Maya Adam

All Publications

• Evidence-based health messages increase intention to cope with loneliness in Germany: a randomized controlled online trial. NPJ digital medicine Liu, S., Haucke, M., Wegner, L., Gates, J., Bärnighausen, T., Adam, M. 2024; 7 (1): 105

  Abstract

  Loneliness poses a formidable global health challenge in our volatile, post-pandemic world. Prior studies have identified promising interventions to alleviate loneliness, however, little is known about their effectiveness. This study measured the effectiveness of educational entertainment ("edutainment") and/or evidence-based, written health messages in alleviating loneliness and increasing intention to cope with loneliness. We recruited 1639 German participants, aged 18 years or older. We compared three intervention groups who received: (A) edutainment and written health messages, (B) only edutainment, or (C) only written health messages, against (D) a control group that received nothing. The primary outcomes were loneliness and intention to cope with loneliness. Participants were also invited to leave comments about the interventions or about their perception or experiences with loneliness. We found a small (d = 0.254) but significant effect of the written messages on increased intention to cope with loneliness (b = 1.78, t(1602) = 2.91, P = 0.004), while a combination of edutainment and written messages significantly decreased loneliness scores (b = -0.25, t(1602) = -2.06, P = 0.04) when compared with the control, even after adjusting for covariables including baseline values, self-esteem, self-efficacy, and hope. We also observed significantly higher self-esteem scores after exposure to a combination of edutainment and written messages (b = 0.821, t(1609) = 1.76, one-tailed P = 0.039) and significantly higher hope scores after exposure to edutainment-only (b = 0.986, t(1609) = 1.85, one-tailed P = 0.032) when compared with the control group. Our study highlights the benefits of using written messages for increasing intention to cope with loneliness and a combination of edutainment and written messages for easing loneliness. Even in small "doses" (less than 6 min of exposure), edutainment can nurture hope, and edutainment combined with written messages can boost self-esteem.

  View details for DOI 10.1038/s41746-024-01096-7

  View details for PubMedID 38684903

  View details for PubMedCentralID 8826180

• Evaluating the impact of short animated videos on COVID-19 vaccine hesitancy: An online randomized controlled trial. Internet interventions Beleites, F., Adam, M., Favaretti, C., Hachaturyan, V., Kühn, T., Bärnighausen, T., Barteit, S. 2024; 35: 100694

  Abstract

  Addressing the global challenge of vaccine hesitancy, amplified during the COVID-19 pandemic due to misinformation propagated via social media, necessitates innovative health communication strategies. This investigation scrutinizes the efficacy of Short, Animated, Story-based (SAS) videos in fostering knowledge, behavioral intent, and engagement around COVID-19 vaccination. We conducted an online three-arm parallel randomized controlled trial (RCT) involving 792 adult participants (≥18 years, English-speaking) from the United States. The intervention group viewed a SAS video on COVID-19 vaccination, the attention placebo control group watched a SAS video on hope, and the control group received no intervention. Our primary objectives were to assess the influence of SAS videos on knowledge, behavioral intent, and engagement regarding COVID-19 vaccination. Participants in the intervention group displayed significantly higher mean knowledge scores (20.6, 95 % CI: 20.3-20.9) compared to both the attention placebo control (18.8, 95 % CI: 18.5-19.1, P < .001) and control groups (18.7, 95 % CI: 18.4-19.0, P < .001). However, SAS videos did not notably affect behavioral intent. Perception of COVID-19 as a significant health threat emerged as a strong predictor for engaging with the post-trial video without further incentives (OR: 0.44; 95 % CI: 0.2-0.96). The 35-44 age group exhibited the highest post-trial engagement (P = .006), whereas right-wing political inclination negatively associated with engagement (OR: 1.98; 95 % CI: 3.9-1.01). Vaccination status correlated significantly with self-efficacy (P < .001), perceived social norms (P < .001), and perceived response efficacy of the COVID-19 vaccine (P < .001), all heightened in the intervention group. These findings suggest that while SAS videos effectively amplify COVID-19 vaccination knowledge, their impact on behavioral intent is not direct. They do, however, affect determinants of vaccination status, thereby indirectly influencing vaccination behavior. The study highlights the appeal of SAS videos among younger audiences, but underscores the need for further examination of factors impeding vaccination engagement. As SAS videos closely mirror conventional social media content, they hold significant potential as a public health communication tool on these platforms. Trial Registration: Trial was registered at drks.de with the identifier DRKS00027938, on 5 January 2022.

  View details for DOI 10.1016/j.invent.2023.100694

  View details for PubMedID 38149090

  View details for PubMedCentralID PMC10750063

• "The Videos Gave Weight to Our Work": Animated mHealth Videos and Tablet Technology Boost Community Health Workers' Perceived Credibility in Khayelitsha, South Africa. Qualitative health research Adam, M., Job, N., Mabaso, B., Barnighausen, T., Kuhnert, K., Johnston, J., Mqungwana, N., Le Roux, I., Mbewu, N., Gates, J., Scott, K., Vandormael, A., Greuel, M., Prober, C., McMahon, S. A. 2022: 10497323221091504

  Abstract

  Mobile health (mHealth) interventions are increasingly used to support community health workers (CHWs) in low-and middle-income countries. As near-peers within their communities, the credibility of CHWs is sometimes questioned-a recognized barrier to their efficacy. Nested within a large, randomized-controlled trial, this qualitative study captured the experiences of South African CHWs, called "Mentor-Mothers," using tablets and animated videos to promote exclusive breastfeeding. We conducted in-depth telephone interviews with 26 tablet-carrying Mentor-Mothers. We analyzed interview transcripts using a Grounded Theory approach, then developed a theoretical framework, based on an emerging theme, for understanding how tablet technology boosts the perceived credibility of CHWs. Tablet-carrying Mentor-Mothers described an increase in their perceived credibility, which they attributed to overt and signaling effects related to enhanced credibility of (1) their messages, (2) themselves as messengers, and (3) the program employing them. Mobile technology investments in CHWs could enhance their credibility, translating into meaningful investments in the health of under-served communities.

  View details for DOI 10.1177/10497323221091504

  View details for PubMedID 35674176

• Hope as a predictor for COVID-19 vaccine uptake in the US: a cross-sectional survey of 11,955 adults. Human vaccines & immunotherapeutics Adam, M., Mohan, D., Forster, S., Chen, S., Gates, J., Yu, F., Barnighausen, T. 2022: 2072138

  Abstract

  Widespread vaccine uptake is critical for ending the COVID-19 pandemic. As public health officials focus on overcoming vaccine hesitancy, simultaneously boosting hope may be equally important in the US. We analyzed data from an online cross-sectional survey conducted in June 2021. Participants were 11,955 US adults (ages 18-83) of various ethnicities, living in urban and rural settings. Of these, 71.3% had some college education. Mean age was 32.3years and 72.4% reported being vaccinated against COVID-19. Main measures were COVID-19 self-reported vaccination status (vaccine uptake), vaccine hesitancy (Adult Vaccine Hesitancy Scale), and hope (Adult Hope Scale). The US grand mean hope score fell within the low-hope range. COVID-19 vaccine uptake was positively associated with hope, even after adjusting for vaccine hesitancy, gender, age, ethnicity, income, and urban vs. rural residence. The strong relationship between hope, vaccine confidence and vaccine uptake persisted across US populations at risk for low vaccine uptake. Our mediation analysis revealed that, for every unit increase in hope, the probability of being vaccinated went up by 5% points. Of this association, 52% was not mediated by vaccine hesitancy, but rather through a direct pathway from hope to vaccine uptake. Mediation analyses of US populations at risk of low vaccine uptake revealed similar findings. Hope may play an important role in vaccine uptake by reducing vaccine hesitancy and by directly enhancing vaccine uptake. Especially in populations at risk of low vaccine uptake, vaccine interventions that boost hope may augment public health efforts to increase US vaccination rates.

