DIGITAL METAMORPHOSIS

This empirical study explores how young women in Nyalenda B, Kisumu County, interpret and engage with campaign posters promoting modern contraception. Drawing from focus group discussions, key informant interviews, and ethnographic fieldwork, the study examines how visual and linguistic elements color, image, layout, tone, and placement shape perceptions across diverse educational backgrounds and age groups. Grounded in Visual Semiotic Theory and supported by Peirce’s triadic model of signs, findings reveal that interpretation is not passive but actively filtered through lived experience, literacy, and socio-cultural context. While most young women found the posters appealing and empowering, others expressed skepticism when visuals felt unrealistic or culturally detached. Misinterpretations were common where poster messages omitted nuance or ignored pervasive myths and fears about contraception. The study concludes that effective poster design must integrate localized semiotics, emotionally intelligent language, and participatory design strategies to bridge the gap between message intent and community interpretation.

Background: Cervical cancer is the most common gynaecological cancer and a significant cause of Disability-Adjusted Life Years (DALYs). It is estimated that 85% of cervical cancer cases are in low- and middle-income countries. Kenya became the 16th African country to introduce the HPV vaccine into its routine immunization schedule. The main hindrance was initially the cost, but even as the vaccine has been rolled out free of charge, we still have acceptability and uptake challenges. Objectives: To determine the uptake of the HPV vaccine by 10-year-old school-going girls in Kisumu County and to assess the factors associated with parental acceptability of the HPV vaccine in Kisumu County, using the Health Belief Model. Methods: We conducted a mixed-method analysis of the uptake of the HPV vaccine by 10-year-old school-going girls in Kisumu County and the factors affecting parental acceptability. The study’s first phase was a cross-sectional quantitative study, where secondary data of randomly sampled 384 girls, ten years of age, was collected from the school registry retrospectively between December 2019 and December 2021. A descriptive analysis was conducted. The results were presented in frequency and percentage. 34 parents purposively sampled for the FGDs. Transcripts were analyzed from the four focus groups in rural and urban Kisumu. Results: The average uptake of the HPV vaccine in Kisumu County was (252) 65.63% (n=384). Only (119) 30.98% were fully vaccinated, while 26.82% (103) were partially vaccinated. 34.37% were not vaccinated during the study period. Upon analysis of the qualitative data from the focused group discussion (FGDs), four main themes emerged as regards the HBM: the lack of knowledge and misinformation about Human Papillomavirus, cervical cancer, and the HPV vaccine, the fear of the HPV vaccine side effects, non-vaccine costs like transportation cost and institutional barriers like availability of the vaccine and proximity to a facility offering the vaccine services. Conclusion: The study confirms that the HPV vaccination uptake is low, especially for the two doses. The study findings indicate that many parents and guardians did not possess vital information regarding the HPV vaccine that would enable them to allow their daughters to receive the vaccine. Recommendations: It is, therefore, imperative that policymakers investigate and verify the efficacy of a single dose of the HPV vaccine and shift to one dose, and also employ other modalities of HPV vaccination campaigns to include door-to-door campaigns. Moreover, vital information regarding the causal relationship between the HPV cervical cancer and the HPV vaccine, and the side effects should be part of the disseminated information to the target groups.

BACKGROUND AND OBJECTIVES: Farmers in rural East Kalimantan face significant challenges, including limited access to information, low digital literacy, and inadequate technology infrastructure, which hinder the implementation of sustainable farming practices. Despite the increasing availability of digital communication tools and platforms, farmers in remote areas continue to struggle with utilizing technology to manage livestock operations, access markets, and enhance animal health. This study aims to examine the use of digital communication tools by small-scale livestock farmers in East Kalimantan, as well as the benefits they gain and the barriers that limit wider adoption. The objective of this research is to understand the role of digital communication in supporting sustainable livestock practices in rural communities. METHODS: This study employs a qualitative approach, utilizing semi-structured in-depth interviews and focus group discussions (FGDs) with farmers, agricultural extension officers, and relevant stakeholders. The research was conducted in East Kalimantan Province, Indonesia, which was selected for its significant challenges, including limited access to technology and low digital literacy among farmers. Despite these challenges, East Kalimantan also holds great potential for the development of sustainable livestock farming, particularly through the use of digital communication tools. The data was analyzed thematically to identify patterns related to technology adoption, perceived benefits, barriers, and the contribution of digital tools to sustainable livestock management. FINDINGS: The study's findings reveal that farmers utilize smartphones, mobile apps, and social media platforms to access market information, livestock health consultations, and knowledge about sustainable farming practices. The adoption of advanced technologies such as the Internet of Things (IoT) and automation systems remains limited due to high costs, limited digital skills, and weak internet infrastructure. Farmers reported benefits such as improved animal health, better decision-making, and increased efficiency in livestock management; challenges related to digital literacy and access to technology remain significant. CONCLUSION: Digital communication tools have significant potential to enhance sustainable livestock practices among small-scale farmers in rural areas. Several key barriers, primarily the digital literacy gap, infrastructure limitations, and high technology costs, need to be addressed for wider adoption. Strengthening digital training programs, improving internet connectivity in rural areas, and supporting farmer-centered technological initiatives are important steps to maximize the benefits of digital tools. This study contributes to the understanding of digital empowerment in rural livestock farming, emphasizing the need for integrated policy interventions. The limitations of this research include its focus on a single region and a relatively small sample size, indicating the need for further, broader, and comparative research

