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Exposure to Family Planning Messages through Mass Media and Interpersonal
Communication and Current Contraceptive Use in Ghana
Claire [email protected]
Supervisors: Dr J.W. McDonald & Dr Zoë Matthews
Outline of Presentation
Rationale for study - The Ghanaian context
Aims of studyTheoretical backgroundIntroduction to data – Ghana 2003 DHSMethodologyDefinition of study variablesResultsConclusions
The Ghanaian Context
Estimated population in 2005 of 21 million
Population growth rate in 2005 was 1.25%.
The 2005 Total Fertility Rate is 3.02
GDP per capita (ppp) was estimated in 2004 as $2,300
Trends in Contraceptive Use in Ghana
Trends in contraceptive use among currently married women
aged 15-49 (%)
05
1015202530
1988 1993 1998 2003
any method
modern method
traditionalmethod
Ghana’s Poverty Reduction Strategy
Vision 2020 Plan of Action Aim to have contraceptive prevalence of
modern methods of 15% by 2000 and 50% by 2020
Strategy to decentralize service delivery and support national campaign on fertility regulation including comprehensive Information, Education and Communication (IEC) programme to promote the use of family planning
Aims of Study
The aims of my study were to determine if there is any association between current use of modern contraceptives among Ghanaian women and:exposure to family planning messages
through a range of different mass media channels
exposure to interpersonal communication regarding the use of family planning
Theoretical Background
The appeal of using mass media communication channels to promote family planning messages is the wide spread coverage and cost effectiveness.
Some debate about its effectiveness and two primary competing theories: Ideational Hypothesis - media effects are universal
and each individual may be prompted to change their attitude and behaviour by exposure to modern ideas
Diffusion of Innovation Theory - mass media is effective at creating awareness and knowledge of innovations, but interpersonal communication is necessary for actual behaviour change
Data
2003 Ghana Demographic Health Survey (GDHS) Sub-sample drawn to include all women who are
potentially at risk of pregnancy and therefore potential contraceptive users:All women aged 15-49 currently in union (married or living with a man) ANDAll unmarried women aged 15-49 who are currently sexually active (within past month of survey date) – unmarried includes, never
married, separated, widowed and divorced
From this subset cases were excluded where the women is
one or more of the following:Currently pregnantAmenorrheic InfecundMenopausalCurrently abstaining
The final data set contains 2065 cases
Methodology
Binary logistic regression modelling with current use of a modern contraceptive as the response variable.
Multi-level modelling was used, to allow for random variation at the group as well as the individual levels, to account for the hierarchical clustered data structure which is a function of the sampling of the survey and could lead to dependence among the observations.
Study Variables
Binary response variable: 0 = not currently using a modern contraceptive method
1 = currently using a contraceptive method
Explanatory variables:Exposure to Mass Media - Respondent has heard
a family planning message in the few months prior to survey
from:
• Radio – yes/no
• Television – yes/no
• Newspaper/magazine – yes/no
Explanatory variables – Interpersonal communication:
Respondent has heard a family planning message from a Health worker
Respondent has heard a family planning message at a community Meeting
Respondent has discussed family planning with someone other than partner
Control variables:AgeEducationOccupationReligionEthnicityRegionUrban/ruralNumber of living
childrenMarital status
Results – Respondent Characteristics
Variable % of respondents (n) Total n=2065
Response
Current use
No 71 (1461)
Yes 29 (604)
FP exposure- mass media
fpnews
No 81.1 (1675)
Yes 18.9 (390)
Fptv
No 49.3 (1018)
Yes 50.7 (1047)
Fpradio
No 19.2 (396)
Yes 80.2 (1669)
Variable % of respondents (n) Total n=2065
Interpersonal Communication
Fphealthworker
No 43.7 (903)
Yes 56.3 (1162)
Fpcommunity
No 63.0 (1301)
Yes 27.0 (764)
Discussedothers
No 69.9 (1443)
Yes 30.1 (622)
Results- Simple Logistic Regression
β SE (β) Exp (β) 95% CI
fpnews 0.34** 0.12 1.40 (1.12,1.76)
fptv 0.36*** 0.10 1.44 (1.19,1.74)
fpradio 0.43*** 0.13 1.54 (1.19,1.99)
discuss 0.67*** 0.10 1.96 (1.61,2.40)
fphealth 0.62*** 0.10 1.85 (1.52,2.26)
fpcomm 0.18 0.10 1.20 (0.99,1.46)
***p<0.001; **p<0.01; *p<0.05NB: The intercepts and the baseline categories are omitted from this table, all
baselines are β=0 and Exp (β) = 1
Results- Multiple Logistic Regression
β SE (β) exp (β) 95% CI
Discussed FP with someone other than partner
No (RC) 0.00 1.00
Yes 0.91*** 0.16 2.48 (1.82,3.38)
FP message from health worker
No (RC) 0.00 1.00
Yes 0.54*** 0.12 1.72 (1.34,2.19)
FP message from community meeting
No (RC) 0.00 1.00
Yes 0.46* 0.23 1.58 (1.01,2.52)
***p<0.001; **p<0.01; *p<0.05 RC = Reference Category
What next? – Model 2
To explore the possible indirect effect of exposure to messages in the mass media a new model is fitted with discussed family planning with others as the response variable.
Discussing family planning with others was chosen as the response as literature suggests it is an intermediate behaviour change variable and part of the mechanism through which receiving family planning information from mass media influences contraceptive behaviour.
All other variables and model specification remain the same
Results- Simple Logistic Regression
β SE (β) Exp (β) 95% CI
fpnews 1.18*** 0.11 3.25 (2.59,4.08)
fptv 0.82*** 0.10 2.28 (1.88,2.77)
fpradio 1.16*** 0.15 3.19 (2.37,4.29)
***p<0.001; **p<0.01; *p<0.05 NB: The intercepts and the baseline categories are omitted from this table, all baselines are β=0 and Exp (β) = 1
Results- Multiple Logistic Regression
β SE (β) Exp (β) 95% CI
FP message from radio
No (RC) 0.00 1.00
Yes 0.56** 0.18 1.76 (1.24,2.48)
FP message from Television
No (RC) 0.00 1.00
Yes 0.29* 0.13 1.34 (1.04,1.73)
FP message from Newspaper
No (RC) 0.00 1.00
Yes 0.53*** 0.14 1.70 (1.26,2.28)
***p<0.001; **p<0.01; *p<0.05 RC = reference category Other variables in the model are: Number of living children, Education, Region FP message from
health worker & FP message from community meeting
Random effects
Both final models were tested for the inclusion of random effects components at the household and cluster level.
The models were re-fitted with the same fixed effects and adjusted to allow the intercept to vary first at household then at cluster level.
In all cases it was concluded that there is no significant clustering effect and all of the observations in the data can be treated as independent. The fixed effects models are a valid and adequate approach to analysing this data.
Conclusions Exposure to mass media family planning messages does
not have a direct association with current use of modern contraceptives after controlling for socio-economic factors.
There is evidence that it does have indirect influence through its strong positive association with interpersonal communication which in turn is strongly and positively associated with contraceptive use.
Results support the diffusion of innovation hypothesis where mass media works as part of a two-step flow process where knowledge disseminated through the media prompts interpersonal discussions, which then diffuses through social networks and prompts behaviour change.
