Preparedness Messages Research Articles

Child participation in disaster resilience education: potential impact on child mental well-being

PurposeChildren can play an active and valuable role to minimise disaster risks and vulnerabilities. Yet, peer-reviewed literature on child participation in Disaster Resilience Education (DRE) is lacking. This knowledge gap is larger in low- and middle-income countries, especially related to vulnerable communities. The current study explores how child participation in developing and delivering a DRE intervention is associated with their mental well-being and resilience.Design/methodology/approachThis qualitative study is part of a larger project where a DRE intervention was co-developed and delivered by children in the informal settlements in Chennai, India, using a participatory approach. This project used qualitative methods including interviews and focus group discussions with children who co-developed the intervention, their parents and staff members of the collaborating Non-Government Organisation (NGO) to understand their experiences and inform its processes.FindingsThe children involved in the development and delivery of the intervention reported that not only did they learn the skills necessary to prepare for hazards in the future, it also increased their confidence, self-worth and self-efficacy. This was also observed by parents and staff members of the collaborating NGO. They expressed pride towards the children and applauded their ability to communicate key Disaster Risk Reduction (DRR) messages with assertiveness.Research limitations/implicationsThere is a dearth of empirical papers on child participation in DRR activities, and this study fills some of that gap by reporting the perceived impact of children's participation on their mental well-being and resilience. Furthermore, this study can act as a roadmap for researchers aiming to do action research with children.Practical implicationsDRR is more effective when all stakeholders, especially the affected and at-risk children, and communities are closely involved in structuring, planning, developing and delivering key disaster preparedness messages. This study serves to show that children's participation in DRR activities not only impacts their preparedness but that it helps children in disaster recovery as well, in addition to building their resilience and overall improvement in their mental well-being.Social implicationsGiven the participatory nature of this study, it involves children closely in the development and delivery of DRE intervention. The communities involved in this study had complex vulnerabilities including poverty, marginalisation and based in a low-and-middle income country, India. Oftentimes, these communities are not represented in scientific literature, and this study attempts to bridge that gap.Originality/valueThis study presents a multi-stakeholder perspective on child participation in its potential impact on children's mental well-being and resilience. The DRE intervention was co-developed and delivered by children in the community making it unique in its development process as well as the context it was developed in – informal settlements in Chennai, India.

The relationship between the disaster communication action context and citizen intent to shape climate-related disaster policy across California wildfire seasons

ABSTRACT The current study examined the psychological and social factors that motivate individuals to share and seek wildfire preparedness and resilience-building messages within disaster communication ecologies. California residents who either lived in counties that (a) experienced the 2018 Mendocino Complex or Camp Fires or (b) bordered active wildfire zones were surveyed. Hierarchical regression and serial mediation analysis revealed that descriptive social norms and Pre-event citizen disaster communication mediate the relationship between climate risk perception and intent to contact local, state, and federal government officials to combat wildfire and extreme weather. Results (a) identify disaster-specific factors that facilitate a disaster communication action context and (b) provide evidence that citizen disaster communication is a cross-ecological process that can be used to foster resilience.

Nuclear weapons risk communication: evaluating the impact of message exposure and format

Many experts believe the risk of nuclear war today is the highest it’s been in generations. Yet much of the public has little awareness of nuclear threats and is ill-prepared to take the actions needed to save lives, including their own. Using a survey experiment on a diverse national sample of U.S. citizens fielded across two time periods, this study evaluates the impact of risk communication regarding nuclear weapons threat. We measure the effectiveness of nuclear preparedness messages across formats, finding infographics to be the most effective. Importantly, we also find that any message exposure improves recall of the recommended action, confidence, and message acceptance, with these shifts positively impacting subsequent behavioral intentions.

The Utility of Choice-Enhancing Language in Emergency Preparedness Messages: An Application of Psychological Reactance Theory.

