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Formative baseline study methods l.jpg

  • This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • In Slide Show, click on the right mouse button

  • Select “Meeting Minder”

  • Select the “Action Items” tab

  • Type in action items as they come up

  • Click OK to dismiss this box

  • This will automatically create an Action Item slide at the end of your presentation with your points entered.

Formative & Baseline Study Methods

Befekadu Girma, M.Ph.

Development Studies Associates

Addis Ababa, Ethiopia

Kim Witte, Ph.D.

JHU/CCP

JHU/PCS - Ethiopia Reproductive Health Communication Project


Acknowledgements l.jpg
Acknowledgements which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Regional Heads

  • CSA

  • Enumerators

JHU/PCS - Ethiopia Reproductive Health Communication Project


Design l.jpg
Design which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Sample

    • Males and Females Aged 15-30

    • In Two Most Urban Towns in Five Regions

      • Addis Ababa and Environs: Akaki and Gedam-Sefer

      • Amhara: Bahr Dar and Gonder

      • Oromia: Jimma and Nazareth

      • SNNPR: Awassa and Arba-Minch

      • Tigray: Adigrat and Mekele

JHU/PCS - Ethiopia Reproductive Health Communication Project


Design continued l.jpg
Design Continued which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Qualitative Research

    • 20 Focus Groups

      • 4 per region

      • Males 15-20, Females 15-20, Males 21-30, Females 21-30

  • Quantitative Research

    • Face-to-Face Surveys

    • 800 participants total (792 completed)

    • b > .80, a = .05 (2 tailed tests)

JHU/PCS - Ethiopia Reproductive Health Communication Project


Sampling procedures focus groups l.jpg
Sampling Procedures – which will create action items. Use PowerPoint to keep track of these action items during your presentationFOCUS GROUPS

  • Purposively Selected to capture age, sex, demographic differences in perceptions and practices

  • Excluding any participants already interviewed for survey.

  • Average of 8 participants per group

  • 161 total focus group participants

  • Discussions lasted about 2 hours

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Sampling Procedures -- SURVEYS which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Complete Random Sample

    • Using random numbers table

      • Randomly selected zone, then woreda, then kebele, then households (all from fresh lists)

      • Households having persons aged 15-30 were eligible for the study

  • Non-responses replaced by next eligible household (occurred only 5 times).

  • One person per household interviewed.

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Quality Control Procedures which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Coordination: National & Regional

  • Manual Developed

    • Objectives, strategies, norms for study

    • Asking demographic, sexual questions

    • Family planning, HIV/AIDS issues

    • Procedures, precautions during survey/focus groups

    • Do’s and Don’ts

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Quality Control Continued which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Training

    • Two Stages: Training of trainers, training of supervisors and interviewers

    • Theory, sampling techniques

    • Mock exercises, Practice in the field

    • Feedback

  • Completed questionnaires reviewed at the end of each day

  • Spot checks of interviewers/moderators throughout study by national coordinator

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Instrument Development which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Questions and items developed according to theory

  • Based on validated and reliable items used in previous studies

  • Piloted and refined to fit Ethiopian culture

  • Focus Group Guide

    • Open-ended questions

    • Piloted and refined for flow, understandability

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Instrument Development – Cont. which will create action items. Use PowerPoint to keep track of these action items during your presentation

Survey Questionnaire

  • Open and close-ended items

  • 5-point Likert-type scales

    1 2 3 4 5

    Strongly Strongly

    Disagree Agree

  • Respondents adapted easily to response format

  • Item analysis indicated valid and reliable scales

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Analysis Procedures which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Focus Groups

    • Audiotapes professionally transcribed

    • Translated ver batim into English

    • Research team developed Classification Scheme to code phrases/thoughts

    • Subgroup analysis conducted by age, sex, region

    • Similarities/Dissimilarities extracted

    • Coded material placed into tables

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Analysis Procedures which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Survey Questionnaires

    • Pre-coded numerical responses

    • Open-ended items numerically coded

    • Data entered, cleaned in SPSS

    • 10% data double-entered to verify accuracy

    • Scales created, reliability analysis conducted for all theoretical variables

    • Frequencies, descriptives analyzed

    • T-tests, one-way ANOVA, correlations, and logistic regression analysis conducted

JHU/PCS - Ethiopia Reproductive Health Communication Project


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TEA BREAK – 20 minutes which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Tea Break OVER which will create action items. Use PowerPoint to keep track of these action items during your presentation Please Be Seated

JHU/PCS - Ethiopia Reproductive Health Communication Project


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FOCUS GROUP RESULTS which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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General results – Family Planning which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Major Health Problems

    • HIV/AIDS, malaria, TB, dysentery

  • Most Important Health Problem

    • HIV/AIDS

  • Ideal Family Size

    • 12 groups preferred 2-4 children

    • Nazareth groups preferred 10-12 children

JHU/PCS - Ethiopia Reproductive Health Communication Project


Theoretical results family planning l.jpg
Theoretical results: Family Planning which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Defining the Threat: What is negative about Having More Children than Desired (if anything)?

