Evaluation of the Confiance Totale Campaign in Togo: Associations Between Campaign Exposure and Family Planning Outcomes of Interest.

In Togo, family planning (FP) use remains low; only 24.1% of married woman ages 15 to 49 use modern FP. The West Africa Breakthrough ACTION (WABA) project developed the Confiance Totale radio campaign, which used a Saturation+ approach to encourage FP use. This study presents the results of an evaluation of Confiance Totale which investigates associations between campaign exposure and outcomes of interest. Following the broadcasts, the team conducted a cross-sectional household survey among 2,200 respondents ages 18 to 49. Combined and sex-stratified multivariable models predicting outcomes of interest controlled for sex, age, site, marital status, educational attainment, religion, and economic status. Upon hearing a campaign jingle, approximately 45% of participants had heard the campaign. Exposure to the campaign was associated with many ideational and behavioral outcomes including current use of a facility-dependent FP method (OR = 1.77, p < .001). In stratified models, several outcomes were significantly associated with exposure in the women-only models but not in the men-only models. Exposure to Confiance Totale was associated with nearly all ideational and behavioral outcomes of interest, particularly among women. This demonstrates that high dosage broadcasting may be effective in promoting confidence in the health system and improving perceptions of FP.

Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d'Ivoire: triangulation of three independent evaluations.

Merci Mon Héros (MMH) is a youth-designed multi-media campaign seeking to improve sexual and reproductive health and family planning (SRH/FP) outcomes among youth living in nine francophone countries. A mixed methods approach was implemented to assess the MMH campaign progress and impact in Côte d'Ivoire. Three data sources were triangulated to evaluate the campaign: social media listening (October 2019-January 2021); a quantitative cross-sectional monitoring survey (September 2020) with 412 youth (aged 16-24) and 597 adults (aged 25-49); and a qualitative study using a Most Significant Change approach (March 2021), including a total of 24 focus group discussions with youth (aged 15-24) and adults (aged 25+) exposed to the MMH campaign. Data from all three studies were analysed independently and then brought together through a triangulation workshop where the study team compared findings to achieve convergence in evaluation results. Social listening results showed topic-specific online conversations related to MMH campaign spiked significantly during the two-week period after topic-specific campaign posts (p < .05), suggesting potential campaign impact. Survey results showed both adults and youth were more likely to have spoken with someone about FP in the past five months if exposed to the campaign (p < 0.01). Qualitative findings support the campaign's effect on shifting attitudes and behavioural uptake of intergenerational communication among adults and youth. This evaluation shows evidence of MMH's strong potential for impact in encouraging communication and the need to focus efforts on strategies to strengthen supportive adults' communication competencies and redefine what it means to act in support of SRH/FP for youth.

The Salience of Trust to the Client-Provider Relationship in Post-Ebola Guinea: Findings From a Qualitative Study.

Lack of trust in the health care system can serve as a barrier to service utilization, especially in pandemic and postemergency settings. Although previous research has identified domains of trust that contribute to individuals' trust in the health system, little research exists from low- and middle-income countries, particularly during and after infectious disease outbreaks. The current study-conducted to inform activities for a post-Ebola program-explored perceptions and experiences of health care provision in post-Ebola Guinea, with particular attention to trust. Researchers conducted in-depth interviews with health workers (n=15) and mothers of young children (n=29) along with 12 focus group discussions with grandmothers of young children and 12 with male heads of household. The study occurred in Basse Guinée and Guinée Forestière-2 areas hardest hit by Ebola. Respondents identified a breach of trust during the epidemic, with several domains emerging as relevant for renewed trust and care-seeking practices. At the core of a trusting client-provider relationship was the inherent belief that providers had an intrinsic duty to treat clients well. From there, perceived provider competence, the hospitality at the facility, provider empathy, transparency about costs, and commitment to confidentiality emerged as relevant influences on participant trust in providers. Community members and providers expressed similar viewpoints regarding trust and discussed the role of open communication and community mobilization in rebuilding trust. Study findings informed a variety of program activities, including the development of campaign messages and interpersonal communication trainings for health workers. This study provides valuable insight about some underlying components of trust that can provide key leverage points to rebuild trust and promote care seeking in postemergency settings. This insight is informing program activities in the current Ebola response in Guinea and could be useful in other crises, such as the global coronavirus disease (COVID-19) pandemic.

'I can't leave everything in the hands of my husband': Economic constraints and gender roles in care-seeking in post-Ebola Guinea.

The 2014-2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men's engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when 'navigating' the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services - even when lacking direct financial control. Essentialist descriptions of men as 'providers' and women as 'navigators', therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men's engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays.

Parental factors and sexual risk-taking among young people in Côte d'Ivoire.

Côte d'Ivoire is the country worst affected by the HIV epidemic in West Africa, and young people in this country are a particularly vulnerable group. This study examined the relation between parental factors and sexual risk-taking among young people using logistic regression and survival analysis methods. Three parental factors (living in the same household as the father during childhood, perceived parental disapproval of early and premarital pregnancy, and parent-child communication about sexual abstinence) were positively associated with primary sexual abstinence (defined as yet to experience sexual debut), secondary sexual abstinence (defined as sexual abstinence subsequent to sexual debut) and reduced number of sex partners. The findings suggest that parental monitoring and control are important predictors of youth sexual behaviours and underscore the need to target parents and guardians in efforts to promote responsible sexual behaviours among adolescents. It is important to promote parent-child communication about sexual issues and empower parents and guardians to communicate effectively with their children and wards about sexual issues.

Parental factors and sexual risk-taking among young people in Côte d'Ivoire

Côte d'Ivoire is the country worst affected by the HIV epidemic inWest Africa, and young people in this country are a particularly vulnerable group. This study examined the relation between parental factors and sexual risk-taking among young people using logistic regression and survival analysis methods. Three parental factors (living in the same household as the father during childhood, perceived parental disapproval of early and premarital pregnancy, and parent-child communication about sexual abstinence) were positively associated with primary sexual abstinence (defined as yet to experience sexual debut), secondary sexual abstinence (defined as sexual abstinence subsequent to sexual debut) and reduced number of sex partners. The findings suggest that parental monitoring and control are important predictors of youth sexual behaviours and underscore the need to target parents and guardians in efforts to promote responsible sexual behaviours among adolescents. It is important to promote parent-child communication about sexual issues and empower parents and guardians to communicate effectively with their children and wards about sexual issues