-vaccine supply chain management barriers. Regarding COVID-19 vaccination, three common themes emerged: fear, barriers related to health education and health promotion, and vaccine supply chain management. Supply chain management was a common theme in both domains. However, each domain also had additional themes. Our study contributed empirical findings that could be of interest to stakeholders in migrant health. However, limitations regarding the generalizability of the findings and social desirability should be considered in the interpretation of the findings.
Citation: Htet H, Wichaidit W, Chuaychai A, Sottiyotin T, Htet KKK, Sriplung H, et al. (2025) Perspectives of stakeholders on barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in southern Thailand: A qualitative study. PLoS ONE 20(3): e0317714. https://doi.org/10.1371/journal.pone.0317714
Editor: Kyaw Lwin Show, SingHealth Polyclinics, SINGAPORE
Received: August 19, 2024; Accepted: January 2, 2025; Published: March 11, 2025
Copyright: © 2025 Htet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist
Introduction
Globally, there are 281 million international migrants, including 169 million migrant workers [1]. There are different categories of migrants, including economic migrants, refugees, asylum seekers, and internally displaced persons [1]. Health-related challenges among migrants in host countries include cultural, structural, financial and language barriers [2]. During the COVID-19 pandemic, migrants and ethnic minorities were disproportionately affected by stigma and discrimination [3], as well as being blamed for spreading infections [4,5]. In many countries, migrants were excluded from the COVID-19 relief policy measures, especially if they were undocumented and asylum seekers [6]. Thailand, an upper-middle income country in South East Asia, is one of the top ten destination countries for international migrants in the WHO South East Asia Region [7]. The majority of migrants in Thailand come from neighboring Myanmar with 1.65 million registered workers in 2021 according to the statistics from the Department of Employment, Ministry of Labour, Thailand [8], most of whom work in low-skilled jobs such as construction, factories, and fisheries [9].
Thailand experienced five distinct waves of COVID-19 between 2020 and 2022, where the fifth wave of COVID-19 occurred in late 2022, and included the emergence of more transmissible variants like Alpha and Delta [10]. As of 13 April 2024, Thailand had a cumulative total of 4,770,149 confirmed cases with 34,586 deaths [11]. During the pandemic situation in Thailand, Myanmar migrants experienced higher infection rates especially in the second wave [12–16], faced a shortage of personal protective equipment (e.g., face masks, hand sanitizers, and soaps [17,18], faced challenges in adhering to COVID-19 protective measures [19], and faced barriers in healthcare access due to structural, financial, language, and communication difficulties [20]. The pandemic also exacerbated the discrimination against migrants [21].
Public health interventions to prevent and control COVID-19 have included hand hygiene, face covering use, social distancing in public places, isolation, travel restrictions, vaccination, etc. [22–25]. Different interventions affect disease transmission in different ways [26–28], and a comprehensive strategy is deemed needed in order to effectively control COVID-19 infection [29].
Thailand’s Ministry of Public Health Thailand formulated the National COVID-19 Strategic Plan, with relevant public health measures and social measures [30]. On 28 February 2021 [31], a nationwide government-funded free COVID-19 vaccination program was also launched [16]. The program prioritized frontline health care personnel, people with chronic diseases, and elderly people during the initial period [16], before expanding in the last quarter of 2021 to include non-Thai migrant workers and their families regardless of legal status [16]. However, Myanmar migrants in Thailand were found to have low COVID-19 vaccination rates due to several barriers, including the exclusion from the vaccination program, language barriers, and financial constraints. These challenges are further compounded by previous studies conducted in Southern Thailand, which highlighted unsatisfactory health-seeking behaviors among Myanmar seafarers in Pattani province [32], as well as factory, construction, and rubber trapping workers in Songkhla province [33].