  View details for DOI 10.1080/21645515.2022.2072138

  View details for PubMedID 35659447

• Animated, video entertainment-education to improve vaccine confidence globally during the COVID-19 pandemic: an online randomized controlled experiment with 24,000 participants. Trials Chen, S., Forster, S., Yang, J., Yu, F., Jiao, L., Gates, J., Wang, Z., Liu, H., Chen, Q., Geldsetzer, P., Wu, P., Wang, C., McMahon, S., Barnighausen, T., Adam, M. 2022; 23 (1): 161

  Abstract

  BACKGROUND: Science-driven storytelling and entertainment-education (E-E) media demonstrate potential for promoting improved attitudes and behavioral intent towards health-related practices. Months after the outbreak of coronavirus disease 2019 (COVID-19), emerging research highlights the essential role of interventions to improve public confidence in the COVID-19 vaccine. To improve vaccine confidence, we designed three short, animated videos employing three research-informed pedagogical strategies. These can be distributed globally through social media platforms, because of their wordless and culturally accessible design. However, the effectiveness of short, animated storytelling videos, deploying various pedagogic strategies, needs to be explored across different global regions.METHODS/DESIGN: The present study is a multi-site, parallel group, randomized controlled trial (RCT) comparing the effectiveness of (i) a storytelling-instructional-humor approach, (ii) a storytelling-analogy approach, (iii) a storytelling-emotion-focused approach, and (iv) no video. For our primary outcomes, we will measure vaccine hesitancy, and for secondary outcomes, we will measure behavioral intent to seek vaccination and hope. Using online platforms, we will recruit 12,000 participants (aged 18-59years) from the USA and China, respectively, yielding a total sample size of 24,000.DISCUSSION: This trial uses innovative online technology, reliable randomization algorithms, validated survey instruments, and list experiments to establish the effectiveness of three short, animated videos employing various research-informed pedagogical strategies. Results will be used to scientifically support the broader distribution of these short, animated video as well as informing the design of future videos for rapid, global public health communication.TRIAL REGISTRATION: German Clinical Trials Register DRKS #00023650 . Date of registration: 2021/02/09.

  View details for DOI 10.1186/s13063-022-06067-5

  View details for PubMedID 35183238

• Participant Engagement and Reactance to a Short, Animated Video About Added Sugars: Web-based Randomized Controlled Trial. JMIR public health and surveillance Favaretti, C., Vandormael, A., Hachaturyan, V., Greuel, M., Gates, J., Barnighausen, T., Adam, M. 1800; 8 (1): e29669

  Abstract

  BACKGROUND: Short, animated story-based (SAS) videos are a novel and promising strategy for promoting health behaviors. To gain traction as an effective health communication tool, SAS videos must demonstrate their potential to engage a diverse and global audience. In this study, we evaluate engagement with a SAS video about the consumption of added sugars, which is narrated by a child (a nonthreatening character), a mother (a neutral layperson), or a physician (a medical expert).OBJECTIVE: This study aims to (1) assess whether engagement with the sugar intervention video differs by narrator type (child, mother, physician) and trait proneness to reactance and (2) assess whether the demographic characteristics of the participants (age, gender, education status) are associated with different engagement profiles with the sugar intervention video.METHODS: In December 2020, after 4013 participants from the United Kingdom completed our randomized controlled trial, we offered participants assigned to the placebo arms (n=1591, 39.65%) the choice to watch the sugar intervention video (without additional compensation) as posttrial access to treatment. We measured engagement as the time that participants chose to watch the 3.42-minute video and collected data on age, gender, education status, and trait reactance proneness. Using ordinary least squares regression, we quantified the association of the demographic characteristics and trait reactance proneness with the sugar video view time.RESULTS: Overall, 66.43% (n=1047) of the 1576 participants in the 2 placebo arms voluntarily watched the sugar intervention video. The mean view time was 116.35 (52.4%) of 222 seconds. Results show that view times did not differ by narrator (child, mother, physician) and that older participants (aged 25-59 years, mean = 125.2 seconds) watched the sugar video longer than younger adults (aged 18-25 years, mean = 83.4 seconds). View time remained consistent across education levels. Participants with low trait reactance (mean = 119.3 seconds) watched the intervention video longer than high-trait-reactance participants (mean = 95.3 seconds), although this association did not differ by narrator type.CONCLUSIONS: The majority of participants in our study voluntarily watched more than half of the sugar intervention video, which is a promising finding. Our results suggest that SAS videos may need to be shorter than 2 minutes to engage people who are young or have high trait proneness to reactance. We also found that the choice of narrator (child, mother, or physician) for our video did not significantly affect participant engagement. Future videos, aimed at reaching diverse audiences, could be customized for different age groups, where appropriate.TRIAL REGISTRATION: German Clinical Trials Register DRKS00022340; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25343.

  View details for DOI 10.2196/29669

  View details for PubMedID 35072639

• Participant engagement with a short, wordless, animated video on COVID-19 prevention: a multi-site randomized trial. Health promotion international Favaretti, C., Adam, M., Greuel, M., Hachaturyan, V., Gates, J., Barnighausen, T., Vandormael, A. 2021

  Abstract

  COVID-19 misinformation has spread rapidly across social media. To counter misinformation, we designed a short, wordless and animated video (called the CoVideo) to deliver scientifically informed and emotionally compelling information about preventive COVID-19 behaviours. After 15 163 online participants were recruited from Germany, Mexico, Spain, the UK and the USA, we offered participants in the attention placebo control (APC) and do-nothing arms the option to watch the CoVideo (without additional compensation) as post-trial access to treatment. The objective of our study was to evaluate participant engagement by quantifying (i) the proportion of participants opting to watch the CoVideo and (ii) the duration of time spent watching the CoVideo. We quantified the CoVideo opt-in and view time by experimental arm, age, gender, educational status, country of residence and COVID-19 prevention knowledge. Overall engagement with the CoVideo was high: 72% of the participants [CI: 71.1%; 73.0%] opted to watch the CoVideo with an average view time of 138.9 out of 144.0 s [CI: 138.4; 139.4], with no statistically significant differences by arm. Older participants (35-59 years) and participants with higher COVID-19 prevention knowledge had higher view times than their counterparts. Spanish participants had the highest opt-in percentage whereas Germans exhibited the shortest view times of the five countries. Short, wordless and animated storytelling videos, optimized for 'viral spread' on social media, can enhance global engagement with COVID-19 prevention messages by transcending cultural, language and literary barriers.

