"Empty stomachs don't have ears": the role of local context in shaping the integration and implementation of health education for neglected tropical diseases.

Neglected Tropical Diseases (NTDs) place a health burden on millions of people worldwide. These diseases are particularly harmful because they tend to strike most commonly in poor rural populations and urban slums in developing countries where are limited. In addition, populations are often infected by several of these diseases simultaneously, and particularly in sub-Saharan African countries. Integrating vertical disease programs is an innovative approach to NTDs, and integrated health education is an important feature of this approach. Two health behavior models helped frame this study: the Health Belief Model and the Transtheoretical Model. In addition, two health education models for NTDs framed this study: the PRECEDE-PROCEED Model and the Interactive Model. The purpose of this study was to understand how the local context shaped the integration and implementation of health education in Togo’s pilot Neglected Tropical Disease project. This study was guided by the following research questions: (1) How has the health education for Togo’s pilot NTD integration project been: a) integrated, and b) delivered thus far? (2) What factors shape the integration of NTD health education messages and their delivery? A basic qualitative study design was used to explore these questions. Interviews were conducted with twenty participants from the national, district, and village levels of Togo’s health system. In Togo’s pilot project, NTD health education messages were integrated through the health education materials. In particular, integration occurred through the process of developing key messages, and through designing the pictures in the materials. Using these materials, integrated health education was delivered primarily through village-level group meetings with the support of village leadership. The factors that shaped integrated health education were the socio-cultural factors and structural factors of: 1) gender, 2) local beliefs about illness and diseases, 3) the role of Traditional Healers, 4) poverty, and 5) lack of infrastructure. Two conclusions emerged based on the findings of this study. First, integration of NTD health education hinges on selecting topics and pictures that are appropriate at the village level. Second, the delivery of integrated NTD health education is dependant upon the support of village leadership and the participation of village members.