This study uses psychological reactance theory as a framework for designing effective emergency preparedness messages. Psychological reactance is the motivational state that occurs when individuals perceive their freedom to be threatened. From the standpoint of persuasive message design, reactance is an undesirable outcome that should be avoided whenever possible. Participants (N = 174) were randomly assigned to view 1 of 2 emergency preparedness messages (choice-enhancing language ["the choice is yours"] vs choice-restricting language ["you must"]) in a between-subjects-posttest-only online survey experiment. Structural equation modeling revealed that choice-restricting language resulted in greater freedom threat and subsequent reactance. Reactance resulted in a diminished attitude and subsequent intention to prepare an emergency kit. Public health practitioners would benefit from the inclusion of choice-enhancing language in their public communications, alongside the exclusion of choice-restricting language. Pretesting of messages is recommended to avoid eliciting reactance and subsequent boomerang effects.

Care, competency, or honesty? Framing emergency preparedness messages and risks for nuclear energy in Singapore

It is imperative to provide emergency preparedness messages so that the public can react appropriately to potential nuclear crises. Considering the mass media's extensive audience outreach, this study investigates how emergency preparedness message frames and the type of communication channels can influence individuals’ trust in government, risk perceptions, and acceptance of nuclear energy development in a neighboring country. A 4 (Emergency preparedness message frame: competence vs. care vs. honesty vs. control) × 2 (Communication channel: social media vs. traditional media) between-subjects factorial experiment was conducted online with 600 participants. Messages centered on care influenced participants’ trust in government the most. Messages disseminated through traditional media impacted participants’ trust in government more than social media. Participants’ trust in government and risk perceptions mediated the relationship between message frames and the types of communication channel on their acceptance of nuclear energy development in a neighboring country. Theoretical implications, practical implications, and directions for future research are discussed.

Don’t Let the Tornado Get You! The Effects of Agency Assignment and Self-Construal on Responses to Tornado Preparedness Messages

ABSTRACT This experiment explores the effects of agency assignment and self-construal on responses to tornado preparedness messages. Participants (N = 276) were randomly assigned to one of four conditions crossing agency assignment and self-construal. Results found threat agency associated with greater perceived susceptibility and tornado threat, whereas self-construal was primarily associated with perceived threat severity, such that those primed with interdependent self-construal showed marginally increased perceptions of tornado severity relative to those primed with independent self-construal. Self-construal did not appear to moderate the effects of agency assignment on attitudes or behavioral intentions. Results are discussed in light of potential psychological reactance, suggesting human agency assignment should be used cautiously, since it may pose an increased threat to perceived freedoms in certain instances. Moreover, combining human agency and independent self-construal may trigger negative cognitions directed toward the message and/or its source. It is concluded that cautious, strategic use of agency assignment can improve message acceptance and facilitate adaptive, preparedness actions.

Tweeting to Prepare: An Examination of Government and Organizational Messages during National Preparedness Month

Each year, disasters have devastating consequences in the United States. Consequences are long term and extend beyond the disaster’s immediate impact area. Establishing a culture of preparedness is necessary for the U.S. A prepared populace responds more effectively to disasters and is less stressful on community infrastructure and resources during the response phase. One of the ways government organizations and non-government organizations can encourage preparedness actions is via social media. This study examined preparedness messages existing independently of an emerging event disseminated on Twitter by government and non-government organizations. A total of 6,374 tweets were analyzed from data collected during National Preparedness Month. Tweets were analyzed for preparedness content and whether efficacy was included in preparedness messages.

Strategic Uses of Facebook in Zika Outbreak Communication: Implications for the Crisis and Emergency Risk Communication Model.

