Social And Behavior Change Communication Research Articles

“RadioActive”: an exploration of the critical role of materiality in shaping participatory spaces

ABSTRACT Materiality plays a critical role in determining participatory spaces within social and behaviour change communication (SBCC) interventions focused on the Sustainable Development Goals (SDGs). However, this role remains under-examined. This article draws inspiration from social practice theory to steer away from dominant individual-centred approaches. We focus on the material dimension of social practices to examine how materiality is involved in enabling or hindering participation, with the Rwandan “Itetero” Radio Listening Club (RLC) as case study. This research draws on one year of ethnographically inspired participant observations that involved attending 12 listening club sessions, 12 group discussions, and semi-structured interviews with 45 RLC participants (2019–2020). We provide insight into how the materiality of the RLC – understood here as infrastructure, architecture, and technology – shaped attendants’ ability to participate. We argue that acknowledging the material entanglements of people and (material) space might allow SBCC project implementers to develop more contextually appropriate and inclusive participatory spaces.

Diet Quality Among Mothers and Children in India: Roles of Social and Behavior Change Communication and Nutrition-Sensitive Social Protection Programs

BackgroundLimited evidence exists on determinants of maternal and child diet quality. ObjectivesThis study examined the role of social and behavior change communication (SBCC) and nutrition-sensitive social protection (NSSP) programs on maternal and child diet quality. MethodsData were from cross-sectional phone survey on 6627 Indian mothers that took place in late 2021. The Diet Quality Questionnaire (DQQ) was used to measure maternal and child diet quality, including minimum dietary diversity (MDD), dietary diversity scores (DDSs), noncommunicable disease (NCD)-protect and NCD-risk scores, adherence to dietary guidelines (All-5 and India-All-6), and unhealthy child feeding. Multivariate regression models were used to explore the association between diet indicators and coverage of SBCC and NSSP programs. ResultsMaternal and child diet quality was suboptimal, with more mothers (57%) achieving MDD than children (23%). SBCC was positively associated with healthy food consumption in children (odds ratio [OR]: 2.14 for MDD; β: 0.60 for DDS and 0.54 for NCD-protect) and mothers (β: 0.38 for DDS and 0.43 for NCD-protect). Cash transfers were associated with healthier diets in mothers (OR: 1.45 for MDD, 1.86 for All-5, and 2.14 for India-All-6; β: 0.43 for DDS and 0.26 for NCD-protect), but less associations noted for children (β: 0.14 for NCD-protect). Receiving food was associated not only with healthier diets in mothers (OR: 1.47 for MDD; β: 0.27 for DDS and 0.33 for NCD-protect) and children (β: 0.19 for DDS and 0.15 for NCD-protect) but also with unhealthy food in children (OR: 1.34). Exposure to multiple programs showed stronger associations with diet quality. ConclusionsSBCC has greater positive impact on child feeding than food and cash transfers, while cash has a stronger association with improved maternal diets. Food and cash are also associated with unhealthy food consumption. Our study underscores the importance of interventions that combine education, resource provision, and targeted support to promote maternal and child diet quality.

Specialized nutritious foods and behavior change communication interventions during the first 1000 d of life to prevent stunting: a quasi-experimental study in Afghanistan

