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Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria.

Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L, Fagbemi B, Onyefunafoa EO, Fotheringham M, Lynch M - Malar. J. (2015)

Bottom Line: All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN).Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.

ABSTRACT

Background: While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net.

Methods: The study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State's December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines.

Results: For all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.

Conclusion: Exposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.

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Related in: MedlinePlus

Conceptual model for care and repair behaviours and outcomes. Attitudes towards care and repair are shown on the left, leading to specific intentions and behaviours. Textile strength, knitting pattern, and environmental factors are outside the household’s control, but contribute to overall net integrity. Likewise, overall impact is also affected by bioavailability of insecticide on the net, and presence and proportion of insecticide-resistant vectors (not measured in this study).
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Fig2: Conceptual model for care and repair behaviours and outcomes. Attitudes towards care and repair are shown on the left, leading to specific intentions and behaviours. Textile strength, knitting pattern, and environmental factors are outside the household’s control, but contribute to overall net integrity. Likewise, overall impact is also affected by bioavailability of insecticide on the net, and presence and proportion of insecticide-resistant vectors (not measured in this study).

Mentions: The BCC intervention followed the P-Process©, a five-step planning process for behaviour change programs developed by JHUCCP [20]. The intervention used an evidence-based design, beginning with a conceptual model (Figure 2) used to design formative research and the overall intervention [12], and informed by existing research [15]. Through this process, the target audience, key behaviours, barriers, and motivators related to net care and repair were identified. These findings informed the BCC campaign strategy, which was developed by the Center for Communication Programs Nigeria, a Nigerian non-governmental organization. Materials and messages were designed at a participatory workshop with local malaria stakeholders, scriptwriters, and design experts. The target audience for the care and repair messaging were all adults who own and use mosquito nets, with a focus on women, as they were identified in the formative research as being primarily in charge of net care and repair duties [12]. The multi-channel BCC strategy consisted of advocacy, radio airings, interpersonal communication (IPC), and print materials. Radio spots, print materials, campaign logos, and key messages (Table 1) were pre-tested in focus groups in rural and urban communities and further refined before launch in the 20 focus communities of the intervention site.Figure 2


Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria.

Koenker H, Kilian A, Hunter G, Acosta A, Scandurra L, Fagbemi B, Onyefunafoa EO, Fotheringham M, Lynch M - Malar. J. (2015)

Conceptual model for care and repair behaviours and outcomes. Attitudes towards care and repair are shown on the left, leading to specific intentions and behaviours. Textile strength, knitting pattern, and environmental factors are outside the household’s control, but contribute to overall net integrity. Likewise, overall impact is also affected by bioavailability of insecticide on the net, and presence and proportion of insecticide-resistant vectors (not measured in this study).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4308907&req=5

Fig2: Conceptual model for care and repair behaviours and outcomes. Attitudes towards care and repair are shown on the left, leading to specific intentions and behaviours. Textile strength, knitting pattern, and environmental factors are outside the household’s control, but contribute to overall net integrity. Likewise, overall impact is also affected by bioavailability of insecticide on the net, and presence and proportion of insecticide-resistant vectors (not measured in this study).
Mentions: The BCC intervention followed the P-Process©, a five-step planning process for behaviour change programs developed by JHUCCP [20]. The intervention used an evidence-based design, beginning with a conceptual model (Figure 2) used to design formative research and the overall intervention [12], and informed by existing research [15]. Through this process, the target audience, key behaviours, barriers, and motivators related to net care and repair were identified. These findings informed the BCC campaign strategy, which was developed by the Center for Communication Programs Nigeria, a Nigerian non-governmental organization. Materials and messages were designed at a participatory workshop with local malaria stakeholders, scriptwriters, and design experts. The target audience for the care and repair messaging were all adults who own and use mosquito nets, with a focus on women, as they were identified in the formative research as being primarily in charge of net care and repair duties [12]. The multi-channel BCC strategy consisted of advocacy, radio airings, interpersonal communication (IPC), and print materials. Radio spots, print materials, campaign logos, and key messages (Table 1) were pre-tested in focus groups in rural and urban communities and further refined before launch in the 20 focus communities of the intervention site.Figure 2

Bottom Line: All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN).Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, USA. hkoenker@jhu.edu.

ABSTRACT

Background: While some data on net durability have been accumulating in recent years, including formative qualitative research on attitudes towards net care and repair, no data are available on how the durability of a net is influenced by behaviour of net maintenance, care and repair, and whether behavioural change interventions (BCC) could substantially impact on the average useful life of the net.

Methods: The study used an intervention-control design with before-after assessment through repeated cross-sectional household surveys with two-stage cluster sampling following Nasarawa State's December 2010 mass campaign. All campaign nets were 100-denier polyester, long-lasting insecticidal nets (LLIN). Baseline, midline, and endline surveys occurred at one-year intervals, in March 2012, March 2013, and April 2014, respectively. Outcome measures were the proportion of confirmed campaign nets with observed repairs, and the proportion in serviceable condition, measured with proportionate hole index (pHI) and according to WHO guidelines.

Results: For all respondents, exposure to BCC messages was strongly correlated with increased positive attitude towards care and repair, and increases in attitude were positively correlated with observed net repairs, and with the proportion of nets in serviceable condition. In a multivariate regression model, positive care and repair attitude (OR 6.17 p = 0.001) and level of exposure (1 source: OR 4.00 p = 0.000; 3 sources: OR 9.34 p = 0.000) remained the most significant predictors of net condition, controlling for background and environmental factors. Nets that were tied up had 2.70 higher odds of being in serviceable condition (p = 0.001), while repairs made to nets were not sufficient to improve their pHI category. Estimated median net lifespan was approximately one full year longer for nets in households with a positive compared to a negative attitude.

Conclusion: Exposure to multiple channels of a comprehensive BCC intervention was associated with improved attitude scores, and with improved net condition at endline. It is possible for BCC interventions to change both attitudes and behaviours, and to have an important effect on overall median net lifespan. Care and repair messages are easily incorporated into existing malaria BCC platforms, and will help contribute to improved net condition, providing, in principle, more protection from malaria.

Show MeSH
Related in: MedlinePlus