The Nexus between Environmental Factors and Behaviour Change in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies

https://doi.org/10.51867/ajernet.5.3.94

Authors

Keywords:

Behaviour Change, Environmental Factors, Marketing Strategies, Mediation

Abstract

This study aimed to explore the mediating role of marketing strategies in the relationship between environmental factors and behavior change in healthcare utilisation. A cross-sectional survey design was conducted using a random sampling technique to select 474 healthcare workers from six Health Directorates across Municipalities and Districts in the Upper East Region of Ghana. The target population from which the sample size was determined was 1980. The theories that guided this study were the Health Belief Model and the Theory of Planned Planned Behaviour.  A structured questionnaire was designed using a five-point Likert scale and administered to the respondents. The data was collected over three months from February to April. A Structural Equation Model (SEM) with AMOS was employed to analyse the data. Findings revealed that marketing strategies mediate the relationship between environmental factors and behaviour change. The predicted hypotheses were found to be positive and significant. The study highlights the importance of marketing strategies in disseminating health-related information, which influences positive behaviour change toward healthcare utilisation. The study found that marketing strategies play a crucial role in disseminating health information and promoting behaviour change. The mediating role of marketing strategies in the relationship between environmental factors and behaviour change was established. All hypotheses were confirmed, demonstrating the key role of marketing strategies in improving health outcomes through behaviour modification. It is recommended that healthcare facility managers consider incorporating marketing strategies into their strategic plans to optimise outcomes.

Dimensions

Adua, E., Frimpong, K., Li, X., & Wang, W. (2017). Emerging issues in public health: a perspective on Ghana's healthcare expenditure, policies, and outcomes. EPMA Journal, 8, 197-206. https://doi.org/10.1007/s13167-017-0109-3 DOI: https://doi.org/10.1007/s13167-017-0109-3

Adu-Gyamfi, S., & Brenya, E. (2016). Nursing in Ghana: A search for Florence nightingale in an African City. International Scholarly Research Notices, 2016(1), 9754845. https://doi.org/10.1155/2016/9754845 DOI: https://doi.org/10.1155/2016/9754845

Ajzen, I. (2020). The theory of planned behavior: Frequently asked questions. Human behavior and emerging technologies, 2(4), 314-324. https://doi.org/10.1002/hbe2.195 DOI: https://doi.org/10.1002/hbe2.195

Ajzen, I. 1991. The theory of planned behaviour. Organisational Behavior and Human Decision Processes 50 (2):179-211.

https://doi.org/10.1016/0749-5978(91)90020-T DOI: https://doi.org/10.1016/0749-5978(91)90020-T

Akukwe, C. (2006). Health care delivery in Africa: An overview of the issues, choices, challenges and opportunities. African Renaissance, 3(4), 13-19.

Al-Dmour, H., Salman, A., Abuhashesh, M., & Al-Dmour, R. (2020). Influence of social media platforms on public health protection against the COVID-19 pandemic via the mediating effects of public health awareness and behavioral changes: integrated model. Journal of medical Internet research, 22(8), e19996. https://doi.org/10.2196/19996 DOI: https://doi.org/10.2196/19996

Amoah, P. A., & Phillips, D. R. (2018). Health literacy and health: rethinking the strategies for universal health coverage in Ghana. Public health, 159, 40-49. https://doi.org/10.1016/j.puhe.2018.03.002 DOI: https://doi.org/10.1016/j.puhe.2018.03.002

Ananga, M. K., Agbefu, R. K., Doku, P. N., Manu, A., Alangea, D. O., & Ganle, J. K. (2023). The influence of social capital in the utilisation of sexual reproductive health services among the youth in Ghana. A community-based cross-sectional study. PLOS Global Public Health, 3(10), e0001225. https://doi.org/10.1371/journal.pgph.0001225 DOI: https://doi.org/10.1371/journal.pgph.0001225

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of health and social behavior, 1-10. https://doi.org/10.2307/2137284 DOI: https://doi.org/10.2307/2137284

Ansah, E. K., Narh-Bana, S., Asiamah, S., Dzordzordzi, V., Biantey, K., Dickson, K., ... & Whitty, C. J. M. (2009). Correction: Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial. PLoS medicine, 6(2), e1000033. https://doi.org/10.1371/journal.pmed.1000033 DOI: https://doi.org/10.1371/journal.pmed.1000033

Anuradha, S., & Sheriff, D. S. (2019). Health care delivery in India-SWOT analyses. Int Arch Public Health Community Med, 3(2), 1-7.

https://doi.org/10.23937/2643-4512/1710024 DOI: https://doi.org/10.23937/2643-4512/1710024

Artuso, S., Cargo, M., Brown, A., & Daniel, M. (2013). Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study. BMC health services research, 13, 1-13. https://doi.org/10.1186/1472-6963-13-83 DOI: https://doi.org/10.1186/1472-6963-13-83

Asamrew, N., Endris, A. A., & Tadesse, M. (2020). Level of patient satisfaction with inpatient services and its determinants: a study of a specialized hospital in Ethiopia. Journal of environmental and public health, 2020(1), 2473469. https://doi.org/10.1155/2020/2473469 DOI: https://doi.org/10.1155/2020/2473469

Awoonor-Williams, J. K., Bawah, A. A., Nyonator, F. K., Asuru, R., Oduro, A., Ofosu, A., & Phillips, J. F. (2013). The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC health services research, 13 Suppl 2(Suppl 2), S3. https://doi.org/10.1186/1472-6963-13-S2-S3 DOI: https://doi.org/10.1186/1472-6963-13-S2-S3

Babitsch, B., Gohl, D., & von Lengerke, T. (2012). Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011. Psycho-social medicine, 9, Doc11. https://doi.org/10.1007/978-1-4614-9191-0_2 DOI: https://doi.org/10.1007/978-1-4614-9191-0_2

Barley, E., & Lawson, V. (2016). Using health psychology to help patients: theories of behaviour change. British journal of nursing, 25(16), 924-927. https://doi.org/10.12968/bjon.2016.25.16.924 DOI: https://doi.org/10.12968/bjon.2016.25.16.924

Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: a systematic review. Perspectives in public health, 137(2), 89-101. https://doi.org/10.1177/1757913916634136 DOI: https://doi.org/10.1177/1757913916634136

Beyera, G. K., O'Brien, J., & Campbell, S. (2022). Choosing a health behaviour theory or model for related research projects: A narrative review. Journal of Research in Nursing, 27(5), 436-446. https://doi.org/10.1177/17449871211051566 DOI: https://doi.org/10.1177/17449871211051566

Bish, A., Yardley, L., Nicoll, A., & Michie, S. (2011). Factors associated with uptake of vaccination against pandemic influenza: a systematic review. Vaccine, 29(38), 6472-6484. https://doi.org/10.1016/j.vaccine.2011.06.107 DOI: https://doi.org/10.1016/j.vaccine.2011.06.107

Boachie, M. K., & Ramu, K. (2016). Effect of public health expenditure on health status in Ghana. International Journal of Health, 4(1), 6-11. https://doi.org/10.14419/ijh.v4i1.5794 DOI: https://doi.org/10.14419/ijh.v4i1.5794

Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., ... & Pomey, M. P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science, 13, 1-22. https://doi.org/10.1186/s13012-018-0784-z DOI: https://doi.org/10.1186/s13012-018-0784-z

Boothroyd, R. A., Evans, M. E., Chen, H. J., Boustead, R., & Blanch, A. K. (2015). An exploratory study of conflict and its management in systems of care for children with mental, emotional, or behavioral problems and their families. The Journal of Behavioral Health Services & Research, 42, 310-323. https://doi.org/10.1007/s11414-014-9448-1 DOI: https://doi.org/10.1007/s11414-014-9448-1

Campos, P. A., & Reich, M. R. (2019). Political analysis for health policy implementation. Health Systems & Reform, 5(3), 224-235.

https://doi.org/10.1080/23288604.2019.1625251 DOI: https://doi.org/10.1080/23288604.2019.1625251

Chauhan, B. F., Jeyaraman, M., Mann, A. S., Lys, J., Skidmore, B., Sibley, K. M., ... & Zarychanksi, R. (2017). Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implementation Science, 12, 1-16.

https://doi.org/10.1186/s13012-016-0538-8 DOI: https://doi.org/10.1186/s13012-016-0538-8

Chiu, K., Thow, A. M., & Bero, L. (2022). "Never waste a good crisis": Opportunities and constraints from the COVID-19 pandemic on pharmacists' scope of practice. Research in Social and Administrative Pharmacy, 18(9), 3638-3648. https://doi.org/10.1016/j.sapharm.2022.03.045 DOI: https://doi.org/10.1016/j.sapharm.2022.03.045

Clarke, J. L., Bourn, S., Skoufalos, A., Beck, E. H., & Castillo, D. J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population health management, 20(1), 23-30. https://doi.org/10.1089/pop.2016.0076 DOI: https://doi.org/10.1089/pop.2016.0076

Davidson, K. W., & Scholz, U. (2020). Understanding and predicting health behaviour change: a contemporary view through the lenses of meta-reviews. Health psychology review, 14(1), 1-5. https://doi.org/10.1080/17437199.2020.1719368 DOI: https://doi.org/10.1080/17437199.2020.1719368

Dias, M., and L. Agante. 2011. "Can Advergames Boost Children's Healthier Eating Habits? A Comparison Between Healthy and Non-Healthy Food." Journal of Consumer Behaviour 10 (3):152-160. https://doi.org/10.1002/cb.359 DOI: https://doi.org/10.1002/cb.359

Doctor, H. V., Nkhana-Salimu, S., & Abdulsalam-Anibilowo, M. (2018). Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda. BMC public health, 18, 1-12. https://doi.org/10.1186/s12889-018-5695-z DOI: https://doi.org/10.1186/s12889-018-5695-z

Domegan, C. (2021). Social marketing and behavioural change in a systems setting. Current Opinion in Environmental Science & Health, 23, 100275. https://doi.org/10.1016/j.coesh.2021.100275 DOI: https://doi.org/10.1016/j.coesh.2021.100275

Edmonds, W. A., & Kennedy, T. D. (2016). An applied guide to research designs: Quantitative, qualitative, and mixed methods. Sage Publications. https://doi.org/10.4135/9781071802779 DOI: https://doi.org/10.4135/9781071802779

Filip, R., Gheorghita Puscaselu, R., Anchidin-Norocel, L., Dimian, M., & Savage, W. K. (2022). Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. Journal of personalized medicine, 12(8), 1295.

https://doi.org/10.3390/jpm12081295 DOI: https://doi.org/10.3390/jpm12081295

Fiordelli, M., Diviani, N., & Schulz, P. J. (2013). Mapping mHealth research: a decade of evolution. Journal of medical Internet research, 15(5), e2430. https://doi.org/10.2196/jmir.2430 DOI: https://doi.org/10.2196/jmir.2430

Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of marketing research, 18(1), 39-50. https://doi.org/10.1177/002224378101800104, https://doi.org/10.2307/3151312 DOI: https://doi.org/10.1177/002224378101800104

Fortenberry Jr, J. L., & McGoldrick, P. J. (2016). Internal marketing: A pathway for healthcare facilities to improve the patient experience. International Journal of Healthcare Management, 9(1), 28-33. https://doi.org/10.1179/2047971915Y.0000000014 DOI: https://doi.org/10.1179/2047971915Y.0000000014

Gyasi, R. M., & Phillips, D. R. (2020). Demography, socioeconomic status and health services utilisation among older Ghanaians: Implications for health policy. Ageing International, 45(1), 50-71. https://doi.org/10.1007/s12126-018-9343-9 DOI: https://doi.org/10.1007/s12126-018-9343-9

Gyasi, R. M., Asante, F., Abass, K., Yeboah, J. Y., Adu-Gyamfi, S., & Amoah, P. A. (2016). Do health beliefs explain traditional medical therapies utilisation? Evidence from Ghana. Cogent Social Sciences, 2(1), 1209995. https://doi.org/10.1080/23311886.2016.1209995 DOI: https://doi.org/10.1080/23311886.2016.1209995

Gyasi, R., Buor, D., Adu-Gyamfi, S., Adjei, P. O. W., & Amoah, P. A. (2018). Sociocultural hegemony, gendered identity, and use of traditional and complementary medicine in Ghana. Women & health, 58(5), 598-615. https://doi.org/10.1080/03630242.2017.1321608 DOI: https://doi.org/10.1080/03630242.2017.1321608

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate Data Analysis: A Global Perspective, 7th Edition. New Jersey: Pearson Educational Inc.

Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2022). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM) (3rd ed.). Sage Publishing. https://doi.org/10.1007/978-3-030-80519-7 DOI: https://doi.org/10.1007/978-3-030-80519-7

Hair, J. F., Hult, G. T. M., Ringle, C. M., Sarstedt, M., & Thiele, K. O. (2017). Mirror, mirror on the wall: a comparative evaluation of composite-based structural equation modeling methods. Journal of the academy of marketing science, 45, 616-632.

https://doi.org/10.1007/s11747-017-0517-x DOI: https://doi.org/10.1007/s11747-017-0517-x

Hair, J., & Alamer, A. (2022). Partial Least Squares Structural Equation Modeling (PLS-SEM) in second language and education research: Guidelines using an applied example. Research Methods in Applied Linguistics, 1(3), 100027. https://doi.org/10.1016/j.rmal.2022.100027 DOI: https://doi.org/10.1016/j.rmal.2022.100027

Hair, Jr, J. F., Sarstedt, M., Hopkins, L., & Kuppelwieser, V. G. (2014). Partial least squares structural equation modeling (PLS-SEM): An emerging tool in business research. European Business Review, 26(2), 106-121. https://doi.org/10.1108/EBR-10-2013-0128 DOI: https://doi.org/10.1108/EBR-10-2013-0128

Haldane, V., Chuah, F. L., Srivastava, A., Singh, S. R., Koh, G. C., Seng, C. K., & Legido-Quigley, H. (2019). Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PloS one, 14(5), e0216112. https://doi.org/10.1371/journal.pone.0216112 DOI: https://doi.org/10.1371/journal.pone.0216112

Hoek, J., & Jones, S. C. (2011). Regulation, public health, and social marketing: a behaviour change trinity. Journal of Social Marketing, 1(1), 32-44. https://doi.org/10.1108/20426761111104419 DOI: https://doi.org/10.1108/20426761111104419

Hooper, D., Coughlan, J., & Mullen, M. (2008, September). Evaluating the model fit a synthesis of the structural equation modeling literature. In 7th European Conference on research methodology for business and management studies (Vol. 2008, pp. 195-200).

Hulland, J. (1999). Use of partial least squares (PLS) in strategic management research: A review of four recent studies. Strategic Management Journal, 20(2), 195-204. https://doi.org/10.1002/(SICI)1097-0266(199902)20:2<195::AID-SMJ13>3.0.CO;2-7 DOI: https://doi.org/10.1002/(SICI)1097-0266(199902)20:2<195::AID-SMJ13>3.0.CO;2-7

Iliopoulos, E., & Priporas, C. V. (2011). The effect of internal marketing on job satisfaction in health services: a pilot study in public hospitals in Northern Greece. BMC health services research, 11, 1-8. https://doi.org/10.1186/1472-6963-11-261 DOI: https://doi.org/10.1186/1472-6963-11-261

Johnson, M. J., & May, C. R. (2015). Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ open, 5(9), e008592. https://doi.org/10.1136/bmjopen-2015-008592 DOI: https://doi.org/10.1136/bmjopen-2015-008592

Kan, T., & Zhang, J. (2018). Factors influencing seasonal influenza vaccination behaviour among elderly people: a systematic review. Public health, 156, 67-78. https://doi.org/10.1016/j.puhe.2017.12.007 DOI: https://doi.org/10.1016/j.puhe.2017.12.007

Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult? Public health, 136, 109-116. https://doi.org/10.1016/j.puhe.2016.03.030 DOI: https://doi.org/10.1016/j.puhe.2016.03.030

Kesavayuth, D, Poyago-Theotoky, J., Tran, D. B. & Zikos, V. (2020). Locus of control, health, and healthcare utilization. Economic Modelling, 86, 227-238, https://doi.org/10.1016/j.econmod.2019.06.014 DOI: https://doi.org/10.1016/j.econmod.2019.06.014

Kondilis, E., Tarantilis, F., & Benos, A. (2021). Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece. Public Health, 198, 85-88. https://doi.org/10.1016/j.puhe.2021.06.025 DOI: https://doi.org/10.1016/j.puhe.2021.06.025

Krejcie, R. V., & Morgan, D. W. (1970). Determining sample size for research activities. Educational and Psychological Measurement, 30(3), 607-610. https://doi.org/10.1177/001316447003000308 DOI: https://doi.org/10.1177/001316447003000308

Laverack, G. (2017). The challenge of behaviour change and health promotion. Challenges, 8(2), 25. https://doi.org/10.3390/challe8020025 DOI: https://doi.org/10.3390/challe8020025

Liang, B., and D. Scammon. 2011. "E-Word-of-Mouth on Health Social Networking Sites: An Opportunity for Tailored Health Communication." Journal of Consumer Behaviour, 10(6), 322-331. https://doi.org/10.1002/cb.378 DOI: https://doi.org/10.1002/cb.378

Macassa, G. (2021). Can sustainable health behaviour contribute to ensure healthy lives and wellbeing for all at all ages (SDG 3)? A viewpoint. Journal of Public Health Research, 10(3), jphr-2021. https://doi.org/10.4081/jphr.2021.2051 DOI: https://doi.org/10.4081/jphr.2021.2051

Manzoor, F., Wei, L., Hussain, A., Asif, M., & Shah, S. I. A. (2019). Patient satisfaction with health care services; an application of physician's behavior as a moderator. International journal of environmental research and public health, 16(18), 3318. https://doi.org/10.3390/ijerph16183318 DOI: https://doi.org/10.3390/ijerph16183318

Metcalfe, D., Diaz, A. J. R., Olufajo, O. A., Massa, M. S., Ketelaar, N. A., Flottorp, S. A., & Perry, D. C. (2018). Impact of the public release of performance data on the behaviour of healthcare consumers and Providers. Cochrane Database of Systematic Reviews, (9).

https://doi.org/10.1002/14651858.CD004538.pub3 DOI: https://doi.org/10.1002/14651858.CD004538.pub3

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6, 1-12. https://doi.org/10.1186/1748-5908-6-42 DOI: https://doi.org/10.1186/1748-5908-6-42

Mochari-Greenberger, H., & Pande, R. L. (2021). Behavioral health in America during the COVID-19 pandemic: Meeting increased needs through access to high-quality virtual care. American Journal of Health Promotion, 35(2), 312-317. https://doi.org/10.1177/0890117120983982d DOI: https://doi.org/10.1177/0890117120983982d

Morris, Z. S., & Clarkson, P. J. (2009). Does social marketing provide a framework for changing healthcare practice? Health policy, 91(2), 135-141. https://doi.org/10.1016/j.healthpol.2008.11.009 DOI: https://doi.org/10.1016/j.healthpol.2008.11.009

Mosadeghrad, A. M. (2014). Factors Affecting Medical Service Quality. Iranian journal of public health, 43(2), 210-220. https://doi.org/10.15171/ijhpm.2014.65

Mosadeghrad, A. M. (2014). Factors influencing healthcare service quality. International journal of health policy and management, 3(2), 77. https://doi.org/10.15171/ijhpm.2014.65 DOI: https://doi.org/10.15171/ijhpm.2014.65

Mwangi, S. M. (2015). Marketing strategies and performance of private hospitals in Nairobi county (Doctoral dissertation, University of Nairobi).

Mweshi, G. K., & Sakyi, K. (2020). Application of sampling methods for the research design. Archives of Business Review-Vol, 8(11), 180-193. https://doi.org/10.14738/abr.811.9042 DOI: https://doi.org/10.14738/abr.811.9042

Nagler, R. H., & LoRusso, S. M. (2017). Conflicting information and message competition in health and risk messaging. In Oxford research encyclopedia of communication. https://doi.org/10.1093/acrefore/9780190228613.013.292 DOI: https://doi.org/10.1093/acrefore/9780190228613.013.292

Ngwenya, N., Nkosi, B., Mchunu, L. S., Ferguson, J., Seeley, J., & Doyle, A. M. (2020). Behavioural and socio-ecological factors that influence access and utilisation of health services by young people living in rural KwaZulu-Natal, South Africa: Implications for intervention. PloS one, 15(4), e0231080. https://doi.org/10.1371/journal.pone.0231080 DOI: https://doi.org/10.1371/journal.pone.0231080

Paul, E., Brown, G. W., & Ridde, V. (2020). COVID-19: time for a paradigm shift in the nexus between local, national, and global health. BMJ Global Health, 5(4), e002622. https://doi.org/10.1136/bmjgh-2020-002622 DOI: https://doi.org/10.1136/bmjgh-2020-002622

