Race and gender moderation of the relationship between cessation beliefs and intentions: is race or gender message segmentation necessary in anti-smoking campaigns?

Debate persists over whether different message strategies in anti-smoking campaigns are needed for audiences of different races or genders. This study considers the need for 'message segmentation', which is the process of differentiating the beliefs that might be the focus of messages for population subgroups. We have two aims: (i) lay out an approach that yields evidence about the necessity for message segmentation and (ii) demonstrate and assess findings from this approach using the formative evaluation for the Philadelphia Anti-Smoking Campaign. We examine whether associations between beliefs about quitting smoking and intention to quit are moderated by race (black/white) or gender. Data came from a representative sample of 501 adult smokers (46% black; 56% female) surveyed in July 2010 for the campaign's formative evaluation. Out of 26 beliefs about cessation, 8 were significantly related to cessation intention regardless of subgroup affiliation, suggesting that these would be promising beliefs for messages in a unified campaign. Four beliefs were significant for white smokers only, and three beliefs were significant for female smokers only. The evidence justified a unified message approach because subgroups shared enough beliefs that could become message strategies to increase cessation across smokers without the added costs associated with message segmentation.

The impact of risk information exposure on women's beliefs about direct-to-consumer genetic testing for BRCA mutations.

Despite an increase in direct-to-consumer (DTC) genetic testing, little is known about how variations in website content might alter consumer behavior. We evaluated the impact of risk information provision on women's attitudes about DTC BRCA testing. We conducted a randomized experiment; women viewed a 'mock' BRCA testing website without [control group (CG)] or with information on the potential risks of DTC testing [RG; framed two ways: unattributed risk (UR) information and risk information presented by experts (ER)]. Seven hundred and sixty-seven women participated; mean age was 37 years, mean education was 15 years, and 79% of subjects were white. Women in the RG had less positive beliefs about DTC testing (mean RG = 23.8, CG = 25.2; p = 0.001), lower intentions to get tested (RG = 2.8, CG = 3.1; p = 0.03), were more likely to prefer clinic-based testing (RG = 5.1, CG = 4.8; p = 0.03) and to report that they had seen enough risk information (RG = 5.3, CG = 4.7; p < 0.001). UR and ER exposure produced similar effects. Effects did not differ for women with or without a personal/family history of breast/ovarian cancer. Exposing women to the potential risks of DTC BRCA testing altered their beliefs, preferences, and intentions. Risk messages appear to be salient to women irrespective of their chance of having a BRCA mutation.

Care seeking in Sri Lanka: one possible explanation for low childhood mortality.

This paper examines care-seeking practices of mother caretakers with children less than five years of age in a rural district of Sri Lanka. The study was carried out from June to September 1998, documenting care-seeking practices of mother caretakers in a population of 2248 children in 60 villages. Of the five targeted diseases in the IMCI programme (Integrated Management of Childhood Illnesses) that were the focus of the study, acute respiratory infections (82.0%) and diarrhoea (14.8%) were predominant. Although malnutrition was highly prevalent it was not recognised by mother caretakers as an illness. Findings show that in 65.0% of illness episodes in children the mother caretakers sought outside care and treatment. Caretakers sought treatment from both private and public sectors with the majority seeking care in the private sector. Care seeking of mother caretakers was driven by symptomology. Young children with higher perceived severity and high-risk symptoms were brought to provider care more frequently, although a large percentage of episodes with low-risk symptoms were also brought for outside care. Care seeking was similar across socio-economic groups. The study points out that high care seeking of mother caretakers in Sri Lanka, particularly for illnesses with acute high-risk symptoms and signs, is a plausible explanation for the low level of childhood mortality despite the prevalence of a high rate of malnutrition.

Symptoms and perceived severity of illness as predictive of treatment for diarrhea in six Asian and African sites.

