"On the Wings of Wishes" (Icchedana), Adolescent Girls in Bangladesh Taking Flight Using A Social Behavioral Change Communication Program to Address Child Marriage Related Social Norms: A Longitudinal Panel Study.

This paper examines the relationship between exposure to a transmedia entertainment-education (EE) social and behavior change communication (SBCC) initiative with shifting child marriage-related social norms. Districts were selected purposively, whereas households were selected randomly. A total of 1102 households (n = 3905) with fathers, mothers, adolescent boys, and girls completed the baseline and endline survey. Logistic regression using panel data was conducted. There was a decline in the perceived prevalence of child marriage and dowry exchange within respondents' communities at endline. For injunctive norms, fathers reported significantly higher levels of disapproval for child marriage at endline. However, the reverse was true for mothers and adolescent girls. Almost all respondents had a significantly lower odds of identifying rewards/benefits and punishments/consequences associated with rejecting child marriage at endline. Most respondents with exposure to Icchedana were more likely to report the importance of injunctive norms or expectations of others on their behaviors, than those who were not exposed. Exposure to EE contributes to improved articulation of and shifts in social norms and engenders normative changes at the population level.

Assessing factors that support the abandonment of female genital mutilation in Ethiopia.

This study assessed both demographic and Social Ecological Model (SEM) variables associated with supporting the abandonment of female genital mutilation (FGM) in three regions of Ethiopia. Data were collected through structured quantitative questionnaires with study participants (n=1146), including adolescent girls, caregivers, social network contacts, and community influentials. Data were analyzed using the statistical software STATA/SE. Chi-square, binary logistic regression, and multivariate logistic regression were used to analyze the data. Results found the one significant association between support for FGM abandonment and demographic variables was having an education above secondary level (AOR=0.11, CI=0.01-0.92). For SEM variables, attitudes regarding identity (AOR=5.74, CI=1.42-23.11), expectation to abandon (AOR=56.88, CI=14.99-215.90), sanctions (AOR=23.00, CI=4.77-110.95), and social networks (AOR=4.61, CI=1.21-17.51) were found to be significant factors in supporting FGM abandonment. Programs should intervene on multiple levels of the SEM and focus on social norms to empower and mobilize communities toward the elimination of FGM.

What are the psychometric properties of a menstrual hygiene management scale: a community-based cross-sectional study.

BACKGROUND: The last decade has highlighted how menstrual hygiene management (MHM) is a public health issue because of its link to health, education, social justice and human rights. However, measurement of MHM has not been validated across different studies. The objective of this manuscript was to test the psychometric properties of a MHM scale. METHODS: An embedded mixed-method design was utilized. The girls (age 12-19) were from three districts of Uttar Pradesh (Mirzapur, Jaunpur and Sonebhadra), India. A total of 2212 girls participated in the structured questionnaire. Trained interviewers collected the data on tablets using computer assisted personal interviewing. A total of 36 FGDs were conducted among 309 girls between. Trained moderators collected the data. Factor analysis and thematic analysis was conducted to analyze and triangulate the data. RESULTS: More than 90% of the girls were from a marginalized caste. Overall, 28% of the girls practiced all six MHM behaviors adequately. The factor analysis found five separate constructs corresponding to menstrual health and hygiene management (MHHM) with a variation of 84% and eigenvalue of 1.7. Preparation of clean absorbent, storage of clean absorbent, frequency of changing and disposal loaded separately, corresponding to menstrual health. Privacy to change and hygiene loaded together (eigenvalue 0.91 each), corresponding to hygiene management. An underlying theme from the FGD was menstruation as a taboo and lack of privacy for changing the absorbent. CONCLUSION: MHM is multi-dimensional construct comprising of behaviors which were time-bound by menstruation (menstrual health) and behaviors not time-bound by menstruation (hygiene management). Based on these results, the author recommends that MHHM is used as an acronym in the future and proposes a revised definition for MHHM.

Narrative Persuasion and Social Norms in Entertainment-Education: Results from a Radio Drama in Mozambique.