BackgroundHealth Literacy allows optimizing healthy lifestyles and preventive and health protective behaviors (DGS, 2019). Low literacy can lead to a greater number of hospitalizations, a more frequent use of emergency services and a lower prevalence of preventive attitudes in the field of health. Internet-based interventions could have a positive impact on informal caregivers, reducing the geographical barrier, promoting self-efficacy in managing their own emotions, reducing burden.AimContribute to the training of informal caregivers of a primary health care unit in Lisbon, through the promotion of digital health literacy.MethodsThe Community Intervention project was carried out in the context of a home visit, focusing on 11 informal caregivers, through the presentation of an interactive digital manual. It was based on the methodology of health planning, through the elaboration of a diagnosis of the situation, definition of priorities, setting of objectives, selection of strategies, operational preparation and evaluation (Imperatori & Giraldes, 1993).ResultsIt was found that not all informal caregivers have access to the internet or digital technologies, and it was necessary to deliver the printed manual. Caregivers who accessed the interactive digital manual rated its content as very important, having accessed the suggested links without difficulty. The possibility of forwarding the digital manual to other caregivers was valid for all.ConclusionsDigital technologies promote communication in terms of health promotion, contributing to universal access and digital training in health, giving individuals the opportunity to increase care for their own health. The creation of digital health tools must be directed to the characteristics of the population. For individuals with low digital literacy, simple technologies must be created and for those who cannot or do not want to use digital tools, adequate alternatives must be created.Key messages• Primary care health professionals may use digital technologies to promote health literacy.• Vulnerable groups with low digital health literacy need support to increase access to digital technology that can promote health literacy.

This study aims to analyze the implementation of the principle of public interest in the implementation of public services by the Population and Civil Registration Office (Disdukcapil) of Bekasi Regency, as well as to evaluate the extent to which the implementation of these principles contributes to efforts to realize people's welfare. The principle of public interest is one of the basic principles in the implementation of public services that emphasizes the fulfillment of basic rights of the community in a fair, fast, equitable, and accountable manner. This research uses a qualitative approach with a case study method, where data is collected through in-depth interviews, direct observations in the field, and documentation studies on various policies and service reports. The results of the study show that the Bekasi Regency Disdukcapil has adopted various innovations in services, such as online services, digital queue systems, the use of information technology-based applications, and increasing the transparency of service information through social media and official websites. These steps are taken to improve accessibility, efficiency, effectiveness, and community satisfaction as service recipients. However, the implementation of the principle of public interest still faces several obstacles, such as limited competent human resources (HR), uneven information technology infrastructure, and low digital literacy among certain communities, especially the elderly and people in suburban areas. This condition results in the suboptimal public service oriented to the public interest to the maximum. Therefore, continuous efforts are needed through increasing the capacity of the apparatus, the development of inclusive and adaptive public service technology, and massive education to the public to increase participation, understanding, and awareness of the available services. Thus, the public services that are carried out can really contribute to realizing the welfare of the people as a whole, equitable, and just.

