Key Health Messages Research Articles

Stigma, support, and messaging for people recently diagnosed with HIV: a qualitative study.

Background Despite advances in antiretroviral treatment and the message of undetectable equals untransmittable (U=U), there remain challenges related to stigma and quality of life for people living with HIV. This study aimed to understand the experiences of people recently diagnosed with HIV at a clinical service, to guide insights into how to improve care and support in the contemporary treatment era. Methods This qualitative study involved semi-structured interviews with individuals diagnosed with HIV between 2016 and 2021 at RPA Sexual Health service (a sexual health clinic in Sydney, Australia), or who were referred to the clinic directly after diagnosis. Participants were recruited through a short survey questionnaire between May 2022 and May 2023, and interviews were transcribed and analysed thematically. Results Fourteen participants were interviewed for the study, eight of whom were born outside of Australian or Aotearoa New Zealand. We found that diagnosis was still a shocking event requiring careful support; that there was ongoing stigma, shame, and reduced sexual confidence following diagnosis; and that beyond initial diagnosis, some people would benefit from ongoing support and education about key concepts regarding HIV treatment. Conclusion Our study suggests that HIV diagnosis remains disruptive, and sexual stigma is a key issue negatively impacting quality of life. Health providers can mitigate these issues by supporting the ongoing psychosocial needs of people with HIV in the early period of adjusting to HIV diagnosis, and referring to peer-based and other services. Initiating conversations about sex and dating and checking understandings of key health messages over time may promote improved care.

Effect of Digital-Based Self-Learned Educational Intervention about COVID-19 Using Protection Motivation Theory on Non-Health Students' Knowledge and Self-Protective Behaviors at Saudi Electronic University.

The COVID-19 pandemic has disastrous impacts that impose the cultivation of knowledge and motivation of self-protection to foster disease containment. Evaluate the effect of digital self-learned educational intervention about COVID-19 using the protection motivation theory (PMT) on non-health students' knowledge and self-protective behaviors at Saudi Electronic University (SEU). A quasi-experimental study was accomplished at three randomly chosen branches of SEU (Riyadh, Dammam, Jeddah) using a multistage sampling technique to conveniently select 219 students. An electronic self-administered questionnaire was used, which included three scales for assessing the students' knowledge, self-protective behaviors, and the constructs of the PMT. The educational intervention was designed using four stages: need assessment, planning, implementation, and evaluation. A peer-reviewed digital educational content was developed after assessing the participants' educational needs using the pretest. Then, distributed through their university emails. A weekly synchronous Zoom cloud meeting and daily key health messages were shared with them. Finally, the post-test was conducted after two months. The mean participants' age (SD) among the experimental group was 28.94 (6.719), and the control group was 27.80 (7.256), with a high female percentage (63.4%, 73.8%) and a previous history of direct contact with verified COVID-19 patients (78.6%, 69.2%), respectively. A significant positive mean change (p = 0.000) was detected in the total COVID-19 knowledge of the experimental group post-intervention, either when it was adjusted for the covariates effect of the control group (F1 = 630.547) or the pretest (F1 = 8.585) with a large effect size (η2 = 0.745, η2 = 0.268, respectively). The same was proved by the ANCOVA test for the total self-protective behaviors either when it adjusted for the covariates effect of the control group (F1 = 66.671, p = 0.000) or the pretest (F1 = 5.873, p = 0.020) with a large effect size (η2 = 0.236, η2 = 0.164, respectively). The ANCOVA test proved that post-intervention, all the PMT constructs (perceived threats, reward appraisal, efficacy appraisal, response cost, and protection intention) and the total PMT score were significantly improved (p = 0.000) among the experimental group either when adjusted for the covariates effect of the control group (F1 = 83.835) or the pretest (F1 = 11.658) with a large effect size (η2 = 0.280, η2 = 0.561, respectively). The digital PMT-based self-learned educational intervention effectively boosts non-health university students' COVID-19 knowledge, protection motivation, and self-protective behaviors. Thus, PMT is highly praised as a basis for COVID-19-related educational intervention and, on similar occasions, future outbreaks.

