Evidence for integrated SBCC programming: Changing multiple behaviors across 6 different health areas in Ethiopia
Summary:
Communication for Health, a five-year integrated social and behavior change (SBCC) project aims to improve health services utilization across multiple health areas in 4 regions of Ethiopia. The project completed cross-sectional surveys with 2770 and 1773 rural women (15-49 years) at baseline (2015) and midline (2019). The results indicate about 63% of the midline respondents were exposed to at least one project interventions. The SBCC intervention included radio, mobile app, maternal health videos, health bazaar, roadshows and print materials. Logistic regression analysis depicted exposure to program interventions significantly increases likelihood of women to test for HIV, Adjusted Odds Ratio (AOR) = 2.27, (95% CI: 2.25-2.29); to deliver in health facility, AOR 1.45, (95% CI: 1.44-1.46); to attend postnatal care services, AOR 1.5, (95% CI: 1.49-1.51); to have high equitable gender norms AOR 1.33, (95% CI: 1.07-1.67); to have proper handwashing station in their house AOR 1.4, (95% CI: 1.02-2.40), compared with unexposed women. Women's health service uptake behaviors show significant improvement (p< .05) from baseline to midline: proportion of women tested for HIV during pregnancy increased from 50% to 58%; health facility delivery 43% to 48%; post-natal care within 7 days 27.9% to 41.2%; bed net use by women (15-49 years), 62.3% to 63.2%; presence of handwashing station in the house 13.2% to 16.8%. Women's gender equitable norms shifted from 17% to 36%. These findings support effectiveness of integrated SBCC programming in initiating changes in multiple interrelated health behaviors.
Background/Objectives:
Johns Hopkins Center for Communication Programs is implementing a 5-years integrated SBCC project in 160 woredas in Ethiopia. The project focuses: maternal, and child health, prevention of mother to child HIV transmission, malaria, nutrition, and sanitation and hygiene. Adopting a strategic approach, logistics regression models were run for 16 baseline health behavioral outcomes. This led to the empirical identification of three gateway behaviors which were significantly associated with 4-5 outcome behaviors. Similarly, gender equity norms were associated with 10 out of 16 behaviors. The gateway behaviors and gender were promoted on a priority basis.
Description of Intervention and/or Methods/Design:
We conducted cross-sectional baseline survey and socio-cultural qualitative studies in 2015/16 and identified behavioral determinants, barriers and facilitators to use health services. Results used to design and implement an integrated SBCC program: radio, video, mobile application and print materials. An independent research agency conducted midterm evaluation in 2019 to assess effectiveness of the interventions. A total of 4543 randomly sampled women in reproductive age were interviewed (2770 at baseline and 1773 midline). Respondents' exposure to project interventions and their knowledge, gender norms and health behaviors were assessed. Gender norms was measured using a 21 item Gender Equity Men (GEM) scale adapted for women. Bivariate and multivariate analysis was done to explore changes in outcome behaviors across baseline, midline, exposed and unexposed groups. Association of the changes between outcome behaviors and program exposure were tested using logistic regression models by controlling effect of main confounding variables (age, education, region).
Results/Lessons Learned:
The result indicates 63% respondents had exposure to at least one project intervention. Baseline-midline comparisons indicate significant improvement (p< .05) on women tested for HIV during their pregnancy 50% to 58%; health facility delivery 43% to 48%; post-natal care within 7 days 27.9% to 41.2%; bed net use by pregnant women 54.9% to 74.5%; handwashing station in the house 13.2% to 16.8%; gender equitable norms 17% to 36% from baseline to midline respectively. Regression analysis depicted women exposed to program intervention were more likely to test for HIV, Adjusted Odds Ratio (AOR) 2.27, (95% CI: 2.25-2.29); to deliver in health facility, AOR 1.45, (95% CI: 1.44-1.46); to attend postnatal care services, AOR 1.5, (95% CI: 1.49-1.51); to have high equitable gender norms, AOR 1.33, (95% CI: 1.07-1.67); to have proper handwashing station in their house AOR 1.4, (95% CI: 1.02-2.40) than unexposed women.
Discussion/Implications for the Field:
The advantages of integration of SBC efforts across health areas is that it provides timely, sustainable health behavior promotion within the health system. Most importantly, we identified common influencing factors across 16 health behaviors and leveraged those to promote multiple behaviors. Gender equity norms were interwoven into every layer of the intervention and we see a shift in these norms and a concomitant change in health behaviors across 4 health areas. The study demonstrates that the way forward towards a sustainable strengthening of government health systems has to include integration of SBC areas.
