Using Graphics as an Alternative to Written Instructions: Adapting Oral Self-Implemented Test Instructions for Tanzanian Youth

In sub-Saharan Africa, HIV is the leading cause of death among 15-24-year-olds. Tanzanian youth rank fifth in HIV prevalence, yet testing rates are low. Dissemination of oral HIV self-implemented tests (Oral-SIT) may improve access if tests are coupled with graphic instructions to address low literacy. This study analyzed how a graphic instruction book (GIB) alone, compared to a GIB combined with an instructional video (GIB-video), affected comprehension of the Oral-SIT kit procedures. In a randomized experiment (<i>N</i> = 257; 14-19 yrs), we analyzed misunderstandings of testing procedures across the two study arms. Participants in the GIB-only condition reported more misunderstandings (59%) than in the GIB-video condition (41%). Fifty-eight percent of misunderstandings contained major errors, though most centered on a few graphics. Fewer than 6% of participants had four or more misunderstandings. Overall, the GIB was comprehended well and with modifications, could enhance Oral-SIT fidelity in low-literacy settings.