Australian women's information-seeking preferences and needs in preparation for pregnancy.

The preconception period provides opportunities for health behaviour optimisation for improved maternal and child well-being. However, preconception information sources women engage with are not well-known. To address this gap, the current cross-sectional study retrospectively explored (1) preconception information or advice accessed on recommended preconception health topics and (2) preferred sources of preconception information amongst pregnant women receiving care through Australian public and private maternity settings. Overall, 78% of women reported accessing any preconception health information, predominantly concerning achieving/maintaining a healthy weight, diet, folic acid and multivitamin supplementation. Preferred information sources included health professionals, e.g. general practitioners (74%) and the internet (66%), although source engagement varied. Whilst women predominantly prefer seeking preconception health information from health professionals and the internet, multi-modal resources are needed to reach women and enhance engagement with evidence-based information and healthcare in preparation for pregnancy. SO WHAT?: Evaluation of preconception health resources for women and health professionals is warranted, appraising their adequacy in supporting engagement with key preconception health messages. In particular, assessment of the quality, readability and evidence-base of online resources is needed. Our findings highlight the need for public health experts to take action to raise awareness amongst women of the importance of preconception health, encourage health professional engagement for preconception care and direct women to more appropriate evidence-based online resources.

Improving access to COVID-19 information by ensuring the readability of government websites.

Issue addressedThis study evaluated the readability of web pages from two public‐facing Victorian government websites that were responsible for communicating key health messages relating to the COVID‐19 pandemic in 2020.MethodsWebpages were downloaded and filtered to identify relevant materials (English language materials containing HTML files that referred to COVID‐19). The files were converted to text files and two Python packages, SpaCy and TextStat were used to obtain the data presented here. In addition to running two well‐established readability tests, SMOG Index (Simple Measure of Gobbledygook) and Flesch Reading Ease formula, we also calculated the figures for sentence length and word length, which drive the readability measures and allow a disaggregated view of the data. Type token ratio measures were conducted as a reflection of the breadth of vocabulary used in the web pages.ResultsDerived measures of text complexity were higher than recommended levels of text complexity for health promotion materials, which are generally set at senior primary school levels. This did not vary depending on the intended audience (public or professional). A senior secondary reading level was required for effective engagement with the text published on both sites.ConclusionsImproving the readability of materials on key government websites where information about COVID‐19 is being communicated to the public, represents a low cost and potentially effective means of improving public understanding of the pandemic and the steps individuals need to take to protect themselves and the community.So what?Given the challenges widely identified in ensuring compliance with protective behaviours, confidence in seeking vaccination and increasing distrust of government, it would be strategic to improve public communication to ensure health messages are simple and readily understood.SummaryThe complexity and readability of text contained in web pages during 2020 from two Victorian government departments were evaluated. Communication regarding the restrictions and the management of risks associated with COVID‐19 was the main focus of these 367 individual web pages from the Department of Health and Human Services (DHHS) and the Department of Education and Training (DET). Results indicated that across both sites and on both readability measures used, an education level equivalent to senior secondary school would be required to readily understand the contents.

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

BackgroundHealth 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.ObjectiveThe 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.MethodsThe 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.ResultsBetween 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.ConclusionsOur 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

Developing a scalable framework for partnerships between health agencies and the Wikimedia ecosystem.