Narrative persuasion and social norms are part of the most recent theorizing behind the health communication strategy known as entertainment-education. There is little research, however, that compares these theoretical constructs from Mozambique, a setting that has not been researched to the same extent as other EE practice locations. This study uses mixed methods data from the midline evaluation of Ouro Negro (English translation: Black Gold), an EE radio program for individual health and social change in Mozambique to answer two research questions: what is the relationship between exposure to Ouro Negro and narrative persuasion?, and what is the relationship between narrative persuasion with Ouro Negro and social norms? Quantitative results related to the first question indicated that exposure significantly predicted three narrative persuasion constructs in multivariate regression models, results confirmed by a storytelling activity in focus groups. Quantitative results for the second question, which utilized propensity score matching, were not significant, and findings from a qualitative 2 × 2 table activity confirmed that behaviors were not normative in the directions promoted by the radio drama. Implications and recommendations for future entertainment-education research are discussed.

How does a Social and Behavioral Change Communication Intervention Predict Menstrual Health and Hygiene Management: A Cross-Sectional Study.

BACKGROUND: Interventions in India to improve menstrual health and hygiene management (MHHM) have been implemented at the national, state, district and school level. However, evaluations of these interventions have been scarce. The objective of the study was to determine if a social and behavioral change communication (SBCC) intervention (GARIMA) had a relationship with knowledge, attitudes, interpersonal communication, restrictions and MHHM using a comparison group post-test only design among 2206 adolescent girls. METHODS: Intervention villages and adolescent girls were selected through stratified random sampling based on where GARIMA was implemented. Villages and adolescent girls in comparison villages were matched socio-demographically to intervention villages and adolescent girls. Multi-level logistic regressions assessed the relationship between the encoded exposure, mediators and MHHM. RESULTS: The results showed that the encoded exposure predicted all behaviors corresponding to MHHM. Additionally, adolescent girls in the high encoded exposure group had significantly higher knowledge about puberty and reproductive parts (AOR: 2.03 (95% CI: 1.31 - 3.15)), positive attitudes towards gender (AOR: 1.48 (95% CI: 1.02 - 2.16)) and higher levels of some discussion and dialogue (AOR: 1.41 (95% CI: 1.04 - 1.92)). CONCLUSIONS: Future programs should use SBCC to improve MHHM behavior but involve families, peers and community members to a greater extent in order to improve attitudes towards menstruation, attitudes towards restrictions, attitudes towards absorbent use and reduce restrictions within the community.

Encoded Exposure and Social Norms in Entertainment-Education.

Entertainment-education is an effective health communication strategy that combines or embeds educational messages into entertainment programs to bring about social and behavior change. For years, scholars have considered how entertainment-education works. Some contemporary theories posit that entertainment-education does not engender behavior change directly but does so through mediating variables. This study adds to the literature on this topic by exploring the direct relationship between exposure and social norms instead of their relationship through behavior as a mediator. Novel to this study is the use of encoded exposure, a continuous and recognition-based measure of exposure that includes ever watching, recall, involvement, and dose in its operationalization. Using cross-sectional data from Kyunki … Jeena Issi Ka Naam Hai, an entertainment-education program in India, this exploratory analysis indicates a positive and significant relationship between encoded exposure and social norms. How can this finding be applied to future programs? Questions remain, and replication is needed, but if it is not essential to go through behavior in order to change social norms, then implications emerge for the theory and practice of entertainment-education.

A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions.

Background: Community engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions. Methods: PubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used. Results: The search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement. Conclusion: These results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.

What Determines Vaccine Hesitancy: Recommendations from Childhood Vaccine Hesitancy to Address COVID-19 Vaccine Hesitancy.

Vaccine hesitancy is a prevalent and ongoing issue. However, due to the COVID-19 pandemic, additional attention has been brought to the topic of vaccine hesitancy. Vaccine hesitancy is a threat to the population's health globally. This article aims to acquire insights from previous literature to determine what works to increase vaccine uptake and how we can apply this knowledge to increase COVID-19 vaccine uptake. Research has focused chiefly on childhood vaccination and the hesitancy of caregivers. After conducting an extensive literature review, we have created a conceptual model of indicators that influence vaccine uptake for health providers and caregivers, which can also be used for vaccine recipients. Overall, the reasons for vaccine hesitancy are complex; therefore, a multifaceted approach is needed to address it. Understanding the factors that affect vaccine hesitancy will aid in addressing hesitancy and, in turn, lead to an increase in vaccine uptake.

