A Cluster Randomised Controlled Trial to investigate the acceptability and impact of an educational cartoon package targeting knowledge of Opisthorchis viverrini and soil-transmitted helminths among schoolchildren in the Lower Mekong Basin

The intervention will consist of two "Magic Glasses" cartoons: “Magic Glasses Lower Mekong” (MGLM) targeting soil-transmitted helminths (STH), and “Magic Glasses Opisthorchiasis” (MGO), targeting Opisthorchis viverrini (OV). “Magic Glasses” is an educational cartoon that targets water, sanitation and hygiene (WASH) practices and has been tested in previous studies. MGLM will be adapted from existing Magic Glasses cartoons. The storyline used in previous cartoons (two child protagonists exploring the village and identifying ways that STH is spread, and then how to prevent this) will be retained. To ensure the key messages (e.g., transmission – consumption of contaminated fruit/veg, or uncovered feet when outdoors); treatment – anti-parasitic oral tablets, and prevention of STH – proper WASH practices eg washing hands after going to the toilet/before eating, washing or cooking fruit and vegetables before eating) of existing cartoons are relevant to the LMB, literature reviews conducted by research staff exploring knowledge, attitudes, practices (KAP) and risk factors associated with STH in the LMB region. As necessary, the script will be adapted to address behaviours or risk factors specific to the LMB. MGO will employ a similar storyline to the existing Magic Glasses cartoons, but will contain different key messages, based on the transmission, treatment and prevention of OV. The key messages of MGO (transmission – consumption of raw/undercooked fish; treatment –anti-parasitic oral tablet and prevention – cooking fish before consumption) will be informed by literature reviews conducted by research staff that explored knowledge, attitudes, practices (KAP) and risk factors associated with OV in the LMB region. Research staff will also review popular cartoons in Southeast Asia to inform the cartoon style. Current photos of the local environment, schools, and health clinic settings in the LMB will also be used to ensure that the cartoon depictions are appropriate/accurate. Once completed, MGLM and MGO will each run for approx. 10-15 minutes. At baseline, informed consent will be sought from parents and teachers to participate in the trial, and assent from prospective students. Once consent/assent is obtained, all consenting participants in Years 3-6 at control and intervention schools will complete two questionnaires to ascertain baseline knowledge of STH and OV. The STH questionnaire will include questions on demographic information and students’ knowledge of STH, including general knowledge, transmission, symptoms and treatment; attitudes and health education, and behaviour. The OV questionnaire will follow the same format to assess students’ knowledge of OV. In intervention schools, once baseline is completed, MGLM will be shown to all participating students in the classroom. The cartoon will be shown once, followed by the distribution of a discussion guide with questions on the key messages of the cartoon. The cartoon will then be shown again, and students will be asked to pay attention and answer the questions, in preparation for a classroom discussion following the second showing. Fieldworkers will monitor the showing to ensure students are paying attention to the cartoons. After the cartoon is played again, students will receive a comic developed using content and key messages taken directly from the cartoon. A classroom discussion will then be held to go over the health messages of the cartoon. Once the classroom discussion is complete, students will be asked to complete a questionnaire on acceptability. Once the acceptability questionnaire is completed, students will be asked to participate in a homework drawing competition where they will draw risk behaviours for STH infection. The best drawing will receive a prize. Six to eight weeks after the first presentation of MGLM, the cartoon will be shown twice and classroom discussion will be held again to the school audience again to reinforce the health messages of the cartoon (approx. 15-20 minutes; MGLM delivery 2). Once the cartoon and discussion is finished, students will be asked to participate in a homework essay competition where they will write how people can get infection, and how to prevent it. The best essay will win a prize. Delivery of MGO and the associated acceptability assessment will commence on the same or following day (depending on school size) that the OV baseline questionnaire is completed (MGO delivery 1), and follow the same procedure delivery as used for MGLM.