Ricotta Emily E, Boulay Marc, Ainslie Robert, Babalola Stella, Fotheringham Megan, Koenker Hannah, Lynch Matthew
Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore 21202, MD, USA.
Malar J. 2015 Jan 21;14:15. doi: 10.1186/s12936-014-0531-0.
SBCC campaigns are designed to act on cognitive, social and emotional factors at the individual or community level. The combination of these factors, referred to as 'ideation', play a role in determining behaviour by reinforcing and confirming decisions about a particular health topic. This study introduces ideation theory and mediation analysis as a way to evaluate the impact of a malaria SBCC campaign in Tanzania, to determine whether exposure to a communication programme influenced universal coverage through mediating ideational variables.
A household survey in three districts where community change agents (CCAs) were active was conducted to collect information on ITN use, number of ITNs in the household, and perceptions about ITN use and ownership. Variables relating to attitudes and beliefs were combined to make 'net ideation'. Using an ideational framework, a mediation analysis was conducted to see the impact exposure to a CCA only, mass media and community (M & C) messaging only, or exposure to both, had on household universal coverage, through the mediating variable net ideation.
All three levels of exposure (CCA, M & C messaging, or exposure to both) were significantly associated with increased net ideation (CCA: 0.283, 95% CI: 0.136-0.429, p-value: <0.001; M & C: 0.128, 95% CI: 0.032-0.334, p-value: 0.018; both: 0.376, 95% CI: 0.170-0.580, p-value: <0.001). Net ideation also significantly increased the odds of having universal coverage (CCAOR: 1.265, 95% CI: 1.118-1.433, p-value: <0.001; M & COR: 1.264, 95% CI: 1.117-1.432, p-value: <0.001, bothOR: 1.260, 95% CI: 1.114-1.428, p-value: <0.001). There were no significant direct effects between any exposure and universal coverage when controlling for net ideation.
The results of this study indicate that mediation analysis is an applicable new tool to assess SBCC campaigns. Ideation as a mediator of the effects of communication exposure on household universal coverage has implications for designing SBCC to support both mass and continuous distribution efforts, since both heavily rely on consumer participation to obtain and maintain ITNs. Such systems can be strengthened by SBCC programming, generating demand through improving social norms about net ownership and use, perceived benefits of nets, and other behavioural constructs.
社会行为改变沟通（SBCC）活动旨在作用于个体或社区层面的认知、社会和情感因素。这些因素的组合，即“观念形成”，通过强化和确认关于特定健康主题的决策，在决定行为方面发挥作用。本研究引入观念形成理论和中介分析，作为评估坦桑尼亚疟疾SBCC活动影响的一种方法，以确定接触传播计划是否通过中介观念变量影响全面覆盖。
在三个社区变革推动者（CCA）活跃的地区进行了一项家庭调查，以收集关于长效驱虫蚊帐（ITN）使用情况、家庭中ITN数量以及对ITN使用和拥有情况的看法的信息。将与态度和信念相关的变量合并以形成“净观念形成”。使用观念框架，进行中介分析，以观察仅接触CCA、仅接触大众媒体和社区（M&C）信息或同时接触两者，通过中介变量净观念形成对家庭全面覆盖的影响。
所有三个接触水平（CCA、M&C信息或两者都接触）均与净观念形成增加显著相关（CCA：0.283，95%置信区间：0.136 - 0.429，p值：<0.001；M&C：0.128，95%置信区间：0.032 - 0.334，p值：0.018；两者都接触：0.376，95%置信区间：0.170 - 0.580，p值：<0.001）。净观念形成也显著增加了实现全面覆盖的几率（CCA优势比：1.265，95%置信区间：1.118 - 1.433，p值：<0.001；M&C优势比：1.264，95%置信区间：1.117 - 1.432，p值：<0.001，两者都接触优势比：1.260，95%置信区间：1.114 - 1.428，p值：<0.001）。在控制净观念形成时，任何接触与全面覆盖之间均无显著直接效应。
本研究结果表明，中介分析是评估SBCC活动的一种适用新工具。观念形成作为沟通接触对家庭全面覆盖影响的中介，对于设计SBCC以支持大规模和持续分发努力具有启示意义，因为这两者都严重依赖消费者参与来获取和维持ITN。通过SBCC规划可以加强此类系统，通过改善关于蚊帐所有权和使用的社会规范、蚊帐的感知益处以及其他行为构成要素来创造需求。