In this era of information overload and misinformation, it is a challenge to rapidly translate evidence-based health information to the public. Wikipedia is a prominent global source of health information with high traffic, multilingual coverage, and acceptable quality control practices. Viewership data following the Ebola crisis and during the COVID-19 pandemic reveals that a significant number of web users located health guidance through Wikipedia and related projects, including its media repository Wikimedia Commons and structured data complement, Wikidata. The basic idea discussed in this paper is to increase and expedite health institutions' global reach to the general public, by developing a specific strategy to maximize the availability of focused content into Wikimedia's public digital knowledge archives. It was conceptualized from the experiences of leading health organizations such as Cochrane, the World Health Organization (WHO) and other United Nations Organizations, Cancer Research UK, National Network of Libraries of Medicine, and Centers for Disease Control and Prevention (CDC)'s National Institute for Occupational Safety and Health (NIOSH). Each has customized strategies to integrate content in Wikipedia and evaluate responses. We propose the development of an interactive guide on the Wikipedia and Wikidata platforms to support health agencies, health professionals and communicators in quickly distributing key messages during crisis situations. The guide aims to cover basic features of Wikipedia, including adding key health messages to Wikipedia articles, citing expert sources to facilitate fact-checking, staging text for translation into multiple languages; automating metrics reporting; sharing non-text media; anticipating offline reuse of Wikipedia content in apps or virtual assistants; structuring data for querying and reuse through Wikidata, and profiling other flagship projects from major health organizations. In the first phase, we propose the development of a curriculum for the guide using information from prior case studies. In the second phase, the guide would be tested on select health-related topics as new case studies. In its third phase, the guide would be finalized and disseminated.

From Salt to Stroke-Evaluation of a Media Campaign for Sodium Reduction in Philadelphia.

Excess dietary sodium contributes to the burden of chronic disease, including cardiovascular disease and stroke. Media-based health education campaigns are one strategy to raise awareness among populations at greater risk for stroke, including African Americans. During 2014–2015, the Philadelphia Department of Public Health conducted a health education campaign using radio, print news, and transit ads, to promote awareness of the link between dietary sodium, hypertension and stroke, and encourage reduced consumption of high sodium foods. Using a repeated cross-sectional design, street intercept surveys were conducted with ~400 Philadelphia residents representing the campaign's priority audience (African Americans ages 35–55) before and 6–13 weeks after the campaign, to evaluate both process (campaign exposure) and impact (recall of key health messages). Thirty percent of post-campaign respondents reported familiarity with one of the most engaging radio spots, and 17% provided accurate unaided recall of its key content, with greater recall among older respondents and frequent radio listeners. Forty-one percent of post-campaign respondents named stroke as a consequence of excess salt consumption, compared to only 17% of pre-campaign respondents, with greater awareness of the salt-stroke connection among those accurately recalling the radio spot from the campaign. Results suggest that priority populations for sodium reduction can be effectively reached through radio and transit campaigns. From a pragmatic perspective, street intercept surveys may offer one low resource strategy for evaluating public health education campaigns conducted by local health departments, especially among urban populations.

Myhealth–developing accessible health materials with men with intellectual disability: a co-created Proof of Concept

This paper describes the development of user focussed health materials for men, in the form of a tactile set of health post cards and a digital web-based platform- Myhealth. Health experts with Intellectual Disability (ID) co-created Myhealth over the two phases of work reported in the paper. Men with ID experience more health concerns when compared with the non-disabled population and themselves require user sensitive health promotion materials to effectively access health provision. Following the successful co-creation of Men’s health postcards, Co-creation also underpinned the method adopted to create the digital version of Myhealth. Through a series of prototyping workshops, we co-created the content, key health messages and navigation of information for a web-based version. Human centred engagement with this able, but marginalized group of men enabled the production of user accessible health materials relevant for all men.

Engaging ethnic minority communities through performance and arts: health education in Cambodian forest villages.

BackgroundIn Siem Pang, northeastern Cambodia, malaria transmission persists in remote forested areas populated by ethnic minorities. Engaging affected communities in health education campaigns is challenging due to language, access and literacy constraints. During 2018, a newly established medical research station conducted a health education programme in local villages harnessing traditional songs, arts and crafts, along with theatre, comedy and health talks and quizzes. Health education topics were proposed by community leaders and focused on maternal and child health and malaria. This article describes a process evaluation of these activities, the community's response and whether this was an appropriate form of health education in this context.MethodsIn-depth interviews were conducted with community members, leaders and performers. Interviews were audio-recorded, transcribed and translated to English for thematic analysis.ResultsIn total, 65 interviews were conducted; 20 of these were follow-up interviews with respondents interviewed prior to the performances. Respondents were able to recall the key health messages about malaria, antenatal care and infant vaccination. They also showed good awareness of malaria transmission and prevention and described how they enjoyed the events and appreciated the efforts of the project team.ConclusionsIn isolated communities in Cambodia, a health education programme harnessing performance and arts engaged the whole community and its messages were readily recalled and prompted reflection.

