Assessing the appropriateness of dissemination strategies and the role of community-based volunteers in promoting insecticide-treated bed nets in Kalumbila District, Zambia: A qualitative study

Introduction: Despite global efforts to eliminate malaria, it remains a significant issue. Insecticide-treated nets (ITNs) are widely available and cost-effective, yet their adoption and proper use are often hindered. Understanding the challenges in ITN uptake involves examining the dissemination strategies used by community-based volunteers (CBVs), which are often understudied. This study investigated these strategies and CBVs' roles in rural health facilities of Kalumbila District, Zambia. Methods: This exploratory case study used four focus group discussions with a total of 28 household heads, seven in-depth interviews with community leaders and CBVs, and seven key informant interviews with health facility staff and ITN distribution program officers to gather data. Interviews and focus group discussions were transcribed and coded manually before generating themes through inductive thematic analysis. Results: CBVs played crucial roles in advocacy, social mobilization, awareness creation, registration and distribution of nets, and enforcing correct net use. However, low manpower, high turnover, and inadequate incentives hinder sustained CBV engagement. Contextually appropriate communication strategies with culturally relevant messages were vital to improving net use. The credibility of information sources, particularly health facility staff and CBVs, influenced community acceptance and trust. Findings highlighted the need for communication strategies that are linguistically accessible and visually engaging, considering diverse literacy levels. Conclusions: Effective ITN promotion depends on the vital roles of CBVs and contextually appropriate communication strategies, with a focus on overcoming sustainability challenges for long-term malaria control and elimination.