This qualitative study explores multi-stakeholder perception of e-mutation (digital land mutation) using interviews of 31 service recipients and four service providers, two focus group discussions (FGDs) and key informant interviews (KII). A deductive thematic analysis has been conducted, with initial themes informed by the components of the Technology Acceptance Model (TAM). The study identified ten codes from the participants' responses, and these codes have been organized into thematic categories aligned with TAM components. The study on Gazipur Sadar finds a low perceived ease of use and perceived usefulness due to structural barriers, which in turn negatively shaped behavioral intention and actual use of e-mutation services. This study finds socio-institutional and technical barriers such as rent-seeking behavior, reliance on intermediaries, low digital literacy, limited ability to navigate online platforms, and gendered exclusion significantly hinder the adoption of e-mutation services. Similarly, barriers within administration, including unreliable internet connectivity, weak server capacity, software inefficiencies, and long wait times, further affect the perceived usefulness of e-mutation. Consequently, actual use of the e-mutation platform remains marginal. The study recommends ensuring efficiency through introducing a user-friendly interface for e-mutation, initiatives on digital literacy, gender inclusivity, and strengthening administrative capacity, focusing on structural limitation at the upazila level.

: Breastfeeding is essential for infants providing them the much-needed nutrients for a health start. The World Health Organization recommends exclusive breastfeeding for the first six months of the infant’s life. The objective of this study was to assess the influence of nutritional education among fathers on exclusive breastfeeding practices for infants aged 0-6 months in Kisumu County, Kenya. An interventional study was conducted. The study setting was Kisumu East Sub County, Kenya. A total of 290 father-mother pairs were recruited into the study. Recruitment took place at Kisumu County hospital when the mothers were at 23-27 weeks gestational age. Pairs were randomized into either intervention or control group with 145 pairs per group. Pairs in the intervention group received nutrition education on breastfeeding (exclusive breastfeeding and male involvement), while those in the control group did not receive any intervention during the one-year research period. Quantitative data on exclusive breastfeeding practice, maternal and paternal knowledge and support towards breastfeeding were collected using an interviewer administered pretested questionnaire, while qualitative data were collected through 4 focus group discussions in both intervention and control groups. The proportion of infants fed only mother’s milk at 6 months was significantly higher (77.7 %) in the intervention group than in the control group (45.1%, p<0.001). Fathers in the intervention group who had been exposed to nutrition education on breastfeeding and were knowledgeable on exclusive breastfeeding were twice more likely to exclusively breastfeed. Nutrition education to fathers on breastfeeding impacts positively on breastfeeding rates.

Learners with cerebral palsy experience motor and communication challenges as a result of their condition. As children with cerebral palsy grow into adults, these difficulties persist. The study aimed to analyze how teaching strategies employed by educators influence the academic achievement of learners with cerebral palsy at Joyland Special Primary School for the Physically Disabled in Kisumu County, Kenya. A case study approach was adopted for this research with a target population of 156. Joyland Special Primary School was specifically chosen since it is the largest school in the area for students with disabilities, the majority of whom have cerebral palsy. One head teacher, thirty-two teachers, and sixty-nine students made up the 102 participants in the study sample. Teachers were given questionnaires, the head teacher was interviewed, and students with cerebral palsy participated in focus group discussions as part of the data collection process. The Statistical Package for the Social Sciences (SPSS) was used to code, analyze, and show quantitative data using descriptive statistics including frequencies, tables, and percentages. Thematic and content analysis were utilized to examine the qualitative data. The results uncovered that teachers tended to use strategies they found most convenient, often due to their heavy workload. Learners with cerebral palsy experienced physical strain when participating in subjects like mathematics and sciences, which required manipulation of apparatus and experiments. Consequently, they showed a preference for activities related to daily living and social studies. Subjects such as Kiswahili and English were less favored, partly because some learners faced communication difficulties. Based on these findings, the researcher recommends that the Teachers Service Commission urgently assign more qualified teachers capable of supporting learners with cerebral palsy at Joyland School; conduct ongoing in-service training for teachers in this field; incorporate cerebral palsy-related content into special needs education (SNE) teacher training curricula; redesign classrooms to better accommodate learners with cerebral palsy; and provide assistive technologies and modern wheelchairs. Additionally, the Ministry of Education should ensure that learners with disabilities are not disadvantaged and that adequate support systems are in place.

