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McGill Family Medicine Studies Online, 14: e03

Page history last edited by reem.elsherif@mail.mcgill.ca 2 years, 11 months ago

Safieh, Jacqueline (2019). The role of media in sexual and reproductive health education in low- and middle-income countries: a mixed methods investigation. McGill Family Medicine Studies Online, 14: e03


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Background: An estimated 200 million women and girls in low and middle-income countries (LMICs) wish to delay, space or avoid becoming pregnant, yet are not using contraceptives. This thesis seeks to investigate the effectiveness of mass media interventions for increasing knowledge and use of contraceptives, and to identify barriers to program implementation. However, while media represents a promising tool for health education, even the most efficacious interventions rely on reach of the media program. Therefore, this thesis also seeks to identify the important variables associated with radio and television use, in order to better characterize audiences and to guide media health education programs.


Methods: First, using a mixed-methods systematic approach, five electronic databases were searched using pre-determined search strategies and hand-searching of articles of mass media interventions for family planning education. Two reviewers independently applied clearly defined eligibility criteria to the search results, quality appraisal, data extraction from published reports, and data analysis (using meta-analysis and thematic analysis) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Next, using Demographic and Health Survey (DHS) datasets of 41 countries, we used two statistical prediction methods, conventional logistic regression model (main effects only) and random forests, to estimate respondents' expected use of radio and/or television in relationship to various individual- and country-level predictor variables. The most important variables for determining media use were further analyzed for direction of relationships and the cross-validated misclassification errors of each method were compared.


Findings: The mixed methods systematic review found an overall low quality of studies evaluating media interventions for improving contraceptive and family planning knowledge and use. Moreover, although the majority of studies suggest a positive association between media interventions and family planning outcomes, the pooled results are still consistent with possibly null or small effects. The qualitative analysis indicates that barriers to contraceptive uptake include individual-level socio-demographic factors and knowledge, access (including issues relating to mobility and financing), and programming (including lack of participatory approaches). The multi-country analysis found that women who are slightly younger, urban-residing, more educated, and of a higher wealth status have a higher reported percentage of frequent radio and television use. For each media method (radio and television), having either a radio and/or television in the household was the most important predictor of media use. The second most important variable for determining use of both media methods was the respondent's reported frequency of engaging with other media sources (i.e. television, radio or newspapers).


Conclusion: There is a need for rigorous impact evaluation, including randomised controlled trials, of mass media interventions on knowledge and uptake of family planning in LMIC settings. Interventions should be better tailored to cultural and socio-demographic characteristics of the target populations, while access to resources, including contraceptives, should continue to remain a priority and be improved, where possible. It is also important to keep in mind potential gaps in access to media sources when designing health education programs through media.

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