Challenges and facilitators of public engagement with water, sanitation, hygiene and other environmental health issues in Ghana and Uganda: perspectives of scientists, journalists and the public Uncorrected Proof

Despite many water, sanitation, hygiene (WASH) and other environmental health challenges in sub-Saharan Africa, little is known about interactions involving scientists, journalists and the public to aid public understanding of the relationship between WASH and health. Using purposive sampling, we conducted key informant interviews and focus group discussions with scientists, journalists and members of the public in Ghana and Uganda to identify issues associated with the promotion of public engagement with WASH and environmental health issues. An inductive thematic analysis was used to explore the evidence, challenges and opportunities of public engagement. The effectiveness of public engagement was constrained by poor interaction between scientists and journalists and limited understanding among the public on WASH and other environmental health issues. Challenges identi ﬁ ed included inadequate scientists – journalists collaborations, scientists ’ lack of time, pressure from media organizationsandconcernsaboutjournalists ’ inadequatecapacitytocommunicateenvironmentalissues due to lack of training. Possible solutions included increased interactions, science communication training and using public information of ﬁ cers as knowledge brokers between scientists and journaliststo boostpublicengagementwithWASHandotherenvironmentalhealthissues.Ourstudycontributestothe literature ontheneed toactivelyengage the public with WASH andotherenvironmentalhealth concerns.


INTRODUCTION
Environmental health issues such as water, sanitation and hygiene (WASH) confront sub-Saharan Africa, resulting in avoidable diseases on the continent (World Health Organization ). Unfortunately, sub-Saharan Africa is one of the developing regions that missed the water and sanitation targets proposed in the Millennium Development Goal (World Health Organization ). Greater efforts are needed to attain the Sustainable Development Goals (SDGs) of increasing access to improved water sources for all by 2030 (Cornish ). Such efforts require a multidisciplinary approach (Cornish ), including the active involvement of scientists, science journalists, policymakers and members of the public.
Interactions between scientists and others, such as science journalists, policymakers and members of the public, are important for at least three reasons. First, scientists have a social responsibility to let members of the publictaxpayersand policymakers understand the potential impact of their research through such interactions (Davies ). Second, many journalists with interest in reporting science do not have scientific backgrounds (Appiah et al. ), and thus such interactions could help journalists develop more interest in covering science.
Finally, in part through the public image of scientists as people who are disconnected from society or not 'normal', the gap between scientists and the public is wider (Massarani & Peters ). Scientists' interactions with the public in forms such as media interviews and face-to-face meetings including scientific café could help bridge this gap (Matheson ). While it is the responsibility of journalists to translate scientific terms to the public, scientists should be able to communicate directly with the public (Brownell Price & Steinman ).
The interactions involving scientists, science journalists and members constitute a form of public engagement.
In addressing the effectiveness of public engagement in the context of WASH and other environmental health issues, it is necessary to describe what is meant by 'public engagement'. Some researchers indicate that public engagement has no specific definition and have interchanged it with the term 'public participation' (Bauer & Jensen ).
Others define public engagement as 'any scientific communication that engages an audience outside of academia' (Poliakoff & Webb ,p. 244 The two countries were selected because of the following reasons: (1) Both 'made limited or no progress' on the Millennium Development Goal targeting water and sanitation (World Health Organization ).
(2) Both have made recent discoveries of oil, resulting in the likelihood of environmental issues becoming prominent (Bybee & Johannes ).
(3) A science and technology university in each country was part of a consortium that aimed to tackle water and sani-

Sampling and recruitment
In both Ghana and Uganda, we conducted key informant interviews and focus group discussions (FGDs) with journalists, scientists and members of the public.
The scientists whose views were sought distinguished

Data collection tools and process
Respondents were informed of the voluntary nature of the study. Written informed consent was obtained from all respondents before beginning the interviews and the FGDs.  Table 1). The mix of three diverse groupsscientists, journalists and members of the publicin the FGDs journalists and 10 members of the public participated in the study (Table 1).

Data analysis
An In other words, the quality of a theme is valued more than the frequency of statements that make up the theme (Vaismoradi et al. ).
Two coders with experience in analysing qualitative data used an integrated approach to develop a thematic index from the transcripts. Using Excel spreadsheets, the data were summarized and assigned to three broad themes: evidence of public engagement efforts, challenges of public engagement and facilitators of public engagement.
Similar identified themes were grouped and relationships existing between them were explored. The two coders met several times to resolve discrepancies such as the wrong placement of quotes and themes.

RESULTS
In both countries, themes that resulted from the interviews and the FGDs were about (a) current nature of public engagement, (b) challenges of public engagement and (c) facilitators of public engagement.

Evidence of public engagement
In Ghana, members of the public thought that environmental health issues were reported less in media than other issues. Among the few environmental health topics, journalists covered water and sanitation issues more than other environmental health topics. Limited understanding and curiosity among the public on matters related to environmental health was a potential reason for low coverage of such issues in the media.

Facilitators of public engagement
In Ghana, collaborations among corporate bodies, governments, research institutions and media houses were considered integral to promote public engagement. Respondents mentioned the critical role of government agencies such as information service department in publicizing environmental health issues.
A collaboration suggested was one involving research institutions and the country's information service department.
'Maybe the information service department too can do more … to educate us so if the public health officials carry out a research which would be beneficial to the community I believe the information service department too should be empowered to spread these outcomes. Some findings were specific to the countries. In Uganda, respondents mentioned how members of the public were interested more in short-term rather than long-term WASH

ACKNOWLEDGEMENT
The authors are grateful to the Wellcome Trust for funding the study (WT102039/Z/13/Z). The support given by the AfricanSNOWS (Scientists Networked for Outcomes from Water and Sanitation) consortium is also acknowledged.