Marc Boulay

Impact of the integrated Radio Communication Project in Nepal, 1994-1997.

The Radio Communication Project (RCP) in Nepal is an ongoing, theory-based, multimedia reproductive health campaign which began in 1995. It consists of two entertainment-education radio serials (a soap opera for the general public and a dramatized distance education serial for health workers), additional radio spot advertisements and promotions, and complementary print materials. This paper examines impact data from a variety of sources, including a pre- and postpanel survey of currently married women (N = 1905), three waves of clinic-based observations of client-provider interactions (N = 240 per wave) and client exit interviews (N = 240 per wave), and 2 years of clinic service statistics, in order to draw inferences about the separate and combined effects of the RCP components. The study found increased health worker interpersonal interaction skills, improved quality of client-provider interactions, increased client self-efficacy in dealing with health workers, improved client attitudes toward health services and toward the practice of family planning, increased adoption of family planning, and increased family planning service utilization, all attributable to the RCP. The panel data allowed statistical control of the influence of predisposing factors before the campaign on postcampaign ideation and behavior. The effect of the RCP on contraceptive behavior was largely indirect through its influence on ideation. Implications for the design of integrated, multimedia, entertainment-education campaigns and integrated evaluation designs are discussed.

Indirect Exposure to a Family Planning Mass Media Campaign in Nepal

It is often noted that some individuals become aware of a mass media programs messages through discussions with other individuals. However, the extent to which indirect exposure occurs, and its influence on behavior, are somewhat unclear. This study examines the role of indirect exposure in extending the reach of a family planning mass media campaign in Nepal. Sociometric data, gathered from nearly all women between the ages of 15 and 49 years living in six villages in Dang District, Nepal (N = 667), assessed indirect exposure to the radio program. Indirect exposure was extensive; half of all respondents were indirectly exposed to the programs messages and the overall reach of the program increased from 50% to 75% when indirect exposure was considered. Members of community groups had higher levels of direct exposure to the radio program and more extensive and diverse social networks, allowing them to serve as a conduit for these messages into the wider community. While direct exposure to the radio program appeared to influence family planning knowledge, indirect exposure was more strongly associated with contraceptive use. These findings suggest that program evaluations that ignore indirect exposure underestimate the impact of a mass media program on behavior.

Peer, parent and media influences on adolescent smoking by developmental stage

Previous studies of social influences on adolescent smoking have focused on peers and parents, using data collected prior the 1998 Master Settlement Agreement. This study used the 2004 wave of the National Youth Tobacco Survey to examine associations between peer smoking, smoking at home, tobacco-related media exposure, and smoking behavior during early and middle adolescence. Findings indicate that peer smoking and smoking at home remain strongly associated with current smoking among early and middle adolescents, controlling for gender, race/ethnicity and exposure to tobacco industry and anti-tobacco media. The magnitude of the association between peer smoking and current smoking decreases from early adolescence to middle adolescence while the association between smoking at home and current smoking is static across developmental stage. Exposure to tobacco-related media is associated with increased current and former smoking in both early and middle adolescence.

The Relationship of Social Affiliation and Interpersonal Discussion to Family Planning Knowledge, Attitudes and Practice

Data from the 1994 Kenya Situation Survey was used to examine the association between club membership interpersonal communication about family planning and contraceptive knowledge attitudes and practice. Samples were composed of 2217 women aged 15-49 and 2152 men aged 15-54. Results showed that after controlling for demographic variables the association between club membership and knowledge of modern methods strengthened among women (odds ratio of 2.0 to one of 2.3). Among men controlling for individual characteristics weakened the association between membership and knowledge (odds ratio of 1.84 to one of 1.47). Women club members were 2.3 times as likely as nonmembers to know about modern methods of family planning; male club members were 1.5 times as likely as nonmembers to know about modern contraceptives and 1.7 times as likely as nonmembers to approve family planning. Club membership was indirectly associated with increased use of contraceptives. Additionally club members showed significantly greater odds of having family planning discussions with members of their core and extended social networks. Thus social clubs in their promotion of informal discussions about family planning within a group comprising a diverse membership were seen to play a mediating role in the diffusion of new information and innovative behaviors.

