Behavior Change Communication Research Articles

A Scoping Review of Existing Policy Instruments to Tackle Overweight and Obesity in India: Recommendations for a Social and Behaviour Change Communication Strategy

Background The Indian government is committed to address various manifestations of malnutrition, including overweight and obesity, inorder to improve individual health and well-being. The scoping review aims to map existing national policy instruments (programmes, schemes, regulations and guidelines) addressing overweight and obesity in India and analysing them for Social and Behaviour Change Communication (SBCC) strategies. Methods Systematic identification and selection of policy instruments using ‘Arksey and O’Malley’ framework was conducted from central government ministry websites, between March and June 2023. These instruments focused on nutrition and/or physical activity, targeting specific demographic groups like pregnant women, lactating mothers, children (0-5 years and 5-9 years), or adolescents (10-19 years); excluding those focusing on specific diseases like micronutrient deficiencies, wasting, and stunting. Based on search strategy six policy instruments were included and analysed for SBCC strategies. Results While many policy instruments incorporated SBCC plans; the ‘National Programme for Prevention of Non-Communicable Diseases (NP-NCD)’ stands out as a significant policy initiative specifically targeting the prevention of overweight and obesity within the broader context of Non-Communicable Diseases. It adopts a comprehensive approach addressing key drivers contributing to overweight/obesity across multiple levels of behavioural influence i.e., individual, interpersonal, community and organisation for health promotion. However, there’s need to strengthen SBCC strategies related to prevention and management of obesity, especially screening and counselling, to cover all age groups with a particular focus on adolescents and youth. SBCC strategies can also be incorporated into India’s Integrated Nutrition Support Programme (POSHAN 2.0) and/or Reproductive, Maternal, New-born, Child, Adolescent Health and Nutrition (RMNCAH+N) under the National Health Mission. Conclusion This paper underscores the necessity for comprehensive strategies to address multifaceted origin of overweight and obesity. The NP-NCD stands out as a noteworthy initiative, and there is considerable potential for other programmes to emulate it SBCC strategies to bolster their overall effectiveness. Note : *Policy instrument’s throughout the paper has been used to cover programmes, schemes, regulations and guidelines.

Semiquantitative Risk Evaluation Reveals Drivers of African Swine Fever Virus Transmission in Smallholder Pig Farms and Gaps in Biosecurity, Tanzania.

African swine fever (ASF) has remained persistent in Tanzania since the early 2000s. Between 2020 and 2021, pig farms in twelve districts in Tanzania were infected with ASF, and ≥4,804 pigs reportedly died directly due to the disease with disruption to livelihoods. We conducted semiquantitative field investigations and rapid risk assessment (RRA) to understand the risk factors and drivers of ASF virus (ASFV) amplification and transmission in smallholder pig farms, and determine the gaps in biosecurity through hazard profiling, focus group discussions and expert opinion. Outbreaks were connected by road and aligned along the pig product value chain and reported in the northern, central, and southern parts of Tanzania. The patterns of outbreaks and impacts differed among districts, but cases of ASF appeared to be self-limiting following significant mortality of pigs in farms. Movement of infected pigs, movement of contaminated pig products, and fomites associated with service providers, vehicles, and equipment, as well as the inadvertent risks associated with movements of animal health practitioners, visitors, and scavengers were the riskiest pathways to introduce ASFV into smallholder pig farms. Identified drivers and facilitators of risk of ASFV infection in smallholder pig farms were traders in whole pigs, middlemen, pig farmers, transporters, unauthorized animal health service providers, and traders in pork. All identified pig groups were susceptible to ASFV, particularly shared adult boars, pregnant and lactating sows, and other adult females. The risk of ASF for smallholder pig farms in Tanzania remains very high based on a systematic risk classification. The majority of the farms had poor biosecurity and no single farm implemented all identified biosecurity measures. Risky practices and breaches of biosecurity in the pig value chain in Tanzania are profit driven and are extremely difficult to change. Behavioural change communication must target identified drivers of infections, attitudes, and practices.

