Free Digital Health Education for Diseases of Public Health Importance (HIV, Tuberculosis and Taenia Solium Cysticercosis/Taeniosis) in Iringa, Tanzania
Phase: NA
Conditions: HIV Infections, Tuberculosis, Cysticercosis, Tapeworm Pork
Sponsor: University of Oslo

 
 
PhD research protocol 
 
Free digital health education for diseases of public health importance (HIV / AIDS, 
Tuberculosis and Taenia solium cysticercosis/taeniosis) in Iringa, Tanzania 
 
Christine Holst 
Department of Community Medicine and Global Health,  
Institute of Health and Society, Faculty of Medicine   
 
 
 
 
 
Supervisor: Professor Andrea Sylvia Winkler, Department of Community Medicine 
and Global Health, Institute of Health and Society,  
Faculty of Medicine   
Co-supervisor: Professor Josef Noll, Department of Technology Systems (ITS),  
Faculty of Mathematics and Natural Sciences 
 
 
 
Last updated: 2.1.2019 
 
 
 
 

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Project summary 
Increased health education has the potential to facilitate better use of health care services and to promote 
early treatment, thus it can strengthen the health care system, and ultimately reduce morbidity and mortality. 
In this study, we will develop and test the effect of digital health messages related to HIV, Tuberculosis (TB) and 
Taenia solium cysticercosis/taeniosis (TSCT) (the intervention diseases) in Migoli and Izazi (the intervention 
villages), in Iringa, Tanzania (TZ).   
The intervention is planned as follows: A digital platform, providing the intervention villages with digital health 
messages related to the above-mentioned diseases, will be implemented in TZ in 2019. The platform will be 
accessible free of charge, through own devices and tablets based in the local Wi-Fi spots in the villages.  
In the first part of the PhD-project, the doctoral research fellow will participate in developing the digital health 
messages, together with experts from the medical and teaching environments in Tanzania, Norway, Germany 
and USA.  
The second part of the PhD-project consists of a cluster non-randomised controlled trial and semi-structured 
interviews in Tanzania. The digital health messages will be physically shown to the participants in the 
intervention group. The study is planned to investigate the knowledge related to the intervention diseases, 
before the intervention, immediately after exposure to the intervention, and at follow-up points throughout 
one year, after the intervention has been implemented. Semi-structured interviews with clients (users of the 
intervention) from each of the intervention villages are included, to explore the perception and reception of 
the intervention.  
The baseline study and the immediate after survey will take place in Tanzania in Q1 2019, while the other 
follow-up studies and interviews (3, 6 and 12 months after baseline) will be undertaken throughout one year.  
Introduction 
This protocol is registered in Helseforsk, University of Oslo, and the project has been assessed by Norwegian 
Centre for Research Data (NSD), ref. number 59643. Ethical approval from the National Institute for Medical 
Research (NIMR), Tanzania,  has been granted with the reference number NIMR/HQ/R.8a/Vol IX/2947.  
The PhD-project consist of three work packages: WP1: A systematic review and meta-analysis, WP2: A cluster 
non-randomised controlled trial and WP3: Semi-structured interviews with clients in the intervention group. 
Only WP2 and WP3 are elaborated upon in this protocol. 
The planned PhD-project will be included as a health-research component in the Norwegian Government- and 
Norwegian Research Council- funded innovation project ”Non-discriminating access for Digital Inclusion” (DigI). 
The project runs from January 2017 to September 2020. Altogether 11 partnersi from eight countries are 
collaborating on the project. Professor Josef Noll from the Dept. of Technology Systems (ITS), University of Oslo 
(UiO), is the project owner, and the doctoral research fellow’s co- supervisor. Responsible for the health-
research component and main supervisor of the doctoral research fellow, is Professor Dr. Andrea Winkler at 
the Institute of Health and Society, UiO. Head in TZ, is Dr. Bernard Ngowi (HIV/AIDS and TB specialist) from 
NIMR and Associate professor Helena Ngowi (TSCT specialist) from Sokoine University of Agriculture (SUA). 
Associate professor Maurice Isabwe from Dept. of Information and Communication Technology at University of 
Agder is head of developing the digital health messages. This study is thus multicentre with several institutions 
responsible for research. 
In Tanzania, DigI will facilitate a digital health education platform, where digital health messages related to HIV 
/ AIDS, Tuberculosis (TB) and Taenia solium cysticercosis/taeniosis (TSCT) will be transferred to the community; 
hereby called clients, defined by the World Health Organization (2017) as “members of the public that are 
potential or current users of health services, including promotion activities”1.  
                                                          
