BackgroundIn the last decade, the proportion of Ethiopian women using contraceptive methods has increased substantially (from 14% in 2005 to 35% in 2016 among married women). Numerous factors have contributed to the increased uptake. An important one is the implementation of the Health Extension Program, a government-led health service delivery strategy that has deployed more than 38,000 health extension workers (HEWs) throughout the country. Key mechanisms underlying the success of this program are not well understood. Using a case study approach, the goal of this study is to describe how key features of local contexts, community perceptions, and messaging by HEWs have contributed to the increased use of modern contraception in one community in Ethiopia.MethodsWe conducted focus groups and individual interviews with men, women, adolescents, and key informants, including (HEWs), in Oromia, Ethiopia. We used a random sampling protocol to recruit all participants except key informants, with whom purposive sampling was used to ensure participants were knowledgeable on family planning in the village. Interviews were audio recorded, translated, transcribed, and then analyzed using applied thematic analysis and NVivo v.11 qualitative research software.ResultsWe identified four themes that may explain uptake of contraception: (1) HEWs are seen as trusted and valued community members who raised awareness about family planning; (2) the HEW messaging that contraception is useful to space pregnancies among married women was effective; (3) the message that spacing is healthy for mother and child was also effective; and (4) communicating to the entire community (including men, women, adolescents, and religious leaders), contributed to changing attitudes around contraception.ConclusionThe four aspects of the Health Extension Program approach increased uptake of contraception in our sample. In contexts where community health workers are valued by the health systems and local communities they serve, this type of approach to widening modern contraception use could help increase uptake and address unmet need. Understanding these granular aspects of the program in one local context may help explain how use of contraception increased in the country as a whole.

We used qualitative in-depth interviews to evaluate the effects of a mass media climate change program on audiences' efficacy beliefs, outcome expectations, emotional responses, and motivations and intentions to address climate change. We conducted in-depth interviews with 73 participants from five US cities and three political parties who had watched episodes of the documentary television series, Season Two of Years of Living Dangerously. Eligible participants completed an in-depth interview within 24 h of viewing a select episode. Data were transcribed and then coded and analyzed using QSR NVivo 10. Weak efficacy beliefs limited intentions to enact concrete behavioral change. Outcome expectations, national-level actions, imagery, and emotional responses to stories played an important role in these processes. Explicit information about expected outcomes of various actions, and specifically successes, should be provided in order to boost efficacy and incentivize behavior.

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