Abstract submitted by:
Habtamu Tamene - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Nandita Kapadia Kundu - Johns Hopkins Center for Communication Programs (CCP)
Mnyahil Ayele Woldegiorgis - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Tsega Berhan - Johns Hopkins Center for Communication Programs (CCP)
Simon Heliso - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Guda Alemayehu Gebru - USAID
Communication for Health, a five-year integrated social and behavior change (SBCC) project aims to improve health services utilization across multiple health areas in 4 regions of Ethiopia. The project completed cross-sectional surveys with 2770 and 1773 rural women (15-49 years) at baseline (2015) and midline (2019). The results indicate about 63% of the midline respondents were exposed to at least one project interventions. The SBCC intervention included radio, mobile app, maternal health videos, health bazaar, roadshows and print materials. Logistic regression analysis depicted exposure to program interventions significantly increases likelihood of women to test for HIV, Adjusted Odds Ratio (AOR) = 2.27, (95% CI: 2.25-2.29); to deliver in health facility, AOR 1.45, (95% CI: 1.44-1.46); to attend postnatal care services, AOR 1.5, (95% CI: 1.49-1.51); to have high equitable gender norms AOR 1.33, (95% CI: 1.07-1.67); to have proper handwashing station in their house AOR 1.4, (95% CI: 1.02-2.40), compared with unexposed women. Women's health service uptake behaviors show significant improvement (p< .05) from baseline to midline: proportion of women tested for HIV during pregnancy increased from 50% to 58%; health facility delivery 43% to 48%; post-natal care within 7 days 27.9% to 41.2%; bed net use by women (15-49 years), 62.3% to 63.2%; presence of handwashing station in the house 13.2% to 16.8%. Women's gender equitable norms shifted from 17% to 36%. These findings support effectiveness of integrated SBCC programming in initiating changes in multiple interrelated health behaviors.
Background/Objectives:
Johns Hopkins Center for Communication Programs is implementing a 5-years integrated SBCC project in 160 woredas in Ethiopia. The project focuses: maternal, and child health, prevention of mother to child HIV transmission, malaria, nutrition, and sanitation and hygiene. Adopting a strategic approach, logistics regression models were run for 16 baseline health behavioral outcomes. This led to the empirical identification of three gateway behaviors which were significantly associated with 4-5 outcome behaviors. Similarly, gender equity norms were associated with 10 out of 16 behaviors. The gateway behaviors and gender were promoted on a priority basis.
Description of Intervention and/or Methods/Design:
We conducted cross-sectional baseline survey and socio-cultural qualitative studies in 2015/16 and identified behavioral determinants, barriers and facilitators to use health services. Results used to design and implement an integrated SBCC program: radio, video, mobile application and print materials. An independent research agency conducted midterm evaluation in 2019 to assess effectiveness of the interventions. A total of 4543 randomly sampled women in reproductive age were interviewed (2770 at baseline and 1773 midline). Respondents' exposure to project interventions and their knowledge, gender norms and health behaviors were assessed. Gender norms was measured using a 21 item Gender Equity Men (GEM) scale adapted for women. Bivariate and multivariate analysis was done to explore changes in outcome behaviors across baseline, midline, exposed and unexposed groups. Association of the changes between outcome behaviors and program exposure were tested using logistic regression models by controlling effect of main confounding variables (age, education, region).
Results/Lessons Learned:
The result indicates 63% respondents had exposure to at least one project intervention. Baseline-midline comparisons indicate significant improvement (p< .05) on women tested for HIV during their pregnancy 50% to 58%; health facility delivery 43% to 48%; post-natal care within 7 days 27.9% to 41.2%; bed net use by pregnant women 54.9% to 74.5%; handwashing station in the house 13.2% to 16.8%; gender equitable norms 17% to 36% from baseline to midline respectively. Regression analysis depicted women exposed to program intervention were more likely to test for HIV, Adjusted Odds Ratio (AOR) 2.27, (95% CI: 2.25-2.29); to deliver in health facility, AOR 1.45, (95% CI: 1.44-1.46); to attend postnatal care services, AOR 1.5, (95% CI: 1.49-1.51); to have high equitable gender norms, AOR 1.33, (95% CI: 1.07-1.67); to have proper handwashing station in their house AOR 1.4, (95% CI: 1.02-2.40) than unexposed women.
Discussion/Implications for the Field:
The advantages of integration of SBC efforts across health areas is that it provides timely, sustainable health behavior promotion within the health system. Most importantly, we identified common influencing factors across 16 health behaviors and leveraged those to promote multiple behaviors. Gender equity norms were interwoven into every layer of the intervention and we see a shift in these norms and a concomitant change in health behaviors across 4 health areas. The study demonstrates that the way forward towards a sustainable strengthening of government health systems has to include integration of SBC areas.
Abstract submitted by:
Habtamu Tamene - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Nandita Kapadia Kundu - Johns Hopkins Center for Communication Programs (CCP)
Mnyahil Ayele Woldegiorgis - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Tsega Berhan - Johns Hopkins Center for Communication Programs (CCP)
Simon Heliso - Johns Hopkins Center for Communication Programs (CCP) Ethiopia
Guda Alemayehu Gebru - USAID
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: CCP