1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation • In Slide Show, click on the right mouse button • Select “Meeting Minder” • Select the “Action Items” tab • Type in action items as they come up • Click OK to dismiss this box • This will automatically create an Action Item slide at the end of your presentation with your points entered. Formative & Baseline Study Methods Befekadu Girma, M.Ph. Development Studies Associates Addis Ababa, Ethiopia Kim Witte, Ph.D. JHU/CCP JHU/PCS - Ethiopia Reproductive Health Communication Project

2. Acknowledgements • Regional Heads • CSA • Enumerators JHU/PCS - Ethiopia Reproductive Health Communication Project

3. Design • Sample • Males and Females Aged 15-30 • In Two Most Urban Towns in Five Regions • Addis Ababa and Environs: Akaki and Gedam-Sefer • Amhara: Bahr Dar and Gonder • Oromia: Jimma and Nazareth • SNNPR: Awassa and Arba-Minch • Tigray: Adigrat and Mekele JHU/PCS - Ethiopia Reproductive Health Communication Project

4. Design Continued • Qualitative Research • 20 Focus Groups • 4 per region • Males 15-20, Females 15-20, Males 21-30, Females 21-30 • Quantitative Research • Face-to-Face Surveys • 800 participants total (792 completed) • b > .80, a = .05 (2 tailed tests) JHU/PCS - Ethiopia Reproductive Health Communication Project

5. Sampling Procedures – FOCUS GROUPS • Purposively Selected to capture age, sex, demographic differences in perceptions and practices • Excluding any participants already interviewed for survey. • Average of 8 participants per group • 161 total focus group participants • Discussions lasted about 2 hours JHU/PCS - Ethiopia Reproductive Health Communication Project

6. Sampling Procedures -- SURVEYS • Complete Random Sample • Using random numbers table • Randomly selected zone, then woreda, then kebele, then households (all from fresh lists) • Households having persons aged 15-30 were eligible for the study • Non-responses replaced by next eligible household (occurred only 5 times). • One person per household interviewed. JHU/PCS - Ethiopia Reproductive Health Communication Project

7. Quality Control Procedures • Coordination: National & Regional • Manual Developed • Objectives, strategies, norms for study • Asking demographic, sexual questions • Family planning, HIV/AIDS issues • Procedures, precautions during survey/focus groups • Do’s and Don’ts JHU/PCS - Ethiopia Reproductive Health Communication Project

8. Quality Control Continued • Training • Two Stages: Training of trainers, training of supervisors and interviewers • Theory, sampling techniques • Mock exercises, Practice in the field • Feedback • Completed questionnaires reviewed at the end of each day • Spot checks of interviewers/moderators throughout study by national coordinator JHU/PCS - Ethiopia Reproductive Health Communication Project

9. Instrument Development • Questions and items developed according to theory • Based on validated and reliable items used in previous studies • Piloted and refined to fit Ethiopian culture • Focus Group Guide • Open-ended questions • Piloted and refined for flow, understandability JHU/PCS - Ethiopia Reproductive Health Communication Project

10. Instrument Development – Cont. Survey Questionnaire • Open and close-ended items • 5-point Likert-type scales 1 2 3 4 5 Strongly Strongly Disagree Agree • Respondents adapted easily to response format • Item analysis indicated valid and reliable scales JHU/PCS - Ethiopia Reproductive Health Communication Project

11. Analysis Procedures • Focus Groups • Audiotapes professionally transcribed • Translated ver batim into English • Research team developed Classification Scheme to code phrases/thoughts • Subgroup analysis conducted by age, sex, region • Similarities/Dissimilarities extracted • Coded material placed into tables JHU/PCS - Ethiopia Reproductive Health Communication Project

12. Analysis Procedures • Survey Questionnaires • Pre-coded numerical responses • Open-ended items numerically coded • Data entered, cleaned in SPSS • 10% data double-entered to verify accuracy • Scales created, reliability analysis conducted for all theoretical variables • Frequencies, descriptives analyzed • T-tests, one-way ANOVA, correlations, and logistic regression analysis conducted JHU/PCS - Ethiopia Reproductive Health Communication Project

13. TEA BREAK – 20 minutes JHU/PCS - Ethiopia Reproductive Health Communication Project

14. Tea Break OVER Please Be Seated JHU/PCS - Ethiopia Reproductive Health Communication Project

15. FOCUS GROUP RESULTS JHU/PCS - Ethiopia Reproductive Health Communication Project

16. General results – Family Planning • Major Health Problems • HIV/AIDS, malaria, TB, dysentery • Most Important Health Problem • HIV/AIDS • Ideal Family Size • 12 groups preferred 2-4 children • Nazareth groups preferred 10-12 children JHU/PCS - Ethiopia Reproductive Health Communication Project

17. Theoretical results: Family Planning • Defining the Threat: What is negative about Having More Children than Desired (if anything)? • Inability to feed, clothe, educate, provide medical care • Maternal death • Loss of hopes/dreams, poverty, family breakups • Perceived Severity – outcomes listed above serious, but rare • Perceived Susceptibility (too many children) • High for members of 12 groups • Lower risk for members of 4 groups JHU/PCS - Ethiopia Reproductive Health Communication Project

18. Theoretical results: Family Planning • High Knowledge for Perceived Best Responses to prevent too many children • Perceived Response Efficacy: High, except for Condoms • Modern methods believed effective • Condoms -- many reservations • Perceived Self-Efficacy: Low to moderate • Inadequate knowledge re use, access • Fear of side effects • Lack of couples’ agreement • Lack of cultural or religious consent • Improper Use (failure to follow schedules, guidelines) JHU/PCS - Ethiopia Reproductive Health Communication Project

19. Theoretical results: HIV/AIDS • Perceived Causes of HIV/AIDS: Accurate • Perceived Severity: Strong • Perceived Susceptibility: Sexually active persons, drivers, soldiers, youth, govt • Perceived Best Responses: Accurate • Perceived Response Efficacy • Monogamy 1st, then abstinence, then condoms JHU/PCS - Ethiopia Reproductive Health Communication Project

20. Theoretical results: HIV/AIDS • Perceived Self-Efficacy: Mixed • Ambivalent toward condoms • Significant barriers • Influence of Religion • Promotes abstinence and monogamy • Mixed opinions regarding whether religion influences HIV/AIDS protection practices • Influence of Local Beliefs • Doubted HIV existence • Doubted effectiveness of condoms • Fatalistic beliefs JHU/PCS - Ethiopia Reproductive Health Communication Project

21. Conclusions: Family Planning • High knowledge levels • Serious threats identified, but rare events • High perceptions of susceptibility to having too many children; low susc to experiencing serious threats • High response efficacy • Except condoms – very low • Low self-efficacy (esp. condoms) • Perceived anti-religious sentiments JHU/PCS - Ethiopia Reproductive Health Communication Project

22. Conclusions: HIV/AIDS Prevention • High levels of knowledge about causes and best responses • High perceived severity • Low perceived susceptibility (others will get it, not me) • Response efficacy high, except for condoms (low) • Mixed self-efficacy perceptions; low for condoms • High perceived barriers to preventive methods • Local beliefs negatively affect prevention JHU/PCS - Ethiopia Reproductive Health Communication Project

23. SURVEY RESULTS Dr. Kim Witte Johns Hopkins University, and, Michigan State University wittek@msu.edu JHU/PCS - Ethiopia Reproductive Health Communication Project

24. Sample Characteristics • 74% Female, 26 % Male • 80% Orthodox, 10.4% Muslim • 49.9% Age 15-20; 51.1% Age 21-30 • 68.3% Single, 22.2% Married • 40% students, 19.1% housewives, 15.4% unemployed • 84.7% primary or secondary education • 51.6% had ever had sex • 28% had at least one child • Age at 1st Sex** • Females = 16.69 years old • Males = 18.26 years old JHU/PCS - Ethiopia Reproductive Health Communication Project

25. Ideal Family • Preferred family size was 2 – 4 children • Last pregnancy: • Wanted to get pregnant later, 22.1% • Did not want to get pregnant at all, 12.6% • Indicates Unmet Family Planning Need JHU/PCS - Ethiopia Reproductive Health Communication Project

26. Family Planning Awareness & Practices • 85.1% spontaneous awareness • 95.1% prompted awareness • 17% of males and 44% of females used some family planning method the “last time they had sex” JHU/PCS - Ethiopia Reproductive Health Communication Project

27. Attitudes toward Family Planning Methods JHU/PCS - Ethiopia Reproductive Health Communication Project

28. Intentions to Use Family Planning Methods JHU/PCS - Ethiopia Reproductive Health Communication Project

29. FAMILY PLANNING: Perceived Threat & Efficacy JHU/PCS - Ethiopia Reproductive Health Communication Project

30. Associations of theoretical variables and intentions • The greater one’s perceived susceptibility, the stronger one’s intentions to use the pill. (r = .14, p < .005) • The greater one’s perceived response efficacy, the stronger their intention to use family planning. (r = .16, p < .005) • The greater one’s perceived self-efficacy, the stronger their intention to use the pill. (r = .64, p < .001) • Perceived severity was unrelated to intentions to use the pill. (probable cause ceiling effects – 82% scored 4 or 5 on a five-point scale; only 12% choose a 1, 2, or 3) JHU/PCS - Ethiopia Reproductive Health Communication Project

31. Perceived Severity from Having too Many Children • Item read having more children than wanted led “to problems,” was “harmful to their future,” led “to bad outcomes,” and led “to negative consequences.“ JHU/PCS - Ethiopia Reproductive Health Communication Project

32. Perceived Susceptibility of Having too Many Children JHU/PCS - Ethiopia Reproductive Health Communication Project

33. Perceived Response Efficacy for Family Planning Methods JHU/PCS - Ethiopia Reproductive Health Communication Project

34. Perceived Self-Efficacy for Family Planning Methods JHU/PCS - Ethiopia Reproductive Health Communication Project

35. Intentions to Use the Pill JHU/PCS - Ethiopia Reproductive Health Communication Project

36. Defensive Avoidance toward Getting Pregnant JHU/PCS - Ethiopia Reproductive Health Communication Project

37. Perceived Self-Efficacy for the Pill JHU/PCS - Ethiopia Reproductive Health Communication Project

38. Mechanisms Underlying Intentions to use the Pill. • Best Fitting Model • Self-Efficacy, Susceptibility, Defensive Avoidance, being Married • c2 = 8.89, p = .35; Successfully predicts membership in fear control or danger control group 78% of the time; predicts pill usage correctly 91.2% of the time. JHU/PCS - Ethiopia Reproductive Health Communication Project

39. Variables Underlying Perceived Self-Efficacy to Use the Pill. • Best Fitting Model - c2 = 7.18, p = .52 • Predicts group membership 76% of the time; predicts membership in high self-efficacy group 91% of the time • Subjective Norms • Other People • Religion • Barriers • Inconvenient • Talking with my partner • Past Behavior (prior usage of pill) • Response Efficacy JHU/PCS - Ethiopia Reproductive Health Communication Project

40. Variables to target in Family Planning Messages Advocating the Pill • Increase Perceived Self-Efficacy • Increase Perceived Susceptibility to having more children than desired or having a child now when you’d rather wait • Decrease Defensive Avoidance • Reinforce High Severity Perceptions • Reinforce High Response Efficacy Perceptions JHU/PCS - Ethiopia Reproductive Health Communication Project

41. Variables to target in Family Planning Messages Advocating the Pill • Address Subjective Norms • Other People • Religion • Barriers • Inconvenient • Talking with my partner • Convince to Try on Trial Basis • Increase Response Efficacy Perceptions JHU/PCS - Ethiopia Reproductive Health Communication Project

42. Family Planning Messages JHU/PCS - Ethiopia Reproductive Health Communication Project

43. HIV/AIDS Awareness & Practices • 99.2% Aware of HIV/AIDS • 97% Knew could avoid infection • Spontaneous Knowledge of methods: • Use Condoms (79%) • Be Monogamous (77.8%) • Abstain from Sex (42.5%) • Avoid unclean needles (36%) • Avoid sharing razors/blades (28.3%). JHU/PCS - Ethiopia Reproductive Health Communication Project

44. Perceived HIV/AIDS Status - Self JHU/PCS - Ethiopia Reproductive Health Communication Project

45. Perceived HIV Status -- Others JHU/PCS - Ethiopia Reproductive Health Communication Project

46. Current Behaviors – I Protect (through monogamy) JHU/PCS - Ethiopia Reproductive Health Communication Project

47. Current Behaviors – Partner Protects (through monogamy) JHU/PCS - Ethiopia Reproductive Health Communication Project

48. Current Behaviors – I Use Condoms to Protect Self JHU/PCS - Ethiopia Reproductive Health Communication Project

49. HIV/AIDS PREVENTION:Perceived Threat and Efficacy JHU/PCS - Ethiopia Reproductive Health Communication Project

50. Associations of theoretical variables and condom behaviors • The greater one’s perceived susceptibility, the greater the condom use. (r = .32, p < .0001) • The greater one’s perceived response efficacy, the greater the condom use. (r = .48, p < .0001) • The greater one’s perceived self-efficacy, the greater the condom use. (r = .53, p < .0001) • The greater one’s perceived severity toward HIV/AIDS, the greater the condom use. (r = .06, p =.06; marginal significance, probably due to ceiling effect, M = 4.78 on 5-pt scale) JHU/PCS - Ethiopia Reproductive Health Communication Project