Comparing Effectiveness of Communication Channels in Increasing Utilization of Surgical Services in Rural Eastern Uganda.

Abstract

Background: Access to surgical care in low- and middle-income countries (LMICs) is hindered by multiple factors. Although healthcare initiatives have sought to enhance accessibility, surgical conditions still contribute to 32.9% of the global disease burden. Effective communication and outreach methods-including community engagement, mass media, and interpersonal interactions-have been widely used to improve global health outcomes. However, their roles in promoting surgical care in LMICs remains underexplored. This study evaluates the effectiveness of different communication strategies on patient care access at an ambulatory surgical center in rural Uganda.

Methods: This is a retrospective descriptive case study of patients who sought surgical consultation at Kyabirwa Surgical Center (KSC) in rural Uganda from 1/2021 to 7/2023. Records from KSC's electronic medical record system, financial records, and attendance logs were reviewed to extract demographic, communication channel, and cost data. RStudio was used for statistical analysis.

Results: In total, 3515 patients had documented communication channels that led them to seek surgical consultation at KSC. Among this cohort, 842 patients (24.01%) were reached through channels initiated by KSC, termed "active channels," and the remaining through referrals or word-of-mouth, termed "passive channels." Active channels include community mobilization via in-person outreach visits (550/842, 65.3%), interpersonal communication via radio talk-shows (254/842, 30.1%), and mass communication via text message broadcasts (38/842, 4.5%). Consultation confirmed surgically correctable diseases in 78.9% of patients reached through community mobilization, 78.3% through interpersonal communication, and 100% through mass communication. Active channels were more likely to recruit patients with surgically correctable diseases than passive channels (p = 0.01). Cost analysis demonstrated that community mobilization was most expensive ($76.39/patient) compared to radio talk-shows ($7.11/patient) and mass communication ($22.59/patient).

Conclusions: This study demonstrates the pivotal role of proactive community outreach and patient engagement in recruiting individuals with surgically treatable conditions. Although community mobilization emerged as the most effective active recruitment method, cost continues to be a challenge. Additional research into health system development through communication channels will be valuable in identifying strategies to enhance efficiency.