Monitoring the Quality Assurance Branding Campaign Confiance Totale in Côte d'Ivoire

"Radio campaigns and other mass media approaches have been shown to be cost-effective, high-impact practices in promoting FP [family planning] awareness, related ideations, and use..."

Insufficient information, misinformation, and fears related to side effects and loss of fertility are major factors for nonuse of modern family planning (FP) in Côte d'Ivoire among couples with unmet need for FP. Breakthrough ACTION, the United States Agency for International Development (USAID)'s flagship social and behaviour change (SBC) project, aims to increase demand for and use of quality FP services in West Africa through the development and promotion of a quality assurance brand called Confiance Totale (Complete Trust). This report summarises results from a study conducted by Breakthrough RESEARCH, USAID's SBC research and evaluation project, to monitor Confiance Totale radio spots.

The branded campaign, developed in early 2020, theorises that promotion of safe and effective FP within a supportive social context will lead to an increase in demand for FP services, following the theory that mass media influence not only individual FP skills and knowledge but also environmental supports, constraints, and ideational factors in the cognitive, social, and emotional domains. Confiance Totale addressed these determinants by providing guidance to couples to increase communication about FP and by addressing key concerns, encouraging audiences to have confidence in the safety and effectiveness of FP methods, and addressing the need for FP services to offer welcoming, competent providers.

Specifically, Breakthrough ACTION used a Saturation+ approach to promote Confiance Totale, which entailed: saturation (ensuring high exposure to campaign messages), science (basing campaign design on data and modeling), and stories (focusing the dramatic climax of the story on the intented behaviour). Breakthrough ACTION developed 8 short 45-second radio spots that aired through commercial and community radio stations in select urban locations of Burkina Faso, Côte d'Ivoire, Niger, and Togo. This monitoring study considers only implementation in Côte d'Ivoire, where Breakthrough ACTION broadcasted the radio campaign in 3 districts of Abidjan and 2 health districts in urban areas outside of the capital region from May 19 to September 30 2020. Radio spots were broadcast at least 6 times in 3 local languages (French, Dioula, and Baoulé) per day by all participating radio stations.

Spot content focused on: encouraging spousal communication about birth spacing; encouraging communication with a health provider about FP methods and managing side effects; seeking FP services at a facility during the COVID-19 pandemic; spousal communication about FP during the COVID-19 pandemic; importance of giving birth in a health facility during the COVID-19 pandemic and choosing an FP method for postpartum use; adopting the lactational amenorrhea method (LAM) for postpartum women; raising awareness of FP method availability in pharmacies; and reminding young people to protect themselves against unintended pregnancy by using condoms during the COVID-19 pandemic.

Breakthrough RESEARCH conducted a quantitative repeated cross-sectional survey in 3 waves between August 28 and October 15 2020 using mobile phones in Abobo, Port-Bouet, and Yopougon. Researchers sampled roughly 500 men and 500 women in each of the 3 waves, for a total sample of 3,001 (1,514 men and 1,487 women). The study sought to determine (i) the level of unprompted recall of the Confiance Totale campaign among beneficiaries and (ii) if recall of the campaign was associated with higher levels of perceptions of FP safety, FP-related social norms, self-efficacy, spousal communication about FP, intention to talk to a partner about FP, intention to seek FP information at a health facility, intention to use FP, and current use of FP methods.

Fewer than 20% of respondents recalled being exposed to the Confiance Totale campaign. Statistically significant associations of recall of exposure to the campaign were found for the following ideational and behavioural outcomes: belief in safety of FP methods (men and women), spousal communication about FP (women), high perceived self-efficacy to communicate with partner about FP (women), intent to communicate with partner about FP (women), intent to go to health facility to seek FP information (men and women), communication about FP with health provider in the previous month (men and women), and current use of FP (men and women).

To detail one set of findings, controlling for sociodemographic and ideational factors, men and women who recalled hearing a campaign radio spot at least once a day were twice as likely (men) and 2.9 times more likely (women) to report currently using FP compared to those who did not recall the campaign (p < .05, < .01 respectively). Controlling for all factors and campaign recall, for every additional week of data collection, male respondents were 10% more likely and women were 9% more likely to report current use of contraception than respondents in the previous week (p < .05). Other significant factors shared among male and female respondents included: spousal communication (odds ratio (OR) = 3.78 and 4.29 respectively, p < .001); belief that others in the community would approve of FP use, which is an injunctive norm (OR = 1.7 and 2.14 respectively, p <.001); belief that other people in the community use FP, which is a descriptive norm (OR = 2.18, 1.89; p < .001, < .05, respectively); and belief that FP is important to delay or avoid pregnancy (OR =2.97, 7.38; p < .05, < .01, respectively).

Reflecting on the findings, the researchers note that campaign recall was at lower levels than expected with a Saturation+ approach. Also, descriptive analyses showed that radio listenership was skewed male, with about one-third of female participants reporting not listening to the radio at all. The researchers suggest that future FP campaigns in Abidjan should consider a multichannel approach to reach women, who have lower radio listenership than men, and should specifically reach out to women nearing the end of their reproductive life, since they are particularly vulnerable to unintended pregnancies.

Other notable results drawn from multivariate analyses include the fact that, among men, relationship status was a significant factor associated with descriptive social norms around FP communication and FP use in their community. This finding may indicate that men are most attuned to FP-related social norms when they enter long-term relationships, regardless of age. Thus, future campaigns could purposefully reach out to unmarried men to highlight the relevance and importance of FP use and promote FP as a concern for both sexes in nonpermanent relationships. Other findings suggest that campaigns should note the potential need to particularly reassure male audiences about FP safety.

In conclusion, this study "found significant associations, particularly among women, between campaign recall and FP-supportive ideational factors targeted by the campaign such as FP-related spousal communication....Campaigns may also consider prioritizing messages addressing descriptive and injunctive social norms around FP, as this study observed there are already high levels of FP-positive attitudes, and greater gains can yet be achieved in shifting social norms towards a more FP supportive environment."