C-Change Picks - Information about Behaviour and Social Change Communication
C-Change Picks #1 - Information about Behaviour and Social Change Communication
Sponsored by C-Change
August 26 2008
From The Communication Initiative (The CI) and the United States Agency for International Development (USAID)'s C-Change programme.
~
C-Change Picks is a new e-magazine that is supported by C-Change and implemented by The Communication Initiative and focuses on recent case studies, reports, analyses, and resources on communication for behaviour and social change to address health, environment, and civil society. If you have received this newsletter from a friend or colleague and would like to subscribe, please contact cchange@comminit.com
Communication for Change (C-Change), implemented by AED, is USAID's flagship programme to improve the effectiveness and sustainability of communication for behaviour and social change as an integral part of development efforts in health, the environment, and civil society. C-Change works with global, regional, and local partners to use communication to change behaviours and social norms, supported by evidence-based strategies, state-of-the-art training and capacity building, and cutting-edge research. The ultimate goal is the improved health and well-being of people in the developing world. Please see the C-Change website. To contact C-Change, please email cchange@aed.org
The Communication Initiative (The CI) network is an online space for sharing the experiences of, and building bridges between, the people and organisations engaged in or supporting communication as a fundamental strategy for economic and social development and change. It does this through a process of initiating dialogue and debate and giving the network a stronger, more representative and informed voice with which to advance the use and improve the impact of communication for development. This process is supported by web-based resources of summarised information and several electronic publications, as well as online research, review, and discussion platforms providing insight into communication for development experiences. Please see The CI website.
C-Change Picks seeks new knowledge and experiences in behaviour change and social change communication - your case studies, strategic thinking, support materials, and any other relevant documentation. Please contact cchange@comminit.com
~
FAMILY PLANNING
1. The Role of Men and Boys in Women’ Health: Seminar Aims to Build on Lessons Learned
2. Addressing Gender Equity Issues: WHO Evaluation of Health Interventions with Men and Boys Provides Promising Evidence
3. Ugandan “Love Letters” Pull Men to Fetal Heartbeats
4. Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar: A Case Study on CARE’s Extra Mile Initiative
5. Pathfinder Chart Provides Helpful Family Planning Discussion Topics for VCT Counselors
6. Training and Reference Guides Developed by FHI to Facilitate the Use of Family Planning Screening Checklists
7. Information Bundle on Behaviour Change Communication Compiled by INFO Project to Help Family Planning Programme Managers in Building Effective BCC Programmes
HIV/AIDS
8. A Framework for Classifying HIV Prevention Interventions Is Needed, According to Report to the Joint United Nations Programme on HIV/AIDS (UNAIDS)
9. Sexuality and HIV Education: Population Council Brief Urges a Paradigm Shift
10. Zimbabwean Film “Ndizvo Zvandiri” Helps to Create Dialogues on HIV, PMTCT, and Male Participation in Reproductive Health
11. Tewerwari Kewakebt (The Shooting Stars) Serial Comic Book Illuminates HIV Prevention for Ethiopian Police Officers
12. Report from UNAIDS Examines the Role of Social Change Communication on Achieving HIV/AIDS Goals
MALARIA
13. Role of Information and Communication Networks in Malaria Survival Is Examined in Research Study
14. Faith-Based Models for Improving Maternal and Newborn Health
~
1. The Role of Men and Boys in Women’ Health: Seminar Aims to Build on Lessons Learned
This summary document discusses the proceedings of a seminar held May 29 2007 in Washington, DC by the International Center for Research on Women to discuss the importance of working with men and boys to promote healthy lifestyles among women and men, to learn what is happening in the field with this approach, and to develop a consensus on how to move forward. A review of existing programmes demonstrated that most programmes which target men and boys for health care interventions use one of three approaches, or a combination of these. They are: (1) serve men as clients, (2) involve men in improving women's health, or (3) work directly with men and boys to promote a positive shift in gender norms, away from attitudes and behaviours that undermine women's and their own health and well-being. Seminar participants reported that the third approach has had the farthest reach, and shows the most promise for scaling up. Throughout the day’s discussions, participants underscored that successful health interventions for both women and men depend on changing social norms around masculinity that undermine men's and women's health. This emerged as a key recommendation for moving forward in program and funding efforts. Participants also agreed that changing harmful gender norms – while important – is not sufficient to bring about the necessary changes in health care to curb rising HIV and gender-violence rates or to otherwise improve reproductive and sexual health. They suggested that stakeholders also need to build partnerships across organisations working with women or men, and establish links with other social justice movements. This document identifies and details a number of additional recommendations addressed to disparate audiences: programme designers and managers; advocates; and donors.
2. Addressing Gender Equity Issues: WHO Evaluation of Health Interventions with Men and Boys Provides Promising Evidence
This review, authored by Gary Barker, Christine Ricardo, and Marcos Nascimento, summarises 58 evaluation studies of interventions that were intended to change the behaviours and attitudes of men and boys to achieve health-related gender equity. The document includes ratings of these programmes based on level of impact, and gives more weight to interventions that confirmed behaviour change on the part of men or boys. Key findings included:
a. Well-designed programmes with men and boys show compelling evidence of leading to changes in behaviours and attitudes; programmes rated as being gender-transformative had a higher rate of effectiveness.
b. Integrated programmes and programmes within community outreach, mobilisation, and mass-media campaigns show more effectiveness in producing behaviour change.
c. Relatively few programmes with men and boys go beyond the pilot stage or a short-term time frame. Hence, little information is available on bringing such programmes to scale. The document suggests that this would require addressing questions of programme coherence, programme use beyond the original sites, cost effectiveness, and the effects of cultural variables, and including these issues as part of programme evaluations and public reflection and debate.
3. Ugandan “Love Letters” Pull Men to Fetal Heartbeats
This article, by Rachel Scheier, outlines a behaviour change strategy being used by clinics in the Jinja district of Uganda to encourage men to be involved in the pre-natal care and reproductive health of their wives. When a woman visits a clinic alone, after her consultation she is given a brief letter for her husband, signed by the local district health director, which includes some basic information and a polite request to come to the clinic in person to discuss health matters, such as: HIV testing; what to expect during the delivery; and how to care for a pregnant woman. The letter is designed to encourage men to attend the clinic as an expression of love for their family. When a man arrives at the clinic for a first pre-natal visit, he is weighed and his temperature and blood pressure are taken alongside his partner's to demonstrate to men that they are directly involved in the childbearing process. According to one man interviewed for the article, this letter encouraged him to take the time to come to the clinic and find out what the couple could expect in the time leading up to the birth of their child. In addition to getting more men to come to the clinics, the love letter also gives women much-needed bargaining power, providing them with a way to approach their husbands about sensitive issues related to health care.
4. Going the Extra Mile to Provide and Sustain Family Planning Services in Remote Madagascar: A Case Study on CARE’s Extra Mile Initiative
This case study, written by Catherine Toth, documents experiences with the Extra Mile Initiative (EMI), a two-year effort undertaken by CARE in Madagascar to bring education and family planning services to remote communes located in conservation zones that are threatened by the growing population. EMI aimed to increase awareness of and access to family planning services through a combination of community planning, identification of the economically poorest families not able to utilise existing family planning support, expansion of existing community-based distribution schemes, person-to-person training, and information, education, and communication (IEC) materials. This publication explores how the EMI was embedded into the local health system, communities, and local government of the communes it served - providing a network of people and institutions to continue to meet the family planning needs of the population after the project ended.
According to this report, when the EMI began, the contraceptive prevalence rate there was about 11% (traditional and modern methods combined), which is well below the national average of 27%. Twelve months later, 24% of women of reproductive age in the project area were using some method to plan their families.
A key to the programme’s success, according to this study, was the decision to embed the project not only in the local health system and the communities it serves, but also in local government, forming a triad of implementation and oversight, and essentially changing the “culture” of service provision within the communes served. In Madagascar, the national government mandates the structure of commune government; among the key administrative bodies is the Social Development Committee (SDC), charged with supporting basic services such as health and education. Most SDCs exist in name only, however, since they lack the training and guidance to function successfully. CARE trained and supported the SDCs to become functioning members of the triad and to promote and reinforce the social and behavioural changes that were required to improve family planning within the communes. The integration of the project within the three main spheres of influence - health centres, community leaders, and SDCs - created space for dialogue and collaboration where none previously existed. As trust and communication grew within each triad, they also grew in the communities they served.
