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

Abstract

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.

Reported bed net ownership and use in social contacts is associated with uptake of bed nets for malaria prevention in pregnant women in Ghana

“…No other studies specifically addressing the role of interpersonal relationships or direct peer influence and bed net use were identified in the published literature during the course of the study. However, exposure to community change agents (CCA), educators who are from and work within communities to actively engage families about malaria prevention and control, were found to have modestly influenced household-level universal coverage targets through its influence on net ideation [23]. There is, however, relative consistency in the associations between social factors such as education, income and bed net ownership and use among both pregnant women and the general population [7, 17, 22].…”

“…Interpersonal influences have been found to be critically important in the adoption of health promoting behaviors in other contexts [18–22]. The larger concept of ideation, which includes beliefs and values, social norms, emotional responses, and social support and influence about a particular subject has been demonstrated to be correlated with household ITN use in Tanzania [23]. …”

Use of SMS-Based Surveys in the Rapid Response to the Ebola Outbreak in Liberia: Opening Community Dialogue

“…For the EVD response in Liberia, one such model used was the ideation metatheory of communication and behavior change (Kincaid, Delate, Storey, & Figueroa, 2012; see Figure 1). Originally developed to explain the decline in fertility in the developing world (Cleland & Wilson, 1987;Kincaid, 2000), the ideation metatheory has been widely used in and adapted to a variety of sociocultural settings and across a range of health and development issues, including family planning and reproductive health (Kincaid, Storey, Figueroa, & Underwood, 2006), HIV/AIDS prevention (Babalola, 2007), hygiene and water handling (Kincaid & Figueroa, 2010), and more recently malaria prevention (Ricotta et al, 2015), among…”

Determinants of bed net policy implementation: A case study of Southern Benin

“…Increasing interest has emerged in the effectiveness of social and behavioral change communication, whether aiming to promote the use of insecticide‐treated nets (ITNs), disseminating messages to foster intermittent preventive treatment for malaria in pregnancy, or malaria treatment uptake. Various channels are involved in social and behavioral change communication: radio, mass events, and print media . Effective behavior change is, however, extremely difficult to implement and sustain, even in places where populations are aware of public health promotion or harm reduction campaigns .…”

“…Various channels are involved in social and behavioral change communication: radio, mass events, and print media. [6][7][8][9] Effective behavior change is, however, extremely difficult to implement and sustain, even in places where populations are aware of public health promotion or harm reduction campaigns. 10,11 Panter-Brick 12 argues that there are remarkably few examples of truly successful health interventions where the measure of success is a behavior change that is acceptable, affordable, effective, sustainable, and generalizable.…”