While social media has been increasingly used for communication of infectious disease outbreaks, little is known about how social media can improve strategic communication across various stages of the health crisis. The Crisis and Emergency Risk Communication Model (Reynolds & Seeger, 2005; CERC) outlines strategies across different crisis phases and can guide crisis communication on social media. This research therefore investigates how social media can be utilized to implement and adapt the CERC model, by examining the strategic uses of Facebook in communicating the recent Zika epidemic by health authorities in Singapore. Zika-related Facebook posts of three main Singapore health agencies published within the one year period from January 2016 to December 2016 were thematically analysed. Results suggest that Facebook was used to communicate the crisis strategically, which supported and added to the CERC model. Novel uses of Facebook for outbreak communication were demonstrated, including promoting public common responsibility for disease prevention and expressing regards to the public for cooperation. Results also suggested that preparedness messages might be the most effective, as they produced a great level of public engagement. The adaptability of the CERC model in social media contexts to improve crisis communication is discussed.

Correction: Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia.

[This corrects the article DOI: 10.1371/journal.pone.0190145.].

The persuasive efficacy of real versus salient hazard scenarios in motivating citizen-level hazard preparedness

Despite projections that both the frequency and magnitude of natural and man-made hazards are expected to grow, U.S. government sponsored research continues to show that American citizens remain unprepared or underprepared for such events. Recently, the U.S. Centers for Disease Control launched a campaign framing citizen-level preparedness in the context of a zombie apocalypse. Using the Heuristic-Systematic model (HSM), this research measured several theoretically relevant cognitive and attitudinal constructs to examine the persuasive efficacy of the zombie message as compared to a similar one addressing a real, salient natural hazard. Results show that the salient threat message was more effective in promoting positive attitudes, cognitive processing, and behavioral intentions to prepare. Those who read about either a hurricane, tornado, or earthquake, were more likely to report more positive preparedness attitudes, increased preparedness knowledge, and increased behavioral intentions and enhanced risk perception. The results support the conclusion that preparedness messages tailored to locally salient threats facilitate systematic processing, and beneficial persuasive outcomes. Practitioners can use these findings to modify existing preparedness campaigns to bolster preparedness related attitudes, cognitions and behavioral intentions. Implications for communication theory and practice are discussed.

An evaluation of a college campus emergency preparedness intervention

IntroductionGiven the range of emergencies that beset postsecondary institutions, university administrators must take a multimodal approach to prepare campus stakeholders for safety threats. One such strategy is emergency preparedness communication. MethodsIn the present investigation, we tested the efficacy of a professionally produced video that uses the federally endorsed slogan, Run-Hide-Fight(r). Undergraduate students participated in a quasi-experiment with a pretest-posttest-delayed posttest control group design. ResultsUsing the theory of planned behavior as our guiding framework, we found that video exposure increased attitudes, perceived norms, perceived behavioral control, intentions, as well as knowledge of recommended behavioral responses. Favorable attitudes and injunctive norms positively predicted intentions at the initial and delayed posttests. Importantly, the video's effects on most of the outcomes endured two weeks after video exposure. ConclusionsA brief emergency preparedness video using the Run-Hide-Fight(r) theme can have immediate and lingering effects on psychosocial predictors of appropriate emergency response behaviors. Practical ApplicationsAdministrators at higher education institutions should consider showing emergency preparedness messages to increase the likelihood that stakeholders will take appropriate action in case of a campus threat. In particular, these messages should aim to promote favorable attitudes toward appropriate response behaviors and instill beliefs that appropriate responses ought to be performed.

Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia.

BackgroundA community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia’s poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas.MethodologyThree serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0–5 months of age using a ‘before-and-after’ evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention.ResultsMothers’ mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38–1.99) and SBA (aOR 1.72; 95% CI 1.38–1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62–2.79) and a SMAG (aOR 4.87; 95% CI 3.14–7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20–2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88–5.75) were significant predictors for SBA at delivery and PNC.ConclusionsStrengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa.

