The role of ideation on the effect of an SBC intervention on consistent bed net use among caregivers of children under 5 years in Nigeria: a multilevel mediation analysis.

BACKGROUND: Malaria remains a significant public health challenge in Nigeria. Consistent bed net use (sleeping under a treated net every night) has been identified as a key malaria prevention behavior. This paper explores the relationship between mass media social and behavior change interventions, psychosocial factors, and consistent bed net use. METHODS: Data is from the endline survey of a USAID-funded social and behavior change communication campaign conducted from 2012 to 2017 across five states in Nigeria. The outcome measure was consistent bed net use, and the mediator variable was a composite measure called ideation from a set of psychosocial factors believed to influence bed net use. The independent variable was recall of malaria specific media messages. Multilevel mediation analysis explored if recall of malaria specific media messages had any effect on bed net related ideation and if this ideation had any effect on consistent net use. RESULTS: Respondents included in this study were on average aged 31 years, mostly married or cohabiting (97.5%) and female 75%. Four in 10 (39.7%) respondents were able to recall malaria specific messages. Respondents with low, moderate and high recall were 23, 32 and 80% more likely to have a higher ideational score in the emotional domain compared to those not able to recall. Respondents were more likely to have higher ideational scores in the cognitive domain if they had low (AOR = 1.26, 95% CI 1.15-1.38), moderate (AOR = 1.16, 95% CI 1.00-1.34) or high recall (AOR = 1.55, 95% CI 1.16-2.06), respectively compared to those with no recall. Similarly, respondents with low (AOR = 1.03, 95% CI .99-1.08), moderate (AOR = 1.15, 95% CI 1.08-1.23) and high (AOR = 1.15, 95% CI 1.01-1.30) recall were more likely to have a higher ideational score in the social domain compared to those with no recall. After adjusting for recall of media messages and other potential covariates, all three ideational domains also had a significant positive effect on consistent bed net use. For every unit increase in ideational score, the likelihood of reporting consistent bed net use increased by 5 to 10%. There was a significant indirect effect of recalling malaria specific messages on consistent bed net use through each of the ideational domains. CONCLUSION: Access to a bed net is a critical first step in the process of bed net utilization. However, psychosocial factors e.g., emotional, cognitive, and social domains of ideation also play a major role in bed net use. Mass media SBC interventions could potentially influence bed net related ideation and consequently improve net use behavior. Future Social and behavior change interventions should employ approaches that improve these domains of ideation within their audiences in order to increase bed net utilization.

Factors associated with caregivers' consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data.

BACKGROUND: Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets. METHODS: The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President's Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets. RESULTS: The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model. CONCLUSIONS: The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant.

The effectiveness of a national communication campaign using religious leaders to reduce HIV-related stigma in Ghana.

This article describes the effects of a national mass media and community-level stigma-reduction programme in Ghana, in which national and local religious leaders urged their congregations and the general public to have greater compassion for people living with HIV or AIDS (PLHA). Data were collected from men and women living in three regions, first in 2001 (n = 2 746) and again in 2003 (n = 2 926). Attitudes related to a punitive response to PLHA both improved over time and were positively associated with exposure to the programme's campaign, controlling for potential confounding variables. Respondents in the 2003 survey were 20% more likely than respondents in the 2001 survey to be willing to care for an HIV-infected relative in their own household and 40% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Overall, respondents exposed to the campaign were 45% more likely than those not exposed to it to be willing to care for a HIV-infected relative, and 43% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Respondents exposed to the campaign also had significantly more favourable scores on an attitude scale measuring the belief that HIV-infected individuals should be isolated from others. The results of this evaluation suggest that mass media channels and religious leaders can effectively address HIV-related stigma on a national scale.

An audit of fluid and heparin administration during interventional neuroradiologic procedures.

Vascular lesions of the brain such as aneurysms and arteriovenous malformations are increasingly being treated by radiologists. They use heparinized saline in pressurized bags to flush the catheter systems continuously. This fluid could have detrimental effects if the volume infused is high. Therefore, we measured the amount of heparinized saline used by radiologists and tried to assess its significance. Data were collected from the first 50 patients who underwent interventional treatment during September to December 2004. Fluid and heparin, administered by both the radiologists and anesthesiologists, were recorded in addition to demographics and postoperative complications. The mean age of patients was 49+/-14 years. The average volume of fluid given by the radiologists was 980+/-480 mL. The anesthesiologists administered an average of 1500 mL crystalloids and 650 mL of colloids. The overall fluid balance at the end of procedure was positive by 2122+/-947 mL. The amount of heparin administered by flush solution was a mean of 2500+/-1200 IU. The total amount of fluid administered had no relation to the development of vasospasm or infection. However, a statistically nonsignificant (P=0.15) 30% increase in total fluid administered to patients, who required postoperative mechanical ventilation, suggests that the relationship between fluid administration and postoperative mechanical ventilation should be investigated further in patients who undergo interventional neuroendovasular procedures. In conclusion, radiologists administer significant amount of fluid and heparin during interventional procedures. Routine recording and monitoring of all fluid and heparin administered is advisable in interventional neuroendovasular procedures. The relationship between fluid administration and postoperative mechanical ventilation should be investigated further in patients who undergo interventional neuroendovasular procedures.

Using health education theories to explain behavior change: a cross-country analysis. 2000-2001.

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.