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C-Channel Issue 6

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C-Channel header  February 2009

Dear Colleagues,

C-Channel, the monthly e-newsletter from the C-Change program, provides peer-reviewed literature on behavior and social change communication in the health sector to connect you with state-of-the-art research findings that may be useful in your work.

In C-Channel 6, eleven peer-reviewed articles on behavior and social change communication are summarized: three on HIV and AIDS, three on family planning and reproductive health, three on malaria, and two on other topics, which this month feature research on sexual risk behaviors. Articles cover research carried out in Laos, sub-Saharan Africa, Burkina Faso, Nigeria, Tajikistan, Russia, Turkey, Peru, Slovakia, and the urban United States.

C-Change is implementing a program in Lesotho on HIV prevention that addresses the practice of multiple concurrent partners, a major driver of the HIV epidemic there and a sexual risk behavior. C-Change has partnered with regional organizations to support a mass media campaign called ‘One Love’ that focuses on reducing the occurrence of multiple and concurrent partnerships. Additional information is available at the program’s website: www.c-changeprogram.org.

Thank you,
The Knowledge Management Team at C-Change 


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



HIV/AIDS

1. Gender-specific HIV prevention with urban early-adolescent girls: Outcomes of the Keepin' It Safe Program

2. Building capacity and community resilience to HIV: A project designed, implemented, and evaluated by young Lao people

3. HIV prevention in sub-Saharan Africa: A multilevel analysis of message frames and their social determinants
 

FAMILY PLANNING/REPRODUCTIVE HEALTH

4. Modelling prenatal health care utilization in Tajikistan using a two-stage approach: Implications for policy and research

5. Women's reproductive health needs in Russia: What can we learn from an intervention to improve post-abortion care

6. Post abortion family planning counseling as a tool to increase contraception use
 

MALARIA

7. Role of information and communication networks in malaria survival

8. A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso

9. Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria
 

SEXUAL RISK BEHAVIORS

10. Sexual behavior and drug consumption among young adults in a shantytown in Lima, Peru

11. Psychological and behavioural factors associated with sexual risk behaviour among Slovak students
 


HIV/AIDS

1. Gender-specific HIV prevention with urban early-adolescent girls: Outcomes of the Keepin' It Safe Program

Authors: Di Noia, J; Schinke, SP
Source: AIDS Education and Prevention December 2007, 19(6): 479-488.

ABSTRACT

This study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome. Recruited through youth services agencies located in the greater New York City area, study participants comprised 204 adolescent girls aged 11-14 years. Girls exposed to Keepin' It Safe, relative to wait-list control girls, increased their HIV/AIDS knowledge, perceived efficacy and enjoyment of abstinence, perceived efficacy and enjoyment of condoms, and sexual assertiveness, suggesting that a theory-based, gender-specific, CD-ROM-mediated HIV prevention program can enhance knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls.

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

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2. Building capacity and community resilience to HIV: A project designed, implemented, and evaluated by young Lao people

Authors: Hoy, D; Southavilay, K; Chanlivong, N; Phimphachanh, C; Douangphachanh, V; Toole, MJ
Source: Global Public Health January 2008, 3(1): 47-61.

ABSTRACT

A partnership was formed between a mass youth organization, a national HIV coordinating committee, and an international agency, to implement an HIV capacity building project in the youth sector of Lao PDR. Involving the local community in situation analysis, planning and skills-building was a key focus of the project. District project working teams were trained in situation analysis, strategic planning, proposal development, and the implementation of HIV prevention activities. Young village volunteers were trained in participatory research, analysis, and behaviour change communication to promote HIV prevention. After 6 years, the partnership used qualitative methods to evaluate the local outcomes of the project. We found that district project working teams and young volunteers had improved skills in the areas in which they had been trained. Communities and local government workers had developed greater understanding of the HIV situation in their districts, and expressed a strong sense of ownership over their activity plans. Young people more readily acknowledged personal risk of HIV infection and were more comfortable talking about sexually transmitted infections. Although there were challenges to sustaining project activities in some areas, we found that our approach helped to engage youth and build their resilience to HIV in this country of low prevalence.

Keywords: HIV, Lao PDR, youth, young people, capacity building, district-level

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

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3. HIV prevention in sub-Saharan Africa: A multilevel analysis of message frames and their social determinants

Author: Beaudoin, CE
Source: Health Promotion International 2007, 22(3): 198-206.