BackgroundConsiderable evidence supports the effectiveness of nutritional supplementation with or without nutrition education in preventing stunting in developing countries, but evidence from Afghanistan is scarce. ObjectivesThis project aimed to assess the effectiveness of specialized nutritious food (SNF), social and behavior change communication (SBCC) intervention to prevent stunting among children under 2 y during the first 1000 d of life in Badakhshan, Afghanistan. MethodsWe used a community-based quasi-experimental pre–post study design with a control group. Pregnant and lactating women received a monthly ration of 7.5 kg of super cereal (250 g/d) during pregnancy and the first 6 mo of breastfeeding. Children aged 6–23 mo received 30 sachets of medium-quantity lipid-based nutrient supplement (50 g/sachet/d) monthly. We compared pre- and postintervention assessments of the intervention and control groups to isolate the effect of the intervention on key study outcomes at the endline by difference-in-differences (DID) estimates. ResultsA total of 2928 and 3205 households were surveyed at baseline and endline. DID estimates adjusted for child, maternal, and household characteristics indicated a significant reduction in stunting (DID: −5% (95% confidence interval [CI]: −9.9, −0.2) and underweight (DID: −4.6% (95% CI: −8.6, −0.5) among children <2 y of age. However, DID estimates for wasting among children in the intervention and control groups were not significantly different (DID: −1.7 (95% CI: −5.1, 1.6). Furthermore, exposure to the SBCC messages was associated with improvements in the early initiation of breastfeeding (DID: 19.6% (95% CI: 15.6, 23.6), exclusive breastfeeding under 6 mo (DID: 11.0% (95% CI: 2.3, 19.7), minimum meal frequency (DID: 23% (95% CI: 17.7, 28.2), and minimum acceptable diet (DID: 13% (95% CI: 9.8, 16.3). ConclusionsThe provision of SNF in combination with SBCC during the first 1000 d of life was associated with reduction in stunting and underweight and improvements in infant and young child feeding practices among children under 2 y of age.This trial was registered at clinicaltrials.gov as NCT04581993.

A Scoping Review of Existing Policy Instruments to Tackle Overweight and Obesity in India: Recommendations for a Social and Behaviour Change Communication Strategy

Background The Indian government is committed to address various manifestations of malnutrition, including overweight and obesity, inorder to improve individual health and well-being. The scoping review aims to map existing national policy instruments (programmes, schemes, regulations and guidelines) addressing overweight and obesity in India and analysing them for Social and Behaviour Change Communication (SBCC) strategies. Methods Systematic identification and selection of policy instruments using ‘Arksey and O’Malley’ framework was conducted from central government ministry websites, between March and June 2023. These instruments focused on nutrition and/or physical activity, targeting specific demographic groups like pregnant women, lactating mothers, children (0-5 years and 5-9 years), or adolescents (10-19 years); excluding those focusing on specific diseases like micronutrient deficiencies, wasting, and stunting. Based on search strategy six policy instruments were included and analysed for SBCC strategies. Results While many policy instruments incorporated SBCC plans; the ‘National Programme for Prevention of Non-Communicable Diseases (NP-NCD)’ stands out as a significant policy initiative specifically targeting the prevention of overweight and obesity within the broader context of Non-Communicable Diseases. It adopts a comprehensive approach addressing key drivers contributing to overweight/obesity across multiple levels of behavioural influence i.e., individual, interpersonal, community and organisation for health promotion. However, there’s need to strengthen SBCC strategies related to prevention and management of obesity, especially screening and counselling, to cover all age groups with a particular focus on adolescents and youth. SBCC strategies can also be incorporated into India’s Integrated Nutrition Support Programme (POSHAN 2.0) and/or Reproductive, Maternal, New-born, Child, Adolescent Health and Nutrition (RMNCAH+N) under the National Health Mission. Conclusion This paper underscores the necessity for comprehensive strategies to address multifaceted origin of overweight and obesity. The NP-NCD stands out as a noteworthy initiative, and there is considerable potential for other programmes to emulate it SBCC strategies to bolster their overall effectiveness. Note : *Policy instrument’s throughout the paper has been used to cover programmes, schemes, regulations and guidelines.

Social norms, diffusion, and women's risk of intimate partner violence in Nepal: Impact assessment of a social and behavior Change communication intervention (Change Starts at home)

IntroductionIntimate partner violence (IPV) is a significant public health, human rights, and development issue. While existing evidence posits that addressing social norms is key to IPV prevention, successful IPV interventions that include a norms approach are limited in number and methodological rigor and rarely include a formal investigation of the diffusion of intervention impact. We contribute novel findings to this intellectual and programmatic space with evidence on a social and behavior change communication (SBCC) intervention (Change Starts at Home) in Nepal designed to prevent IPV and shift social norms towards greater gender equity. MethodsParticipants included 442 married women across 13 communities assessed at three timepoints: before intervention (baseline), at the completion of the core couple's curriculum and edutainment (midline), and at the conclusion of the diffusion curriculum (endline). Generalized estimating equations with propensity-score adjustments were used to determine change in outcomes at midline and endline for two intervention conditions (direct beneficiary, N = 173; and resident of the intervention community, (N = 178) relative to control (N = 91). ResultsIPV victimization significantly decreased in both intervention conditions at midline, with larger reductions in direct beneficiaries. At endline, direct beneficiaries had sustained reduction in IPV relative to control participants. Positive injunctive norms also significantly improved by midline for both intervention groups, whereas improvements in descriptive norms for intervention groups were matched by improvements in the control group at both midline and endline. Several secondary outcomes showed significant improvements for both intervention groups at midline and/or endline, including in-law violence, financial decision-making, communication, and relationship quality, with additional improvements for the direct beneficiaries in attitudes, leadership, GBV advocacy, and diffusion. ConclusionThis study sheds light on the effectiveness of the Change intervention, the role of addressing social norms in IPV prevention efforts, and the benefits of organized diffusion.

Supporting Preparedness and Response to Cyclone Freddy In Madagascar- A Contribution from the Social and Behaviour Change Communication

Social and Behaviour Change Communication (SBC) is one of the vital strategic programs that aim to empower people to be resilient in preparation and response to emergencies. This paper outlines steps undertaken by SBC partners in Madagascar as a contribution towards preparation and response initiatives to cyclone Freddy, and discusses observations and lessons learnt to inform future programming in the country and other cyclone-affected regions. It bases its conceptual framework around the emergency prevention, preparedness, response and recovery (PPRR), the Emergency Risk Management Framework (ERM) as well as the UNICEF Framework on Accountability to Affected Population (AAP) to define the interventions based on three major phases of the intervention i.e., before, during and after. An SMS-based survey was used as a feedback mechanism and as a tool to assess SBC interventions 3 days after the passage of cyclone Freddy. The survey used a structured questionnaire where 450 respondents participated from 13 regions of the country. Scouts (youth mobilisers) and other NGO partners in the emergency network conducted phone calls, entered data into a Kobo-Collect template and analysed the data using simple percentiles in excel sheets. Analysis of the processes and results of the survey indicated that there was adequate utilisation of systematic steps in emergency preparedness. These included strategic planning and prepositioning of communication materials in all the 23 regions of the country, coordination and partnership at national, regional and district levels, implementation of a mixture communication and engagement methods and efforts to collect and respond to feedback. Three days from the onset of Freddy, the affected people were highly exposed to life saving messages (86%) but needed more exposure to life improving messages i.e., health (29.6%), child stimulation (29.3%), WASH (29.3%), nutrition (18%), Gender-based Violence (10.2%) and Violence against Children (4%). SBC interventions showed positive results in the use of bed nets to prevent malaria (85.7%), hand washing with soap to prevent diarrheal diseases and COVID-19 (95.6%) and reporting of cases on gender-based violence and violence against children (31.6%). 50.9% of the interviewed individuals acknowledged having been well informed about humanitarian interventions.

Communication for Social and Behaviour Change: A Case Study of Puppetry Animation in Kenya.

The COVID-19 pandemic has claimed over six million lives worldwide (Ritchie, 2022). In Kenya, more than three hundred thousand lives have been lost (Ministry of Health, 2022). Prevention has been the main focus. This has necessitated behaviour change. The government, non-governmental organisations, and private agencies set out to find Social and Behaviour Change Communication (SBCC) strategies at the start of the pandemic. Different strategies received different types of feedback. One strategy that has been proven time and time again to be effective in mass communication and education while entertaining is puppetry. It was, however, only partially utilised. This research sought to explore communication for social and behaviour change communication and how it was applied to curb the spread of COVID 19 using a case study of puppetry in Kenya. It attempted to answer the following questions: What types of puppets were used in Kenya for social and behaviour change communication? Which advocacy messages were communicated for social and behaviour change using puppetry? How was puppetry used for social mobilisation for social and behaviour change communication? What factors hindered puppetry's use for social and behaviour change communication? The theoretical base of this research was informed by the health belief model, which provides a framework for designing messaging that targets perceived barriers, benefits, self-efficacy, and threats; the social learning theory, which explains how behaviour is learned through observation; and the social marketing theory, which provides a framework for how behaviour change messages are designed using marketing principles. This study used a qualitative research design. It analysed past studies to give a framework and then used interviews and observation to collect current data by observation and key informant interviews for thematic analysis. The population chosen for this study was all the puppet shows created, digitally recorded, and aired for SBCC to communicate behaviour change as a prevention measure against COVID-19. For this research, the Dr Pamoja show was purposely chosen as the sample as it met all the criteria for this study. Coding was used for thematic analysis of the collected puppetry video samples from the Dr Pamoja show produced by Project hand up to communicate SBCC against COVID-19. The codes were derived using the deductive approach, and the show analysed both the latent and the semantic. The gaps in the data were informed by Key informants, including the Dr Pamoja show’s director, an AMREF representative, sixteen (16) puppeteers, a community leader, a health representative, and ten (10) parents. After collecting and analysing the data, findings showed that the main types of puppets used are glove puppets, and puppetry remains an effective tool for social and behavioural change communication in Kenya. It was found to be efficient in communicating advocacy messages through influence, persuasion, and social marketing, and also in social mobilisation at both the community level and national level by promoting health messaging that is personalised, normative, and identity-relevant and relies on people’s connections and sense of accountability. The data also showed that episodes translated to Kiswahili and Kikuyu were more popular than the other languages. It is, however, faced with social challenges such as perception, motivation, cultural, psychological, and production challenges such as financing. The study recommends better utilisation of puppetry for SBCC and incorporation of puppetry in communication by the government, non-governmental organisations, and mainstream media. It further recommends that further research be conducted on memory retention of new behaviours learned from puppetry, gender issues in puppetry, and the use of puppetry in other areas such as therapy, play, and education.

Conducting formative research during a pandemic threat to inform the development of an obesity prevention social and behaviour change communication strategy in Tonga.

The global epidemic of obesity is overtaking many parts of the world with the Pacific Islands at particular risk. Tonga population surveys identify significant increases in overweight and obesity with Social and Behaviour Change Communication (SBCC) offering opportunities for curbing the rise in non-communicable diseases. Formative research was conducted during the Covid-19 pandemic to assess stakeholder and program beneficiary needs and wants toward an obesity prevention SBCC strategy in Tonga. Semi-structured interviews with 17 key informants and 18 focus group discussions (N = 168) were conducted in Tongatapu. Data analysis was conducted on Nvivo 2020 qualitative software with desk research of secondary data supporting in-field findings. Potential barriers to behavioural compliance included social/cultural norms, poor attitudes; low motivation and capability; and vulnerabilities of gender and other social determinants. Opportunities included the Tongan collective mindset and the desire for greater social interaction and fun. Strong political will to affect change was apparent with the need to consider targeting to youth, social mobilisation of communities through empowering messaging, and an integrated range of activities. Co-design in the formative research process was able to be fostered via online communication processes to overcome the challenges of Covid-19 travel restrictions. The innovative approach provided a number of learnings including identification of national and regional priorities and improved efficiencies in SBCC planning, implementation and evaluation. SO WHAT?: Formative research adopting co-design approaches with stakeholders and program beneficiaries can provide optimal engagement and ownership in the SBCC strategy including insights into messaging approaches.

A good egg: An evaluation of a social and behavior change communication campaign to increase egg consumption among children in Rwanda.

Childhood malnutrition, which is endemic in rural areas of low-income countries, leads to a host of deleterious outcomes such as poor cognitive development, low educational attainment and lower lifetime wages. Promoting the consumption of eggs among young children has emerged as a promising strategy to combat childhood malnutrition, though pathways to scale remain unclear. In this paper, we evaluate the impact of a social and behaviour change communication (SBCC) campaign combined with a program in which rural families purchased chickens on credit (poultry + SBCC; n = 769) relative to an arm in which families only received the poultry intervention (poultry only; n = 750), using a difference-in-difference estimation strategy with propensity score matching. The SBCC consisted of radio messages, in-person training, text message reminders and posters. We found a relatively modest but statistically significant increase in the number of times per week respondents in the poultry + SBCC arm reported feeding eggs to children of 0.28 (p = 0.02) compared to the poultry-only arm. The increase in egg feeding, however, was more pronounced for boys (0.42, p < 0.01) than for girls (0.14, p = 0.26). In addition, the campaign increased egg feeding more for those who were already feeding eggs to children (0.63, p < 0.01) than those who were not engaging in those practices at baseline (0.26, p < 0.01). However, the difference in these differences was not statistically significant. Future campaigns should ensure higher saturation of messaging and include specific messaging around the importance of feeding girls as well as boys. Campaigns seeking to scale up egg feeding quickly could potentially target the easier-to-reach segment of caregivers who already occasionally feed eggs to children though these might not be the neediest group.