This paper examines associations between symptoms, judgement of severity and treatments given for episodes of childhood diarrhea. Using data from ten large sample surveys conducted in six research sites in Asia and Africa, the paper addresses three main questions. One, to what extent are judgments of severity of diarrhea among young children a function of the symptoms observed during an episode of diarrhea? Two, what is the relative importance of symptoms observed vs judgments of severity in the treatments given for diarrhea? And three, what do the results imply for programs promoting the use of ORT for diarrhea? The study found that mothers, perception of severity of illness is linked most closely to three symptoms: vomiting, fever and lassitude. These symptoms are associated with (a) treating the child at all and (b) taking the child to a health facility. These conclusions take on particular significance since they are based on a comparison of ten data sets from six sites differing widely in population density, ecology, access to medical services, educational level and financial resources.

Evaluating the program effects of a radio drama about AIDS in Zambia.

This study describes an approach to the analysis of data that is designed to isolate program effects for evaluations and applies that approach to a program in Zambia designed to disseminate AIDS information. Evidence is considered that a radio drama broadcast for nine months had an impact on knowledge and behavior related to AIDS among Bemba speakers in northern Zambia. Using results from large sample surveys (1,600 men and women), conducted before and after the drama was broadcast, the analyses compare changes in knowledge and behavior in those most likely and least likely to have listened to the broadcast. While the population as a whole had improved its knowledge substantially, and some people reported having reduced risky behavior, attributing these changes to the program itself was not possible.

PIP: Sample surveys conducted before and after a radio drama designed to disseminate information about acquired immunodeficiency syndrome (AIDS) revealed substantial improvements in both knowledge and adoption of risk-reduction behaviors; however, these changes could not be causally linked to the program. The 10-episode drama, which was broadcast for 9 months during 1991-92, portrayed two families in Lusaka, Zambia, struggling with issues such as raising teenage children, making ends meet, having sexual relations, and learning about AIDS. For the baseline survey, 1613 adult men and women from the Zambian provinces of Copperbelt and Northern completed a questionnaire about their personal characteristics, use of the mass media, AIDS knowledge, attitudes about condoms, and sexual activity. In the follow-up study, the same questionnaire--with the addition of questions on the broadcast--was administered to 1682 men and women from the same two areas. 664 respondents in the baseline survey and 685 in the follow-up survey both owned a radio and listened one or more times a week (high-access group); the remainder did not own a radio (low-access group). 53% of those in the second survey had heard of the radio drama and 45% had listened, but less than 1/3 were regular listeners. The proportion of respondents who considered AIDS the most serious health problem rose from 7% in 1991 to 23% in 1992; however, the change was nearly identical for high and low-access groups. Condom use increases were moderate. Overall, the high-access group showed more changes in the areas of knowledge of the extended period of infection, willingness to discuss AIDS with spouses and children, and--among women--reductions in number of sex partners and belief in personal vulnerability to AIDS. However, there were no differences within the high-access group between those who listened to the radio drama and those who did not in measures such as general AIDS knowledge and condom use, suggesting that the positive changes reflected other influences (e.g., socioeconomic status).

Social influences on the sexual behavior of youth at risk for HIV exposure.

OBJECTIVES: Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS: A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS: Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS: The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.

Quality of home use of oral rehydration solutions: results from seven HEALTHCOM sites.

This study examined the volume of oral rehydration solutions given to children during diarrhea and the length of time the solutions are administered. It also attempted to test the importance of individual and contextual factors--especially mothers' knowledge--in explaining the administration of oral rehydration solutions. Data about the treatment of an episode of child diarrhea within the last three months were collected from large samples of mothers in seven sites in Africa, Asia, and Latin America. The results showed that oral rehydration solutions were given in smaller volumes and for shorter periods of time than recommended. The majority of children received at least a glass (200-250 ml) of solution on the first day, but few received more than that. Daily administration of packet-based solutions or of sugar-salt solutions (promoted in two of the countries) during diarrhea was generally quite low, ranging from 16 to 60% of cases given an oral rehydration solution. However, in four out of six sites, at least half of the children with diarrhea for more than one day were given an oral rehydration solution for more than one day. The majority of children were given some form of other fluids (e.g. more water, special teas, or continued breastfeeding), but their value in preventing dehydration was not clear because the volume of other fluids given could not be assessed. Few of the hypothesized predictors of administration explained the variation in volume or duration of ORS/SSS administration within any specific country or across sites. The research points to the need for more information on the decision process used by mothers when treating their children's diarrhea and on outside factors influencing this process.