i The partners are: Basic Internet Foundation, The University of Oslo, Orange, Ministry of Health (TZ), National 
Institute for Medical Research (TZ), Sokoine University of Agriculture (TZ), Mondragon University (Spain), 
Global Health Media Project (US), IPX Extenso, Future Competence and Motivation 

3 
 
The digital health messages will be accessible at a Wi-Fi spot in the local village close to the local health post. 
The digital health messages will also be shown face-to-face to each of the participants in the intervention 
group, by enumerators in the research team from SUA and the doctoral research fellow. The intervention will 
be available for all clients in the intervention villages, not only for the participants in the study described in this 
protocol.  
The intervention will be maintained by NIMR Muhimbili Centre in Dar es Salaam during the first phase, but is 
going to be managed as a sustainable business model where a local sales man or woman is selling vouchers to 
access the World Wide Web. NIMR have close contact with the village authorities and health workers in the 
intervention villages, and will be alerted if the intervention for some reason is not functioning. The Wi-Fi 
network that provides the access to the digital health education platform, reaches within a radius of 50 meters, 
and is driven by a solar panel. This means that the intervention will be accessible even if the electricity locally 
shuts down. 
Background and Rationale 
Today’s education channels are changing, thus health education interventions must meet the target population 
at their own level of technology,2 and further do rely upon the characteristics of the technology available.3  A 
useful tool to deliver education and improve health seeking behaviour and health-related lifestyle decisions, is 
mobile technologies, because they make people more contactable.4 Health seeking behaviour may change 
after the target group has been exposed to adequate health messages that provide relevant information to the 
target population,5,6 thus digital health information can contribute to prevention and management of 
diseases.7  
Digital health and digital health education 
Digital health is defined by WHO (2016) as “The use of digital, mobile and wireless technologies to support the 
achievement of health objectives. Digital health describes the general use of information and communications 
technologies (ICT) for health and is inclusive of both mHealth and eHealth”8. eHealth is defined by the WHO 
(2005) as “the cost-effective and secure use of information and communications technologies in support of 
health and health-related fields, including health-care services, health surveillance, health literature, and health 
education, knowledge and research”9. mHealth is a component of eHealth, and commonly referred to as the 
use of mobile and wireless technologies for health. WHO (2011) defines it as: “medical and public health 
practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital 
assistants (PDAs), and other wireless devices”10. 
Health behaviour change may reduce the burden of preventable disease and death around the world, “as 
health education covers the continuum from disease prevention and promotion of optimal health to the 
detection of illness to treatment, rehabilitation, and long-term care”11. 
The use of eHealth is now understood as central in order to provide more care and better care to more people, 
especially those most in need.12 A key part of the Sustainable Development Goal 3 relates to reaching people 
with the information they need in order to live healthier lives, and eHealth is regarded as a tool to reach the 
public with health messages and support, as well as encouraging clients to take active roles in their health and 
wellbeing (ibid).  
The use of smart devices and mobile data services are rapidly changing, and it is likely that an increasingly part 
of the population in for example Sub-Saharan Africa will have access to both in the future.13 
Focus diseases  
Creating awareness of prevalence, causes / transmission, symptoms, how to treat and prevention of diseases, 
aiming to provide early treatment and increase appropriate use of health care services in rural areas in the 
global south, is important in order to reducing infectious diseases like HIV/AIDS, TB and zoonotic diseases like 
TSCT. In lower income countries (World Bank classification) 60% of the population live in rural areas.14 These 
are hard to access populations, due to underdeveloped infrastructure and resource poverty, which need the 