  View details for DOI 10.1093/heapro/daab179

  View details for PubMedID 35137068

• Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial PLOS MEDICINE Adam, M., Johnston, J., Job, N., Dronavalli, M., Le Roux, I., Mbewu, N., Mkunqwana, N., Tomlinson, M., McMahon, S. A., LeFevre, A. E., Vandormael, A., Kuhnert, K., Suri, P., Gates, J., Mabaso, B., Porwal, A., Prober, C., Baernighausen, T. 2021; 18 (9)

  View details for DOI 10.1371/journal.pmed.100374

  View details for Web of Science ID 000750871100018

• Design preferences for global scale: a mixed-methods study of "glocalization" of an animated, video-based health communication intervention. BMC public health Adam, M., Chase, R. P., McMahon, S. A., Kuhnert, K., Johnston, J., Ward, V., Prober, C., Barnighausen, T. 2021; 21 (1): 1223

  Abstract

  BACKGROUND: Designing health communication interventions for global scaling promotes health literacy and facilitates rapid global health messaging. Limited literature explores preferences for animation prototypes and other content characteristics across participants in different global regions. Prior research underscores an urgent need for health communication interventions that are compelling and accessible across culturally and geographically diverse audiences. This study presents feedback from global learners on animation design preferences and other key considerations for the development of educational video content intended for global adaptation and scaling.METHODS: We used a mixed-methods, sequential explanatory design, with a qualitative descriptive approach to the analysis of the qualitative data. We recruited participants from an international group of learners enrolled in a massive open online course. Through an online quantitative survey (n=330), we sought preferences from participants in 73 countries for animation design prototypes to be used in video-based health communication interventions. To learn more about these preferences, we conducted in-depth interviews (n=20) with participants selected using maximum variation purposive sampling.RESULTS: Generally, respondents were willing to accept animation prototypes that were free of cultural and ethnic identifiers and believed these to be preferable for globally scalable health communication videos. Diverse representations of age, gender roles, and family structure were also preferred and felt to support inclusive messaging across cultures and global regions. Familiar-sounding voiceovers using local languages, dialects, and accents were preferred for enhancing local resonance. Across global regions, narratives were highlighted as a compelling approach to facilitating engagement and participants preferred short videos with no more than two or three health messages.CONCLUSIONS: Our findings suggest that global learners may be willing to accept simplified visuals, designed for broad cross-cultural acceptability, especially if the content is localized in other ways, such as through the use of locally resonating narratives and voiceovers. Diverse, inclusive portrayals of age, gender roles and family structure were preferred.

  View details for DOI 10.1186/s12889-021-11043-w

  View details for PubMedID 34172016

• Effect of a wordless, animated, social media video intervention on COVID-19 prevention: an online randomized controlled trial of 15,163 adults in the USA, Mexico, UK, Germany, and Spain. JMIR public health and surveillance Vandormael, A., Adam, M., Greuel, M., Gates, J., Favaretti, C., Hachaturyan, V., Barnighausen, T. 2021

  Abstract

  BACKGROUND: Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated, global health communication video (CoVideo) that was rapidly distributed through social media channels to an international audience.OBJECTIVE: The objectives of this study were to: 1) establish the CoVideo's effectiveness in improving COVID-19 prevention knowledge, and 2) establish the CoVideo's effectiveness in increasing behavioral intent toward COVID-19 prevention.METHODS: In May and June 2020, we enrolled 15,163 online participants from the United States of America, Mexico, United Kingdom, Germany, and Spain. We randomized participants to (i) the CoVideo arm, (ii) an attention placebo control (APC) arm, and (iii) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments.RESULTS: Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first four months. Knowledge in the CoVideo arm was significantly higher (mean = 16.95; 95% CI: 16.91, 16.99) than in the do-nothing (mean = 16.86; 95% CI: 16.83, 16.90; p < 0.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors.CONCLUSIONS: Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent towards one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises.CLINICALTRIAL: The study and its outcomes were registered at the German Clinical Trials Register (www.drks.de) on May 12th, 2020: #DRKS00021582.

  View details for DOI 10.2196/29060

  View details for PubMedID 34174778

• Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial. PLoS medicine Adam, M., Johnston, J., Job, N., Dronavalli, M., Le Roux, I., Mbewu, N., Mkunqwana, N., Tomlinson, M., McMahon, S. A., LeFevre, A. E., Vandormael, A., Kuhnert, K. L., Suri, P., Gates, J., Mabaso, B., Porwal, A., Prober, C., Bärnighausen, T. 2021; 18 (9): e1003744

  Abstract

  In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs ("mentor mothers").We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants' median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers' time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations.This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs' direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services.The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.

  View details for DOI 10.1371/journal.pmed.1003744

  View details for PubMedID 34582438

• Effect of a story-based, animated video to reduce added sugar consumption: A web-based randomized controlled trial. Journal of global health Vandormael, A., Hachaturyan, V., Adam, M., Favaretti, C., Gates, J., Barnighausen, T. 2021; 11: 04064

  Abstract

  Background: Short and animated story-based (SAS) videos, which can be rapidly distributed through social media channels, are a novel and promising strategy for promoting health behaviors. In this study, we evaluate the effectiveness of a SAS video intervention to reduce the consumption of added sugars.Methods: In December 2020, we randomized 4159 English-speaking participants from the United Kingdom (1:1:1) to a sugar intervention video, a content placebo video about sunscreen use (no sugar message), or a placebo video about earthquakes (no health or sugar message). We nested six list experiments in each arm and randomized participants (1:1) to a control list or a control list plus an item about consuming added sugars. The primary end-points were mean differences (on a scale of 0-100) in behavioral intent and direct restoration of freedom to consume added sugars.Results: Participants (N=4013) who watched the sugar video had significantly higher behavioral intent to cut their daily intake of added sugar (mean difference (md)=16.7, 95% confidence interval (CI)=1.5-31.8, P=0.031), eat fresh fruit daily (md=16.7, 95% CI=0.5-32.9, P=0.043), and check food labels for sugar content (md=20.5, 95% CI=2.6-38.5, P=0.025) when compared with the sunscreen (content placebo) video. The sugar video did not arouse intent to restore freedom and consume added sugars when compared with the two placebo videos.Conclusions: Our SAS intervention video did not arouse reactance and increased short-term behavioral intent among participants to reduce their consumption of added sugars. SAS videos, which draw on best practices from the entertainment-education media, communication theory, and the animation industry, can be an effective strategy for delivering emotionally compelling narratives to promote health behavior change.Trial registration: German Clinical Trials Register: DRKS00022340.