Perceptions of severity of diarrhoea and treatment choice: a comparative study of HealthCom sites.

This paper examines the association of treatments given for childhood diarrhoea with the severity of the illness as perceived by mothers and caretakers. Drawing on 11 large sample surveys in seven research sites of the HealthCom project, the study shows that in all sites, the children judged as very sick were more likely to receive treatment than those not very sick, and that the more severe cases were more likely to be taken to a health facility. The results also show that in half of the surveys, the more severe cases were more likely to be given SSS or ORS. No overall pattern of relations was found between severity and giving herbal medicine or pharmaceutical drugs at home. The study found that most carers of children with diarrhoea give some form of treatment at home in all research sites and that treatment choice is influenced by the severity of the episode. The results suggest that the perception of mothers and carers of the severity of episodes of diarrhoea is an important factor in their choice of treatment, and thus could be used in messages promoting improved treatment of diarrhoeal disorders.

PIP: Staff of the Communication for Child Survival (HealthCom) project oversaw and reviewed 11 surveys from 7 HealthCom sites in 5 developing countries to determine the effect mother's perception of severity of illness has on diarrhea treatment choices. Mothers who perceived their children to be very sick were more likely to seek or give treatment than those who did not perceive their children to be very sick. They also were more likely to take the children perceived to be very ill to a health facility (e.g., in Zaire, 55% vs. 29% for somewhat sick and 24% for not sick; p .0001). In 5 surveys, mothers who perceived their children to be very sick were more likely to administer oral rehydration therapy (ORT) at home (e.g., in the Philippines, 52% vs. 30% for somewhat sick and 20% for not sick). On the other hand, severity was not associated with administering herbal treatment or pharmaceutical drugs at home, indicating that mothers applied cues other than severity for using herbal medicines and pharmaceuticals. At all sites, most mothers (range, 52% in 1 site in Lesotho to 76% in the Philippines) treated diarrhea at home. These findings showed that mothers were not only willing to treat their children with diarrhea at home, they were especially motivated to treat them when the children appeared seriously ill. In fact, at least 88% of children considered to be very sick were treated in 8 of 11 surveys. The results suggested that staff of health communication programs on diarrhea should consider perception of severity of diarrheal illness as well as knowledge of ORT when designing ORT promotion campaigns.

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.

PIP: The Philippine Department of Health conducted a national mass media communication campaign during the period March-September 1990 to support routine vaccination services. The campaign focused upon measles as a way to get mothers to bring their children to the health center, emphasized logistic knowledge in the mass-media messages, and focused upon urban areas with lower vaccination rates than rural areas. Examples of logistic emphasis include designating one day per week as vaccination day and giving clear information about the age for measles vaccination. An increase in vaccination coverage and a substantial increase in the timeliness of vaccination were observed which may be attributed to the improvement in carers' knowledge about vaccination. Most observed increase in knowledge was related to campaign exposure. There was no evidence of any programmatic change which could account for the increase in vaccination or evidence that increased health education efforts at health centers could account for the change in knowledge. These results indicate that when countries meet certain conditions, a mass communication campaign can significantly improve vaccination coverage. Conditions include access to media, expertise, and funds to produce and air high quality television and radio spots, and a routine system capable of handling the increased demand.

The impact of the Healthcom mass media campaign on timely initiation of breastfeeding in Jordan.

Initiation of breastfeeding within several hours after a child's birth increases the likelihood of exclusive breastfeeding and longer duration of breastfeeding. However, common beliefs among mothers and health-care providers and routine hospital practices can constrain timely breastfeeding initiation. This article examines the impact of a mass media breastfeeding campaign in Jordan within the context of other activities occurring during and after the child's birth. The campaign had a positive impact on all mothers' knowledge, and on timely initiation of breastfeeding for home and public hospital deliveries, but not for those in private hospitals. The findings indicate that a communication campaign can bring about change in breastfeeding initiation behavior, but that providing mothers with information should be but one part of an integrated program to ensure that hospital and midwife policies and practices support timely initiation.

