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C-Channel Issue 4

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Depending on your geographical location, visit Developing World or Industrialized World.
C-Channel header  December 2008

Dear Colleagues,

C-Channel is the e-newsletter from the C-Change program that features articles from the peer-reviewed literature about behavior change communication (BCC) and social change in the health sector. Readers in the developing world have access to the full content of articles in many cases. This issue features three articles on HIV and AIDS, two on family planning, two on malaria prevention, and two about behavior change in the broader health arena. The HIV and AIDS articles include an examination of wealth and sexual behavior among Cameroonian men; an assessment of the differences in the efficacy of various HIV prevention interventions among Latin Americans based on education, gender and nationality; and a look at consistent condom use and partner type among men in western Kenya. The family planning articles explore use of birth control methods to postpone pregnancy that is different than spacing; and a study in Brazil of male involvement in couple’s contraceptive options. The malaria articles describe the development of a BCC strategy to support treatment of malaria in infants in Tanzania and progress toward ownership and use of nets to combat malaria in four African countries. One of the final two articles looks at how to increase health care use by male adolescents and the other describes a CDC project that offers tools to assist local creative developers incorporate BCC messages into the storylines of serial dramas and soap operas for TV and radio.

We welcome your feedback and ideas that can be sent to c-channel@healthnet.org.

Thank you,
The Knowledge Management Team at C-Change


To view archived issues, visit http://c-changeprogram.org/c-channel


 

HIV/AIDS

1. Wealth and sexual behaviour among men in Cameroon

2. Effects of HIV-prevention interventions for samples with higher and lower percents of Latinos and Latin Americans: A meta-analysis of change in condom use and knowledge

3. Determinants of consistent condom use vary by partner type among young men in Kisumu, Kenya: A multi-level data analysis
 

FAMILY PLANNING/REPRODUCTIVE HEALTH

4. On postponement and birth intervals

5. Contraceptive methods with male participation: a perspective of Brazilian couples
 

MALARIA

6. Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania

7. Gains in awareness, ownership and use of insecticide-treated nets in Nigeria, Senegal, Uganda and Zambia
 

COMMUNICATION AND BEHAVIOR CHANGE

8. Masculine beliefs, parental communication, and male adolescents' health care use

9. Applying behavioral science to behavior change communication: The Pathways to Change tools
 


HIV/AIDS

1. Wealth and sexual behaviour among men in Cameroon

Authors: Kongnyuy, EJ; Wiysonge, CS; Mbu, RE; Nana, P; Kouam, L
Source: BioMed Central International Health and Human Rights 2006, 6:11.

ABSTRACT

Background: The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon.

Methods: We analysed data from 4409 sexually active men aged 15–59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI).

Results: When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32–0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12–1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60–2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16–0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10–3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02–3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services.

Conclusion: Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society.

To link to the website containing this article, click here. Full Text is freely available.

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2. Effects of HIV-prevention interventions for samples with higher and lower percents of Latinos and Latin Americans: A meta-analysis of change in condom use and knowledge

Authors: Albarracin, J; Albarracin, D; Durantini, M
Source: AIDS and Behavior July 2008, 12(4): 521-43.

ABSTRACT

This meta-analysis (N = 110,092) assessed the efficacy of HIV-prevention interventions across samples with higher and lower concentrations of Latinos/Latin Americans. Findings indicated that groups with higher percents of Latinos increased condom and HIV-related knowledge to a lesser extent than groups with lower percents of Latinos/ Latin Americans. Moreover, groups with greater percents of Latinos/Latin Americans only benefited from intervention strategies that included threat-inducing arguments, whereas groups with lower percents of Latinos/Latin Americans benefited from numerous strategies. In addition, groups with greater percents of Latinos/Latin Americans increased condom use when interventions were conducted by a lay community member, whereas groups with lower percents of these groups increased condom use the most in response to experts. Not surprisingly, there were important differences among Latinos/Latin Americans with different education levels, different genders, and US/Latin American nationality.

Keywords: HIV prevention, Knowledge, Behavior, Intervention, Ethnicity, Culture

To link to the website containing this article, click here.

