Using public health communication strategies for dementia risk reduction in Lagos, Nigeria

Theoretical Background and research questions/hypothesis:

Dementia imparts a global significant public health burden and the majority of persons with dementia (68%) will reside in low- and middle-income countries (LMICs) by 2050. Yet, dementia risk reduction initiatives do not have a wide reach in adults in LMICs. Since there is no effective treatment to cure dementia, the best global approach will be to reduce risks by promoting healthy aging; and lifestyle/ risk factor modification.Despite the importance of risk reduction through this means, many people remain unaware and those from LIMCs are disproportionately affected. In Nigeria, community health workers make up more than half of the primary healthcare (PHC) workforce. Scaling up the competencies of health educators has been utilized for implementing various risk reduction strategies, however, this approach has not been applied in dementia risk reduction.

The study aims to (1) determine the effectiveness of a training program in improving the competency of PHC workers in three key areas: theoretical dementia risk-reduction knowledge; and practical field work on communicating dementia risk factors and dementia risk-reduction guidelines for middle-aged and older adults and (2) evaluate the feasibility of the intervention.

We hypothesize that the training intervention would improve the competencies of PHC workers in dementia-risk knowledge and furthermore consolidate this knowledge with the public health communication skills to educate community members on dementia risk factors and risk-reduction guidelines

Methods:

This project will use a mixed method design to determine the effectiveness of a training program. It will take place in the 57 local districts of Lagos State. We will select and train 57 PHC workers who are health educators: one from each government district. It will build on previous work in PHCs in Lagos and the community’s existing structures and resources. The principal investigator and an experienced health communication expert will train the PHC workers using the WHO (mhGAP) guide and the WHO strategic communications framework. The training will be designed based on adult training theories using blended learning and involving a high level of team interaction. The effectiveness of the intervention will be evaluated using the New World Kirkpatrick model for learning in the areas mentioned. The feasibility of the intervention will be evaluated using qualitative analysis of problem-focused individual interviews.

Results:

The primary outcomes of this project are to demonstrate the effectiveness of the training at three points of assessment (post-training, 4 weeks and 3 months after the training); and the feasibility of the training. The secondary outcomes will provide baseline epidemiological data on the dementia risk profile and cognition in middle-aged and older adults respectively.

Conclusions:

Overall, the goals are to integrate education and effective communication training in dementia risk reduction into the existing primary care system and to incorporate epidemiological and public health research in the area of brain health in Nigeria.

Implications for research and/or practice:

Training health educators on effective public health communication can be a useful tool for risk-reduction strategies by providing culturally appropriate and accessible health education and information; and building individual and community capacity.