PIP: The study aim was to examine the role of mass communication in increasing timely initiation of breast feeding after a birth in Jordan through 1) a 2-day seminar on lactation management for health professionals, and 2) 2 intensive television and radio campaigns aired between May 15 and July 15, 1989 and from mid-March through April 1990. Surveys were conducted before the media campaign in August and September 1988 and after in July and August 1990. 930 interviews were carried out in 1988 among mothers under 35 years of age with a child under 2 years of age; and 777 women with children under 20 months of age in 1990. Sample were weighted because of differences. The results showed that breast feeding significantly from 90.5% to 97.2%. Among breast feeding mothers, timely initiation increased significantly from 40% to 54%; timely initiation increased significantly only in public hospitals and home births. Knowledge about initiation of breast feeding within 6 hours of the birth increased from 51% to 75%. Only 5% of mothers were unexposed. There was a low, significant correlation between campaigns exposure in 1990 and knowledge. Logistic regression analysis, controlling for demographic predictors of breast-feeding initiation, showed that changes in initiation were related to media exposure in general and exposure to the campaigns. Women with high media exposure were significantly more likely to initiate breast feeding within 6 hours of the birth, if the birth was after the media campaign. Significant predictors of breast-feeding initiation were rooming in, delivery without use of anesthesia, withholding of supplementary feedings during the first 3 days, health personnel's advice to the mother about breast-feeding initiation, and a day or early evening birth. Surprisingly, a strong positive predictor of timely initiation was a mother's having received formula to take home. Those less likely to initiate breast feeding within the first 6 hours were urban mothers and those with a first child; although both urban and rural mothers showed increased timely initiation, there were larger increases outside the city and among experienced mothers. Delayed initiation was influenced more by policies and routine practices than individual impacts. Independent predictors of timely initiation, that were interrelated, were parity, residence, and where the child was born, which when controlled for, showed that rural, experienced mothers showed a significantly greater change in timing behavior. Caution is urged in applying these findings to other countries, or applying these findings to supplementation or duration of breast feeding. A careful media campaign must also be supported with appropriate hospital policies and routines.

HIV education for youth: the importance of social consensus in behaviour change.

Most theories of health education focus on change in the knowledge, beliefs, and skills of individuals as causes of behaviour change. We argue that this neglects the important contribution of the social environment in supporting healthier behaviour, and we describe a model of social consensus that allows alternative routes for educational influence at both individual and social levels. This model assumes that basic knowledge and skills for avoiding health threats may not be sufficient for behaviour change unless socially-mediated influences that can inhibit behaviour change are addressed. This is especially crucial given the nature of HIV infection and the controversy surrounding its discussion. We illustrate the potential for social influences to have played a role in inhibiting the adoption of safer sexual behaviour in young people, and use our model to analyse young people's responses to the epidemic as documented in available research. The analysis also suggests possible educational strategies to overcome social obstacles in the future.

Development communication today: optimism and some concerns.

PIP: Successful communication projects show that effective development communication depends on good context, good messages, good channel use, and good audience knowledge. Knowledgeable communication professionals know when and where not to carry out a communication program and when a communication program may be successful based on the context. A communication campaign in Jordan promoting breast feeding within 6 hours of delivery was not successful in private hospitals because they did not promote early initiation of breast feeding. Good communication programs use formative research to develop messages that solve problems of which audiences are aware and build on or respond to current behaviors. In the Philippines, messages about child's age for measles vaccination resulted in improved vaccination coverage rather than those emphasizing the dangers of measles. Precampaign research helps identify what communication channels are the most effective and reach the greatest audience. In Swaziland, face to face communication was 1.5 times more effective than the mass media, but 3 times as many people has access to a radio. So the radio was more effective. Communication programs must know their audience well and be able to track it to determine the successes as well as the failures of the campaign. Even though some professionals have adequate technical knowledge to affect development communication well, the successes of early communication projects do not seem to endure. Sometimes the immediate health benefits justify the communication campaign. Further, limited political will, the fact that the campaign does not match the health educators' routine, and limited skilled health educators are obstacles to institutionalization. The key to sustained communication capacity is patience to stay for the long term. Other needs are a consistent call on budgets and staff, some satisfaction with what has already been accomplished, and translating the successful strategies used in the short term to successful strategies in the long term.^ieng

Knowledge of oral rehydration and response to diarrhea: a comparison among healthcom sites.

