Assessing the acceptability of photographs and medical illustrations in Buruli ulcer health communication among health providers, community volunteers and community members in endemic districts of Ghana

BACKGROUND: The control of Buruli ulcer (BU) relies on early case detection to improve disease outcomes. While lesion photographs are currently used in health communication materials, they have many drawbacks. Medical illustrations, though proven effective in many contexts, remain unutilised for skin NTDs. We therefore aimed to assess their acceptability in health communication materials in BU-endemic districts of Ghana. METHODOLOGY/PRINCIPAL FINDINGS: We conducted eleven focus group discussions, using a guide developed from the PICO framework and the Theoretical Framework of Acceptability (TFA). Participants were shown photographs and clinically approved medical illustrations of different presentations of BU. All participant groups confirmed that images of BU play a key role in health communication. However, photographs of the disease may frighten the viewer, either deliberately or not, especially when they show advanced stages of the BU resulting in revulsion and anxiety. All agreed that illustrations were acceptable and do not evoke the same negative emotional response, whilst still providing accurate information for detection. Health providers expressed the view that the psychological distress associated with real-life images are beneficial for prompt healthcare-seeking; however, the views of community members contradicted this. Health providers and CBSVs currently manage such negative reactions through a variety of methods. However, these strategies do not always work as some viewers shy away from the materials. CONCLUSION: Medical illustrations have a potentially important role to play in BU health messaging. As well as their role in communicating the characteristic features of the disease without distracting elements or ethical issues, they are also particularly well-suited to depict BU in the later stages to produce health communication materials that are sensitive to the emotional states of viewers. We encourage health communicators to place materials within appropriate social and cultural contexts, to promote their effectiveness and uptake of the health messaging.