INT J TUBERC LUNG DIS 24(1):28–35 Q 2020 The Union http://dx.doi.org/10.5588/ijtld.19.0161 Evaluating the use of educational videos to support the tuberculosis care cascade in remote Madagascar H. Reeves, 1 S. Grandjean Lapierre, 2,3 K. Razafindrina, 2,4 A. Andriamiadanarivo, 2,4 N. Rakotosamimanana, 5 T. Razafindranaivo, 6 T. Seimon, 7 B. Blalock, 8 J. Bello-Bravo, 8 B. Pittendrigh, 8 J. McKinney, 2,4 P. M. Small, 2 A. M. Knoblauch, 2,9 E. Fair 1,10 1 Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, 2 Global Health Institute, Stony Brook University, New York, NY, USA; 3 Centre de Recherche du Centre Hospitalier de l’Universit ´ e de Montr ´ eal, Montr ´ eal, QC, Canada; 4 Centre ValBio, Ifanadiana, 5 Institut Pasteur de Madagascar, Antananarivo, 6 Madagascar National Tuberculosis Control Program, Antananarivo, Madagascar; 7 In Tune for Life, London, UK and Geneva, Switzerland; 8 Michigan State University, East Lansing, MI, USA; 9 Swiss Tropical and Public Health Institute, Basel, Switzerland; 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA SUMMARY SETTING: Access to information about tuberculosis (TB) is vital to ensure timely diagnosis, treatment, and control among vulnerable communities. Improved ap- proaches for distributing health education materials to remote populations are needed. OBJECTIVE: To evaluate the impact of two comprehen- sive video training curricula in improving patient, community member, and community health worker knowledge of TB in a remote area of Madagascar. DESIGN: A pre-test/post-test design was used to mea- sure knowledge acquisition. Educational videos were short, culturally appropriate films presented at critical moments in the TB cascade of care. RESULTS: Of the total 146 participants, 86 (58.9%) improved their score on the post-test, 50 (34.2%) obtained the same score, and 10 (6.8%) received a worse score. A statistically significant difference was observed between the pre- and post-test scores, wherein scores increased by a median of 10.0% (interquartile range 0.0–20.0) after viewing the videos (P , 0.001). There was a significant difference between the number of correct answers on the pre- test and the number of correct answers on the post-test (P , 0.001). CONCLUSION: Educational videos were found to sig- nificantly improve TB knowledge among a low-literacy, remote population in Madagascar. Our findings suggest educational videos could be a powerful, low-cost, and sustainable tool to improve access to TB education materials globally. KEY WORDS: health education; TB case finding; rural health; electronic health; mobile health LIVING IN A REMOTE location is a primary barrier to accessing timely and appropriate healthcare. 1 Accessing tuberculosis (TB) care can prove particu- larly challenging for remote populations due to geographic barriers and lack of infrastructure. 2,3 If TB symptoms are recognized, patients in these settings are often referred to distant health facilities for diagnosis and treatment. 4,5 As a result of the significant distances TB patients must travel, medi- cation adherence and treatment outcomes can suffer. 3 In addition, remote populations are particularly difficult to reach, generally know less about the disease, and have lower levels of literacy. 3 In order to eliminate TB, it is essential for patients who develop the disease to have the necessary knowledge to prevent transmission to others. Furthermore, im- proved access to high-quality TB care for both TB patients and communities will be necessary for elimination. 6 There is sparse systematic research on methods and approaches for TB education in remote, low-literacy populations. Although there are often community health workers (CHWs) available to provide basic healthcare in remote areas, increasing awareness about TB remains a challenge. Innovative technologies present one method for improving TB education across the cascade of care in these hard to reach areas. 7 Over the last two decades, rapid advances in health technology have increased access to healthcare for millions across the world. Information and communication technologies are used extensively to assist in the growth of electronic health (eHealth) and telemedicine. With two thirds of Correspondence to: Elizabeth Fair, University of California, San Francisco, Division of Pulmonary and Critical Care Medicine, Department of Medicine, 1001 Potrero Avenue, Room 5K1, San Francisco, CA 94110, USA. e-mail: Elizabeth. Fair@ucsf.edu Article submitted 7 March 2019. Final version accepted 15 June 2019.