This article examines evidence for the relationship between knowledge of diarrhea and oral rehydration and treatments given for diarrhea among young children in seven different research sites. The evidence comes from cross-sectional analyses of household surveys conducted for the evaluation of oral rehydration programs. The cross-site comparisons show that mothers or caretakers who understand most about the dangers of diarrhea are not more likely to treat the diarrhea, but that those who understand the benefits of using oral rehydration are more likely to give fluids, particularly oral rehydration solutions, than those without such understanding.

A descriptive analysis of infant social referencing.

The study was designed to provide a descriptive analysis of the frequency and patterning of social referencing in a seminaturalistic setting. 32 infants, half of them 12 and half 18 months old, were observed exploring a caged rabbit with their mothers present. Referencing was operationalized as looks directed toward the mother following a look to the rabbit, accompanied by quizzical facial or vocal expressions. As a function of initial reaction to the rabbit, the infants were classified as wary or bold. Wary infants were more likely to reference their mothers when the rabbit was first presented; however, as the exploration period progressed, bold and wary infants referenced equally often. Referencing occurred less often than affective sharing; it increased in frequency when the mother was instructed to actively offer information and the infant no longer needed to solicit information by looking at her. Mothers directed both affective and instrumental information to their infants, providing affective information through facial expressions and tone of voice, and emphasizing instrumental information in the semantic content of their vocalizations.

Reaching mothers in Swaziland: preliminary findings of a child survival program.

PIP: The Swaziland Diarrheal Disease Control campaign, a collaboration of the Ministry of Health of Swaziland, the Combatting Childhood Communicable Diseases project, and the Agency for International Development (AID) Communication for Child Survival (HEALTHCOM) Project, was based on earlier work in Swaziland as well as the previous health communications programs in Honduras and Gambia. As in the other programs, it relied on a combination of mass media and face-to-face channels in an effort to change practices related to the treatment of diarrheal disease. The preparatory phase of the campaign was initiated in April 1984; the formal campaign ran from September 1984 through March 1985. The campaign involved 3 components: radio programs to be developed in an intensive radio workshop and broadcast on current development programs carried on the national radio system; printed materials including a flyer with mixing instructions and posters for display at health clinics and elsewhere; and workshops to train the health staff, other extension personnel, and local volunteers in treatment of diarrheal diseases, including use of oral rehydration therapy (ORT) for dehydration. The campaign focused on a few objectives, specifically: acceptance of a home-mixed water/sugar/salt (WSS) solution as a treatment for diarrheal dehydration; continued feeding during episodes of diarrhea; and feeding with special foods after diarrheal episodes. The campaign particularly emphasized the introduction of a new formula for mixing the solution -- 1 liter of water, 8 soda bottlecapfuls of sugar, and 1/2 capful of salt. The evaluation reveals preliminary results suggesting that the campaign achieved noteworthy success, particularly in rates of adoption of recommended practices. Data sources included before and after campaign surveys, each with 450 rural mothers chosen through national random sampling procedures, and a diarrheal disease registry kept by 20 clinics which listed more than 10,000 children during the course of the campaign. 9 of every 10 mothers reported having had contact with at least 1 of the selected campaign channels. 3 out of 4 rural Swazi households have working radios, and of those more than 80% reported having listened to the programs that carried the messages. The flyers, the only widely distributed printed materials, were recognized by 3 out of 5 mothers and were owned by 1 in 5 mothers. After the first 6 months of the campaign, more than 1 in 5 rural women had learned and could repeat the correct formula. By the 3rd month of the campaign, 60% of the children had been treated with WSS or ORS -- a level sustained over the remainder of the campaign. These are preliminary evaluation results. Analysis will continue for some months with subsequent reports on data from a study of the validity of self-report data; analyses of effects of exposure to campaign channels on individuals' learning and practice; and people's susceptibility to campaign messages.^ieng