Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d’Ivoire: triangulation of three independent evaluations

Figures & data

Figure 1: Merci Mon Héros Illustrative Hero Videos

Figure 2: The Merci Mon Héros Campaign Theory of Change

Table 1: Overview of study methodologies included in triangulation analysis

	Social Listening^Citation32	Exposure Survey^Citation34	Most Significant Change^Citation36
Objective	To assess online conversations prior to and throughout the MMH campaign’s first year to understand the potential impact of the campaign on the broader online topic-relevant conversation.	To measure exposure to the MMH campaign and investigate associations between exposure and FP outcomes among youth and adults	To determine the most significant changes in the communities exposed to the mixed media campaign
Data collection timeline	Baseline: October 2018–October 2019. Campaign monitoring: November 2019–October 2020. Endline: November 2019–January 2021	September 2020	March 2021
Setting	Côte d'Ivoire’s internet penetration was estimated at approximately 47.0% in 2018. Social media would be accessed by just a subset of the online population, with urban, socioeconomic, and education skews very likely.	Abidjan (Port-Bouet-Vridi, Abobo-Ouest, Youpongon Ouest-Songon), Bouaké (Bouaké Nord-Ouest), and Daloa (District de Daloa)	Data collection took place in the capital city of Abidjan, Côte d'Ivoire
Study Design	Quantitative monitoring of online conversation and descriptive-qualitative	Descriptive – cross-sectional quantitative household survey	Descriptive - qualitative
Sampling strategy	The analysis also draws on subject-relevant mentions on public-facing social media platforms, including Twitter, YouTube comments, forums, blogs, Reddit, news channels, and Tumblr. While some data can be tracked from Facebook, the vast majority of Facebook data is not accessible through social listening tools due to its privacy policy. Likewise, Instagram and WhatsApp data are also restricted by privacy rights and therefore inaccessible. For this analysis only the public-facing MMH campaign Facebook page could be included.	Randomly selected clusters from pre-determined intervention districts. To recruit participants, we divided the five districts where the Breakthrough ACTION programme was active (Port-Bouet-Vridi, Abobo-Ouest, Youpongon Ouest-Songon in Abidjan; Bouaké Nord-Ouest in Bouaké; District de Daloa in Daloa) into primary sampling units (PSUs) and weighted the probabilities of selection based on relative population sizes. From each district, a maximum of 10 PSUs were randomly selected. In each PSU, up to five random starting points that represent areas of highest population density (e.g. a main market, a neighbourhood chief’s home, a health center, etc.) were identified from which data collectors started a random walk, visiting every nth house on the left-hand side of the street. The interval was determined by the population density of the cluster and ranged from every third household to every tenth household. If eligible participants agreed to participate a trained data collector obtained informed consent before administering the survey.	Data collection was facilitated by the MMH campaign. In Côte d’Ivoire, the West Africa Breakthrough ACTION team helped mobilise people who had been exposed to MMH activities. Potential participants were identified from participant lists for Breakthrough ACTION activities, fans of the Facebook page, and members of the campaign’s WhatsApp group.
Sample size	The sample of social media data draws on subject-relevant mentions on public-facing social media platforms (N = 6667), including Twitter (79.0%), Facebook (1.0%), forums (6.0%), blogs (3.0%), news channels (11.0%). While some data can be tracked from Facebook, the vast majority of Facebook and Instagram data is not accessible through social listening tools due to its privacy policy. For this analysis only the public-facing MMH campaign Facebook page could be included.	Male and female youth aged 16–24 (n = 412)Male and female adults aged 25–49 (n = 597)	The sample consisted of adolescents aged 15–17 years old, young adults aged 18–24 years old, and adults aged 25 and above that had an influential relationship with at least one youth. The sample in each age range was stratified by gender. A total of 24 FGDs were conducted.

Table 2: Socio-demographic characteristics of MMH exposure survey sample

Socio-demographic characteristics	Youth (n = 412)		Adults (n = 597)		Overall (n = 1009)
	n	%	n	%	n	%
Age group
16–24 years old	412	40.8%	0	0.0%	412	40.8%
25 years and older	0	0.0%	597	59.2%	597	59.2%
Sex
Male	183	44.4%	274	45.9%	457	45.3%
Female	229	55.6%	323	54.1%	552	54.7%
Zone
Bouake Nord- Ouest	89	21.6%	113	18.9%	202	20.0%
Daloa	98	23.8%	102	17.1%	200	19.8%
Youpougon Ouest Songo	73	17.7%	133	22.3%	206	20.4%
Port Bouet Vridi	61	14.8%	131	21.9%	192	19.0%
Abobo Ouest	91	22.1%	118	19.8%	209	20.7%
Education completed
No school	27	6.6%	66	11.1%	93	9.2%
Primary school	30	7.3%	120	20.1%	150	14.9%
Secondary school	229	55.6%	177	29.6%	406	40.2%
Technical training	46	11.2%	69	11.6%	115	11.4%
University or more	79	19.2%	159	26.6%	238	23.6%
Ever had sex	287	71.2%	577	98.1%	864	87.2%

Table 3: Exposure to MMH among youth and adults (n = 1009)

	Youth (n = 412)		Adults (n = 597)		Total		Chi-squared	p
	n	%	n	%	n	%
Exposed to MMH*	89	21.6%	158	26.5%	247	24.5%	3.1192	0.077
Exposure by channel
Radio exposure	23	25.8%	55	34.8%	78	31.6%	2.12	0.150
TV exposure**	9	10.1%	5	3.2%	14	5.7%	5.14	0.023
Social media exposure	21	23.6%	35	22.2%	56	22.7%	0.07	0.795
Exposed through Community Event	9	10.1%	24	15.2%	33	13.4%	1.27	0.260
MMH video shown on bus	8	9.0%	13	8.2%	21	8.5%	0.04	0.837
Exposed at a school activity	13	14.6%	14	8.9%	27	10.9%	1.93	0.165
Exposed through other channel	6	6.7%	12	7.6%	18	7.3%	0.06	0.804

*p < 0.1; **p < 0.05; ***p < 0.01.

