Is audio storytelling the most effective way of teaching communities about leprosy?

A special Leprosy Research Initiative focus.

Is audio storytelling the most effective way of teaching communities about leprosy?

“We have a tendency to write leprosy awareness materials from the perspective of doctors and then we put them out there in communities without ever gaining any real understanding of whether they were effective. We decided to change that way of working.”

These are the words of Ngozi Murphy-Okpala, a researcher with RedAid Nigeria who has used funding from the Leprosy Research Initiative to assess how best to educate communities about leprosy in Nigeria.

“One of the problems we have noticed is that we usually share written materials, but these communities often do not have high literacy levels. We decided to test the efficacy of producing audio materials and consider whether consulting persons affected by leprosy on the messaging would make a difference.”

How did the project work?

Ngozi and the team ran two mirroring versions of this project in the north and the south of Nigeria, primarily in rural communities. They enrolled around 800 participants and through qualitative and quantitative tools, they assessed their baseline understanding of leprosy.

Then, working with a group of 20 persons affected by leprosy, they developed awareness materials that were designed to respond to some of the misconceptions they encountered through their baseline study. Some of the materials were traditional health materials, but others were inspired by how the persons affected by leprosy wanted to tell this story. They did this through a seven-day participatory co-creation workshop.

It was their idea that they

should teach their communities through the story of Mama Bassey in southern Nigeria; similarly common names were used for different narratives in northern Nigeria.

In the education materials that were produced, Mama Bassey, a local mother expresses outright shock and fear upon

learning her neighbour has been recently diagnosed with leprosy, reacting with stigma and immediately distancing herself despite her neighbour's reassurance that she is receiving treatment. An educator intervenes, questioning the dramatic reaction and setting the stage for practical correction of misconceptions. The story ends with a convinced Mama Bassey agreeing that there should be no more stigma or discrimination as she willingly resumes interacting with her neighbour.

Once the outline of the story had been developed, it was dramatised into pictorials as a picture book (a jotter), leaflets and into an audio story. These were produced in Pidgin English for the south and in Hausa for the north.

Of the 800 individuals enrolled into the study, one third received the written materials, one third received a solar-powered mp3 player with the audio files installed, and one third were a control group who received no materials.

How were the materials distributed?

Written materials only
Audio files only
Both written and audio

What were the findings?

As Ngozi explains, ‘We’re still in the process of finalising our manuscript at the moment, but I can tell you that the study performed as we expected. We repeated the assessments that we had conducted at the start of the study and when compared to the baseline results, we found that the audio stories proved the most effective method of teaching people about leprosy. However, we also saw that the written materials did lead to an improvement, as well.

‘We have a few factors we are taking into consideration when looking at these results. The individuals in the audio part of the study received a free mp3 player, which may have been more treasured than a book. This may have prompted a greater desire to engage.

‘However, even with this taken into consideration, we think the audio files were more effective for other reasons. First, for communities with limited access to education, it was easier to engage with audio materials than written materials.

‘Second, we found that engaging with the audio materials became a community experience. In these communities, people do things together and so we found that not only those in the study were engaged, but even their neighbours were listening to and reported to talk about the story of Mama Bassey.

‘Third, these are rural communities and poorer communities. They don’t have the same content saturation that you might find elsewhere in the world. People don’t have TVs or streaming services, they might have a radio, and there may be a few smartphones but with very limited internet data. When new materials arrive in the community, they are happy to receive it.’

What was the most effective teaching method?

Audio stories
Written materials
Both equally

The process proved transformative for persons affected by leprosy

‘The materials were more effective because of the input of persons affected by leprosy, but that wasn’t the only outcome of their engagement. One of the most striking parts of this study was the impact it had on the persons affected by leprosy who contributed to the production of the materials.’

Ngozi and the team assessed these individuals for internalised self-stigma and self-esteem at the start of the project, after six months, and after a year. They found that the impact was overwhelmingly positive.

‘The internalised stigma scores dropped dramatically throughout the project and the self-esteem scores went up. This is because they got to see their ideas turned into a real product and then they saw it distributed in their communities. As this process was underway, their perceptions of themselves began to change. By the time the project had come to an end, they were self-proclaimed advocates.’

Before I came here to be educated about the leprosy disease, people of my community used to speak insulting words to me because of my condition. But after the last meeting and went back home, I didn’t bother again with the words they said to me because I had been educated about the disease and its mode of transmission. So, I have been educating others as well and am happy to be here today again”

(Female patient, FGD)

How did the project affect persons with leprosy?

Reduced internalized stigma
Increased self-esteem
Transformed them into advocates

Could this be replicated in other contexts?

'Absolutely. I believe very strongly that this approach should be considered for many other contexts. Because we were conducting a study, we were quite controlled about how we shared these awareness materials; if the control group had been sent the files through a friend, then it would have skewed our results.

'However, if you ran this project not as a study but as a mass awareness campaign, you could make the audio files as shareable as possible. You could share them to participants through WhatsApp and allow them to share it with their contacts. Equally, you could broadcast it over the radio or put it on an SD card that could be inserted into phones.

'Ultimately, we know that the story of Mama Bassey works and we know that dramatising this in the form of an audio story is effective. The only question now is how to make that shareable and how to adapt it to different languages and contexts.

'Hausa and Pidgin English are spoken across multiple countries in West Africa, so that would be a very easy place to start, but I can see how this could work far beyond West Africa.'

This project was presented as an ePoster at the 2 Skin-NTDs Global Meeting in Geneva earlier this year, and will be presented as an ePoster at the International Leprosy Congress in July 2025.

Do you think this approach could work in your context?

Yes, definitely
Maybe, with adaptations
No, our context is too different