Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
7
,
No.
1
,
Ma
rch
201
8
, pp.
7
2
~
8
0
IS
S
N:
22
52
-
8806
, DO
I: 10
.11
591/ij
phs.
v7
i
1.
1
07
67
72
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
S
ources
of
C
ardi
ovascula
r
H
ealth
I
nform
ation and
C
hann
els of
H
ealth
C
ommu
nicati
on
amon
g
U
rban
P
opulation
in Nige
ria
Ejiof
or A.
Ez
i
ka
1
,
B
e
th Cr
oss
2
, Moir
a
Le
w
itt
3
1
,3
School
of
H
ealth, Nursing
and
Midwifer
y
,
Un
iv
ersity
of
th
e
W
es
t
of
Sco
tl
and
,
U
K
2
School
of Educ
at
ion
,
Univ
ersity
of
th
e
W
est
of
S
cot
l
and, UK
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Dec
2
8
, 201
7
Re
vised
Feb
2
5
, 2
01
8
Accepte
d
Ma
r
15
, 201
8
Thi
s
stud
y
empl
o
y
ed
m
ixe
d
m
ethods
to
inve
stiga
te
th
e
pre
fer
r
ed
source
s
of
hea
l
th
information
and
la
ter
ex
plore
d
the
vi
ew
s
of
com
m
unity
hea
lt
h
ca
r
e
workers
on
the
ena
bl
ers,
bar
ri
er
s
and
way
s
of
over
coming
bar
ri
ers
to
hea
lt
h
comm
unic
at
ion.
The
stud
y
foun
d
tha
t
m
aj
or
ity
of
the
pa
rticipa
n
ts
pre
fer
r
e
d
the
ir
source
of
CV
(ca
rdiova
sc
ula
r)
he
al
th
info
rm
at
ion
from
the
hea
l
thcar
e
workers
inc
ludi
n
g
the
m
edi
c
al
do
ct
ors,
nurses,
an
d
phar
m
ac
ists.
O
n
the
othe
r
hand,
the
least
pre
fer
red
source
of
he
al
th
infor
m
at
ion
was
fro
m
frie
nds,
famil
y
m
embers
,
and
comm
unit
y
l
ea
de
rs.
Som
e
of
the
ide
n
ti
fi
ed
ena
blers
to
comm
unity
he
alth
comm
unic
at
i
on
inc
lud
e
awa
r
ene
ss
progra
m
me
via
Non
-
Governm
ent
al
Organi
sati
ons
(
NG
Os
),
com
m
u
nity
-
base
d
orga
nisat
ions
such
as
fai
th
-
b
ase
d
o
rga
nisations
and
he
althc
are
f
acil
it
ie
s
.
Other
s
are
tra
di
ti
ona
l
m
edi
a
and
soc
ial
m
edi
a
.
Th
e
id
ent
ified
ba
rrie
rs
to
comm
unity
-
base
d
he
al
t
h
comm
unic
at
ion
inc
lud
e
la
ck
of
knowledge
and
pover
t
y
,
l
anguage
bar
rie
rs
,
and
othe
r
m
iscella
n
eous
issues
inc
ludi
ng
m
isuse
of
int
ern
e
t,
l
a
ck
of
basic
amenit
i
es
and
r
el
igi
ous
b
el
i
efs.
The
comm
unit
y
-
bas
ed
he
al
th
c
are
provid
ers
art
i
cul
a
te
d
wa
y
s
to
over
come
th
e
ide
nti
f
ie
d
b
arr
i
e
rs
,
inc
lud
ing
enli
ghte
nm
ent
progra
m
m
es,
us
ing
the
la
nguag
e
of
the
ta
rg
et
audi
en
ce,
fund
ing
healt
h
awa
ren
ess
progr
amm
es,
and
m
onit
oring
of
heal
th
educat
ion
interve
nt
ions.
Thi
s
stud
y
co
ncl
udes
that
di
ss
eminat
ion
of
hea
lt
h
informati
on
usin
g
num
ero
us
cha
nnel
s
is
essential
in
ensuring
popula
t
ion
-
wi
de
prima
r
y
pre
vention
of
dis
ea
ses.
Ke
yw
or
d:
Healt
h
c
omm
u
nicat
ion
Healt
h
in
f
or
m
at
ion
Me
dia ch
a
nnel
s
Nige
ria
Publi
c h
eal
th
Copyright
©
201
8
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Moira Le
witt
,
School
of
Healt
h,
Nursin
g
a
nd Mi
dwife
ry
,
Un
i
ver
sit
y o
f
t
he West
of
Scot
la
nd
,
High St
reet,
Pa
isl
ey
,
PA1
2BE
,
Un
it
ed
K
i
ngdo
m
.
Em
a
il
: M
oira.
le
witt
@uws.ac.
uk
1.
INTROD
U
CTION
Healt
h
com
m
un
ic
at
ion
s
a
nd
s
ocial
m
ark
et
in
g
cam
paign
s
use
m
ult
iples
channels
to
rais
e
awar
e
ness
and
pro
vid
e
c
ultur
al
ly
appr
opriat
e
m
essages
about
the
dis
ease
,
en
vir
onm
ental
con
diti
on
s
,
nutrit
io
n,
safety
,
li
te
racy
a
m
on
g
oth
er
issues
to
ope
n
up
a
ccess
to
new
knowle
dge
a
nd
ef
fect
a
behavio
ur
c
ha
nge
[1]
.
I
n
dev
el
op
i
ng
ec
onom
ie
s,
it
is
ver
y
c
halle
nging
to
dissem
inate
inf
or
m
at
ion
to
the
public
beca
us
e
m
any
li
ve
in
dem
og
ra
ph
ic
c
on
te
xts
that
ar
e
hard
to
reac
h
an
d
beca
us
e
com
m
un
ic
at
ion
m
eans
are
oft
en
li
m
it
ed
[2]
.
The
pr
e
requisi
te
f
or
el
im
inati
ng
he
al
th
ine
qu
al
it
ie
s
is
f
or
pu
blic
healt
h
pro
fess
ion
al
s
t
o
e
xp
a
nd
thei
r
us
e
of
healt
h
com
m
un
ic
at
ion
strat
egies
with
the
ai
m
of
a
ff
ect
in
g
ind
ivi
du
al
,
c
omm
un
it
y,
or
gan
isa
ti
ons
a
nd
poli
cy
form
ulati
on
s.
This
a
ppr
oach
can
c
on
t
rib
ute
to
ad
dressi
ng
t
he
m
ulti
ple
determ
inants
of
he
al
th
that
giv
e
rise
to
healt
h
in
eq
ualit
ie
s
[3]
.
The
evi
de
nce
highli
gh
ti
ng
th
e
i
m
po
rt
ance
of
div
e
rsificat
io
n
of
healt
h
c
om
m
un
ic
at
ion
appr
oach
es
t
o
i
m
pr
ove
CV
he
al
th
ou
tc
om
es
inform
ed
the
researc
h
ob
j
ect
ives
of
this
stu
dy.
The
ai
m
was
to
inv
est
igat
e
the
pr
e
ferred
s
our
ces
of
C
V
he
al
th
inf
orm
ati
on
in
an
urba
n
popula
ti
on
in
Nige
rian
as
well
as
ex
pl
or
e
the
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Sour
ces
o
f C
ardiov
as
c
ula
r
He
alth
In
f
or
m
atio
n and C
hannel
s o
f
He
alth Comm
unic
atio
n
.
.
..
(
Eji
ofo
r
A. E
zik
a)
73
per
ce
ptio
ns
of
com
m
un
it
y
healt
hcar
e
pro
vide
rs
a
nd
healt
h
prom
otion
pr
a
ct
it
ion
ers
on
e
nab
le
rs,
ba
rr
ie
r
s
a
nd
ways
to
overc
om
e
bar
rie
rs
to
healt
h
c
omm
u
nicat
ion
withi
n
the
c
omm
un
ity.
