Table 3. Format of outreach education.

Nine sections of outreach education program	Key messages conveyed	Issues downplayed or emphasized
Signs and symptoms of BU, how to recognize the disease, and the need to treat it early	Visuals of physical signs of BU in different stages Visual and tactile cues suggesting that a lesion, abscess ulcer or edema may be BU Progression of disease if not treated	Category I and II BU depicted, but not category III as this evoked great fear
High risk environments and modes of transmission	High risk environments where one is more likely to be exposed to Mycobacterium ulcerans Focus was on addressing incorrect ideas about BU transmission and contagion	Less time and attention allotted to risk environments and possible modes of transmission as the science is inconclusive and behavior change related to exposure to water sources difficult given the local reality
What clinic staff do to determine if the affliction is BU or some other disease	Why health staff take swabs, what they look for under the microscope, why medicine for BU is specific and not the same as medications used for other ulcers	Step-by-step explanation of what staff is actually doing along with pictures to offset fears and rumors about what they are doing as a means to increase trust
Effective and ineffective treatments for BU	Why 56 days of pills and injections are needed Why herbal medicine for this disease does not lead to a cure even if a wound is dried	Agricultural analogies used to convey the idea that medication is taken beyond treatment for the visible wound, as a means to get at the roots and seeds of BU as a systemic infection in the body Pictures used to show inappropriate treatment, how drying wound is not curing, and effectiveness of medication after herbal medicine has failed to treat the wound
Traditional healers and rapid referral to clinics Emphasis on rapid referral	Positive messages about exemplar healers who recognize signs of BU and rapidly refer patients to clinic after spiritual protection is offered	No message disrespecting local practices as superstitious Respect for traditional healers’ role in offering spiritual protection for those for whom this is a concern
Quality of care at the clinic	Quality of care offered by staff: pictures of what care in the clinic looks like, approachable staff, hygienic conditions, empathetic caretakers, etc.	To offset fear and evoke confidence
Before and after pictures of BU related wounds successfully treated	Pictures of BU treatment, and the healing process at different stages Depict the healing of ulcers on different parts of the body	Pictures depict children and male and female patients of different ages so members of the audience can personally relate
The presentation ends on a note of hope	Testimonials of patients who have been cured speak of their experiences and to the quality of care they have received at the clinic.	Open microphone: some testimonials are planned and others are spontaneous
Questions from the audience	On any topic related to information presented or any other issue related to BU	Open microphone empowers people to speak Questions are recorded and responses to questions assessed as part of iterative process of ongoing research