    • Inability to feed, clothe, educate, provide medical care

    • Maternal death

    • Loss of hopes/dreams, poverty, family breakups

  • Perceived Severity – outcomes listed above serious, but rare

  • Perceived Susceptibility (too many children)

    • High for members of 12 groups

    • Lower risk for members of 4 groups

JHU/PCS - Ethiopia Reproductive Health Communication Project


Theoretical results family planning18 l.jpg
Theoretical results: Family Planning which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • High Knowledge for Perceived Best Responses to prevent too many children

  • Perceived Response Efficacy: High, except for Condoms

    • Modern methods believed effective

    • Condoms -- many reservations

  • Perceived Self-Efficacy: Low to moderate

    • Inadequate knowledge re use, access

    • Fear of side effects

    • Lack of couples’ agreement

    • Lack of cultural or religious consent

    • Improper Use (failure to follow schedules, guidelines)

JHU/PCS - Ethiopia Reproductive Health Communication Project


Theoretical results hiv aids l.jpg
Theoretical results: which will create action items. Use PowerPoint to keep track of these action items during your presentationHIV/AIDS

  • Perceived Causes of HIV/AIDS: Accurate

  • Perceived Severity: Strong

  • Perceived Susceptibility: Sexually active persons, drivers, soldiers, youth, govt

  • Perceived Best Responses: Accurate

  • Perceived Response Efficacy

    • Monogamy 1st, then abstinence, then condoms

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Theoretical results: HIV/AIDS which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Perceived Self-Efficacy: Mixed

    • Ambivalent toward condoms

    • Significant barriers

  • Influence of Religion

    • Promotes abstinence and monogamy

    • Mixed opinions regarding whether religion influences HIV/AIDS protection practices

  • Influence of Local Beliefs

    • Doubted HIV existence

    • Doubted effectiveness of condoms

    • Fatalistic beliefs

JHU/PCS - Ethiopia Reproductive Health Communication Project


Conclusions family planning l.jpg
Conclusions: Family Planning which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • High knowledge levels

  • Serious threats identified, but rare events

  • High perceptions of susceptibility to having too many children; low susc to experiencing serious threats

  • High response efficacy

    • Except condoms – very low

  • Low self-efficacy (esp. condoms)

  • Perceived anti-religious sentiments

JHU/PCS - Ethiopia Reproductive Health Communication Project


Conclusions hiv aids prevention l.jpg
Conclusions: HIV/AIDS Prevention which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • High levels of knowledge about causes and best responses

  • High perceived severity

  • Low perceived susceptibility (others will get it, not me)

  • Response efficacy high, except for condoms (low)

  • Mixed self-efficacy perceptions;

    low for condoms

  • High perceived barriers to

    preventive methods

  • Local beliefs negatively affect prevention

JHU/PCS - Ethiopia Reproductive Health Communication Project


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SURVEY RESULTS which will create action items. Use PowerPoint to keep track of these action items during your presentation

Dr. Kim Witte

Johns Hopkins University, and,

Michigan State University

[email protected]

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Sample Characteristics which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • 74% Female, 26 % Male

  • 80% Orthodox, 10.4% Muslim

  • 49.9% Age 15-20; 51.1% Age 21-30

  • 68.3% Single, 22.2% Married

  • 40% students, 19.1% housewives, 15.4% unemployed

  • 84.7% primary or secondary education

  • 51.6% had ever had sex

  • 28% had at least one child

  • Age at 1st Sex**

    • Females = 16.69 years old

    • Males = 18.26 years old

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Ideal Family which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • Preferred family size was 2 – 4 children

  • Last pregnancy:

    • Wanted to get pregnant later, 22.1%

    • Did not want to get pregnant at all, 12.6%

  • Indicates Unmet Family Planning Need

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Family Planning which will create action items. Use PowerPoint to keep track of these action items during your presentationAwareness & Practices

  • 85.1% spontaneous awareness

  • 95.1% prompted awareness

  • 17% of males and 44% of females used some family planning method the “last time they had sex”

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Attitudes toward Family Planning Methods which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Intentions to Use Family Planning Methods which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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FAMILY PLANNING: Perceived Threat & Efficacy which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Associations of theoretical variables and intentions which will create action items. Use PowerPoint to keep track of these action items during your presentation

  • The greater one’s perceived susceptibility, the stronger one’s intentions to use the pill. (r = .14, p < .005)

  • The greater one’s perceived response efficacy, the stronger their intention to use family planning. (r = .16, p < .005)

  • The greater one’s perceived self-efficacy, the stronger their intention to use the pill. (r = .64, p < .001)

