Utilizing community InfoSpots for health education: perspectives and experiences in Migoli and Izazi, Tanzania.

Limited access to health education can be a barrier for reaching the Sustainable Development Goals, especially in rural communities in sub-Saharan Africa. We addressed this gap by installing community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in Migoli and Izazi, Tanzania. The objective of this case study was to explore the perspectives and experiences of InfoSpot users and non-users in these communities. We conducted 35 semi-structured interviews with participants living, working or studying in Migoli or Izazi in February 2020 and subsequently analysed the data using content analysis. The 25 InfoSpot users reported variations in use patterns. Users with more education utilized the platform for their own health education and that of others, in addition to internet surfing. High school students also used the platform for practicing English, in addition to health education. Most InfoSpot users found the platform easy to use; however, those with less education received guidance from other users. Non-users reported that they would have used the InfoSpot with the platform if they had been aware of its existence. All participants reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. In conclusion, different and unintended use of the platform shows that the communities are creative in ways of utilizing the InfoSpots and gaining knowledge. The platform could have been used by more people if it had been promoted better in the communities.

Access to good-quality health education is crucial for reaching the Sustainable Development Goals. We installed community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in two rural villages in Tanzania in November 2019. This qualitative case study was conducted in Migoli and Izazi in February 2020, and 35 people participated in semi-structured interviews. Content analysis was performed with the software NVivo, and quotations were used to illustrate the themes. Twenty-five participants were classified as InfoSpot users. Variations and creativity in use patterns were reported. Less educated users were guided by others, while users with more education used the platform for their own and for the education of others, in addition to internet surfing. The students who used the InfoSpot for health education and for practicing English demonstrated unintended use of the platform. All non-users reported that they would have used the InfoSpots if they had been aware of their existence. All participants, users and non-users, reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. The use of such platforms can be an important factor in disease prevention.

Improving Health Knowledge Through Provision of Free Digital Health Education to Rural Communities in Iringa, Tanzania: Nonrandomized Intervention Study.

BACKGROUND: Community health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. OBJECTIVE: The objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. METHODS: We conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. RESULTS: Between April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7%) or control (n=302, 50.3%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2% (95% CI 5.0%-15.4%), 12% (95% CI 7.7%-16.2%), and 31.5% (95% CI 26.8%-36.2%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8% (HIV/AIDS), 7.5% (TB), and 13.9% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. CONCLUSIONS: Digital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25128.

GP phone calls to improve COVID-19 vaccine uptake among patients at increased risk of severe COVID-19: a randomised trial.

BACKGROUND: English media have reported that many unvaccinated individuals took the COVID-19 vaccine after receiving a phone call from their GP. AIM: To determine whether phone calls from GPs to unvaccinated patients at increased risk of severe COVID-19 improves uptake of the COVID-19 vaccine. DESIGN & SETTING: Randomised trial where 202 participants were allocated to receive a phone call from their GP, and 452 participants were allocated to not get the call. Twenty-five GPs at 11 medical centres in Norway took part. The post-trial focus group discussion was with five GPs. METHOD: Participants were sourced from the GP electronic medical record system, which communicates with the Norwegian Immunisation Registry and can generate a list of the GPs' unvaccinated patients at increased risk of severe COVID-19. RESULTS: The GPs managed to speak over the phone with 154 (76%) patients allocated to receiving a phone call. At follow-up (average 7.5 weeks), 8.9% in the intervention group and 5.3% in the control group had been vaccinated (odds ratio [OR] 1.72; 95% confidence interval [CI] = 0.90 to 3.28). Findings from the focus group discussion suggested the timing of the intervention as a likely key reason for its limited success. CONCLUSION: An increase in the proportion of patients who took the COVID-19 vaccine in the intervention group was observed, but the difference was smaller than anticipated, and may be a chance finding. The effect of this type of intervention will likely vary across contexts and may have proved more effective if a larger proportion of the population were unvaccinated.

Effects of a Digital Health Literacy Intervention on Porcine Cysticercosis Prevalence and Associated Household Practices in Iringa District, Tanzania.

