Change Communication Research Articles

A Process Evaluation Revealed That Flexibility Was Key to Delivering Nutrition Education to Vulnerable Tribal Groups in India.

This study is a process evaluation of a nutrition education intervention that is part of a large-scale development program targeting vulnerable tribal groups in Odisha, India. The objectives are to examine whether the intervention is operating as planned (implementation fidelity), investigate potential pathways to achieve greater impact, and provide recommendations on how to design nutrition education interventions in similar contexts. A program impact pathway forms the basis of this process evaluation, tracing inputs, processes, outputs, outcomes, and impacts. The study's mixed-methods approach includes semistructured interviews, focus group discussions, and Process Net-Mapping. Narrative analysis was applied to examine the transcripts. Data were analyzed in the context of the program impact pathway. The intervention was not delivered as intended (low implementation fidelity). Flexibility was key in providing nutrition education to beneficiaries despite challenges, such as the inability to utilize behavior change communication, inadequate funding, and language and cultural barriers. Despite low fidelity, the qualitative results show that the intervention improved awareness of nutrition and health among beneficiaries. Providing adequate resources for training frontline workers and beneficiaries is required for nutrition education programs to achieve their desired effectiveness and impact. Utilizing existing organizations, integration into production-based interventions, and incorporating easy-to-understand nutrition models, practical demonstrations, and videos would increase frontline worker and beneficiary engagement and understanding, leading to improved maternal and child nutritional and health outcomes.

Pregnancy, childbirth, and breastfeeding experience of women with epilepsy in Me’enit community, South West Ethiopia

IntroductionPoor obstetric care leading to prenatal brain injury is thought to be one potential cause of epilepsy. Epilepsy affects approximately 0.5–1.0% of women of childbearing age. In the Me’enit community, due to poor delivery practices (delivering in a standing position) and suffering from birth trauma, there are many women with epilepsy. Thus, this study aimed to explore the pregnancy, childbirth, and breastfeeding experiences of women living with epilepsy in the Me’enit community, in southwest Ethiopia.MethodsA phenomenological approach was employed to gather data on women with epilepsy (WWE) on their pregnancy, childbirth, and breastfeeding experiences. The study participants were women with epilepsy in the reproductive age group (15–49 years) in the selected areas. Data were collected from participants through in-depth interviews with 15 women with epilepsy who experienced childbirth. The rigor and trustworthiness of the study were maintained based on Lincoln and Guba’s criteria of credibility, dependability, conformability, and transferability. The data were analyzed by using ATLAS. ti 7.1.4. software and organized into thematic categories. Verbatim the transcripts were used as illustrations to uncover the meaning of the participants’ experiences.ResultsThe pregnancy, childbirth, and breastfeeding experiences of women with epilepsy were clustered into five theme clusters, including prepregnancy and childbirth practices, social stigma and support, institutional care, and support, seizure as a cause of maternal death, pregnancy as a cause of the seizure, and perception of feeding breast milk. The results show that there is no preconception care for WWE. There is also a knowledge gap and misconception about epilepsy by the family and surrounding community which resulted in stigma and discrimination against epileptic women. The discrimination started right from childhood as soon as they manifested the diseases. Maternal mortality in women with epilepsy was considered to be high. However, it was noted that epilepsy was not aggravated by the pregnancy and women with epilepsy breastfeed their children similarly to their non-epileptic peers.ConclusionThe findings imply the need for special attention to WWE before, during, and after pregnancy to improve maternal and child health. Behavioral change communication needs to target the knowledge gap and misconception about epilepsy by the family and surrounding community to reduce stigma and discrimination against epileptic women and associated maternal mortality.