  View details for DOI 10.7189/jogh.11.04064

  View details for PubMedID 34737864

• Design for extreme scalability: A wordless, globally scalable COVID-19 prevention animation for rapid public health communication. Journal of global health Adam, M. n., Bärnighausen, T. n., McMahon, S. A. 2020; 10 (1): 010343

  View details for DOI 10.7189/jogh.10.010343

  View details for PubMedID 32411360

  View details for PubMedCentralID PMC7183247

• The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa. BMC health services research Adam, M., Tomlinson, M., Le Roux, I., LeFevre, A. E., McMahon, S. A., Johnston, J., Kirton, A., Mbewu, N., Strydom, S., Prober, C., Barnighausen, T. 2019; 19 (1): 211

  Abstract

  BACKGROUND: In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. In-home counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region.METHODS: We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eighty-four mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted.DISCUSSION: This trial will be among the first to explore a video-based, entertainment-education intervention delivered by CHWs and created using a community-based, human-centered design approach. As such, it could inform health policy, with regards to both the routine adoption of this intervention and, more broadly, the development of other entertainment-education interventions for health promotion in under-resourced settings.TRIAL REGISTRATION: The study and its outcomes were registered at clinicaltrials.gov ( #NCT03688217 ) on September 27th, 2018.

  View details for PubMedID 30940132

• Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach. Journal of medical Internet research Adam, M., McMahon, S. A., Prober, C., Barnighausen, T. 2019; 21 (1): e12128

  Abstract

  Drawing on 5 years of experience designing, producing, and disseminating video health education programs globally, we outline the process of creating accessible, engaging, and relevant video health education content using a community-based, human-centered design approach. We show that this approach can yield a new generation of interventions, which are better aligned with the needs and contexts of target communities. The participation of target communities and local stakeholders in the content production and design process fosters ownership of the content and increases the likelihood that the resulting intervention will resonate within its intended primary audience and be disseminated broadly. Ease of future adaptation for additional global audiences and modification of the content for multiple dissemination pathways are important early considerations to ensure scalability and long-term impact of the intervention. Recent advances in mobile technology can facilitate the dissemination of accessible, engaging health education at scale, thereby enhancing the potential impact of video-based educational tools. Accessible and engaging health education is a cornerstone of health behavior change. Especially in low- and middle-income countries, increasing access to effective health education can contribute to improved health outcomes. Prior research has identified several characteristics of effective health education interventions. These include the integration of pictures, narratives, and entertainment-education, in which the health messages that make up the educational content are embedded. However, the effectiveness and long-term impact of health messages ultimately depend on how well the end users can identify with the content that is presented. This identification, in turn, is a function of how well the messages correspond to user needs and wants and how this correspondence is communicated through the design characteristics of the health education intervention.

  View details for PubMedID 30698531

• Community health workers' experiences of using video teaching tools during home visitsA pilot study HEALTH & SOCIAL CARE IN THE COMMUNITY Coetzee, B., Kohrman, H., Tomlinson, M., Mbewu, N., Le Roux, I., Adam, M. 2018; 26 (2): 167–75

  Abstract

  Innovations in health, such as the use of tablet computers, show promise in broadening the scope of work of community health workers (CHWs), and play an important role in keeping CHWs and their clients up to date with advancements in health. While the use of mobile phones and tablets is innovative, the applicability of these technologies in different contexts remains poorly understood. Furthermore, little is known about the acceptability and feasibility of the use of video teaching tools on such devices across diverse contexts. In this study, we aimed to explore the acceptability and feasibility of using tablets with teaching videos (about HIV, alcohol, nutrition and breastfeeding) to support the health promotion efforts of 24 CHWs who work with pregnant mothers and mothers of young children in an urban township in South Africa. Between November 2015 and May 2016, we conducted focus groups and identified four key themes (with several sub-themes) that demonstrated factors related to the acceptability and feasibility of these devices and their content. Focus group transcripts were analysed thematically using qualitative data analysis software. The findings indicated that while the devices contained several supportive features (such as lightening the workload, and stimulating interest in their work), they also contained several restrictive features (safety and confidentiality). CHWs considered the video content an important tool to engage not only their clients but also family members and the community at large. Issues surrounding safety, privacy and confidentiality of using these devices require careful consideration prior to implementation in large-scale studies. Furthermore, stigma associated with household visits by CHWs and the nature of their work also need to be addressed by researchers and programme implementers. Overall, CHWs deemed the devices and the video content an acceptable and feasible means with which to provide health promotion and education among their clients.

  View details for PubMedID 28872210

• The Use of Short, Animated, Patient-Centered Springboard Videos to Underscore the Clinical Relevance of Preclinical Medical Student Education. Academic medicine Adam, M., Chen, S. F., Amieva, M., Deitz, J., Jang, H., Porwal, A., Prober, C. 2017

  Abstract

  Medical students often struggle to appreciate the clinical relevance of material taught in the preclinical years. The authors believe videos could be effectively used to interweave a patient's illness script with foundational basic science concepts.In collaboration with four other U.S. medical schools, educators at the Stanford University School of Medicine created 36 short, animated, patient-centered springboard videos (third-person, narrated accounts of authentic patient cases conveying foundational pathophysiology) in 2014. The videos were used to introduce students to 36 content modules, created as part of a microbiology, immunology, and infectious diseases curriculum. The videos were created with input from faculty content experts and in some cases medical students, and were piloted using a flipped classroom pedagogical approach in January 2015-June 2016.Student feedback from course evaluations and focus groups was analyzed using a mixed-methods approach. On the course evaluations, the majority of students rated the patient-centered videos positively, and the majority of comments on the videos were positive, highlighting both enhanced engagement and enhanced learning and retention. Comments from focus groups mirrored the course evaluation comments and highlighted different usage patterns for the videos.The authors will continue to gather and analyze data from schools using the videos as part of their core preclinical curriculum, and will produce similar videos for use in other areas of undergraduate medical education. These videos could support students' review of content taught previously and be repurposed for use in continuing and graduate medical education, as well as patient education.

  View details for DOI 10.1097/ACM.0000000000001574

  View details for PubMedID 28121656

• Massive open online nutrition and cooking course for improved eating behaviors and meal composition. international journal of behavioral nutrition and physical activity Adam, M., Young-Wolff, K. C., Konar, E., Winkleby, M. 2015; 12 (1): 143-?

  View details for DOI 10.1186/s12966-015-0305-2

  View details for PubMedID 26630879

• Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers. Journal of medical Internet research Adam, M., Nguyễn, V. K. 2024; 26: e55930

  View details for DOI 10.2196/55930

  View details for PubMedID 38345840

• Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial. Journal of medical Internet research Adam, M., Kwinda, Z., Dronavalli, M., Leonard, E., Nguyễn, V. K., Tshivhase, V., Bärnighausen, T., Pillay, Y. 2023; 25: e47266

  Abstract

  Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging.We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa.We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction.We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] -0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series.While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations.Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny.

  View details for DOI 10.2196/47266

  View details for PubMedID 37831505

• An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study. JMIR formative research Liu, S., Wegner, L., Haucke, M., Gates, J., Adam, M., Barnighausen, T. 2023; 7: e43036

  Abstract

  BACKGROUND: More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested.OBJECTIVE: In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness.METHODS: We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on "what really matters" in one's life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform "Unipark," on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS).RESULTS: We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (beta=4.14; t248=1.74; 1-tailed P=.04).CONCLUSIONS: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness.TRIAL REGISTRATION: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116.

