The results showed that cross-cultural collaboration was perceived as beneficial by all participants and that the use of an accommodated communication strategy was considered to be essential to fulfilling the purpose of the health campaigns. The participants highlighted the campaign’s relevance for increasing the level of health competence in the local community.
Experiences of the Norwegian nursing students
The nursing students said that working in a Tanzanian context is very different from the Norwegian one, and they regarded guidance by the responsible staff at TICC as necessary. Supervision by and cooperation with employees at TICC was considered crucial for deciding which topics were relevant to present.
Collaboration with an interpreter was necessary. However, the use of interpreters was also linked to uncertainty and lack of control over what and how the information was communicated to the public. Several students expressed concerns about misinformation in relation to the interpreter’s prior knowledge of the topic, which was perceived as crucial in determining how the information was translated.
It was considered important to adjust the campaigns’ themes and information to gain acceptance within the cultural environment. The students said that they had to think creatively to be able to present controversial topics without offending anyone or conflicting with the cultural norms.
Several highlighted how music, song, and dance are a central part of Tanzanian culture and that their incorporation into the campaigns was useful for capturing the audience’s attention. The play was considered important for relating the information to everyday situations. The students also perceived that meeting people where they live their daily lives was necessary for reaching the target group. One of the students said, “Here you actually have to go out to meet people. You cannot just write it on a blog or an online newspaper.”
The students discussed their experiences of mastery by successfully implementing the campaigns. Some mentioned their uncertainty about the relevance of the campaigns in relation to their academic benefits. Others said that the campaigns were perceived as an exercise and part of their training to fulfil a pedagogical function. They valued the learning outcomes from attending the health campaigns.
Several of the students talked about the responsibility of the health professional when disseminating health information. Fear of giving incorrect information when answering questions from the audience and the pressure to keep to the schedule were expressed as concerns because the topics presented in the health campaigns were decisive to the future health choices of the attendees.
Experiences of participants from the TICC youth program
The local youths enjoyed collaborating with the Norwegian nursing students and perceived the students as pleasant, cooperative, and welcoming; these feelings were considered to be mutual. The informants felt that their contribution to the health campaigns was valued and respected by the students.
Several youths mentioned that they gained knowledge through their collaboration with the students. They considered this important for their life and health situation. “The students strengthen us. They let us talk to them, and they let us learn through the campaigns we perform together.”
The youths specifically mentioned that campaigns are an appropriate method to reach out to people in the villages that lacked access to electricity.
If you travel to villages without electricity, they [the inhabitants] can also, through the use of campaigns, get information. They would not have received this information if it was communicated via radio or television, since they do not have electricity. But with campaigns, because they see you physically, they can learn in a reasonable way.
Using different methods to disseminate the health information was perceived as essential. One commented, “I like the way we present the information. Some can understand through words, while for others the information becomes clearer through acting, singing, and dancing.”
The campaigns gave the youths opportunities to share their experiences with others who sought their expertise, and they talked about their increased self-confidence and self-esteem as a result of their involvement in the HCP. One noted, “The campaigns give us strength, self-confidence, and help us trust ourselves so that we can stand in front of many people and teach.”
The local youths described the health campaigns as sustainable because each campaign’s audience communicated what they had learned to others who were not present. They perceived that the audience appreciated and enjoyed the campaigns, and that the local community learned much.
Experiences of employees at TICC
The employees described the Norwegian nursing students as committed and open minded about doing something new. Both the nursing students’ learning goals and the population’s benefits were perceived as important priorities.
Given the different cultural and professional orientations, it was sometimes challenging to understand what the students presented in the planning phase of the campaigns. Nevertheless, the students’ competence was considered to be important to the academic quality of the health campaigns. One employee said, “When we travel and the students are with me, I feel very safe and confident.”
The collaboration with the youths enrolled in the TICC youth program was perceived as important, and it was considered favourable that the play was presented in Kiswahili. They perceived that the youths were positive and willing to do something new. One employee said about the youths, “For many, I think it is like stepping out of their own comfort zone. One tries to do something one has never done before. Many have never acted in plays … It is like opening up a new world for their talents, in a way.”
The employees said that it was important to investigate whether the students’ chosen topics reflected a local challenge. Their experiences as Tanzanians were presented as an advantage in such assessments. One commented, “I’m from Tanzania. I live here, I can see the challenges in my community.”
They said that the final choice of themes for the health campaigns were based on both the students’ interest and the employees’ local insight and competence. This collaboration was important for adapting the content to the area and target group. An employee commented, “For example, now students have chosen the topic of malaria. It was the right time for this topic, because it rains a lot and then there are a lot of malaria mosquitoes.”
The employees perceived the campaigns as important for people’s understanding of health-related topics. Schizophrenia was exemplified as a phenomenon that residents believed was caused by witchcraft. After a campaign about schizophrenia, the audience talked about schizophrenia in a different way, and the employees perceived that people understood that it was not connected to witchcraft.
The employees reported uncertainty associated with the long-term effect of the health campaigns. After each campaign, evaluation and reflection were conducted among those involved in the TICC. Conducting the formal evaluations of the campaigns among the audience was challenging, and the employees were uncertain about the best method for this. The employees said that they usually discuss each campaign with the local population to form an impression of the campaign’s usefulness and the audience’s response.
Several mentioned that the Norwegian nursing students’ participation in HCP created great audience engagement.
Experiences of a village leader and a primary school teacher
The village leader said that the actors from the TICC were cooperative and believed it desirable to maintain this relationship. He perceived the Norwegian nursing students’ involvement in the health campaigns as valuable. He commented, “The kindness that the students bring; they show us great care. People feel that they are valued by the students coming here to meet them.”
The campaigns were considered as useful, and both the leader and the teacher assumed that, after the campaign, the audience discussed what they had learned with others. The teacher mentioned particularly that her pupils needed health information and that they had not learned about the topics before the campaign presentation. The teacher highlighted that to carry on with the campaigns were important in the work with health information.
The teacher thought that the different activities in the campaign enhanced the children’s interest in learning. The village leader said that the use of entertainment was important to create engagement and was something the audience appreciated.
Both the village leader and teacher highlighted the use of questions in the end of the campaign as important for the audience’s benefit and that gifts were given to those who answered the questions correctly after the performance. The village leader thought that these gifts contributed to greater attendance and commitment among the audience.
The teacher and the village leader had received feedback from the audiences that the information delivered in the health campaigns was important to them. The teacher mentioned that several parents had thanked her for this initiative. The village leader said, “People in the village come to me directly and ask for more campaigns. This shows that they like them and that they benefit from them.”
Both the village leader and teacher had noticed changes in people’s behaviour after the campaigns. The teacher mentioned that she had perceived an improvement in the pupils’ cleanliness after a campaign. The village leader had recently seen, after a campaign about epilepsy, that a family with a child with epilepsy brought the child to the hospital for treatment. The village leader had also noticed changes in people’s behavior regarding dental health. He said, “Such things [changes] are a sign that they [the audience] like the campaign, and that they benefit from the campaigns.”