By Suchi Gaur and Taru Bahl
Too many words clutter a poster on symptoms of Japanese Encephalitis put up at a district hospital; a hoarding outside a busy town’s interstate bus stand has information on who to contact in case of an animal or child getting infected with JE, but its photographs are rather depressing and chilling; a flip book on JE for use by health workers in their community interactions has visuals but without a local connect. They appear to be drawn from another country; comic strips developed for students as part of an advocacy drive on JE has been translated in the local language but not in the dialect that is familiar to the children with whom it is being shared.
These are some of the pitfalls of ill-planned communication materials that have been developed in a vacuum, without being part of a well-planned comprehensive communication strategy. A communication strategy for vector borne diseases (VBD) has to be seen in the context of the specific disease and country/setting in question. A general trend seen in most JE-endemic nations like China, Lao, Vietnam, Cambodia and Hong Kong, amongst others, has been to focus on printed information, education and communication (IEC) materials in the form of pamphlets, posters, flip charts and fact sheets addressing gaps in information and knowledge and hoping these would lead to desired behaviour change.
Where funds are available and there is a deeper commitment towards disseminating messages across platforms, visibility is created through outdoor media like hoardings, banners, wall paintings, flex posters stuck on public transport and messages on inter-city buses. Radio and television spots which are effective but expensive are used in some cases during specific time-periods like the monsoon season, when AES/JE transmission is highest.
Sifting through the maze of JE messaging
According to communication experts, for any public health intervention, especially one as sensitive as JE, it is imperative to develop materials based on findings of formative research. The gap analysis that wouldbe undertaken as part of the exercise would guide material design and finalisation. Sufficient thought must be given to training those who would disseminate materials in the community. For example when New Concept worked on the Kala Azar communication strategy for the National Vector Borne Disease Programme (NVBDCP) they not only did formative research thatfed into the development of the BCC strategy along with implementation plans at national and sub-national levels, developing TV and radio spots, FAQ booklet and flipbook for frontline workers in Hindi, Bengali and English but also pretested them and developedcapacity building materials for training state/district/sub-district teams involved in Kala-azar elimination.
Meanwhile, NVBDCP developed VBD- specific tool kits on elimination of lymphatic filariasis, dengue and chikunguniya, malaria and AES/JE. While most are in printed form there are others with audio-visual elements in English and Hindi. Posters developed by NVBDCP on JE capture a set of Do’s and Dont’s for JE, informing the reader what JE is and what its symptoms are Uploaded on their website, they are a resource which states can download and adapt/translate as per their need. Elsewhere, as part of health risk communication a poster in Hong Kong titled, “Prevention of Japanese Encephalitis and Dengue Fever Act Now!” went beyond providing basic information. It motivated communities to be watchdogs, encouraging them to report the mosquito problem to the department.
Edutainment format and its place in health communication Lack of awareness is a major bottleneck to navigate for health communication professionals. This becomes even more challenging in resource constrained settings, marked by illiteracy, poverty, backwardness and poor health seeking behaviour. There have been many successes in the area of HIV/AIDS, Malaria, Tuberculosis, food and nutrition where technical and programme teams have worked closely with communication professionals to create socially and culturally relevant platforms to disseminate messages with a view to inform and bring about desired change in behaviours.
Approaches like Edutainment (Rogers & Singhal, 1999) have helped customise messages with a view to entertain and educate. They have succeeded in increasing knowledge about issues, creating favourable attitudes and change in behaviours. In such a situation, stories converted into comics, theatre and songs have helped a great deal in fastening the process of positive behaviour change.
Comics as an information and advocacy tool
With a strongvisual appeal, simple dialogues, crisp storyline and realistic characters, comics not only add a personal touch to the public health issue in a culturally sensitive manner but also engage participants in the process. Though the challenge of literacy remains, comics have been used as a major public health communication tool. Comics like “Intelligent" on malaria allowed people to learn about transmission, and what the scientific community is doing to fight it and has been translated in eight different languages. Comics on Ebola published by International Organization for Migration (IOM) Liberia, has been raising awareness about preventing Ebola and seeking early care.Comics like Luke & Lucy titled “Auntie Biotica” by Belgian Antibiotic Coordination Committee have provided correct information on use of antibiotics.
With the onset of monsoon, and threat of malaria, diarrhoea and other VBDs looming on the horizon, Odisha state government in India, created awareness among schoolchildren on the mosquito menace and its link with VBDs through comic books and cartoon films.Schools were asked to conduct health education activities for elimination of mosquito breeding sources, sanitation, hand washing and hygiene practices among children. The comic book 'Masanka Bhagadauda' and a cartoon film titled 'Masanaka Birudhare Yudha Dakara' was distributed among children and was extremely well received.
RCZI develops a comic strip series on JE
Closer home, the PHFI/RCZI’s JE study on “Identifying Sources, Pathways and Risk Drivers in Ecosystems of JE in an Epidemic-Prone North Indian District” from 2011-14 concluded with a set of findings and recommendations for policy makers and the research community. One of the most glaring findings that emerged was the half-baked knowledge which vulnerable, at-risk communities had on JE. Many did not recognise symptoms, were not fully aware of precautions and preventive measures that could safeguard them and nearly all reached the right health care facility late into the disease. Health workers inspite of being most the accessible and credible source of information to households, were not fully informed on JE and unclear of when/where to make appropriate referrals.
Once the study concluded, the RCZI research and communication teams worked to create a basket of communication materials based on findings and which could serve as additional information/resources/tools for advocacy, scale-up, replication and learnings. A set of five colour comics in A-4 size were developed, each scenes having accompanying blurbs, dialogue boxes and narratives with characters drawn from the community. They follow a simple and linear story telling format, bringing out the central message on JE.
This commentary section invites you to share your experience of conceptualising, creating and disseminating JE materials. Also, as observers, programme managers, policy makers and field staff, what is your take on what communities really need and what can be impactful for them in a way that brings about change in their health seeking behaviours.
Suchi is Manager, Communication & Knowledge Management at RCZI and Taru is a communication specialist and freelance journalist.
JE outbreaks are being reported from previously unknown foci. Further, encephalitis outbreaks of other aetiologies in endemic areas have only added to their complexity. For programme managers, researchers and community health professionals, access to accurate and updated information is key to planning interventions and other relief measures.read more