Although studies have been conducted regarding COVID-19 vaccination among migrants, studies on migrant health in Thailand only included the perspectives of the migrants but not their Thai employers or healthcare workers [20] who coordinate and provide vaccination and other resources for the migrants. Recent research on COVID-19’s impact on vulnerable migrant communities in Thailand incorporated diverse viewpoints from various stakeholders, including representatives of migrant advocacy organizations, NGOs, and community-based support groups [34]. Such data can provide valuable insights for relevant stakeholders that enable planning and preparations for future infection control practices and crises. Building upon this foundation, our qualitative study aims to provide a comprehensive understanding of the barriers to COVID-19 protective behaviors adherence and vaccination among Myanmar migrant workers in Thailand according to the perspectives of three important stakeholders for migrant health: migrant workers, employers, and healthcare providers. This multi-stakeholder approach will generate valuable insights to inform future crisis preparedness and infection control strategies.
Methods
Study design and setting
This study was a descriptive qualitative study conducted from the 1st of September 2022 to the 24th of January 2023 during the COVID-19 pandemic. During the COVID-19 pandemic (2020–2022), the industries in Southern Thailand were transiently affected, and the government issued several non-pharmacological measures, including social distancing, compulsory mask wearing, travel restrictions, and workplace disinfection, to prevent further spread among the workers. In late 2021, the government offered vaccinations to migrant workers free of charge as part of an inclusive vaccine policy [35].
Study areas included the cities of Hat Yai city of Songkhla province and Pattani city of Pattani province in southern Thailand. Songkhla and Pattani provinces are major industrial commercial area of the Southern Thailand with many factories that process rubber, wood and seafood as well as numerous construction and fishery sites [36]. Many Myanmar migrant laborers live in these provinces, with different ethnic groups, religions, and cultures. According to the 2021 Thailand Employment Statistics, there were 19,810 and 4,122 legal Myanmar migrant workers granted by cabinet resolution in Songkhla and Pattani provinces, respectively [37].
Study participants
Twenty-two stakeholders were interviewed, including Myanmar migrants (n = 7 persons), Thai employers (n = 6 persons), and Thai healthcare providers (n = 9 persons). Migrants were enrolled if the following predetermined inclusion criteria was met: (i) Myanmar Nationality; (ii) age at least 18 years old; (iii) residing or working in the study area for at least six months, and; (iv) able to communicate in Burmese. Migrants with the following criteria were excluded from the study: (i) those with mental or auditory problems; (ii) those who received COVID vaccination outside of Thailand. Inclusion criteria for employers and health care provider were (i) Thai nationality (ii) Government or Non-government officers whose work was related to COVID-19 vaccination services for migrants within the study area for at least six months; (iii) Owners, managers, supervisors in-charges, safety officers, etc., who were employing Myanmar migrants within the study area for at least six months. Their exclusion criteria were (i) employers with no experience of employing Myanmar migrants; (ii) healthcare providers who were working at facilities with migrant exclusionary policy. Participants were selected through purposive sampling by the research team and local key informants to ensure a diverse range of perspectives within each stakeholder group. Myanmar migrants were identified with the help of the key informants from the Migrant Workers Right Network (MWRN) and the Stella Maris Organization. These key informants were Myanmar Nationalities who had been working in the study area for more than 10 years. They could well acquaint with the Myanmar migrant population within Hat Yai and Pattani and could provide information on places of worksite and residence, types of occupations, legal status, approximate population sizes, and their lifestyles. For Thai employers and Thai healthcare providers, they were also identified by the Thai research coordinator and invited via official request letters, emails, or phone calls and invited to participate in individual in-depth interviews.
Study instrument
The semi-structured in-depth interviews guides were developed based on the previous COVID-qualitative studies. Three separate question guidelines were used for the migrant workers, the employers, and the health care providers. The interview guides included open-ended questions to explore the main issues related to potential challenges for adherence to COVID-19 protective measures (e.g., In your opinion, what do you consider to be your main limitations or barriers to adhere or follow COVID-19 protective measures in your workplace? Would you mind telling us about these barriers in detail?) and vaccination (Example: “In your opinion, what do you consider to be the main barriers, if there are any, to COVID-19 vaccination for you and why?”) from the aspects of Myanmar migrant workers, Thai health care providers, and Thai employers. The interview guides were first drafted in English and then translated into Burmese (for Myanmar migrant workers) and into Thai (for Thai health care providers, Thai employers) and validated before implementation of the main interviews upon discussion with experts. Prior to the main interviews, the interview guides were piloted and iteratively revised based on feedback from the participants.