Supported biopsychosocial self-management for back-related leg pain: a randomized feasibility study integrating a whole person perspective

BackgroundThere is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP.MethodsParticipants were randomized to 12 weeks of individualized supported self-management delivered by physical therapists and chiropractors or medical care consisting of guideline-based pharmacologic care. Supported self-management was based on a behavioral model that used a whole person approach to enhance participants capabilities, opportunities, and motivations to engage in self-care. It combined BRLP education with psychosocial strategies (e.g., relaxed breathing, progressive muscle relaxation, guided imagery, communication skills) and physical modalities such as exercise and spinal manipulation therapy. Providers were trained to address participants’ individualized needs and use behavior change and motivational communication techniques to develop a therapeutic alliance to facilitate self-management. Feasibility was assessed using pre-specified targets for recruitment and enrollment, intervention delivery, and data collection over the six-month study period. In addition, areas for potential refinement and optimization of processes and protocols for the full-scale trial were assessed.ResultsWe met or exceeded nearly all feasibility targets. Forty-two participants were enrolled over a six-month period in 2022 and very few individuals declined participation due to preferences for one treatment. All but one participant received treatment and 95% of participants attended the minimum number of visits (self-management = 6, medical care = 2). At 12 weeks, 95% of participants in the self-management group reported engaging in self-management practices learned in the program and 77% of medical care participants reported taking medications as prescribed. Satisfaction with the self-management intervention was high with 85% of participants reporting satisfaction with the program overall. Self-management intervention providers delivered all required activities at 72% of visits. Providers also noted some challenges navigating the shared decision-making process and deciding what self-management tools to prioritize. Over the six-month study period, completion rates were 91% for monthly surveys and 86% for weekly surveys.ConclusionWe were able to demonstrate that a full-scale randomized trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP is feasible and identified important areas for optimization.

Low ITN utilization among households in SWEPR Ethiopia: challenge for malaria elimination, a mixed design approach

IntroductionTo prevent malaria starting from 2005 more than 2 billion insecticide-treated nets (ITNs) have been distributed globally. Even though Ethiopia has been doing nationwide ITN distribution starting from 2016 with 64% ITN coverage, there is a significant gap in its utilization in different settings. Therefore, this study aimed to assess the utilization of ITN and associated factors among households in SWEPRS, 2023.MethodsCommunity-based mixed study designs were applied in the present study. Firstly, the malaria area was selected purposively and the study participants were reached by using multi-stage stratified sampling techniques. Data was collected by using structured and pre-tested tools through an electronic data collection software, Kobo tool kit was analyzed by using STATA version 14. The multicollenearity between independent variables and model fitness were checked by using the variable inflation factor (VIF) and Hosmer Lemeshow model fitness test, respectively. A binary Logistic Regression model was fitted to identify the associated factors. In the multivariable analysis, an adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) was used to measure the strength of the association and the statistically significant association was declared at a P-value less than 5%. Focus group discussion (FGD) and in-depth interviews (IDI) were employed for the qualitative study and analyzed using Quirkos. The findings of qualitative data were presented in thematic analysis.ResultsIn this study, a total of 1,552 households participated. In all households, the ownership of at least one mosquito net per household was found to be 89% (95%: CI: 87.62–90.72%) whereas the proper use of ITNs was found to be 20.38% (95%: CI: 18.25–22.50%) in the region. From the multivariable logistic regression analysis, the urban residents, NGO employees, having a corrugated iron sheet house type, having good knowledge toward malaria, having good knowledge toward ITNs, having a favorable attitude towards malaria and having a favorable attitude towards ITNs had higher odds of the proper utilization of ITNs as compared to their counterparts. In addition to these, misconceptions about ITNs, unfair distribution of ITNs, lack of health education from health extention workers (HEWs), community resistance, improper use (use for other purposes) of ITNs and shortage of HEWs were explored barriers to ITNs use from the qualitative data.ConclusionsThis study showed relatively a high coverage of ITNS, but low proper ITN utilization among the households. Therefore, behavioral change communications (BCC) interventions and education and communication (IEC), interventions should be done in the region.

Resource constraints, patient emotions, and therapy: experiences of healthcare providers in the screening and management of gestational diabetes mellitus in northern Ghana.