Impact of the Use of Street Play Mode of Education on the Self-care Capacity of Village Women for Lifestyle Modification for Prevention of Hypertension

Objectives: The objectives of this study were as follows: (1) To ascertain the prevalence of hypertension (HTN) among village women. (2) To determine the impact of an intervention strategy of Behavior Change Communication utilizing a camp approach supplemented with nukkad natak on the self-care capacity of village women for lifestyle modification for prevention of HTN. Materials and Methods: The study was conducted during June–July 2023 in the field practice area of Community Medicine of a medical college. Sample size was arbitrary (n = 200) out of all willing women attending outpatient departments during the study period. First, a baseline assessment of the study population was done. Street plays were held for the study population on HTN-related healthy lifestyle. Changes in their knowledge were documented. Appropriate statistical analysis was done using Excel sheets. Results: Most (79%) of the women in the village had normal blood pressure, with 19% of them having mild and 2% had moderate HTN. Most hypertensive women (72%) were not taking medications. Out of 12 hypertensive women who were taking antihypertensive medications, half of them were regular. There was a significant improvement in the score of self-care capacity, treatment HTN diet-related knowledge of the women after the intervention. Respondents liked the idea of organizing drama to propagate health-related messages. Conclusion: One in every five persons in the study population of rural health training centre (RHTC) had HTN. Most hypertensive women (72%) were not taking medications. Those who were taking antihypertensive medications, only half were regular in it. After Nukkad Natak based intervention, there was a significant improvement in the scores of HTN diet and treatment-related knowledge and self-care capacity of the respondents for prevention of HTN. Our respondents liked the idea of organizing drama to propagate health-related messages.

‘Counselling is not just providing information’: perceptions of caregivers and stakeholders on the design of nutrition and health counselling interventions for families with young children in rural Kenya

BackgroundGlobally, a fifth of the children continue to face chronic undernutrition with a majority of them situated in the Low- and Middle-Income Countries (LMIC). The rising numbers are attributed to aggravating factors like limited nutrition knowledge, poor feeding practices, seasonal food insecurity, and diseases. Interventions targeting behaviour change may reduce the devastating nutrition situation of children in the LMICs.ObjectiveFor the co-design of a Behaviour Change Communication (BCC) intervention for young children in rural Kenya, we aimed to identify the experiences, barriers, facilitators, and preferences of caregivers and stakeholders regarding nutrition and health counselling.DesignWe employed a qualitative study design and used a semi-structured interview guide. The in-depth interviews were recorded, transcribed, and analysed using content analysis, facilitated by the software NVivo.SettingHealth and Demographic Surveillance System (HDSS) area in Siaya County, rural Kenya.ParticipantsWe interviewed 30 caregivers of children between 6 and 23 months of age and 29 local stakeholders with experience in implementing nutrition projects in Kenya.ResultsNutrition and health counselling (NHC) was usually conducted in hospital settings with groups of mothers. Barriers to counselling were long queues and delays, long distances and high travel costs, the inapplicability of the counselling content, lack of spousal support, and a high domestic workload. Facilitators included the trust of caregivers in Community Health Volunteers (CHVs) and counselling services offered free of charge. Preferences comprised (1) delivering of counselling by CHVs, (2) offering individual and group counselling, (3) targeting male and female caregivers.ConclusionThere is a disconnect between the caregivers’ preferences and the services currently offered. Among these families, a successful BCC strategy that employs nutrition and health counselling should apply a community-based communication channel through trusted CHVs, addressing male and female caregivers, and comprising group and individual sessions.

Community Conversations: A Tool in Improving Health Outcomes and Reducing the Burden of Visceral Leishmaniasis (Kala-azar) in Isiolo County, Kenya