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3. Determinants of consistent condom use vary by partner type among young men in Kisumu, Kenya: A multi-level data analysis

Authors: Westercamp, N; Mattson, CL; Madonia, M; Moses, S; Agot, K; Ndinya-Achola, JO; Otieno, E; Ouma, N; Bailey, RC
Source: AIDS and Behavior 13 September 2008, online access only.

ABSTRACT

To evaluate whether determinants of consistent condom use vary by partner type among young sexually active Kenyan men, we conducted a cross-sectional assessment of lifetime sexual histories from a sub-sample of men enrolled in a clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using a condom with their partners. Condoms were always used in 2672 (34%) of the total relationships—212 (70%) of the relationships with sex workers, 1643 (40%) of the casual and 817 (23%) of the regular/marital relationships. Factors influencing condom use varied significantly by partner type, suggesting that HIV prevention messages promoting condom use with higher-risk partners have achieved a moderate level of acceptance. However, in populations of young, single men in generalized epidemic settings, interventions should promote consistent condom use in all sexual encounters, independently of partner type and characteristics.

Keywords: Condom use, Partner type, Multiple partners, Concurrent partners, Kenya, Africa

To link to the website containing this article, click here.

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FAMILY PLANNING/REPRODUCTIVE HEALTH

4. On postponement and birth intervals

Authors: Timæus, IM; Moultrie, TA
Source: Reprinted with permission of the Population Council and John Wiley & Sons. (c) 2008 Population Council. Originally published in Population and Development Review, September 2008, 34(3): 483-510.

Much of the literature on fertility transition presumes that birth control is practiced either to limit family size or to space births. This article argues that women also use birth control to postpone pregnancy. Postponement is not synonymous with spacing. It arises when women delay their next birth for indefinite periods for reasons unrelated to the age of their youngest child, but without deciding not to have any more children. Postponement has a distinctive impact on the shape of birth-interval distributions that differs from the impacts of family size limitation, birth spacing, or a mixture of the two behaviors. Some populations, such as that in South Africa, have developed fertility regimes characterized by birth intervals far longer than can be accounted for by birth spacing. Postponement of further childbearing that eventually becomes permanent may be an important driver of the transition to lower fertility in sub-Saharan Africa.

To link to the website containing this article, click here.

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5. Contraceptive methods with male participation: a perspective of Brazilian couples

Authors: Marchi, NM; de Alvarenga, AT; Osis, MJ; Bahamondes, L
Source: International Nurse Review Mar 2008, 55(1): 103-9.

ABSTRACT

Objective: To assess the perspectives of couples who requested vasectomy in a public health service on the use of male participation contraceptive methods available in Brazil: male condoms, natural family planning/calendar, coitus interruptus and vasectomy.

Methods: A qualitative study with semi-structured interviews was held with 20 couples who had requested vasectomy at the Human Reproduction Unit of the Universidade Estadual de Campinas, Brazil. Data analysis was carried out through thematic content analysis.

Findings: The couples did not, in general, know any effective contraceptive options for use by men and/or participating in their use, except for vasectomy. The few methods with male participation that they knew of were perceived to interfere in spontaneity and in pleasure of intercourse. Men accepted that condom use in extra-conjugal relations offered them protection from sexually transmitted diseases; that their wives might also participate in extra-marital relationships was not considered.

Discussion: The few contraceptive options with male participation lead to difficulty in sharing responsibilities between men and women. On the basis of perceived gender roles, women took the responsibility for contraception until the moment when the situation became untenable, and they faced the unavoidable necessity of sterilization.

Conclusions: Specific actions are necessary for men to achieve integral participation in relation to reproductive sexual health. These include education and discussions on gender roles, leading to greater awareness in men of the realities of sexual and reproductive health.

Keywords: Brazil, Contraception, Gender, Male Roles

To link to the website containing this article, click here. Full Text is freely available.

