Evaluation of an educational intervention on villagers’ knowledge, attitude and behaviour regarding transmission of Schistosoma japonicum in Sichuan province, China

Health education is an important component of efforts to control schistosomiasis. In China, while education programmes have been implemented intensively, few articles in recent years in either the Chinese or English literature report randomised, controlled interventions of the impacts on knowledge, attitudes and behaviours. Thus, we designed and carried out a cluster-randomised controlled education intervention trial that targeted 706 adults from rural areas in 28 villages in Sichuan, China. We evaluated the effects of the intervention on five endpoints: (1) schistosomiasis knowledge, (2) attitudes towards infection testing and treatment, (3) use of personal protective equipment (PPE), (4) reducing defecation in the field, and (5) reducing dermal contact with potentially contaminated water sources. The results indicated that people in both the intervention and control groups showed improvement in knowledge, attitudes and reduction in field-defecation in the follow-up surveys. However, there was little evidence that suggested statistically significant differences between the two groups regarding any endpoint. Participation in intervention classes was associated with age, gender, occupation and education level. Our study suggests short-term health education interventions may not be effective in improving schistosomiasis knowledge or in the adoption of health-protective behaviours. This might be partially due to the spontaneous learning process of people subject to repeated surveys and other disease control activities. Considering the difficulties of occupation-associated behaviour change and knowledge reinforcement in general, longer-term education programmes should be considered in the future.