Visceral Leishmaniasis (Kala-azar) is a neglected tropical disease (NTD) caused by Leishmania species that affects human. Transmission is through the bite of Phlebotomus sandflies. Globally, WHO ranks Kala-azar as the second largest parasitic killer after Malaria. The disease poses a threat to more than a billion people on almost every continent. Approximately 90% of Kala-azar global burden is found in Africa. Major endemicity is documented in Eastern Africa (Kenya, South Sudan, Sudan, Ethiopia, and Somalia). Accurate burden of the disease in Kenya is unknown attributable to inadequate information on disease prevalence, diagnostic challenges, and spatial distribution. Additionally, morbidity and mortality levels from the disease in the Country are unknown ascribable to a low index of suspicion by healthcare workers, diagnostic challenges, and case management. An example of diagnostic challenges is a reported outbreak of ‘unknown disease’ akin to Kala-azar in Marsabit County in May 2023 where nine people were confirmed dead and over 80 hospitalized. This study aimed to analyze community’s prioritization of causes of Kalaazar as well as community awareness of disease prevention and control. Quantitative data were collected using Participatory Epidemiology methods in purposively selected study villages. Qualitative data were collected through semi-structured interviews. Study findings indicated that 97.2% of respondents had heard about Kala-azar. Despite the awareness, a broad gap between knowledge and practice of prevention and control strategies of the disease was evident. Kala-azar was associated with human behaviour like preferences for traditional and alternative treatment approaches (45.2%), evening outdoor practices before going to bed (99.6%), sleeping outdoors (60.1%), occasional bed nets use (69.2%), and availability of domestic animals and wild animals within house yards (54.6%). Cultural beliefs and practices were noted to play a key role in augmenting the disease burden, where most cases had burn scars from traditional healers’ therapeutic burns. As a consequence, they sought medical help after onset of complications, which ranged from increased severity to fatalities. Community engagement was minimal in prevention and control. In this participatory research, we propose behaviour change communication activities for the elimination of Kala-azar as a public health problem. This article serves as a base for future studies aimed at giving voice to communities while enhancing their understanding of causes of diseases, the possibility of enhanced early diagnostic techniques, and options for prevention, control, and surveillance which in turn is translated to action.

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

BackgroundEngagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.PurposeThe purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.MethodsDescriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.ResultsTotal of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.ConclusionThe study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

Improving the social communication skills of preschoolers with autism spectrum disorder: robot-based intervention on Picture Exchange Communication System use

Objectives Children diagnosed with autism spectrum disorder (ASD) often exhibit challenges in social communication. Picture Exchange Communication System (PECS) is effective in enhancing the social skills of children with ASD, and interventions using social robots are potentially beneficial training tools. However, it is uncertain whether robots can facilitate more effective training for children with ASD compared to human therapists. Methods In the present study, we compared the effectiveness of robot-based and human-based interventions on enhancing the social communication behaviors in young children diagnosed with ASD. The feasibility and efficacy of integrating the PECS in robotic systems were evaluated using a single-case design. Eight children with ASD were randomly assigned to either a robot-based group (N = 4) or a human-based group (N = 4). Participants in the two groups underwent phases I–III of the PECS protocol facilitated by either a human therapist or a robot therapist. Changes in social communication behaviors were assessed in each child after intervention using a single-case design. Results Half of the participants in the robot-based intervention group showed significant improvement in both verbal and nonverbal communication behaviors after a two-month PECS intervention. A higher proportion of children in the robot-based intervention group showed significantly enhanced social communication skills encompassing both verbal and nonverbal behaviors than in the human-based intervention group. Conclusions This study demonstrates the effectiveness of robot-based PECS intervention in enhancing verbal and nonverbal communication behaviors in young children with ASD. These findings present novel intervention tools for early intervention educators engaged in supporting children with ASD.

Exploring barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public hospitals; Northeast, Ethiopia, 2023: application of socio-ecological model

BackgroundHealth literacy is the important for the prevention of non-communicable disease to make informed health decisions, and practice healthy and protective behaviours. Therefore, application of socioecological model to this study aimed to identify multilevel factors on health literacy among patients and develop scientific health communication interventional strategies to improve health literacy on non-communicable disease prevention and care.ObjectiveTo explore barriers of health literacy on non-communicable disease prevention and care among patients in north wollo zone public Hospitals, Northeast Ethiopia, 2023.MethodIn this study phenomenological study design was conducted from February 5 to 30/2023.We have used purposive sampling technique to select study participants from chronic follow up clinics. Data were collected using in-depth interview and focused group discussion in which audio was recorded, transcribed verbatim and translated to English. Thematic analysis was performed with atlas ti. 7 software.ResultIn this study four main themes with seven subthemes were developed. The main themes were factors at the organizational, community, interpersonal, and intra-personal factors. The poor knowledge, lack of enough money for transportation and medication at the hospital were identified as barrier to get early diagnosis and treatment. Some participants explored that they have no any support from family or others. The cultural norms like weeding and funeral ceremonies enforce patients to consume prohibited substances like alcohol and salty foods.ConclusionIn this study different barriers of health literacy were explored. Lack of knowledge, economic problems, lack of social support, poor communication with health care providers, cultural influences, lack of regular health education, lack of access to health care services and poor infrastructure were main barriers of health literacy in patients with NCD. Therefore, we recommended all concerned bodies to work on social and behavioral change communication intervention focusing on awareness creation, supply of drugs and create supportive environment to get accessible and affordable health care service to decrease the impact of non-communicable disease at personal, community and national level.

