Going door-to-door with public health messages can be an effective way to educate at-risk populations, suggest the results of such an effort in New Zealand.
Lay educators visited more than 11,000 homes in Auckland, New Zealand to raise awareness of a contagious form of bacterial meningitis known as meningococcal disease--an infection of the fluid surrounding the brain and spinal cord.
"Feedback from individuals, families, and groups contacted through the awareness program was overwhelmingly positive about the house-to-house visiting by lay educators, small group sessions, the resources used, and the key messages," said study author Chris Bullen, a public health physician at Auckland Healthcare Public Health Protection Service.
The door-to-door campaign was initiated in Auckland in 1998 after a sharp rise in subtype B meningococcal disease cases, for which no vaccine is currently available. Most of those affected were children from Pacific Islands and Maori families, which make up about 20 percent of Auckland's population.
In the United States, approximately 3,000 people develop meningococcal disease every year, and 10 to 13 percent of these cases are fatal. Of those who survive, 10 percent suffer mental retardation, hearing loss, and loss of limbs as a result of the disease, according to the U.S. Centers for Disease Control and Prevention.
Under the management of the Auckland Public Health Department, local individuals in the New Zealand study were trained to visit homes and communicate key facts about the disease, including the need for immediate action should parents spot meningococcal disease symptoms in children. Symptoms of this rapidly advancing disease include high fever, headache, stiff neck, nausea, vomiting, and confusion. The disease symptoms are often more difficult to detect in newborns and small infants.
Parent-education sessions were also conducted at early childhood centers, schools, churches, and sports clubs. Parents of at-risk children were given fact sheets, which included contact information of physicians as well as those of neighbors willing to help out in case of an emergency. Parents were also given wallet-sized cards containing instructions in English, to help those with poor English skills communicate with health care personnel.
To test the effectiveness of the door-to-door campaign, a survey was later distributed to approximately 300 Auckland residents, about half of whom had been visited by a lay educator. Nearly all (99 percent) of those who were visited by a lay educator classified meningococcal disease as serious or very serious, compared with approximately 70 percent of those who did not recall such a visit. The study results appear in the June 2000 issue of the journal Health Education & Behavior.
No meningococcal disease-related deaths occurred in the areas targeted by the campaign during its duration (April-December 1998). By contrast, the winter of 1997 saw a 40 percent increase in diagnoses, mostly among Pacific Islanders and Maori people, compared to the same period in 1996. But Bullen urged caution in interpreting these results.
"The fall in case fatality coincident with the program was encouraging," said Bullen. "However, because of the small numbers involved, no firm conclusions can be drawn from these data."
The study results do suggest that door-to-door visits by lay educators may be an effective way to spread important health information. Such approaches are becoming increasingly popular in New Zealand, according to Bullen. "Communities in greatest need are being asked to do more, often with little or no remuneration for their expertise and time," said the researcher.
The meningococcal education campaign succeeded despite limitations in funding. "People were willing to be involved on this issue, regardless of the funding because they felt passionately about the need to communicate the key messages to their people," said Bullen.
Health Education & Behavior, a bimonthly peer-reviewed journal of the Society for Public Health Education (SOPHE), publishes research on critical health issues for professionals in the implementation and administration of public health information programs. SOPHE is an international, non-profit professional organization that promotes the health of all people through education. For information about the journal, contact Elaine Auld at (202) 408-9804.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
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