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health education already available. 
Related to this project, the spread of information regarding the following diseases will be essential: 
HIV/AIDS 
In sub-Saharan Africa, AIDS is the leading cause of death among teenagers,15 and 25.6 million people in Africa 
are living with HIV in 2016.16 Quality information, rapid diagnosis and early treatment and care are essential to 
control the virus and help prevent transmission to others.  
Tuberculosis (TB) 
TB treatment saved 49 million lives globally between 2000 and 2015, but despite TB being both treatable and 
curable, 1.7 million people are dying globally from the disease, each year.17 The most efficient way to save lives 
is to diagnose and treat TB as early as possible.  
Taenia solium (neuro)cysticercosis/taeniosis (TSCT)  
TSCT is an emerging but neglected parasitic and zoonotic disease, caused by the tapeworm Taenia solium. In 
humans the disease manifests itself mainly as neurocysticercosis (NCC) - the most frequent preventable cause 
of epilepsy in sub-Saharan Africa.18 TSCT has been listed as a priority disease for international attention 
towards elimination, to alleviate poverty.19 
Messages on Anthrax, Cholera and maternal and new born health will also be available, but they are not part of 
this particular PhD-project. 
Objectives 
The overarching objective of the study is to acquire new knowledge within the field of digital health education / 
digital health promotion and health literacy of clients in Iringa, Tanzania. The study will employ both 
quantitative and qualitative methods (mixed method) of data collection and analysis. The primary objective of 
the PhD-project is to develop, describe and understand the use of a digital health literacy intervention, and its 
effect on health literacy outcomes in Migoli and Izazi, Iringa, Tanzania. 
Main objectives in WP 2 
 
Assess the effect of the digital health intervention, related to knowledge uptake and knowledge 
retention by assessing the knowledge score before and after the intervention, in both groups. 
 
To investigate if the intervention increase health literacy related to the intervention diseases among 
the clients that cannot read.  
 
Main objectives in WP 3 
 
Explore the reception and perception of the intervention among the users, by semi-structured 
interviews. 
 
The doctoral research fellow will strive to present and review the findings from the research within the 
Sustainable Development Goals (SDGs),20 as over-arching framework. There are especially two goals of major 
importance related to this study: SDG 3 Good health and well-being, and SDG 9 Industry, innovation and 
infrastructure.   
One of the targets in SDG 3, states that they are making a bold commitment to end the epidemics of (among 
others) HIV/AIDS and TB by 2030. Another target emphasizes to strengthen the capacity of all countries, in 
particular developing countries, for early warning, risk reduction and management of national and global 
health risks.21 Bridging the digital gap is an important task related to targets of SDG 9. They state among other 
targets: “Significantly increase access to information and communications technology and strive to provide 
universal and affordable access to the Internet in least developed countries by 2020”22. The DigI project directly 
addresses this target through the aim of free access to information for all. The free access to information is also 
the catalyst for several other SDG goals (4, 8, 10 and 11). 