Handwashing Practices among Public Primary School Students in East Dembiya District, Ethiopia.

Poor water sanitation and hygiene is a public health problem in developing and underdeveloped countries, including Ethiopia, and remains an important public health issue among primary school students. Students have been repeatedly exposed to various communicable diseases associated with water sanitation and hygiene. The objective of this study was to assess predictors of handwashing practice among second-cycle public primary school students in East Dembiya District, northwestern Ethiopia, 2022. A cross-sectional study was conducted among 752 second-cycle primary school students. Data were gathered through face-to-face interviews using a structured interviewer-administered questionnaire and observational checklists adopted and modified from different sources of literature. The data were checked further by visualizing and computing rates with the SPSS version 26 statistical software. Multivariable logistic regression was used to identify predictors. The prevalence of washing practices among second-cycle primary school students was 57.6% (95% CI 53.90-61.10). Residency (urban) (adjusted odds ratio [aOR] = 2.17, 95% CI: 1.30-2.87), access to media (aOR = 1.66, 95% CI: 1.11-2.49), hygiene and sanitation club membership (aOR = 1.88, 95% CI: 1.26-2.80), good knowledge about handwashing (aOR = 3.93, 95% CI: 2.34-6.60), and a positive attitude toward handwashing (aOR = 3.63, 95% CI: 2.01-5.584) were predictors of handwashing practice among second-cycle primary school students. This study showed that handwashing practice among primary school students was low. Availing handwashing facilities, better media access, formation of a hygiene and sanitation club in the school, celebration of "Handwashing Day" with students, and leading behavior change communication are all important for improving students' handwashing practice.

The Cost and Cost-Effectiveness of an Integrated Wasting Prevention and Screening Intervention Package in Burkina Faso and Mali

BackgroundLittle is known about costs and cost effectiveness of interventions that integrate wasting prevention into screening for child wasting. ObjectivesThis study’s objective was to estimate the cost and cost-effectiveness of an intervention that integrated behavior change communication (BCC) and small-quantity lipid-based nutrient supplements (SQ-LNS) into platforms for wasting screening in Burkina Faso (a facility-based platform, where BCC was enhanced compared with standard care) and Mali (a community-based platform, with standard BCC). MethodsActivity-based costing was used to estimate the cost per child-contact for the intervention and the comparison group, which did not receive the intervention. Costs were ascertained from accounting records, interviews, surveys, and observations. The number of child-contacts was calculated using population size estimates and average attendance rates for each service. Costs per disability-adjusted life year (DALY) averted were estimated using a Markov model populated with data from the parent trials on impact of wasting incidence and treatment coverage. ResultsIn the intervention group in Burkina Faso, the cost per child-contact of facility-based screening was $0.85 of enhanced BCC was $4.28, and of SQ-LNS was $8.86. In Mali, the cost per child-contact of community-based screening was $0.57, standard BCC was $0.72, and SQ-LNS was $4.14. Although no SQ-LNS costs were incurred in the comparison groups (hence lower total costs), costs per child-contact for screening and BCC were higher because coverage of these services was lower. The intervention package cost $1073 per DALY averted in Burkina Faso and $747 in Mali. ConclusionsIntegration of wasting prevention into screening for child wasting led to higher total costs but lower unit costs than standard screening due to increased coverage. Greater cost-effectiveness could be achieved if BCC were strengthened and led to improved caregiver health and nutrition practices and if screening triggered appropriate use of services and higher treatment coverage.