Opening doors during lockdown

When lead dental nurse Juliette Moss couldn't visit schools to share key oral health messages, she got busy editing a video instead…

Hand washing behavior change effect of community-based hygiene and sanitation intervention in low resource setting.

Lack of hygiene and sanitation causes significant disease, disability and death. Majority of diarrheal diseases are related to hygiene and drinking water. Hand washing with soap after toilet use and before eating reduces these risks significantly. This report is based on a behavior change project in the rural community setting (union council Nahqi), Peshawar, Pakistan aimed to improve hygiene- and sanitation-related behavior. A pre-intervention survey was conducted at household level (n=958), followed by a structured behavior change communication program with motivational and educational material and key health messages for three months. Lastly, an end-line survey was conducted measuring change in practice domains. All the domains of hygiene and sanitation showed statistically significant improvement (11-59% P<0.001), including handwashing before meals (28.2%), before cooking (54.1%), before child feeding (21.2%), after defecation (30.6%); tooth brushing twice daily (7.3%); nail clipping at least weekly (16.3%); bathing daily (11.3%); change of clothing twice weekly (24.7%); covering the water containers (59.3%) and house orderliness (30.6%). The findings conclude that a behavior change communication program that is in accord with community needs, level of their understanding, beliefs and sociocultural norms is well received for positive behavior change.

MHealth tool to improve community health agent performance for child development: study protocol for a cluster-randomised controlled trial in Peru

IntroductionCultivating child health and development creates long-term impact on the well-being of the individual and society. The Amazon of Peru has high levels of many risk factors that are associated...

A first step to improving maternal mortality in a low-literacy setting; the successful use of singing to improve knowledge regarding antenatal care

Preventable maternal mortality is related to delays in recognizing the problem, transport to a facility, and receiving appropriate care on arrival. Reducing maternal mortality in low-literacy settings is particularly challenging. In the rural villages of Nepal, the maternal mortality rate is among the highest in the world; the reasons include illiteracy and lack of knowledge of the needs of pregnant women. Culturally, singing and dancing are part of Nepalese daily life and present an opportunity to transmit knowledge of antenatal care and care at birth with a view to reducing the first 2 delays. We hypothesized that health messages regarding the importance of antenatal care and skilled birth assistance would be effectively transmitted by songs in the limited literacy environment of rural Nepal. We randomly grouped 4 rural village development committees comprising 36 villages into 2 (intervention and control) clusters. In the intervention group, local groups were invited to write song lyrics incorporating key health messages regarding antenatal care to accompany popular melodies. The groups presented their songs and dances in a festival organized and judged by the community. The winning songs were performed by the local people in a song and dance progression through the villages, houses, and fields. A wall chart with the key health messages was also provided to each household. Knowledge of household decision makers (senior men and women) was assessed before and after the intervention and at 12 months using a structured questionnaire in all households that also assessed behavior change. Structured interviews were conducted at baseline, immediately postintervention in the control and intervention areas (intervention n= 735 interviews, control n= 775), and at 12 months in the intervention area only (n= 867). Knowledge scores were recorded as the number of correct items out of 36 questions at baseline and postintervention, and of 21 questions at follow-up. Postintervention, test score doubled in the intervention group from a mean of 11.60/36-22.33/36 (P < .001), with no practically significant change in the control population (17.48/36-18.26/36). Improvement was greatest among the most illiterate members of the community (6.8/36-19.8/36, P < .001). At 12 months follow-up, a majority of the participants (63.9%) indicated that they provided information learned from the songs to their neighbors and friends, and 41.3% reported still singing the songs from the intervention. The use of songs bypassed the limitations of literacy in communicating health messages that are key to improving maternal care in this low-literacy rural setting within a developing country. The improvements were maintained without further intervention for 12 months. With appropriate sociocultural adaptation to local contexts, this low-cost method of community education may be applicable to improving maternal health knowledge and behavior change in other low-resource and limited literacy settings that may lead to reductions in maternal mortality.