Studies on healthcare providers' experiences in screening and managing Gestational Diabetes Mellitus (GDM) are rare in northern Ghana. Understanding the experiences of healthcare providers in the screening and management of GDM has the potential to identify best practices to improve GDM care. Hence, this study sought to explore the experiences of healthcare providers in screening and managing GDM. This was a qualitative study of five key informants involved in the screening and management of GDM, specifically an obstetrician, adietician/nutritionist, anurse, and twomidwives in the northern region of Ghana. Face-to-face interviews were conducted with the aid of an interview guide, and the data were analysed via thematic analysis. We ensured trustworthiness through reflexivity, member checking, peer-debriefing, providing rich text, and keeping an audit trail. Two main themes and six subthemes were generated. The first theme was resource-centred experiences, which explored events at the Antenatal Care (ANC) and the challenges in GDM screening and management, with subthemes namely: ANC setups, inadequate resources, and non-compliance. The second theme was care-centred experiences, which explored patient emotions during GDM care, andthe care they receive post-GDM diagnosis, with subthemes namely: raw emotions, non-pharmacological therapy, and pharmacotherapy. Findings suggest the need for health system strengthening through the training and recruitment of dedicated skilled personnel, as well as government intervention through policy revision to cover the cost of GDM diagnostic tests. Healthcare providers should also consider the psycho-emotional impact of diagnosis when managing GDM.The findingscould be relevant for health policy, planning, advocacy, and social and behaviour change communication aimed at effective screening and management of GDM.

Building a rights-based approach to nutrition for women and children: harnessing the potential of women’s groups and rights-based organizations in South Asia

Women face numerous gender-based barriers that hinder their access to resources, nutritious foods, nutrition services, and maternity entitlements. Evidence shows that certain types of women’s groups can improve women’s access to resources and social capital and in some approaches also improve health and nutrition outcomes. Women’s rights-based organizations in South Asia have a longstanding tradition of collective action toward gender equality. Women’s rights-based organizations work in areas such as microfinance, livelihoods, women’s rights, health, and combating violence against women. In this perspective article, we explore how women’s groups and rights-based organizations can leverage their collective strength to advance nutrition outcomes for women and children. We identify seven pathways implemented through women’s groups toward improving nutrition outcomes. These pathways include (i) income generation, (ii) agriculture, (iii) health and nutrition behavior change communication and participatory learning and action, (iv) advocating for rights to better health and social services, (v) food access, (vi) cash transfers, and (vii) strengthening service delivery and fostering convergence with health systems. We also note that women’s groups have the potential to implement integrated interventions through combined food-systems-rights pathways. Investing in this area can support transforming nutrition policy from a service delivery model to a rights-based approach.

El uso del humor gráfico en español e inglés para comunicar los relatos del cambio climático y cómo aparece en Google Imágenes

The characteristics of graphic humour make it ideal for raising awareness and mobilising in the fight against climate change. This work aims to contribute in this direction by investigating the use of graphic humour to communicate climate change stories. Thus, it quantitatively and qualitatively analyses the main results of cartoons in Spanish (n=100) and English (n=100) published in the media, blogs, websites and social networks that Google, the most popular search engine among citizens, offers in its specialised image search engine. It concludes that graphic humour uses all the stories of climate change communication, demonstrating its diversity of registers to reach public opinion, that one of the main stories is the criticism of denialism, and that there are notable differences in the use of the stories and between the cartoons in both languages. It is proposed that cartoonists not limit themselves to pessimistic messages that may fail in raising awareness and climate mobilisation, and incorporate hope and solutions.

Email outreach attracts the US policymakers’ attention to climate change but common advocacy techniques do not improve engagement

One of the most challenging aspects of climate change mitigation today is not identifying solutions but reaching political leaders with climate scientists’ existing solutions. Although there is substantial research on climate change communication, research rarely focuses on one of the most impactful groups: policymakers. It is essential to test theoretically sound methods to increase lawmakers’ attention to research evidence. In a series of four rapid-cycle randomized controlled email trials (N = 6642–7620 per trial), we test three common and theoretically derived advocacy tactics to increase U.S. policymaker engagement with a climate change fact sheet sent via email (i.e., a norms manipulation, a number focused manipulation, and emotional language manipulation). In all four trials, the control message increased engagement more than messages using advocacy tactics, measured by fact sheet clicks. This demonstrates the importance of testing communication methods within the appropriate populations, especially a population with considerable influence over climate policy.

