Facilitating Evidence Informed Decision Making to Non-Literate Consumers in Cameroon

Facilitating Evidence Informed Decision Making to Non-Literate Consumers in Cameroon Introduction The peculiar context of basic services consumers calls for diverse approaches in evidence translation and communication. In Africa for example, literacy rates are low, and the people are ingrained in a culture of storytelling and the arts. The African Union Agenda 2063 under Aspiration 5 has also identified the culture of storytelling and arts as an identity and heritage that can contribute to development and growth in Africa. Evidence informed decision making (EIDM) capacity is still weak and access to relevant research evidence is limited. People are however eager to make evidence informed choices. Research evidence presented as text and numbers tends to be indigestible to consumers in this context. An approach that uses the arts; storytelling, drama, poems, music, graphics, and dance will be better suited here. eBASE Africa and a consumer representative group in healthcare and education in collaboration with local traditional story tellers developed an approach of knowledge translation whereby evidence recommendations are modeled into stories, poems or graphics and communicated to consumers during art shows. Research Translation Activities We worked in two sectors, Education and Health. In Education, we identified evidence gaps in homework where students were reluctant to use evidence-based approaches for doing homework in schools. We developed a PICO. Population: TVET students in secondary schools; Intervention: Interventions to improve homework effectiveness; Comparator: current methods; Outcome: Number of children completing homework, exam pass rates. We searched evidence from Cameroon Ministry of Education guidelines database; Campbell Collaboration; Education Endowment Foundation database; and eBASE Teaching and Learning Toolkit. In Health, we identified evidence gaps from the consumer perspective in the treatment of malaria; consumers not wanting to do tests and demanding injections. We developed our PICO: P - children under 5 years with uncomplicated malaria; I - Any WHO (World Health Organization)-recommended Artemisinin-Based Therapy; C - any standard evidence deviating care, O - absence of malaria parasite. We searched for relevant evidence from Cameroon Ministry of Health guidelines database, Cochrane Reviews, WHO guidelines and JBI (Joanna Briggs Institute) database. We summarized the relevant evidence that we found into one sentence per piece of evidence. We worked closely with artists to model the summarized evidence into art (songs, drama, stories, graphics, and poems), ensuring that the evidence is communicated. We moved on to organize three performing arts events during which stories, poems, songs, dramas, and graphics were exhibited to communicate this evidence. Impact Measuring actual impact of artistic presentations is a long and rigorous process requiring funding. We however have some results on our activities and the number of persons reached. From our search of relevant evidence from evidence ecosystems and databases, we found 2 national guidelines; 3 Campbell reviews; 5 Cochrane Reviews; three JBI evidence reports; one WHO guideline; and six relevant primary studies. We used evidence on the back end of the eBASE Teaching and Learning Toolkit. We developed evidence summaries (three sentences: one sentence for each piece of evidence). We modelled evidence summaries into two dramas; two poems; one piece of music and several graphics (drawings and posters). Three events organized with 1889 people in attendance generated USD 735. We generated 218 code systems from MAXQDA and identified seven emerging themes including evidence acceptance; evidence hesitancy; diversity needs; role of culture; evidence communication; evidence reaffirmation, and recommendations on the process. Six out of 10 consumers were likely to accept evidence while four out of 10 were still hesitant about evidence.  Challenges and Lessons Learnt Measuring impact is expensive and can presently not be possible without funding. To mitigate this challenge, we are looking for avenues to develop proposals and submit for funding. Global competition for funding is however not so fair to the African researcher. South-South collaborations and healthy North-South collaborations will be helpful in overcoming this challenge. Communicating scientific evidence of what works to traditional storytellers and artists is a complicated process. We resolved to having several work sessions to ensure communication happens. We also explored traditional behavioural and spiritual aspects that guide artistic creativity in Africa. Sessions were organised rural areas that had bad roads and no electricity. With large crowds, storytelling could be challenging without loudspeakers and appropriate lighting. We mitigated this challenge by using small groups of villagers by firesides under baobab trees. Funding to cover costs for travels, time for story tellers and researchers, and other logistics was a challenge. We mitigated this by charging a participation fee for attendance for people in the cities to cover costs for people in the village. Transferring and scaling out this innovative initiative to other African countries