Celebrity endorsed music videos: innovation to foster youth health promotion.

There are calls for innovation in health promotion and for current issues to be presented in new and exciting ways; in addition to creating engaging messages, novel ways to deliver health messaging are needed, especially where youth are the key target audience. When pupils in WHO Health Promoting Schools were asked what health messages would resonate with them, they also identified celebrities as the 'messengers' they would be particularly likely to listen to. Expanding on these discussions, the pupils quoted celebrity-recorded music videos containing health and lifestyle messaging as an example of where they had learned from celebrities. Their ability to sing phrases from the songs and repeat key health messages they contained indicated the videos had commanded attention and provided knowledge and perspectives that had been retained. We located on YouTube the video titles the pupils identified and evaluated the content, messaging and production concepts these celebrity-recorded music videos incorporated. All are good examples of the health promotion genre known as education entertainment, where educational content is intentionally included in professionally produced entertainment media to impart knowledge, create favorable attitudes and impact future behaviors. The importance of this genre is growing in parallel with the burgeoning influence of social media. Music videos resonate with youth, and celebrity recordings combine young people's love of music with their fascination for the aura of celebrity. Hence, producing videos that combine an effective health message with celebrity endorsement offers potential as an innovative conduit for health promotion messaging among youth.

Adaptation of child oral health education leaflets for Arabic migrants in Australia: a qualitative study

BackgroundThe purpose of this study was to gain an in-depth understanding of Arabic-speaking mothers views on the usefulness of existing oral health education leaflets aimed at young children and also to record their views on the tailored versions of these leaflets.MethodsThis qualitative study was nested within a large ongoing birth cohort study in South Western Sydney, Australia. Arabic-speaking mothers (n = 19) with young children were purposively selected and approached for a semi-structured interview. Two original English leaflets giving advice on young children’s oral health were sent to mother’s prior to the interview. On the day of interview, mothers were given simplified-English and Arabic versions of both the leaflets and were asked to compare the three versions. Interviews were audio-recorded, subsequently transcribed verbatim and analysed by thematic analysis. Ethical approval was obtained from Human Research Ethics Committees of the former Sydney South West Area Health Service, University of Sydney and Western Sydney University.ResultsMothers reported that simplified English together with the Arabic version of the leaflets were useful sources of information. Although many mothers favoured the simplified version over original English leaflets, the majority favoured the leaflets in Arabic. Ideally, a “dual Arabic - simplified English leaflet” was preferred. The understanding of key health messages was optimised through a simple layout and visual images.ConclusionsThere is a need to tailor oral health education leaflets for Arabic-speaking migrants. Producers of dental leaflets should also consider a “dual Arabic – simplified English leaflet” to improve oral health knowledge of Arabic-speaking migrants. The use of simple layout and pictures assists Arabic-speaking migrants to understand the content of dental leaflets.

Do You Know? Edutainment, HIV/AIDS, and African Americans

ABSTRACTA 33-minute dramatic production, Do You Know?, was written and produced using episodic framing to create a storyline around several college students and the potential spread of HIV/AIDS. This edutainment project was also constructed using exemplars to present key health messages that show the importance of getting tested, knowing your status and protecting yourself in personal relationships. Study participants over 18 years old watched Do You Know? on the Internet (Facebook or YouTube) and completed a survey. Study participants under 18 years old watched the video as part of a focus group, completed the survey, and then participated in a 30-min discussion. The findings of this study suggest that edutainment and the Internet can be effective in reaching African Americans with important health information.

Art and theatre for health in rural Cambodia

ABSTRACTThis article describes our experience using art and theatre to engage rural communities in western Cambodia to understand malaria and support malaria control and elimination. The project was a pilot science–arts initiative to supplement existing engagement activities conducted by local authorities. In 2016, the project was conducted in 20 villages, involved 300 community members and was attended by more than 8000 people. Key health messages were to use insecticide-treated bed-nets and repellents, febrile people should attend village malaria workers, and to raise awareness about the risk of forest-acquired malaria. Building on the experience and lessons learnt in the year prior, the 2017 project which was conducted in 15 villages involved 600 community members and attracted more than 12,000 people. In addition to the malaria theme, upon discussion with local health authorities, secondary theme (infant vaccination) was added to the 2017 project. We learnt the following lessons from our experience in Cambodia: involving local people including children from the beginning of the project and throughout the process is important; messages should be kept simple; it is necessary to take into consideration practical issues such as location and timing of the activities; and that the project should offer something unique to communities.