IJCM_351A: A study on Internet use and its association with psychopathology of Sleep among: students at a Government Medical college in Koppal, Karnataka

Background: Internet addiction has become a very common disorder because of which youngsters are wasting a lot of time, becoming irritable and depressed and having poor academic/ work performance and are becoming victims of social isolation. College students have easy access to internet and so there is high chance of higher prevalence of Internet addiction among them. By studying the association of internet usage and its impact on sleep we can set boundaries for early warning signs of underlying psychopathology at the earliest. Objective: The Objectives of the study were: 1) To estimate the prevalence of Internet addiction among medical students in the study setting, 2) To estimate the prevalence of psychopathology in sleep pattern among medical students in the study setting, and 3) To determine the impact of Internet addiction on psychopathology in sleep pattern among them. Methodology: : A cross sectional study was conducted among medical students at a Government Medical college, Koppal, Karnataka for a duration of 3 months from June 2023 to August 2023. Data collection was done using a pretested and semi structured questionnaire (shared through Google form) consisting of questionnaires of Internet addiction test (IAT) to assess Internet use and Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep among them along with socio demographic and other relevant details. Statistical analysis was done using WHO Epi info software version 3.5.4. Results: The prevalence of Internet addiction among medical students was 286 (57.2%) and was found to be mild, moderate and severe in 214 (42.8%), 68 (13.6%) and 4 (0.8%) of students respectively. Quality of sleep was disturbed in 270 (54%) of students according to PSQI. The study found significant association between Internet addiction among medical students and quality of sleep among them Conclusion: Need for Behavior change communication strategies to reduce unnecessary use of Internet.

IJCM_28A: Prevalence of anemia and its association with Knowledge, Attitude, Practice and Health seeking behaviour regarding anemia among women in the age group of 15 - 59 years : a community based cross-sectional study in a rural area in Ernakulam District.

Background: 29.9% of reproductive-age women globally and 57% in India suffer from anemia making it a public health concern. Objectives: 1. To determine the prevalence of anemia among women aged 15-59 years in a rural area in Ernakulam District. 2. To assess the knowledge, attitude, practice and health seeking behaviour related to anemia among women in the study setting. 3. To find the association between anemia and the knowledge, attitudes, practices and health-seeking behavior (HSB) of women in the study setting. Methodology: A community based cross-sectional study was conducted over 3 months in Chengamanad panchayat among 208 women aged 15-59 years using cluster sampling. Study tool was an expert-validated semi-structured questionnaire in local language and participants were interviewed after taking informed consent. Hemoglobin levels were measured by Junior Public Health Nurses using a Digital Hemoglobinometer. Statistical analysis was done using SPSS software and p < 0.05 was considered as statistically significant. Results: In the study among 208 participants (mean age: 41.52 ± 12.11 years), anemia prevalence was 43.8% (37.1%, 50.5%) (Mild: 20.2%, Moderate: 19.7%, Severe: 3.8%), with a mean hemoglobin level of 11.98 ± 1.82 gm/dl. Among the 91 women with anemia, 72.5% (66.4%, 78.6%) lacked adequate knowledge, though 89% had a positive attitude. Only 59.3% (52.6%, 65.9%) practiced effective anemia prevention strategies, and 50.5% exhibited insufficient HSB. Anemia was found to be significantly associated with religion (?2 = 10.66) and education (?2 = 8.09). Significant association was found between knowledge and attitude (?2 = 5.88), practice (?2 = 3.60) and HSB (?2 = 19.24). Conclusion: A high anemia prevalence (43.8%) was idenitifed and was significantly associated with religion and education. Emphasizing behaviour change communication is crucial for effective intervention.

IJCM_172A: Risk Scoring of Type 2 Diabetes Mellitus and Coverage of Screening Services through Primary Health Care System among Adults in a Block of Murshidabad District, West Bengal

