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

Figures & data

Fig. 1. CBH program theory of change.

Table 1. Study questions used to measure social network characteristics

Social network characteristic	Study question
Partner is male/married	What is the sex, level of education, and marital status of the network partner?
Partner is health professional	What is your relationship to [name of social contact]? (relationship is health provider)
Advice from partner	Between you and [name of social contact] which of you knows the most about pregnancy? and Between you and [name of social contact] which of you gives the other more resources such as money and transport or other support during pregnancy?
Residence of network partner	Where does [name of social contact] stay? (same household/compound, same village, same district, somewhere else)
Intimacy level with partner	How intimate is [name of social contact] to you? (confidant/close friend, friend, acquaintance, or stranger)

Table 2. Description of respondents

	Base control	Base messaging	Base incentive	End control	End messaging	End incentive
Demographic characteristics	%	%	%	%	%	%
Mother’s age
15–24	34.4	34.6	29.4	35.5	30.7	26.5
25–29	17.9	27.9	27.3	26.3	22.5	24.2
30–34	28.5	20.2	24.2	16.8	21.4	28.3
35–49	19.2	17.3	19.1	21.5	25.4	21.0
Mother’s education
No education	66.7	64.5	71.1	63.1	72.8	72.6
Primary	19.2	23.2	21.1	19.6	15.6	12.8
Secondary+	14.1	12.3	7.7	17.3	11.6	14.6
Mother’s religion
Christian	68.0	60.1	79.9	75.7	67.2	83.6
Muslim	12.7	10.9	6.2	14.3	11.1	12.3
Traditional	19.2	29.0	13.9	10.1	21.7	4.1
Parity
1 Child	25.4	24.1	25.8	24.0	18.3	21.5
2–3 Children	26.8	34.3	26.8	36.6	33.9	28.8
4+ Children	47.8	41.6	47.4	39.4	47.9	49.8
Attends women’s group	64.6	54.6	61.9	63.4	69.8	71.7
Listened to radio in the last week	52.2	49.9	44.3	50.6	46.8	55.3
N =	291	341	194	358	378	219
Social network characteristics
Network size
0	66.0	55.4	52.6	14.8	13.8	16.4
1	18.2	27.9	25.8	28.8	29.6	22.4
2	7.2	11.7	17.5	17.3	20.1	20.6
3+	8.6	5.0	4.1	39.1	36.5	40.6
First network partner is male	52.0	30.7	42.5	28.5	26.4	46.5
First network partner education level secondary+	36.8	52.5	44.7	27.8	25.2	28.7
First alter married	77.6	64.7	58.6	74.8	77.9	83.1
Relationship to first network partner
Partner	24.5	25.5	31.0	21.0	19.0	27.3
Family	28.6	25.5	8.1	30.2	35.0	27.3
Friend/other	13.3	16.3	10.3	23.6	21.5	22.4
Health professional	33.7	32.7	50.6	25.3	24.5	23.0
Residence of first network partner
Same household	32.7	30.7	33.3	37.1	41.1	39.9
Same village	26.5	21.6	20.7	38.0	35.9	44.8
Same district	18.4	26.8	32.2	10.8	15.3	7.1
Somewhere else	22.5	20.9	13.8	14.1	7.7	8.2
Intimacy with first network partner
Close friend/confidante	66.3	62.1	48.3	69.5	63.2	67.8
Acquaintance	33.7	37.9	51.7	30.5	36.8	32.2
Advice from first network partner
Mostly gets information	75	70.63	65.48	72.79	75.88	76.7
Mostly give and get information	19.05	12.59	20.24	15.65	16.72	13.64
Mostly give information	5.95	16.78	14.29	11.56	7.4	9.66
N =	98	153	87	304	326	183

Table 3. Odds ratio of social network characteristics and effects of intervention by maternal and breastfeeding outcomes⁸

Social network characteristics	Early ANC	ANC4	SBA	PPC	IBF	EBF
Network size
1.00	Ref	Ref	Ref	Ref	ref	Ref
2.00	0.89	1.09	1.16	1.06	1.27	1.63
3+	1.20	1.82	1.31	1.50	1.04	1.38
First network partner is male	1.22	1.01	2.25**	1.19	0.67	0.73
First network partner education level secondary+	0.73**	1.21	1.08	0.90	0.96	1.18
First alter married	0.96	0.68	1.46	1.28	1.55*	0.51
Relationship to first network partner
Partner	Ref	Ref	Ref	Ref	ref	Ref
Family	1.00	0.70	2.00	1.51	0.60	0.63
Friend/other	1.74	0.75	2.24	1.71	0.65	0.65
Health professional	1.99	0.83	1.99	3.02*	0.67	1.39
Residence of first network partner
Same household	Ref	Ref	Ref	Ref	ref	ref
Same village	0.83	0.61	1.05	0.94	0.91	1.11
Same district	0.69	0.21**	0.58	0.94	0.71	0.68
Somewhere else	0.61	0.29**	0.70	0.94	0.53**	0.51
Intimacy with first network partner
Close friend/friend	0.65	0.46	0.63	1.26	0.67	2.83
Advice from first network partner
Mostly gets information	Ref	Ref	Ref	Ref	ref	ref
Mostly give and get information	1.29	0.60	1.01	0.74	0.68*	1.22
Mostly give information	1.27	0.56	0.80	1.09	0.81	1.50
Exposure to intervention
Exposure to intervention score	1.12	1.48	1.22	1.04	1.09	0.56*
Messaging study arm	1.69*	0.97	1.66**	0.81	1.06	0.55
Messaging+incentive study arm	2.00*	1.67	0.63*	0.84	0.91	1.10
Endline (ref baseline)	1.71*	2.20*	1.42	1.81**	1.25	1.23
N =	1051	1043	1056	1037	1028	235

Signif: *p = < 0.05; **p = < 0.01; ***p < 0.001

Table 4. Odds ratio of demographic characteristics and effect of intervention by maternal and breastfeeding outcomes

Study characteristics	Early ANC	ANC4	SBA	PPC	IBF	EBF
Woman’s age
15–24	ref	ref	ref	ref	ref	ref
25–29	1.28	1.25	1.28	0.85	1.00	1.64
30–34	1.27	1.43	1.40	1.05	1.27	1.45
35–49	1.08	1.54	1.43	0.98	1.27	1.15
Mother’s education
No education	Ref	ref	ref	ref	ref	ref
Primary	0.76	1.33	1.24	1.31	0.86	1.29
Secondary+	0.55***	0.94	1.55*	1.16	0.95	0.75
Religion
Christian	ref	ref	ref	ref	ref	ref
Muslim	1.17	1.17	0.94	1.59*	0.88	2.36
Traditional	1.06	1.13	0.48***	0.85	0.82	0.82
Parity
1 Child	Ref	ref	Ref	Ref	ref	ref
2–3 Children	0.99	1.07	0.49***	0.93	0.82	0.80
4+ Children	0.78	1.00	0.31***	0.87	0.64*	1.59
Attends women’s group	1.74***	1.42	1.50***	1.38*	1.26*	0.99
Radio in last week	1.24	1.16	1.01	1.08	1.18	0.86
Network size
0	Ref	ref	Ref	Ref	Ref	ref
1	0.58	1.32	1.34*	0.97	1.19	1.20
2	1.00	1.55	1.50*	0.88	1.45*	2.02
3	0.35	2.52**	2.05***	1.33	1.15	1.97
Exposure to intervention
Exposure to intervention score	1.34*	1.81***	1.32**	1.11	1.14	0.72
Messaging study arm	1.27	0.81	1.68***	0.97	1.17	0.43**
Messaging+incentive study arm	1.82***	1.11	1.03	1.25	0.93	0.54
Endline (Reference baseline)	1.45*	1.16	1.18	1.57**	1.36*	1.11
N =	1770	1754	1781	1758	1725	440

Signif: *p = < 0.05; **p = < 0.01; ***p < 0.001

Fig. 2. Adjusted effect of the CBH program on early ANC, ANC4+, and skilled birth attendance.

Fig. 3. Adjusted effect of the CBH program on postpartum care, early initiation of breastfeeding, and exclusive breastfeeding.