The
c
om
plexity
of
c
ultu
re
sh
oul
d
be
unde
rstoo
d
be
fore
i
nter
ve
nti
on
to
inc
ul
cat
e
cultural
var
ia
bles
int
o
healt
h
com
m
un
ic
at
io
n
e
ffo
rts
[
3]
.
Unde
rstan
ding
the
ta
r
get
a
ud
ie
nce
healt
h
ne
eds
is
esse
ntial
to
determ
ine
the
c
ha
nn
el
s
t
ha
t
will
be
em
plo
ye
d
to r
eac
h
t
hem
. Ev
ery c
ha
nn
el
is dif
fer
e
nt and
h
as
d
if
fer
e
nt e
ng
a
gem
ent
, content, a
nd c
omm
un
it
y no
rm
s
[4]
.
2.
METHO
D
S
The
m
et
ho
dol
og
y
a
dopte
d
f
or
this
st
ud
y
is
m
ixed
m
eth
ods
seq
ue
ntial
ex
planato
ry
desi
gn.
T
he
m
ixed
-
m
et
ho
ds
sequ
e
ntial
exp
la
nato
ry
des
ign
c
on
sist
s
of
two
disti
nct
ph
ases
,
inclu
ding
qua
ntit
at
i
ve
a
nd
qu
al
it
at
ive
pha
ses
resp
ect
ivel
y. The
qu
al
it
at
ive d
at
a
are co
l
le
ct
ed
and
a
naly
sed
seco
nd
in
the seq
ue
nce
to
hel
p
el
aborate
on
t
he
qu
a
ntit
at
ive
res
ults
obta
ined
in
the
fir
st
ph
a
se
[
5
]
.
T
his
stu
dy
in
vo
l
ved
tw
o
sa
m
pl
ing
m
et
ho
ds
i
nclu
ding
co
nve
nience
a
nd
pur
posive
sam
pling
.
This
stu
dy
e
m
plo
ye
d
conv
enience
sam
pling
t
o
recr
uit
50
pa
rtic
ipants
via
w
ord
of
m
ou
th
,
poste
rs
,
ha
ndbil
ls
and
c
omm
u
nity
networ
ks
.
The
incl
us
io
n
crit
eria
for
par
ti
ci
pa
nts
that
to
ok
pa
rt
in
the
stu
dy
re
flect
ed
t
hr
ee
com
po
sit
e
at
tribu
te
s.
T
he
par
ti
ci
pa
nts
we
r
e
Nige
ri
ans
resi
ding
in
a
giv
e
n
urba
n
dem
og
ra
phic
con
te
xt
s
who
unde
rst
and
a
nd
s
pea
k
Eng
li
sh,
an
d
betwee
n
the
ages
of
20
-
80.
H
ow
e
ve
r,
tho
s
e
that
par
ti
ci
pated
in
the
stud
y
we
re
bet
ween
t
he
ages
of
20
-
59.
E
xc
lusio
n
crit
eria
inclu
de
non
-
Ni
ger
ia
ns,
Ni
ger
ia
ns
ou
t
side
t
he
age
br
acket
(
20
-
80),
and
Ni
ger
ia
ns
residin
g
outsi
de
the
giv
e
n
urba
n
ge
ogra
ph
ic
al
ar
ea.
Qu
e
sti
onna
ires
wer
e
a
dm
inist
ered
to
the
50
par
ti
ci
pan
ts
to
ide
ntify
their
pr
e
ferred
sou
r
ces
of
healt
h
inf
or
m
at
ion
.
La
te
r
on,
te
n
c
om
m
un
it
y
health
care
w
orkers
and
heal
th
pro
m
ot
ion
prof
e
ssio
nals
am
on
g
the
50
pa
rtic
ipants
we
r
e
pu
r
posively
sel
ect
ed,
an
d
their
vie
ws
on
enab
le
rs,
ba
rr
i
ers
an
d
ways
of
overc
om
ing
ba
rr
ie
rs
to
c
omm
un
ity
healt
h
c
omm
un
ic
at
ion
w
ere
e
xp
l
or
e
d
us
in
g
sem
i
-
structu
re
d
intervie
w
guid
e.
A
Sp
ea
rm
an'
s
ran
k
c
orrelat
ion
was
run
to
determ
ine
the
relat
ion
s
hip
be
tween
par
ti
ci
pan
t
s
’
pr
e
ferred
sou
r
ces
of
he
al
th
inf
or
m
at
ion
.
H
om
og
en
ous
sa
m
pl
ing
te
ch
nique
was
us
ed
,
i
n
wh
ic
h
the
se
le
ct
ion
crit
eria
was
ba
sed
on
s
ha
re
d
sim
i
la
r
chara
ct
erist
ic
s
reg
a
rd
i
ng
occ
up
at
i
on
[
6
]
.
O
ne
-
to
-
one
inter
vie
w
s
with
each
of
the
he
al
thcare
w
orke
rs
an
d
healt
h
prom
otion
prof
e
ssion
al
s
la
ste
d
45
–
60
m
inu
te
s.
The
se
que
nci
ng
a
nd
ap
proac
he
s
to
key
quest
i
on
s
we
re
c
ha
nged
de
pe
nd
i
ng
on
the
detai
ls
that
nee
ded
to
be
dr
a
w
n
out
[
7
]
.
An
appr
oach
to t
hem
at
ic
an
al
yses
prese
nted by
Brau
n
a
nd Cl
ar
k was
us
e
d
to
a
naly
se the
qual
it
at
ive d
at
a
[
8
]
.
3.
RESU
LT
S
The
age
distri
bu
ti
ons
of
the
par
ti
ci
pan
ts
are
dem
on
stra
te
d
in
F
igure
1.
The
m
ajo
rity
of
the
par
ti
ci
pa
nts
w
ere
am
on
g
the
age
gro
up
of
30
-
39.
T
he
pa
rtic
ipants
betw
een
t
he
a
ge
group
of
50
-
59
were
few
est
.
Fig
ure
1
.
A
ge gr
oups o
f
t
he p
arti
ci
pan
ts
The
a
ge
gro
up
30
–
39
has
the
highest
num
ber
of
pa
rtic
ipa
nts
w
her
ea
s
th
e
age
gro
up
20
–
29
a
nd
40
–
49
ha
ve
an
e
qu
al
num
ber
of
par
ti
ci
pa
nts.
The
age
group
50
–
59
ha
ve
the
le
ast
nu
m
ber
of
par
ti
ci
pa
nts.
The
fig
ur
e
belo
w
de
picts
the
gat
he
red
i
nfor
m
at
i
on
on
pa
rtic
ip
ants
prefe
rr
e
d
so
urces
of
hea
lt
h
inf
or
m
at
ion
.
T
he
pr
e
ferred
s
our
ces
of
public
healt
h
inf
orm
a
ti
on
withi
n
the
c
omm
un
it
y
wh
ere
the
publi
c
healt
h
inter
ve
ntion
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
, No
.
1
,
Ma
rch
201
8
:
7
2
–
8
0
74
was
unde
rtake
n
are
sho
wn
in
F
igu
r
e
2.
Five
ty
par
ti
ci
pan
ts
wer
e
as
ked
to
identify
their
prefe
rr
e
d
source
s
of
healt
h
in
f
or
m
ation
.
Fig
ure
2
.
S
our
ces o
f heal
th i
nfo
rm
ation
i
n
th
e comm
un
it
y
Sp
ea
rm
an'
s
ran
k
co
rr
el
at
io
n
was
run
to
det
erm
ine
the
rel
at
ion
s
hip
betw
een
par
ti
ci
pa
nt
s’
pr
e
ferred
so
urces
of
he
al
th
inf
or
m
at
i
on.
Str
ongest
correla
ti
on
was
f
ound
be
tween
th
os
e
who
pr
e
ferred
healt
h
inf
or
m
at
ion
fr
om
e
m
a
il
s/t
e
xt
m
essages/
phone
ap
ps
and
t
ho
se
w
ho
pr
e
ferr
e
d
inform
at
ion
from
Faceb
ook/T
witt
er/YouT
ub
e/
L
ink
e
dIn
(
r
s
=
0.639
4,
n
=
50,
p
=
0.0
000).