Community-based survey during rabies outbreaks in Rangjung town, Trashigang, eastern Bhutan, 2016

BackgroundRabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. An assessment of community knowledge, awareness and practices on rabies is important during outbreak to understand their preparedness and target educational messages and response activities by the rapid response team.MethodsA rabies outbreak has occurred in Rangjung town, eastern Bhutan on 4 October 2016. A rapid response team was activated to investigate outbreak and to establish a control program. A community-based questionnaire survey was conducted from 20 to 21 October 2016 to assess the community knowledge of rabies to guide outbreak preparedness and also target educational messages and response activities by the RRT.ResultsA total of 67 respondents were interviewed, of which 61% were female and 39% male. All the respondents have heard of rabies (100%), have knowledge on source of rabies (dog) and its mode of transmission in animals and humans. Most (61%) respondents were aware and also indicated that they would wash the animal bite wound with soap and water and seek medical care on the same day of exposure (100%). Majority (94%) of the respondents have indicated that they would report to the government agencies if they see any suspected rabid dogs in the community and suggested various control measures for dog population management and rabies in Rangjung including neutering procedure and mass dog vaccination. Although only few (10%) of the respondents households owned dogs and cats, but 50% of them have indicated that their dogs were allowed to roam outside the home premises posing risk of contracting rabies through rabid dog bites.ConclusionsAlthough this study indicates a high level of knowledge and awareness on rabies among the community, there exists some knowledge gaps about rabies and therefore, an awareness education should be focused on the source of rabies and rabies virus transmission route to reduce public concern on nonexposure events thereby reducing the cost on unnecessary postexposure treatment.

How Do Low-Literacy Populations Perceive "Dirty Bombs"? Implications for Preparedness Messages.

Potential terror events such as "dirty bombs" could have significant public health effects, but little is known about how low-literacy populations perceive dirty bombs, their trust in public health or government officials to provide credible information, and their willingness to comply with recommended actions. We surveyed 50 low-literacy adults from a large urban center; they were mostly members of ethnic minority groups. We used unique social marketing methods-perceptual mapping and vector message modeling-to create 3-dimensional models that reflected respondents' knowledge of what a dirty bomb is, their intended behaviors should one occur, and their concerns about complying with "shelter in place" recommendations. To further understand individual variations in this at-risk group, a k-means cluster analysis was used to identify 3 distinct segments, differing on trust of local authorities and their emergency response, willingness to comply with emergency directives, and trust of information sources. Message strategies targeting each segment were developed to focus on concepts important to moving the groups toward a "shelter in place" behavior, revealing key differences in how best to communicate with risk communication. We discuss how these methods helped elucidate specific differences in each segment's understanding of and likely response during the event of a "dirty bomb" and how these techniques can be used to create more effective message strategies targeted to these groups.

Using eye tracking and gaze pattern analysis to test a "dirty bomb" decision aid in a pilot RCT in urban adults with limited literacy.

BackgroundEye tracking is commonly used in marketing to understand complex responses to materials, but has not been used to understand how low-literacy adults access health information or its relationship to decision making.MethodsThis study assessed how participants use a literacy appropriate “dirty bomb” decision aid. Participants were randomized to receive a CDC “factsheet” (n = 21) or literacy-appropriate aid (n = 29) shown on a computer screen. Using 7 content similar slides, gaze patterns, mean pupil fixation time and mean overall time reading and looking at slides were compared. Groups were also compared by literacy level and effect on 'confidence of knowledge' and intended behavior.ResultsResults revealed differing abilities to read densely written material. Intervention participants more precisely followed text on 4 of 7 content-similar slides compared to control participants whose gaze patterns indicated unread text, or repeated attempts at reading the same text, suggesting difficulty in understanding key preparedness messages. Controls had significantly longer pupil fixations on 5 of 7 slides and spent more overall time on every slide. In those with very low literacy, intervention participants were more likely than controls to say they understood what a “dirty bomb” is and how to respond if one should occur.ConclusionsResults indicate limited- literacy adults, especially those with very low literacy, may not be able to understand how to respond during a “dirty bomb” using available materials, making them vulnerable to negative health events. This study provides insights into how individuals perceive and process risk communication messages, illustrating a rich and nuanced understanding of the qualitative experience of a limited literacy population with written materials. It also demonstrates the feasibility of using these methods on a wider scale to develop more effective health and risk communication messages designed to increase knowledge of and compliance with general health guidelines, and enhance decision making. This has application for those with learning disabilities, those with limited media-literacy skills, and those needing to access the diverse array of assistive technologies now available. Eye tracking is thus a practical approach to understanding these diverse needs to ensure the development of cogent and salient communication.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0304-5) contains supplementary material, which is available to authorized users.