"Koko et les lunettes magiques": An educational entertainment tool to prevent parasitic worms and diarrheal diseases in Côte d'Ivoire.

BackgroundIntegrated control programs, emphasizing preventive chemotherapy along with health education, can reduce the incidence of soil-transmitted helminthiasis and schistosomiasis. The aim of this study was to develop an educational animated cartoon to improve school children’s awareness regarding soil-transmitted helminthiasis, diarrheal diseases, and related hygiene practices in Côte d’Ivoire. The key messages included in the cartoon were identified through prior formative research to specifically address local knowledge gaps.MethodologyIn a first step, preliminary research was conducted to assess the knowledge, attitudes, practices, and beliefs of school-aged children regarding parasitic worm infections and hygiene, to identify key health messages to be included in an animated cartoon. Second, an animated cartoon was produced, which included the drafting of the script and story board, and the production of the cartoon’s initial version. Finally, the animated cartoon was pilot tested in eight selected schools and further fine-tuned.Principal findingsAccording to the questionnaire results, children believed that the consumption of sweet food, eating without washing their hands, sitting on the floor, and eating spoiled food were the main causes of parasitic worm infections. Abdominal pain, diarrhea, lack of appetite, failure to grow, and general fatigue were mentioned as symptoms of parasitic worm infections. Most of the children knew that they should go to the hospital for treatment if they experienced symptoms of parasitic worm diseases. The animated cartoon titled “Koko et les lunettes magiques” was produced by Afrika Toon, in collaboration with a scientific team composed of epidemiologists, civil engineers, and social scientists, and the local school children and teachers. Pilot testing of the animated cartoon revealed that, in the short term, children grasped and kept key messages. Most of the children who were shown the cartoon reported to like it. Acceptance of the animated cartoon was high among children and teachers alike. The messaging was tailored to improve knowledge and practices for prevention of helminthiases and diarrheal diseases through prior identification of knowledge gaps. Integration of such education tools into the school curriculum, along with deworming campaigns, might improve sustainability of control and elimination efforts against helminthiases and diarrheal diseases.

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study

BackgroundIn resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai.MethodsBetween May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis.ResultsAll study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers’ group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs.ConclusionsOur findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings.

Exploring parents' and teachers' perceptions of promoting oral health in children

Objectives: The study aimed to explore the perceptions of teachers and parents of infant school children in primary schools positioned and servicing affluent and deprived populations as intermediate and end users of oral health promotion services in the Vale of Glamorgan, Wales. Method: Two primary schools within the Vale of Glamorgan were selected each representing different geographical locations within the area as well as different socio-economic profiles. A focus group of parents (n=8 school 1); an individual face-to-face interview with one parent (school 2) and individual face-to-face interviews with both headteachers and one reception teacher from each school. A 12-item interview schedule was devised in which face and content validity was established. A thematic analysis using Nvivo was then undertaken in which themes and sub-themes were identified. Results: Seven themes emerged from the analysis of the data. These included: ‘responsibility’, ‘the dentist’, ‘the role of the health visitor and school nurse’, ‘school policy’, ‘oral health education’, ‘positive role modelling’ and ‘Designed to Smile’. Confused messages were reported by both teachers and parents, which suggest that different approaches are needed in the delivery of key oral health messages. Conclusions: There were clear differences in the perceptions of disease experiences of children in the teachers and the parents of each school and clear evidence of dental disease having an impact on some of the children in school 1. Health visitors and school nurses as public health professionals are best placed to take the lead on oral health promotion in pre-school, school children, young people and their families in communicating clear, accurate, consistent and unambiguous evidence-based messages. Working more collaboratively with Designed to Smile, general and community dentists can do much to raise the profile of oral health promotion particularly for those families who need it most.