P-1719. Promoting antibiotic stewardship for commercial poultry production in Bangladesh: using social and behavioral change communication approach

Abstract Background Bangladesh has a high prevalence of antimicrobial resistance due to extensive antibiotic use in humans and animals. This study aimed to develop social and behavioral change communication (SBCC) strategies to promote antibiotic stewardship in commercial poultry production in Bangladesh. Methods In 2022, we used formative research findings to explore contextual factors of antibiotic sale, prescribing, promotion, and use among four groups in Narsingdi, Bangladesh: 1) poultry farmers, 2) pharmacy shop employees, 3) veterinarians, and 4) pharmaceutical representatives. We conducted multiple intervention design workshops to select target behaviors and develop SBCC messaging. We used the behavior change wheel model to analyze the data and summarize the findings. Results Participants identified their behaviors considered to be changed and assisted in developing SBCC for all four stakeholder groups. Poultry farmers had two behaviors to change: not following infection control measures and irrational antibiotic use. SBCC target behaviors included taking appropriate infection control measures, seeking registered veterinarian consultations, and rational antibiotic use. Pharmacy shop employees had one behavior to change: unnecessary antibiotic dispensing practices. SBCC target behaviors included asking farmers for prescriptions and referring them to registered veterinarians. Registered veterinarians had one behavior to change: unnecessary antibiotic prescribing practices. SBCC target behaviors included appropriate antibiotic prescribing practices and increasing farmer awareness for rational antibiotic use. Pharmaceutical sales representatives had one behavior to change: unethical antibiotic promotion. SBCC target behaviors included appropriate antibiotic promotion. Conclusion We identified stakeholders considered behavior change and SBCC intervention delivery to them to promote antibiotic stewardship for commercial poultry production, including improved health-seeking behaviors, and improved health literacy on antibiotic transactions. The study findings may contribute to developing health communication materials to promote antibiotic stewardship among stakeholders in commercial poultry production in Bangladesh. Disclosures All Authors: No reported disclosures

Assessment of Four Essential Features of the Alive & Thrive Initiative to Improve Maternal, Infant, Young Child, and Adolescent Nutrition.

Alive & Thrive has been a major global nutrition initiative that aimed to learn how to improve maternal, infant, young child, and adolescent nutrition and health on a large scale. During 2009-2014, Alive & Thrive developed and implemented interventions to improve infant and young child feeding at scale in three countries. Subsequently, Alive & Thrive expanded its work to more than 15 geographies, including six country-specific and two regional programs, to additionally address maternal and adolescent nutrition while adding agriculture and social protection programs to improve maternal, infant, and young child nutrition. Reflecting on the big picture of what the Alive & Thrive initiative has accomplished in its 16 years and how it did so, four features warranted emphasis because additional learning was needed. These four features were: commitment to exemplary large-scale social and behaviour change communication, explicit focus on policy and advocacy to achieve and sustain change, promotion of country-led initiatives through technical assistance, and attention to quality assurance and improvement in programming. For each feature, an assessment across the Alive & Thrive portfolio was commissioned, each led by an external consultant or team. The assessments highlighted designing and implementing exemplary social and behaviour change programming and policy advocacy in each country, undertaking a large-scale effort through careful, in-depth, and evidence-based planning that is bolstered by strong engagement with relevant stakeholders at multiple levels. The assessments also highlighted technical assistance that is responsive to country contexts to support country-led initiatives and attention to assuring and improving the quality of programming to achieve effectiveness.

Interpretative phenomenological analysis of guidance advocates’ online counseling experiences

IntroductionIn order to document and understand the lived experiences of guidance advocates navigating transactional distance in education, this phenomenological study examined the experiences of advocates in the Philippines.MethodsThis study examined how clients and guidance advocates interact in online learning environments, with a particular emphasis on the experiences of eight individuals who underwent online counseling (OC). These individuals provided firsthand experiences that elaborated the phenomenon.ResultsThe study, which has its roots in Transactional Distance Theory (TDT), finds interesting connections between the variables and the experiences of the individuals. Among these variables are: (i) discourse that mirrors the exchanges between a counselor and a client; (ii) framework, which includes OC dynamics and changing communication requirements; and (iii) learner autonomy, which stands for the involvement of clients in online learning.DiscussionA community-based framework for developing students is formed by these variables. The data shared by participants reveal complex issues as they struggle with the limitations and realities of applying standards in multimodal counseling sessions. This change emphasizes how important it is for students to have a strong support system. The study, which focused on guidance advocate-client relations, took inspiration from the eight participants’ OC experiences. The mechanisms that promote a reciprocal, technology-mediated kind of communication are central to this emerging structure.

