{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T01:35:01Z","timestamp":1783560901194,"version":"3.55.0"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Global Health Alliance of Western Australia"},{"name":"the research training scheme of the Australian Government"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Rural and remote communities often face significant challenges maintaining their health and well-being. In developing countries, these challenges are further compounded by (1) limited access to clean water, (2) ineffective sanitation, (3) low education and literacy levels and (4) low awareness of the role of personal hygiene practices in reducing communicable disease transmission. Existing health education materials distributed within such communities are often presented in a traditional written format, making them inaccessible to people with low literacy levels. Therefore, recent evidence supports an alternative health communication approach through the use of picture-based materials. This study has assessed the effectiveness of a cartoon-based pictorial educational tool (CBPET) in communicating key messages about hygiene and bacteria contained within the environment and bodily fluids. The CBPET that was developed was tested in a Tanzanian village, representative of a community with low literacy and a resource-poor setting. The CBPET was found to effectively deliver key health promotion messages to the local community. Developing healthcare education in a universal language format based on pictures or cartoons could be the way forward.<\/jats:p>","DOI":"10.3390\/ijerph22040516","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T13:36:49Z","timestamp":1743169009000},"page":"516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Replacing Text with Pictures for Multi-Lingual Health Education: Meeting the Needs of a Community with Low Literacy in Tanzania"],"prefix":"10.3390","volume":"22","author":[{"given":"Jeremy C.","family":"Barrett","sequence":"first","affiliation":[{"name":"Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0625-4330","authenticated-orcid":false,"given":"Jaya A. 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