Development of Tools to Re-Orient Social Mobilization Strategies to Close the MDA Coverage-Compliance Gap

In the effort to achieve global elimination program for lymphatic filariasis (LF), there is a heightened focus on creating field applicable tools and mechanisms that ensure community uptake of donated treatments and reduce the coverage-compliance gap. This is particularly urgent for those communities with mass drug administration fatigue (>6 rounds), where coverage has been consistently low and where new alternative treatments (e.g. triple therapy for LF) require enhanced mass drug administration (MDA). Presently, social mobilization approaches and messages are not usually specifically adapted to the stage of MDA, may not be based on timely formative research and may not be tailored to ensure that the hardest to reach populations have equal knowledge and access to treatment. This study aims to create simple, field-applicable tools to identify factors influencing drug taking behavior, provide guidance on tailoring health education messages based on formative research pre MDA and demonstrate the effectiveness of this approach in terms of change in compliance post MDA. The ultimate goal is to empower endemic country LF programs to create enhanced and targeted social mobilization strategies to ensure improved and equitable MDA coverage. The study team used the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) behavioral framework to identify behavioral factors influencing MDA compliance for lymphatic filariasis (LF) in Ambon, Indonesia. RANAS promotes a systematic approach to assess the influence of five primary behavioral blocks on a specific behavior. The results guide the design effective social mobilization tools and messages that address specific factors affecting behaviors in a community. The team applied the RANAS framework to identify key messages that would address the gaps as identified by the survey results and then worked collaboratively to design data driven social mobilization tools to disseminate these messages. Community stakeholders were closely involved in the planning and promotion of these messages. The results of this work showed a slight improvement in MDA compliance of individuals in Aer Salboar in 2018 (57.5%) compared to MDA compliance in 2017 (35.0%). In contrast, in Waihaong, where the local uptake of new social mobilization strategies was more limited, only a modest improvement in compliance, of 41.2% in 2018, compared to 38.4% in 2017, was observed. However, the improved messages and resultant better compliance occurred with a very limited social mobilization budget. Additional resources to expand social mobilization efforts may yield greater results. The RANAS technique is a promising new strategy for empowering NTD programs to identify the unique and predominant drivers of MDA compliance in their setting and apply evidence-based solutions to improve compliance. This survey can be deployed and analyzed without specialized knowledge. More experiences are needed to further refine and simplify the tool and determines its utility for other NTDs. Due to the importance of context in this qualitative research, the study's authors request that you contact Dr. Alison Krentel ([e-mail]) prior to using this data.