Characteristics of study participants
A total of 140 individuals participated in the study, 100 community members and 40 experts. Of the 100, 54 participated in the community survey and all (100) participated in the community dialogue sessions. The experts’ survey had 40 participants. Their characteristics are summarized in Table 1.
The recruited (n= 54) community members completed the community survey and responded to all questions in the questionnaire. The majority of these participants were females (69%; n = 37). Ages of the participants ranged between 18 and 78 years old, with a median age of 43 years. Heads of household accounted for 31% (n = 17) of the participants. The majority of the participants (68%, n = 36) were unemployed and 65% (n = 35) of the participants had some form of basic education. A total of 76% (n = 41) participants were from section 9 (Ebiva), followed by section 8 with 15% (n = 8) and section 2 with 9% (n = 5).
All 100 community members participated in the community dialogue sessions. The age range of participants was between 18 – 78 years with 69% being females. Participants included mothers, fathers, grandparents, youth and caregivers.
A total of 40 experts completed the self-administered questionnaire. Of these, 65% (n = 26) were medical scientists, 27% (n = 11) were malaria control programme members and 8% (n = 3) were educators. The majority of the participants were female 72% (n = 29). The median age was 36, with an interquartile range of 23 – 66.
Four cross-cutting themes relating to the song’s appropriateness were identified and explored during both the surveys and CDS. These included the song’s cultural appropriateness, content appropriateness, appropriateness of delivery and overall appropriateness. Table 2 summarises individual questions relating to each of these themes and open-ended responses as well as CDS.
Cultural appropriateness of song
All community members (100%) agreed that the song was culturally appropriate for Jozini community, as did 75% of the experts. In the CDS, many community members highlighted that the genre with ‘an African beat’ and use of isiZulu as elements made the song appropriate for intended use.
“We love this genre of music called “Maskandi” a lot and the song warned us about malaria.” (Group 1, Female, 60)
“The song is perfect and having it in Isizulu is really helping in making us understand malaria. It is also good that the singer is a local resident.” (Group 2, Female, 49)
On age appropriateness of lyrics in the song, all community members answered in the affirmative while 80% of experts agreed on the suitability of the lyrics for the targeted age groups. However, there were mixed views during CDS. Some opinions aligned with the survey:
“This song is appropriate for all age groups and it warns us about the signs and symptoms of malaria.” (Group 2, Female, 49)
However, other community members thought the song genre was more attractive to older listeners. One 26-year old female community member from Group 1 explained that it was less the content than the genre she found inappropriate:
“The song is very informative and warns us about malaria. However, I do not enjoy this type of music.”
This opinion was however not shared by all young people, with a 28 year old female from Group 3 exclaiming: “This song has great rhythm and I can dance to it.”
Appropriateness of song delivery
A variety of questions were asked regarding the song format. Over 95% of community members reported that the words were clear and easy to understand, that the message was easy to remember and that the use of repetition supported engagement. While community feedback was mainly positive, a few people highlighted issues around the aesthetic delivery of the song. For instance, one participant complained:
“The song is not clear enough. I did not get everything that the song is about, especially the backing vocalists.” (Group 1, Female, 32)
Most negative comments about the song delivery focused on audibility, particularly towards the end of the song.
While the majority of experts gave positive responses regarding the delivery of the song, 85% of experts responded in the affirmative to all the three questions on song delivery, while there were more who expressed concern on the delivery of the song when compared to community members. One expert concluded, “The song is good, easy to understand, affirmative and appropriate.” (Scientist and MCP staff) However, another expert expressed frustration: “The song is too long, too much repetition.” (MCP staff)
This concern was however not echoed by any of the community members.
Appropriateness of content
In summary, 92% of all participants (both experts and community members combined) agreed that the malaria content and the SIT information in the song was useful and adequate.
To further explore content effectiveness, community comments were analysed using open-ended questions to determine what participants remembered from the song and what they learned. These results were coded, grouped and quantified (see Table 3). This data supplemented information obtained from the six closed-ended questions that were posed to both experts and community members about the song content.
Three strong themes about malaria emerged when the community was probed on what they learned from the song. These were: malaria is fatal but treatable, male mosquitoes do not bite and the morphological difference between a male and female mosquito. Of these, the message that female mosquitoes transmit pathogens that cause infections was the most remembered theme (33%), followed by the fact that malaria can kill but is treatable (24%). Malaria signs and symptoms were least remembered, with fewer than 10% remembering this thematic area. One expert (MCP staff, Male 38) summed this by recommending: “Expand on what is malaria and signs and symptoms.”
The inclusion of information on mosquitoes being vectors for malaria was applauded by 97% of the experts. Repeated emphasis on the point that male mosquitoes do not bite in the song was hailed by 85% of the experts (Table 2), with 11% of community members spontaneously recalling this point (Table 3). This critical message was cited as a lesson learnt by 24% of the community members surveyed. About 18% participants from the community specified that they have learned about the difference in behaviour between male and female mosquitoes through the song, with 33% reporting that the song reminded them that only female mosquitoes transmit malaria (Table 3).
These views were also consistent with those expressed during CDS. In the CDS, participants expressed knowledge acquisition. One female participant summed:
“I gained a lot more information about malaria that I did not know before, including that only female mosquito transmit infection.” (Female 61 and Male 49)
The inclusion of SIT as an additional vector control method in the song was applauded by 87% of experts (Table 2). About 80% of the experts surveyed thought mentioning that SIT also targets outdoor mosquitoes was appropriate and that the song had enough information to help people understand the SIT technology. A higher proportion of community (96%) members also shared the same views. By contrast, when it came to retaining this information, fewer than 10% of the community remembered or reported learning about SIT in the open-ended questions.
In CDS, one participant noted:
“I have learned that male mosquito will be sterilized and released back into the wild, to help reduce the spread of malaria.” (Female 40)
Most experts (90%) and all community members (100%) agreed that the song was appropriate to engage the community about SIT.
In the CDS, participants noted:
“The song can really help communities and schools with malaria awareness and engagement. It is also useful to know that only female mosquito transmit infection.” (Female 36)
“This song should be played on national radio for everyone to understand and hear about the SIT project.” (Male 49)
The participants emphasized that this song should be played at schools, churches and the community, so that everyone can know and understand malaria and the SIT project, especially the young children. When asked if there was anything they could change about the song, all those who responded to this question (12%) agreed with this recommendation: “Tone down the guitars so that back-up singers can be heard better” (Females, ages 18 – 40).