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WP 2 –A cluster non-randomised controlled trial  
The overall strategy chosen is a non-randomised controlled trial, with a two-stage cluster sampling. The study 
will be conducted in four villages in Iringa district in Tanzania, assessing the effect of digital health messages 
related to HIV / AIDS, Tuberculosis (TB) and Taenia solium cysticercosis/taeniosis (TSCT). 
The aim of the digital health intervention is to contribute to increased health knowledge of the clients that has 
the potential to facilitate better use of health care services, and to promote early treatment, thus to strengthen 
the health system. 
Hypotheses: We hypothesize that the intervention increases the proportion of correct answers, related to the 
intervention diseases, when comparing pre and post knowledge scores, also among clients that cannot read.  
We will measure if the intervention leads to an increase in the number of correctly answered questions, from 
21 out of 42, to 28 out of 42 (equivalent to 16,7 % increase) questions from the study questionnaire, during the 
12-months intervention in the intervention group compared to the control group. 
Methods and study design 
Iringa district was selected because the prevalence of all three diseases is high, and the areas are known to be 
endemic, in addition to being a rural district with mainly unconnected villages. The intervention villages were 
conveniently chosen at an early stage23 in the DigI project, thus randomization of the participants to 
intervention / control groups will not be feasible. The intervention group, group 1, consists of randomly 
selected participants from the villages Izazi and Migoli.   
Izazi village is not connected to internet, while Migoli has recently been connected through 3G.  According to 
the village authorities, 3G is not used for health information.  
The control group, group 2, consists of randomly selected participants from the villages Kimande and Idodi. 
These villages are candidates for the 7 next villages to get access to the digital health platform, in the DigI 
project phase II. The control villages are both located at least 70 km away from the intervention villages, and 
have at least three villages in between, in order to hinder contamination between the two groups.  
Around 494 participants (15-70 years of age) will be included in the study. The study will take place at randomly 
selected households in the four villages. The ten-cells (sub-villages with up to 50 households) will be the 
clusters and randomization will occur at ten-cell and household level. Group 1 will receive a 12- months 
intervention, and group 2 will function as a control group and will get usual information through the village 
health posts available resources (see the section on control group below). Study variables will be measured at 
baseline, immediately after exposure to the intervention, 3, 6 and 12 months after exposure. The main 
outcome will be knowledge uptake and score after intervention, and scores related to retention of knowledge 
throughout the year.  
Development of the intervention- Development of digital health messages 
In collaboration with the Tanzanian, German and American partners, we will develop the intervention that 
consists of digital health messages for the digital health education intervention, converting traditional learning 
material into a digital format such as a video, including sequences with interactive questions. When the 
enumerators and the doctoral research fellow are in the field, they will carry personal electronic devices; 
tablets. The tablet will contain both the videos and the digital questionnaires to be used in the surveys.  
The digital health messages will focus on public health important diseases in a Tanzanian context. The diseases 
have been selected after a need assessment locally, with the Tanzanian partners, and are diseases of public 
health importance. The digital health messages will address prevalence, causes / transmission, symptoms, 
treatment and prevention for HIV/AIDS, TB and TSCT. The local medical experts on the intervention diseases 
have pointed out key messages in traditional written material (some leaflets and some presentations), and the 
content is being reshaped and digitalized, before approval from the Ministry of Health Community 
Development, Gender, Elderly and Children (MoHCDGEC) in TZ will be sought to approve the health messages. 
The pedagogical strategy in the digital health messages is Micro-learning, applied to informal learning, which 

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enables users to learn without information overload, by the combination of micro-content with a sequence of 
micro-interactions. The micro-content will consist of the digital health message, and the micro-interactions will 
be the interactive questions that follow a key message. While developing the health messages, a constructive 
alignment approach is adopted, derived from the constructivist learning theory. This theory of learning can be 
summarized as following: First comes the key message – for example the health video that the client is 
watching on the device. Thereafter comes some digital questions, directly related to the key message. After the 
question is answered, the video continues. The outcome is presented first, and then the teaching and 
assessment are aligned to the outcomes. The learner’s activities in creating meaning are central in this theory. 
The aim is that the digital health messages bring short important messages out to the target population, and 
that the clients can use this information to make good choices regarding own and family health.  
In order to maintain the essential aim of the DigI project, to give non-discriminating access to basic 
information, the digital health messages will also target the illiterate. Voice-over will be used, and the language 
will be Swahili. The viewers will not be asked about own health, rather their knowledge related to the 
intervention diseases. The questions in the videos will be the same questions as in the questionnaire.   
Control group 
Participants from the control villages will serve as the control group and will be informed to live as normal. No 
restrictions or expectations will be given with respect to behavior change or information seeking, so they can 
continue the standardized care they get from the health information services. 
Recruitment and participants 
The research population is people living in the selected villages, the study units are individuals, but only people 
over 15-70 years old are eligible for participating in the study. This is a two-stage cluster where the intervention 
villages initially were sampled by stratification, and two-stage sampling frame will be undertaken at a ten-cell 
and household level. The number of households within the ten-cells will be selected by the size of the ten-cell, 
according to the Probability Proportional to Size. In the randomly chosen households, 3-4 household members 
will be interviewed all together five times. Ten-cell and household lists will be used for randomisation in both 
groups. 
A baseline survey conducted in both groups will determine the knowledge with regard to the diseases in the 
groups before the intervention is implemented.  
In group 1, the random selected sample of people, previously naïve to health messages delivered by the DigI 
project, will be given the intervention physically, as they will be shown the digital health messages at the 
researchers/ enumerators tablets. This is to make sure that all the participants in group 1 will actually receive 
the intervention, in order for the analysis to be able to indicate the overall effect of the digital health messages. 
All the participants in group 1 will be informed that the intervention is available for all, at all times, in the local 
Wi-Fi spot, however, we cannot be certain  that the participants will use the intervention more than the first 
exposure by the enumerators.  
Group 1 will, immediately after the exposure to the digital health messages, be asked the same questions as in 
the baseline questionnaire. 3 months, 6 months and 12 months after first exposure to the intervention, the 
questions will be repeated to the same participants.  
Inclusion criteria: 
 
Living in the selected household (15-70 years), at least for the past six months, and at least planning to 
not move the next 12 months.  
 