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MALARIA

6. Development of behaviour change communication strategy for a vaccination-linked malaria control tool in southern Tanzania

Authors: Mushi, AK; Schellenberg, J; Mrisho, M; Manzi, F; Mbuya, C; Mponda, H; Mshinda, H; Tanner, M; Alonso, P; Pool, R; Schellenberg, D
Source: Malaria Journal 2008, 7:191.

ABSTRACT

Background: Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.

Methods: Mixed methods including a rapid qualitative assessment and quantitative health facility survey were used to investigate communities' and providers' knowledge and practices relating to malaria, EPI, sulphadoxine-pyrimethamine and existing health posters. Results were applied to develop an appropriate behaviour change communication strategy for IPTi involving personal communication between mothers and health staff, supported by a brand name and two posters.

Results: Malaria in young children was considered to be a nuisance because it causes sleepless nights. Vaccination services were well accepted and their use was considered the mother's responsibility. Babies were generally taken for vaccination despite complaints about fevers and swellings after the injections. Sulphadoxine-pyrimethamine was widely used for malaria treatment and intermittent preventive treatment of malaria in pregnancy, despite widespread rumours of adverse reactions based on hearsay and newspaper reports. Almost all health providers said that they or their spouse were ready to take SP in pregnancy (96%, 223/242). A brand name, key messages and images were developed and pre-tested as behaviour change communication materials. The posters contained public health messages, which explained the intervention itself, how and when children receive it and safety issues. Implementation of IPTi started in January 2005 and evaluation is ongoing.

Conclusion: Behaviour Change Communication (BCC) strategies for health interventions must be both culturally appropriate and technically sound. A mixed methods approach can facilitate an interactive process among relevant actors to develop a BCC strategy.

To link to the website containing this article, click here. Full Text is freely available.

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7. Gains in awareness, ownership and use of insecticide-treated nets in Nigeria, Senegal, Uganda and Zambia

Authors: Baume, CA; Marin, MC
Source: Malaria Journal 2008, 7:153.

ABSTRACT

Background: In April 2000, the Roll Back Malaria (RBM) "Abuja Summit" set a target of having at least 60% of pregnant women and children under five use insecticide-treated nets (ITNs). Thereafter, programmes were implemented to create demand, reduce taxes and tariffs, spur the commercial market, and reach vulnerable populations with subsidized ITNs. Using national ITN monitoring data from the USAID-sponsored AED/NetMark project, this article examines the extent to which these activities were successful in increasing awareness, ownership, and use of nets and ITNs.

Methods: A series of surveys with standardized sampling and measurement methods was used to compare four countries at two points in time. Surveys were conducted in 2000 and again in 2004 (Nigeria, Senegal, Zambia) or 2006 (Uganda). They contained questions permitting classification of each net as untreated, ever-treated or currently-treated (an ITN). Household members as well as nets owned were enumerated so that households, household members, and nets could be used as units of analysis. Several measures of net/ITN ownership, plus RBM ITN use indicators, were calculated. The results show the impact of ITN activities before the launch of massive free net distribution programmes.

Results: In 2000, treated nets were just being introduced to the public, but four to six years later the awareness of ITNs was nearly universal in all countries but Nigeria, where awareness increased from 7% to 60%. By any measure, there were large increases in ownership of nets, especially treated nets, in all countries. All countries but Nigeria made commensurate gains in the proportion of under-fives sleeping under a net/ITN, and in all countries the proportion of pregnant women sleeping under a net/ITN increased greatly.

Conclusion: A mix of demand creation, a strengthened commercial sector, reduced taxes and tariffs, and programmes making ITNs available at reduced prices resulted in impressive gains in awareness, ownership, and use of nets and ITNs in Nigeria, Senegal, Zambia, and Uganda between 2000 and 2004–2006. None of the countries reached the ambitious Abuja targets for ITN use, but they made substantial progress towards them.

To link to the website containing this article, click here. Full Text is freely available.

