https://orcid.org/0009-0009-7867-6565
Figures
Abstract
Background
Health communication materials (HCMs) are widely used to support health education and promotion activities in clinical and community settings. However, evidence regarding their use by healthcare providers in low- and middle-income countries (LMICs) remains inconsistent. This scoping review aims to systematically map and describe the existing literature on the utilization of health communication materials by healthcare providers in low- and middle-income countries (LMICs).
Methods
This scoping review was conducted in accordance with the PRISMA-ScR reporting guideline and the Joanna Briggs Institute (JBI) framework for scoping reviews. The studies were searched from database inception to September 2025 using electronic databases (PubMed, ScienceDirect, Cochrane, and Hinari) were searched, and studies were selected based on predefined inclusion and exclusion criteria aligned with the Population–Concept–Context framework. Data extraction was performed using a standardized form, and findings were narratively synthesized spreadsheet by two independent reviewers. Findings were synthesized using descriptive numerical analysis and thematic analysis.
Result
A total of 728 records were identified. 715 were screened after removing duplicates. Following title/abstract and full-text review, 18 studies were included. HCMs, including printed, audiovisual, and electronic tools, were covered in these studies. NGO support, perceived utility, and material accessibility were facilitators, while organizational limitations, patient disengagement, limited availability, and inadequate training were major obstacles.
Conclusion
The use of health communication materials by healthcare providers in LMICs is influenced by contextual, institutional, and individual factors. While HCMs are widely available in many settings, their use remains inconsistent and is influenced by systemic challenges. Strengthening accessibility, provider training, culturally appropriate content, and integration into routine care may support improved implementation.
Citation: Yirsaw AN, Lakew G, Nigusie A (2026) Use of health communication materials by health-care providers for health education in low- and middle-income countries: A scoping review. PLoS One 21(4): e0347576. https://doi.org/10.1371/journal.pone.0347576
Editor: Pracheth Raghuveer, National Institute of Mental Health and Neurosciences: National Institute of Mental Health and Neuro Sciences, INDIA
Received: August 25, 2025; Accepted: April 3, 2026; Published: April 23, 2026
Copyright: © 2026 Yirsaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data included in a scoping review are available in the main manuscript and in the supporting file.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Low- and middle-income countries (LMICs) face the significant challenge of managing both communicable and non-communicable diseases simultaneously [1–3]. A substantial portion of this health burden stems from behavioral factors that cannot be fully addressed through medical interventions alone, emphasizing the critical need for effective health communication and education among healthcare providers at the individual, group, and community levels [4,5]. Health education is recognized as an essential element of primary health care and is pivotal in achieving the goal of “health for all.” It plays a crucial role in enhancing the quality of care at a reduced cost, promoting preventive behaviors, encouraging proactive health measures, and improving self-care practices [6–8].
Despite recognition of its importance, LMICs face barriers including limited access to well-designed educational materials, inadequate training for providers, and low health literacy among patients. Studies indicate that 40–80% of medical information provided is quickly forgotten [9], and a significant portion of what patients do remember is often inaccurate [10]. Health communication materials (HCMs) such as printed resources (posters, leaflets, flipcharts), audio tools (radio, mobile apps), and audiovisual aids (TV, videos, social media) enhance knowledge retention, reinforce key messages, and support behavior change [7,10,11]. However, current health education practices in LMICs often suffer from inadequate distribution, lack of culturally appropriate materials, and insufficient integration into routine healthcare services [12–15]. Although some studies show that HCMs can improve health literacy and patient outcomes, there is still limited evidence on how healthcare providers in LMICs actually use these materials in their daily practice. Most existing research focuses on patient outcomes or broad health promotion strategies, leaving an important knowledge gap regarding provider-level use.
Well-designed and accessible health communication materials may support patients’ understanding, help reduce misinformation, and have been reported to strengthen patient-provider interactions. For instance, research shows that giving patients written information after a consultation may increase how much they remember by up to 50% [14]. Consistent use of these materials in everyday practice may facilitate patient engagement, support preventive behaviors, and contribute to strengthening health systems, as reported in some studies [8,16].
This scoping review aims to systematically explore how healthcare providers in low- and middle-income countries (LMICs) use health communication materials (HCMs) for health education. The primary question focuses on utilization patterns, while secondary questions examine types of materials, health areas addressed, and barriers and enablers. there fore this scoping review study is exploratory and does not test causal hypotheses.