Data collection
After receiving ethical approval and permission from the participants, the research team scheduled in-depth interviews upon their feasible date and time. Appointments for interviews were scheduled 1 or 2 weeks prior to the actual interview date. Due to the COVID-19 pandemic, individual interviews were conducted either in person or via telephone, by three experienced investigators with prior qualitative research experience. We conducted all in-person interviews at the participant’s workplace. The primary investigator (HH), a Myanmar national, conducted interviews with migrants in Burmese, and the two Thai co-investigators (AC and TS) interviewed with both employers and healthcare providers in Thai. We matched the nationality of the interviewers and participants in order to reduce potential language barriers, manage cultural nuances, and enable more effective probing. At the time of the study, HH was a male PhD student with a background as a public health physician. During the interview, HH made attempts to be conversational and build rapport with the participants in order to lower the potential social desirability and response acquiescence. The Thai co-investigators were female university lecturers with graduate-level education. The participants and the members of the research team were never acquainted with one another prior to data collection. None of the research team members had experience working or advocating on Myanmar migrant issues prior to the study. Each interview lasted between 45 and 60 minutes, with an explanation of the purpose and procedure of the study to the participants before the start of the interviews. No individuals other than the interviewer and the participant were present at all of the interviews. Following each interview, a brief interview summary was provided to all participants to verify the accuracy of the content and key messages. The participants did not provide us with any feedback after the interview summary. We did not make field notes during and/or after the interviews. We did not conduct any repeat interviews.
Data management and analysis
All interviews were audio recorded with consent and transcribed verbatim. All transcripts were carefully reviewed by study investigators to check the accuracy with the identification of new concepts and the assessment of data saturation levels. For in-depth interviews of the migrant workers in Burmese, the primary investigator (HH) who spoke Burmese as a native language transcribed the interview to Burmese texts, then used an artificial intelligence system (ChatGPT) to translate the Burmese texts into English. HH then manually checked the translations and corrected the parts deemed to be inaccurate. For in-depth interviews of the employers and healthcare providers in Thai, the investigators hired native Thai speakers via a popular freelance website to transcribe the interview into Thai texts. Investigators then used a machine-assisted translation tool (Google Translate) to translate the Thai texts into English texts. A co-investigator and the corresponding author (WW) who spoke Thai as a native language, manually checked the translations and corrected the parts deemed to be inaccurate. The decision to use ChatGPT to translate Burmese texts was made after HH made an assessment of both ChatGPT and Google Translate and found that ChatGPT had a higher accuracy and a better ability to manage cultural nuances. The decision to use Google Translate for the Thai texts was based on WW’s prior experiences with the validation of translated texts.
Investigators analyzed the qualitative data in the English translations. The transcribed data were inductively explored manually, using thematic analysis in accordance with the research objective. The analytical steps were as follows: first, open coding, defining as many codes as needed to describe all aspects of the content; second the codes were categorized to create themes and sub themes, all leading to an explanation. Two investigators (HH and WW) identified relevant text segments in the translated transcripts based on consensus. The two investigators then separately identified codes, sub-themes, and themes, based on the frequency of occurrence and significance, relevance to research objectives, cultural and contextual sensitivity [38–40]. Then, the two investigators met after the completion of the process to cross-check the findings, discuss discrepancies, and finalize the themes, sub-themes, and codes based on consensus. The two investigators then asked a third investigator, a subject specialist in infectious diseases (VC) to verify the interpretation and conclusions. VC informed the investigators that he concurred with the interpretation and the conclusion and that he had no further comments. The investigators then made coding trees to summarize the findings.
Ethical considerations
This qualitative study was approved by the Human Research Ethics Committee of the Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand (approval number: REC. 65 − 071 − 18 − 1). This study was also conducted in full compliance with the COVID-19 preventive guidelines. Prior to participation, only verbal consent was obtained from migrants due to the sensitive nature and confidentiality of their immigration status, whereas written informed consent or verbal consent was obtained from Thai health care providers and Thai employers.
