Developing effective health communication messages for community acquired pneumonia in children under five years of age: A rural North Indian qualitative study

Abstract

Background with objectives: Community acquired pneumonia (CAP) is the leading cause of childhood deaths globally. Poor recognition of the danger signs of CAP, inappropriate care seeking, and community distrust in the primary health system are factors largely responsible for CAP related deaths in rural India. Our objective was to develop and pilot test culturally sensitive communication messages for improving symptom recognition of CAP as a means of encouraging timely health care seeking, and to promote trust in the government primary health system as an effective source of CAP treatment among children. Methods and materials: Qualitative research was carried out between February and July 2014 in the states of Uttar Pradesh (U.P.) and Bihar in northern India. Message development entailed a six-step process: (1) theme identification, (2) creative conceptualization of messages, (3) pretesting messages in focus groups (FGs), (4) modification of messages, tagline/logo based on feedback, (5) piloting modified messages in FGs and further refinement and (6) harmonization of final communication products to ensure consistency. Results: Messages were piloted in 49 FGs in 7 rural districts. Hindi terms for the signs of respiratory illness and lay use of “pneumonia” as a term encompassing CAP were understandable across all dialects. Five text, five audio and four video based messages were initially developed and pretested. Three text based messages, four audio and three video were deemed acceptable for pilot testing and refinement. Messages selected for use in future communication programs balanced measures of popularity with measures of maximum comprehension and least misunderstanding. Messages selected were harmonized so they would reinforce one another. Common logo and tagline ensured that the messages would be seen as components of a new outreach program associated with the government's efforts to address CAP as a primary healthcare priority. Conclusions: Culturally sensitive messages for improving case management of CAP were developed through a multi-stage, evidence-based research process in a rural population. They need to accompany health systems strengthening efforts to increase confidence in government health facilities.