Method
Literature search and search methods
This scoping review aimed to identify and synthesize existing evidence to provide a comprehensive overview of the current knowledge on the use of health communication materials by Health-Care Providers for Health Education. The scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines (S1 File), and adhered to the Joanna Briggs Institute (JBI) scoping review framework [17,18]. A thorough search was conducted across several electronic databases, including PubMed, ScienceDirect, Cochrane Library, and HINARI databases, covering both published and unpublished (grey) literature. Additionally, grey literature was searched using Google Scholar and general web searches through Google.
Searches were conducted from database inception to September 2025. Controlled vocabulary terms (e.g., MeSH terms in PubMed) and free-text keywords were combined using Boolean operators (“AND” and “OR”) to ensure comprehensive retrieval of relevant studies (S2 File). To further uncover relevant literature, references of included studies were manually searched, along with targeted searches on websites like the pubmed focused on health communication materials used by healthcare providers.
Screening abstracts
Two independent reviewers screened titles and abstracts. Full texts of potentially eligible studies were assessed independently. Disagreements were resolved through discussion or consultation with a third reviewer.
Scoping review research question
Using the Population–Concept–Context (PCC) framework recommended by the Joanna Briggs Institute, this review addressed the following:
Primary question:
- How are health communication materials used by healthcare providers to deliver health education in low- and middle-income countries?
Secondary questions:
- What types of health communication materials are utilized?
- In which health areas and service contexts are these materials implemented?
- What enablers influence their use?
- What barriers influence their use?
This review employed the PCC format to ensure that the study selection was aligned with these research questions. Eligibility of studies according to the participant, concept, and context (PCC) framework.
Study selection criteria
Inclusion and exclusion criteria for the scoping review.
Inclusion criteria.
- •. Restricted to studies Published in English.
- •. Studies published Database inception to September 2025.
- •. Countries were classified as low- and middle-income according to the World Bank income classification at the time of study publication.
- •. This scoping review included observational (cross-sectional, case control, cohort and observational follow up), qualitative, and mixed-methods studies) that documented how healthcare providers in low- and middle-income countries used health communication materials for health education.
Exclusion criteria
- •. Studies for which a full-text article could not be obtained (i.e., studies with no full-text were excluded after repeatedly contacting the authors) and non-primary research (e.g., review articles, conference and abstract)
Operational definition
Health Communication Materials are defined as structured printed, audio, or audiovisual resources designed to provide health education to patients or communities. This definition encompasses printed materials (posters, leaflets, brochures, flipcharts), audio tools (radio programs, mobile messages), and audiovisual resources (videos, TV programs, digital apps). The operational definition of health communication materials was adapted from previous health communication literature [19,20].
Variables were extracted as reported in primary studies; no additional cut-offs or composite indices were imposed. We acknowledge that reliance on self-reported data may introduce recall bias and misclassification.
Data extraction and management
A standardized spreadsheet was employed for data extraction, capturing study characteristics including title, author name, publication year, country, study method/design, participants, types of interventions, outcomes, and the health communication materials used. Two individuals (ANY and AN) independently extracted the data. The level of agreement between the reviewers was assessed using Cohen’s kappa coefficient [21]. The two authors resolved any disagreements through discussion, and if disagreements persisted, they consulted a third person (GL). Study characteristics, variable definitions, and measurement approaches were extracted exactly as reported in primary studies. All results are presented consistently in text, tables, and supplementary materials. This approach follows PRISMA-ScR guidelines to maximize transparency and reproducibility.
Data on variable definitions, measurement approaches, and categorization methods were extracted as reported in the original studies. This review did not impose additional classifications or cut-off values beyond those used by the primary studies.
Data analysis and quality appraisal
Two complementary analytical approaches were used for presenting the findings [18]. First, a basic numerical analysis was conducted to assess the extent and distribution of the included studies. This analysis covered various aspects, including the geographical distribution of study settings, urban or rural contexts, types of publications, and the types of health education materials used, with the results displayed in tables and graphs. Second, the study findings from the existing literature were presented using thematic analysis. The narrative literature review was then organized around the themes derived from the study results. Themes were generated inductively from the extracted data and refined through iterative discussion among the review team [22–25].
Consistent with scoping review methodology, no inferential statistical analyses, subgroup analyses, or interaction tests were performed. Findings are summarized using descriptive statistics and thematic analysis. This approach ensures that all analyses are exploratory and aligned with the objectives of mapping evidence rather than testing hypotheses.