Avoidance, fear, helplessness: young Africans contemplate a future shaped by climate change

Abstract This article considers, and theorises, the negative emotions expressed in discussions about climate change in a project that sought to understand how young adults in Mozambique, South Africa and Kenya articulated their thoughts and feelings on the topic. A literature review synthesises key work on climate communication, emotions and youth in Africa. A detailed discussion of methods (qualitative interviews) is offered. Empirical findings show that three key negatives feelings were expressed: avoidance, fear, and helplessness. Participants claimed to not think about climate change due to other pressing concerns in their lives. Nevertheless, they admitted that they are aware of climate change and deeply fear its impact. Although they know suffering lies ahead, they feel helpless to stop climate change. These sobering findings should be considered in climate change communication research in Africa. The article concludes by theorising the communicative weight of negative emotions as African climate pessimism.

Interdisciplinary Perspectives: Rethinking Communication for Development and Social Change in Health Communication

Communication for development and social change is an evolving field both in research and practice, transcending paradigms of conventional communication towards engaging and somewhat exposing some of the real-life communicative disorders experienced by communities. While public health and communication for development and social change operate from diverse paradigmatic thinking and are applied quite independently as disciplinary fields of study, health communication converges these fields in research and practice. In this paper, I discuss these interdisciplinary perspectives that draw from communication for development and social change principles and public health through a process of divergence and convergence towards new ways of thinking about decision making. Much of this discourse stems from understanding many health problems as a development problem first, one that recognises the role of community responses during pandemics yet at the same time places the agency back with individuals to make informed choices. Communicating for health decision making from this perspective is what I call Communicating for Health-as-Development (C4HD). C4HD foregrounds health as development, which caters to the messy, unidirectional, non-process-orientated, non-measurable and often non-data-driven approaches to health outcomes. It is in these messy health communication efforts that real development takes place. This paper, using examples from HIV and COVID-19, discusses these ongoing developments in the field and the convergence of public health and communication for development and social change from an interdisciplinary perspective, by exploring three key concepts: community engagement to influence decision making, community agency and ownership, and context and collaboration, which contribute to understanding communication for health-as-development.

Effect of Behavioral Change Communication Using Health Belief Model on Knowledge and Practice of Breast Self‐Examination Among Rural Women

Effect of Behavioral Change Communication Using Health Belief Model on Knowledge and Practice of Breast Self‐Examination Among Rural Women

Perceptions of patients and stakeholders on a prenatal sickle cell disease screening and its results among tribal populations of Gujarat: a participatory mixed-method research.

Prenatal screening (PNS) for Sickle Cell Disease (SCD) offers a potential avenue for informed reproductive choices and the sickle elimination initiative of the Government of India. The objective of the study was to explore perceptions and ethical dilemmas surrounding prenatal screening for sickle cell disease and subsequent termination of pregnancy among pregnant women and key stakeholders from the tribal region of Gujarat. The study employed sequential mixed-methods research, embedding a participatory research approach. Pregnant women and key stakeholders from Jhaghadia, Bharuch District of Gujarat were interviewed. The qualitative data was analyzed using a thematic analytic framework, and the quantitative data was presented with descriptive statistics. Findings revealed key themes such as knowledge about SCD and its management, knowledge about PNS, barriers to PNS, acceptance of PNS and ethical dilemmas related to the termination of pregnancy (TOP). The results show a mixed preference for prenatal screening from both qualitative and quantitative data, primarily due to the complex decision-making process. Couples with SCD reported a high preference for PNS and TOP if the foetus had sickle cell disease whereas couples living with SCD trait were assigned lowest priority and preference to under-go PNS and TOP. Decisions were influenced by limited knowledge, lack of lived experience of SCD, family pressure, cultural and religious beliefs, and social stigma. A comprehensive behaviour change communication strategies that empower couples and key stakeholders through culturally sensitive SCD & PNS literacy, and genetic counselling is essential to promote informed decision-making within the cultural context of tribal communities.

