A Mixed-Methods Evaluation of a Community-Based Behavior Change Program to Improve Maternal Health Outcomes in the Upper West Region of Ghana

Abstract

Background: The Community Benefits Health (CBH) program introduced a community-based behavior change intervention to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in rural Ghana. The purpose of this study was to determine if CBH influenced maternal health outcomes by stimulating community-level support in woman’s social networks.Methods: A mixed-methods study was conducted to evaluate changes in six antenatal/postpartum care, birth attendance, and breastfeeding behaviors in response to the CBH intervention and to assess how the program was implemented and to what extent conditions during implementation influenced the results.Results: We found increases in five of the six outcomes in both the intervention and control areas. Qualitative findings indicated that this may have resulted from program spillover. We considered the dose of exposure to program activities and found that women were significantly more likely to practice maternal health behaviors with increased exposure to program activities while controlling for study area and time.Conclusions: Overall, we determined that exposure to the CBH program significantly improved uptake of three of the six study outcomes, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes.

Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria

“…Community dialogues with small groups of male leaders have been found to motivate fathers to act as change agents and enable them to encourage other community members to assist with maternal health needs in the community in Nigeria [32]; these could be expanded to include child health interventions [33]. Programs can also introduce a community based non-monetary incentive to support male attendance at community information sessions to strengthen their understanding of their role in supporting mothers in recognizing and seeking care for sick children [34]. Given the role and status of mothers as primary caregivers, future studies should consider to what extent they are instructed by others on what to do; how often they understand and are in agreement with these instructions; how they circumvent instances when delays occur, when fathers are unavailable, or when inappropriate decisions are directed; and what factors enable them to take appropriate action in these situations [35].…”

“…The social ties in more traditional communities could be leveraged to increase a mother's access to advice on appropriate treatment or to provide financial support. Engaging community members as active participants in supporting a mother can help to shift social norms towards positive health behaviors and create social support that improves health outcomes [34]. Program managers should consider adopting a community readiness model to better understand how communities can be engaged to overcome cultural and gender norms that may serve as a barrier to seeking biomedical care for sick children [45].…”

Understanding factors influencing care seeking for sick children in Ebonyi and Kogi states, Nigeria

“…Community dialogues with small groups of male leaders have been found to motivate fathers to act as change agents and enable them to encourage other community members to assist with maternal health needs in the community in Nigeria (32); these could be expanded to include child health interventions (33). Programs can also introduce a community based non-monetary incentive to support male attendance at community information sessions to strengthen their understanding of their role in supporting mothers in recognizing and seeking care for sick children (34). Given the role and status of mothers as primary caregivers, future studies should consider to what extent they are instructed by others on what to do; how often they understand and are in agreement with these instructions; how they circumvent instances when delays occur, when fathers are unavailable, or when inappropriate decisions are directed; and what factors enable them to take appropriate action in these situations (35).…”

“…The social ties in more traditional communities could be leveraged to increase a mother's access to advice on appropriate treatment or to provide financial support. Engaging community members as active participants in supporting a mother can help to shift social norms towards positive health behaviors and create social support that improves health outcomes (34). Program managers should consider adopting a community readiness model to better understand how communities can be engaged to overcome cultural and gender norms that may serve as a barrier to seeking biomedical care for sick children (43).…”

Possibilidades de assistência ao aleitamento materno: Um panorama sobre as redes de apoio à amamentação

“…No final do estudo, foram vistas 14 práticas. Os autores explicam que esforços futuros devem ser direcionados para ampliar esta iniciativa em todo o estado e determinar seu impacto 20. No entanto, estudos que avaliam o impacto das redes de apoio à amamentação ainda são muito heterogêneos e negligenciam as características maternas e familiares, o tipo de programa de apoio utilizado ou os contextos em que os programas de suporte são aplicados 16.…”