title: Health education interventions to raise awareness of rheumatic fever: a systematic review protocol.
abstract: BACKGROUND
  There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF.
  
  
  METHODS
  This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before-after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops.
  
  
  CONCLUSIONS
  This review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
authors.forename: Laura Susan
authors.initials: LS
authors.lastname: Ramsey
authors.forename: Lauren
authors.initials: L
authors.lastname: Watkins
authors.forename: Mark Emmanuel
authors.initials: ME
authors.lastname: Engel
mesh_terms: D001364:Awareness; D003906:Developing Countries; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D015201:Meta-Analysis as Topic; D010612:Pharyngitis / Q000517:prevention & control; D012107:Research Design; D012213:Rheumatic Fever / Q000517:prevention & control*; D012214:Rheumatic Heart Disease / Q000517:prevention & control; D013290:Streptococcal Infections / Q000517:prevention & control; D000078202:Systematic Reviews as Topic