Evaluation of context-specific evidence-based strategies to improve knowledge, attitudes, and practices towards female genital schistosomiasis using re-aim framework: an embedded mixed-methods study
Background
Recent studies highlight significant knowledge gaps and misconceptions about Female Genital Schistosomiasis among healthcare workers (HCWs) and community members in endemic regions. These studies had recommended the need to implement targeted education, awareness campaigns, and improve healthcare workers’ training to address the multifaceted challenges associated with FGS detection and management. This study evaluated a context-specific evidence-based intervention designed to improve FGS-related knowledge, attitudes, and practices among HCWs and women of reproductive age using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in Lower Manya-Krobo and Shai Osudoku Municipalities in Ghana.
Methods
A repeated cross-sectional embedded mixed-methods study was conducted in Lower Manya-Krobo Municipal (intervention district) and Shai Osudoku District (control district) in Ghana following six months of intervention implementation. The intervention included HCWs training, provision of screening and educational materials, supportive supervision and community awareness activities. Quantitative surveys were conducted among HCWs and women at baseline and post-intervention, while qualitative data were collected through key informant interviews and focused group discussion. The data was transcribed and coded using deductive and inductive approach, and thematically analysed. Descriptive analyses were performed on the survey data, a composite score was derived for knowledge, attitudes, and practices and reported as a mean score. Findings were interpreted using the RE-AIM framework.
Results
The intervention reach 107 HCWs across 22 health facilities and was implemented through multiple community engagement activities. In the intervention district, HCWs knowledge scores increased from 41.38% to 72.55%, attitudes from 60.99% to 63.94% and practices from 17.61% to 55.71%. Among women of reproductive age, knowledge scores increased from 44.62% to 56.51%, attitudes from 48.86% to 57.54%, and practices from 29.76% to 44.44%. qualitative finding corroborated these improvements, with participants reporting increased FGS awareness, confidence in screening and management, and improved health-seeking behaviours. The intervention was widely adopted and integrated into routine health services and community activities.
Conclusion
Context-specific, evidence-based FGS interventions are feasible and acceptable within schistosomiasis-endemic settings and can improve FGS-related knowledge and practices among HCWs and women of reproductive age. The findings support the integration of FGS interventions into routine health services and demonstrate the usefulness of the RE-AIM framework for evaluating implementation and informing scale-up.