T
he
reas
on
f
or
t
he
relat
io
ns
hi
p
coul
d
be
as
a
resu
lt
of
the
fact
that
t
he
form
er
and
la
tt
er
gr
oup
s
ha
re
on
e k
ey
fea
ture
in
com
m
o
n
w
hich
is
bein
g
par
t
of
m
od
ern
m
e
dia.
It
is
inter
est
ing
t
hat
the
re
is
no
c
orrelat
ion
betwee
n
those
who
pr
efer
red
their
he
al
th
inf
or
m
at
ion
from
m
edical
do
ct
or
s/n
urses/
ph
arm
aci
s
ts
and
tho
s
e
who
pref
err
e
d
their
hea
lt
h
inform
ation
fr
om
any
oth
e
r
s
our
ce
(e.
g.
r
s
=
0.
0316,
n
=
50,
p
=
0.8
275).
I
n
li
gh
t
of
t
his
ob
s
er
vation,
it
is
i
m
po
rtant
f
or
t
he
m
edical
do
ct
ors/nurses/
pha
rm
aci
sts
to
dev
is
e
ot
her
m
eans
to
c
reate
a
wa
ren
es
s
a
bout
CV
healt
h,
inc
lud
in
g
signp
os
ti
ng
th
ei
r
patie
nts
to
releva
nt
healt
h
m
agazines
a
nd
jo
urnals
or
TV
healt
h
program
m
es
since
the
y
wer
e
unli
kely
to
be
acce
ssin
g
inform
ation
from
oth
er
so
urc
es
or
us
i
ng
othe
r
sel
f
-
help
m
a
te
rial
s.
Ther
e
was
a
m
od
erate
rela
ti
on
s
hip
betw
een
t
ho
se
w
ho
prefe
rred
their
source
of
C
V
healt
h
in
form
at
io
n
from
fr
ie
nds/fam
il
y/comm
un
it
y
le
a
der
s
a
nd
tho
s
e
who
pref
er
red
their
source
of
healt
h
inf
orm
a
ti
on
f
ro
m
te
le
vision
(r
s
=
0.433
6,
n = 5
0,
p
=
0.00
017).
3.1.
Enablers
t
o
c
om
munit
y
h
eal
th
c
ommu
nica
tion
In
ex
plorin
g
th
e
quest
io
ns
on
the
e
nab
le
rs
of
c
omm
un
it
y
healt
h
com
m
un
ic
at
ion
in
the
c
omm
un
it
y,
the foll
owin
g
t
hem
es e
m
erg
ed:
3.1.1.
Awarenes
s pr
og
r
amme
s
via no
n
-
gover
nm
ent
al o
r
ganisa
tion (
NGO’s
)
The
pa
rtic
ipan
ts
hig
hlig
hted
that
awar
e
ness
pr
og
ram
m
es
via
NGO’s
as
channel
of
co
m
m
un
ic
at
ion
prom
ote
co
m
m
un
i
ty
healt
h
edu
cat
io
n.
T
he
NGOs
act
ivit
ie
s
that
the
resp
on
den
ts
wer
e
awar
e
of
we
r
e
qu
it
e
wide
-
ra
ng
i
ng
.
‘Aware
ness
program
m
es,
fo
r
exam
ple
du
ri
ng
t
he
la
st
Eb
ola
outb
reak
i
n
Ni
ger
ia
,
i
nfo
rm
ation
was
dissem
inate
d
on
wh
at
t
o do li
ke wat
chin
g o
f
h
a
nds’
-
P
2 1
So
m
e
co
m
m
u
nity
-
base
d
hea
lt
hcar
e
w
orkers
su
ggest
e
d
th
at
condu
ct
in
g
fr
ee
m
edical
c
heck
-
up
a
nd
us
in
g peer
edu
cat
ion
ca
n be
use
d
as
v
e
hicle
s
to pr
om
ote h
e
al
th educat
io
n.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Sour
ces
o
f C
ardiov
as
c
ula
r
He
alth
In
f
or
m
atio
n and C
hannel
s o
f
He
alth Comm
unic
atio
n
.
.
..
(
Eji
ofo
r
A. E
zik
a)
75
‘Conduct
in
g
f
r
ee
checks,
if
gove
r
nm
ent,
NG
O
’s,
ca
n
com
e
ou
t
a
nd
do
free
checks
f
or
pe
op
l
e
if
they
can
be
able
to
reach
pe
op
le
t
hat
can
’t
af
for
d
to
pay
f
or
it
,
they
can
pass
healt
h
in
form
a
ti
on
th
rou
gh
these m
eans’
-
P45:
2
‘T
her
e
is
a
ne
ed
to
bri
ng
it
(
healt
h
c
omm
u
nicat
ion)
to
l
owest
le
vel,
f
or
exam
ple,
a
vil
la
ge
w
om
an
ta
lking
t
o
a
v
il
la
ge wo
m
an’
-
P1
:6
3.1.2.
Co
m
munit
y o
rganisa
tions
The
par
ti
ci
pa
nt
s
highli
gh
te
d
var
i
ous
com
m
un
it
y
chan
ne
ls
that
ena
ble
com
m
un
it
y
-
base
d
healt
h
edu
cat
io
n.
Th
ese
com
m
un
ity
channels
in
cl
ud
e
fait
h
-
bas
ed
or
gan
isa
ti
ons
,
sc
hools
a
nd
pri
m
ary
healt
hcare
facil
it
ie
s,
pubs
,
and
s
uperm
ark
et
s.
‘Th
e
best
cha
nn
el
is
the
on
e
that
can
reach
the
vill
age.
Ther
e
m
us
t
be
a
way
to
integrate
al
l
the
channels.
O
ne
of
the
c
ha
nn
e
ls
cou
l
d
be
a
r
el
igion
but
if
so
m
ebo
dy
is
goin
g
to
sit
in
an
office
in
Abu
j
a
(F
e
der
al
Ca
pital
of
Ni
ger
ia
)
a
nd
pa
ss
th
e
(
healt
h)
in
form
ation
via
t
he
te
le
visi
on
or
r
adi
o
a
nd
m
y
m
u
m
in
the
vill
age
has
not
seen
pow
er
su
pply
for
a
m
on
t
h
how
is
th
at
go
in
g
to
w
ork
?
My
m
u
m
m
ay
no
t
even
know
how
to
on
(t
urn
on)
t
he
te
le
vision
or
m
ay
no
t
even
ha
ve
acce
ss
to
te
le
vision
su
c
h
a
ppro
ac
h (u
se
of tel
evisi
on only
)
ca
n n
ever be
ef
fecti
ve
in
N
i
ger
ia
f
or now’
-
P
1:
8
–
9
So
m
e
argued
t
hat
c
hurch
e
s
a
nd
ot
her
fait
h
-
base
d
groups
e
nab
le
com
m
un
it
y
healt
h
-
com
m
un
ic
at
ion
,
oth
e
rs
s
uggeste
d
it
is
no
t a
com
m
on
pract
ic
e in
Nige
ria.
‘N
i
ger
ia
is
a
ve
ry
re
li
gious
c
ountry,
a
nd
pe
op
le
te
nd
to
li
s
te
n
m
or
e
to
their
reli
gious
le
ader
s
t
han
the
(go
vernm
ent)
auth
or
it
ie
s.
A
s
a
resu
lt
,
the
churc
h
is
a
go
od
platf
or
m
to
reach
m
any
people
with
healt
h
in
f
or
m
ation’
-
P
8:10
–
11
It
ap
pears
disease
outb
reak
is
a
fact
or
t
ha
t
infl
uen
ces
the
us
e
of
the
c
hur
ch
as
a
platf
or
m
fo
r
healt
h
prom
otion
in
Nige
ria.
