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formative baseline study methods
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
Acknowledgements
  • Regional Heads
  • CSA
  • Enumerators

JHU/PCS - Ethiopia Reproductive Health Communication Project

design
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

design continued
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

sampling procedures focus groups
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

sampling procedures surveys
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

quality control procedures
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

quality control continued
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

instrument development
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

instrument development cont
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

analysis procedures
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

analysis procedures12
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

tea break 20 minutes
TEA BREAK – 20 minutes

JHU/PCS - Ethiopia Reproductive Health Communication Project

tea break over please be seated
Tea Break OVER Please Be Seated

JHU/PCS - Ethiopia Reproductive Health Communication Project

focus group results
FOCUS GROUP RESULTS

JHU/PCS - Ethiopia Reproductive Health Communication Project

general results family planning
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

theoretical results family planning
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

theoretical results family planning18
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

theoretical results hiv aids
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

theoretical results hiv aids20
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

conclusions family planning
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

conclusions hiv aids prevention
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

survey results
SURVEY RESULTS

Dr. Kim Witte

Johns Hopkins University, and,

Michigan State University

[email protected]

JHU/PCS - Ethiopia Reproductive Health Communication Project

sample characteristics
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

ideal family
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

family planning awareness practices
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

attitudes toward family planning methods
Attitudes toward Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

intentions to use family planning methods
Intentions to Use Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

family planning perceived threat efficacy
FAMILY PLANNING: Perceived Threat & Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project

associations of theoretical variables and intentions
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

slide31
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

slide32
Perceived Susceptibility of Having too Many Children

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide33
Perceived Response Efficacy for

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide34
Perceived Self-Efficacy for

Family Planning Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

intentions to use the pill
Intentions to Use the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project

defensive avoidance toward getting pregnant
Defensive Avoidance toward Getting Pregnant

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide37
Perceived Self-Efficacy for the Pill

JHU/PCS - Ethiopia Reproductive Health Communication Project

mechanisms underlying intentions to use the pill
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

variables underlying perceived self efficacy to use the pill
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

variables to target in family planning messages advocating the pill
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

variables to target in family planning messages advocating the pill41
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

family planning messages
Family Planning Messages

JHU/PCS - Ethiopia Reproductive Health Communication Project

hiv aids awareness practices
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

perceived hiv aids status self
Perceived HIV/AIDS Status - Self

JHU/PCS - Ethiopia Reproductive Health Communication Project

perceived hiv status others
Perceived HIV Status -- Others

JHU/PCS - Ethiopia Reproductive Health Communication Project

current behaviors i protect through monogamy
Current Behaviors – I Protect (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project

current behaviors partner protects through monogamy
Current Behaviors – Partner Protects (through monogamy)

JHU/PCS - Ethiopia Reproductive Health Communication Project

current behaviors i use condoms to protect self
Current Behaviors – I Use Condoms to Protect Self

JHU/PCS - Ethiopia Reproductive Health Communication Project

hiv aids prevention perceived threat and efficacy
HIV/AIDS PREVENTION:Perceived Threat and Efficacy

JHU/PCS - Ethiopia Reproductive Health Communication Project

associations of theoretical variables and condom behaviors
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

slide51
Perceived Severity of HIV/AIDS infection

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide52
Perceived Susceptibility to HIV/AIDS Infection

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide53
Perceived Response Efficacy for

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

slide54
Perceived Self-Efficacy for

HIV/AIDS Prevention Methods

JHU/PCS - Ethiopia Reproductive Health Communication Project

variables to target in hiv aids prevention messages
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

variables to target in hiv aids prevention messages56
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

hiv aids prevention messages
HIV/AIDS Prevention Messages

JHU/PCS - Ethiopia Reproductive Health Communication Project

after burying ourselves in data
After Burying Ourselves in Data…

JHU/PCS - Ethiopia Reproductive Health Communication Project

future plans supplemental report
Future Plans: Supplemental Report

Due June/July

JHU/PCS - Ethiopia Reproductive Health Communication Project

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