Prepared for what? addressing the disaster readiness gap beyond preparedness for survival.

BackgroundConventional disaster preparedness messaging focuses largely on promoting survival actions and communications planning for the immediate post-disaster period. While such preparedness is vital, we have long-observed a gap in preventive medicine and disaster planning for building personal resilience – preventatively – to persevere through prolonged recovery timeframes. There are many helpful attitudes and behaviors that people can develop to increase their readiness and capacity for drastic life changes, encompassing not only health-protective preparedness actions but health-promoting attitudes for “minding the risk” and “practicing resilience” as well. For instance, quality of life assessments and well-being interventions are widely-known for the clinically significant improvements they can produce in patient-reported outcomes. Similarly, health promotion interventions are implemented preventatively when a risk is identified yet a disease is not present, and can provide health benefits throughout people’s lives, regardless of the type of adversities they eventually encounter (medical, environmental, or other).DiscussionWe argue there is an overlooked opportunity to leverage well-being theories and methods from clinical settings and public health practice for the purpose of preventatively boosting disaster readiness and bolstering capacity for long-term resilience. We also highlight our previously-published research indicating a role for integrating personal meaning into preparedness messages. This is an opportune time for applying well-being concepts and practices as tools for developing disaster readiness, as risk awareness grows through real-time tracking of hazardous events via social media. For example, two sudden-onset disasters occurred within ten days of each other in 2014 and caught worldwide attention for their extreme hazards, despite dramatic differences in scale. The 22 March 2014 landslide tragedy in Washington State, USA, and the 1 April 2014 Chilean earthquake and Pacific-wide tsunami alerts brought home how persistently vulnerable we all are, and how developing intrinsic personal readiness for scientifically-known risks before disaster unfolds is essential policy.SummaryGap programming that addresses personal readiness challenges in prevention timeframes could save lives and costs. We contend that bridging this readiness gap will prevent situations where people, communities, and systems survive the initial impact, but their resilience trajectories are vulnerable to the challenges of long-haul recovery.

Birth preparedness and complication readiness – a qualitative study among community members in rural Tanzania

BackgroundBirth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR.DesignA qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data.ResultsThe community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees.ConclusionsThis study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

Increasing institutional deliveries among antenatal clients: effect of birth preparedness counselling

The World Health Organization recommends birth and emergency preparedness (BEP) as essential components of the Focused Antenatal Care model. The purpose of providing BEP messages to women during their antenatal visits is to increase the use of skilled attendance at childbirth. However, the effectiveness of this component has not yet been clearly established in routine contexts. This retrospective cohort study examined the association between exposing women to BEP messages during antenatal visits and the use of the skilled attendance at childbirth in two rural districts of Burkina Faso (Koupela and Dori). The study included 456 antenatal care users in 30 rural health centres in these two districts. Data were collected using modified questionnaires from the Johns Hopkins Program for International Education in Gynecology and Obstetrics and from demographic and health surveys. Logistic regression was performed with a model of generalized estimating equation to adjust for clustered effects. In the Koupela district, where the rate of institutional deliveries (80%) was relatively high, the use of BEP messages was not associated with an increase in institutional deliveries. In contrast, in the district of Dori, where the rate of institutional deliveries (47%) was lower, messages regarding danger signs [Adjusted Odds Ratio (AOR) = 1.93; 95% Confidence Interval (CI): 1.07, 3.49] and cost of care (AOR = 2.13; 95% CI: 1.09, 4.22) were associated with an increased probability of institutional births. Based on these results, it appears that birth and emergency preparedness messages provided during antenatal visits may increase the use of skilled attendance (increase the rate of institutional births) in areas where institutional births are low. Therefore, it is important to adapt the content of the messages to meet the particular needs of the users in each locality. Furthermore, BEP counselling should be implemented in health facilities.