‘I
t
is
not
ve
ry
com
m
on
for
pe
op
le
t
o
us
e
ch
urches
t
o
pass
he
al
th
inf
or
m
at
i
on
unle
ss
w
he
n
the
re
is
an
ou
t
br
ea
k’
–
P
25:9
In
c
reasin
g
the
us
e
of
fait
h
-
ba
sed
or
gan
isa
ti
on
s
as
a
c
omm
un
it
y
reso
urce
for
healt
h
prom
otion
i
n
Nige
ria
is
i
m
po
rta
nt
in
m
inim
isi
ng
healt
h
ineq
ualit
ie
s.
So
m
e
par
ti
ci
pan
ts
in
the
c
urr
ent
stud
y
sta
te
d
that
sch
oo
ls,
stadi
um
, an
d
healt
hc
are f
aci
li
ti
es se
rv
e
as c
hannels
for
c
omm
un
it
y healt
h
c
omm
un
ic
at
io
n.
‘Th
e
go
vernm
ent
m
ay
decide
to
us
e
pu
bs
,
sc
hools,
hosp
it
al
s,
bill
boar
ds
d
e
pendin
g
on
the
gro
up
t
hey
are
ta
rg
et
i
ng.
I
f
the
go
vernm
ent
is
try
ing
t
o
ta
r
get
yout
h,
they
m
ay
wan
t
to
use
the
s
ta
diu
m
.
The
sch
oo
ls,
s
uper
m
ark
et
s
....
the
real
issue
is,
ar
e
they
read
y
to
do
it
?
The
im
plem
entat
ion
is
the
issue
’
-
P1
:1
0
So
m
e p
os
it
that town
c
ryi
ng
i
s essen
ti
al
as it deli
ver
s
healt
h i
nf
orm
at
ion
in
the langua
ge
of the tar
get
aud
ie
nce
w
hich
help
assim
il
a
ti
on
of
the
in
form
ation
.
Othe
r
s
adm
it
te
d
that
town
cryi
ng
m
ay
s
ti
l
l
be
need
ed
i
n
the rural c
omm
un
it
ie
s
bu
t
no l
onge
r
c
omm
on
in
to
day’s
wo
r
ld.
‘U
si
ng
t
own
c
riers
is
one
of
the
best
opti
on
s,
pe
op
le
ca
n
a
ccess
inf
or
m
ation
in
t
heir
la
ngua
ge,
a
nd
the in
form
at
io
n wil
l si
nk’
-
P
1:11
‘I
do
n’
t
thi
nk
they
sti
ll
us
e
town
c
ryi
ng
(la
ug
hs)
e
ven
i
n
oth
e
r
local
c
om
m
un
it
ie
s,
but
it
m
a
y
help
to
gathe
r
t
he
pe
op
le
t
og
e
ther,
the
n
t
he
he
al
th
pro
fessi
onal
w
ould
no
w
ta
lk
to
the
pe
ople
’
-
P
18
:
12
3.1.3.
Tr
ad
itio
na
l
m
edia
Ma
j
ori
ty
of
he
al
thcare
w
ork
ers
sta
te
d
that
healt
h
pro
gr
a
m
m
es
on
TV
and
rad
i
o
pro
m
ote
healt
h
inf
or
m
at
ion
.
‘
Wh
e
n
the
re
was
a
case
of
Eb
ola
in
Nige
ria,
the
healt
h
a
uthoriti
es
li
ai
se
with
TV
,
ra
dio
a
nd
new
s
pa
per o
utf
it
to
create
a
wa
ren
es
s’
–
P25:
4
The
par
ti
ci
pa
nt
s
in
this
stu
dy
po
inte
d
ou
t
that
wro
ng
ti
m
ing
of
healt
h
edu
cat
i
on
pro
gr
am
m
es
on
te
le
vision
c
ould
be
a
ba
rr
ie
r
to
reachi
ng a la
rg
e
po
pu
la
ti
on.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
, No
.
1
,
Ma
rch
201
8
:
7
2
–
8
0
76
‘A
t
le
ast
I
can
assure
yo
u
that
ever
y
hom
e
in
Nige
ria
has
te
le
visio
n;
it
(TV)
is
ve
ry
com
m
on,
but
th
e
on
ly
pro
blem
i
s
that
a
lot
of
people
m
ay
m
i
ss
the
op
portu
nity
to
watch
a
healt
h
pr
ogra
m
m
e
wh
en
it
is
bein
g
ai
re
d
be
cause t
hey m
a
y no
t
be
at
ho
m
e’
-
P
18:6
So
m
e comm
un
it
y
-
based
healt
hcar
e
worke
rs arg
ue
t
hat r
a
di
o
is
easi
e
r
to
a
ccess t
ha
n
T
V.
‘Radio
is
e
ve
n
m
or
e
com
mo
n
as
a
m
eans
of
healt
h
co
m
m
un
ic
at
ion
,
there
are
sm
all
pieces
of
equ
i
pm
ent
that
has
ra
dio,
phon
e
s
hav
e
ra
di
o,
ca
rs
ha
ve
ra
dio
,
eve
n
if
yo
u
e
nter
c
omm
ercial
buses
you
s
ee them
pl
ay
ing
r
a
dio,
ra
dio
is
ve
ry co
m
m
on
as a c
ha
nn
el
of
healt
h com
m
un
ic
at
ion
’
–
P45:
7
So
m
e
com
m
u
nity
-
base
d
hea
lt
hcar
e
pr
act
it
ion
e
rs
quest
io
ne
d
how
of
te
n
TV
a
nd
ra
dio
are
us
ed
to
dissem
inate
h
eal
th infor
m
at
ion
.
‘A
lt
ho
ugh
t
he
re
are
te
le
visi
on
an
d
ra
dio
in
Ni
ger
ia
,
th
e
quest
io
n
is
how
m
any
pe
o
ple
(
healt
h
prof
e
ssio
nals) do us
e it
for he
al
th infor
m
at
ion
dissem
inati
on
’
-
P1
:
2
3.1.4.
So
ci
al
medi
a
an
d
phone
ap
ps
T
The
com
m
un
it
y
healt
hcar
e
workers
sta
te
d
that
so
ci
al
m
edia
su
ch
a
s
Twitt
er,
Wh
at
sA
pp
an
d
Faceb
ook
as
well
as
phone
app
s
as
m
eans
of
m
od
er
n
com
m
un
ic
at
i
on
facil
it
at
e
disse
m
inati
on
of
healt
h
inf
or
m
at
ion
wi
thin
t
he
c
ommun
it
y.
Affor
da
bili
ty
of
data
and
br
oadba
nd
seem
ed
to
be
i
m
po
rta
nt
fact
or
s
in
us
in
g
s
ocial
m
edia f
or h
eal
t
h com
m
un
ic
at
ion
in
the c
omm
un
it
y.
‘Th
e
yo
uth
a
r
e
ve
ry
act
ive
i
n
s
ocial
m
edia
b
eca
us
e
c
omm
un
ic
at
ion
ou
tl
et
no
w
r
ollo
ut
br
oadba
nd
wh
ic
h
is
chea
p
and
a
fforda
ble
and
m
any
pe
op
le
acce
ss
i
nfor
m
at
ion
thr
ough
t
heir
ph
on
e
s,
Faceb
oo
k
and twit
te
r un
li
ke bef
or
e
whe
n
yo
u ha
ve
to
go to
cy
ber caf
e’
-
P
8:
5
In
this
stu
dy,
s
om
e
healt
hcar
e
work
e
rs
s
ug
ge
ste
d
that
the
use
of
the
inter
ne
t
is
m
or
e
co
m
m
on
a
m
on
g
the educat
e
d
a
nd yo
unge
r popu
la
ti
on.
‘Inter
net
is
m
ai
nly
for
the
e
du
cat
e
d
on
e
s.