Background: Type 2 diabetes is a major public health challenge. Indian Diabetes Risk Score (IDRS), a simple and cost-effective tool consisting of two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, parental history) for diabetes, can be easily applied in mass screening programmes. Opportunistic screening for diabetes among individuals aged = 30 years is being done under the programme for Prevention and Control of Non-communicable Diseases. Objective: To assess the risk of type 2 diabetes mellitus using IDRS, coverage of screening services for diabetes through the primary health care delivery system and to identify their correlates. Methodology: : A descriptive, cross-sectional study was conducted in a block of Murshidabad district, West Bengal during September to November 2023 among permanent residents aged = 30 years on a calculated sample of 300 selected through multi-stage sampling. Required data were collected by interviewing the study subjects using pre-designed, pre-tested schedule including IDRS, reviewing medical records and measuring waist circumference. Analysis was done using SPSS-20. Results: Among 300 participants, 40.7% had high risk; 54% and 5.3% had moderate and low risk of diabetes respectively according to IDRS. In multivariable analysis, age =35 years (AOR 18.10, 95% CI 5.07-64.66), female gender (AOR 2.36, 95% CI 1.40-4.00) and being in joint family (AOR 3.53, 95% CI 1.77-7.04) were significant correlates for high-risk category according to IDRS. Only 67% were screened for diabetes within last six months, of which 89% were through primary health care delivery system. Screening status varied significantly by age group (OR 3.81, 95% CI 1.98-7.35) and IDRS risk categories (OR 1.72, 95% CI 1.06-2.80). Conclusion: Alarmingly substantial proportion of people in the area are at high/moderate risk of diabetes coupled with low opportunistic screening coverage, which highlights the need for intensive behaviour change communication and stronger service delivery.

Study to assess the effectiveness of behavioural change communication aid for the anger management in adolescents: A Quasi experimental study in the selected juvenile aid center, New Delhi

Background and purposeRising anger issues among young individuals are becoming increasingly prevalent in contemporary society. Comprehensive examinations and literary investigations have illuminated the detrimental consequences of unregulated anger in adolescents. Consequently, it is imperative to investigate the efficacy of various anger management interventions in curbing the anger of adolescents. Behavioral change communication aids represent an effective and accessible method for anger management in juveniles. The researcher identified juvenile aid centers as optimal locations for conducting such intervention studies. Materials and methodsIn this study, we conducted research within a Juvenile Aid Center and evaluated the anger levels of the participants using a clinical anger scale. Following the initial assessment, only the experimental group received the Behavior Change Communication aid, and after a four-week period, we reevaluated the juveniles using the same measurement tool. ResultsThe total sample size for this study comprised 73 adolescents. The experimental group received the Behavior Change Communication aid, and their anger levels were assessed using the Clinical Anger Scale, which showed improvements in all participants. ConclusionThe findings of this study indicated a significant effectiveness of the Behavior Change Communication aid in managing anger among adolescents residing in juvenile aid centers.

Implementation and effectiveness outcomes of Community Health Advocacy Teams to improve long-lasting insecticide net distribution and use in six districts in Ghana: A one-group pre-post-test study.

Malaria remains a leading cause of illness and death especially among children and pregnant women in Ghana. Despite the efforts made by the National Malaria Elimination Programme (NMEP), including distribution of Long-Lasting Insecticide Nets (LLINs) to households through periodic Point Mass Distribution (PMD) campaigns and continuous channels (antenatal, schools and postnatal), there is a gap between access and use of LLINs in Ghana. An effective and functional community-based group that would seek to improve the effectiveness of LLIN distribution before, during, after PMD Campaigns and continuous distribution at the community level could help address this gap. This paper assesses the implementation outcomes and short-term effectiveness of the pilot implementation of co-created community health advocacy teams (CHAT) intervention in Ghanaian communities to plan and implement campaigns to increase LLIN use. The study employed a one-group pre-post study design and measured implementation outcomes (acceptability, appropriateness, and feasibility) and effectiveness outcomes (LLIN awareness, LLIN access, willingness to purchase LLIN, and LLIN use) among 800 community households. The CHAT intervention was implemented for four months across six districts in the Eastern and Volta regions of Ghana. The data were downloaded directly from REDCap and analyzed statistically (descriptive and McNemar test of association) using SPSS 22 software. After the implementation period, the majority of respondents in all six districts indicated that the CHAT intervention was acceptable (89.8%), appropriate (89.5%), and feasible (90%). Also, there was a significant association between baseline and end-line assessment on all four effectiveness outcome measures. Household members' awareness of, access to, willingness to purchase, and use of LLINs increased significantly over the four-month period that the CHAT intervention was implemented. The study concludes that CHAT is an acceptable, appropriate, and feasible intervention for supporting the National Malaria Programme in LLIN PMD and for engaging in Social and Behaviour Change Communication activities through the continuous channels of distribution. Additionally, the CHAT demonstrates short-term effectiveness outcomes in terms of creating LLIN awareness, providing access to LLIN, and encouraging Ghanaian community members to be willing to purchase and use LLINs. Although the activities of CHAT members were largely voluntary, integration into the existing primary health care system will make it sustainable.