Results
Study participants
All potential participants agreed to participate in the study. A total of 7 Myanmar migrant workers (three worked in factories, two seafarers, and two construction workers), 6 Thai employers, and 9 Thai healthcare workers participated in our in-depth interviews. All participants resided in Songkhla or Pattani Provinces at the time of the interview. Their relevant background information is summarized in Table 1.
Key themes related to the barriers to adherence to COVID-19 preventive behaviors
With regards to adherence to COVID-19 prevention behaviors, each of the three stakeholder groups revealed several key themes (Table 2). The most common theme reported by all three groups was lifestyle and habit-related barriers. These issues included living in crowded dormitories, poor mask compliance at residential areas, conditions at workplaces. Stakeholders also noted issues pertaining to family attachment and non-compliance with quarantine facilities. Another common theme reported by migrant workers and healthcare providers was barriers related to non-vaccine supply chain management. Myanmar migrant workers also identified complacency as an issue. For example, one participant reported that migrant workers tend to remove their masks or ignore guidelines when supervisors were not present in their workplaces. Participants also reported financial constraints in purchasing face masks. Stakeholders also identified lack of health education and promotion as barriers. One particularly common issue identified by Thai employers was language barrier and the lack of interpreters when communicating with the Myanmar migrants. Fig 1 illustrates these themes and sub-themes as a coding tree chart.
Key themes related to the barriers of COVID-19 vaccination
Regarding COVID-19 vaccination, one barrier consistently reported by all three stakeholder groups was fear of vaccination (Table 3), including concerns for side effects, overall vaccine hesitancy, and unspecified fear. One migrant worker participant reported personal experience with adverse effects of vaccination and refusal of subsequent doses, whereas a Thai employer used a reminder of reduced vaccination support as a way to motivate vaccination. Another common theme was the need for health education and health promotion, including educational materials in a language they understand, which could help to encourage uptake of booster doses. All three stakeholder groups mentioned issues pertaining to vaccine supply chain management, including lack of vaccination opportunity, insufficient vaccine supply, logistical challenges, and delays in both procurement and delivery of vaccines. Migrant workers and Thai employers mentioned policy related barriers, such as the requirement for legal documents, the need for the Thai employers to cover the cost of vaccination, and the prioritization of Thai citizens over Myanmar migrants. Thai employers and healthcare providers also frequently reported language barriers, including in vaccination-related tasks such as documentation, vaccination data entry, providing vaccination history, and communicating about medical histories. Migrant workers and healthcare providers also reported data system barriers, including the need for identification and documents for both vaccination data and registration system, service delays, data entry problem, communication, and coordination challenges. We also presented these themes and sub-themes in Fig 2 as a coding tree chart.
Analysis of the frequency in which themes appeared for both adherence to COVID-19 prevention behaviors and COVID-19 vaccination showed that the theme that appeared most frequently for adherence to COVID-19 protective measures was lifestyle and habit-related barriers (Supplementary Table 1). On the other hand, the most common theme for COVID-19 vaccination was vaccine supply chain management (Supplementary Table 2).
Discussion
Our study examines the barriers to adherence to COVID-19 protective behaviors and COVID-19 vaccination among Myanmar migrant workers in Southern Thailand during the COVID-19 pandemic according to the workers, their Thai employers, and healthcare providers. Each of the three stakeholder groups revealed several key themes related to barriers affecting COVID-19 related health behaviors among migrants. Two common themes emerged regarding adherence to COVID-19 protective behaviors: lifestyle and habit-related barriers, and non-vaccine supply chain management barrier. For COVID-19 vaccination, three common themes were identified: fear, barriers related to health education and health promotion, and vaccine supply chain management.
