Rethinking health communication to address social-contextual barriers for malaria control.

The soaring levels of malaria in some sub-Saharan African countries, and Uganda in particular, have raised concern about the need for effective interventions to promote prevention and treatment of this epidemic. The disease is both preventable and curable, yet much is yet to be done to eradicate it. Over the years, scholarly attention in the field of health communication has been focused on individual-based barriers to malaria control, though the burden associated with underlying societal and environmental barriers is high in many sub-Saharan African countries. Researchers now propose a re-orientation of health communication research towards focusing on the social contexts of malaria control. A key issue that is prevalent in the literature is the emphasis on isolated social-contextual issues, specifically socio-economic and cultural challenges, rather than the broader range of underlying barriers that constrain the use of available malaria prevention and treatment techniques. Thus, despite the remarkable progress on the deployment of health communication to promote malaria control, ability to address social-contextual barriers to is still low in Uganda. This study was, therefore, motivated by the need to improve capacity for malaria control through exploring the policy and practice of health communication and their relation to addressing social contextual barriers to malaria control in Uganda. Drawing on the models of social ecology, participatory communication and empowerment, this study was based on empirical evidence from on a qualitative case study involving two selected Ugandan districts. The material was collected using participant observation, focus group discussions and respondent interviews with selected actors involved in malaria control. The study also comprised an analysis of selected malaria control policy documents from the perspective of health communication. The findings show that the ability of individuals and communities to undertake prevention and treatment of malaria was contingent on communication strategies that could facilitate community participation, social support, empowerment, inter-sectoral collaboration and partnerships. When this was not possible, there was limited or no opportunity at all for individuals and communities to disentangle from underlying barriers to malaria control, including gender inequalities, socio-economic constraints and inadequate and poor quality healthcare. Based on these findings, this study proposes the need to rethink the future of both health communication policy and practice with regard to addressing social contextual barriers to malaria control. Such a proposal is grounded in the need to improve the quality of communication various levels so that action for malaria can be both meaningful and sustainable. Specifically, the conclusion from this study is that there is clearly a need for wider use of communication strategies that disseminate information, promote community participation and facilitate empowerment, as well as focus on multiple levels and issues affecting malaria control.