Climate change is (NOT) funny: insights from a climate change comedy event

In recent years there has been an increasing call for new modes of climate change communication. These calls have gone beyond classic consensus-building and fact-sharing to addressing affective dimensions and meaning-making in relation to the climate crisis. In this article we reflect on a proof-of-concept climate change comedy project — “Climate Change is NOT Funny!”. Building on audience and performer insights, we reflect on the effectiveness and affective dimensions of comedy as a climate change communication method, as well as institutional and funding constraints on delivery. Finally, we introduce how we designed our project to go on making an impact beyond the grant's lifespan. By empowering professional comedians to embed new research-informed climate change material into their regular sets, we argue that our approach can amplify the reach of climate communication activities, and in turn provide new forums for individuals to engage with the most pressing aspects of the climate crisis.

Beliefs and perceptions towards congenital anomalies in Dilla town, Gedeo Zone, Southern Ethiopia; a qualitative study

IntroductionMorbidity and mortality associated with congenital anomalies are higher in low-income countries. People’s knowledge, beliefs, and attitudes towards congenital anomalies vary from community to community. In some communities, it is believed to be untreatable and the burden remains devastating. Studies addressing the societal perspectives were scarce, therefore this study aimed to explore beliefs and perceptions in the community about congenital anomalies.MethodologyThis study was conducted in Southern Ethiopia, Dilla town from September to November 2023. A qualitative study with a community-based exploratory study design was implemented. A total of 33 participants who were selected conveniently among permanent residents of Dilla town were included. Data were collected using face-to-face in-depth interviews and focus group discussions. The collected data were transcribed verbatim and translated into the English language. Data analysis was implemented thematically using Open Code 4.03 software. Finally, the result was presented descriptively based on the themes that emerged. Trustworthiness was ensured throughout the data analysis.ResultIn this study, most participants poorly understood congenital anomalies. God’s punishment, curse, parents’ sin, magical practices and evil spirits, illness, lack of pregnancy care and contraceptive pills were the believed causes of congenital anomalies. The burden of congenital anomalies dismantles the social, economic, and psychological dimensions of the life of parents. In addition, the study identified attitudinal variations and doubts about treatment outcomes and prevention strategies of congenital anomalies.ConclusionThis study highlights that people’s perceived knowledge, beliefs, and awareness of congenital malformations were limited to socio-cultural and religious roots. Understanding beliefs and perceived knowledge would be significant in planning risk-reduction strategies. Hence health education, behavioral change communications, and information dissemination strategies should be strengthened at each community level.

Determinants and the Correlates of menstrual cup usage among medical students in a tertiary care hospital in Puducherry

ABSTRACT: INTRODUCTION: Adolescence is the period between 10-19 years of life and about 1/5th total female population in the world are adolescent girls who requires specific and special attention. Menstruation is a unique phenomenon happening at this age which has lots of social stigma attached to it. It affects the physical, mental and social functioning of any teenager which is of greater concern in order to prevent any major disorder of sexual and reproductive health in future. OBJECTIVES: To determine the prevalence of usage of menstrual cup among medical students and to determine the barriers and facilitators regarding the use of menstrual cup and finally to estimate the knowledge and practises and its association with various determinants of menstrual cup. METHODS: This study was a analytical cross sectional study conducted among the female medical students of a private medical college in Pondicherry. The study tool was a Google form comprising the socio demographic details of the study participant and the details regarding the usage of menstrual products especially menstrual cup. This study followed the universal sampling method and a total of 328 students responded. The responses were downloaded in the Microsoft excel and analysed using the SPSS version 21. RESULTS: Out of the total 328 study participants 54.9% belonged to the age group of 18-23 years , 45.1% were in age group of 24-27 years. Of these 62% were I – III years, 37.8% were IV- CRRI, these students resided in all the types of families, such as 42.1% in the nuclear type, 57.9% in the three-generation type and the joint family. The knowledge prevalence of menstrual cups was 42% among the study participants. The prevalence of the usage of menstrual cups was 41.5%. The logistic regression model showed statistical significance with age (OR=5.078, p = 0.003). Students aged 18 to 23 were 5.078 times more likely to face barriers to using menstrual cups than those aged 24 to 27. Furthermore, increasing age was associated with a decrease in the likelihood of barriers to usage. Those in lesser years of study were 12.086 times more likely to have a barrier. CONCLUSION: From this study its evident that literacy about a concept plays a key role in adapting to a new change. Thus behaviour change communication has to be the key strategy in formulating the change in behaviour to convert theory into practise.