Result
Database searching turned up a total of 728 records. 715 records were left for title and abstract review after 13 duplicate records were eliminated prior to screening. Following screening, 40 records remained for full-text evaluation, after 407 records were excluded based on title and abstract, and 268 were excluded because the full text was unavailable.twenty two of the 40 reports were disqualified since they did not fit the requirements for inclusion in the category of health
Communication materias used by healthcare professionals. Ultimately, this scoping review included 18 studies that met the inclusion criteria (Fig 1).
Characteristics of included studies
A total of 18 studies met the inclusion criteria, encompassing 7 countries, with half conducted in Ethiopia. Study designs included observational (cross-sectional [8], case control (n = 1), cohort (n = 1) and observational follow up (n = 1)), mixed-methods (n = 6), and qualitative (n = 1) studies (Table 1) (Table 2).
The key insights drawn from these 18 articles are summarized and analyzed below.
Themes in the studies
The review identified four primary themes that were commonly addressed: the types of HCMs used, the health areas targeted by these materials, and the barriers and enablers influencing their use.
1. Use of health communication materials.
This scoping review highlights that while health communication materials, including printed items like posters, leaflets, and flipcharts, as well as audio and audiovisual tools such as television, radio, mobile apps, and YouTube videos, are available, they are not widely utilized by healthcare providers in low- and middle-income countries.
2. Health areas addressed by health communication materials.
In this scoping review, the health communication materials and healthcare provider interventions in low- and middle-income countries specifically address a range of critical health areas. These include hypertension, tuberculosis (TB), human immunodeficiency virus (HIV)/acquired imsmunodeficiency syndrome (AIDS), child health, maternal health service delivery, cardiovascular disease, and glaucoma prevention. Additionally, they focus on hemorrhage prevention and treatment, risk communication and community engagement during COVID-19, and family planning service utilization. These efforts also encompass broader health campaigns and related topics, all aimed at improving public awareness, prevention, and management of these health conditions. Such initiatives are vital for promoting overall public health and ensuring better health outcomes for communities.
3. Enablers of the use of HCMs by health care providers.
3.1 Availability of HCMs. Some Health facilities in low- and middle-income countries commonly have a variety of HCMs available. These include printed educational materials such as posters, flipcharts, brochures, leaflets, cards, and charts, as well as audio resources like phone-based messages, mass media (TV), and other electronic devices like the internet.
3.2 Culture and programs of distribution and use of HCMs. There is a well-established practice of distributing printed HCMs both within and outside health facilities to convey health-related messages. Posters and flipcharts on topics like antenatal care, EPI, TB, and HIV prevention and control are regularly utilized to enhance health education. Additionally, health issues are frequently addressed on TV channels, with scheduled programs that focus on national health priorities, where health experts are assigned to discuss these critical topics.
3.3 Perceived usefulness of HCMs by health care providers. The findings indicated that healthcare providers’ perceptions significantly impact the utilization of health learning materials. Most respondents emphasized that these materials are crucial for delivering health information, enhancing health service utilization, reducing medical errors, serving as guidelines, and accessing updated information.
3.4 Support from a Non-Government Organization. The use of printed HCMs, as well as audio and audiovisual educational resources, was significantly boosted by strong support from non-governmental organizations.
4. Barriers to the use of HCMs by healthcare providers.
4.1 HCMs related barriers. The studies reviewed highlighted several barriers related to health communication materials, including language barriers, the lack of appropriate health learning materials, and challenges with accessibility and availability, all of which significantly hinder their use.
4.2 Patient-related barriers. A lack of interest among patients in engaging with HCMs was identified as a major barrier.
4.3 Healthcare provider-related Barriers. Barriers related to healthcare providers included work overload, insufficient knowledge and skills, inadequate training in the use of health communication materials, and negative attitudes toward these materials.
4.4 Government-related barriers. A lack of government attention and concern for health education communication materials was identified as a significant barrier.
Discussion
This scoping review found that several included studies reported positive outcomes associated with the use of health communication materials, including improved service delivery and patient engagement. However, due to the predominance of descriptive and heterogeneous study designs, causal conclusions regarding effectiveness cannot be drawn. HCMs have been described as playing an important role in maternal health, as well as in the prevention and treatment of communicable and non-communicable diseases. The successful use of these materials is often influenced by contextual and systemic factors rather than proven intervention effects. Key factors such as the development of evidence-based health policies, access to reliable internet, mobile networks, and electricity, and the production and distribution of printed materials were reported in some studies as potentially relevant, but these observations are hypotheses and not confirmed causal mechanisms [26,27]. As a scoping review, this study maps the available evidence and identifies knowledge gaps rather than evaluating intervention effectiveness.