  • Perceived severity was unrelated to intentions to use the pill. (probable cause ceiling effects – 82% scored 4 or 5 on a five-point scale; only 12% choose a 1, 2, or 3)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Severity from which will create action items. Use PowerPoint to keep track of these action items during your presentation

Having too Many Children

  • Item read having more children than wanted led “to problems,” was “harmful to their future,” led “to bad outcomes,” and led “to negative consequences.“

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Susceptibility of Having too Many Children which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Response Efficacy for which will create action items. Use PowerPoint to keep track of these action items during your presentation

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for which will create action items. Use PowerPoint to keep track of these action items during your presentation

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


Intentions to use the pill l.jpg
Intentions to Use the Pill which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Defensive Avoidance toward Getting Pregnant which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for the Pill which will create action items. Use PowerPoint to keep track of these action items during your presentation

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Mechanisms Underlying which will create action items. Use PowerPoint to keep track of these action items during your presentationIntentions to use the Pill.

  • Best Fitting Model

  • Self-Efficacy, Susceptibility, Defensive Avoidance, being Married

  • c2 = 8.89, p = .35; Successfully predicts membership in fear control or danger control group 78% of the time; predicts pill usage correctly 91.2% of the time.

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables Underlying which will create action items. Use PowerPoint to keep track of these action items during your presentationPerceived Self-Efficacy to Use the Pill.

  • Best Fitting Model - c2 = 7.18, p = .52

    • Predicts group membership 76% of the time; predicts membership in high self-efficacy group 91% of the time

  • Subjective Norms

    • Other People

    • Religion

  • Barriers

    • Inconvenient

    • Talking with my partner

  • Past Behavior (prior usage of pill)

  • Response Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables to target in Family Planning Messages Advocating the Pill

  • Increase Perceived Self-Efficacy

  • Increase Perceived Susceptibility to having more children than desired or having a child now when you’d rather wait

  • Decrease Defensive Avoidance

  • Reinforce High Severity Perceptions

  • Reinforce High Response Efficacy Perceptions

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables to target in Family Planning Messages Advocating the Pill

  • Address Subjective Norms

    • Other People

    • Religion

  • Barriers

    • Inconvenient

    • Talking with my partner

  • Convince to Try on Trial Basis

  • Increase Response Efficacy Perceptions

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Family Planning Messages the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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HIV/AIDS the PillAwareness & Practices

  • 99.2% Aware of HIV/AIDS

  • 97% Knew could avoid infection

  • Spontaneous Knowledge of methods:

    • Use Condoms (79%)

    • Be Monogamous (77.8%)

    • Abstain from Sex (42.5%)

    • Avoid unclean needles (36%)

    • Avoid sharing razors/blades (28.3%).

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived HIV/AIDS Status - Self the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived HIV Status -- Others the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – I Protect the Pill (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – Partner Protects the Pill (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – the PillI Use Condoms to Protect Self

JHU/PCS - Ethiopia Reproductive Health Communication Project


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HIV/AIDS PREVENTION: the PillPerceived Threat and Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Associations of theoretical variables and condom behaviors the Pill

  • The greater one’s perceived susceptibility, the greater the condom use. (r = .32, p < .0001)

  • The greater one’s perceived response efficacy, the greater the condom use. (r = .48, p < .0001)

  • The greater one’s perceived self-efficacy, the greater the condom use. (r = .53, p < .0001)

  • The greater one’s perceived severity toward HIV/AIDS, the greater the condom use. (r = .06, p =.06; marginal significance, probably due to ceiling effect, M = 4.78 on 5-pt scale)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Severity of HIV/AIDS infection the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Susceptibility to HIV/AIDS Infection the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Response Efficacy for the Pill

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for the Pill

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables to target in HIV/AIDS Prevention Messages the Pill

  • Increase Perceived Self-Efficacy

    • Increase Knowledge/Awareness of HIV-Related Services

    • Make using condoms easy

    • Address Subjective Norms

      • Other people like me

      • My best friends

      • Unrelated = religion, partner

    • Decrease Stigma in Talking about HIV/AIDS

    • Address cost issues (perceive costs too much)

    • Increase discussion/talk in referent groups about HIV/AIDS and prevention messages

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables to target in HIV/AIDS Prevention Messages the Pill

  • Increase Perceived Susceptibility to experiencing HIV/AIDS (address Optimistic Bias)

  • De-Emphasize the Perceived Severity of AIDS (give people hope, talk about living (not dying) with HIV/AIDS, etc.).

  • Decrease Defensive Avoidance

  • Reinforce High Response Efficacy Perceptions

JHU/PCS - Ethiopia Reproductive Health Communication Project


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HIV/AIDS Prevention Messages the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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After Burying Ourselves in Data… the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Future Plans: the PillSupplemental Report

Due June/July

JHU/PCS - Ethiopia Reproductive Health Communication Project



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