A cross-sectional survey on the effectiveness of public health campaigns for changing knowledge, attitudes, and practices in Kenyan informal settlements during the COVID-19 pandemic

We performed two surveys at three large informal settlements in Kenya to establish if public health interventions were effective in changing knowledge, attitude and practices (KAPs) of residents during the COVID-19 pandemic. A total of 720 participants were selected for each survey from 120 randomly selected geographical locations (240 participants per settlement per survey). A coordinated health promotion campaign, based on the core principles advocated by the Government of Kenya, was delivered between the two surveys by an experienced international relief agency. Information related to KAPs was collected by trained community health volunteers using a validated bespoke survey tool developed through multi-stakeholder engagement. The main outcomes after the public health campaign showed improvements in: (i) mask wearing; (ii) behaviours and practices in relation to the use of face masks; (iii) attitudes and expectations relating to mask wearing; and (iv) attitudes, knowledge and wider understanding of government directives. Social distancing remained a challenge for many people (approximately 50% of responders) and fears associated with volunteering for COVID-19 testing were resistant to change. Access to COVID-19 testing facilities was limited, leaving a large proportion of people unable to test. As willingness to take a COVID-19 test did not change between surveys, we recommend that greater policy level interventions, aimed at mitigating the consequences of a positive test are needed in parallel. Finally, we observed that the improvement in KAPs observed at the more crowded urban settlement was less than the changes seen at settlements in less crowded rural or semi-urban settings. We conclude that a coordinated public health campaign is effective in changing the KAPs amongst people living amidst challenging socio-economic conditions in informal settlements. However, their ability to respond positively may be limited by several extraneous factors that are unique to each settlement.