  View details for DOI 10.2196/43036

  View details for PubMedID 37285206

• Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review. JMIR mHealth and uHealth Greuel, M., Sy, F., Barnighausen, T., Adam, M., Vandormael, A., Gates, J., Harling, G. 2023; 11: e42023

  Abstract

  BACKGROUND: Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs' lack of adequate supplies. The rising penetration of "smart" technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field.OBJECTIVE: This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change.METHODS: We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework.RESULTS: We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients-and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap.CONCLUSIONS: Smart mobile devices may augment CHWs' field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point.

  View details for DOI 10.2196/42023

  View details for PubMedID 36811947

• Development and Field-Testing of Proposed Food-Based Dietary Guideline Messages and Images amongst Consumers in Tanzania. Nutrients Du Plessis, L. M., Job, N., Coetzee, A., Fischer, S., Chikoko, M. P., Adam, M., Love, P., On Behalf Of The Food-Based Dietary Guideline Fbdg Technical Working Group Twg Led By Tanzania Food And Nutrition Centre Tfnc 2022; 14 (13)

  Abstract

  In this paper we report on the development and field-testing of proposed food-based dietary guideline (FBDG) messages among Tanzanian consumers. The messages were tested for cultural appropriateness, consumer understanding, acceptability, and feasibility. In addition, comprehension of the messages was assessed using culturally representative images for low literacy audiences. Focus group discussions were used as method for data collection. Results indicate that the core meaning of the proposed FBDG messages and images were understood and acceptable to the general population. However, participants felt that nutrition education would be required for improved comprehension. Feasibility was affected by some cultural differences, lack of nutrition knowledge, time constraints, and poverty. Suggestions were made for some rewording of certain messages and editing of certain images. It is recommended that the field-tested messages and images, incorporating the suggested changes, should be adopted. Once adopted, the FBDGs can be used to inform and engage various stakeholders, including parents, caregivers, healthcare providers and educators on appropriate nutritional practices for children and adults. They can also be used to guide implementation of relevant policies and programmes to contribute towards the achievement of sustainable healthy diets and healthy dietary patterns.

  View details for DOI 10.3390/nu14132705

  View details for PubMedID 35807884

• Optimizing knowledge and behavioral intention of women and their partners in the perinatal period in South Africa: a randomized control trial study protocol in the Tshwane district, Gauteng province, South Africa. BMC public health Leonard, E., Kwinda, Z., Baernighausen, T., Dronavalli, M., Adam, M., Pillay, Y. 2022; 22 (1): 1224

  Abstract

  BACKGROUND: Maternal knowledge that motivates improvements in critical perinatal health behaviors has the potential to significantly reduce maternal and neonatal mortality. However, evidence-based health information often fails to reach mothers and their partners. mHealth video micro-messages, which disseminate evidence-based perinatal health messages, have the potential to address this gap.METHODS: The study will make use of a mixed method design, using both qualitative and quantitative methods. The study consists of two phases. During Phase 1, qualitative in-depth interviews will be used as part of a human-centered design approach to co-create 10 videos on priority perinatal behaviors. During Phase 2, quantitative methods (a randomized control trial) will be used to test the effectiveness of the videos in improving maternal knowledge and intended behavioral change.DISCUSSION: We hypothesize that by engaging mothers and their partners through emotive, resonant narratives and visuals, we can facilitate the delivery of evidence-based health messages at the foundation of perinatal health, thereby motivating life-saving improvements in health behaviors during the perinatal period.TRIAL REGISTRATION: This trial has been prospectively registered on the Pan African Clinical Trials Registry (PACTR), with the registration number PACTR202203673222680 . Registration date: 14 March 2022. TRIAL REGISTRATION WHO DATA SET: Registry - Pan African Clinical Trials Registry (PACTR). Date: 14 March 2022. Secondary identification number - grant number: GCCSOAFMNH1. Source of support: Science for Africa Foundation. Primary sponsor - Clinton Health Access Initiative South Africa. Secondary sponsor - Stanford University School of Medicine and Heidelberg University. Contact for public & scientific queries: amandlamamasa@clintonhealthaccess.org ; +27 123,426,911; 1166 Francis Baard St, Hatfield, Pretoria, 0028. Public title - Amandla Mama. Scientific title - Optimizing knowledge and behavioral intention of women and their partners in the perinatal period in South Africa. Countries of recruitment - South Africa. Health conditions - antenatal care. Intervention - Amandla Mama mHealth videos, short 2D animated health promotional videos that promote healthy behavior in expectant mothers. Inclusion and exclusion criteria - Expectant mothers and their partners must be 18years and older. Study type - randomized control trial. Date of first enrollment - 14 March 2021. Sample size - plan to enrol 450 participants, participants enrolled 29 participants. Recruitment Status - suspended. Primary outcome - improving knowledge. Secondary outcome - intended behavioral change. Ethics review - Approved on 24 January 2022 by Pharma-Ethics, contact Mrs. Marzelle Haskins, marzelle@pharma-ethics.co.za . Completion date - N/A. Summary results - N/A. IPD sharing statement - yes, through the publication of results in a journal article.

  View details for DOI 10.1186/s12889-022-13600-3

  View details for PubMedID 35725421

• The effect of a short, animated story-based video on COVID-19 vaccine hesitancy: A study protocol for an online randomized controlled trial. Frontiers in public health Barteit, S., Hachaturyan, V., Beleites, F., Kuhn, T., Favaretti, C., Adam, M., Barnighausen, T. 2022; 10: 939227

  Abstract

  Introduction: Exposure to a high volume of vaccine misinformation on social media can have a negative effect on vaccine confidence and rates. To counteract misinformation, we designed a collage of three short, animated story-based (SAS) videos to convey scientifically informed and accessible information about COVID-19 vaccine applicable to a social media context.Methods and analysis: We will conduct an online randomized controlled trial primarily to: (1) determine the effectiveness of SAS videos in improving COVID-19 vaccine knowledge; (2) evaluate the effectiveness of SAS videos in increasing behavioral intent for COVID-19 vaccination; and (3) quantify people's interest in watching SAS videos about the COVID-19 vaccine. We also aim to identify barriers and facilitators to COIVD-19 vaccinations that have been shown to minimize vaccine hesitancy between vaccinated and unvaccinated populations. Using a web-based recruitment platform, a total of 10,000 adults from the United States will be recruited and randomly assigned to (1) a SAS video collage arm, (2) an attention placebo control video arm, or (3) no intervention arm (1:1:1). Furthermore, we will measure behavioral intent to obtain information on vaccination regarding COVID-19. At the end of the trial, participants randomized to arm 2 and arm 3 will be given the option of watching one of the intervention videos voluntarily to assess participant engagement with SAS videos. Finally, we will assess individual factors associated with vaccine hesitancy - hope, optimism, COVID-19 perceived risks and benefits, self-efficacy, perceived social norms, and trust - and compare vaccinated and unvaccinated participants across the three arms.Discussions: Evidence-based information from official channels can be complex and inaccessible to the general public, whereas false information on social media is frequently shared in brief postings, images, or videos that can easily reach the general public, thereby rapidly disseminating (mis-)information. To avoid the spread of misinformation, social media may be used to deliver evidence-based and emotionally compelling information in a readily accessible format in order to pre-empt misinformation. Our findings may help inform future SAS efforts addressing COVID-19 and other important public health challenges.Ethics and dissemination: The study was approved by the Heidelberg University Hospital's Ethics Committee (S-163/2022). The trial was registered with German Clinical Trials Register (www.drks.de) on 5 January 2022: number DRKS00027938. Findings of the study will be published in peer-reviewed scientific publications and possibly presented at scientific conferences.

