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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


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Acknowledgements

  • Regional Heads

  • CSA

  • Enumerators

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Design

  • 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


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Design Continued

  • 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


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Sampling Procedures – FOCUS 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

  • 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

  • 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

  • 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

  • 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.

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

  • 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

  • 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Tea Break OVERPlease Be Seated

JHU/PCS - Ethiopia Reproductive Health Communication Project


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FOCUS GROUP RESULTS

JHU/PCS - Ethiopia Reproductive Health Communication Project


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General results – Family Planning

  • 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


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Theoretical results: Family Planning

  • 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


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Theoretical results: Family Planning

  • 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


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Theoretical results: HIV/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

  • 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


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Conclusions: Family Planning

  • 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


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Conclusions: HIV/AIDS Prevention

  • 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

Dr. Kim Witte

Johns Hopkins University, and,

Michigan State University

wittek@msu.edu

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Sample Characteristics

  • 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

  • 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 Awareness & 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Intentions to Use Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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FAMILY PLANNING: Perceived Threat & Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Associations of theoretical variables and intentions

  • 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

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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Response Efficacy for

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Intentions to Use the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Defensive Avoidance toward Getting Pregnant

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Mechanisms Underlying Intentions 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 Perceived 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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HIV/AIDS Awareness & 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived HIV Status -- Others

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – I Protect (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – Partner Protects (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Current Behaviors – I Use Condoms to Protect Self

JHU/PCS - Ethiopia Reproductive Health Communication Project


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HIV/AIDS PREVENTION:Perceived Threat and Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Associations of theoretical variables and condom behaviors

  • 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Susceptibility to HIV/AIDS Infection

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Response Efficacy for

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Perceived Self-Efficacy for

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Variables to target in HIV/AIDS Prevention Messages

  • 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

  • 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

JHU/PCS - Ethiopia Reproductive Health Communication Project


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After Burying Ourselves in Data…

JHU/PCS - Ethiopia Reproductive Health Communication Project


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Future Plans: Supplemental Report

Due June/July

JHU/PCS - Ethiopia Reproductive Health Communication Project


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JHU/PCS - Ethiopia Reproductive Health Communication Project


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