Defining the importance of mental preparedness for risk communication and residents well-prepared for wildfire

Building on a recognised information-to-action gap in wildfire risk communication, this paper examines what being physically and mentally ‘well prepared’ actually means to wildfire agency staff and volunteers in charge of disseminating risk information. Using the results of an open-ended survey conducted in southeast Australia, we examine how a set of preparedness messages is interpreted. The paper demonstrates that the concept of wildfire preparedness is ambiguous, and that being ‘well prepared’ is a complex mix of practical and mental preparedness measures. Many of the individual interpretations of preparedness messages are found to not align with the official outlined intent. In particular, we argue that the lack of a clear definition and engagement with ‘mental preparedness’ in wildfire risk communication has resulted in an inability to clearly relate to, and articulate what it means to be both physically and mentally prepared for wildfire. The survey illustrates how even well-trained wildfire management professionals and volunteers misinterpret relatively uncontested risk messages, and we describe how these misinterpretations might result in dangerous decisions if wildfire threat is realised. The work also reveals three key themes that define different aspects of mental preparedness: emotional control, understanding psychological strain, and the ability to know when and how to implement a wildfire plan. The paper concludes that wildfire risk communication efforts can be improved through heightened attention to the disseminators’ as well as the recipients’ understanding, explanation and adoption of risk information.

Caractéristiques des centres de santé et conseils prénatals de préparation à la naissance

AimCounseling relating to birth preparedness is an essential component of the WHO Focused Antenatal Care model. During the antenatal visits, women should receive the information and education they need to make choices to reduce maternal and neonatal risks. The objective of this study conducted among women attending antenatal visits in rural Burkina Faso was to search for a link between the characteristics of the center delivering the health care and the probability of being exposed to information and advice relating to birth preparedness. MethodsA multilevel study was performed using survey data from women (n=464) attending health centres (n=30) in two rural districts in Burkina Faso (Dori and Koupela). The women were interviewed using the modified questionnaire of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO). ResultsWomen reported receiving advice about institutional delivery (72%), signs of danger (55%), cost of institutional delivery (38%) and advice on transportation in the event of emergency (12%). One independent factor was found to be associated with reception of birth preparedness advice: number of antenatal visits attended. Compared with women from Dori, women from Koupela were more likely to have received information on signs of danger (OR=3.72; 95%CI: 1.26–7.89), institutional delivery (OR=4.37; 95%CI: 1.70–10.14), and cost of care (OR=3.01; 95%CI: 1.21–7.46). The reduced volume of consultations per day and the availability of printed materials significantly remain associated with information on the danger signs and with the institutional delivery advices. Comparison by center activity level showed that women attending health centers delivering less than 10 antenatal visits per day were more likely to receive information on signs of danger (OR=2.63; 95%CI: 1.12–6.24) and to be advised about institution delivery (OR=6.30; 95%CI: 2.47–13.90) compared to health centers delivering more than 20 antenatal visits per day. Women attending health centres equipped with printed materials (posters, illustrated documents) were more likely to receive information on signs of danger (OR=4.25; 95%CI: 1.81–12.54) and be advised about institutional delivery (OR=6.85; 95%CI: 3.17–14.77). ConclusionEfforts should be made to reach women with birth preparedness messages. Rural health centres in Burkna Faso need help to upgrade their organizational services and provide patients with printed materials so they can improve antenatal care delivery.