Must be capable and willing to sign written informed consent and thumb-print for illiterate 
participants 
Exclusion criteria 
 
Planning to be out of the village for more than 6 weeks in the next 12 months 
 
Those above 71 or under 15 
 
Not capable of signing consent letter (very sick) 

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In order to financially conduct the study, a cluster design is chosen over an individually randomised sampling 
procedure. The research group will be in contact with the participants five times, and it would demand 
increased financial resources if all ten-cells in the villages would be included. Even if the villages are not 
overwhelming in size, the populations are spread out over large areas. 
To reduce contamination between intervention and control participants, the villages in the intervention and 
control groups are located at different geographical locations.  
Data collection and instruments 
The research team will have training prior to fieldwork. The doctoral research fellow will be in charge of 
training with regards to use of tablets, interviewing the participants, submission of digital questionnaires and 
uploading of the personal identification code (described below). The training will take place in Morogoro, at 
SUA. 
Study tools  
Enumerators from SUA and NIMR and the doctoral research fellow will collect the data in the field. The first 
round will consist of localizing the participants and the baseline study. Health message provision to participants 
in group 1, and the immediate after questionnaire, will follow in the intervention villages.  The survey will start 
in Migoli, then Izazi, and then continue to the control villages, Kimande and Idoli. The first follow-up will start 
three months after exposure to the intervention, the second will start six months after, and the final follow-up 
will start 12 months after expose to the intervention.  
When collecting the data through the questionnaire, an android app, KoboCollect24, will be used. The 
questionnaire has been developed in KoboToolbox25, a software for field data collection in challenging 
environments, developed by Harvard Humanitarian Initiative26. This is a free, open source tool that allows their 
users to create and employ questionnaires, to be used in the field without Wi-Fi, 4G, 3G or other connectivity 
to internet.  
Accessing KoboToolbox can only be done with username and password. The questionnaire will be shared with 
other users, the enumerators, who only will be able to submit data, but not access the collected information. 
When tablets are online the app will automatically synchronize the collected data to the online platform, 
KoboToolbox. After each survey round the information will be transferred from KoboToolbox to UiO’s Services 
for sensitive data (TSD) and a server at NIMR, and deleted from KoboToolbox. This is described further below.  
The digital questionnaire contains questions to be checked off at the tablet. The language in both the digital 
health messages and the questionnaire will be Swahili. In the first survey round, the participant will be asked 
about demographic information. This personal information; name, sex, age, mobile number, village and GPS 
coordinates, will be registered on the household list, and not in KoboCollect, nor uploaded to KoboToolbox, in 
order to reduce privacy information risk. A Digital Object Identifier (DOI) will be created to each participant, 
and the DOI will be registered in KoboCollect together with age segment and sex. Thus, no personal 
information will be uploaded to KoboToolbox. The personal identification key will be stored directly in TSD via 
the tablets, and will not be sent through email.   
Tools to be used in the field 
A personal device, the tablet, containing: 
Household lists, containing: 
 
A digital questionnaire (KoboCollect) with: 
1. 
DOI, Age segment, sex 
2. 
14 knowledge questions on HIV / AIDS 
3. 
11 knowledge questions on TB 
4. 
17 knowledge questions on TSCT 
5. 
5 questions on digital literacy 
6. 
6 questions on general health literacy 
 
Digital health messages. 
 
The personal identification key (household lists) with: 
1. 
DOI 
2. 
Name 
3. 
Sex 
4. 
Age 
5. 
Village 
6. 
Mobile number 
7. 
GPS-coordinates 
Table 1 
The reason for asking the participants for their names, mobile number and GPS is to be able to re-locate the 
participants in the follow-up surveys. In the follow-ups, the research staff will carry lists with GPS-coordinates, 

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together with names and DOIs. When entering the data from the follow-ups, the enumerators will only have to 
identify the participants according to the list, and use the DOI when collecting data.  
In the follow-ups, the participants will be asked if they have used the intervention, at the local Wi-Fi spot, and if 
yes, how many times in the previous (three/six) months. This will provide information on the actual use of the 
intervention.  
Sample size calculation 
The data will be gathered from Migoli village, Mtera 
ward and Izazi Village, in Izazi ward (both in Iringa,  
population 10.036 and 2.567 people), in addition to 
the control villages, Kimande village in Pawaga ward 
and Idodi village in Idodi ward, also in Iringa district.  
After internal discussion in the DigI group, it is 
assumed that the people would have 21 correct 
answers out of 42 questions in total, if they were 
asked questions from the questionnaire today. It is further assumed that the intervention will 
increase the number of correct answers to at least 28 of 42.  The sample size calculation is to be 
found in appendix 1. The power of the study was set to 80%, the drop-outs calculated to be 20% and the 
cluster correlation was set to 1,5. After calculating the sample size, the proportions to each village was 
allocated, see table 2. 
After ethical approval from NIMR is granted, the questionnaire will be piloted in a village near Morogoro to see 
how it corresponds with the assumed proportion mentioned (at least 21 correct answers out of 42).   
Data management and statistical analysis 
A data management plan is being developed using a tool from the Norwegian Centre for Research Data (NSD). 
UiO is responsible for the data stored in TSD. The de-identification code will be stored separately in TSD, and 
deleted in 2022. After this, the anonymous data will be kept in NSDs archives, for re-use purposes.  
The data will be analysed in TSD, by multilevel models to address the dependency related to cluster trials. 
Summary tables with calculated averages (mean, median, and mode), will be created. The baseline knowledge 
scores will be calculated with data from the first survey. The doctoral research fellow will compute an overall 
score for each section (prevalence, cause/transmission, symptoms, treatment and prevention) at individual and 
village level, based on the answers to the questions.  Then a comparison between intervention groups and 
between intervention and control groups will be made. Data from the follow-ups will also be analysed in TSD 
accordingly.  
After data collection is completed the GPS data will be able to illustrate the use of the intervention, related to 
distance from household to Wi-Fi spot and frequency of use. In this planned illustration, no direct households 
will be identified, but rather summarize on village level the frequency of the use of the intervention. 
WP3 - Semi-structured interviews  
In order to get complimentary qualitative data, 8-10 semi-structured interviews with clients from the 
intervention villages will be conducted. The main aim is to get people to reveal their own perspectives related 
to the intervention.27  
The research question reads as follows: How is the intervention perceived and received among those who use 
it in the intervention villages? 
Semi-structured interviews allow the doctoral research fellow to have an informal tone with the informants, 
and it adds meanings, values, feelings, personal experiences and points of view to the research. A checklist will 
be prepared to steer the conversations and make sure that no question remains unanswered or unclear.  
The interviews will be held with clients in the intervention villages, in English if possible, otherwise in Swahili 
with a translator. This is to provide in-depth information on how the intervention is perceived and received 
Sample size per village 
  
  
  
Population 
Proportion 
Sample 
Migoli 
10036 
0,79 
195 
Control village 1, 
Kimande 
3000 
0,55 
135 
Izazi 
2657 
0,21 
52 
Control village 2, 
Idodi 
2500 
0,45 
112 
N 
18193 
  
Sample 
  
  
494 
Table 2 

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among the people who actually use the intervention locally. It can also shed light on the possible effects of the 
intervention, raise specific issues, opportunities and problems, and provide a different view on the use of the 
health messages. The interviews can also work as a discussion arena and a strategy of validity.  
The participants will be randomly picked from the same lists as in WP2. The semi-structured interviews will be 
recorded with the recording app from TSD, and transcribed thereafter. The records and transcription will be 
held separately from the de-identification code, both in the TSD. The de-identification code will be deleted two 
years after the overall project is finished. After this, the data will be kept anonymous in the NSD archives.  
When analysing and summarizing the interviews, a table will be made that excerpts the most important 
findings from the qualitative research, together with quotes from the interview.   
Ethical considerations 
Ethical approval will be sought from the Medical research coordinating Committee (MRCC) of the Ministry of 
Health, Community Development, Gender, Elderly and Children (MoHCDGEC) in TZ. The safety of the study 
participants will be assured. Permission to participate in the study will be asked from the study participants. 
Data on actual harms in digital health interventions are relatively sparse.28 In this study, we will state to all 
participants that they can withdraw any time from the surveys. All the digital health messages will be ethically 
approved by the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) in 
TZ. This will contribute to minimize the risk of promoting harmful messages.  
We will follow ethical and legal practice and all information about the participants will be handled in 
confidence and will remain de-identified until two years after the overall project has ended. In 2022, the de-
identification code will be deleted, thus the material will be kept anonymous for public re-use. Informed 
consent forms are developed according to templates from Regional Committees for Medical and Health 
Research Ethics (REK), Norway and NSD.  
A possible benefit for the participants in the survey is a greater knowledge on the high-endemic diseases of HIV 
/ AIDS, TB and TSCT. A benefit for the control villages will be to receive the digital health intervention in the 
phase II of the DigI project. The protocol has been approved by NSD and the doctoral research fellow is 
applying for ethical approval from the NIMR, before research permit at Tanzania Commission for Science and 
Technology (COSTECH).  
Quality assurance 
The project will be registered in the ClinicalTrials.gov after approval from NSD in Norway and NIMR and in TZ. 
Even if this is not a clinical trial, it is a controlled trail, and registration of all health studies is now 
recommended by the World Medical Association. UiO procedures for quality assurance, the core values when 
planning, carrying out and reporting the research, will be followed. The doctoral research fellow commits to 
following the authority’s regulations, and will adhere to international standards for conducting clinical trials, 
and further make sure that subcontractors and partners are in line with the same regulations. Every person 
who has access to the research material will have to consent to confidentiality. These agreements will be 
developed and uploaded to Helseforsk, which is part of UiOs internal quality assurance and control system. The 
doctoral research fellow together with the supervisor will review the project documents in Helseforsk every six 
months. In order to meet national guidelines for collecting and managing personal sensitive information, 
KoboToolbox and KoboCollect are currently being risk assessed by professor Josef Noll at the ITS. 
Budget 
The study is being funded by DigI (NFR-ID: 267558, UiO-project number: 144497). The budget frame for the 
cluster non-randomized controlled trial in Tanzania is estimated to be 82,3 MTZS. The DigI funding will cover 
the costs for the research staff / enumerators from SUA and transport from NIMR, and the doctoral research 

10 
 
fellow will cover owns costs related to the study with project funding from the position at UiO, in addition to 
funding from the DigI project. Two detailed budgets are to be found in appendix 2 and 3.   
Cooperation institutions/project group 
A detailed list of contributors can be found in appendix 4.   
Potential risks related to the study 
The doctoral research fellow is aware of the potential risks linked to implementation of both the intervention 
and the research. Politically, Tanzania is stable; however, other risks, such as natural disasters, may occur 
everywhere. In this case, the doctoral research fellow will have to adapt, and use the year of data collection 
wisely. In case of major disasters or unforeseen events of great importance, the protocol will have to be 
rewritten. 
 
 
Publications in scientific journals 
The research in the DigI project consists of the described PhD-project in addition to another PhD-project at SUA 
(focusing on porcine cysticercosis), and possibly a post-doc project at SUA. These three projects represent the 
health research component of DigI, and are linked to allow for free information about the intervention diseases 
in the overall project. The results from the WPs will be published in international, scientific, peer-reviewed 
journals. We are aiming at publishing four articles from this study. The doctoral research fellow suggests these 
working titles of articles to be submitted for publication in scientific journals: 
- 
The digital health transition: Converting traditional learning material into a digital format (not first 
author) 
- 
The effect of a digital health intervention in Iringa, Tanzania: The change in health literacy related to 
One-Health diseases, particularly TSCT  
- 
The effect of a digital health intervention in Iringa, Tanzania: The change in health literacy related to 
HIV/AIDS and Tuberculosis 
- 
Experiences from implementing a digital health intervention in Iringa, Tanzania: Semi-structured 
interviews with clients 
 
 

11 
 
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