  View details for DOI 10.3389/fpubh.2022.939227

  View details for PubMedID 36081470

• The effect of malaria on childhood anemia in a quasi-experimental study of 7,384 twins from 23 Sub-Saharan African countries. Frontiers in public health Starck, T., Dambach, P., Rouamba, T., Tinto, H., Osier, F., Oldenburg, C. E., Adam, M., Barnighausen, T., Jaenisch, T., Bulstra, C. A. 2022; 10: 1009865

  Abstract

  Background: Young children in Sub-Saharan Africa (SSA), particularly those from resource-limited settings, are heavily burdened by anemia and malaria. While malaria infected children frequently become anemic (hemoglobin < 110 g/L), anemia is a strongly multifactorial disease with many other risk factors than malaria. Due to the complex and often overlapping contributors to anemia, it remains challenging to isolate the true impact of malaria on population level hemoglobin concentrations.Methods: We quantified the malaria-induced effect on hemoglobin levels in children under 5 years of age, leveraging data from 7,384 twins and other multiples, aged 6 to 59 months, from 57 nationally representative Demographic and Health Surveys (DHSs) from 23 SSA countries from 2006 to 2019. The quasi-experimental twin fixed-effect design let us minimize the impact of potential confounders that do not vary between twins.Results: Our analyses of twins revealed a malaria-induced hemoglobin decrease in infected twins of 9 g/L (95% CI -10; -7, p<0.001). The relative risk of severe anemia was higher (RR = 3.01, 95% CI 1.79; 5.1, p<0.001) among malaria positive children, compared to malaria negative children. Conversely, malaria positive children are only half as likely to be non-anemic (RR = 0.51, 95% CI 0.43; 0.61, p<0.001).Conclusion: Even after rigorous control for confounding through a twin fixed-effects study design, malaria substantially decreased hemoglobin levels among SSA twins, rendering them much more susceptible to severe anemia. This effect reflects the population-level effect of malaria on anemia.

  View details for DOI 10.3389/fpubh.2022.1009865

  View details for PubMedID 36561861

• How can human-centered design build a story-based video intervention that addresses vaccine hesitancy and bolsters vaccine confidence in the Philippines? A mixedmethod protocol for project SALUBONG. BMJ open Renosa, M. D., Wachinger, J., Barnighausen, K., Aligato, M. F., Landicho-Guevarra, J., Endoma, V., Landicho, J., Bravo, T. A., Demonteverde, M. P., Guevarra, J. R., de Claro Iii, N., Inobaya, M., Adam, M., Chase, R. P., McMahon, S. A. 2021; 11 (6): e046814

  Abstract

  INTRODUCTION: Since the onset of a dengue vaccine controversy in late 2017, vaccine confidence has plummeted in the Philippines, leading to measles and polio outbreaks in early 2019. This protocol outlines a human-centered design (HCD) approach to co-create and test an intervention that addresses vaccine hesitancy (VH) via narrative and empathy with and among families and healthcare workers. METHODS AND ANALYSIS: 'Salubong' is a Filipino term that means to welcome someone back into one's life, reinforcing notions of family ties and friendships. We apply this sentiment to vaccines. Following the phases of HCD, guided by a theoretical framework, and drawing from locally held understandings of faith and acceptance, we will conduct in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Filipino communities that witnessed dramatic increases in measles cases in recent years. During qualitative engagements with caretakers, providers, and policymakers, we will collect narratives about family and community perceptions of childhood vaccinations, public health systems and opportunities to restore faith. IDIs and FGDs will continuously inform the development of (and delivery mechanisms for) story-based interventions. Once developed, we will test our co-created interventions among 800 caretakers and administer a VH questionnaire prior to and immediately following the intervention encounter. We will use the feedback gained through the survey and Kano-style questionnaires to further refine the intervention. Considering the data collection challenges posed by the ongoing COVID-19 pandemic, we have developed workarounds to conduct data collection primarily online. We will use systematic online debriefings to facilitate comprehensive participation of the full research team.ETHICS AND DISSEMINATION: Ethical approval has been granted by the Institutional Review Board of the Research Institute for Tropical Medicine (number 2019-44) and Ethical Commission of Heidelberg University, Faculty of Medicine (S-833/2019). Study findings will be disseminated in scientific conferences and published in peer-reviewed journals.

  View details for DOI 10.1136/bmjopen-2020-046814

  View details for PubMedID 34108166

• Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial. JMIR research protocols Vandormael, A., Adam, M., Hachaturyan, V., Greuel, M., Favaretti, C., Gates, J., Baernighausen, T. 2021; 10 (5): e25343

  Abstract

  Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message-a phenomenon known as reactance.In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child's mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator's perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants' interest in watching the entertainment-education intervention video.This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video.The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021.In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs.German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340.DERR1-10.2196/25343.

  View details for DOI 10.2196/25343

  View details for PubMedID 34047702

• Reactance to Social Authority in a Sugar Reduction Informational Video: Web-Based Randomized Controlled Trial of 4013 Participants. Journal of medical Internet research Hachaturyan, V., Adam, M., Favaretti, C., Greuel, M., Gates, J., Bärnighausen, T., Vandormael, A. 2021; 23 (11): e29664

  Abstract

  Short and animated story-based (SAS) videos can be an effective strategy for promoting health messages. However, health promotion strategies often motivate the rejection of health messages, a phenomenon known as reactance. In this study, we examine whether the child narrator of a SAS video (perceived as nonthreatening, with low social authority) minimizes reactance to a health message about the consumption of added sugars.This study aims to determine whether our SAS intervention video attenuates reactance to the sugar message when compared with a content placebo video (a health message about sunscreen) and a placebo video (a nonhealth message about earthquakes) and determine if the child narrator is more effective at reducing reactance to the sugar message when compared with the mother narrator (equivalent social authority to target audience) or family physician narrator (high social authority) of the same SAS video.This is a web-based randomized controlled trial comparing an intervention video about sugar reduction narrated by a child, the child's mother, or the family physician with a content placebo video about sunscreen use and a placebo video about earthquakes. The primary end points are differences in the antecedents to reactance (proneness to reactance, threat level of the message), its components (anger and negative cognition), and outcomes (source appraisal and attitude). We performed analysis of variance on data collected (N=4013) from participants aged 18 to 59 years who speak English and reside in the United Kingdom.Between December 9 and December 11, 2020, we recruited 38.62% (1550/4013) men, 60.85% (2442/4013) women, and 0.52% (21/4013) others for our study. We found a strong causal relationship between the persuasiveness of the content promoted by the videos and the components of reactance. Compared with the placebo (mean 1.56, SD 0.63) and content placebo (mean 1.76, SD 0.69) videos, the intervention videos (mean 1.99, SD 0.83) aroused higher levels of reactance to the message content (P<.001). We found no evidence that the child narrator (mean 1.99, SD 0.87) attenuated reactance to the sugar reduction message when compared with the physician (mean 1.95, SD 0.79; P=.77) and mother (mean 2.03, SD 0.83; P=.93). In addition, the physician was perceived as more qualified, reliable, and having more expertise than the child (P<.001) and mother (P<.001) narrators.Although children may be perceived as nonthreatening messengers, we found no evidence that a child narrator attenuated reactance to a SAS video about sugar consumption when compared with a physician. Furthermore, our intervention videos, with well-intended goals toward audience health awareness, aroused higher levels of reactance when compared with the placebo videos. Our results highlight the challenges in developing effective interventions to promote persuasive health messages.German Clinical Trials Registry DRKS00022340; https://tinyurl.com/mr8dfena.RR2-10.2196/25343.