Figure 3: Menstruation / puberty online mentions (conversation volume) in Côte d’Ivoire

Table 4: Logistic regression model results of exposure to MMH on outcomes of interest: age-combined and disaggregated models

Outcomes of Interest:	Attitudes: It is acceptable for young people and their parents or other trusted adults to talk about reproductive health issues Odds Ratio (95% CI)	Self-efficacy: I am comfortable discussing family planning with members of my family Odds Ratio (95% CI)	Social norms: Most parents and other adults talk to youth about their questions on reproductive health Odds Ratio (95% CI)	Behaviour: Talked to someone about SRH and/or FP in the last 5 months Odds Ratio (95% CI)	Self-efficacy: I could go to a site where family planning methods are offered if I decided to use one Odds Ratio (95% CI)
Age-combined model (youth and adults combined; n = 985)
MMH exposure (Referent: unexposed)	0.76* (0.56–1.03)	1.12 (0.82–1.53)	0.90 (0.64–1.28)	2.71*** (1.84–3.99)	0.89 (0.65–1.23)
Age group 25–49 (Referent: 16–24)	1.07 (0.80–1.44)	1.16 (0.86–1.57)	1.12 (0.81–1.55)	1.04 (0.75–1.44)	1.17 (0.87–1.59)
Female sex (Referent: males)	1.27* (0.97–1.68)	1.14 (0.86–1.50)	1.34* (0.99–1.82)	1.77*** (1.31–2.40)	1.54*** (1.16–2.05)
Among adults (age 25–49; n = 583)
MMH exposure (Referent: unexposed)	0.72 (0.48–1.09)	1.05 (0.70–1.57)	1.03 (0.66–1.61)	2.54*** (1.53–4.23)	-
Female sex (Referent: males)	1.31 (0.90–1.89)	1.12 (0.78–1.62)	1.53** (1.02–2.29)	2.07*** (1.12–3.64)	-
Among youth (age 16–24; n = 402)
MMH exposure (Referent: unexposed)	0.77 (0.47–1.26)	1.20 (0.72–2.01)	0.69 (0.39–1.22)	2.83*** (1.54–5.21)	0.66 (0.39–1.12)
Female sex (Referent: males)	1.26 (0.82–1.94)	1.17 (0.75–1.83)	1.10 (0.68–1.76)	1.46 (0.92–2.32)	1.56* (0.99–2.44)

*p < 0.1; **p < 0.05; ***p < 0.01.

Other independent variables included in the model: education, zone of residence, and whether the respondent has ever had sex.

Box 1. Stories of significant change.

Since seeing the campaign, Exaucée* gained the courage to talk to her children about anything related to sexuality, which was very difficult for her to do before. Communication with her children improved and she gained confidence in herself. This self-confidence led her to spread the MMH campaign to her peers, so much so that some families close to her have introduced sex education in their homes. (Adult female)

Malick used to beat his daughter when she returned from outings, making their relationship difficult. He attended an event encouraging positive parent–child exchanges on sexuality thanks to the MMH campaign. Afterward, he understood the need to communicate with his children and decided to stop beating his daughter. Since then, Malick and his daughter have had a more relaxed and peaceful relationship. (Adult male)

Fatou shared that her cousin contacted her and told her that something had happened at home because one day she was watching television with her brothers and they were watching a program called CMIDI,† and that day a representative of MMH came by the program to provide information. Her father heard about it and without telling anyone he went to the MMH Facebook page. He saw a little bit and decided to go to a hospital, a health center specialized on the issue, to get more information. One day he gathered them in the living room to talk to them about SRH. They were all surprised, but confirm that the [MMH] TV broadcast representatives pushed the father to go to a health center to get the information he needed to talk with his children about SRH. (Young female)

Marouan is the president of a religious youth organization in Abidjan. Following an MMH event with young people and adults, he was given a referral ticket that could be redeemed at a local medical center that cares for young people in the same town. At this center, Marouan met a midwife, but he felt embarrassed to talk about sex with the woman. However, the midwife’s friendly attitude allowed him to relax and tell her about his girlfriend and reveal that they do have sex. The midwife again talked to him about pregnancy prevention and even offered to see his girlfriend. These meetings broke a taboo for him. (Young male)

Diaby is a young practicing Muslim man, and he has never had sex. People around him started making fun of him, making him doubt his conviction of abstaining from sex until marriage. He was depressed and conflicted, questioning whether he was making the right choices. The MMH campaign in which he participated freed him psychologically from his fears after he became aware of the risks of STIs/HIV/AIDS diseases and the impact of unwanted pregnancies to which sexually active youth are exposed. He is now comforted in his position of abstinence until marriage. Since then, he has been happy, at peace with himself, and in tune with his religion’s recommendations. (Young male)

* All names have been changed to protect participant identities. † CMIDI is a TV programme in Côte d’Ivoire. The acronym means “It’s noon!”

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