Communication behavior affects health behavior: Understanding family planning behaviors among young couples in Nepal

Summary:

The purpose of this study is to develop and test a parsimonious model exploring how observable communication behaviorsinterpersonal and mediatedaffect a non-communication health behavior: contraceptive use. Evaluations of social and behavior change communication (SBCC) interventions often show how media exposure predicts behavior, with interpersonal communication having indirect effects on the behaviors of interest. The present study explores this interaction further, using longitudinal data from the Health Communication Capacity Collaborative (HC3) project in Nepal, to test whether the relationship between recall of or participation in HC3 Nepal activities and contraceptive use, itself, is moderated by social network communication about family planning (SNC on FP). Descriptive statistics and unadjusted and adjusted logistic regression models were used to assess associations between 1) program exposure, SNC on FP, and any current contraceptive use and 2) program exposure, SNC on FP, and any current contraceptive use stratified by baseline SNC on FP in order to identify the potential moderating effects of SNC on FP. Preliminary results showed significant differences in associations between SNC on FP at endline and contraceptive use when analyses were stratified by baseline SNC on FP. Similarly, exposure to HC3 activities and SNC on FP were significantly associated with contraceptive use among those reporting no use at baseline. Future research should examine in greater depth the complex underlying processes of communicative interaction, how people use it in their daily lives, and how it influences health behaviors.

Background/Objectives:

Social and behavior change communication (SBCC) interventions often use media to communicate health messages while also encouraging audiences to communicate with their social networks about the messages. These interventions draw on evidence showing how media exposure predicts behavior, with interpersonal communication having indirect effects on behaviors of interest. The present study explores this interaction further, using longitudinal data from the Health Communication Capacity Collaborative (HC3) project in Nepal, whether the relationship between recall of or participation in HC3 Nepal activities and contraceptive use, itself, is moderated by social network communication about family planning (SNC on FP).

Description Of Intervention And/or Methods/Design:

The HC3 Nepal project aimed to improve health outcomes in Nepal through a strategic family planning SBCC campaign. We analyzed panel data from currently married women of reproductive age (MWRAs, 18-49 with a child under five at baseline) cohabitating with their spouses at endline. Data were collected in 2015 and 2017 in 12 districts across Nepal. The independent variable was exposure to HC3 activities. The dependent variable was any current contraceptive use. The moderating variable was SNC on FP, defined as recent communication with all vs. less than all of the five closest social network members about FP. Descriptive statistics and unadjusted and adjusted logistic regression models assessed associations between 1) program exposure, SNC on FP, and any current contraceptive use and 2) program exposure, SNC on FP, and any current contraceptive use stratified by baseline SNC on FP to identify potential moderating effects of SNC on FP.

Results/Lessons Learned:

Nine-hundred fifty-five MWRAs were cohabitating with their spouse at endline. High SNC on FP increased from 47% to 54% at endline. Sixty-nine percent of participants described exposure to HC3 activities. Any current contraceptive use increased from 51% to 71% at endline. Multivariate logistic regression models showed that program exposure was not significantly associated with current contraceptive use at endline after adjusting for SNC on FP, baseline contraceptive behavior, or relevant socio-demographic characteristics. SNC on FP at endline was significantly associated with current contraceptive use among MWRAs reporting low SNC on FP at baseline only (AOR: 1.58, 95% CI: 1.04-2.42, p=0.033). Stratification by baseline contraceptive behavior showed that MWRAs exposed to HC3 activities or SNC on FP at endline had 2.0 and 1.6 times greater odds, respectively, of current contraceptive use at endline, but only among those not using a method at baseline (p=0.009 and p=0.022).

Discussion/Implications For The Field:

The purpose of this study was to develop and test models exploring how observable communication behaviorsinterpersonal and mediatedaffect a non-communication health behavior: contraceptive use. Preliminary results suggested a potential moderating role of SNC on FP as well as the influential role of baseline contraceptive behavior on subsequent contraceptive practices. Building on these preliminary findings, subsequent structural equation models of the moderating and potential mediating role of SNC on FP will be presented to examine in greater depth the complex underlying processes of communicative interaction, how people use it in their daily lives, and how it influences health behaviors.

Abstract submitted by: 

Ron Hess - JHU

Zoe Hendrickson - JHU

Douglas Storey - JHU

Carol Underwood - JHU