Engagement with communities at-risk of scrub typhus: lessons learned from Northen Thailand

Background In northern Thailand, scrub typhus primarily affects rural and hill tribe communities, yet awareness is low. In 2020 we trained community health volunteers (CHVs) to raise awareness in their communities using a train-the-trainer approach. CHV knowledge rose dramatically. However, we did not assess the effectiveness in community members and our strategy relied heavily on CHVs, who have limited availability. Methods In a second phase, object of this manuscript and conducted in 2022-2023, after training CHVs we measured the effectiveness in community members and compared in-person sessions carried out by CHVs with sessions using video or audio recordings only. All materials included key information about scrub typhus transmission, symptomatology, prevention, and management and had been developed following feedback from participants from the first round of activities in 2020. Effectiveness was evaluated using a questionnaire assessing scrub typhus knowledge. CHVs were also asked to rate the feasibility of suggested preventative measures. Results A total of 74 community members participated in six sessions. Knowledge of scrub typhus significantly improved post-training (median score increased from 2 to 6 out of 9, p<0.001) and audio and video recordings were as effective as in-person trainings. CHVs noted that some of the preventative measures recommended are difficult to put in practice such as wearing gloves, washing daily after work, avoiding kneeling and resting on the ground, and washing clothes daily. Conclusions Our findings support the use of locally adapted multimedia training for scrub typhus prevention, showing that scalable formats can be as effective as in-person ones. Further collaborative work with people at risk should refine preventative messages to improve feasibility and acceptance.