title: Using WeChat official accounts to improve malaria health literacy among Chinese expatriates in Niger: an intervention study.
abstract: BACKGROUND
  Malaria is the main health risk for Chinese expatriates working in Niger. Health education is a recommended intervention for prevention of malaria among non-immune travellers and expatriate workers. It is urgent to develop an effective and feasible way for these populations to obtain information about the prevention and treatment of malaria.
  
  
  METHODS
  An individually randomized, unblinded, controlled trial was used to evaluate the effectiveness of using WeChat official accounts for health education to improve malaria health literacy among Chinese expatriates in Niger. A total 1441 participants completed a baseline malaria health literacy questionnaire and were randomly assigned to an intervention or comparison group in a ratio of 1:1. From July to October 2014, 50 malaria prevention and treatment messages were sent to the intervention group; 50 health news messages were concurrently sent to the control group. Both groups completed the malaria health literacy questionnaire again 4 months after the start of the education intervention. A questionnaire addressing satisfaction with the health education programme was completed by the intervention group. Malaria morbidity data for 2013 and 2014 were also collected.
  
  
  RESULTS
  At baseline, participant health literacy rates were 58.29, 62, 54, and 34% for skills, knowledge, practice, and attitude, respectively. After the intervention, rates for all four aspects of malaria literacy were above 70%. There was greater change in knowledge, attitude, practice, skills, and overall health literacy among the intervention group compared with the controls, with a statistically significant difference (p < 0.01). This was especially true for acquisition of malaria-related knowledge, practice and attitude; comprehensive intervention practices; and, correct use of rapid diagnostic tests (p < 0.001). The reported malaria morbidity during the study period decreased from 23.72 to 15.40%. Participants reported high levels of satisfaction with the WeChat health education programme with over 80% stating that they would continue to follow the programme.
  
  
  CONCLUSIONS
  The present health education intervention, via a WeChat official account, for the prevention and treatment of malaria among non-immune travellers and expatriate workers proved to be an effective, sustainable, feasible, and well accepted strategy for improving malaria health literacy among Chinese expatriates in Niger.
authors.affiliation: Health Care Center Manager of HSE Department, China National Oil and Gas Exploration and Development Corporation, 6-1 Fuchengmen Beidajie, Xicheng District, Beijing, 100034, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Infectious Disease Department, Dalian Sixth People's Hospital, No. 269 Huibai Road, Lugang, Ganjingzi District, Dalian, 116031, Liaoning, China.
authors.forename: Le Qiang
authors.initials: LQ
authors.lastname: Han
authors.affiliation: Beijing Jishuitan Hospital, No. 31 Xinjiekou Street, Xicheng District, Beijing, 100035, China.
authors.forename: Yan Jun
authors.initials: YJ
authors.lastname: Guo
authors.affiliation: School of Nursing, Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China. sunjing99@bjmu.edu.cn.
authors.forename: Jing
authors.identifier: http://orcid.org/0000-0003-2983-8053
authors.initials: J
authors.lastname: Sun
mesh_terms: D000328:Adult; D044466:Asian People; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009548:Niger / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Chinese expatriates; Malaria health literacy; Niger; WeChat official account