Abstract
INTRODUCTION
MSF’s health promotion frequently involves one-way communication with communities. The success of this approach is often temporary and little evidence suggests sustainable behavioural change, with measurable effects on morbidity or mortality. Moreover, lasting change relies upon repeated reminders or cues to action. Our “MSF Story of Change” project aimed to use co-creation methods for health promotion messaging. This was piloted in campaigns focusing on noma, a gangrenous infection causing pain and disfigurement, Nigeria.
METHODS
In Jan 2018, local community members came together to share their stories about noma. This group involved staff, including MSF health promoters, patients, and caretakers from the Noma Children's Hospital, as well as community members, family members, neighbors, traditional healers, imams, village heads, and midwives. MSF staff recorded 50 stories to create a “storyweb” - mapping recurring words, perceptions, beliefs, and archetypes. Using this storyweb, the MSF team worked with a further group of community members to co-create a story of change for noma identification, prevention and treatment. The story focused on Abubakar, a fictional child with noma, whose parents who are unaware of noma symptoms or prevention, and cannot afford medical care, but who ends up receiving treatment and recovering. This story was retold by MSF health promoters within communities, supported by dialogue with community members about similarities and differences in their experience. Following the pilot, a MSF health promotion coach conducted two days of observations per month with the health promotion team to assess whether the story was still in circulation.
ETHICS
This description of an innovation project involved human participants or their data, and has had ethics oversight from Kiran Jobanputra, Deputy Medical Director, Operational Centre Amsterdam, MSF.
RESULTS
Observations and narratives suggest that community members continued to retell the co-created story, often as adapted versions. Community members would frequently ask questions and contribute their own stories. Between Jan and Aug 2018, MSF monthly medical reports showed an increase in noma patients identified by the outreach team and community members. In Feb 2018, six patients were identified by the outreach team, in May 2018, 21 patients, and in Aug 2018, 26 patients. Similarly, we saw increased numbers of referrals from key community members. Additionally, many of the MSF health promoters had used participatory approaches, making the nature of the community engagements more conversational.
CONCLUSION
The preliminary observations indicate that by incorporating key local language, beliefs and experiences into health promotion “stories”, the co-creation methods may help to impact on health seeking behaviour and further the sustainability of health promotion messages. These methods can be adapted for other settings and behaviours, providing local co-creation is used as a fundamental principle.