IJCM_371A: Patterns of patient self-identification of ailments: A cross-sectional study from tertiary care centers in Mangalore

Background: Self-diagnosis is the process of determining a disease or disorder without seeking medical care. Advances in technology have made it easier for patients to get medical information online, fostering self-diagnosis and doctor cross-examination. The aim of this study is to estimate the proportion of study respondents who use the internet and other sources for self-diagnosis and explore their attitudes concerning self-diagnosis. Methodology: This cross- sectional study was conducted among 186 participants from hospitals affiliated to Kasturba Medical college, Mangalore (Govt Wenlock hospital and KMC Hospital, Attavar). The data was collected using a semi-structured, internally validated questionnaire- consisting of 3 sections: 1) General information of study participants 2A) Questions on self- diagnosis through different sources 2B) On their attitudes concerning self-diagnosis. Data was analyzed using SPSS version 24. Results were expressed in descriptive statistics. Results: This study on self-diagnosis was conducted among OPD attendees and found a mean age of 31 years, with 66.0 % males and 34.0 % females. Majority (98.4%) had media access, in which 67.7% online media for self-diagnosis. Specific diseases like cancer and infectious disease were common search topics (76.3%). One third of the total participants reported they have done online search for ailments related to their relatives or friends. Around 61.3% considered their sources reliable, while 50.5% intended to continue self-diagnosing. Notably, 61.3% made correct self- diagnoses which were confirmed later after the physical consultation with their treating physician, particularly among participants under 25 with higher education. Conclusion: Due to the development of artificial intelligence and internet access, even non-medical people are now searching the media for medical issues. Although there is a growing dependence on internet resources, most individuals still say they trust in future self-diagnosis but still prefer visiting a doctor rather than self-medicating. To educate the public about the risks associated with self-diagnosis and the purchase of over-the-counter medications, community-based behavioral change communication should be employed.

IJCM_82A: Behavioral and Functional Changes Due to Smartphone Over-usage among Under-five Children in Rural Puducherry- A Community-Based Cross-Sectional Study

Background: Smartphone have revolutionized, and become an integral part of a child’s life. The child’s interaction with these modern devices needs to be assessed because it could have an enormous effect on their behavior, sleep habits, and psychological addiction. Objective: The objective of this study is to determine the pattern of exposure to smartphone, and the association between the exposure and behavioral, functional changes among under-five children in rural Puducherry Methodology: This community based cross-sectional study was done in the field practice area of a private medical college in Puducherry. A multistage sampling technique was used to select 340 eligible participants. A semi- structured questionnaire was used to assess the pattern of exposure, physical, social, and behavioral changes among study participants. The data were analyzed using SPSS software, and p-value of Results: Among 340 children, more than half of participants 180(52.9%) were female. Interestingly, around half of the study participants parents 181(53.2%) accepted that, their children were exposed to smartphone for entertainment purposes, and around one-tenth 35 (10.3%) of the participants viewed screen for more than the recommended screen time for age. Increased smartphone exposure was statistically associated with behavioral, and functional changes. Conclusion: Measures must be undertaken to prevent the deleterious behavioral and functional changes in under-five children due to excessive smartphone usage. Health education sessions and social behavioral change communication should be planned for the parents to protect the budding generation from the negative effects of smartphone usage.

IJCM_255A: Knowledge, attitude, and practice of No-Scalpel Vasectomy among married men attending a rural health facility in Kundrathur, Chennai

