Using Graphics as an Alternative to Written Instructions: Adapting Oral Self-Implemented Test Instructions for...

Area of Science:

• Public Health
• Health Communication
• Adolescent Health

Background:

• HIV remains a leading cause of death for young people in sub-Saharan Africa.
• Tanzanian youth have high HIV prevalence but low testing rates.
• Oral HIV self-implemented tests (Oral-SIT) can increase access, especially with clear instructions for low-literacy populations.

Purpose of the Study:

• To evaluate the effectiveness of a graphic instruction book (GIB) compared to a GIB combined with an instructional video (GIB-video) for understanding Oral-SIT procedures.
• To identify specific areas of misunderstanding in HIV self-testing procedures among adolescents.

Main Methods:

• A randomized experiment was conducted with 257 participants aged 14-19 years in Tanzania.
• Participants were assigned to either a GIB-only group or a GIB-video group.
• Comprehension of Oral-SIT procedures and the number/severity of misunderstandings were analyzed.

Main Results:

• The GIB-video group reported significantly fewer misunderstandings (41%) compared to the GIB-only group (59%).
• Major errors in understanding testing procedures were present in 58% of misunderstandings, often related to specific graphics.
• Most participants (over 94%) had fewer than four misunderstandings.

Conclusions:

• The graphic instruction book was generally well-comprehended by Tanzanian youth.
• Modifications to the GIB, potentially incorporating video elements, could further improve the accuracy and fidelity of Oral-SIT use in low-literacy settings.
• This approach has the potential to enhance HIV testing uptake and management among adolescents in high-prevalence regions.