Menstrual management among adolescent girls in Uttar Pradesh, India: An examination of interpersonal and mediated communication as delivery mechanisms for practical guidance.

Background: Adolescent girls' right to achieve menstrual health and hygiene management (MHHM) healthfully is yet to be realized. One reason is the lack of practical guidance on the procurement, use, and disposal of menstrual products. This study defined interpersonal practical guidance (IPG) as face-to-face communication and mediated practical guidance (MPG) as social and behavior change communication (SBCC) intervention-driven communications through print and media materials. We examine the impact of these two delivery mechanisms of practical guidance on adolescent MHHM knowledge, attitudes, and practices (KAP) following an SBCC intervention in India. Objectives: To understand how IPG and SBCC-driven MPG independently influence adolescent girls' KAP on the procurement, use, and disposal of menstrual products and whether those who receive both IPG and MPG have better KAP related to the procurement, use, and disposal of menstrual cloth or sanitary pads than those who receive only one form of practical guidance or none at all. Methods: Adolescent girls' questionnaire responses from GARIMA's case-comparison evaluation were analyzed using Stata/SE 17 (n = 2,384). Girls were matched on sociodemographic and socioeconomic variables. χ 2 analysis examined relationships between sociodemographic, practical guidance, and KAP variables. Multivariate logistic regression assessed associations between practical guidance and KAP variables. Results: There are significant associations between adolescent girls' KAP depending on whether they received IPG, SBCC-driven MPG, or both. IPG and MPG delivered together has greater odds of predicting correct menstrual management KAP than when delivered separately. These effects were most notable for adolescent girls' knowledge and practices related to using and disposing of menstrual hygiene products. Conclusion: There is urgent need to create positive, sustainable changes to address menstrual health and hygiene management. This study introduces an innovative approach that utilizes interpersonal and mediated communication as mechanisms to deliver practical guidance on menstrual management. Future interventions should implement and evaluate to better understand the role of practical guidance in ensuring all women and girls are prepared to confidently manage their menstrual health.

A Systematic Review of Menstrual Health and Hygiene Management (MHHM) as a Human Right for Adolescents Girls.

Despite its relationship with several development issues and sexual health, menstrual health and hygiene management among adolescents have until recently been ignored by practitioners and researchers. This paper is a systematic review of existing literature and argues that menstrual health and hygiene management is a human rights issue. 28,745 articles were screened, with 84 articles included in the full-text review and quality assessment. The results indicate that using a cross-cutting, human rights framework to address inadequate menstrual health and hygiene management is fundamental to promoting menstrual health and hygiene management with dignity among girls and women across the globe.

What Works to Address Violence Against Children (VAC) in and Around Schools.

Violence against children (VAC) is a pervasive, global issue with both short- and long-term health, social, and economic consequences. This systematic review sought to identify best practices for designing and implementing social and behavior change communication (SBCC) programs targeting VAC in and around schools. Combinations of key search terms within five domains were entered into four databases: PubMed Central, Google Scholar, Sociological Abstracts, and EBSCOhost. Results were screened according to the inclusion and exclusion criteria. Namely, articles had to be published in English, be published after March 2014, focus on VAC in and around schools, focus on children, and use SBCC approaches. The searches produced 892,271 results. Of these, 63,183 were screened and 54 articles were selected. These articles were combined with 16 articles, gathered from a previous systematic review using the same databases and search domains conducted by the same research team, for a total of 70 articles. Articles were quantitatively analyzed using a coding guide in STATA and qualitatively analyzed using Nvivo. Results showed that most programs addressed bullying, were implemented in high-income countries, and included children aged 10 and older. Best practices in program design were using theory, conducting formative research, and involving program beneficiaries. Best practices in implementation were combining whole-school and targeted approaches, including special and hidden populations, involving secondary and tertiary audiences, using nonclassroom settings, using peer leader/mentor and cascade training models, and conducting process monitoring. Implications and avenues for future planning and implementation of SBCC interventions to address VAC in and around schools are discussed.

Combining Theory and Research to Validate a Social Norms Framework Addressing Female Genital Mutilation.

Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question "Have you undergone FGM?" and "Do you know a family member who has undergone FGM?" respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1-3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02-0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05-0.3)], being 36 years old and above vs. 10-19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1-7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1-0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7-687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1-0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01-5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.

Measuring the effectiveness of communication programming on menstrual health and hygiene management (MHM) social norms among adolescent girls in India.

This manuscript has two objectives: (1) operationalise and measure the fit of two theory-based measures of social norms and (2) examine the relationship between a social and behaviour change communication (SBCC) initiative, social norms, and menstrual health and hygiene management (MHM) among rural adolescent girls in Uttar Pradesh, India. A population-based, case-comparison design was utilised. Interviews were conducted (n = 2212) using quantitative questionnaires. Social norms were operationalised in two ways: (1) a composite additive measure of self-approval, perception of other girls' approval and perception of other girls' practice of the desired MHM behaviour; (2) based on social restrictions. The composite measure had a better model fit, suggesting that social norms should be examined as a multi-dimensional construct with a two-way relationship between personal beliefs and injunctive and descriptive norms. Bivariate and multivariate analysis assessed the relationship between the SBCC intervention, social norms, and adequate MHM. Adolescent girls in the intervention group had more positive social norms (43.99% versus 21.11%) and those reporting positive social norms had 1.66 (95% CI: 1.33-2.09) times greater odds of being in the 'high' MHM practice group, indicating that SBCC interventions promoting positive social norms can impact practice of MHM.

Using TV talk show for public health media advocacy: a case study.

OBJECTIVES: Much of the focus of public health communication has been on bringing about individual change with relatively little attention to changing public policy through mass media. We conceptualized using TV talk shows as a tool to influence district level health policy. METHODS: A series of TV talk shows was recorded to present the maternal and newborn health situation and promises of public representatives and health officials from 10 project districts. The shows were aired on national circuit. Panellists were interviewed after the airing to know how much were they influenced by this advocacy intervention. RESULTS: Both public representatives and health officials remembered the issue of maternal and newborn health, the project and their participation in the show. Two third of the participants felt more accountable after having given on-camera commitments while half of them informed there were policy discussions or progress in implementation of decisions to improve maternal and newborn health after attending the show. The participants felt a sense of accountability after appearing on TV screen to make pledges on improving the health situation in their district. They appreciated this advocacy initiative and expressed their desire to participate in such shows in future as well. The cost of production and airing of the show was $1800 per episode. CONCLUSION: TV talk show is an effective media intervention having low costs, and can be used for public health advocacy in developing countries.

Using Social Media to Communicate Sustainable Preventive Measures and Curtail Misinformation.

Effective crisis and risk communication strategies are crucial to promote preventive measures, particularly during times of emergency such as the global SARS-CoV-2 (COVID-19) pandemic. With its global reach, social media is a key source of news and information about COVID-19. However, the abundance of misinformation about personal protective measures that people post on social media, makes it imperative to develop a deeper understanding of effective messaging strategies. Improving the quality of information and strategy with which it is disseminated through social media is crucial to minimizing anxiety, panic and improving the adoption of sustainable preventive measures in addition to curtailing misinformation. Understanding the components of effective health communication strategies allows us to glean common methods to address misinformation which in turn lead to people adopting the appropriate preventive measures. The purpose of this article is to understand how effective social media communication strategies can be crafted to promote sustainable preventive measures and curtail wide-spread misinformation. Health organizations as well as communications organizations have made available information for effective social media messaging and more importantly serve as a gateway to other resources. We review their recommendations to identify common social media communication elements on the adoption of sustainable preventive measures and effective strategies for curtailing misinformation. We further review social media messaging during the Ebola and Zika outbreaks to evaluate the success of social media strategies and draw from lessons learned. We then create a set of best practices for developing and disseminating social media messaging regarding COVID-19.

From Salt to Stroke-Evaluation of a Media Campaign for Sodium Reduction in Philadelphia.