People
use
int
ern
et
t
o
s
olv
e
pro
blem
s
fo
r
them
sel
ves,
people
bo
t
h
in
the
r
ural
an
d
urba
n
com
m
unit
ie
s
us
e
it
but
de
pe
ndin
g
on
the
le
vels
of
edu
cat
io
n
of
the p
e
rs
on’
–
P
30
:
8
3.2.
Barri
ers t
o he
alth com
muni
cat
i
on
The
t
hem
es that e
m
erg
ed
from
ex
plo
rin
g
ba
rr
ie
rs
to
healt
h
com
m
un
ic
at
ion
a
re show
n
be
low.
3.2.1.
Lack
of kn
owle
dg
e
and p
ove
rty
The
c
omm
un
it
y
healt
hcare
w
orkers
wer
e
as
ked
to
m
ention
the
key
barrie
rs
to
the
c
ommun
it
y
healt
h
com
m
un
ic
at
ion
. In
res
pondin
g
to the q
ue
sti
on, th
e
m
ajo
rity
of
h
eal
thcare
w
orke
rs
identi
fied
la
ck
of ed
ucati
on
and po
ver
ty
as
barriers t
o heal
th co
m
m
un
ic
at
ion
i
n
Nige
ria.
‘My
gran
dm
oth
er
in
the
vill
age
if
yo
u
te
ll
he
r
s
he
s
houl
d
no
t
eat
chic
ke
n
(in
fected
c
hi
cken)
due
t
o
avian
i
nf
l
uen
za
, s
he
wo
uld l
au
gh at y
ou a
nd
go ah
ea
d
a
nd s
ti
ll
eat t
he
chicken’
–
P37:1
6
So
m
e
com
m
u
nity
-
base
d
hea
lt
hcar
e
wor
kers
ad
de
d
that
in
a
dd
it
io
n
t
o
i
gnorance
,
la
ck
of
fun
d
a
nd
pove
rty
aff
ect
people’s
ab
il
it
y t
o
ad
he
re to
healt
h
e
ducat
io
n give
n
to
the
m
.
‘Dur
i
ng
the ca
se o
f
Eb
ola outbr
ea
k,
the
re was a ca
m
paign
f
or p
e
op
le
not to eat
bu
sh
m
eat
(
m
eat
fr
om
wild
a
nim
a
ls)
.
..
bu
t
th
ere
a
re
so
m
e
peo
ple
their
s
ources
of
incom
e
are
f
r
om
sel
li
ng
bus
h
m
eat
and
their
on
ly
s
our
ce
of
protei
n
f
resh
is
from
bu
sh
m
eat
so
t
he
y
can
no
t
a
dh
ere
to
the
te
achin
g
(h
eal
th
edu
cat
io
n) that
can
c
ha
ng
e
th
ei
r
li
ves’
–
P
45:13
A
com
m
un
it
y
-
base
d
healt
hc
are
wor
ker
e
xpresse
d
co
n
c
ern
that
Nige
rian
gove
r
nme
nt
m
ay
be
fina
ncial
ly
h
an
dicap
ped to
co
ntinu
e
to
m
ake
su
sta
ina
ble a
w
aren
es
s
on pu
bl
ic
h
eal
th iss
ue
s.
‘Ano
t
her
c
halle
ng
e
I
m
a
y
mention
is
po
or
fund
i
ng
f
r
om
the
Niger
ia
n
gove
rn
m
ent
.
Mon
ey
is
a
resou
rce
that
ge
ts
exh
a
us
te
d.
Fo
r
y
ou
to
kee
p
m
aking
aware
ness
ab
out
a
healt
h
issue
m
on
ey
ne
ed
t
o
be
in
volve
d’
-
P18:1
8
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Sour
ces
o
f C
ardiov
as
c
ula
r
He
alth
In
f
or
m
atio
n and C
hannel
s o
f
He
alth Comm
unic
atio
n
.
.
..
(
Eji
ofo
r
A. E
zik
a)
77
3.2.2.
Langua
ge
So
m
e
co
m
m
u
nity
-
base
d
hea
lt
hcar
e
w
orkers
po
sit
that
la
ngua
ge
co
uld
be
a
barrier
to
com
m
un
it
y
healt
h
c
omm
u
nicat
ion
.
T
hey
reas
on
e
d
t
hat
even
with
the
t
rad
it
io
nal
an
d
so
ci
al
m
edia,
inf
or
m
at
ion
m
a
y
sti
ll
be
diff
ic
ult
to
get to t
he ru
ral
com
m
un
it
ie
s.
‘Lang
uag
e
c
ou
ld
be
a
barrier
;
if
you
don’t
unde
rstan
d
the
l
angua
ge
of
the
people,
yo
u
m
igh
t
fi
nd
it
diff
ic
ult t
o ren
der ser
vices to
the p
e
ople
yo
u wan
t t
o
se
rv
e
’
-
P
45
:
2
‘One
of
the
barriers
as
fa
r
as
our
c
omm
un
it
y
is
con
ce
rn
e
d
is
the
inabili
ty
of
the
in
form
at
i
on
t
o
get
to
the
ta
rg
et
gro
up.
E
ve
n
if
the
i
nfor
m
at
ion
is
passe
d
th
rou
gh
these
cha
nnel
s
,
so
m
e
people
m
ay
no
t
get
the in
form
at
io
n; for exam
ple,
let
m
e say
the
people in
rur
al
com
m
un
it
y’
-
P1
:1
5
Howe
ver,
the
par
ti
ci
pa
nts
in
this
stud
y
are
of
the
opinio
n
t
hat
the
us
e
of
ja
rgo
n
is
no
lo
nger
a
ba
rr
ie
r
to co
m
m
un
it
y healt
h
c
omm
u
nicat
ion
i
n Nig
eria since t
he p
racti
ce sto
pp
e
d o
ver a
decad
e
ago.
‘I
t d
oes hap
pe
n
(
us
e of j
a
r
gon
in h
eal
t
h
co
m
m
un
ic
at
ion
) bu
t i
n recent y
ears,
le
t m
e
say fr
om
the
ye
a
r
2000,
t
he
ex
pe
rt
now
break
dow
n
th
e
bi
g
w
ords
.
..
t
hey
do
n’
t
incl
ud
e
th
ose
w
ords
a
gain
.
Wh
e
n
yo
u
look
at
the
pam
ph
le
t
(h
eal
th
resou
rce
m
at
erial
s),
it
is
so
m
et
i
m
es
wr
it
te
n
in
three
m
ajo
r
la
nguag
e
s
in
Nige
ria’
-
P
8:
20
3.2.3.
Miscel
lane
ou
s
issues
The
c
omm
un
it
y
-
base
d
healt
hc
are
wor
ker
s
highli
gh
te
d
ot
her
m
isc
ellaneo
us
iss
ues
t
ha
t
co
ns
ti
tute
barriers
to
c
om
m
un
it
y
health
com
m
un
ic
at
i
on
incl
ud
i
ng,
m
isuse
of
inter
net,
an
d
la
ck
of
basic
am
enities.
For
exam
ple,
the
com
m
un
it
y
-
based
healt
hca
re
work
e
rs
poin
te
d
out
that
m
isuse
of
inter
ne
t
and
la
ck
of
basic
a
m
eniti
es
su
ch
as
power s
uppl
y
cou
ld
pose
a
thr
eat
t
o
c
omm
un
it
y healt
h
com
m
un
ic
at
ion
.
‘Dur
i
ng
E
bola
case
in
Nige
ria,
there
we
re
ca
ses
of
los
s
of
li
ves
due
to
ab
use
of
ne
w
c
omm
un
ic
at
ion
syst
e
m
;
peo
ple
we
re
se
ndin
g
m
essages
via
SMS
a
nd
al
l
that
to
t
heir
fa
m
ily
and
f
rien
ds
t
o
dr
i
nk
plenty
of
sal
t
water
an
d
have
a
bath
wit
h
it
,
that
is
how
bad
t
he
ab
us
e
of
m
od
er
n
c
om
m
un
ic
at
ion
gadget c
ou
l
d b
e’
–
P
30 :2
1
Othe
r
co
nce
rns
highli
ghte
d
by
the
c
omm
u
nity
-
base
d
hea
lt
hcar
e
work
e
r
s
inclu
de
iss
ue
s
relat
ed
t
o
powe
r
fail
ures,
corr
up
ti
on,
and
reli
g
io
us
belie
f.