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COMMUNICATION AND BEHAVIOR CHANGE

8. Masculine beliefs, parental communication, and male adolescents' health care use

Authors: Arik V. Marcell, MD, MPHa, Carol A. Ford, MDb, Joseph H. Pleck, PhDc and Freya L. Sonenstein, PhDd
Institutions: a Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland; b Departments of Medicine and Pediatrics, University of North Carolina, Chapel Hill, North Carolina; c Department of Human and Community Development, University of Illinois, Urbana, Illinois; d Center for Adolescent Health Promotion and Disease Prevention, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Source: Pediatrics April 2007, 119(4): e966-e975.

OBJECTIVES: Male adolescents frequently become disconnected from health care, especially as they get older, which limits physicians' abilities to address their health needs and results in missed opportunities to connect them to the health care system as they enter adulthood. In this study we tested the ability of modifiable (beliefs about masculinity, parental communication, sex education, and health insurance) and nonmodifiable (age, race/ethnicity, and region of residence) factors to prospectively predict health care use by male adolescents.

PATIENTS AND METHODS: We conducted a prospective analysis of data from 1677 male participants aged 15 to 19 years who completed the National Survey of Adolescent Males, a household probability survey conducted throughout the United States in 1988 (wave 1, participation rate: 74%) and in 1990–1991 (wave 2, follow-up rate: 89%). We present percentages and adjusted relative risks of the factors that predict male adolescents' self-report of a physical examination by a regular provider in the past year measured at wave 2.

RESULTS: On average, 1067 (66%) of 1677 male adolescents at wave 2 reported having a physical examination within the last year. Factors associated with a lower likelihood of a physical examination included living in the South, Midwest, and West; being older in age; and holding more traditional masculine beliefs. Factors associated with a higher likelihood of a physical examination included communicating about reproductive health with both parents and being insured. Male adolescents who were sexually active or engaged in 2 other risk behaviors had neither a higher nor lower likelihood of a physical examination.

CONCLUSIONS: Efforts to enhance male adolescents' health through health care should include work to modify masculine stereotypes, improve mothers' and fathers' communication about health with their sons, expand health insurance coverage, and identify interventions to connect male adolescents at increased risk for health problems with health care.

To link to the website containing this article, click here. Full Text is freely available.

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9. Applying behavioral science to behavior change communication: The Pathways to Change tools

Authors: Joseph Petraglia, PhD 1; Christine Galavotti, PhD 2; Nicola Harford, MA 3; Katina A. Pappas-DeLuca, PhD 4; Maungo Mooki, HND 5
Institutions: 1 Emory University's Center for the Study of Public Scholarship in Atlanta, Georgia; 2 Division of Reproductive Health at the Centers for Disease Control and Prevention in Atlanta, Georgia; 3 Harare, Zimbabwe; 4 Division of Reproductive Health of the Women's Health and Fertility Branch at the Centers for Disease Control and Prevention in Atlanta, Georgia; 5 Gaborone, Botswana
Source: Health Promotion Practice 2007, 8(4): 384-393.

Entertainment-education (EE) is a popular vehicle for behavior change communication (BCC) in many areas of public health, especially in the developing world where soap operas and other serial drama formats play a central role in encouraging people to avoid risky behavior. Yet BCC/EE developers have been largely unable to integrate behavioral theory and research systematically into storylines and scripts, depending instead on external, technical oversight of what should be an essentially local, creative process. This article describes how the Modeling and Reinforcement to Combat HIV/AIDS project at the Centers for Disease Control and Prevention has developed a set of tools through which creative writers can exercise greater control over the behavioral content of their stories. The Pathways to Change tools both guide scriptwriters as they write BCC/EE storylines and help project managers monitor BCC/EE products for theoretical fidelity and sensitivity to research.

Key Words: Entertainment-education, HIV/AIDS, Behavior change communication, Behavior change, Behavioral theory, Behavioral science, Training, Scriptwriting, Narrative intervention

To link to the website containing this article, click here. Full Text is freely available.

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C-Change, managed by AED, is USAID's flagship program to improve the effectiveness and sustainability of communication programs for behavior and social change in low and middle income countries.
To contact us, please send an email to c-channel@healthnet.org
Additional information about the project is available at the website www.c-changeprogram.org/