Relevance of printed materials: An illustrated booklet for reinforcing CHW knowledge of tuberculosis

3 June, 2018

Dear HIFA colleagues,

Here is a new paper in the African Journal of Primary Health Care & Family Medicine. It's a reminder of the continuing reliance on printed books despite the increasing prevalence of mobile phone ownership. Is anyone aware of research that compares the advantages and disadvantages of print format versus mobile format?

CITATION: Ida L.A. Okeyo1, Ros Dowse

An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling

African Journal of Primary Health Care & Family Medicine ISSN: (Online) 2071-2936, (Print) 2071-2928


Background: Community health workers (CHWs) have facilitated the move to decentralise tuberculosis (TB) management, but lack access to information appropriate both for personal use and in patient interaction and education.

Aim: To explore the impact of a pictorial-based TB booklet on reinforcing CHW knowledge and facilitating patient counselling.Setting: This study was conducted in local primary health care clinics and the Hospice in Grahamstown, Eastern Cape Province in South Africa.

Methods: Quantitative and qualitative methods were used. A simple, 17-page, A5 booklet containing pictograms and simple text was designed in collaboration with CHWs who advised on preferred content. Its influence on knowledge was assessed in 31 CHWs using a 17-item questionnaire in a before-and-after study. The experiences of CHWs using the booklet were qualitatively explored using focus group discussions (FGD) and semi-structured interviews.

Results: Overall knowledge increased significantly from 70.6% to 85.3% (p < 0.001) with 8 of 17 questions significantly better answered at follow-up. These addressed meaning of side effects and side effect advice for patients, cause and prevention of TB, action if a dose is forgotten, timing of dose in relation to food intake and the possibility that not all patients are cured. Community health workers reported using the booklet during patient interactions, commenting that it enhanced their confidence in their own TB-related knowledge, improved recall of information and reduced uncertainty. They appreciated the simplicity of the text and its user-friendliness because of the inclusion of pictograms. The booklet was perceived to be valuable as a tool for both patient education as well as improved communication with patients.

Conclusion: A simple, user-friendly TB booklet containing pictograms improved CHW knowledge and acted as a valuable tool in patient communication and education.

Selected quotes from CHWs:

‘The first time I took it and read, I was so interested, then I show the clients here in front [waiting area] what I have and I educate them about TB.’ (Participant 19, female, SSI 4)

‘It actually shows pictures … so with the pictures and us explaining to them the actual way of doing it, it’s very easy to interact with people.’ (Participant 4, male, FGD 1)


Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on five global forums in three languages. He also currently chairs the Dgroups Foundation (, which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: