Transcript Document

Exposure to Family Planning Messages
through Mass Media and Interpersonal
Communication and Current Contraceptive
Use in Ghana
Claire Bailey
[email protected]
Supervisors: Dr J.W. McDonald & Dr Zoë Matthews
Outline of Presentation
Rationale
for study - The Ghanaian context
Aims of study
Theoretical background
Introduction to data – Ghana 2003 DHS
Methodology
Definition of study variables
Results
Conclusions
The Ghanaian Context

Estimated population in
2005 of 21 million
 Population growth rate in
2005 was 1.25%.
 The 2005 Total Fertility
Rate is 3.02
 GDP per capita (ppp) was
estimated in 2004 as
$2,300
Trends in Contraceptive Use in Ghana
Trends in contraceptive use
among currently married women
aged 15-49 (% )
30
25
20
15
10
5
0
any method
modern method
1988
1993
1998
2003
traditional
method
Ghana’s Poverty Reduction Strategy
Vision 2020 Plan of Action
 Aim to have contraceptive prevalence of modern
methods of 15% by 2000 and 50% by 2020
 Strategy to decentralize service delivery and
support national campaign on fertility regulation
including comprehensive Information, Education
and Communication (IEC) programme to
promote the use of family planning
Aims of Study
 The
aims of my study were to determine if there
is any association between current use of
modern contraceptives among Ghanaian
women and:
exposure to family planning messages
through a range of different mass media
channels
exposure to interpersonal communication
regarding the use of family planning
Theoretical Background

The appeal of using mass media communication
channels to promote family planning messages is the
wide spread coverage and cost effectiveness.
 Some debate about its effectiveness and two primary
competing theories:
 Ideational Hypothesis - media effects are universal
and each individual may be prompted to change their
attitude and behaviour by exposure to modern ideas
 Diffusion of Innovation Theory - mass media is
effective at creating awareness and knowledge of
innovations, but interpersonal communication is
necessary for actual behaviour change
Data

2003 Ghana Demographic Health Survey (GDHS)
 Sub-sample drawn to include all women who are
potentially at risk of pregnancy and therefore potential
contraceptive users:
 All women aged 15-49 currently in union
(married or living with a man) AND
 All unmarried women aged 15-49 who are
currently sexually active (within past month
of survey date) – unmarried includes, never married,
separated, widowed and divorced
From this subset cases were excluded where the women is
one or more of the following:
 Currently pregnant
 Amenorrheic
 Infecund
 Menopausal
 Currently abstaining
The final data set contains 2065 cases
Methodology
 Binary
logistic regression modelling with current
use of a modern contraceptive as the response
variable.
 Multi-level modelling was used, to allow for
random variation at the group as well as the
individual levels, to account for the hierarchical
clustered data structure which is a function of
the sampling of the survey and could lead to
dependence among the observations.
Study Variables
Binary response variable:
0 = not currently using a modern contraceptive method
1 = currently using a contraceptive method
Explanatory variables:
Exposure to Mass Media - Respondent has heard a family
planning message in the few months prior to survey from:
• Radio – yes/no
• Television – yes/no
• Newspaper/magazine – yes/no
Explanatory variables –
Interpersonal
communication:
 Respondent has heard
a family planning
message from a Health
worker
 Respondent has heard
a family planning
message at a
community Meeting
 Respondent has
discussed family
planning with someone
other than partner
Control variables:
Age
Education
Occupation
Religion
Ethnicity
Region
Urban/rural
Number of living
children
Marital status
Results – Respondent Characteristics
Variable
% of respondents (n)
Total n=2065
Variable
% of respondents (n)
Total n=2065
Response
Interpersonal Communication
Current use
No
71 (1461)
Fphealthworker
Yes
29 (604)
No
43.7 (903)
Yes
56.3 (1162)
FP exposure- mass media
fpnews
No
81.1 (1675)
Fpcommunity
Yes
18.9 (390)
No
63.0 (1301)
Yes
27.0 (764)
Fptv
No
49.3 (1018)
Yes
50.7 (1047)
Fpradio
No
19.2 (396)
Yes
80.2 (1669)
Discussedothers
No
69.9 (1443)
Yes
30.1 (622)
Results- Simple Logistic Regression
β
SE (β)
Exp (β)
95% CI
fpnews
0.34**
0.12 1.40
(1.12,1.76)
fptv
0.36***
0.10 1.44
(1.19,1.74)
fpradio
0.43***
0.13 1.54
(1.19,1.99)
discuss
0.67***
0.10 1.96
(1.61,2.40)
fphealth
0.62***
0.10 1.85
(1.52,2.26)
fpcomm
0.18
0.10 1.20
(0.99,1.46)
***p<0.001; **p<0.01; *p<0.05
NB: The intercepts and the baseline categories are omitted from this table, all
baselines are β=0 and Exp (β) = 1
Results- Multiple Logistic Regression
β
SE (β)
exp (β)
95% CI
Discussed FP with someone
other than partner
No (RC)
0.00
Yes
0.91***
1.00
0.16
2.48
(1.82,3.38)
FP message from health worker
No (RC)
0.00
Yes
0.54***
1.00
0.12
1.72
(1.34,2.19)
FP message from community meeting
No (RC)
0.00
Yes
0.46*
1.00
0.23
1.58
(1.01,2.52)
***p<0.001; **p<0.01; *p<0.05 RC = Reference Category
What next? – Model 2