  View details for DOI 10.2196/29664

  View details for PubMedID 34813490

• The First, Comprehensive, Open-Source Culinary Medicine Curriculum for Health Professional Training Programs: A Global Reach. American journal of lifestyle medicine Hauser, M. E., Nordgren, J. R., Adam, M., Gardner, C. D., Rydel, T., Bever, A. M., Steinberg, E. 2020; 14 (4): 369-373

  Abstract

  Providing a strong foundation in culinary medicine (CM)-including what constitutes a healthy diet and how to find, obtain, and prepare healthy and delicious food-is a cornerstone of educating health professionals to support patients in achieving better health outcomes. The Culinary Medicine Curriculum (CMC), published in collaboration with the American College of Lifestyle Medicine, is the first, comprehensive, open-source guide created to support the implementation of CM at health professional training programs (HPTPs) worldwide. The CMC is modeled after the successful CM elective course for Stanford University School of Medicine students. Key goals of the CMC include presenting healthy food as unapologetically delicious, quick, and inexpensive; translating lessons learned to healthy eating on-the-go; practicing motivational interviewing on healthy dietary behavior changes; and demonstrating how to launch a CM course. The CMC highlights a predominantly whole food, plant-based diet as seen through the lenses of different world flavors and culinary traditions. It was developed, published, and distributed with the aim of expanding CM by reducing barriers to creating CM courses within most types of HPTPs and practice settings. During the first 2 months the CMC was available, it was downloaded 2379 times in 83 countries by a wide variety of health care professionals interested in teaching CM. The global interest in this first, freely available, evidence-based CMC underscores the demand for CM resources. Such resources could prove foundational in expediting development of CM courses and expanding the reach of CM and counseling on dietary behavior changes into patient care.

  View details for DOI 10.1177/1559827620916699

  View details for PubMedID 33281516

  View details for PubMedCentralID PMC7692007

• The First, Comprehensive, Open-Source Culinary Medicine Curriculum for Health Professional Training Programs: A Global Reach AMERICAN JOURNAL OF LIFESTYLE MEDICINE Hauser, M. E., Nordgren, J. R., Adam, M., Gardner, C. D., Rydel, T., Bever, A. M., Steinberg, E. 2020; 14 (4): 369–73

  View details for DOI 10.1177/1559827620916699

  View details for Web of Science ID 000548638900006

• Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study (vol 7, e13604, 2019) JMIR MHEALTH AND UHEALTH Isler, J., Sawadogo, N., Harling, G., Baernighausen, T., Adam, M., Kagone, M., Sie, A., Greuel, M., McMahon, S. A. 2020; 8 (1)

  View details for DOI 10.2196/17666

  View details for Web of Science ID 000509538100001

• Correction: Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study. JMIR mHealth and uHealth Isler, J., Sawadogo, N. H., Harling, G., Bärnighausen, T., Adam, M., Kagoné, M., Sié, A., Greuel, M., McMahon, S. A. 2020; 8 (1): e17666

  View details for DOI 10.2196/17666

  View details for PubMedID 32012112

• 'If he sees it with his own eyes, he will understand': how gender informed the content and delivery of a maternal nutrition intervention in Burkina Faso. Health policy and planning Isler, J. n., Sawadogo, N. H., Harling, G. n., Bärnighausen, T. n., Adam, M. n., Sié, A. n., McMahon, S. A. 2020

  Abstract

  A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world's most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.'s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one's own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men's perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso.

  View details for DOI 10.1093/heapol/czaa012

  View details for PubMedID 32106288

• A short, animated video to improve good COVID-19 hygiene practices: a structured summary of a study protocol for a randomized controlled trial. Trials Vandormael, A. n., Adam, M. n., Greuel, M. n., Bärnighausen, T. n. 2020; 21 (1): 469

  Abstract

  Entertainment-education (E-E) media can improve behavioral intent toward health-related practices. In the era of COVID-19, millions of people can be reached by E-E media without requiring any physical contact. We have designed a short, wordless, animated video about COVID-19 hygiene practices-such as social distancing and frequent hand washing-that can be rapidly distributed through social media channels to a global audience. The E-E video's effectiveness, however, remains unclear. The study aims to achieve the following objectives. To: 1.Quantify people's interest in watching a short, animated video about COVID-19 hygiene (abbreviated to CoVideo).2.Establish the CoVideo's effectiveness in increasing behavioural intent toward COVID-19 hygiene.3.Establish the CoVideo's effectiveness in improving COVID-19 hygiene knowledge.The present study is a multi-site, parallel group, randomized controlled trial (RCT) comparing the effectiveness of the CoVideo against an attention placebo control (APC) video or no video. The trial has an intervention arm (CoVideo), placebo arm (APC), and control arm (no video). Nested in each trial arm is a list experiment and questionnaire survey, with the following ordering. Arm 1: the CoVideo, list experiment, and questionnaire survey. Arm 2: the APC video, list experiment, questionnaire survey, and CoVideo. Arm 3: the list experiment, questionnaire survey, and CoVideo. For each list experiment, participants will be randomized to a control or treatment group. The control group will receive a list of five items and the treatment group will receive the same five items plus one item about COVID-19 hygiene. We will use the list experiment to reduce response bias associated with socially desirable answers to COVID-19 questions. The questionnaire survey will include items about the participant's age, sex, country of residence, highest education, and knowledge of COVID-19 spread. After completing the list experiment and questionnaire survey, participants in Arms 2 and 3 will receive the CoVideo to ensure post-trial access to treatment.This will be an online study setting. We will use Prolific Academic (ProA: https://www.prolific.co) to recruit participants and host our study on the Gorilla™ platform (www.gorilla.sc). To be eligible, participants must be between the age of 18 and 59 years (male, female, or other) and have current residence in the United States, the United Kingdom, Germany, Spain, Mexico, or France. Participants will be excluded from the study if they cannot speak English, German, French, or Spanish (since the instructions and survey questions will be available in these 4 languages only).The intervention is an E-E video about COVID-19 hygiene (CoVideo). Developed by our co-author (MA) for Stanford Medicine, the CoVideo is animated with sound effects, and has no words, speech, or text. The CoVideo shows how the novel coronavirus is spread (airborne, physical contact) and summarizes the public's response to the COVID-19 outbreak. Key components of the CoVideo are the promotion of five hygiene practices: i) social distancing and avoiding group gatherings, ii) frequently washing hands with soap and water or sanitizer, iii) cleaning surfaces at home (e.g., kitchen counters), iv) not sharing eating utensils, and v) avoidance of stockpiling essential goods (such as toilet paper and face masks). The CoVideo, which was designed for universal reach and optimized for release on social media channels, can be viewed at https://www.youtube.com/watch?v=rAj38E7vrS8. The comparators are an APC video (Arm 2) or no video (Arm 3). The APC video is similar in style to the CoVideo; it is also animated with a duration of 2.30 minutes, has sound effects but no words, speech, or text. The video message is about how small choices become actions, which become habits, which become a way of life. It is available at https://www.youtube.com/watch?v=_HEnohs6yYw. Each list experiment will have a control list as the comparator. The control list is needed to measure the prevalence of behavioral intent toward COVID-19 hygiene.This study will measure primary and secondary outcomes related to COVID-19 hygiene. By hygiene, we mean the adoption of behaviors or practices that reduce the chances of being infected or spreading COVID-19. As our primary outcome, we will measure changes in behavioral intent toward five hygiene practices: social distancing, washing hands, cleaning household surfaces, not sharing eating utensils, and not stockpiling essential goods. As a secondary outcome, we will measure knowledge about behaviors that can prevent the spread of COVID-19.Using a web-based randomization algorithm, Gorilla will randomly allocate participants to the intervention (CoVideo), placebo (APC), or control (no video) arm (sequence generation) at a 1:1:1 ratio. Within each trial arm, Gorilla will randomly allocate participants at a 1:1 ratio to the control or treatment group. Items in the lists will be randomly ordered to avoid order effects. The presentation order of the list experiments will also be randomized.Because ProA handles the interaction between the study investigators and participants, the participants will be completely anonymous to the study investigators. The outcome measures will be self-reported and submitted anonymously. All persons in the study team will be blinded to the group allocation.The Gorilla algorithm will randomize 6,700 participants to each trial arm, giving a total sample size of 20,100.The protocol version number is 1.0 and the date is 18 May 2020. Recruitment is expected to end by 22 June 2020. Thus far, the study investigators have recruited 2,500 participants on ProA. Of these participants, 800 have completed the study on the Gorilla platform.The study and its outcomes were registered at the German Clinical Trials Register (www.drks.de) on May 12th, 2020, protocol number: #DRKS00021582. The study was registered before any data was collected.The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

