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

Abstract

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://ichgcp.net/clinical-trials-registry/NCT03808597.

International registered report identifier (irrid): RR2-10.2196/25128.

Keywords: HIV/AIDS; Tanzania; cysticercosis; digital health; digital health promotion; eHealth; health education; mHealth; mobile health; mobile phone; tapeworm; tuberculosis.

Conflict of interest statement

Conflicts of Interest: None declared.

©Christine Holst, Dominik Stelzle, Lien My Diep, Felix Sukums, Bernard Ngowi, Josef Noll, Andrea Sylvia Winkler. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.07.2022.

Figures

Figure 1

Geographic location of the study site. From left to right: Tanzania within Africa and the Iringa district within Tanzania. Both illustrations are from Wikimedia Commons contributors (CC BY-SA 3.0).

Figure 2

Examples of illustrations of key messages from the animations. Important key messages were, for example, “never share sharp objects” and “avoid unsafe blood transfusions” for HIV/AIDS, “cover mouth and nose with paper or cloth when coughing or sneezing” for tuberculosis, and “cook meat well” for Taenia solium cysticercosis and taeniosis. These key messages were well illustrated, narrated, and repeated in the animations.

Figure 3

Screenshot of the platform.

Figure 4

Flowchart of the study. The figure shows the number of households assessed for inclusion before a random generator selected the 298 households for the intervention group and 302 households for the control group. One participant per household was included in the study. Further, the figure shows the remaining participants at the 3- and 12-month assessment.

Figure 5

Box plot and density plots for knowledge and by disease, group, and time point: (A) HIV/AIDS, (B) tuberculosis, (C) Taenia solium cysticercosis and taeniosis.