Background: Male sterilisation, i.e., Vasectomy is one of the safest and most effective contraceptive methods as it has very low complication and failure rates. According to the NFHS-5 data, the male sterilisation rates in India and Tamil Nadu are about 0.3% and 0.1% respectively. Though there is sufficient knowledge on the effectiveness of No-scalpel vasectomy, there is lack of acceptance of male sterilisation as a permanent method of contraception Objective: To assess the knowledge, attitude and practice of No-scalpel Vasectomy among married men of Kundrathur, Chennai Methodology: A cross-sectional study was conducted among 116 married men between 22 to 60 years of age, attending the Upgraded Primary Health Centre, Kundrathur by consecutive sampling. A pretested semi-structured questionnaire was used to assess their knowledge and practice. Attitude was measured using 4-point Likerts scale. Data was analysed using SPSS software version 21 Results: Among the 112 participants who consented to participate in the study, 82 i.e., 73.2% of them were aware of vasectomy and the most common source of information was Mass media (51.2%). 74.2% agreed that contraception was not the sole responsibility of a wife, yet 48.2% of them disagreed that men should undergo vasectomy. The most perceived barrier for non-acceptance of vasectomy was Lack of awareness (33%), followed by Impotency following vasectomy (13.4%) and “Inability to do heavy work following vasectomy (12.5%). None of the participants (0%) underwent vasectomy, whereas 57.1% were willing to undergo, and 61.6% were willing to recommend the same to others. Conclusion: There seems to be a huge gap between the knowledge, attitude and practice of No-Scalpel Vasectomy among the study population. Thus, intense behavioural change communication should be advocated to increase the awareness and decrease the misconceptions regarding Vasectomy.

IJCM_143A: Dietary changes during pregnancy: exploring the influencing factors as perceived by antenatal women and health care providers - a mixed methods study from a rural area in Dakshina Kannada district.

Background: Maternal nutrition impacts maternal-child health. Antenatal diet affects well-being and anaemia-related maternal mortality. Objectives: The objectives are to assess the dietary changes made by antenatal women, its association with socio demographic and clinical variables and to explore the factors influencing the dietary changes as perceived by the antenatal women and health care providers (Medical officer, ANMs and ASHA) Methodology: A mixed method study was conducted. The study involved interviewing antenatal women registered between October2020 to October 2021 in Kurnad PHC area and those who have completed their second trimester and in-depth interview of antenatal women and the health care providers (Medical officer, ANMs and ASHA) of Kurnad PHC in 2021 and two quarters of 2022. Results: Most participants were aged 26-30 (43.1%), mean age 27.41±4.838 years. 47.3% had high school education, 75.5% were unemployed, and 17.8% were self-employed. 77% were below the poverty line, 55.4% belonged to joint families, and 39.3% to nuclear families. 42% lived with husband’s family, 22% with maternal family. Co-morbidities were in 36%, anaemia in 87%, gestational diabetes in 51.85%, pregnancy-induced hypertension in 42.95%. Reasons were health improvement, healthy child, co-morbidities, and gastritis. Statistical significance existed between pregnancy dietary changes and socio- demographics, clinical variables. Factors influencing changes were health promotion, advice from family and providers, co-morbidity management, cravings, affordability, community-based services. Conclusion: Dietary changes were seen in more than half of the antenatal women. Behaviour change communication strategies and adequate support for decision making and availing nutritious food will facilitate appropriate dietary changes during pregnancy.

IJCM_181A: Health behavioral change and Associated factors among patients diagnosed with non-communicable diseases in the Rural areas of Southern India

Background: Non-communicable diseases (NCDs) contributed to 71% of the global mortality and affect the ageing population with variable proportions. NCD diagnosis gives an opportunity for patients to change their health behaviors. Secondary prevention strategies like diet modification, physical activity and smoking cessation after NCD diagnosis are important and should be emphasized particularly for middle-aged and older adults. Objectives: 1. To assess the level of health behavioral change adopted by the patients diagnosed with NCDs registered under Rural field practice area. 2. To evaluate the factors influencing the health behavioral change in NCD patients. Methodology: This is a Cross-sectional study design conducted at Rural Health & Training Centre, Government Medical College, Ananthapuramu, from August 2023 to October 2023. Simple random sampling was used to select 150 registered NCD cases from the RHTC data-base. We included participants who were diagnosed with either diabetes, cardiovascular disease, chronic lung disease, or cancer after recruitment. Data were collected by using pre-designed semi-structured questionnaire. Data was analyzed using IBM SPSS version 25.0. Associations were tested using chi-squares and for all comparisons p-value <0.05 was considered significant. Results: In total 48 (32%) NCD cases have adopted suggested behavioral change instructed by the physician. Factors such as females, graduates, Class III & above SES, diagnosed between 5 to 10 years, not having any other co-morbidities were significantly associated with good health behavioral change. Conclusion: Around two third of the diagnosed NCD cases were not compliant to health behavioral change. Hence, health care providers need to provide behavioral change communication related to health behaviors in addition to standard medical care.