Knowledge, Attitudes and Practices Regarding Community-Based Health Insurance in Dembecha Town, Ethiopia, 2014: A Cross- Sectional Design By Xiuzhe (Ally) Mai Touro University – California, 2015 Professor Sahai Burrowes, Faculty Advisor Date: April 23 rd,

Background High out-of-pocket household health expenditure; Lack of access; Low utilization of health; services; Free health care: for the informal sector 88% of the total population 2

Research Questions What is/are: 1.Current level of enrollment and utilization; 2.Percentage of households with sufficient knowledge or favorable attitude; 3.Demographic and socio- economic factors; 4.The association between knowledge, attitudes, and practices (KAP) of CBHI? 3

Problem Statement 1.Lack of studies on the association between health literacy and health behavior; 2.Existing studies mostly focused on scheme uptake and acceptable price range across Ethiopia. 3.This study will also provide evidence for program evaluation, monitoring, and implantation. 4

Literature Review Overall high acceptance and strong WTJ (willingness to join): 60% -78% WTJ and 5-10 ETB per month (Asfaw & Braun, 2004; Abay et al., 2005; Ololo, Jirra, Hailemichael & Girma, 2009; Haile, Ololo & Megersa, 2014). Rapid enrollment rate: 46% in 2012; Positive impact: A 13% reduction in indebtedness and an 1087 ETB ($54 USD) increase of annual income, 35% lower risk of mortality with shorter distance to health facility, and 37% lower risk of mortality with higher education (Derseh et al., 2013). 5

Methods Cross-sectional study: secondary data from DMU Study locations: 2 urban Kebeles (villages) of Dembecha Woreda (town) 95% response rate & random sampling Exclusion: < 18 years old & not permanent resident Study Variables: Outcome & explanatory variables Additive Indexes of KAP: From 3 sets of questions about KAP; Mean value as cut-off point for K/A; Practice=enrollment. 6

Methods 1.Data analysis: Descriptive statistics Pearson Chi Square tests Multivariate linear regression Multivariate logistic regression 2.Diagnostic tests: Histograms & normal distribution Multi-collinearity 7

Result 8

Each reason was a dichotomous question, so the percentages do not add up to 100%. 9

Result 10

Determinants of Knowledge of CBHI N=311 R 2 = 27% 11

Determinants of Attitudes Towards CBHI N=311 R 2 = 29% 12

Level of Practices of CBHI N=311 R 2 = 28% 13

Discussion The majority of participants had: sufficient knowledge & favorable attitude Low enrollment (16%) Indigents (10%) The national level (46%) The Amhara regional enrollment rate (63%) (Mebratie et al., 2014b). The low enrollment rate: The lack of knowledge and unaffordability. 14

Discussion The WTJ is 70% among non-members; Utilization of CBHI is modest; The under-utilization: The poor quality of care and unaffordability. 15

Implications 1.Discrepancy of knowledge; 2.Poor info dissemination; 3.Poor documentation; 4.Attitude isn’t a significant predictor in behavior (LaPiere, 1934) Attitude predicts general behavior, not specific ones. 16

Study Limitations 1.The study population only focused on urban kebeles not generalizable to rural areas. 2.Lack of qualitative data & similar studies; 3.Survey design: professional jargon and concepts, social desirability bias; 4.Missing data; 5.Regional differences: climate, geography, ethnicity, religion, etc. 17

Recommendations 1.Future research: qualitative studies 2.Information dissemination: Additional channels Content change New strategy: Members’ testimonials 3.Incorporation into the Health Extension Program (HEP) 4.Flexible payment collection schedule: bi-monthly, quarterly, monthly, annually 18

19