‘
Wh
e
n
the
re is
no li
gh
t
(
powe
r
fail
ure)
p
e
opl
e can
no
t
watc
h ne
ws’
-
P38:
4
‘Th
e
insi
ncer
it
y
of
the
peopl
e
that
su
ppos
e
d
to
i
m
ple
m
ent
the
healt
h
com
m
un
ic
at
ion
s
is
the
m
ajo
r
issue; t
he f
und m
ay
be
div
e
rte
d
for pers
onal
us
e’
–
P
30
:
29
‘Ano
t
her
b
ar
rier
is
t
he
reli
gious
belie
f,
f
or
e
xam
ple...
if
yo
u
lo
ok
at
the
iss
ue
of
poli
o
(
po
li
o
m
ye
liti
s)
vaccinati
on.
..som
e
Muslim
l
eaders
in
nort
hern
Nige
ria
di
scourag
e
their
subj
ect
s
from
ta
king
poli
o
vaccines
as th
e
y beli
eve it ca
n m
ake th
ei
r
w
om
en
infe
rtil
e and
de
popula
te
them
’
-
P1
:
25
3.3.
Ov
erc
omin
g
t
he b
arrier
s to
healt
h c
ommu
nicati
on
The
them
es
that
e
m
erg
ed
on
how
to
ov
e
rc
om
e
bar
riers
to
healt
h
c
omm
un
ic
at
ion
ar
e
discuss
e
d
belo
w.
3.3.1.
Enl
ight
en
men
t
pr
ogram
mes
The
c
omm
un
ity
-
base
d
healt
hc
are
work
e
rs
op
i
ned
that
it
is
i
m
po
rta
nt
to
enlig
hten
the
r
el
igio
us
le
ader
s,
e
sp
eci
al
ly
Isla
m
ic
l
eaders
on
the
i
m
po
rtance
of
enc
oura
ging
Muslim
s
to
par
ti
ci
pate
in
healt
h
protect
ion act
ivit
ie
s su
c
h
as
im
m
un
isa
ti
on
.
‘En
li
ghte
n
pe
ople
ver
y
w
el
l,
especial
ly
in
t
he
nort
hern
pa
rt
of
this
c
o
un
try
wh
er
e
reli
gi
on
play
s
a
ver
y
big
(a
n
i
m
po
rtant)
ro
le
...
in
t
he
case
of
poli
o,
so
m
e
north
er
n
isl
a
m
ic
le
ader
s
be
li
eve
that
it
is
against
t
heir
re
li
gio
n
t
o
im
m
u
nise
their
child
ren,
(a
nd
woul
d)
go
a
hea
d
an
d
kill
people
t
hat
w
ould
giv
e t
hem
the v
acci
natio
n’
-
P8
:2
3
So
m
e
com
m
u
nity
-
base
d
hea
lt
hcar
e
w
orke
r
s
ad
vo
cat
e
for
a
sit
uation
w
her
e
healt
h
e
ducat
ion
an
d
stud
y
of d
ise
as
es sho
uld
be
e
nshri
ned
in
sch
ool cu
rr
ic
ulu
m
acro
ss
N
i
ger
ia
.
‘Let
there
be
a
curriculum
wh
ere
people
st
ud
y
diseases
or
healt
h.
M
or
e
edu
cat
io
n
on
diseases
an
d
change
of strat
egies
by h
eal
th
org
a
nisati
ons
sh
oul
d be
help
fu
l’
.
–
P30:2
9
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
, No
.
1
,
Ma
rch
201
8
:
7
2
–
8
0
78
3.3.2.
Langua
ge
The
c
omm
un
it
y
-
based
healt
hcar
e
w
orke
rs
sta
te
d
that
di
sse
m
inati
ng
he
al
th
inf
or
m
at
ion
i
n
the
la
nguag
e
of
th
e
aud
ie
nce
is
ve
ry
i
m
po
rtant
in
gaini
ng
t
hei
r
trust
and
est
ab
li
sh
ing
a
sens
e
of
owne
rs
hip
of
the
pro
j
ect
am
on
g t
he
ta
r
get co
m
m
un
it
y.
‘Th
e
re
is
need
to
trai
n
l
ocals
who
unde
rsta
nd
t
he
la
ng
uage
of
t
he
local
it
y
(co
m
m
un
it
y)
wh
e
re
th
e
healt
h
cam
paig
ns
will
be u
nd
e
rtake
n
’
-
P18:
19
‘
The
pr
im
ary
thing
is
la
ngua
ge;
when
yo
u
sp
ea
k
the
la
ngua
ge
of
the
people
you
a
re
delive
rin
g
healt
h
e
ducat
io
n
to
, th
ey
will
unde
rstan
d
yo
u bett
er a
nd see
you
a
s
on
e
of t
heir o
wn’
–
P
8:
2
7
3.3.3.
Fundin
g
he
alt
h p
r
og
r
amme
s
The
c
omm
un
ity
-
base
d
he
al
th
care
w
orke
rs
e
m
ph
asi
sed
the
need
f
or
pr
i
va
te
ind
ivi
du
al
s
to
sup
port
healt
h fou
nd
at
i
on
s
w
it
h
their
re
sources
.
‘In
Am
erica
a
nd
E
uro
pe,
th
ere
are
so
m
a
ny
orga
nisati
on
s
that
raise
m
on
ey
fo
r
dif
fer
e
nt
healt
h
issues
;
so
m
e
create
awar
e
ne
ss
on
diabet
es,
oth
e
rs
on
hype
rtensio
n,
m
any
oth
ers
on
HIV
a
nd
hep
at
it
is.
Y
ou ask
yo
ursel
f
w
her
e
t
hey
get
t
he
m
on
ey
from
.
It
is
pe
ople
li
ke
m
e
and
yo
u
that
sponso
r
su
c
h program
m
es if w
e ca
n st
art that i
n Ni
ger
ia
,
it
can be
reall
y nice’
–
P3
7: 18
So
m
e comm
un
it
y
-
based
healt
hcar
e
w
orkers
su
ggest
th
at
r
el
ie
vin
g p
rivate
ho
s
pital
s of tax
es w
il
l help
them
reinv
est
their
pro
fit
to
hire
m
or
e
heal
thcare
w
orke
rs
that
will
be
sadd
le
d
with
t
he
respo
ns
ibil
it
ie
s
of
healt
h
prom
otion.
The
com
m
un
it
y
-
based
he
al
thcare
wor
ke
rs
are
of
the
op
inion
that
m
os
t
healt
hcar
e
fac
il
ities
especial
ly
pr
iv
at
el
y
-
owned
ones
are
unders
ta
ff
ed
.
Als
o
,
they
sugg
est
e
d
that
of
fe
rin
g
fr
ee
an
d
c
om
pu
lso
ry
m
edical
ser
vic
es w
il
l be
h
el
pful.
‘Th
e
governm
ent sh
ould s
upport private
hos
pital
s
and
r
el
ie
ve
them
o
f
ta
xes.
I
f
the hos
pital
s
are f
ully
sta
ff
e
d
,
they
c
an
reac
h
ou
t
t
o
m
any
patie
nts,
but
a
hos
pital
that
has
on
l
y
on
e
doct
or,
f
or
e
xam
ple,
won’
t
h
a
ve
t
he
tim
e to g
ive
hea
lt
h
inf
or
m
at
i
on to pati
ents
’
-
P
45
:
11
4.