We found that lifestyle and habit-related barriers hindered adherence to COVID-19 preventive measures, similar to the findings of previous qualitative studies conducted among migrant workers in Qatar [41], Norway [42], and Uganda [43]. The findings also concurred with those of previous reports conducted in Thailand during the COVID-19 lockdown among factory workers [16], construction workers [44], and fishery workers [45]. In Thailand, Myanmar migrant workers tend to live in overcrowded accommodations with poor hygienic conditions [45–49], which can increase the risk of further outbreaks of COVID-19 and other communicable diseases [14,16]. The improvement of migrants’ living and working conditions may require shifting of existing economic equilibrium between conditions and costs on the part of the migrants and their employers [2]. Thus, future studies should consider exploring approaches to shift this equilibrium in a direction that enables effective disease prevention and control.
Non-vaccine supply chain management issues included the shortage of essential hygiene items and personal protective equipment (PPE), which could have improved the overall adherence to COVID-19 and other respiratory infection preventive measures [50]. In Malaysia, one study among Myanmar refugees and irregular migrants in Malaysia reported lack of employer support for masks and hand sanitizers during COVID-19 pandemic [51]. In Thailand, although over 200,000 migrants in also requested hygiene items and food from migrant support groups [19], survey data from the International Organization of Migration reported that the migrants faced many challenges including an inadequate supply of essentials [52]. Future studies should explore the determinants of supply inadequacy to make evidence-based recommendations to stakeholders to prepare for future outbreaks and epidemics.
Regarding barriers to COVID-19 vaccination, our participants reported the lack of health education and health promotion as barriers. Previous studies also made similar reports, i.e., that the lacks of trustworthy information and culturally-accessible information deterred ethnic minorities from receiving the COVID-19 vaccinations [53,54]. Our participants also reported that they feared COVID-19 vaccination, particularly about the vaccine’s side effects. These findings were similar to previous studies, which reported that the reasons for COVID-19 vaccine uptake (or lack thereof) among minority groups and migrants included the fear of needles and side effects of vaccines [55,56], safety concerns [57,58]. A negative attitude toward the vaccine could be partly attributed to the influence of information sources [53]. The lack of documentation of less common side effects of vaccines also could have contributed to the mistrust [59]. These findings highlight that addressing fears might be useful in increasing vaccination uptake. Future studies should explore the determinant of fears in a holistic manner, such as considering the influence of financial impact of vaccination as a potential determinant [60]. Our study only included migrants with relatively low socioeconomic status. Studies have found that context of migration [61], language barrier and employer support [51] are associated with COVID-19 vaccine intention. These attributes tend to correlate with socioeconomic status; thus it is possible that skilled Myanmar migrants working in professional services might have different levels and domains of vaccination concerns compared to our participants. Future studies should consider expanding the scope of the study to include migrants in higher socioeconomic status.
Vaccine supply chain management barriers in our study included the lack of vaccination opportunity, insufficient vaccine supply, delays in vaccine procurement and delivery, and logistical challenges. Other studies also suggested that logistical issues have driven low COVID-19 vaccine uptake among migrants and racial minorities [53,57]. Disparities in vaccine delivery have been evident, particularly affecting minority and vulnerable communities, such as undocumented migrants in Thailand and the Roma community in Europe [62]. However, in addition to logistics, we also found structural issues such as difficulties in arranging vaccination appointments, similar to the findings of a previous study [54]. Despite the allocation of 500,000 doses of the COVID-19 vaccine for migrant workers to combat labor shortages and promote economic recovery [63], migrant workers who were insured by the Social Security Scheme (SSS) were prioritized over uninsured migrants [64], or the number of doses received by migrant workers might be limited [16,65]. The situation seemed to have improved by late 2021 [16]. However, in that year, approximately 1.3 million uninsured migrants did not receive any vaccinations in Thailand [66]. This highlights the critical need for more equitable distribution systems that ensure vaccine access regardless of insurance status. To improve vaccine access for migrant populations, supply chain management should be optimized through stratified budgeting, buffer stock systems, and mobile vaccination units, while strengthening cold chain infrastructure.
