Credit with Health Education in Benin: A Cluster Randomized Trial Examining Impacts on Knowledge and Behavior
Credit with Health Education in Benin: A Cluster Randomized Trial Examining Impacts on Knowledge and Behavior
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DOI：
10.4269/ajtmh.16-0126
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Gray, Bobbi
中科院分区：
文献类型：
--
作者：
Karlan, Dean;Thuysbaert, Bram;Gray, Bobbi
我们评估是否健康教育纳入小额信贷贷款团体通过提高贝宁东部城市和农村借款人的健康知识和自我报告的行为，降低健康风险。2007年，我们随机分配了贝宁高原地区的138个村庄，使用2x2设计，将其分配给四种不同的团体责任信贷产品之一，改变贷款团体的性别组成和/或纳入健康教育。接受保健教育的村庄妇女，不论其群体的性别组成如何，对疟疾和人体免疫机能丧失病毒/后天免疫机能丧失综合症（艾滋病毒/艾滋病）的知识有所提高，但对儿童疾病危险迹象的知识没有提高。除了艾滋病毒/艾滋病预防行为的增加外，没有观察到健康行为的显着变化，这主要是由于受访者自我报告的获得避孕套的能力增加，这可能是一个增加感知获得的指标，而不是预防行为的改善。在分配给混合性别群体的村庄中，妇女的社会资本水平明显低于分配给女性群体的村庄。这表明，通过向男女混合群体提供服务，寻求改善健康结果和社会资本的干预措施可能需要考虑一个重要的权衡。虽然将健康教育与小额信贷捆绑在一起可以扩大健康教育的覆盖面，降低提供服务的成本，但这种方法可能不足以改善健康行为。
We evaluate whether health education integrated into microcredit lending groups reduces health risks by improving health knowledge and self-reported behaviors among urban and rural borrowers in eastern Benin. In 2007, we randomly assigned 138 villages in the Plateau region of Benin to one of four variations of a group liability credit product, varying lending groups' gender composition and/or inclusion of health education using a 2 x 2 design. Women in villages receiving health education, regardless of gender composition of the groups, showed improved knowledge of malaria and of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), but not of childhood illness danger signs. No significant changes in health behavior were observed except an increase in HIV/AIDS prevention behavior, a result predominantly driven by an increase in respondents' self-reported ability to procure a condom, likely an indicator of increased perceived access rather than improved preventative behavior. Women in villages assigned to mixed-gender groups had significantly lower levels of social capital, compared with villages assigned to female-only groups. This suggests there may be an important trade-off to consider for interventions seeking improved health outcomes and social capital through provision of services to mixed-gender groups. Although bundling health education with microcredit can expand health education coverage and lower service-delivery costs, the approach may not be sufficient to improve health behaviors.