The study investigated the influence of education levels on adoption of improved cook stoves (ICS) in Kakamega, Kisumu and Uasin Gishu counties. Sampling in stages was applied to categorize the population into low, middle and high income household using income levels. Convenience sampling was used to select six estates to represent the counties. The Institutions and hotels used population served and nearness to urban setting. Three estates in Kakamega (Shikambi, Amalemba and Milimani), Kisumu (Manyata, Tom Mboya and Milimani) and Uasin Gishu (Langas, Kapsoya and Elgon View) counties were sampled. In low-income estates 50 households were sample, 40 in middle income and 30 in high-income. In each county, 7 educational institutions and 23 hotels (4 large hotels serving more than 601 people per day, 7 medium hotels serving between 301 to 600 and 12 small size hotels serving less than 300 people) were sampled too. Data was collected using semi-structured questionnaires, direct interviews and focus group discussions. Data collected was analyzed through both descriptive and chi-square (?2) statistics in SPSS version 23. The results revealed that education level and charcoal saving cook stove properties significantly influenced ICS adoption in households (?2=115.7548; p<0.05). However, the education level of the head cooks (?2=0.6622) and awareness level of head cooks (?2=0.5057) did not significantly influence adoption in institutions. In hotels, no socio-economic factor (head cooks education level ?2=0.4333) or head cook ICS awareness ?2=0.1000 significantly influenced ICS adoption in hotels at p<0.05. The study concluded that socio-economic factors influenced adoption of ICS in varied degrees. However, increasing the awareness of ICS availability and benefits would increase adoption in spite of education levels among households, institutions and hotels. The stove manufactures should also maximize on the availability and benefits such as durability and charcoal saving aspect of the ICS stove.

Low- and middle-income countries continue to bear the burden of cervical cancer partly due to low uptake of screening services. Interventions through the media to increase demand for screening services among women of reproductive age (WRA) have not yielded the desired results mainly due to the unidirectional flow of information. The current study evaluated the use of a dialogue-based approach to community health education to improve the demand for cervical cancer screening services among WRA in rural sub-counties in Kisumu County. This was a mixed-method longitudinal pre and post-intervention study with a control group. The self-reported screening rates were assessed at baseline in both the intervention and control groups followed by dialogue-based community health education in the intervention arm. This was followed by endline screening rates evaluation. The screening rates at baseline and endline were compared followed by a focused group discussion among the leaders of the community units to discuss the contributors to the observed screening rates. The proportion of change in the screening rates was calculated and statistical significance was assessed at p ≤ 0.05. There was a significant increase in the number of WRA reporting to have been screened at the endline in the intervention arm (p = 0.007). The number of those being screened due to the health talks conducted by the Community health volunteers also increased significantly at the endline (p = 0.036). The barriers included; not knowing where to get screened (p < 0.0001), violation of ones' privacy (p < 0.0001), lack of spousal support (p < 0.0001), waiting time at the facility (p = 0.001), attitude of the health providers (p < 0.0001) and cost of transport to the facility (p < 0.0001). The use of dialogue-based community health education has the potential to improve the uptake of cervical cancer screening services and identify the additional barriers as experienced by the WRA targeted for screening.

Improved health of infants is dependent on the supportive role of the fathers.There is limited research done in Kenya on father involvement and how it affects feeding practices of the infant.The objective of this study was to evaluate the impact on complementary feeding practice of nutrition education targeted to the father.A randomized control trial was conducted with 290 father-mother pairs recruited into the study.The mothers, who were six months pregnant and receiving antenatal services at Kisumu County Hospital, provided the contact point for recruitment of the fathers who were engaged in this study.The consenting mothers provided information of the 'expectant father' who were later contacted and invited to go to the hospital together with the mother.Consent was obtained from the study participants in a written form.Randomization was done to the father-mother pairs and eventually, each group had 145 pairs.The pairs in the intervention group were educated on complementary feeding while the other pairs in the control group did not get any intervention.Post-natal, feeding on solids and semi-solids of the infants were assessed at six months and at nine months of age.Qualitative assessment through focus group discussions were done to obtain information on fathers' support towards complementary feeding.Overall analysis was done on 278 pairs with 12 lost to follow up.Introduction to solids and semi-solids had been done by a majority (96.7%) by six months of the infant's age in both groups.Solid and semi-solid foods were introduced significantly earlier in the control group and compared to the intervention group (chi-square test; p<0.01).Minimum acceptable diet was significantly higher in the intervention group than the control group (chi-square test; p<0.01).In conclusion, giving fathers information on complementary feeding influences their support towards infant feeding, resulting in positive outcomes in complementary feeding practices.

BackgroundGood health decisions depend on one’s ability to think critically about health claims and make informed health choices. Young people can learn these skills through school-based interventions, but learning resources need to be low-cost and built around lessons that can fit into existing curricula. As a first step to developing and evaluating digital learning resources that are feasible to use in Kenyan secondary schools, we conducted a context analysis to explore interest in critical thinking for health, map where critical thinking about health best fits in the curriculum, explore conditions for introducing new learning resources, and describe the information and communication technology (ICT) infrastructure available for teaching and learning.MethodsWe employed a qualitative descriptive approach. We interviewed 15 key informants, carried out two focus group discussions, observed ICT conditions in five secondary schools, reviewed seven documents, and conducted an online catalog of ICT infrastructure in all schools (n=250) in Kisumu County. Participants included national curriculum developers, national ICT officers, teachers, and national examiners. We used a framework analysis approach to analyze data and report findings.FindingsAlthough critical thinking is a core competence in the curriculum, critical thinking about health is not currently taught in Kenyan secondary schools. Teachers, health officials, and curriculum developers recognized the importance of teaching critical thinking about health in secondary schools. Stakeholders agreed that Informed Health Choices learning resources could be embedded in nine subjects. The National Institute of Curriculum Development regulates resources for learning; the development of new resources requires collaboration and approval from this body. Most schools do not use ICT for teaching, and for those few that do, the use is limited. Implementation of Kenya’s ICT policy framework for schools faces several challenges which include inadequate ICT infrastructure, poor internet connectivity, and teachers’ lack of training and experience.ConclusionTeaching critical thinking about health is possible within the current Kenyan lower secondary school curriculum, but the learning resources will need to be designed for inclusion in and across existing subjects. The National ICT Plan and Vision for 2030 provides an opportunity for scale-up and integration of technology in teaching and learning environments, which can enable future use of digital resources in schools. However, given the current ICT condition in schools in the country, digital learning resources should be designed to function with limited ICT infrastructure, unstable Internet access, and for use by teachers with low levels of experience using digital technology.

Despite the need, adolescents and young adults (AYAs) in resource-limited settings have limited access to sexual and reproductive health (SRH) care services for improved health outcomes. This is worse for AYAs living with HIV in resource-limited settings where much is unknown about contexts and issues inhibiting access to SRHs. We explored adolescents', healthcare workers, and caregivers' preferences for access to sexual and reproductive health services for adolescents and young adults living with HIV. We conducted 30 in-depth interviews and 8 focus group discussions among a subset of AYA aged 14-24 living with HIV, healthcare workers, and caregivers/parents. We recruited participants from Lumumba Sub-County Hospital (KLM) and Kisumu County Referral Hospitals in Kisumu County (KCH). Trained and experienced qualitative research assistants 5-10 years older than the adolescents conducted interviews and facilitated discussions using guides designed to elicit detailed views and perspectives on sex and sexuality, access to SRH services, challenges of AYA living with HIV, and potential interventions to improve access to SRH services. Audio files were transcribed verbatim and translated to English where necessary before coding and analysis. We applied constant comparative analysis for theme and content to arrive at our conclusions. Our analysis yielded two main themes: preferences for a venue for SRH services and choices for qualities of an SRH counsellor. We found that AYAs generally preferred receiving SRH services to be co-situated within clinical facilities. We also observed gender differences in the qualities of SRH providers, with male AYAs preferring older male service providers compared to females who preferred younger female providers close to their age. The study highlighted the preferences of AYAs for accessing SRH, which need to be considered when designing their health programs. Further, AYAs seem to endite health systems to individualize access to SRH for AYAs living with HIV by providing a combination of attributes that meet individual preferences.

Purpose: The study sought to establish barriers of effective political communication and youth behavior during 2022 elections in Kisumu County, Kenya. The existing gap in knowledge was the understanding of how barriers of effective political communication can influence youth behavior during election campaigns. Methodology: The study was conducted using the descriptive design, with the mixed methods approach. Quantitative data was collected from 400 respondents of Kisumu County, Kenya, while qualitative data obtained through 10 in-depth interviews and 30 respondents for Focus Group Discussions. Findings: The study findings revealed that even though youth play a critical role in various stages in future leadership, they can be used as a source of unity as well as source of division. If youth are not used productively during electioneering periods, they have negative impact on themselves, families and society at large affecting voter turnout, voting trends and inter-ethnic relationships. The study further found that barriers of effective political communication influence youth behavior. Unique Contribution to Theory, Practice and Policy: The study was informed by Speech Act Theory, Theory of Political Propaganda and Mediatization of Politics Theory.The study recommends the need for political class to follow laid down legislations by avoiding the use of barriers of effective political communication for proper youth engagement in political matters without causing mayhem among themselves in the society through use of hate, propaganda, stereotype and discriminatory political messages.

BackgroundAs innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD.MethodsQualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach.ResultsFifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings.ConclusionTo address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes.