A SOCIAL MODEL OF HEALTH APPROACH TO UNDERSTANDING THE INTERACTIVE RELATIONSHIP AMONG DETERMINANTS OF ITN USE: AN EXPLORATION OF MALARIA INTERVENTION STRATEGY AMONG HOUSEHOLD MEMBERS IN GHANA.

Abstract

This study aims to explore the context-specific factors associated with ITN use that focuses on the interactive relationship among determinants of ITN use. The study adopts the social model of health as a conceptual approach to explore the interplay among determinants of ITN use at the individual, net, household, and community levels. This conceptual approach is developed to test the moderating influence of net-level factor (i.e., the number of ITNs) on the relationship between the number of children under five years and household members’ ITN use. The thesis involved a sample size of 10,977 based on a nationally representative sample of Ghanaian households drawn from the Ghana Demographic and Health Survey (DHS) - 2020 dataset. A single-level moderation model was appropriate for the data analysis method. From the results of the data analysis, the main predictor variable the number of children under five years was positively associated with household members’ ITN use (OR = 0.29, p < .001). A moderation effect of the number of ITNs ((OR = -.05, p < .001) on the relationship between the number of children under five years and household members’ ITN use was reported. The key finding of the study is that the number of children under five years influenced household members’ ITN use, but this relationship was determined by the number of ITNs in the household. The proportion of the number of children under five years and ITN use is moderately different for a high and low number of ITNs in the household with the former decreasing ITN use and the latter increasing ITN use. The results of the thesis indicate a critical consideration for the complex interplay of determinants of ITN use which reveal the significant connection between the individual, net, household, and community-level factors shaping ITN use. The interaction between individual and net level factors on household members’ ITN use is relevant to the social model of health that implies adequate access to health services towards supporting health-related behavior and better health outcomes. The thesis provides a conceptual approach to malaria intervention that engages a comprehensive discussion of health promotion action. This considers a review of extensive theoretical and empirical literature in outlining practical implications and proposes outlooks for future research in engaging more scientific and evidence-oriented health action toward malaria prevention in Ghana.