Does health communication (HC) work in a nationwide complex behavioral change health program? - Evidence from CHC Listening Surveys

Summary:

From 2013 to date, CHC program has been implemented in Uganda. The programs aim was to contribute to a reduction in HIV, total fertility, maternal child mortality, malnutrition, malaria and tuberculosis. The program was designed with a component evidence-based learning. The overriding learning question was whether CHC-led HC would yield positive effects such as; comprehensive knowledge of health issues, harmful gender and social norms and ultimately increase adoption pro-health behaviors or uptake of recommended services. Methodology: Over the three years, CHC conducted repeated cross-sectional listening surveys, covering 16 districts in each of the eight regions of Uganda, multi-stage approach was used to reach households and eligible respondents. At household level a kish-grid was used to select respondents. Analysis was at three was levels; univariate, bivariate descriptive and logistic regressions for key outcome variables. Results; The results indicated that individuals who were exposed to a health message were more likely to take up health behavior than the non-exposed. For instance, individuals who were exposed to messages on condom use were 8 times more likely to use a condom at higher risk sex (OR=8.163 (95% CI 1.794 37.151). Discussion/implications; The results from the repeated surveys indicated evidence of specific desired changes in health indicators targeted by CHC. The likelihood to adopt a promoted health behavior was high among individuals exposed to HC messages.

Background/Objectives:

From 2013 to date, CHC program has been implemented in Uganda. The programs aim was to contribute to a reduction in HIV, total fertility, maternal child mortality, malnutrition, malaria and tuberculosis. The program was designed with a component of evidence-based learning. The overriding learning question was whether CHC-led health communication (HC) would yield positive outcome effects such as; comprehensive knowledge of health issues, addressing harmful gender and social norms and ultimately increase adoption pro-health behaviors or uptake of recommended services.

Description of Intervention and/or Methods/Design:

CHC uses an integrated HC platform that is grounded in the proven C-Change SBCC Framework and its Socio-Ecological Model. CHCs theory of change is that high quality, well-coordinated HC interventions that are conducted based on research and evidence relevant to Ugandas context will result in increased adoption of healthy behaviors. CHC adopted a repeated cross-sectional study executed in 16 purposively selected districts (one urban and one rural) in each of the eight regions of Uganda. Within each district, multi-stage approach was used to reach households and eligible respondents. At household level a kish-grid was used to select respondents aged 15-49 years. Data was collected using ODK mobile application and a structured questionnaire. Interviews were conducted mainly in local languages. Analysis was at three levels; univariate, bivariate descriptive and logistic regressions for key outcome variables. MoH sanctioned the studies through authentication (Health Promotions Department).

Results/Lessons Learned:

The results indicated that individuals who were exposed to a health message were more likely to take on a health behavior than those who were not exposed. For example the findings show that the individuals who were exposed with messages on condom use were 8 times more likely to use a condom at higher risk sex (OR=8.163 (95% CI 1.794 37.151), and individuals reached with HIV messages on test and receive results were 3 times more likely to test for HIV and receive results (OR=2.623 (95% CI 1.275 5.398). The likelihood to adopt a promoted health behavior was high among individuals exposed to HC messages. The changes were observed after target audience reaching tipping-point for change. (saturation level in HC)

Discussion/Implications for the Field:

The results from the repeated surveys indicated consistent evidence of specific desired changes in health indicators targeted by CHC that could be attributed HC role from the baseline and subsequent listening-surveys. Well-planned listening-surveys are a powerful tool and should be used to successfully manage and deliver large complex SBCC interventions adaptively. Participatory design, validation and evaluation approaches have facilitated CLA and linkages among stakeholders.

Abstract submitted by:

Richard Kanakulya - FHI 360
Richard Batamwita - FHI 360
Armstrong Mukundane - FHI 360
Tabley Bakyaita - Ministry of Health
Sheila Marunga Coutinho - FHI 360