Histochemical demonstration of hydrogen peroxide production by leukocytes in fixed-frozen tissue sections of inflammatory lesions.

The production of H2O2 by cells in cold paraformaldehyde‐fixed frozen sections of inflammatory lesions was histochemically demonstrated by incubating them with diaminobenzidine (DAB) for 2 to 6 h. Catalase (150 μg/ml, about 1400 U/ml) inhibited the reaction, indicating that H2O2 was required to produce the chromogenic DAB product. Granulocytes (PMNs and eosinophils) were the main types of cells stained by the DAB reaction. Positive staining of macrophages was less frequent. The H2O2 was produced by metabolic enzymes that were still active after cell death and mild fixation. An atmosphere of 95 to 100% oxygen enhanced the specific DAB reaction, and an atmosphere of 100% nitrogen eliminated it. The DAB histochemical reaction to detect H2O2 requires the presence of peroxidases to produce the colored reaction product. Within our tissue sections, such peroxidases were evidently present in excess, because addition of low concentrations of H2O2 significantly increased the reaction product. Although some of the H2O2 produced by the granulocytes may have been derived from the dismutation of superoxide (O2 ‐), the NADPH oxidase pathway for O2 ‐ formation did not seem to be involved: NADPH oxidase, a rather labile enzyme, should not be active after mild fixation, and diphenyleneiodonium (100 μM), an inhibitor of flavine‐requiring NADPH oxidase, did not inhibit the reaction. Reactive nitrogen intermediates were also not involved, because N G‐monomethyl‐l‐arginine and N G‐nitro‐l‐arginine methyl ester, inhibitors of nitric oxide synthetase, did not appreciably inhibit the reaction. We conclude that stable, non‐flavine‐requiring oxidases, possibly cyclooxygenases or lipoxygenases, produced the H2O2 measured histochemically by our DAB reaction. These studies were made on tissue sections of acute dermal inflammatory lesions produced in rabbits by the topical application of 1% sulfur mustard [bis(2‐chloroethyl) sulfide] in methylene chloride. Both intact PMNs and disintegrating PMNs in the base of the crust produced H2O2. Despite the production of H2O2 and the presence of peroxidase activity, no tissue damage was seen microscopically near the H2O2‐ producing cells, which indicates that the tissues are well protected by the antioxidants present in this self‐limiting inflammatory reaction. J. Leukoc. Biol. 56: 436–443; 1994.

The effectiveness of a national communication campaign using religious leaders to reduce HIV-related stigma in Ghana

This article describes the effects of a national mass media and community-level stigma-reduction programme in Ghana, in which national and local religious leaders urged their congregations and the general public to have greater compassion for people living with HIV or AIDS (PLHA). Data were collected from men and women living in three regions, first in 2001 (n = 2 746) and again in 2003 (n = 2 926). Attitudes related to a punitive response to PLHA both improved over time and were positively associated with exposure to the programmes campaign, controlling for potential confounding variables. Respondents in the 2003 survey were 20% more likely than respondents in the 2001 survey to be willing to care for an HIV-infected relative in their own household and 40% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Overall, respondents exposed to the campaign were 45% more likely than those not exposed to it to be willing to care for a HIV-infected relative, and 43% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Respondents exposed to the campaign also had significantly more favourable scores on an attitude scale measuring the belief that HIV-infected individuals should be isolated from others. The results of this evaluation suggest that mass media channels and religious leaders can effectively address HIV-related stigma on a national scale.

Using Health Education Theories to Explain Behavior Change: A Cross-Country Analysis:

Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four theories provide an excellent fit to the data, but that certain variables within them may have particular value for understanding specific aspects of behavior change. Recommendations for the selection of theories to use as guidelines in the design and evaluation of reproductive health programs are provided.