Excess dietary sodium contributes to the burden of chronic disease, including cardiovascular disease and stroke. Media-based health education campaigns are one strategy to raise awareness among populations at greater risk for stroke, including African Americans. During 2014-2015, the Philadelphia Department of Public Health conducted a health education campaign using radio, print news, and transit ads, to promote awareness of the link between dietary sodium, hypertension and stroke, and encourage reduced consumption of high sodium foods. Using a repeated cross-sectional design, street intercept surveys were conducted with ~400 Philadelphia residents representing the campaign's priority audience (African Americans ages 35-55) before and 6-13 weeks after the campaign, to evaluate both process (campaign exposure) and impact (recall of key health messages). Thirty percent of post-campaign respondents reported familiarity with one of the most engaging radio spots, and 17% provided accurate unaided recall of its key content, with greater recall among older respondents and frequent radio listeners. Forty-one percent of post-campaign respondents named stroke as a consequence of excess salt consumption, compared to only 17% of pre-campaign respondents, with greater awareness of the salt-stroke connection among those accurately recalling the radio spot from the campaign. Results suggest that priority populations for sodium reduction can be effectively reached through radio and transit campaigns. From a pragmatic perspective, street intercept surveys may offer one low resource strategy for evaluating public health education campaigns conducted by local health departments, especially among urban populations.

Comparative cost-effectiveness of the components of a behavior change communication campaign on HIV/AIDS in North India.

Numerous studies show that exposure to entertainment-education-based mass media campaigns is associated with reduction in risk behaviors. Concurrently, there is a growing interest in comparing the cost-effectiveness of HIV prevention interventions taking into account infrastructural and programmatic costs. In such analyses, though few in number, mass media campaigns have fared well. Using data from a mass media communication campaign in the low HIV prevalence states of Uttar Pradesh, Rajasthan, and Delhi in Northern India, in this article we examine the following: (1) factors that mediate behavior change in different components of the campaign, comprising a TV drama, reality show for youth audiences, and TV spots; (2) the relative impact of campaign components on the behavioral outcome: condom use; and (3) the cost-effectiveness calculations arising from this analysis. Results suggest that recall of the TV spots and the TV drama influences behavior change and is strongly associated with interpersonal communication and positive gender attitudes. The TV drama, in spite of being the costliest, emerges as the most cost-effective component when considering the behavioral outcome of interest. The analysis of the comparative cost-effectiveness of individual campaign components provides insights into the planning of resources for communication interventions globally.

Involving husbands in safe motherhood: effects of the SUAMI SIAGA campaign in Indonesia.

Maternal death has implications for the entire family, although few, if any, interventions have addressed the role that the husband could play in his wife's pregnancy and delivery. The Suami SIAGA Campaign in Indonesia was a multi-media entertainment-education intervention, implemented in 1999/2000, that targeted husbands with messages about birth preparedness. The present paper presents the effects of this campaign (1) on the acquisition of new knowledge by husbands about birth preparedness, and (2) on husbands' action toward becoming an alert husband (a Suami SIAGA). When husbands were directly exposed to the messages from the Suami SIAGA campaign, new knowledge gain and birth preparedness activities occurred. However, the interaction of direct exposure to the campaign and the interpersonal communication stimulated by the campaign about Suami SIAGA was an even stronger predictor of knowledge gain and birth preparedness actions. Limitations of the study included post-only measures and a relatively short time period between the intervention and impact evaluation. We suggest that communication campaigns to educate husbands and to stimulate discussion about the innovative concept of birth preparedness may contribute to improved birth outcomes in Indonesia.

Indirect exposure to a family planning mass media campaign in Nepal.

It is often noted that some individuals become aware of a mass media program's messages through discussions with other individuals. However, the extent to which indirect exposure occurs, and its influence on behavior, are somewhat unclear. This study examines the role of indirect exposure in extending the reach of a family planning mass media campaign in Nepal. Sociometric data, gathered from nearly all women between the ages of 15 and 49 years living in six villages in Dang District, Nepal (N = 667), assessed indirect exposure to the radio program. Indirect exposure was extensive; half of all respondents were indirectly exposed to the program's messages and the overall reach of the program increased from 50% to 75% when indirect exposure was considered. Members of community groups had higher levels of direct exposure to the radio program and more extensive and diverse social networks, allowing them to serve as a conduit for these messages into the wider community. While direct exposure to the radio program appeared to influence family planning knowledge, indirect exposure was more strongly associated with contraceptive use. These findings suggest that program evaluations that ignore indirect exposure underestimate the impact of a mass media program on behavior.