The use of mediation analysis to assess the effects of a behaviour change communication strategy on bed net ideation and household universal coverage in Tanzania

Malaria Journal

Research

Matthew Lynch¹  Emily E Ricotta¹  Hannah Koenker¹  Stella Babalola¹  Robert Ainslie¹  Marc Boulay¹  Megan Fotheringham² 

[1] Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, 21202, Baltimore, MD, USA;President’s Malaria Initiative, US Agency for International Development, Washington, DC, USA;

关键词: Malaria;    Mediation;    Ideation;    Social behaviour change communication;    ITN;   

DOI  :  10.1186/s12936-014-0531-0

 received in 2014-08-25, accepted in 2014-12-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundSBCC campaigns are designed to act on cognitive, social and emotional factors at the individual or community level. The combination of these factors, referred to as ‘ideation’, play a role in determining behaviour by reinforcing and confirming decisions about a particular health topic. This study introduces ideation theory and mediation analysis as a way to evaluate the impact of a malaria SBCC campaign in Tanzania, to determine whether exposure to a communication programme influenced universal coverage through mediating ideational variables.MethodsA household survey in three districts where community change agents (CCAs) were active was conducted to collect information on ITN use, number of ITNs in the household, and perceptions about ITN use and ownership. Variables relating to attitudes and beliefs were combined to make ‘net ideation’. Using an ideational framework, a mediation analysis was conducted to see the impact exposure to a CCA only, mass media and community (M & C) messaging only, or exposure to both, had on household universal coverage, through the mediating variable net ideation.ResultsAll three levels of exposure (CCA, M & C messaging, or exposure to both) were significantly associated with increased net ideation (CCA: 0.283, 95% CI: 0.136-0.429, p-value: <0.001; M & C: 0.128, 95% CI: 0.032-0.334, p-value: 0.018; both: 0.376, 95% CI: 0.170-0.580, p-value: <0.001). Net ideation also significantly increased the odds of having universal coverage (CCAOR: 1.265, 95% CI: 1.118-1.433, p-value: <0.001; M & COR: 1.264, 95% CI: 1.117-1.432, p-value: <0.001, bothOR: 1.260, 95% CI: 1.114-1.428, p-value: <0.001). There were no significant direct effects between any exposure and universal coverage when controlling for net ideation.ConclusionsThe results of this study indicate that mediation analysis is an applicable new tool to assess SBCC campaigns. Ideation as a mediator of the effects of communication exposure on household universal coverage has implications for designing SBCC to support both mass and continuous distribution efforts, since both heavily rely on consumer participation to obtain and maintain ITNs. Such systems can be strengthened by SBCC programming, generating demand through improving social norms about net ownership and use, perceived benefits of nets, and other behavioural constructs.

【 授权许可】

CC BY   
© Ricotta et al.; licensee Biomed Central. 2015