To explore the possible indirect effect of exposure to
messages in the mass media a new model is fitted with
discussed family planning with others as the response
variable.
 Discussing family planning with others was chosen as
the response as literature suggests it is an intermediate
behaviour change variable and part of the mechanism
through which receiving family planning information from
mass media influences contraceptive behaviour.
 All other variables and model specification remain the
same
Results- Simple Logistic Regression
β
SE (β)
Exp (β)
95% CI
fpnews
1.18***
0.11
3.25
(2.59,4.08)
fptv
0.82***
0.10
2.28
(1.88,2.77)
fpradio
1.16***
0.15
3.19
(2.37,4.29)
***p<0.001; **p<0.01; *p<0.05 NB: The intercepts and the baseline
categories are omitted from this table, all baselines are β=0 and Exp (β) = 1
Results- Multiple Logistic Regression
β
SE (β)
Exp (β)
95% CI
FP message from radio
No (RC)
0.00
Yes
0.56**
1.00
0.18
1.76
(1.24,2.48)
FP message from Television
No (RC)
0.00
Yes
0.29*
1.00
0.13
1.34
(1.04,1.73)
FP message from Newspaper
No (RC)
0.00
Yes
0.53***
1.00
0.14
1.70
(1.26,2.28)
***p<0.001; **p<0.01; *p<0.05 RC = reference category
Other variables in the model are: Number of living children, Education, Region FP message from
health worker & FP message from community meeting
Random effects

Both final models were tested for the inclusion of random
effects components at the household and cluster level.
 The models were re-fitted with the same fixed effects
and adjusted to allow the intercept to vary first at
household then at cluster level.
 In all cases it was concluded that there is no significant
clustering effect and all of the observations in the data
can be treated as independent. The fixed effects models
are a valid and adequate approach to analysing this
data.
Conclusions

Exposure to mass media family planning messages does not
have a direct association with current use of modern
contraceptives after controlling for socio-economic factors.
 There is evidence that it does have indirect influence through
its strong positive association with interpersonal
communication which in turn is strongly and positively
associated with contraceptive use.
 Results support the diffusion of innovation hypothesis where
mass media works as part of a two-step flow process where
knowledge disseminated through the media prompts
interpersonal discussions, which then diffuses through social
networks and prompts behaviour change.
Thank-you very much.
Claire Bailey
[email protected]