Although several included studies reported positive outcomes related to the use of health communication materials, these findings should be interpreted with caution. Most of the included studies were cross-sectional in design, which means they can only show associations, not cause-and-effect relationships. Therefore, any suggested mechanisms or potential benefits should be viewed as preliminary insights that warrant further investigation, rather than as confirmed effects
The review suggests that the use of HCMs by healthcare providers in LMICs for addressing health issues is relatively low [28–30], although it has been gradually increasing. The literature reviewed spans from database inception to September 2025, with a significant concentration of studies published between 2020 and 2022, likely driven by the COVID-19 pandemic and ongoing challenges like TB, TB/HIV co-infection, and HIV/AIDS in LMICs. Moreover, there has been a noticeable rise in studies addressing non-communicable chronic diseases. These trends describe the existing evidence but do not imply causal effects of HCMs on outcomes.
The patterns found in our LMIC-focused review appear to be universal when compared to other global reviews. For example, evaluations of mHealth behavior change communication interventions in developing nations have revealed conflicting data regarding the efficacy of these interventions, with numerous studies exhibiting inconsistent effects on behavior change outcomes and lacking thorough evaluation. When studies differ greatly in terms of design and methodological rigor, it can be difficult to determine the efficacy of health communication materials [31].
These findings can be further interpreted by incorporating well-established theoretical frameworks of behavior modification and health communication. Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy are factors that influence people’s engagement with health information and subsequent behavior change, according to the Health Belief Model (HBM), which is widely used to design and understand health behavior interventions. This can help explain why patients frequently prioritize receiving immediate clinical care over educational materials [32]. Adistionally The Diffusion of Innovations Theory posits that adoption of new tools depends on perceived advantage, compatibility, complexity, trialability, and observability, which may explain limited use of HCMs when materials do not fit existing workflows or lack support [33].
Most of the research has focused on African and Asian countries, and while the presence of research in this field is growing, much of it has been non-experimental and descriptive. Notably, Ethiopia was the site of a sizable percentage of the included studies. Rather than selection bias, this concentration represents the current distribution of published evidence. Given that half of the included studies were conducted in Ethiopia, findings may disproportionately reflect health system and policy contexts specific to that setting. The greater amount of research in this field may be partially explained by Ethiopia’s robust health extension programs and extensive primary healthcare system, which actively incorporate health communication techniques. Although Ethiopia and many other low-income nations have structural and resource-related similarities, the implementation and use of HCMs may be impacted by contextual variations in the infrastructure, cultural norms, and policy environments of the various LMICs.
HCMs in LMICs are predominantly produced by governmental and non-governmental organizations, targeting all populations, particularly high-risk communities. These materials have been especially useful in managing outbreaks, crises, disasters, and the prevention of communicable and non-communicable diseases.
Although the evidence base on the use of health communication materials is expanding, it remains somewhat limited. The most commonly studied outcomes include increased uptake of maternal health services, such as family planning, post-partum hemorrhage prevention and treatment, antenatal care (ANC), postnatal care (PNC), and facility-based deliveries. Several studies reported favorable outcomes associated with HCM use, although variability in methodological rigor limits definitive conclusions regarding effectiveness [34–37].
This review summarizes reported outcomes related to infectious diseases such as HIV/AIDS and TB; however, the strength of evidence varies across studies [38–40]. While further research is needed to strengthen the evidence base for other health-related outcomes, there should be an increased focus on evaluating the effectiveness of interventions that address multiple health practices [41,42].
The review identifies several barriers to the accessibility and availability of health communication materials, including inadequate infrastructure, insufficient funding, logistical challenges in distribution, and a lack of training for healthcare professionals on using these materials. These obstacles contribute to the limited use of health communication strategies in healthcare settings [27,43,44]. Previous studies have shown that healthcare providers often deprioritize behavior change communication due to a lack of refresher training and the need to focus on acute diseases. Similarly, studies conducted in Texas found that heavy job burdens were the main reason for inadequate health promotion practices [45].
Language barriers and the lack of suitable materials also contribute to the underutilization of these resources. This suggests that the absence of appropriately tailored materials for various outpatient departments (OPDs) and wards, along with the lack of printed materials in local languages, are key factors limiting their use by healthcare professionals. These findings align with studies conducted in other regions [46–48]. An additional barrier identified is the lack of patient interest in engaging with printed, audio, and audiovisual materials. The findings indicate that clients visiting health facilities are primarily focused on receiving medical care and show little interest in health education or health-related television programs. This lack of interest is consistent with findings from previous studies [45,49]. Comparative global evidence suggests that multifaceted communication strategies that combine community engagement, tailored messaging, and supportive systems tend to be more effective than single‑channel approaches, emphasizing the need for integrated communication frameworks in future health education interventions globally.