The use of mediation analysis to assess the effects of a behaviour change communication strategy on bed net ideation and household universal coverage in Tanzania

BackgroundSBCC campaigns are designed to act on cognitive, social and emotional factors at the individual or community level. The combination of these factors, referred to as ‘ideation’, play a role in determining behaviour by reinforcing and confirming decisions about a particular health topic. This study introduces ideation theory and mediation analysis as a way to evaluate the impact of a malaria SBCC campaign in Tanzania, to determine whether exposure to a communication programme influenced universal coverage through mediating ideational variables.MethodsA household survey in three districts where community change agents (CCAs) were active was conducted to collect information on ITN use, number of ITNs in the household, and perceptions about ITN use and ownership. Variables relating to attitudes and beliefs were combined to make ‘net ideation’. Using an ideational framework, a mediation analysis was conducted to see the impact exposure to a CCA only, mass media and community (M & C) messaging only, or exposure to both, had on household universal coverage, through the mediating variable net ideation.ResultsAll three levels of exposure (CCA, M & C messaging, or exposure to both) were significantly associated with increased net ideation (CCA: 0.283, 95% CI: 0.136-0.429, p-value: <0.001; M & C: 0.128, 95% CI: 0.032-0.334, p-value: 0.018; both: 0.376, 95% CI: 0.170-0.580, p-value: <0.001). Net ideation also significantly increased the odds of having universal coverage (CCAOR: 1.265, 95% CI: 1.118-1.433, p-value: <0.001; M & COR: 1.264, 95% CI: 1.117-1.432, p-value: <0.001, bothOR: 1.260, 95% CI: 1.114-1.428, p-value: <0.001). There were no significant direct effects between any exposure and universal coverage when controlling for net ideation.ConclusionsThe results of this study indicate that mediation analysis is an applicable new tool to assess SBCC campaigns. Ideation as a mediator of the effects of communication exposure on household universal coverage has implications for designing SBCC to support both mass and continuous distribution efforts, since both heavily rely on consumer participation to obtain and maintain ITNs. Such systems can be strengthened by SBCC programming, generating demand through improving social norms about net ownership and use, perceived benefits of nets, and other behavioural constructs.

Spinal cord stimulation with interleaved pulses: a randomized, controlled trial.

Objectives.  The development of multicontact electrodes and programmable, implanted pulse generators has increased the therapeutic success of spinal cord stimulation (SCS) by enhancing the ability to capture and maintain pain/paresthesia overlap. This study sought to determine if interleaved stimulation and/or frequency doubling improves pain/paresthesia overlap in patients with failed back surgery syndrome.

The Effect of Single or Repeated Home Visits on the Hanging and Use of Insecticide-Treated Mosquito Nets following a Mass Distribution Campaign - A Cluster Randomized, Controlled Trial

Background Study objective was to evaluate the effectiveness of commonly used post-campaign hang-up visits on the hanging and use of campaign nets. Methods A cluster-randomized trial was carried out in Uganda following an ITN distribution campaign. Five clusters (parishes, consisting of ∼11 villages each) were randomly selected for each of the three study arms with between 7,534 and 9,401 households per arm. Arm 1 received one hang-up visit, while Arm 2 received two visits by volunteers four and seven months after the campaign. Visits consisted of assistance hanging the net and education on net use. The control arm was only exposed to messages during the campaign itself. Three cross-sectional surveys with a two-stage cluster sampling design, representative of the study populations, were carried out to capture the two key outcome variables of net hanging and ITN use. Sample size was calculated to detect at least a 15 percentage-points change in net use, and was 1811 at endline. The analysis used an intention-to-treat approach. Findings Both hanging and use of ITN increased during follow-up in a similar way in all three study arms. The proportion of the population using an ITN the previous night was 64.0% (95% CI 60.8, 67.2), for one additional visit, 68.2% (63.8, 72.2) for two visits and 64.0% (59.4, 68.5) for the control. The proportion of households with all campaign nets hanging increased from 55.7% to 72.5% at endline (p<0.0005 for trend), with no difference between study arms. Financial cost per household visited was estimated as USD 2.33 for the first visit and USD 2.24 for the second. Conclusions Behavior change communication provided during the campaign or through other channels was sufficient to induce high levels of net hanging and use and additional “hang-up” activities were not cost-effective.