Consumer perspectives on the national electronic health record and barriers to its adoption in Germany: does health policy require a change in communication?

BackgroundThe national health record (ePA) was introduced January 1st, 2021 in Germany and is available to every person insured under statutory health insurance. This study investigated the acceptance and expectations of the national health record in Germany, focusing on consumer perspectives, expectations, barriers, information needs, and communication aspects.MethodsAn exploratory, observational, cross-sectional online survey was conducted one year after ePA introduction, followed by descriptive statistical analysis.ResultsThe top three ePA use cases were medical document collection, simplified data exchange between medical institutions, and emergency medical information. Adoption barriers included lack of information and access, privacy concerns, and perceived lack of necessity. Participants that felt informed about the ePA, reported they received information primarily from health insurances, the media, and educational or professional sources, mainly through printed brochures, social media, or via emails. Most participants (86.5%) preferred being informed through conversations, particularly with health insurance providers (81.5%) and doctors (61.0%). Written information was highly desired (94.5%), preferably via email or information letters/flyers. However, more than half of the participants (55.6%) reported being uninformed about the ePA introduction.ConclusionThe study revealed a communication gap between providers and consumers, leading to a low acceptance rate of digital health technologies. Comparisons with other countries showed low adoption rates for opt-in systems. The authors suggest changing communication strategies, given users prefer direct information from doctors or health insurance companies. Adopting an opt-out system with professional social media and marketing campaigns could increase nationwide ePA adoption.

Effectiveness of targeted social and behavior change communication on maternal health knowledge, attitudes, and institutional childbirth: a cluster-randomized trial in Jimma Zone, Ethiopia

Abstract Maternal mortality remains a critical global health challenge, with 95% of deaths occurring in low-income countries. While progress was made from 2000 to 2015, regions such as Ethiopia continue to experience high maternal mortality rates, impeding the achievement of the sustainable development goal to reduce maternal deaths to 70 per 100 000 live births by 2030. This study evaluated the effectiveness of a Social and Behavior Change Communication (SBCC) intervention to improve maternal health behaviors. A community-randomized trial was conducted in three districts of Jimma Zone, rural Ethiopia, involving 5057 women. Sixteen primary healthcare units were randomly assigned to either the intervention (SBCC) or control (standard care) group. Data on socio-demographics, antenatal care (ANC) visits, maternal health knowledge, attitudes, and institutional childbirth rates were collected at baseline and endline. Statistical analyses included t-tests, effect sizes, and generalized estimating equations. The intervention group demonstrated significant improvements. Maternal health knowledge increased from 5.68 to 7.70 (P < .001, effect size = 0.34), attitudes improved from 37.49 to 39.73 (P < .001, effect size = 0.29), and ANC visits rose from 3.27 to 4.21 (P < .001, effect size = 0.50). Institutional childbirth rates increased from 0.52 to 0.71 (P < .001, effect size = 0.18). ANC attendance (B = 0.082, P = .002) and positive attitudes (B = 0.055, P < .001) were significant predictors of institutional childbirth. The SBCC intervention significantly enhanced maternal health knowledge, attitudes, ANC utilization, and institutional childbirth rates, highlighting the value of community-based strategies in improving maternal health behaviors.