[Also see - Extra Mile Initiative (EMI) – Madagascar]
5. Pathfinder Chart Provides Helpful Family Planning Discussion Topics for VCT Counselors
This resource, from Pathfinder International, is a two-sided chart of family planning goals for women, men, and couples, with additional information for adolescents, sex workers, men with multiple partners, and pregnant or post-partum women. It includes such topics as having a healthy baby, preventing pregnancy, and postponing pregnancy. It is designed for use by HIV/AIDS voluntary counseling and testing (VCT) counselors wishing to integrate family planning messages into their counseling sessions.
6. Training and Reference Guides Developed by FHI to Facilitate the Use of Family Planning Screening Checklists
This is a series of four training and reference guides designed by Family Health International to help programme managers, administrators, trainers, and service providers to use checklists for screening women on a variety of family planning methods. There is one guide each on using checklists to initiate use of oral contraceptives, injectables, and the copper IUD. A fourth guide addresses the use of a screening checklist that enables providers to rule out pregnancy among non-menstruating women who want to start a family planning method. A fifth guide on using a checklist for initiating the use of implants will be available in the future, according to the FHI web site. Each guide provides a four-to-six-hour curriculum for training service providers to use the checklist and a CD-ROM containing key resources needed during the training. Each guide also provides reference information to supplement the training.
7. Information Bundle on Behaviour Change Communication Compiled by INFO Project to Help Family Planning Programme Managers in Building Effective BCC Programmes
For use in planning behaviour change communication (BCC) programmes, this is a bundle of reports focused on BCC in family planning, reproductive health, HIV prevention, and other health and development areas. Compiled by USAID's INFO Project, the bundle includes the Population Reports issue, "Communication for Better Health" (see below for more information); two companion INFO Reports issues, "Tools for Behavior Change Communication" and "Entertainment-Education for Better Health"; several online tools such as a PowerPoint presentation; and a Question and Answer summary. Links to two short online courses, one on "Monitoring and Evaluation Fundamentals" and the other on "Fostering Change in Health Services,” are also available.
The "Communication for Better Health" issue of Population Reports, authored by Ruwaida M. Salem, Jenny Bernstein, and Tara M. Sullivan, is intended to help family planning programme managers to build behaviour change communication (BCC) into their overall strategies. The contents include a concise summary of BCC with examples of its use and efficacy in different context, an outline of the BCC process, two practical case studies - briefs on an Ethiopian radio serial and a multi-media campaign in Egypt - an article about scaling up BCC programmes, and a brief about participatory BCC approaches. A summary of this issue is available – click here.
8. A Framework for Classifying HIV Prevention Interventions Is Needed, According to Report to the Joint United Nations Programme on HIV/AIDS (UNAIDS)
Authored by Michael Sweat, this document is premised on the claim that there is little consistency in how interventions to address HIV and AIDS are described and defined. Based on a review of the scientific literature, the author and his colleagues first examine how the field of HIV behavioural prevention science has been described and categorised historically. The initiatives explored include the following features: voluntary counselling and testing (VCT), condom social marketing, partner notification, family planning for HIV-positive women, mass media, messages focused on abstinence and/or abstinence-only, needle and syringe exchange, psychosocial support, and the impact of medical treatment on HIV risk behaviour. Citing specific examples of interventions reflecting the above-cited approaches, the author finds that most interventions were combinations of multiple activities. Despite this, according to the author, investigators tended to identify the intervention by a single, often prominent, component. In addition, "frequently, detailed descriptions of interventions were missing completely and only a word or brief phrase was used to describe the activities conducted." Sweat argues that "the current ad hoc manner of conveying the content of interventions results in difficulty in establishing quality standards."
The solution proposed here is an ontology, which is a specific system of classification based on an explicit logic and purposefully designed with objective criteria in mind. The following steps are recommended for establishing clear definitions for HIV and AIDS interventions: "(1) Identify brief definitions describing activities or services and commodities provided in the intervention. When relevant, also refer to key message content included with the intervention. (2) Through consensus meetings with key stakeholders and experts, provide a rich description of other requisite components of the intervention, including message content, the method of delivery, how to tailor the intervention to audiences and settings, the intervention's desired outcomes, and its theoretical basis. With the establishment of clearly defined interventions with associated quality standards, estimated costs and optimal bundling strategies, it will be possible to provide improved recommendations to programme planners and policy-makers striving to intensify HIV prevention programmes. Consensus in these areas would enhance our ability to plan, allocate requisite resources - including human resources - advocate prevention, and monitor and evaluate the success of prevention programmes."
9. Sexuality and HIV Education: Population Council Brief Urges a Paradigm Shift
This brief from the Population Council (and written by Nicole Haberland and Deborah Rogow) examines curriculum-based sexuality education as a cornerstone of school- and community-based efforts to improve young people’s sexual and reproductive health, and, more recently, to prevent HIV infection. A review of the impact of school-based sexuality and HIV education programmes in developed and developing countries found that two-thirds of the programmes reduced the risk associated with one or more reported sexual behaviours. To further increase these programmes' effectiveness, the authors examine several key areas in need of rethinking to further address curricular effectiveness.
These areas include: focusing on underlying gender attitudes and behaviours as an element in developing curricula; examining and teaching about the broader social contexts in settings with younger adults; investing in training teachers in interactive and participatory methods, as well as expanding the focus on critical-thinking skills (instead of rote learning); examining the outcomes of same-sex versus coeducational programmes in different settings; and examining the demographics of the youth reached to determine who is being “missed” by existing programmes.
10. Zimbabwean Film “Ndizvo Zvandiri” Helps to Create Dialogues on HIV, PMTCT, and Male Participation in Reproductive Health
"Ndizvo Zvandiri" is a 30-minute film that aims to promote advocacy in prevention of mother-to-child transmission (PMTCT) of HIV, to encourage disclosure of HIV status, and to urge male participation in reproductive health issues. "Ndizvo Zvandiri," which means "This is What I Am," tells the story of Miriam, who discovers that she is HIV positive when she seeks antenatal care. Representative of the challenges that many women in Zimbabwe face, the film chronicles the gender challenges Miriam faces in disclosing her status to her husband, as well as how the couple eventually join hands to protect the future of their unborn child.
Intended to be shown and discussed in public health institutions, churches, workplaces, schools, community meetings, and any other group setting where dialogue on HIV/AIDS can be initiated, the film is complemented by a discussion guide to help facilitate discussion on the various PMTCT and social issues portrayed in it.
11. Tewerwari Kewakebt (The Shooting Stars) Serial Comic Book Illuminates HIV Prevention for Ethiopian Police Officers
This is a 52-edition serial comic book designed to reduce the risk of HIV infection among members of Ethiopia's police force. It is distributed to officers within the Federal Police for use during ongoing peer group discussions. According to the press release issued on the launch of the comic book, the Ethiopian Police Force is known for its swift and efficient response in crises. The main characters of this comic serial, who are also members of the police force, are seen using their crisis-handling skills in responding to HIV and AIDS. By combining humour, action, and drama, the comic book aims to enable officers within Ethiopia's Federal Police to better understand the risks they face from HIV and to develop strategies that will keep them safer.
The Shooting Stars is part of the Modeling a Reinforcement to Combat HIV/AIDS (MARCH) project, which aims to be a model for HIV prevention. MARCH promotes behaviours that reduce the risk of HIV infection, such as faithfulness, condom use, and early detection and treatment of sexually transmitted infections (STIs) by using role models to demonstrate positive behaviour change through serial dramas and entertainment education.
12. Report from UNAIDS Examines the Role of Social Change Communication on Achieving HIV/AIDS Goals
This document provides an overview of the discussions at the Joint United Nations Programme on HIV/AIDS (UNAIDS) technical consultation on social change communication on August 2-3 2007. The meeting explored the role of social change communication in achieving the ends of matching HIV/AIDS epidemic responses at the country level to the social drivers prevalent in each country, such as gender inequality, HIV-related stigma and discrimination, and human rights abuses, through activities that are effective, measurable, and can be taken to scale. Challenges to achieving those ends within the field of health communication and social change communication include a lack of coordination, investment, and consensus on key issues.
Key issues in social change communication described in the document include:
• Participation and the limits of participation - Participatory communication, participatory monitoring and evaluation, and local ownership were cited as central to good health communication, but the knowledge, skills, and technical capacities required for social change communication are not always resident within a community. Also, there may be local aversion to tackling the topic of sexual transmission of the virus.
• Building the body of knowledge - Using the example of social marketing of condoms, the report suggests that the lack of investment in generating good baseline information before interventions is now hindering development years after the first social marketing interventions took place.
• Civil society’s role - The experiences of participants highlighted the fact that any effort to place communication solely within the hands of national governments would possibly jeopardise the initiative, innovation, and energy within civil society.
13. Role of Information and Communication Networks in Malaria Survival Is Examined in Research Study
This research, by Pallab Mozumder and Achla Marathe, investigates the impact of information and communication network (ICN) density variables on malaria death probability. It pools data from 70 different countries from 1960 to 2004 to construct a panel dataset of health and socio-economic variables that are used to study the effects of the density of telephone lines and television sets in malaria-exposed populations to see if higher ICN density improves the effectiveness of existing resources for malaria prevention and treatment.
The study states that "[w]ell-communicated information and collective decision making can lead to faster and superior home-based treatment." Through the use of ICN, sources of shared information on treatment of disease can be made available to a community as a kind of social capital. Because studies have shown that communities with high social capital have lower disease rates, and that "mass media and interpersonal communication channels can create a sense of urgency to react and take initiative at the early signs of malaria," the value of ICN for increasing problem identification, decision-making, and resolving problems collectively "can increase the level of confidence of those infected, and it can pool resources and expertise at the community level to provide treatment in a timely manner."
"The results suggest that information and communication networks can substantially scale up the effectiveness of the existing resources for malaria prevention...Furthermore, the impact of TV density is much higher compared to telephone density across all models, implying that public and mass media has a higher influence on establishing effective ICN outreach...Expanded information and communication networks will widen the avenues for community based 'participatory development' that encourages the use of local information, knowledge and decision making. Timely information, immediate care and collective knowledge-based treatment can be extremely important in reducing child mortality and achieving the millennium development goal."
14. Faith-Based Models for Improving Maternal and Newborn Health
This brief by Sarla Chand and Jacqui Patterson highlights the contribution of faith-based organisations (FBOs) to health care by focusing on four FBO programme models that, despite multiple challenges, have been effective in improving maternal and newborn health (MNH) outcomes. The programme models are based on FBO health networks, community health behaviour change programmes, congregation-based health programmes, and comprehensive health care programmes. Using project examples mainly from Africa, the document shows how these models can strengthen and expand health services and contribute to the achievement of the health-related Millennium Development Goals (MDGs). The brief concludes with recommended actions for all stakeholders - FBOs, policy makers, and donors.
One of the programme models, a malaria prevention programme of the Synod of Livingstonia, Malawi, illustrates how congregations can be mobilised to promote behaviour change to improve health and save lives. As the document states, every village has at least one faith community which can provide a strong foundation for positive change.
Established in 2000, the Synod of Livingstonia’s malaria prevention programme provides: health education about prevention and early treatment of malaria; insecticide-treated nets (ITNs) at subsidised prices to pregnant women and children five and under; re-treatment of nets; and follow-up services for pregnant women and children who have had malaria. "The programme was implemented in 26 of 150 Church of Central Africa, Presbyterian (CCAP) congregations, primarily in hard-to-reach areas along the lake shore of northern Malawi and in the interior of the country...This region has received fewer services than other areas of the country. The Synod Health Department trained women from the congregations to deliver messages about malaria prevention and treatment.
In 2004, a post-intervention survey about malaria prevention and treatment was conducted in 43 villages with 1,035 respondents who were either pregnant women or caretakers of children under the age of five. The survey highlighted the programme’s successful outreach efforts (transfer of knowledge and availability of ITNs), with a high percentage (81%) of the respondents aware of the benefits of sleeping under a mosquito net. In addition, there was a significant increase in the percentage of respondents who reported having nets in their homes. The results also suggest that there are reasons, in addition to people’s knowledge about malaria transmission and prevention, that still influence their decision or ability to purchase mosquito nets or ITNs. These barriers must be identified and removed to enable widespread use of ITNs for malaria prevention."
~
This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the Communicative Initiative and the C-CHANGE project, managed by AED, and do not necessarily reflect the views of USAID or the United States Government.
~
Sent to you from The Communication Initiative...where communication and media are central to social and economic development...
To subscribe to or unsubscribe from C-Change Picks, please contact cchange@comminit.com
- Log in to post comments