Implications of this scoping review
The findings of this scoping review offer important insights for healthcare organizations, professionals, researchers, and the general public interested in enhancing the use of HCMs in LMICs. Although the existing body of literature on this topic is somewhat limited. however, most of the studies are descriptive in nature. HCMs can contribute to improved public health by supporting disease surveillance, mass communication, health education, knowledge translation, and collaboration among healthcare providers. However, concerns about the quality of information and the risk of misinformation present challenges to their use. Poorly communicated or incorrect information could lead to harmful health behaviors and negative outcomes for consumers. To address these challenges, it is crucial to promote the use of credible HCMs and to educate the public on the responsible use of social media to minimize the spread of misinformation. Furthermore, the rapid advancements observed in the use of HCMs in LMICs could provide valuable lessons, potentially leading to similar progress in other health-related areas or sectors such as education.
Limitations
This review has several limitations. We included only studies published in English, which may have excluded relevant evidence in other languages. Focusing solely on LMICs limits the applicability of findings to high-income settings.
The included studies varied widely in design, quality, and outcome measurement, limiting direct comparability and introducing residual and unmeasured confounding. Factors such as provider experience, patient socio-economic status, facility resources, or health literacy may have influenced outcomes but were not consistently reported or controlled for. Additionally, many studies relied on self-reported data, which may be affected by recall bias, social desirability bias, and inconsistencies in measurement across settings, leading to potential information bias.
While we examined both printed and digital materials, differences in access to technology such as internet connectivity, mobile phone availability, and electricity could not be fully accounted for publication bias is possible, as negative or inconclusive studies may not have been published or captured, despite searching grey literature. Excluding review articles to avoid duplication may have limited our ability to capture broader implementation barriers often reported in systematic reviews.
Most studies were descriptive and non-experimental, restricting causal inference. As is common in scoping reviews, no formal quality appraisal was conducted, limiting the ability to judge evidence strength and calling for cautious interpretation.
Some primary studies may not have fully accounted for potential confounding factors, which could influence the observed associations. Another important limitation is that a large proportion of the included studies were conducted in Ethiopia, which may limit the applicability of the findings to other low- and middle-income countries. Differences in healthcare systems, provider training, resource availability, and health literacy across settings may affect how health communication materials are used and implemented.
The efficacy of HCMs cannot be fully interpreted because this scoping review did not include a formal critical appraisal of the studies. Rather than assessing study quality, the goal was to map and compile the available evidence. The results may therefore be influenced by differences in study design, reporting, and methodological rigor. Future systematic reviews that include quality appraisal are needed to provide stronger evidence.
The findings of this review should also be considered in light of differences in definitions and measurement approaches across studies, which made direct comparison more difficult.
Conclusion
This scoping review mapped the current evidence on the use of HCMs by healthcare providers in LMICs. The results show that while different types of materials are accessible and utilized across multiple health areas, their use is influenced by contextual and systemic challenges. Barriers include limited access, inadequate training, language constraints, and organizational factors. Although some studies report positive outcomes associated with HCM use, this review does not establish causal effectiveness. Strengthening implementation strategies, improving accessibility, and investing in provider training may enhance the integration of HCMs into routine healthcare delivery.
Recommendation
Short-term (Facility-level)
- Ensure availability and accessibility of HCMs (printed, audio, and audiovisual) at points of care.
- Integrate interactive elements into HCM use during patient consultations to improve engagement.
- Promote the use HCMs within health facilities to support timely access to health education materials.
Medium-term (Training & guideline updates)
- Provide comprehensive training for healthcare providers on HCM use, and risk communication strategies.
- Update national and facility-level guidelines to integrate standardized health communication practices.
- Enhance cultural relevance and context-specific adaptation of materials to better meet patient needs.
Long-term (Policy & Systems Strengthening)
- Strengthen national policies and career structures to support health education and promotion.
- Foster coordinated collaboration between federal/regional authorities, NGOs, and health facilities for the production, distribution, and monitoring of HCMs materials.
- Invest in sustainable health communication systems, including digital infrastructure, consistent funding, and evaluation mechanisms to monitor effectiveness and impact.
Supporting information
S2 File. Searching stratagey of included studies.
https://doi.org/10.1371/journal.pone.0347576.s002
(DOCX)
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