ABSTRACT

In light of the great threat that HIV/AIDS poses in sub-Saharan Africa, the current study assesses HIV/AIDS posters from this region with specific reference to health message frames, including HIV sources, consequences, self-efficacy, preventive means, and barriers and benefits to employing such means of prevention. There is a two-step methodology. First, the content of HIV/AIDS posters from 15 sub-Saharan African countries was coded for the six health message frames. Second, relationships between the health message frames and four social determinants (HIV rate, HIV awareness, condom use and uncertainty avoidance (UAI)) were assessed with hierarchical linear modeling (HLM). Analysis indicates that self-efficacy is the most common frame, but that almost one-quarter of the posters has none of the six health message frames. HLM indicates some favorable findings, including that health message frames are used most often in countries with the most troubling levels of HIV awareness and condom use. Less favorably, health message frames are used least common in countries that have high levels of UAI and high HIV rates. Improvements for related media practices and policy are articulated.

Key words: HIV, HIV messages, HIV media, message frames

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

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FAMILY PLANNING/REPRODUCTIVE HEALTH

4. Modelling prenatal health care utilization in Tajikistan using a two-stage approach: Implications for policy and research

Authors: Habibov, NN; Fan, L
Source: Health Policy and Planning 2008, 23(6): 443-451.

Since the transition from a centrally planned to a market economy, Tajikistan has witnessed a high rate of child and maternal mortality, a decline in the birth rate and a significant drop in public expenditures on health care. Against this backdrop, this paper analyses the determinants of prenatal health care utilization using Andersen's behavioural model, which has been modified to the context of Tajikistan. We applied a two-stage sequential model to data drawn from a nationally representative survey. Binary logit regression is used to predict and explain the probability of using prenatal health care services, while negative binomial regression is used to predict and explain the frequency of using these services. Findings suggest that higher educational attainment increases the utilization of prenatal care. Conversely, poverty, limited knowledge about matters related to sex, low quality of health care service, lack of public infrastructure, as well as absence of or long distance of travel to the nearest health facility, all reduce the utilization of prenatal health care. Health policy and research implications are presented and discussed.

Key Words: Two-part model, reproductive health, maternal care, family planning, Central Asia, Tajikistan

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

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5. Women's reproductive health needs in Russia: What can we learn from an intervention to improve post-abortion care

Authors: David, PH; Reichenbach, L; Savelieva, I; Vartapetova, N; Potemkina, R
Source: Health Policy and Planning 2007 Mar, 22(2): 83-94.

ABSTRACT

It has been well documented that abortion is a common means of controlling fertility in Russia. Women undergo repeat abortions throughout their reproductive lives, but recent studies of abortion trends in the Russian Federation suggest that abortion rates are on the decline, use of modern contraceptives is increasing, and women dislike abortion as a method of fertility control. Using data collected during 1999-2003 in women's health facilities in three Russian cities, this paper reports the results of an evaluation of interventions to improve post-abortion care, which show an impressive increase in post-abortion contraceptive counselling but no reduction in the rate at which women present at clinics for repeat abortions. The findings indicate a discrepancy between women's stated preferences for modern medical contraceptive methods and their abortion-seeking behaviour. Further exploration of these data suggests that certain women resort to abortion with greater frequency than others, and points to the need for a more focused investigation of these women. These results indicate the complexities associated with changing what has been a relatively common and long-standing practice, and have implications for improving reproductive health services. Meeting the reproductive health needs of Russian women requires not only improved provider and client knowledge but may also demand a more focused delivery of client-centred care than may be the case in other settings.

Key Words: Reproductive health policy, abortion, post-abortion care, Russia, contraceptive counselling, family planning programmes

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

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6. Post abortion family planning counseling as a tool to increase contraception use

Authors: Ceylan, A; Ertem, M; Saka, G; Akdeniz, N
Source: BMC Public Health 2009, 9:20.

ABSTRACT

Background: To describe the impact of the post-abortion family planning counseling in bringing about the contraceptive usage in women who had induced abortion in a family planning clinic.

Method: The Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and nongovernmental organization which runs a family planning clinic to serve the lower socio-economic populations, in Diyarbakir-Turkey. Post abortion counseling is introduced by using proper communication skills and with using appropriate methods to women. In this study we introduced contraceptive usage of women who had induced abortion one year ago and followed by DTFPA's clinic.

Results: 55.3% of our clients were not using contraceptive methods before abortion. At the end of the one year, 75.9% of our followed-up clients revealed that they were using one of the modern contraceptive methods. There was no woman with IUD before induced abortion. At the end of one year 124 (52.3%) women had IUD. "A modern method was introduced immediately after abortion" was the most important factor increasing modern method usage.

Conclusion: Our results advocate that post-abortion counseling may be an effective tool to increase the usage of contraceptives. Improved and more qualified post-abortion family planning counseling should be an integral part of abortion services.

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

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MALARIA

7. Role of information and communication networks in malaria survival

Authors: Mozumder, P; Marathe, A
Source: Malaria Journal 2007, 6:136.

ABSTRACT

Background: Quite often symptoms of malaria go unrecognized or untreated. According to the Multilateral Initiative on Malaria, 70% of the malaria cases that are treated at home are mismanaged. Up to 82% of all malaria episodes in sub-Saharan Africa are treated outside the formal health sector. Fast and appropriate diagnosis and treatment of malaria is extremely important in reducing morbidity and mortality.

Method: Data from 70 different countries is pooled together to construct a panel dataset of health and socio-economic variables for a time span of (1960-2004). The generalized two-stage least squares and panel data models are used to investigate the impact of information and communication network (ICN) variables on malaria death probability. The intensity of ICN is represented by the number of telephone main lines per 1,000 people and the number of television sets per 1,000 people.

Results: The major finding is that the intensity of ICN is associated with reduced probability of deaths of people that are clinically identified as malaria infected. The results are robust for both indicators i.e. interpersonal and mass communication networks and for all model specifications examined.

Conclusion: The results suggest that information and communication networks can substantially scale up the effectiveness of the existing resources for malaria prevention. Resources spent in preventing malaria are far less than needed. Expanded information and communication networks will widen the avenues for community based "participatory development", that encourages the use of local information, knowledge and decision making. Timely information, immediate care and collective knowledge based treatment can be extremely important in reducing child mortality and achieving the millennium development goal.

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

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8. A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso

Authors: Gies, S; Coulibaly, SO; Ouattara, FT; Ky, C; Brabin, BJ; D'Alessandro, U
Source: Malaria Journal 2008, 7:180.

ABSTRACT

Background: Intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) is currently being scaled up in many countries in sub-Saharan Africa. Despite high antenatal clinic (ANC) attendance, coverage with the required two doses of SP remains low. The study investigated whether a targeted community-based promotion campaign to increase ANC attendance and SP uptake could effectively improve pregnancy outcomes in the community.

Methods: Between 2004 and 2006 twelve health centres in Boromo Health District, Burkina Faso were involved in this study. Four were strategically assigned to community promotion in addition to IPTp-SP (Intervention A) and eight were randomly allocated to either IPTp-SP (Intervention B) or weekly chloroquine (Control). Primi- and secundigravidae were enrolled at village level and thick films and packed cell volume (PCV) taken at 32 weeks gestation and at delivery. Placental smears were prepared and newborns weighed. Primary outcomes were peripheral parasitaemia during pregnancy and at delivery, placental malaria, maternal anaemia, mean and low birth weight. Secondary outcomes were the proportion of women with ≥ 3 ANC visits and ≥ 2 doses of SP. Intervention groups were compared using logistic and linear regression with linearized variance estimations to correct for the cluster-randomized design.

Results: SP uptake (≥ 2 doses) was higher with (Intervention A: 70%) than without promotion (Intervention B: 49%) (OR 2.45 95%CI 1.25-4.82 p = 0.014). Peripheral (33.3%) and placental (30.3%) parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37-0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44-0.78 p = 0.002) but did not differ between Intervention A (17.4%; 18.1%) and Intervention B (20.1; 20.5%) (peripheral: OR 0.84 95%CI 0.60- 1.18 p = 0.280; placental: OR 0.86 95%CI 0.58-1.29 p = 0.430). Mean PCV and birth weight and prevalence of anaemia and low birth weight did not differ between study arms.

Conclusion: The promotional campaign resulted in a major increase in IPTp-coverage, with two thirds of women at delivery having received ≥ 2 SP. Despite lower prevalence of malaria infection this did not translate into a significant difference in maternal anaemia or birth weight. This data provides evidence that, as with immunization programmes, extremely high coverage is essential for effectiveness. This critical threshold of coverage needs to be defined, possibly on a regional basis.

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

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9. Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria

Authors: Onwujekwe, O; Uzochukwu, B; Eze, S; Obikeze, E; Okoli, C; Ochonma, O
Source: Malaria Journal 2008, 7:5.

ABSTRACT

Background: Equitable improvement of treatment-seeking for malaria will depend partly on how different socio-economic groups perceive the ease of accessing and utilizing malaria treatment services from different healthcare providers. Hence, it was important to investigate the link between socioeconomic status (SES) with differences in perceptions of ease of accessing and receiving treatment as well as with actual health seeking for treatment of malaria from different providers.

Methods: Structured questionnaires were used to collect data from 1,351 health providers in four malaria-endemic communities in Enugu state, southeast Nigeria. Data was collected on the peoples' perceptions of ease of accessibility and utilization of different providers of malaria treatment using a pre-tested questionnaire. A SES index was used to examine inequities in perceptions and health seeking.

Results: Patent medicine dealers (vendors) were the most perceived easily accessible providers, followed by private hospitals/clinics in two communities with full complement of healthcare providers: public hospital in the community with such a health provider and traditional healers in a community that is devoid of public healthcare facilities. There were inequities in perception of accessibility and use of different providers. There were also inequity in treatment-seeking for malaria and the poor spend proportionally more to treat the disease.

Conclusion: Inequities exist in how different SES groups perceive the levels of ease of accessibility and utilization of different providers for malaria treatment. The differentials in perceptions of ease of access and use as well as health seeking for different malaria treatment providers among SES groups could be decreased by reducing barriers such as the cost of treatment by making health services accessible, available and at reduced cost for all groups.

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

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SEXUAL RISK BEHAVIORS

10. Sexual behavior and drug consumption among young adults in a shantytown in Lima, Peru

Author: Gálvez-Buccollini, JA; DeLea, S; Herrera, PM; Gilman, RH; Paz-Soldan, V
Source: BMC Public Health 2009, 9:23.

ABSTRACT

Background: Risky sexual behaviors of young adults have received increasing attention during the last decades. However, few studies have focused on the sexual behavior of young adults in shantytowns of Latin America. Specifically, studies on the association between sexual behaviors and other risk factors for sexually transmitted infections (STI) and HIV/AIDS transmission, such as the consumption of illicit drugs or alcohol are scarce in this specific context.

Methods: The study participants were 393 men and 400 women between 18 and 30 years of age, from a shantytown in Lima, Peru. Data were obtained via survey: one section applied by a trained research assistant, and a self-reporting section. Logistic regression was used to estimate associations between use of any illicit drug, high-risk sexual behaviors and reported STI symptoms, adjusting for alcohol consumption level and various socio-demographic characteristics.

Results: Among men, age of sexual debut was lower, number of lifetime sexual partners was higher, and there were higher risk types of sexual partners, compared to women. Though consistent condom use with casual partners was low in both groups, reported condom use at last intercourse was higher among men than women. Also, a lifetime history of illicit drug consumption decreased the probability of condom use at last sexual intercourse by half. Among men, the use of illicit drugs doubled the probability of intercourse with a casual partner during the last year and tripled the probability of reported STI symptoms.

Conclusion: Drug consumption is associated with high-risk sexual behaviors and reported STI symptoms in a Lima shantytown after controlling for alcohol consumption level. Development of prevention programs for risky sexual behaviors, considering gender differences, is discussed.

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

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11. Psychological and behavioural factors associated with sexual risk behaviour among Slovak students

Authors: Kalina, O; Geckova, AM; Jarcuska, P; Orosova, O; van Dijk1, JP; Reijneveld, SA
Source: BMC Public Health 2009, 9:15.

ABSTRACT

Background: Knowledge about the prevalence of sexual risk behaviour (SRB) in adolescence is needed to prevent unwanted health consequences. Studies on SRB among adolescents in Central Europe are rare and mostly rely on a single indicator for SRB. This study aims to assess the association of behavioural and psychological factors with three types of SRB in adolescents in Central Europe.

Methods: We obtained data on behavioural factors (having been drunk during previous month, smoking during previous week, early sexual initiation), psychological factors (self-esteem, well-being, extroversion, neuroticism, religiousness), and SRB (intercourse under risky conditions, multiple sexual partners, and inconsistent condom use) in 832 Slovak university students (response 94.3%).

Results: Among those with sexual experience (62%), inconsistent condom use was the most prevalent risk behaviour (81% in females, 72% in males). With the exception of having been drunk in males, no factor was associated with inconsistent condom use. Regarding the other types of SRB, early sexual initiation was most strongly associated. In addition, other, mostly behavioural, factors were associated, in particular having been drunk.

Conclusion: Results suggest that behavioural factors are more closely related to SRB than psychological factors. Associations differ by type of SRB and gender but offer few clues to target risk groups for inconsistent condom use. Results show a high need for health-promotion programmes in early adolescence that target SRB in conjunction with other health risk behaviours such as alcohol abuse.

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/