  View details for DOI 10.1186/s13063-020-04449-1

  View details for PubMedID 32493460

• An entertainment-education approach to prevent COVID-19 spread: study protocol for a multi-site randomized controlled trial. Trials Vandormael, A. n., Adam, M. n., Greuel, M. n., Bärnighausen, T. n. 2020; 21 (1): 1025

  Abstract

  Entertainment-education (E-E) media can improve behavioral intent toward health-related practices. In the era of COVID-19, millions of people can be reached by E-E media without requiring any physical contact. We have designed a short, wordless, animated video about preventive COVID-19 behaviors that can be rapidly distributed through social media channels to a global audience. The E-E video's effectiveness, however, remains unclear.This is a multi-site, parallel group, randomized controlled trial comparing the effectiveness of an E-E video on COVID-19 against (i) an attention placebo control (APC) video and (ii) no video. For our primary outcomes, we will measure knowledge about preventive COVID-19 behaviors. We will also use a list randomization approach to measure behavioral intent toward preventative COVID-19 behaviors. In each trial arm, participants will be randomized to a control list or a control list plus an item about social distancing, washing hands, cleaning household surfaces, sharing of eating utensils, and the stockpiling of essential goods. Using an online platform, we will recruit 17,010 participants (aged 18-59 years) from the USA, the UK, Germany, Spain, France, and Mexico.German Clinical Trials Register #DRKS00021582 . Registered on May 12, 2020.This trial will utilize several randomization procedures, list experimentation methods, and state-of-the-art online technology to demonstrate the effectiveness of an E-E video to improve knowledge of, and behavioral intent toward, the prevention of COVID-19. Our results will inform future E-E video campaigns for COVID-19 and similar public health intervention needs.

  View details for DOI 10.1186/s13063-020-04942-7

  View details for PubMedID 33323130

• Iterative Adaptation of a Maternal Nutrition Videos mHealth Intervention Across Countries Using Human-Centered Design: Qualitative Study. JMIR mHealth and uHealth Isler, J., Sawadogo, N. H., Harling, G., Barnighausen, T., Adam, M., Kagone, M., Sie, A., Greuel, M., McMahon, S. A. 2019; 7 (11): e13604

  Abstract

  BACKGROUND: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso.OBJECTIVE: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings.METHODS: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors.RESULTS: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video's protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted.CONCLUSIONS: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions.

  View details for DOI 10.2196/13604

  View details for PubMedID 31710302

• A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform ACADEMIC MEDICINE Chen, S. F., Deitz, J., Batten, J. N., DeCoste-Lopez, J., Adam, M., Alspaugh, J., Amieva, M. R., Becker, P., Boslett, B., Carline, J., Chin-Hong, P., Engle, D. L., Hayward, K. N., Nevins, A., Porwal, A., Pottinger, P. S., Schwartz, B. S., Smith, S., Sow, M., Teherani, A., Prober, C. G. 2019; 94 (6): 819–25

  View details for DOI 10.1097/ACM.0000000000002663

  View details for Web of Science ID 000474067900026

• A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform. Academic medicine : journal of the Association of American Medical Colleges Chen, S. F., Deitz, J., Batten, J. N., DeCoste-Lopez, J., Adam, M., Alspaugh, J. A., Amieva, M. R., Becker, P., Boslett, B., Carline, J., Chin-Hong, P., Engle, D. L., Hayward, K. N., Nevins, A., Porwal, A., Pottinger, P. S., Schwartz, B. S., Smith, S., Sow, M., Teherani, A., Prober, C. G. 2019

  Abstract

  Medical educators have not reached widespread agreement on core content for a U.S. medical school curriculum. As a first step toward addressing this, five U.S. medical schools formed the Robert Wood Johnson Foundation Reimagining Medical Education collaborative to define, create, implement, and freely share core content for a foundational medical school course on microbiology and immunology. This proof-of-concept project involved delivery of core content to preclinical medical students through online videos and class time interactions between students and facilitators. A flexible, modular design allowed four of the medical schools to successfully implement the content modules in diverse curricular settings. Compared to the prior year, student satisfaction ratings after implementation were comparable or showed a statistically significant improvement. Students who took this course at a time point in their training similar to when the USMLE Step 1 reference group took Step 1 earned equivalent scores on National Board of Medical Examiners-Customized Assessment Services microbiology exam items. Exam scores for three schools ranged from 0.82 to 0.84, compared to 0.81 for the national reference group; exam scores were 0.70 at the fourth school, where students took the exam in their first quarter, two years earlier than the reference group. This project demonstrates that core content for a foundational medical school course can be defined, created, and used by multiple medical schools without compromising student satisfaction or knowledge. This project offers one approach to collaboratively defining core content and designing curricular resources for preclinical medical school education that can be shared.

  View details for PubMedID 30801270