What do we really know about raising awareness of leprosy with children?

Subin Adhikari, TLM Nepal Programmes
Communication Officer

What do we really know about raising awareness of leprosy with children?

“Leprosy awareness is, more often than not, us putting everyone into one bucket and administering a poster or a video or something similar. All people receive the same content and we'll hit some targets, but we'll miss a lot.”

Subin Adhikari, TLM Nepal Programmes Communication Officer

As a communications professional, Subin recognises that reaching people with a message is not the same thing as getting it to stick in their minds or encourage behaviour change. People of different ages, education levels, and learning types need to receive information in different ways. So for Subin, the tools that might work for an adult were not something he was confident would work for a child.

“Young kids learn differently from a young adult or a middle-aged or older person. Right now, they're all receiving the same materials and for kids, that's a problem. So we asked, what if we designed something that's just for kids? Let's design a mascot for them and create a video campaign."

Subin is taking this idea and a grant from the Leprosy Research Initiative to test whether a child-specific campaign is more effective than standard awareness materials.

How do we make kids care?

"Kids don't care. And that's okay. Our job is to work out how we make them care, how to give them a message that they'll remember even ten years later. When I was a kid, UNICEF did a campaign that looked at washing hands. The campaign had a mascot and to this day I still associate hand washing with that mascot.”

Subin Adhikari, TLM Nepal Programmes Communication Officer

Subin and the team have used that UNICEF mascot as inspiration and have created a cartoon mascot for an animated video about leprosy.

“She's like an older sister. Our target audience is between 10-18 years old, so we created someone they can look up to, rather than an authority figure. She does volunteering with NGOs and community groups.

“We did some focus group discussions with kids before we created this mascot. We asked what type of cartoon characters they like and what they have learnt from them. That was really helpful.

“Once we had the mascot, we sat down with leprosy experts to understand what we need to teach kids about leprosy - how much to say and what not to say. Our focus has been on signs and symptoms, rather than on stigma or social issues.

"We hired a consultant to develop the animation and storyline, inviting them to see leprosy for real at Anandaban Hospital.”

Method:

584 children from six government schools in rural areas of Nepal have been enrolled.

292 children are a part of the intervention group. They see the cartoon video that has been custom made for children.

292 children are a part of the control group. They see a video that is used generically across all age groups.

The messaging across both videos is the same, but one is a cartoon and one is live action.

Each child will see their video three times. After the first two showings, the children answer questions in a toolkit immediately. After the third showing, they use the toolkit two months later to see what they have retained.

Fear is not the answer

From the beginning of the study, Subin felt that fear would not help their work with kids.

“We used to assume that fear would make leprosy stick in people's mind. We go to communities with pictures of massive ulcers and amputations, but this only adds a negative association to leprosy, making people fear the disease.

"We want these kids to learn in a more positive way, without fear of the disease. We think fun is a great way to do that and might be more memorable, too. We've made this cartoon with humour in mind because we believe that's the key to getting kids engaged. I've also created a ludo game that is based around leprosy. I've only tried it once, but the kids loved it.”

“Ultimately, we want to use children as agents of change in their communities. We want them to go back to their parents and friends and talk about what they've seen because they find it fun. Maybe we'll even see the parents' attitudes change, too.”

Subin's five takeaways

1 Spell it out

We did a first draft of the video and tested it. We thought the video was clear, but it turned out that it was only clear if you already knew a lot about leprosy.

We learnt that, if you want the kids to learn, you really have to spell it out for them. They need to see the character be asked if the wound hurt and why it didn't hurt.

2 Go to where the people are

This is a fundamental rule of communications. For example, if you want to reach kids, don't go to LinkedIn. We have learnt in Nepal that radio adverts are not as effective as they once were. Even in rural areas, everyone is using TikTok now.

We spoke to the kids and all of them confirmed this. Video content on TikTok is now the dominant media type for them. So creating a mascot adapted for video was the right move. We will likely adapt our animation for TikTok after the research is over.

3 Communications is neglected in research

Communications is often the crucial tool for achieving behaviour change, and yet we aren't researching whether our communications if effective. Campaigns for kids have been done before, but we don't have data to show that it worked.

Even the validation tool we're using wasn't equipped for the task as it wasn't validated for children. We spoke to some experts, took the toolkit to the kids, and remade it based on what we learnt. We're hoping to put the toolkit out there for other teams to use for validation of materials with kids.

Subin's five takeaways

4 Watch and see

We haven't been showing the video in a classroom. Instead, we've been taking 10 kids at a time into a separate room and observing them as they watch the video. It gives us a chance to watch them and see if they're engaged.

With digital communications, you don't get this privilege - engagement comes in the form of likes and comments. If you create something like this and want to test it, get yourself in the room with your audience and see what impact it has for them yourself - see it on their faces and in their laughter.

5 Go beyond the video

If our research shows that this mascot and the cartoon work, we would expand from there. We could create comics, we could paint the mascot on walls, we could create stickers.

In Nepal, at the start of the school year, we all get new notebooks and when you get the notebook, we put stickers all over it. It would be great if our mascot was one of the stickers on these kids' notebooks. I want this mascot to be etched on their memories and something they identify with, just like I do with the old UNICEF hand washing mascot.

What is the potential of this project?

"We started the project in September 2025 and we'll be going until around the end of 2026 with results in early 2027. We want to see if knowledge of leprosy increases with our intervention group, but we'll also be checking to see if stigma levels are different, too, although that's not the primary aim.

"If we see knowledge go up and stigma drop, we're hoping to run another study to track behaviour change over a three-year period. I really hope that, even ten years down the line, kids are going to remember our mascot and remember something of leprosy, too.

“It sounds like a small study, but the way we’re going about it, it could forever change the way we teach leprosy to children.”