DISCU
SSI
ON
The
pe
ople
’s
prefe
ren
ces for
so
urces
of
heal
th
inf
or
m
at
ion
m
ay
chan
ge
de
pendin
g
up
on
h
ow
urge
nt
,
e
m
bar
rassi
ng
or
com
plex
the
healt
h
con
ce
r
n
is.
Stud
ie
s
on
the
sources
of
certai
n
healt
h
inf
or
m
at
ion
su
c
h
as
sex
ual
and
reprod
uctive
healt
h
inf
or
m
at
ion
hav
e
bee
n
doc
um
ented
in
som
e
par
ts
of
Ni
ger
ia
[
9]
.
Howev
e
r
,
there
is
lim
it
ed
inf
or
m
at
ion
a
bout
s
ources
of
CV
healt
h
i
nfo
rm
ation
i
n
N
igeria
in
gen
e
r
al
an
d
La
gos
S
ta
te
in
par
ti
cula
r.
An
exam
ple
of
s
uc
h
a
f
ew
st
ud
i
es
is
a
cr
os
s
-
se
ct
ion
al
sur
vey
carried
out
in
s
ou
t
hw
e
ste
rn
N
igeria
,
cond
ucted by Olada
po
a
nd c
ollea
gu
e
s
w
hic
h
f
ound that th
e
com
m
on
est
so
urce
of
hyper
t
ensio
n
a
nd
C
V
h
eal
th
inf
or
m
at
ion
w
as
the
fam
i
ly
/f
rien
d/opinio
n
le
ader
s
of
tr
us
t
ed
gro
ups
[
(n
=
1198
(
59.9
%
)].
The
stu
dy
fou
nd
that
24.6%
(
n=
492)
of
the
pa
rtic
ipants
s
ource
their
healt
h
inf
or
m
at
ion
f
r
om
m
edia
includi
ng
ra
dio,
public
enlighte
nm
ent
pro
gr
am
m
es,
a
nd
ne
ws
pap
e
rs
wh
il
e
9.1
%
(n=183
)
sou
rce
i
nfor
m
at
ion
f
rom
the
do
ct
or
/
nurse/
healt
h
w
orker
[
10
]
.
Wh
il
e the h
ig
hest num
ber
of
the
par
ti
ci
pan
ts i
n
this c
urre
nt stud
y p
re
ferred
to s
ourc
e their
healt
h
in
f
or
m
a
ti
on
from
the
healt
hcar
e
w
orker
s
inclu
ding
the
m
edical
do
ct
ors,
nurses
,
an
d
ph
a
rm
acist,
th
e
nu
m
ber
of
par
t
ic
ipants
in
the
pr
e
vious
stu
dy
that
acce
ssed
hype
rtensio
n
a
nd
CV
healt
h
inf
or
m
at
ion
fro
m
the
sam
e
so
ur
ce
w
ere
sm
al
le
st.
The
discre
pa
ncies
m
ay
be
as
a
res
ult
of
m
et
ho
dolo
gical
iss
ue
s.
F
or
e
xam
pl
e,
the
current
stu
dy
inv
est
igate
d
‘pref
e
rr
e
d
s
ources’
of
CV
healt
h
inf
orm
at
ion
w
h
erea
s
the
pr
e
vious
stud
y
inv
est
igate
d
‘a
ct
ual
sourc
es’
of
hy
per
te
nsi
on
a
nd
CV
heal
th
in
form
at
ion
.
The
le
ast
pref
err
e
d
s
ource
of
the
CV
healt
h
i
nfor
m
at
ion
in
the
cu
rr
e
nt
stu
dy
is
from
fr
ie
nds,
fam
il
y
m
e
m
ber
s,
an
d
com
m
un
it
y
l
eaders
.
Howe
ver,
thes
e
so
urces
of
CV
healt
h
inf
or
m
at
ion
rep
re
se
nt
the
highest
act
ual
so
urce
of
in
form
at
ion
in
the
pr
e
vious
stu
dy.
Ther
e a
re nume
rous
re
ports of o
r
ga
nisati
ons
that pr
om
ote awar
e
ness
ar
ou
nd
diff
e
re
nt k
ind
s
of
healt
h
issues
i
nclu
ding
hear
t
healt
h,
sex
ual
healt
h,
an
d
nutrit
io
n
am
on
g
m
any
oth
e
rs
i
n
Nige
ria
[
11
]
.
En
g
an
d
colle
agues
rec
ognise
that
ch
urch
-
ba
sed
healt
h
prom
otion
in
te
rv
e
ntion
s
ca
n
reach
br
oad
popula
ti
ons
an
d
hav
e
gr
eat
pote
ntial
for
reducin
g
he
al
th
ine
qu
al
it
ie
s
[
12
]
.
Lasat
er
and
colle
a
gu
es
ag
ree
with
thi
s
posit
ion
an
d
no
te
d
that
m
any
Af
ri
can
-
base
d
c
hur
ches
c
on
t
ri
bute
to
the
so
ci
al
,
econom
ic
,
and
poli
ti
cal
welfare
of
t
heir
m
e
m
ber
s
in
par
ti
cular
a
nd
the
com
m
un
it
y
at
la
rg
e
[13]
.
Fait
h
-
ba
sed
orga
nisati
ons
ha
ve
a
long
histo
ry
of
inde
pe
nd
ently
and
colla
bo
rati
vely
hosti
ng
he
al
th
prom
otion
pro
gr
am
m
es
i
n
area
s
s
uch
as
healt
h
e
ducat
ion
an
d
sc
ree
nin
g
f
or
diff
e
re
nt
healt
h
iss
ues
i
nclu
di
ng
H
IV
[
14]
.
A
sy
nth
esi
s
of
re
viewe
d
a
nd
non
-
r
evie
wed
stu
dy
on
the
us
e
of
m
ass
m
edia
cam
paign
s
to
ch
ang
e
healt
h
be
hav
i
our
ca
rr
ie
d
ou
t
by
W
ake
fi
el
d
and
colle
a
gu
e
s
fou
nd
tha
t
m
as
s
m
edia
ca
m
pai
gn
s
ca
n
produ
ce
po
sit
ive
c
ha
ng
e
s
or
prev
ent
ne
gative
c
hanges
in
heal
th
-
relat
e
d
be
ha
viours
acro
s
s
la
rg
e
popula
ti
ons
[15
]
.
Av
ai
la
bili
ty
of
com
m
un
it
y
-
base
d
pro
gra
m
m
es
and
po
li
ci
es
that
su
pport
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Sour
ces
o
f C
ardiov
as
c
ula
r
He
alth
In
f
or
m
atio
n and C
hannel
s o
f
He
alth Comm
unic
atio
n
.
.
..
(
Eji
ofo
r
A. E
zik
a)
79
beh
a
viou
r
c
ha
ng
e
co
ntri
bu
te
d
to
these
out
com
es.
The
a
ut
hors
s
uggeste
d
t
hat
in
vestm
ent
in
lo
ng
e
r,
bette
r
-
fun
ded cam
pai
gn
s
wo
uld hel
p t
o
ac
hieve
ad
e
qu
at
e
popula
ti
on exp
osure
t
o m
edia
m
essage
s.
Con
ce
rn
i
ng
s
oc
ia
l
m
edia
as
a
channel
f
or
healt
h
com
m
un
ic
at
ion
,
a
c
om
m
entary
carried
out
by
Do
sem
agen
a
nd
Aase
e
xpla
ined
t
hat
healt
h
in
du
st
ry
is
increasin
gly
tu
rn
i
ng
to
so
ci
a
l
m
edia
to
su
pport
,
prom
ote
and
i
ncr
ease
the
dis
sem
inati
on
of
inf
or
m
at
ion
an
d
data
to
im
pr
ov
e
both
per
s
onal
a
nd
com
m
un
it
y
healt
h
pr
act
ic
e
s
[
16
]
.