Pinho, M. (2023). The role of lifestyles in the commitment to the Unites Nations Sustainable Development Goal 3. An exploratory study. International Journal of Health Governance, 28(3), 267-283. https://doi.org/10.1108/IJHG-03-2023-0026 DOI: https://doi.org/10.1108/IJHG-03-2023-0026

Podsakoff, P. M., MacKenzie, S. B., & Podsakoff, N. P. (2012). Sources of method bias in social science research and recommendations on how to control it. Annual review of psychology, 63, 539-569. https://doi.org/10.1146/annurev-psych-120710-100452 DOI: https://doi.org/10.1146/annurev-psych-120710-100452

Porumbescu, G. A. (2016). Linking public sector social media and e-government websites used to trust in government. Government Information Quarterly, 33(2), 291-304. https://doi.org/10.1016/j.giq.2016.04.006 DOI: https://doi.org/10.1016/j.giq.2016.04.006

Robinson, M. N., Tansil, K. A., Elder, R. W., Soler, R. E., Labre, M. P., Mercer, S. L., ... & Community Preventive Services Task Force. (2014). Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review. American journal of preventive medicine, 47(3), 360-371. https://doi.org/10.1016/j.amepre.2014.05.034 DOI: https://doi.org/10.1016/j.amepre.2014.05.031

Sadagheyani, H. E., & Tatari, F. (2020). Investigating the role of social media on mental health. Mental health and social inclusion, 25(1), 41-51. https://doi.org/10.1108/MHSI-06-2020-0039 DOI: https://doi.org/10.1108/MHSI-06-2020-0039

Schwartz, L. M., & Woloshin, S. (2019). Medical marketing in the United States, 1997-2016. Jama, 321(1), 80-96.

https://doi.org/10.1001/jama.2018.19320 DOI: https://doi.org/10.1001/jama.2018.19320

Sekaran, U., & Bougie, R. (2016). Research Methods for Business: A Skill Building Approach. John Wiley & Sons.

Shamasunder, S., Holmes, S. M., Goronga, T., Carrasco, H., Katz, E., Frankfurter, R., & Keshavjee, S. (2020). COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment. Global Public Health, 15(7), 1083-1089. https://doi.org/10.1080/17441692.2020.1760915 DOI: https://doi.org/10.1080/17441692.2020.1760915

Shmueli, L. (2021). Predicting intention to receive the COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model. BMC Public Health, 21, 1-13. https://doi.org/10.1186/s12889-021-10816-7 DOI: https://doi.org/10.1186/s12889-021-10816-7

Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International health care system profiles. The Commonwealth Fund [Internet].

Van Achterberg, T., Huisman-de Waal, G. G., Ketelaar, N. A., Oostendorp, R. A., Jacobs, J. E., & Wollersheim, H. C. (2011). How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques. Health Promotion International, 26(2), 148-162. https://doi.org/10.1093/heapro/daq050 DOI: https://doi.org/10.1093/heapro/daq050

Van Der Wielen, N., Channon, A. A., & Falkingham, J. (2018). Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana. BMJ global health, 3(1), e000590.

https://doi.org/10.1136/bmjgh-2017-000590 DOI: https://doi.org/10.1136/bmjgh-2017-000590

Wakefield, M. A., Loken, B., & Hornik, R. C. (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376(9748), 1261-1271. https://doi.org/10.1016/S0140-6736(10)60809-4 DOI: https://doi.org/10.1016/S0140-6736(10)60809-4

Webb, T., Joseph, J., Yardley, L., & Michie, S. (2010). Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of medical Internet research, 12(1), e1376. https://doi.org/10.2196/jmir.1376 DOI: https://doi.org/10.2196/jmir.1376

Wood, W., & Neal, D. T. (2016). Healthy through habit: Interventions for initiating & maintaining health behavior change. Behavioral Science & Policy, 2(1), 71-83. https://doi.org/10.1177/237946151600200109 DOI: https://doi.org/10.1353/bsp.2016.0008

Published

2024-09-13

How to Cite

Akanyako, J. (2024). The Nexus between Environmental Factors and Behaviour Change in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies. African Journal of Empirical Research, 5(3), 1102–1115. https://doi.org/10.51867/ajernet.5.3.94

Issue

Vol. 5 No. 3 (2024): Jul-Sep 2024

Section

Articles
Copyright & Licensing

Copyright (c) 2024 Joseph Akanyako

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC