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Effect of digital behavior change intervention on malaria prevention practices in selected local government areas in Lagos State, Nigeria

This quasi-experimental study demonstrates that a six-week, theory-driven digital behavior change intervention delivered via WhatsApp and SMS significantly and sustainably improved malaria knowledge, risk perception, and preventive practices among adults in Lagos State, Nigeria.

Original authors: Bernard Ifeanyi Muoneme, Adelere Ezekiel Adeniran, Abdulaziz Abubakar Rasheed

Published 2026-06-30

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Bernard Ifeanyi Muoneme, Adelere Ezekiel Adeniran, Abdulaziz Abubakar Rasheed

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you are trying to teach a crowded city how to avoid a sneaky, invisible enemy: Malaria. For years, health officials have tried to hand out nets and give speeches, but the enemy keeps winning. This study asks a simple question: What if we used the phones everyone already carries to fight back?

Here is the story of that battle, told simply.

The Setup: Two Neighborhoods, One Experiment

The researchers picked two busy neighborhoods in Lagos, Nigeria (Alimosho and Oshodi-Isolo). Think of them as twin cities with similar populations, income levels, and access to doctors.

The "Test" Team (Alimosho): This group got a special six-week digital training course.
The "Control" Team (Oshodi-Isolo): This group got nothing special—just the usual health info available at their local clinic.

Before the experiment started, both groups were checked. They knew about as much about malaria as the average person, they felt about as worried about it, and they were about as good at preventing it. They were a perfect match.

The Weapon: A Digital "Health Coach"

The "Test" team didn't get a textbook; they got a digital coach delivered through their phones. This coach was built on a famous psychological rulebook called the Health Belief Model. Think of this model as a recipe for changing habits:

Make them feel the danger: "This isn't just a story; it could happen to you."
Show them the solution: "Here is exactly what to do."
Remove the excuses: "It's easier than you think."

How the coach spoke:

WhatsApp Broadcasts: Like a personal newsletter sent directly to their phones, not in a noisy group chat.
Automated SMS: Short text reminders, like a nudge from a friend.
Weekly Webinars: Live online meetings where people could ask questions and clear up confusion.

The content covered everything from how mosquitoes breed to how to sleep under nets and when to see a doctor.

The Results: A Digital Transformation

After six weeks, and again ten weeks later, the researchers checked the scorecards. The results were like watching a student go from failing a class to acing it.

1. Knowledge (The "What"):

Before: The average person knew about 10 out of 18 facts about malaria.
After: The score jumped to 16 out of 18.
The Metaphor: It's like going from knowing the rules of a game vaguely to being a pro player. Even better, their knowledge kept growing after the six weeks ended, as if the lessons were finally "clicking" in their brains.

2. Risk Perception (The "Worry"):

Before: People knew malaria was bad, but they didn't feel it was a personal threat. Their "worry score" was moderate.
After: Their worry score skyrocketed to near-perfect levels.
The Metaphor: Before, they thought, "Malaria is a problem for someone else." After the digital coach, they thought, "Malaria is a problem for me, and I need to act." This was the biggest change of all.

3. Preventive Practices (The "Action"):

Before: Even though they knew malaria was bad, they weren't doing much about it. Their "action score" was mediocre.
After: Their action score jumped significantly. They started using nets, cleaning up standing water, and seeking help faster.
The Metaphor: This is the moment the student stops just reading the book and actually playing the game. The fear turned into real movement.

The "Control" Group:
The group that didn't get the digital coach? They stayed exactly the same. Their scores didn't budge. This proves the changes weren't just because time passed or because the weather changed; it was the phone messages that did the work.

Why This Matters (According to the Paper)

The paper claims that using simple, free tools like WhatsApp and SMS is a powerful way to change behavior.

It sticks: The changes didn't fade away after the six weeks; they got stronger.
It levels the playing field: Even people who didn't know much at the start caught up quickly.
It works in the city: In a place like Lagos, where almost everyone has a phone, this is a scalable way to fight disease.

The Bottom Line

The study concludes that you don't need expensive new technology to fight malaria. You just need to use the phones people already have to deliver a smart, well-organized message. By turning a general awareness of danger into a personal feeling of risk, and then showing people exactly how to protect themselves, a simple digital campaign can turn a city's health habits around.

Note: The paper strictly limits its claims to these six weeks of intervention and the ten-week follow-up. It does not claim this works for rural villages with no internet, nor does it claim to have measured long-term habits over a year or more. It simply says: In these two Lagos neighborhoods, the digital coach worked, and the changes lasted.

Technical Summary: Effect of Digital Behavior Change Intervention on Malaria Prevention Practices in Lagos State, Nigeria

Problem Statement
Despite high mobile phone penetration in Nigeria (over 220 million active subscriptions) and the availability of digital platforms, malaria remains a critical public health burden, accounting for approximately 26% of global cases and 31% of global deaths. While digital behavior change interventions (DBCIs) have shown promise in other health domains (e.g., HIV, maternal health), there is limited empirical evidence regarding their effectiveness in improving malaria prevention practices at the community level in Nigeria. Existing programs largely rely on conventional approaches, leaving a gap in understanding how digital strategies influence knowledge, risk perception, and preventive behaviors among urban residents.

Methodology
The study employed a quasi-experimental design with intervention and control groups, utilizing a pre-test, post-test, and follow-up approach.

Setting and Participants: The study was conducted in two Local Government Areas (LGAs) in Lagos State: Alimosho (intervention) and Oshodi-Isolo (control). These sites were selected for their comparability in population density, socioeconomic profile, healthcare access, and mobile penetration. The final analytical sample consisted of 219 adults (110 in the intervention group, 109 in the control group) recruited from Primary Healthcare Centres (PHCs).
Intervention: The intervention group received a six-week, theory-driven DBCI grounded in the Health Belief Model (HBM). The intervention constructs included perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Content was delivered via:
- WhatsApp broadcast messages.
- Automated Short Message Service (SMS).
- Weekly interactive webinars.
- Content included educational messages, reminders for insecticide-treated net (ITN) use, environmental sanitation tips, and motivational health promotion.
- The control group received routine health information available at PHCs without exposure to the DBCI.
Data Collection: Assessments were conducted at three time points: baseline (pre-intervention), immediate post-intervention (6 weeks), and a 10-week follow-up. Data were collected using a structured questionnaire measuring malaria knowledge, risk perception, and preventive practices.
Analysis: Statistical analysis was performed using SPSS version 26. The primary analysis method was repeated measures ANOVA with Greenhouse-Geisser correction to account for sphericity violations, followed by Bonferroni-adjusted pairwise comparisons. A Time × Group interaction term was examined to distinguish outcome trajectories between groups.

Key Results
The study found statistically significant improvements across all outcome variables in the intervention group, with no meaningful changes observed in the control group.

Malaria Knowledge: Scores increased significantly from a baseline mean of 10.20 (SD = 5.08) to 16.09 (SD = 1.36) at the 10-week follow-up ( $F(1.066, 116.235) = 107.631, p < .001$ ). The effect size was large (partial $\eta^2 = .497$ ). Notably, knowledge scores continued to improve significantly between the immediate post-intervention and follow-up periods.
Risk Perception: Scores rose from 72.16 (SD = 13.31) at baseline to 90.59 (SD = 3.41) at follow-up ( $F(1.302, 141.971) = 150.858, p < .001$ ). This outcome yielded the largest effect size among the three variables (partial $\eta^2 = .581$ ).
Preventive Practices: Scores improved from 19.62 (SD = 6.60) to 25.52 (SD = 2.78) ( $F(1.104, 120.340) = 63.696, p < .001$ ), with a medium-to-large effect size (partial $\eta^2 = .369$ ).
Sustainability: All outcomes demonstrated sustained and progressive improvement beyond the immediate post-intervention period, indicating that behavioral changes were consolidating rather than regressing.
Retention: The study achieved a high retention rate of 96.5% (219 of 227 baseline participants), minimizing attrition bias.

Significance and Claims
The paper claims that a low-cost, scalable, theory-driven digital intervention can produce large, sustained improvements in malaria knowledge, risk perception, and preventive practices among urban adults in Nigeria. Key contributions and claims include:

Evidence of Efficacy: The study provides empirical evidence that DBCIs delivered via WhatsApp, SMS, and webinars are effective in a Nigerian urban context, addressing a gap in community-level malaria prevention literature.
Theoretical Validation: Grounding the intervention in the Health Belief Model allowed for the successful translation of general disease awareness into personally felt risk and subsequent protective action, overcoming the "knowledge-perception-practice gap" observed at baseline.
Sustainability: The progressive improvement observed at the 10-week follow-up suggests that multi-channel digital delivery can foster habitual behavior change, outperforming single-message or briefer approaches.
Policy Implications: The findings support the integration of mobile health (mHealth) strategies into routine malaria control programs in Nigeria and sub-Saharan Africa. The authors recommend that public health practitioners prioritize theory-driven content and utilize WhatsApp broadcast lists to preserve privacy and reduce misinformation.
Equity: The intervention acted as a "health literacy equalizer," benefiting participants regardless of their baseline knowledge levels, as content delivery was not conditioned on individual motivation to seek information.

The authors acknowledge limitations, including the quasi-experimental design (lack of random assignment), the restriction to urban LGAs (limiting generalizability to rural areas), and the 10-week follow-up duration (insufficient to determine long-term habit formation beyond 3 months). However, the study concludes that with appropriate adaptation and policy integration, such interventions represent a viable component of Nigeria's malaria control strategy.