Our study also identified policy-related vaccination barriers, specifically documentation requirements, vaccination cost, and vaccine policy. Although the Thai government implemented an inclusive COVID-19 policy with support from the Ministry of Public Health and the Thai Red Cross [35], irregular Myanmar migrants still faced documentation issues as barriers to vaccination, whereas legalization may entail significant costs [67]. In addition to policy, there were barriers within the healthcare system including the necessity for identification in various vaccination procedures as well as data entry problems. Myanmar irregular migrants might be unfamiliar with the COVID-19 vaccination registration system [67]. Existing mobile-phone based applications, such as MorPhrom, can track vaccination records but do not fully support undocumented migrants, creating significant employment obstacles as many employers require proof of vaccination [35]. Therefore, partnerships with civil society organizations and employers, alongside policy adjustments that include amnesty provisions for undocumented migrants and removal of deterrent documentation requirements, ultimately creating an equitable and efficient vaccination system for all migrants regardless of their status. Moreover, structural barriers should be addressed by simplifying registration processes, removing insurance-based prioritization, and establishing multiple convenient vaccination points with flexible scheduling to accommodate work schedules.
In addition to health system and health policy, language is another commonly identified barrier to COVID-19 vaccination. This particular finding concurred with previous qualitative studies that described the difficulties of migrant from Myanmar in understanding vaccination procedures [67] and healthcare information [20]. Language is a common barrier to healthcare access for migrants in Thailand [68] and elsewhere [69]. Migrant workers from Myanmar typically have a limited command of Thai [70,71]. As most foreigners would need approximately 100 hours to learn Thai to sufficiently communicate [72,73], our study findings suggest that stakeholders in migrant health should identify potential translators and interpreters in contingency plans for future outbreaks and pandemics.
Strengths and limitations of the study
The strength of this study was the use of the native languages of the participants (Burmese and Thai) during interviews, which precluded potential information bias from interpretation or translation errors. However, a number of limitations should be considered in the interpretation of our study findings. Firstly, although our protocols did not exclude undocumented migrants, we were only able to recruit documented migrants working in manual labor occupations common in southern Thailand. These circumstances limited the generalizability of our study findings. The barriers among undocumented migrants might have been vastly different from those reported by our participants. Secondly, despite the use of primary languages to interview the participants, the possibility of social desirability bias could not be precluded from the study findings considering the sensitive nature of some of the interview questions. Thirdly, in our study, the transcription and translation of the interviews were different for those of the Myanmar migrants and those of the Thai employers and healthcare workers. The choices were based on the subjective judgment of the investigators. Such practice might have introduced potential inaccuracies. However, considering that we used verbatim texts for our analyses, we anticipate these differences to be small, particularly in the context of the broader study findings. Future studies should consider adapting methods to overcome these limitations.
Conclusion
In this qualitative study, we identified barriers to COVID-19 protective behaviors and vaccination among Myanmar migrants in Thailand. Supply chain management was a common theme in both barriers to vaccination and barriers to adherence to COVID-19 preventive measures. Moreover, each domain also had additional themes, such as lifestyle and habit-related barriers, lack of health education and health promotion, and fear of vaccination. These findings provide potentially useful insights for policymakers and healthcare providers working to enhance vaccine equity among migrant populations and prepare an inclusive plan to respond to future health emergencies. However, limitations regarding the lack of generalizability and social desirability bias should be considered in the interpretation of our study findings. Future research should focus on evaluating targeted interventions that address both systemic barriers and individual concerns, particularly in contexts where migrants face multiple vulnerabilities.
Supporting Information
S1 Table. Frequency of themes during interviews about barriers to adherence to COVID-19 protective measures
https://doi.org/10.1371/journal.pone.0317714.s001
(DOCX)
S2 Table. Frequency of themes during interviews about barriers for COVID-19 vaccination
https://doi.org/10.1371/journal.pone.0317714.s002
(DOCX)
S3 Table. COREQ (COnsolidated criteria for REporting Qualitative research) Checklist
https://doi.org/10.1371/journal.pone.0317714.s003
(DOCX)
Acknowledgments
This study was conducted as part of the first author’s doctoral thesis in the Department of Epidemiology, Prince of Songkla University, Thailand. We wish to thank all migrant workers, authorized persons from hospitals, factories, construction and fishery sites who actively and voluntarily participated in this study. We would like to acknowledge all local key informants who helped with data collection with immense support and cooperation.
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