The Evaluation of a Mass Media Campaign to Promote Exclusive Breastfeeding in Vietnam

This dissertation explores whether a mass media campaign, comprised of two television spots promoting exclusive breastfeeding (EBF), was successful in changing EBF behavior when implemented alone and when implemented in conjunction with other media materials, the training of service providers, and the establishment of a franchise network of infant and young child feeding counseling centers. The data were collected at five waves in four provinces of Vietnam through a three-stage cluster sampling methodology for a total of 11,277 face-to-face interviews with mothers of infants under the age of six months. Although the same individuals were not interviewed over time, the same 118 communes were sampled at each wave. The core analyses explore the longitudinal effects of commune level exposure on commune level EBF. Commune level EBF rates never differed significantly from baseline in mass media only communes. In franchise communes, however, EBF rates improved sharply (from 24% before to 55% after). Further longitudinal analyses indicate that communes that were going to be high in exposure after the campaign began experienced significantly greater overtime increases in EBF than communes that were going to be low in exposure. Mediation analyses suggest that, in franchise communes, the mass media campaign had an effect by driving women to franchise centers to seek additional IYCF support and that appears to have had an effect on EBF behavior. Moderation analyses suggest that exposure to the mass media campaign did not, for the most part, have differential effects on EBF behavior among mothers of younger infants compared to mothers of older infants, first-time mothers as compared to experienced mothers, and mothers with more versus less education. From the studies that comprise this dissertation, we can conclude that: 1) Mass media alone, in the format of two 30-second spots, was not effective in changing EBF behavior in Vietnam; 2) Where other intervention strategies were implemented alongside mass media, the mass media campaign led to greater EBF behavior change; 3) In geographic areas where the intervention was comprised of multiple components, the mass media campaign had effects through a process of social diffusion

Bringing fear into focus: The intersections of HIV and masculine gender norms in Côte d'Ivoire.

This qualitative research study explored the role of masculinity in men's engagement in the HIV care continuum in Côte d'Ivoire. The researchers conducted 73 in-depth interviews and 28 focus group discussions with 227 Ivoirian men between November and December 2016 across three urban sites. Participants in the study expressed that fear was the primary barrier to HIV testing and treatment. These men described five value domains-health, sexuality, work and financial success, family, and social status. Men saw HIV as a direct threat to their agency and strength with respect to each of these value domains, thus shedding light on their reluctance to discover their HIV status through HIV testing. With this data, the researchers created the Masculine Values Framework, a descriptive framework of masculine values that can be applied to better understand the behavior men exhibit in Côte d'Ivoire in the face of HIV. The Masculine Values Framework offers practical guidance for developing gender-sensitive HIV-focused social and behavior change programming in Côte d'Ivoire and similar contexts to reach the UNAIDS 90-90-90 targets

Men's perceptions of HIV care engagement at the facility- and provider-levels: Experiences in Cote d'Ivoire.

Men in sub-Saharan Africa have lower rates of HIV testing and are less likely to initiate treatment compared to women. Service delivery dimensions are a key factor in facilitating engagement along the HIV treatment continuum for men and women, yet male specific overall perceptions of the service delivery environment have received little attention in West Africa. This study draws on qualitative data collected in Côte d'Ivoire to explore provider-level and structural factors affecting men's engagement in HIV testing and treatment through interviews and focus group discussions conducted with health workers and men living with HIV (some on ART) or whose HIV status was unknown. Factors influencing decisions to test or initiate treatment were considered in terms of perceived benefits and costs. Men described costs at the interpersonal (client-provider) level, such as unwanted disclosure or stigma, which were weighed against the potential for social support and clinical guidance. Likewise, fear of unwanted disclosure operated at the facility level, as the layout of facilities sometimes grouped clients living with HIV together. Notably, the benefits men described from engaging in HIV testing and care all operated at the interpersonal level and none at the facility level. In light of the fact that provider- and facility-level factors influenced the perceptions and experiences of men along the treatment continuum, we offer recommendations to reduce barriers to testing and engagement in care related to service delivery