CONTRIBUTORS
Salma Nanjira Musa-Mkanga
Research Officer
Charity Waweru-Mwangi
Communications Officer
Paul Otwate
Research Officer
Symon Kariuki
Research Scientist
When APHRC first introduced the Neuroimaging Project in Nairobi and Kisumu, the research team was excited to introduce a new way of gathering data that would further improve the health and wellness of communities. The team was also cognizant of the fact that a new and unfamiliar approach would be challenging to execute. The neuroimaging project seeks to understand the effects of child stimulation on brain growth and development of children under five years and employs the use of low-level magnetic resonance imaging (MRI) as a research tool. A low-field MRI machine works by using a weaker magnetic field to create a magnetic field. This field causes the protons in the body’s water molecules and other tissues to align with the magnetic field, much like tiny compasses. A radio frequency pulse is then sent through the body. This pulse has a specific frequency that matches the protons’ natural frequency or resonance and temporarily knocks them out of alignment. The process of realignment of protons to original orientation, when the pulse is switched off, releases energy which is reconstructed to create images.
While sensitization is important for any project to be successful, it was more so for this project that is a first of its kind and one that has a higher risk of losing participants because of the introduction of a new technology, strange to the community, as a tool for data collection.
Understanding Community Perceptions
A knowledge, attitude and practices (KAP) survey was conducted to understand the acceptability of the Neuroimaging project. The research team sought to find out what the communities in Kisumu and Nairobi knew about MRI scans and other related investigations such as X-rays and to additionally understand their perception towards the technology. The team also wanted to know if the community would be willing to participate in a study that planned to carry out scans on healthy young children.
The findings of this study revealed significant gaps in the community’s knowledge and perceptions regarding the use of MRI in children, particularly for research purposes. Many caregivers expressed uncertainty about MRI safety, with some associating it with harmful effects such as brain damage or cancer.
The results of the KAP survey guided the development and implementation of a series of sensitization meetings conducted in partnership with Uthabiti Africa (a community based organization that advocates for equitable access to child care services). The engagements began at the county level where the discussion focused on what county officials anticipated as the greatest concerns that the communities would have on the new technology.The county and subcounty officials advised on prompt reporting of any rare condition that might be noticed during the MRI screening for further evaluation and diagnosis.The knowledge gathered informed the messaging of the sensitization activities that were held in Nairobi’s Ruaraka and Dagoretti subcounties and in Kisumu East and Central subcounties.
Focusing the message beyond the technology
While the easiest message to push would have been that MRI technology is safe, the team chose to augment the conversation by addressing the main aim of the project of promoting the nurturing care framework as the best approach to childcare, contributing to brain development in the first 1000 days of life. The team used fliers and charts that were distributed in childcare centers and health facilities for maximum visibility. The community was also engaged in a true or false game aimed to challenge the misconception around MRI use.
The true and false game used a series of prepared statements that we presented to the participants. The participants were required to decide whether the statements were factual or falsehoods that needed to be addressed by experts. The most interesting outcome of the game was the realization that many people thought that the low-field MRI could disrupt brain function and that pregnant mothers should never go anywhere near the machine. These misconceptions and many others were adequately challenged by experts whose final conclusion was that MRI is a safe medical tool that can be used for research.
Following this spirited campaign, the research team conducted the first round of MRI scans using a low-field MRI machine that is more child-friendly. 380 participants agreed to have their children aged between 6 months and two years to be scanned. To further increase the engagement and promote buy-in, the team gathered testimonials from the parents after the scans and packaged them into a documentary that was screened to other community members to further promote acceptability and build dialogue around the safety of MRI.
Creating trust among fathers
In this second round of sensitization the team targeted both mothers and fathers to further build trust and acceptance. This approach was informed by feedback from fathers that indicated a need to be involved in the decision-making process as they too have parental rights. The team also invited study participants who only agreed to participate in the behavioural assessment and remained unconvinced about the value of MRI technology on their healthy babies. This engagement gave them an opportunity to ask questions and interact with experts. After the engagements, with many fathers in attendance, many parents expressed willingness to participate in the study. They felt more informed about the objectives of the study and their fear over the research technology was adequately addressed. Some of the parents who had refused their children to be scanned were willing to have their children scanned after the sensitization meetings.
The experience in both counties clearly demonstrated that sensitization is not just a project activity, it is the backbone of community-based research, and should therefore be continuous and strategically targeted at emerging issues during the study. When the study began, fear and misinformation surrounding MRI scans for young children created hesitation to participate among parents, many of whom had genuine concerns rooted in limited knowledge and awareness. However, through open engagement, clear communication, and the radiographer’s detailed explanation and reassurance of the safety of the low-magnetic MRI, these fears were replaced with understanding and trust, which improved study enrolment. By creating a space where community members could freely ask questions and receive honest, evidence-based answers, the sensitization meetings transformed uncertainty into confidence. As a result, the majority of participants willingly embraced the study, proving that when people are informed, they are empowered.