Out of the box: Boosting your SBCC program by identifying local influencing factors: The Family Health Guide in Ethiopia

Summary:

Family health guide (FHG) is a behavior promotion and tracking tool produced by the Federal Ministry of Health and comprises 79 messages with cues to action and illustrations focusing on various health areas including reproductive health maternal and child health, and non-communicable diseases among others. The project completed cross-sectional studies with an interview of 2770 and 1773 rural women in reproductive ages at baseline and midline respectively. Household availability of the FHG was improved from 9.5% in baseline to 20.5% in the midterm. Baseline-midline with 63.5% program exposure comparison of health services uptake behaviors indicate there is significant improvement on the proportion of women tested for HIV during their pregnancy from 50% to 58%; health facility delivery from 43% to 48%; and post-natal care within 7 days 27.9% to 41.2% from baseline to midline. The regression analysis of midline data depicted women who had the FHG were more likely to test for HIV, Adjusted Odds Ratio (AOR) = 1.76, (95% CI: 1.29-2.4); to deliver in health facility, AOR 1.49, (95% CI: 1.11-1.99); to attend postnatal care services, AOR 1.67, (95% CI: 1.26-2.23). It was identified as a key influencing factor for promoting health behaviors by running 16 behavioral logistic regression models which helped identify it as a common influencing factor across behaviors. Increasing the availability of family health guide at household level improves several key behaviors and programs need to promote the FHG widely and ensure its use by rural communities in Ethiopia.

Background/Objectives

The Family Health Guide (FHG) serves as a behavior promotion and tracking tool for families. Developed by the government of Ethiopia and comprises 79 behavioral messages with cues to action and illustrations focusing on various health areas including reproductive health maternal and child health, malaria, water hygiene and sanitation, and non-communicable diseases among others. The Johns Hopkins Centre for Communication Programs Ethiopia conducted a baseline survey in 2015 and identified household availability of the FHG as a significant predictor for 4 health behaviors. The evidence was used to redesign the FHG and to promote and distribute it in the intervention

Description Of Intervention And/or Methods/Design

A cross-sectional before-after studies conducted for a representative sample of women in reproductive ages 15-49 years (2770 at baseline & 1773 women at midline) in rural districts (woredas) of four regions of Ethiopia: Amhara, Oromia, Southern Nations, Nationalities, and Peopleду»s (SNNP) and Tigray in March/April 2019. Household availability of the FHG, knowledge, gender norms and health behaviors of women were assessed. At baseline, behavioral logistic regression analysis was undertaken for the 16 outcome health behaviors across six health areas. The aim of this analysis was to identify common determinants that can then be strategically promoted to influence multiple behaviors.

Results/Lessons Learned

Household availability of the FHG improved from 9.5% at baseline to 20.5% at midterm. Midline program exposure was 63.5%. Baseline-midline comparison of health services uptake behaviors indicate there is significant (p< .05) improvement on the proportion of women tested for HIV during their pregnancy from 50% to 58%; health facility delivery from 43% to 48%; and post-natal care within 7 days 27.9% to 41.2% from baseline to midline. The regression analysis depicted women who had FHG at their house were more likely to test for HIV, Adjusted Odds Ratio (AOR) = 1.76, (95% CI: 1.29-2.4); to deliver in health facility, AOR 1.49, (95% CI: 1.11-1.99); to attend postnatal care services, AOR 1.67, (95% CI: 1.26-2.23).

Discussion/Implications For The Field

The out of box approach of using behavioral logistic modeling to identify contextual predictors of health behaviors yielded the finding that the FHG can play a major role in the integrated SBCC program in 4 regions of Ethiopia. Promoting FHG is easy, low cost and sustainable. Increasing the availability of family health guide at the household level improves several key behaviors. Behavior change communication programs shall promote the ownership of the FHG widely, and ensure the use of FHG by the rural community in Ethiopia.

Abstract submitted by:

Minyahil Woldegeorgis - Johns Hopkins Center for Communication Programs

Habtamu Tamene - Johns Hopkins Center for Communication Programs

Feleke  Tanga - Johns Hopkins Center for Communication Programs

Nandita Kapadia Kundu - Johns Hopkins Bloomberg School of Public Health

Simon Heliso - Johns Hopkins Bloomberg School of Public Health