02440nas a2200289   4500000000100000008004100001260001000042653001100052653003800063653001700101653001500118653003900133653001300172653001800185653001100203100001300214700001300227700001200240700001400252700001500266700001200281700001600293245010300309856006900412300001400481520165500495       2016                            d  bASTMH10aUganda10aSoil-Transmitted Helminths (STHs)10aShoe wearing10aPrevention10aNeglected tropical diseases (NTDs)10aLiteracy10aInterventions10aImages1 aPaige SB1 aFriant S1 aClech L1 aMalavé C1 aKemigabo C1 aObeti R1 aGoldberg TL00aCombining footwear with public health iconography to prevent soil-transmitted helminth infections.  uhttp://www.ajtmh.org/content/early/2016/11/03/ajtmh.15-0910.long  a15–09103 a<p>Shoes are effective for blocking soil-transmitted helminths (STHs) that penetrate the skin. Unfortunately, shoe-wearing is uncommon in many areas where STHs are prevalent, in part because local populations are unaware of the health benefits of wearing shoes. This is especially true in low-literacy populations, where information dissemination through written m essages is not possible. We launched a public health intervention that combines a public health image with sandals. The image is a “lenticular image” that combines two alternating pictures to depict the efficacy of shoes for preventing STH infection. This image is adhered to the shoe, such that the message is linked directly to the primary means of prevention. To create a culturally appropriate image, we conducted five focus group discussions, each with a different gender and age combination. Results of focus group discussions reinforced the importance of refining public health messages well in advance of distribution so that cultural acceptability is strong. After the image was finalized, we deployed shoes with the image in communities in western Uganda where hookworm is prevalent. We found that the frequency of shoe-wearing was 25% higher in communities receiving the shoes than in control communities. Microscopic analyses of fecal samples for parasites showed a sustained reduction in infection intensity for parasites transmitted directly through the feet when people received shoes with a public health image.<br />
Our results show that combining culturally appropriate images with public health interventions can be effective in low-literacy populations.</p>