The
a
uthors
opine
d
that
so
ci
al
m
edia
pro
vid
e
s
a
platf
or
m
to
s
har
e
preve
ntati
ve
inf
or
m
at
ion
and e
nab
le
d
the
c
reati
on of s
upport str
uctu
res
t
o
trac
k
per
s
ona
l
healt
h
a
nd bu
il
d
patie
nt
-
to
-
pa
ti
ent
su
pp
or
t
net
wor
ks
post
-
diag
nosis
.
The
auth
or
s,
howe
ver,
re
cognise
d
the
chall
eng
e
s
of
usi
ng
so
ci
al
m
edia
fo
r
inf
or
m
at
ion
dissem
inati
on
in
cl
ud
in
g
the
po
te
ntial
fo
r
w
rong
in
form
at
ion
relat
ing
to
pu
blic
healt
h
sp
r
eadin
g
qu
ic
kly as
well
as c
on
ce
rns a
bout
patie
nt
pr
i
va
cy
p
r
otect
ion.
F
ox
a
nd
D
og
a
n
re
porte
d
a
na
ti
on
al
s
urvey
of
3,0
14
ad
ul
ts
li
vin
g
i
n
th
e
U
nited
Stat
e
s.
T
he
stu
dy
involve
d
the
us
e
of
te
le
ph
on
e
i
nter
view
s
to
in
ves
ti
ga
te
1,
80
8
pa
rtic
ipants
us
in
g
la
nd
li
ne
a
nd
1,
206
par
ti
ci
pa
nts
us
i
ng
a
cel
l
phone
.
The
stu
dy
re
ported
that
35
%
of
the
U
.S
a
du
lt
s
say
that
at
on
e
tim
e
or
ano
t
her
they
hav
e
go
ne
on
li
ne
to
fi
nd
ou
t
w
hat
m
edi
cal
con
diti
on
they
or
s
om
eon
e
el
se
m
igh
t
ha
ve.
I
n
ad
diti
on
,
46
%
of
the
pa
rtic
ipants
a
gr
ee
d
t
ha
t
the
in
form
a
ti
on
th
ey
f
ound
le
d
them
to
think
they
nee
ded
the
at
te
ntion
of
m
edical
p
rofes
sion
al
wh
e
reas
3
8% o
f
the
pa
rtic
ipants say that
it
is so
m
et
h
ing
they c
ou
l
d t
ake car
e
of
at
ho
m
e.
Wh
e
n
the
part
ic
ipants
wer
e
asked
a
bout
the
accura
cy
of
thei
r
init
ia
l
diagnosis,
41%
say
a
m
edica
l
prof
e
ssio
nal
pa
rtia
ll
y
con
fir
m
ed
it
wh
erea
s
35%
say
th
ey
did
not
vis
it
a
cl
inici
an
t
o
get
a
prof
e
s
sion
al
op
i
nion
[17]
.
Howe
ver,
the
proliferati
on
of
low
-
qual
it
y
healt
hcar
e
i
nfor
m
at
ion
on
t
he
inter
net
is
on
e
of
th
e
barriers
to
he
al
th
com
m
un
i
cat
ion
.
A
s
the
vo
lum
e
of
in
te
rn
et
co
ntent
increases
on
a
daily
basis,
healt
h
inf
or
m
at
ion
use
rs
nee
d
hel
p
to
evaluate
the
reli
abili
ty
of
t
he
inf
or
m
at
ion
they
acce
ssed
[
18
].
Ma
ny
pe
op
le
arou
nd
the
glo
be
us
e
the
inter
net
for
he
al
th
-
relat
ed
re
aso
ns
.
As
a
r
esult,
the
pote
ntial
fo
r
ha
rm
fr
om
inaccu
rate
inf
or
m
at
ion
an
d
inap
pro
pr
ia
te
serv
ic
es
is
sig
nificant.
Be
ca
us
e
healt
h
in
f
or
m
at
ion
is
norm
al
ly
relay
ed
in
the
form
of
wr
it
te
n
co
m
m
un
ic
at
ion
,
the
il
li
te
rate
or
sem
i
-
il
literat
e
of
te
n
cannot
acce
s
s
the
inf
or
m
at
ion
.
A
s
a
resu
lt
of
this
issue,
it
is
i
m
po
rtant
tha
t
healt
h
li
te
rat
ur
e
is
custom
-
m
ade
fo
r
eac
h
ta
rg
et
aud
ie
nce a
nd
wr
it
te
n
i
n
sty
le
ap
pro
pr
ia
te
to
their level
of c
om
pr
ehe
ns
io
n
[
18
].
5.
CONCL
US
I
O
N
The
dissem
inati
on
of
healt
h
inf
or
m
at
ion
us
ing
nu
m
ero
us
c
hannels
is
essenti
al
in
ensurin
g
popula
ti
on
-
wi
de
pr
im
ary
and
seco
nd
a
ry
pre
ven
ti
on
of
dise
ases.
It
is
a
po
li
cy
that
m
ay
be
ad
opte
d
by
al
l
th
e
orga
nisati
on
s
,
includi
ng
fe
de
ral
and
t
he
36
sta
te
s
Mi
nistries
of
Healt
h
a
nd
non
-
go
vern
m
ental
or
ga
nis
at
ion
s
involve
d
i
n
he
al
th
prom
otion
to
in
flue
nce
pe
op
le
’s
healt
h
-
seekin
g
be
hav
i
ours
i
n
Nige
ria.
T
he
pr
e
requis
it
e
for
el
i
m
inati
ng
he
al
th
ineq
ualit
ie
s,
re
duci
ng
tra
ns
m
issi
on
s
of
com
m
un
ic
able
diseases,
pro
m
ot
ing
a
nd
pr
otect
ing
healt
h
is
fo
r
public
healt
h
pr
of
essi
onal
s
to
exp
a
nd
their
use
of
healt
h
c
om
m
un
ic
at
ion
strat
egies
with
the
aim
of
a
ff
ect
in
g
in
div
id
uals,
c
omm
un
it
y,
or
gan
i
sat
ion
s
a
nd
po
l
ic
y
fo
rm
ulati
on
s.
T
his
ap
pro
ach
can
c
on
t
ribu
te
t
o
add
ressi
ng
t
he
m
ul
ti
ple
determ
inants
of
hea
lt
h
that
giv
e
rise
to
healt
h
i
ne
qu
al
it
ie
s.
I
n
a
dd
it
io
n
,
it
is
es
sentia
l
for
the
fe
der
al
and
var
i
ous
sta
te
s
Mi
nistries
of
Healt
h
in
N
igeria
to
al
way
s
be
on
al
ert
to
dis
pel
false
healt
h
inf
or
m
at
ion
es
pecial
ly
w
he
n
t
her
e
is d
ise
ase
ou
t
br
ea
k
i
n Nigeria.
REFERE
NCE
S
[1]
L.
B
.
Sn
y
der
,
“
'Hea
lt
h
Com
m
un
ic
a
ti
on
C
ampaig
ns
and
Th
ei
r
Im
pac
t
on
Beh
avi
o
r
,”
J
Nu
tr
Educ
Be
hav
.
,
vol/is
sue:
39(2)
,
2007
.
[2]
Hea
lt
h
ca
r
e
Acc
ess
in
Rural
Co
m
m
unit
ie
s
Introduc
tion
,
Availa
ble
from
:
htt
ps://
ww
w.ruralhealthi
nfo
.
org/topics/healt
h
ca
r
e
-
ac
c
ess#barri
ers
[3]
V.
S.
Freimuth
and
S.
C.
Quinn,
“
The
cont
ributions
of
hea
lt
h
c
om
m
unic
at
ion
to
el
iminat
ing
he
al
th
disparitie
s
,”
Ame
rican Journal
of
Public
Hea
lt
h
,
v
ol. 94
, p
p
.
2053
–
5
,
2004
.
[4]
Cent
ers
for
Disea
se
Contro
l
an
d
Preve
nti
on
,
“
The
Hea
lt
h
Co
m
m
unic
at
or’s
S
oci
a
l
Media
To
olki
t
,”
Cen
te
rs
Dis
Control
Pre
v.
,
p
p.
32
,
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