The key informants involved in the study, their demographics and the dissemination channels used by their institutions are summarised in Table 1. The table also shows the different classifications we assigned to each stakeholder according to the power interest matrix.
Clinic matrons said since the inception of the MABISA project in 2015 schistosomiasis cases had dropped. Schistosoma haematobium prevalence rates among school children in the Ndumo area dropped from 37,5% in 2016 to 6% in 2018 after the MABISA project conducted screening and treatment interventions (Kabuyaya, Chimbari et al. 2018). The clinic matrons said they had not sent any messages due to shortage of health education material on schistosomiasis in their clinics and lack of policy led initiatives to sensitize the community residents about the disease.
“Yes, MABISA went into the field and recorded findings about the infection levels in the communities, something that we could not do on our own. They brought back the findings about the infected people and they gave it to us. Now we know how much to anticipate when it comes to schistosomiasis.” (Matron, clinic A)
Nurses were found to have a high influence on the targeted audience and had a high level of interest in schistosomiasis knowledge uptake. Their interest in the disease and influence in the community made the clinic a key stakeholder to partner with in schistomiasis knowledge uptake. Nurses support uptake of schistosomiasis findings through outreach programs conducted by their school health teams. Nurses also have space for posters which can be used to educate communities when they visit the clinic. Nurses acknowledged that the work done by schistosomiasis researchers in the area filled a gap which they could not fill on their own.
Community Health Workers (CHWs)
The CHWs showed low levels of interest in schistosomiasis knowledge uptake. This was attributed to the fact that the burden of schistosomiasis was lower compared to that of HIV and TB cases. Hence, they had spent more time on patients with these diseases leaving out schistosomiasis treatment and awareness visits. However, they showed high level of power to influence the community since their core business was health promotion and care. CHWs proposed that; it would be good to run schistosomiasis awareness programs during the rainy season when the risk is higher. CHWs are already in partnership with nurses since they directly report to the clinic matron. The partnership between these two groups can enhance dissemination of schistosomiasis related activities including scaling up of the treatment programme.
Traditional leaders reported that research activities conducted by schistosomiasis researchers improved awareness of how schistosomiasis is transmitted, prevented and controlled. They were informed about the endemicity of the disease in their areas by the researchers and were now knowledgeable about the disease.
“The recruitment and training of community members to engage and assist in activities conducted by researchers will lead to education of some community members on the disease, since these trained community research assistants will continue to interact with other community members concerning the diseases long after the researchers are gone.” ( Village head, KwaMthanti area)
“Few people knew they got this disease, they would only see the symptoms then go to clinics, but they did not know what had infected them.” Village head, Mgedula area)
“We are now aware that we should not stand in stagnant water bodies or go in the water without protective clothing as these stagnant water sources are the breeding areas for diseases such as schistosomiasis.” (Village head, Makhane area)
The traditional leaders showed high power influence in the community and their role in research uptake was considered important. Village headmen however had low interest in the disease because their focus was mostly on administrative duties. Village heads offered to facilitate the uptake of schistosomiasis knowledge/research findings by helping with mobilising people for community meetings. The village headmen also suggested allocating the researchers space to operate a schistosomiasis research station/centre where the community can get assistance on schistosomiasis related problems.
Primary school principals
Primary school principals reported that they had utilised schistosomiasis findings from MABISA to educate students during morning prayers and parents during parent meetings. However, other school principals stated that they had not shared results from the study outside the classroom. Learners who were screened and tested were given information about schistosomiasis. For example, the learners and school teachers involved in the research learnt from the researchers how schistosomiasis is transmitted and how it could be treated. Primary school teachers have high influence on the affected community as well as the children and their interest in schistosomiasis knowledge uptake is also high. They have the power to influence pupils and they are interested in addressing the schistosomiasis problems affecting their pupils through engagement with MABISA researchers and school health teams from the local clinics in the study area
“We were informed that children contract schistosomiasis when playing in infected water.” (Principal, school A)
“We have sent the information about the work done by the researchers to parents and we encouraged them to support this research by making sure their children get treatment. Also, the young kids who were part of the research now know this information and they can share it with others at home.” (Principal, schools F)
Some schools however, had not yet conducted campaigns on schistosomiasis outside the classroom. They stated that, the life skills lessons cater for that as they contain some lessons on schistosomiasis. One of the headmasters said they had not received the findings from the researchers in printed form:
“We are actually still waiting for posters, booklets and pamphlets from the researchers to see what the findings of the research were.” (Principal, school B)
The outcome of this study was followed by efforts to prepare targeted massages and disseminate them properly through the school’s channel of information sharing. Typical example would be through development of infographics, audio visual materials and other arts-based media such as song and drama competitions (Mindu, Kabuyaya et al. 2020).
The councillor said people in his area had been invited to the project’s research appraisal activities where he observed community members actively participating at the events. The councillor also noted that infected children in schools that were part of the research had been treated and that researchers had helped them to get information on how the disease is transmitted.
“Our children have received treatment, CRAs have also been trained on bilharzia screening and snail sampling. With this knowledge, they can continue the dissemination of work done by MABISA within the community.” Councillor, ward 17
The councillor has high power to influence the processes of intervention but showed a low interest. He is a good stakeholder to include in translation activities as a participant in programs/campaigns meant to influence behaviour change among different community members and groups in the study area. The councillor is in a better position to mobilise the community and attract funds from government for health promotion events and his partnership with the political leadership can help to make research uptake activities credible and be supported by the relevant people in the government especially those that have the power to make decisions that can lead to a reduction of the burden of the disease.
The library’s focus is on helping the community with literary activities, such as reading and learning. Their power to influence schistosomiasis knowledge uptake is rated low because they prioritise creating a book reading culture and improving literacy. However, they can be engaged as stakeholders typically for providing access to information on schistosomiasis to those visiting the library or for conducting trainings at their venue for few key members of the community who can be residents or health workers. The library offers limited space and resources (internet, reading facilities and workshop rooms) for the community in the study area to connect and interact with others outside their area. The library can accommodate children from different schools and supply books and internet resources to the children so that they can learn more about the disease. Hence, they play a useful role pushing the findings to the community.