Effect of stage-matched educational intervention on use of institutional delivery in Northwest Ethiopia: using community readiness model.

Introduction: even though there are many initiatives to improve institutional delivery, there are low service utilization and community readiness for institutional delivery in Ethiopia. This study assessed the role of community readiness on delivery service use.

Methods: a pre-and post-test design with a control group was used for the evaluation of the stage-matched educational intervention following the protocol of the community readiness assessment model. Based on the baseline assessment of community readiness among 15 kebeles where the study was conducted, the overall score of nine kebeles was below stage-5 out of the nine stages, which were targeted for the intervention. The intervention group (n= three kebeles) participated in the stage-matched intervention for 15 months, while the control group (n= three kebeles) were not given the intervention. The data were analyzed using the difference in difference (DiD) method.

Results: there were significant improvements in a stage of change for the promotion of institutional delivery (p-value <0.001) and institutional delivery use (p-value <0.001) in the intervention group as compared to the control group. The study revealed that the intervention influenced community resource allocation (at marginally significant levels), improved leader-ship quality of prevention, and community climate to supportive prevention efforts. There was evidence that the intervention (health promotion) also increased service use at a significant level.

Conclusion: the community readiness-based intervention (health promotion) can be useful to measure the combined attitude and behavior towards institutional delivery services. The village-based mobilizer approach had a positive effect on institutional delivery use and the level of community readiness on the promotion of institutional delivery.