will contribute to Agenda 2063 Aspirations. Facilitating Evidence Informed Decision Making to Non-Literate Consumers in Cameroon Introduction The peculiar context of basic services consumers calls for diverse approaches in evidence translation and communication. In Africa for example, literacy rates are low, and the people are ingrained in a culture of storytelling and the arts. The African Union Agenda 2063 under Aspiration 5 has also identified the culture of storytelling and arts as an identity and heritage that can contribute to development and growth in Africa. Evidence informed decision making (EIDM) capacity is still weak and access to relevant research evidence is limited. People are however eager to make evidence informed choices. Research evidence presented as text and numbers tends to be indigestible to consumers in this context. An approach that uses the arts; storytelling, drama, poems, music, graphics, and dance will be better suited here. eBASE Africa and a consumer representative group in healthcare and education in collaboration with local traditional story tellers developed an approach of knowledge translation whereby evidence recommendations are modeled into stories, poems or graphics and communicated to consumers during art shows. Research Translation Activities We worked in two sectors, Education and Health. In Education, we identified evidence gaps in homework where students were reluctant to use evidence-based approaches for doing homework in schools. We developed a PICO. Population: TVET students in secondary schools; Intervention: Interventions to improve homework effectiveness; Comparator: current methods; Outcome: Number of children completing homework, exam pass rates. We searched evidence from Cameroon Ministry of Education guidelines database; Campbell Collaboration; Education Endowment Foundation database; and eBASE Teaching and Learning Toolkit. In Health, we identified evidence gaps from the consumer perspective in the treatment of malaria; consumers not wanting to do tests and demanding injections. We developed our PICO: P - children under 5 years with uncomplicated malaria; I - Any WHO (World Health Organization)-recommended Artemisinin-Based Therapy; C - any standard evidence deviating care, O - absence of malaria parasite. We searched for relevant evidence from Cameroon Ministry of Health guidelines database, Cochrane Reviews, WHO guidelines and JBI (Joanna Briggs Institute) database. We summarized the relevant evidence that we found into one sentence per piece of evidence. We worked closely with artists to model the summarized evidence into art (songs, drama, stories, graphics, and poems), ensuring that the evidence is communicated. We moved on to organize three performing arts events during which stories, poems, songs, dramas, and graphics were exhibited to communicate this evidence. Impact Measuring actual impact of artistic presentations is a long and rigorous process requiring funding. We however have some results on our activities and the number of persons reached. From our search of relevant evidence from evidence ecosystems and databases, we found 2 national guidelines; 3 Campbell reviews; 5 Cochrane Reviews; three JBI evidence reports; one WHO guideline; and six relevant primary studies. We used evidence on the back end of the eBASE Teaching and Learning Toolkit. We developed evidence summaries (three sentences: one sentence for each piece of evidence). We modelled evidence summaries into two dramas; two poems; one piece of music and several graphics (drawings and posters). Three events organized with 1889 people in attendance generated USD 735. We generated 218 code systems from MAXQDA and identified seven emerging themes including evidence acceptance; evidence hesitancy; diversity needs; role of culture; evidence communication; evidence reaffirmation, and recommendations on the process. Six out of 10 consumers were likely to accept evidence while four out of 10 were still hesitant about evidence.  Challenges and Lessons Learnt Measuring impact is expensive and can presently not be possible without funding. To mitigate this challenge, we are looking for avenues to develop proposals and submit for funding. Global competition for funding is however not so fair to the African researcher. South-South collaborations and healthy North-South collaborations will be helpful in overcoming this challenge. Communicating scientific evidence of what works to traditional storytellers and artists is a complicated process. We resolved to having several work sessions to ensure communication happens. We also explored traditional behavioural and spiritual aspects that guide artistic creativity in Africa. Sessions were organised rural areas that had bad roads and no electricity. With large crowds, storytelling could be challenging without loudspeakers and appropriate lighting. We mitigated this challenge by using small groups of villagers by firesides under baobab trees. Funding to cover costs for travels, time for story tellers and researchers, and other logistics was a challenge. We mitigated this by charging a participation fee for attendance for people in the cities to cover costs for people in the village. Transferring and scaling out this innovative initiative to other African countries will contribute to Agenda 2063 Aspirations.