Digital health is considered an opportunity to engage a wider community in disease control for public health. It has been used in healthcare consultation, in medical treatments and in reporting emergencies. The current study developed digital health literacy content for public health education and assessed its effects on porcine cysticercosis prevalence, pig-keeping style and pig pen and latrine qualities. The intervention was designed and evaluated on the prevention and control of porcine cysticercosis in the Iringa District of southern Tanzania. A quasi-controlled field trial with pre-intervention and post-intervention assessments of porcine cysticercosis, pig-keeping style and pig pen and latrine qualities was conducted. A baseline cross-sectional study was followed immediately by digital health literacy intervention, which comprised educational messages on porcine cysticercosis shown on computer tablets or smartphones. Free internet access supported unsupervised community access. The 25-month post-intervention assessments revealed significantly increased pig confinement (20.1%) (p = 0.026) and pig pen quality (16.2%) (p = 0.025). However, the quality of household latrines (p = 0.453) was not improved, nor was there any significant effect on the prevalence of porcine cysticercosis (p = 0.231). The digital health literacy intervention suggests a strategy for wider and sustainable dissemination of educational messages for Taenia solium infection control.

Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study.

BACKGROUND: Traditionally, health promotion and health education have been provided to communities in the global south in the form of leaflets or orally by health care workers. Digital health interventions (DHIs) such as digital health messages accessed by smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of health care systems. The DHI in this study focuses on disseminating digital health education regarding 3 disease complexes of high public health concern: HIV/AIDS, tuberculosis, and Taenia solium (neuro)cysticercosis or taeniasis, a parasitic zoonotic disease that requires a One Health approach. The DHI presents the participants with animated health videos (animations) and provides access to information spots (InfoSpots) with a free-of-charge digital health platform containing messages about health to rural Tanzanian communities. OBJECTIVE: The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. METHODS: This is a mixed methods study including a nonrandomized controlled trial and qualitative interviews conducted in rural Tanzania. A health platform containing digital health messages for the communities was developed prior to the study. The health messages consist of text, pictures, quizzes, and animations of everyday stories, aimed at disease prevention and early treatment. The baseline and immediate postintervention assessments were completed in Iringa, Tanzania in May 2019. The participants were interviewed by enumerators and completed questionnaires regarding health knowledge. Participants in the intervention group were exposed to 3 different health animations once on a tablet device. The participants' health knowledge was assessed again immediately after the exposure. The first follow-up survey was undertaken in August 2019. The InfoSpots with the digital health platform were thereafter launched in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. RESULTS: A total of 600 participants have been enrolled in the trial. We will assess (1) the difference in knowledge scores between baseline and the immediate postintervention assessments in the intervention group and (2) the difference in knowledge scores between the intervention and control groups at baseline, 3 and 6 months post-DHI rollout. Since a randomized design did not prove feasible, potential confounders (eg, age, gender, education, and time of exposure) may be introduced, and results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, and perspectives and experiences related to use and nonuse of the InfoSpots are being explored. CONCLUSIONS: The data have been collected, and the analysis is ongoing in this digital health study, aimed at evaluating the effects of a DHI based on relevant health messages. The publications of results can be expected this year. TRIAL REGISTRATION: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/25128.

Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach.

BACKGROUND: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. OBJECTIVE: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. METHODS: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania's national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. RESULTS: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. CONCLUSIONS: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government's objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25128.

[Experiences with the FAMACHA-Eye-Colour-Chart for identifying sheep and goats for targeted anthelmintic treatment]. / Erfahrungen mit der FAMACHA- Eye-Colour-Karte zur Identifizierung von Schafen und Ziegen für die gezielte anthelminthische Behandlung.

The bloodsuckling abomasal parasite Haemonchus contortus is the most pathogenic worm in sheep and goats. High prevalences of anthelmintic-resistant isolates make H. contortus difficult to control. Detecting the most anaemic animals could support a targeted selective treatment approach. Leaving the rest of the flock untreated would generate a refuge for anthelmintic-sensitive parasites. South-African researchers tried the FAMACHA-Eye-Colour-Chart for anaemic sheep and goats with good success. Field studies, carried out in Northern Germany on naturally infected sheep and goats showed, that at a comparatively low prevalence of H. contortus the FAMACHA-test proved not being sufficient in detecting all animals with high fecal egg counts. Under these conditions there was no satisfying reliability to identify small ruminants for selective deworming only based on the FAMACHAEye-Colour-Test. But if not working hours are the limiting factor, the repeated score could support the selection of pale animals in need to be treated.