Empowering rural women through gender and nutrition education amid the COVID-19 crisis: Evidence from Myanmar's Central Dry Zone

The COVID-19 pandemic had negative impacts on nutrition and strained intrahousehold relations, particularly among poorer households. Social protection programs intended to mitigate these impacts mainly operated through handing out cash or in-kind items to vulnerable households. Yet social and behavior change communication (SBCC) intervention on gender and nutrition could be another option. We assess the impact of a nutrition and gender SBCC intervention implemented as a cluster-randomized controlled trial in 30 villages in Myanmar's Central Dry Zone during the first year of the COVID-19 pandemic. We rely on data from a baseline survey implemented in February 2020 and a phone survey implemented in February–March 2021. Two indicators of women's empowerment―input in productive decisions and access to and input in decisions over credit―improved, indicating that SBCC interventions can contribute to changing gendered perceptions and behaviors. Some empowerment indicators did not change, indicating it may take more time to change deeply ingrained gender norms—including tolerance toward intimate partner violence. In treatment villages, women's dietary diversity scores were higher by half a food group out of 10. More women in treatment villages consumed nuts, milk, meat or fish, and vitamin A–rich foods daily than in control villages.

Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation.

In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. The CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.

Examining the characteristics of social and behavior change communication intervention costs in low- and middle-income countries: A hedonic method approach.

Understanding the costs of health interventions is critical for generating budgets, planning and managing programs, and conducting economic evaluations to use when allocating scarce resources. Here, we utilize techniques from the hedonic pricing literature to estimate the characteristics of the costs of social and behavior change communication (SBCC) interventions, which aim to improve health-seeking behaviors and important intermediate determinants to behavior change. SBCC encompasses a wide range of interventions including mass media (e.g., radio, television), mid media (e.g., community announcements, live dramas), digital media (e.g., short message service/phone reminders, social media), interpersonal communication (e.g., individual or group counseling), and provider-based SBCC interventions focused on improving provider attitudes and provider-client communication. While studies have reported on the costs of specific SBCC interventions in low- and middle-income countries, little has been done to examine SBCC costs across multiple studies and interventions. We use compiled data across multiple SBCC intervention types, health areas, and low- and middle-income countries to explore the characteristics of the costs of SBCC interventions. Despite the wide variation seen in the unit cost data, we can explain between 63 and 97 percent of total variance and identify a statistically significant set of characteristics (e.g., health area) for media and interpersonal communication interventions. Intervention intensity is an important determinant for both media and interpersonal communication, with costs increasing as intervention intensity increases; other important characteristics for media interventions include intervention subtype, target population group, and country income as measured by per capita Gross National Income. Important characteristics for interpersonal communication interventions include health area, intervention subtype, target population group and geographic scope.

Social and Behavior Change Communication (SBCC) Approach in Tuberculosis Management by Terjang Foundation

The treatment of TB faces many obstacles, both from the patient’s perspective and their environment. Therefore, the presence of TB survivors in the treatment process is expected to assist TB survivors during the recovery and post-recovery stages. Many approaches can be made to deal with TB, including the social and behavior change communication (SBCC) approach. This study aims to analyze the use of SBCC by TB survivors from the Terjang Foundation in treating TB in Bandung. This study adopts a qualitative research method with a case study approach. Data collection techniques include in-depth interviews, field observations, and literature reviews. The study results show that SBCC has been implemented as follows: 1) Advocacy is carried out through meetings to seek support from the government and other stakeholders; 2) Social mobilization is carried out by involving stakeholders, including the Health Office, community elements, and TB survivors. Social mobilization is conducted through TB Day activities, seminars, and patient visits; 3) Education is carried out by explaining TB treatment to survivors and accompanying TB patients during drug administration in hospitals.

COVID-19 Prevention Behaviours and Vaccine Acceptability, and Their Association with a Behaviour Change Campaign in Somalia: Analysis of a Longitudinal Cohort.

Somalia experienced its first wave of COVID-19 infections in March 2020 and has experienced fluctuating infection levels since. Longitudinal data on suspected cases of COVID-19, attitudes, and behaviours were collected by telephone interviews of cash-transfer programme beneficiaries from June 2020-April 2021. A multi-media Social and Behaviour Change Communication (SBCC) campaign was designed and implemented from February 2021 to May 2021. Between the end of the first wave and the onset of the second the perceived threat from COVID-19 increased, with the proportion of respondents viewing it as a major threat increasing from 46% to 70% (p = 0.021). Use of face coverings increased by 24% (p < 0.001) and hand shaking and hugging for social greeting decreased, with 17% and 23% more people abstaining from these practices (p = 0.001). A combined preventative behaviour score (PB-Score) increased by 1.3 points (p < 0.0001) with a higher score in female respondents (p < 0.0001). During wave 2, vaccine acceptance was reported by 69.9% (95% CI 64.9, 74.5), overall. Acceptance decreased with increasing age (p = 0.009) and was higher in males (75.5%) than females (67.0%) (p = 0.015). Awareness of the SBCC campaign was widespread with each of the 3 key campaign slogans having been heard by at least 67% of respondents. Awareness of 2 specific campaign slogans was independently associated with an increased use of face coverings (aOR 2.31; p < 0.0001) and vaccine acceptance (aOR 2.36; p < 0.0001). Respondents reported receiving information on the pandemic from a wide range of sources with mobile phones and radio the most common. Trust in different sources ranged widely.

Engaging fathers to support child nutrition increases frequency of children's animal source food consumption in Rwanda.

Although social support from fathers is associated with improved child feeding practices, evidence on feasible, acceptable, and effective ways to involve fathers in supporting child nutrition, including animal source food (ASF) consumption, is limited. This study was a follow-on to a trial that tested the effects of social and behavior change communication (SBCC) targeted mainly at mothers to promote ASF consumption by children in households that received an exotic or crossbred cow through the government of Rwanda's Girinka "One Cow Per Poor Family" program (NCT0345567). A delayed SBCC intervention was provided to mothers in the non-intervention arms prior to the present pre/post study, which targeted fathers in households across the trial study arms. Baseline and endline surveys with a cohort of 149 fathers with a child <5 years were used to evaluate the effects of a SBCC intervention for fathers on their children's ASF consumption and on fathers' knowledge, awareness, and support for children's ASF consumption. Qualitative data collected from fathers, mothers, and program implementers were used to assess feasibility and acceptability of the intervention for fathers. The SBCC intervention comprised group meetings led by model fathers, text messages, print materials, and megaphone blasts. The odds of children consuming any type of ASF ≥2 times in the last week increased from baseline to endline (OR 4.9, 95% CI 1.9, 12.3), as did the odds consuming milk, eggs, and beef, but not fish. Fathers' mean ASF knowledge and awareness scores increased from baseline to endline (knowledge: 2.3 to 3.5 out of 4 items, P<0.001; awareness: 2.5 to 3.0 out of 3 items, P<0.001), with the largest changes observed in knowledge of timing of introduction of milk and other ASFs. The percentage of fathers who offered two or more supportive actions for their children's milk and other ASF consumption increased from baseline to endline (milk: 19.5% to 31.5%, P = 0.017; other ASFs: 18.8% to 37.6%, P<0.001). Fathers appreciated gaining knowledge on child nutrition in a setting specifically for men and liked the print materials that offered clear actions they could take to support their children's ASF consumption. This study shows that an SBCC intervention for fathers can improve children's ASF consumption and increase fathers' knowledge, awareness, and support for children's nutrition.

Ethics principles for social and behavior change communication

The field of social and behavior change communication (SBCC) has a history reaching back to the period of decolonization following World War II. Since that period, much has been learned about theories and methods pertinent to this communication subfield. One topic that has received too little attention is the ethical dimension of SBCC. This paper considers the need for an SBCC code of ethics and justification for such a code. Amartya Sen's capabilities approach and Habermas's discourse ethics are reviewed as substantial contributions to such a justification. Habermas's U and D principles are selected as especially useful when the criteria for communicative action are considered, including criteria related to validity claims and general symmetry conditions. The paper argues that discourse ethics is the most suitable general ethical approach for SBCC, offering both a theoretical foundation for SBCC ethics and guidelines for practice in the field.

Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs).

Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs).

Menstrual management among adolescent girls in Uttar Pradesh, India: An examination of interpersonal and mediated communication as delivery mechanisms for practical guidance.

Adolescent girls' right to achieve menstrual health and hygiene management (MHHM) healthfully is yet to be realized. One reason is the lack of practical guidance on the procurement, use, and disposal of menstrual products. This study defined interpersonal practical guidance (IPG) as face-to-face communication and mediated practical guidance (MPG) as social and behavior change communication (SBCC) intervention-driven communications through print and media materials. We examine the impact of these two delivery mechanisms of practical guidance on adolescent MHHM knowledge, attitudes, and practices (KAP) following an SBCC intervention in India. To understand how IPG and SBCC-driven MPG independently influence adolescent girls' KAP on the procurement, use, and disposal of menstrual products and whether those who receive both IPG and MPG have better KAP related to the procurement, use, and disposal of menstrual cloth or sanitary pads than those who receive only one form of practical guidance or none at all. Adolescent girls' questionnaire responses from GARIMA's case-comparison evaluation were analyzed using Stata/SE 17 (n = 2,384). Girls were matched on sociodemographic and socioeconomic variables. χ 2 analysis examined relationships between sociodemographic, practical guidance, and KAP variables. Multivariate logistic regression assessed associations between practical guidance and KAP variables. There are significant associations between adolescent girls' KAP depending on whether they received IPG, SBCC-driven MPG, or both. IPG and MPG delivered together has greater odds of predicting correct menstrual management KAP than when delivered separately. These effects were most notable for adolescent girls' knowledge and practices related to using and disposing of menstrual hygiene products. There is urgent need to create positive, sustainable changes to address menstrual health and hygiene management. This study introduces an innovative approach that utilizes interpersonal and mediated communication as mechanisms to deliver practical guidance on menstrual management. Future interventions should implement and evaluate to better understand the role of practical guidance in ensuring all women and girls are prepared to confidently manage their menstrual health.

“On the Wings of Wishes” (Icchedana), Adolescent Girls in Bangladesh Taking Flight Using A Social Behavioral Change Communication Program to Address Child Marriage Related Social Norms: A Longitudinal Panel Study

This paper examines the relationship between exposure to a transmedia entertainment-education (EE) social and behavior change communication (SBCC) initiative with shifting child marriage-related social norms. Districts were selected purposively, whereas households were selected randomly. A total of 1102 households (n = 3905) with fathers, mothers, adolescent boys, and girls completed the baseline and endline survey. Logistic regression using panel data was conducted. There was a decline in the perceived prevalence of child marriage and dowry exchange within respondents’ communities at endline. For injunctive norms, fathers reported significantly higher levels of disapproval for child marriage at endline. However, the reverse was true for mothers and adolescent girls. Almost all respondents had a significantly lower odds of identifying rewards/benefits and punishments/consequences associated with rejecting child marriage at endline. Most respondents with exposure to Icchedana were more likely to report the importance of injunctive norms or expectations of others on their behaviors, than those who were not exposed. Exposure to EE contributes to improved articulation of and shifts in social norms and engenders normative changes at the population level.

Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children’s Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria

ABSTRACTBackgroundFathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers.ObjectivesThe aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers’ and mothers’ complementary feeding knowledge, and fathers’ support for complementary feeding (secondary outcomes).MethodsThe 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6–23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495).ResultsChildren's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers’ and mothers’ knowledge of the timing of introduction of different foods and meal frequency improved. Fathers’ support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers’ and mothers’ reported intervention exposure was low (11–26% across types of SBCC). Child feeding outcomes were not associated with fathers’ exposure. Children's odds of both fish and egg consumption increased significantly with mothers’ exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers’ exposure to home visits.ConclusionsA multipronged SBCC intervention improved complementary feeding practices, fathers’ and mothers’ knowledge of complementary feeding, and fathers’ support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.