Social Behavior Change Communication Research Articles

Social Behaviour Change Communication – Its Impact on Malaria Program - North Bank Regions as a Case Study in The Gambia

Social Behaviour Change Communication – Its Impact on Malaria Program - North Bank Regions as a Case Study in The Gambia

Evaluation of the Improved Feeding Practices for the First 1000 Days Project in Ghana

BackgroundSub-optimal nutrition during the first 1000 days of life can impair the physical andcognitive development of children, as well as limit their health and wellbeing. Theimproved feeding practices for the first 1,000 days (IFP) project aimed to improve thedietary practices of women of reproductive age (pregnant and lactating) and children belowages two years in three selected districts (Kassena-Nankana West [KNW], Sekyere East[SE],and Kintampo South[KS]) in Ghana. This integrated project combined interventions onmicronutrient powder (MNP) distribution, social behaviour-change communication, andnutrition-sensitive agriculture to catalyse enhanced awareness and consumption ofnutrient-rich foods in selected communities.ObjectiveThis paper evaluates the IFP project based on measures associated with relevance,effectiveness, impact, and sustainability.MethodsUsing a mixed-methods design, data from in-depth interviews of project beneficiaries, andkey community-based actors involved in the project’s implementation were triangulatedwith routine project monitoring data, and documentation to answer the evaluationquestions. The evaluation questions and our analyses were guided by the DevelopmentAssistance Committee evaluation criteria. Interviews with key stakeholders wereconducted in June 2023. Key project data were compared between baseline and endlineassessments to ascertain the extent to which the project met its intended objectives andtargets.ResultsThe project demonstrated high relevance of the proposed project among the target groups;for example, nearly half the children were eating low quality, non-diverse diets (49% inKNW, 46% in KS and 35 in SE). The project enabled almost 14,000 children to be reachedwith MNP. While 96,000 eggs were produced, <10% was consumed at home. About 35,000kilograms of orange-fleshed sweet potatoes (OFSP) were produced, resulting in improvedaccess to the nutrient-rich foods produced. Nutrition messages were disseminated widelyand were reported to have contributed to improved awareness of nutrition amongcaregivers. Data-based and reported evidence both indicated there was improved childdietary diversity between baseline and endline of the project; in KNW, 90% of children metminimum dietary diversity at endline compared to 75% at baseline. In KS and SE, theendline estimates of dietary diversity were 71% and 70%, up from 65% in both districts atbaseline, respectively. Multiple strategies aiming to support project sustainability thatwere built into the project design were implemented. Additional sustainability strategiesevolved during the project’s lifetime, including crossbreeding of project chickens withhardier local breeds, continued multiplication of OFSP vines, and transfer of VillageSavings and Loans Association funds accumulated from MNP sale to Village-BasedEntrepreneurs to sustain MNP supply.ConclusionsIFP project delivered interventions successfully, leading to improved awareness andpractices related to diets of women in reproductive age and young children, in projectcommunities. These strategies can be extended to women and children living in similarsettings to improve the diet quality of women and children.

Exploring health care providers’ engagement in prevention and management of multidrug resistant Tuberculosis and its factors in Hadiya Zone health care facilities: qualitative study

BackgroundEngagement of healthcare providers is one of the World Health Organization strategies devised for prevention and provision of patient centered care for multidrug resistant tuberculosis. The need for current research question rose because of the gaps in evidence on health professional’s engagement and its factors in multidrug resistant tuberculosis service delivery as per the protocol in the prevention and management of multidrug resistant tuberculosis.PurposeThe purpose of this study was to explore the level of health care providers’ engagement in multidrug resistant tuberculosis prevention and management and influencing factors in Hadiya Zone health facilities, Southern Ethiopia.MethodsDescriptive phenomenological qualitative study design was employed between 02 May and 09 May, 2019. We conducted a key informant interview and focus group discussions using purposely selected healthcare experts working as directly observed treatment short course providers in multidrug resistant tuberculosis treatment initiation centers, program managers, and focal persons. Verbatim transcripts were translated to English and exported to open code 4.02 for line-by-line coding and categorization of meanings into same emergent themes. Thematic analysis was conducted based on predefined themes for multidrug resistant tuberculosis prevention and management and core findings under each theme were supported by domain summaries in our final interpretation of the results. To maintain the rigors, Lincoln and Guba’s parallel quality criteria of trustworthiness was used particularly, credibility, dependability, transferability, confirmability and reflexivity.ResultsTotal of 26 service providers, program managers, and focal persons were participated through four focus group discussion and five key informant interviews. The study explored factors for engagement of health care providers in the prevention and management of multidrug resistant tuberculosis in five emergent themes such as patients’ causes, perceived susceptibility, seeking support, professional incompetence and poor linkage of the health care facilities. Our findings also suggest that service providers require additional training, particularly in programmatic management of drug-resistant tuberculosis.ConclusionThe study explored five emergent themes: patient’s underlying causes, seeking support, perceived susceptibility, professionals’ incompetence and health facilities poor linkage. Community awareness creation to avoid fear of discrimination through provision of support for those with multidrug resistant tuberculosis is expected from health care providers using social behavioral change communication strategies. Furthermore, program managers need to follow the recommendations of World Health Organization for engaging healthcare professionals in the prevention and management of multidrug resistant tuberculosis and cascade trainings in clinical programmatic management of the disease for healthcare professionals.

IJCM_82A: Behavioral and Functional Changes Due to Smartphone Over-usage among Under-five Children in Rural Puducherry- A Community-Based Cross-Sectional Study

Background: Smartphone have revolutionized, and become an integral part of a child’s life. The child’s interaction with these modern devices needs to be assessed because it could have an enormous effect on their behavior, sleep habits, and psychological addiction. Objective: The objective of this study is to determine the pattern of exposure to smartphone, and the association between the exposure and behavioral, functional changes among under-five children in rural Puducherry Methodology: This community based cross-sectional study was done in the field practice area of a private medical college in Puducherry. A multistage sampling technique was used to select 340 eligible participants. A semi- structured questionnaire was used to assess the pattern of exposure, physical, social, and behavioral changes among study participants. The data were analyzed using SPSS software, and p-value of Results: Among 340 children, more than half of participants 180(52.9%) were female. Interestingly, around half of the study participants parents 181(53.2%) accepted that, their children were exposed to smartphone for entertainment purposes, and around one-tenth 35 (10.3%) of the participants viewed screen for more than the recommended screen time for age. Increased smartphone exposure was statistically associated with behavioral, and functional changes. Conclusion: Measures must be undertaken to prevent the deleterious behavioral and functional changes in under-five children due to excessive smartphone usage. Health education sessions and social behavioral change communication should be planned for the parents to protect the budding generation from the negative effects of smartphone usage.

How using light touch immersion research revealed important insights into the lack of progress in malaria elimination in Eastern Indonesia.

By 2022, the Government of Indonesia had successfully eliminated malaria in 389 out of 514 districts but continues to face a challenge in Eastern Indonesia where 95% of the total 2021 malaria cases were reported from Papua, West Papua and Nusa Tenggara Timur provinces. There is an increased recognition that malaria elimination will require a better understanding of the human behavioural factors hindering malaria prevention and treatment, informed by local context and local practice. This research used a light-touch immersion research approach. Field researchers lived in communities over several days to gather data through informal conversations, group-based discussions using visual tools, participant observation and direct experience. The study was conducted in four high malaria endemic areas in Papua, West Papua, and Sumba Islands in Nusa Tenggara Timur. The research highlights how people's perception of malaria has changed since the introduction of effective treatment which, in turn, has contributed to a casual attitude towards early testing and adherence to malaria treatment. It also confirms that people rarely accept there is a link between mosquitoes and malaria based on their experience but nevertheless take precautions against the annoyance of mosquitoes. There is widespread recognition that babies and small children, elderly and incomers are more likely to be seriously affected by malaria and separately, more troubled by mosquitoes than indigenous adult populations. This is primarily explained by acclimatization and strong immune systems among the latter. Using immersion research enabled behaviour research within a naturalistic setting, which in turn enabled experiential-led analysis of findings and revealed previously unrecognized insights into attitudes towards malaria in Eastern Indonesia. The research provides explanations of people's lack of motivation to consistently use bed nets, seek early diagnosis or complete courses of treatment. The felt concern for the wellbeing of vulnerable populations highlighted during light touch immersion provides an entry point for future social behaviour change communication interventions. Rather than trying to explain transmission to people who deny this connection, the research concludes that it may be better to focus separately on the two problems of malaria and mosquitoes (especially for vulnerable groups) thereby resonating with local people's own experience and felt concerns.

Digitalisation in the WFP fresh food voucher programme: a pilot study from rural Amhara region, Ethiopia.

Malnutrition continues to pose a major challenge to human well-being around the world. In Ethiopia, 39% of children <5 years are stunted, with peaks in northern regions of the country such as Amhara (54.8%). Very few (2%) children in the region achieve the minimum dietary diversity and only a minority (27%) belong to households that can afford a nutritious diet. To tackle the high stunting rate, diets high in fruits and vegetables are widely recommended to improve dietary diversity. Programmes leveraging fresh food vouchers can be used to support vulnerable groups with malnutrition and limited affordability. Cash-based transfer (CBT) programmes have repeatedly been shown to improve child growth and increase household food security and dietary diversity. This study is part of the World Food Programme (WFP) intervention regarding a stunting reduction rural programme of restricted CBT for improving dietary diversity in households with children under 2 years of age and pregnant and lactating women. A community- based pilot study to assess the itemised foods purchased by beneficiaries was conducted in the four most accessible woredas of the Amhara region of Ethiopia. A total of 556 beneficiaries and 12 active retailers were selected randomly from 10 rural markets in the targeted woredas. A point of sale (POS) system was used to collect the itemised food prices and amounts of food procured by the beneficiaries. Approximately 51, 35, and 15% of the beneficiaries purchased vegetables, fruits, and eggs, respectively. Prices, taste preferences of children, and shelf life determine the purchase of certain food items. The average food expenditure was 49 Ethiopian Birr (ETB; US$ 0.94), representing the 63 and 37% daily and monthly requirements, respectively, for affordability. The higher increase in prices of some food items might be due to their seasonality. Almost half of the Fresh Food Voucher (FFV) beneficiaries were purchasing and consuming vegetables. The finding indicates that the WFP fresh food voucher programme contributes 63% (49 ETB, US$ 0.94) and 37% (837 ETB, US$ 16.1) of the daily and monthly needs of affordability, respectively, for a diversified nutritious diet. The use of Unstructured Supplementary Service Data (USSD) technology in the WFP digital voucher under the Fresh Food Voucher (FFV) project was effective at collecting itemised prices of foods purchased by the beneficiaries. The point of sale (POS) system can be scaled up under the Fresh Food Voucher (FFV) programme so that the digital voucher can contain the itemised food prices. Timely data from the point of sale could be used for timely Social Behaviour Change Communication (SBCC) development to improve dietary diversity.

Psychometric Analysis of Personal Anxiety and Students' Academic Achievement in Universities in Cross River State, Nigeria

Social behavioral change communication interventions in Tanzania target populations engaging in high- risk sex behaviors and practices: anal intercourse, sex work, injecting drugs and male same sex relationships excluding women who have sex with women (WSW) or women who identify lesbians. In this paper, I describe terms used in reference to female same-sex sex or sexual relationships, important in health social behavior change communication targeting WSW in Tanzania. Data presented are part of cross-sectional descriptive and retrospective formative study among WSW conducted in Dar-es-Salaam region, Tanzania in 2021. WSW aged 18 and above, stayed in Dar-es-Salaam for six months or more; had had sexual contact with a woman in the past year. Participants were recruited via snowball method. Community leaders/members and managers of NGOs/institution supporting WSW were purposively selected to take part in this study. Researchers used four methods to generated data needed for this study: focus group discussion, in-depth interviewing, observation and collecting WSW’s life stories. Content data analysis was conducted to create categories of terms around female same-sex sex or sexual relationships reported by study participants. Four categories of terms around female same-sex sex or sexual relationships emerged: terms referring to women who identify WSW or lesbians; terminologies referring to female same-sex sex; terms referring to female same-sex-related behaviors and practices; and terminologies referring to items/materials used during female same-sex sex. I conclude WSW in Dar-es-Salaam have coined terms that express their socially- created world. I recommend social behavior change communication programmers in the health education and promotion context to use these terms in developing comprehensive and WSW-friendly research protocols for sustainable behavior change among WSW and the public towards making female same-sex sex safe for reduced HIV and STIs transmission in ..

Leveraging Emotion for Behavior Change: Lessons from Implementation of the “Emo-Demo” Behavior Change Technique in Rural Mozambique

Innovative social behavior change communication (SBCC) can help improve child nutrition, but little is known about the process of implementing innovative nutrition SBCC strategies in resource-poor settings and associated challenges. This research study examines emotional demonstrations (Emo-Demos), interactive game-like group activities that aim to spark behavior change by pulling emotional levers. It seeks to determine whether they are feasible and acceptable for implementers and targeted community members in rural Mozambique, aiming to draw lessons for the application of similar highly interactive SBCC approaches in resource-poor settings—a key equity issue. This is done through a series of structured observations of the approach being delivered in seven communities as well as interviews with facilitators and participants. Results show the Emo-Demos were generally feasible to implement as planned and largely acceptable for both facilitators and participants. However, facilitators did not always understand the theory behind them, the importance of them being interactive, and the exact steps that needed to be followed to do them correctly. Participants universally reported enjoying the sessions and understood the lessons taught, and were able to translate them into potential behavior changes. However, few reported the expected emotional reaction to the sessions, and some had difficulty understanding the symbolic use of props in the exercises. The results underline the importance of strong training of SBCC facilitators, including on underlying theory; adapting approaches to local realities; and considering the incentives for participants to attend. These steps can help ensure high-quality SBCC that functions even in resource-poor settings, increasing intervention equity.

Terms around Female Same-Sex Sexual Relationships: Resource for Social Behavior Change Communication Interventions Targeting Women Who Have Sex with Women in Tanzania

Social behavioral change communication interventions in Tanzania target populations engaging in high- risk sex behaviors and practices: anal intercourse, sex work, injecting drugs and male same sex relationships excluding women who have sex with women (WSW) or women who identify lesbians. In this paper, I describe terms used in reference to female same-sex sex or sexual relationships, important in health social behavior change communication targeting WSW in Tanzania. Data presented are part of cross-sectional descriptive and retrospective formative study among WSW conducted in Dar-es-Salaam region, Tanzania in 2021. WSW aged 18 and above, stayed in Dar-es-Salaam for six months or more; had had sexual contact with a woman in the past year participated in this study. Participants were recruited via snowball method. Community leaders/members and managers of NGOs/institution supporting WSW were purposively selected to take part in this study. Researchers used four methods to generated data needed for this study: focus group discussion, in-depth interviewing, observation and collecting WSW’s life stories. Content data analysis was conducted to create categories of terms around female same-sex sex or sexual relationships reported by study participants. Four categories of terms around female same-sex sex or sexual relationships emerged: terms referring to women who identify WSW or lesbians; terminologies referring to female same-sex sex; terms referring to female same-sex-related behaviors and practices; and terminologies referring to items/materials used during female same-sex sex. I conclude WSW in Dar-es-Salaam have coined terms that express their socially- created world. I recommend social behavior change communication programmers in the health education and promotion context to use these terms in developing comprehensive and WSW-friendly research protocols for sustainable behavior change among WSW and the public towards making female same-sex sex safe for reduced ....

P18-022-23 Association Between Nutrition Social Behaviour Change Communication and Improved Diet Quality Among Households With Children Under Five in Rural Rwanda

P18-022-23 Association Between Nutrition Social Behaviour Change Communication and Improved Diet Quality Among Households With Children Under Five in Rural Rwanda

Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana.

Despite the gains on exclusive breastfeeding (EBF), recent nationwide surveys have consistently revealed a decline in EBF rates in Ghana. The World Food Programme implemented an intervention for Enhanced Nutrition and Value Chain (ENVAC) which was based on three pillars including pregnant women, lactating women, adolescent and children under two years old being beneficiaries of the third pillar since the first 1000 days are critical for averting malnutrition. The social behavior change communication (SBCC) interventions implemented as part of this project have a potential to increase EBF among beneficiaries but this has not been measured. Therefore, this study assessed the prevalence of EBF practice among mothers with children under two years old who were beneficiaries of the ENVAC project and its associated factors in northern Ghana. This was a cross-sectional study involving 339 mother-child pairs in two districts of the northern region of Ghana. Participants were mother-child pairs who benefitted from the ENVAC project, which used SBCC strategies to promote good feeding and care practices as well as address other causes of malnutrition during antenatal care and child welfare clinic services among pregnant women, lactating mothers, and children under two years. We used WHO standard questionnaire to assess breastfeeding practices. Factors associated with EBF were modelled using multivariable logistic regression. Exclusive breastfeeding was 74.6% (95%CI = 69.5% -79.2%) in the ENVAC project areas, a 31.7% points higher than recent national levels. Adjusted analyses showed that EBF practice was associated with increasing maternal education: moderately educated women [aOR = 4.1 (95% CI = 2.17-7.66), P<0.001], and high [aOR = 9.15, (95% CI = 3.3-25.36), P<0.001], and access to pipe-borne water in households [aOR = 2.87, (95% CI = 1.11-7.43), P = 0.029]. A social behaviour change communication strategy implemented by ENVAC to lactating mothers likely improved exclusive breastfeeding practice in two districts of northern Ghana. EBF practices were higher among beneficiaries with high education and households with access to pipe-borne water. A combination of SBCC strategies and maternal and household factors are likely the best way to increase EBF rates in impoverished communities and warrants further investigation through future research.

Inclusive diets within planetary boundaries

Inclusive diets within planetary boundaries

Entomological Surveillance Planning Tool (ESPT)-generated actionable evidence on human and vector behaviours optimizes present interventions and reduces exposure to Anopheles vectors in two communities of Guna Yala, Panamá

BackgroundAlthough most of Panamá is free from malaria, localized foci of transmission persist, including in the Guna Yala region. Government-led entomological surveillance using an Entomological Surveillance Planning Tool (ESPT) sought to answer programmatically relevant questions on local entomological drivers of transmission and gaps in protection to guide local vector control decision-making.MethodsThe ESPT was used to design a sampling plan to answer priority programmatic questions about the appropriateness of Long Lasting Insecticidal Nets (LLINs) and spaces and times where humans remain exposed to Anopheles bites (gaps in protection) in the communities of Permé and Puerto Obaldía, Guna Yala. Adult Anopheles were sampled at three time points via human landing catches (HLCs) during the rainy and dry seasons (2018/2019). Human behaviour observations (HBOs) were conducted alongside HLCs to examine intervention use, indoor versus outdoor activity, and sleeping patterns. HLC and HBO data were integrated to evaluate HBO-adjusted human biting rate (HBR).ResultsA total of 7,431 adult Anopheles were collected across both sites. Of the 450 specimens molecularly confirmed to species-level, 75.5% (n = 340) were confirmed as Anopheles Nyssorhynchus albimanus, followed by Anopheles (Ny.) aquasalis. Anopheles host seeking activity was demonstrated to be primarily exophagic throughout all sampling periods and in both communities. When adjusted with HBOs, exposure to mosquito bites was predominantly indoors and overnight in Permé (Nov, Mar), compared to predominantly outdoors in Puerto Obaldía (Nov, Mar, Jul). Differences in site-specific human-vector exposure profiles were due to contrasting cultural and lifestyle practices between Permé and Puerto Obaldía (possibly partly influenced by the absence of electricity in Permé), and lower LLIN use in Permé. This evidence supported a previously planned LLIN campaign alongside a social behaviour change communication (SBCC) strategy in the Guna Yala Comarca (Jul 2019), which increased LLIN use. In turn, this led to a reduction of indoor exposure to mosquito bites, and a shift to predominant outdoor exposure to mosquito bites.ConclusionESPT-based question-driven planning and the integration of HBOs, intervention, and HLC data generated evidence towards answering the programmatic questions. This evidence enabled the characterization of site-specific human-vector exposure profiles, and the quantification of remaining gaps in protection. These data also provide important insights into remaining gaps in protection that must be addressed to further reduce human exposure to mosquito bites at these sites.

Determinants of Virological Failure in HIV Patients on Highly Active Antiretroviral Therapy (HAART): A Retrospective Cross-Sectional Study in the Upper East Region of Ghana

Background: Even though highly active antiretroviral therapy (HAART) for HIV (Human Immune Deficiency) patients has considerably improved viral load suppression, more people still struggle to reduce viral loads. The aim of the study was to determine the associated factors of virological failure in HIV patients on antiretroviral therapy (ART) in the Upper East Region of Ghana. Methods: A retrospective cross-sectional study involving 366 participants aged 15 years and above who were on HAART for six (6) months or longer with viral load results in 2020. Bivariate and multiple logistic regression analyses were conducted to identify the determinants of virological failure among HIV patients at 95% confidence interval (C.I.) with a significant level pegged at a p value less than 0.05. Results: The prevalence of viral load failure was 47.0% and adherence to antiretroviral therapy was 62.6% among patients on HAART. The significant predicators of virological failure were basic education (AOR (adjusted odds ratio) = 7.36, 95% C.I = 4.91–59.71), High school/Vocational /Technical education (AOR = 4.70, 95% C.I. = 1.90–9.69), monthly salary/income ˂ GHS 375.00 (AOR = 7.20, 95% C.I. = 1.73–29.95), duration on ART for ˂1 year (AOR = 0.27, 95% C.I. = 0.10–0.75), ART regimen (Tenofovir + Lamivudine + Efavirenz) (AOR = 3.26, 95% C.I. = 1.95–11.25), 3–5 times missed medication per month (AOR = 2.86, 95% C.I. = 1.34–6.08) and ≥6 missed medication per month (AOR = 23.87, 95% C.I. = 10.57–53.92). Conclusion: Educational status, salary/income, ART duration, ART combination regimen, and number of doses missed were statistically significantly associated with virological failure in patients on antiretroviral therapy. The majority of the respondents adhered to ART, which led to moderate viral load suppression but lower than the target for 2020. There is the need to strengthen the ongoing accelerated social behavior change communication among patients on ART to enhance adherence in order to attain the new UNAIDS target of 95% viral load suppression by 2030 in the Upper East Region of Ghana.

Evaluating Change Behaviour Training Model for Improving Nutrition Knowledge and Counseling Skill among Peer Couselors in Malang District

Capacity strengthening and interpersonal communication are important in social behavior change communication and would support accelerating the reduction of stunting in Indonesia. Participating actively in learning during the training model can increase capacity among the family support team and the community health workers as peer counselors. The study evaluated the changed behavior training model for nutrition knowledge and counseling skill among peer counselors. The nutrition training using active participation learning was conducted through participants' small discussions on complementary feeding problems and counseling practice. The total participation is 125 from family support teams and community health workers. The study used a mixed methodology with cross-sectional study and open interviews to explore perceived participant training on child feeding problem and couseling skills. A pre-post evaluation of nutrition knowledge showed a significant improvement score (p&lt;0.005). At the end of the training, participants' nutrition knowledge score increased to 17 points, and the proportion of the high category of nutrition knowledge improved from 0.4% to 13.5% (p&lt;0.005). The change behavior training model can increase counseling skills and identify barrier factors of breastfeeding and complementary feeding among peer counselors. &#x0D;

Mothers of Young Children in Nepal Prefer Poshan Nanglo (Nutrition Tray) for Nutrition Social Behaviour Change Communication

It is necessary to significantly accelerate the progress for optimal young child feeding practices in order to attain global nutrition goals and targets. Innovative and compelling communication approaches should be explored and tested to change social behaviours towards nutrition. A concept promoted in Nepal known as Poshan Nanglo (Nutrition Tray), is an interactive demonstration of locally available and nutritiously diverse foods.&#x0D; Using qualitative methodology, this study adopts the phenomenology method to understand preferences and perceptions of Poshan Nanglo among mothers of young children. A total of 305 mothers of children aged 6 to 23 months were interviewed from September 2019 to January 2020. 90%preferred Poshan Nanglo over printed materials. Three themes emerged: a simple and an easy way to learn, the use of real foods help to understand better and it is a practical approach.&#x0D; Thus mothers preferred and appreciated Poshan Nanglo to improve their understanding of good child feeding practices. These mothers also showed improvements in relating the importance of locally available nutritious foods for optimal dietary diversity. Approaching behaviour change should be informed and shaped by the beneficiaries’ interests and preferences. As a simple and sustainable approach in communicating about dietary diversity and good nutrition, Poshan Nanglo has wide relevance and potential.

Association Between Nutrition Social Behavior Change Communication and Improved Caregiver Health and Nutrition Knowledge and Practices in Rural Tanzania.

BackgroundEfforts to improve infant and young child feeding practices include the use of nutrition behavior change communication among caregivers of children under 5 years. We assessed the association between monthly participation in community-level nutrition group meetings on caregiver health and nutrition knowledge and practices (KPs).MethodsData from a community-based cross-sectional survey conducted in the Eastern and Southern Highland Zones of Tanzania were used. Indices were developed for caregivers' knowledge of nutrition, health and childcare, household (HDD) and young child dietary diversity (CDD), and vitamin A (VA) intakes. The comparison of means and proportions was assessed using Student's t-test and the Chi-square test, respectively, between the caregivers participating in nutrition group meetings and non-participants. The impact of the number of nutrition meeting attendance on caregiver KPs scores was examined using multiple regression.ResultsOf 547 caregivers surveyed, 49.7% attended nutrition group meetings and received information on nutrition social behavior change communication (SBCC). Overall, 28% of participating women had a moderate level of nutrition knowledge, 62% had a high level of VA knowledge, and 57% had a high level of health and childcare knowledge. Participation in nutrition group meetings was significantly associated with the health and childcare knowledge score (HKS), HDD and CDD scores, and household and young child VA intake; the magnitude of the associations was greater for caregivers who attended at least four meetings.ConclusionThe findings emphasize the need for programs that seek to address the issues present in the use of nutrition SBCC at the community level to improve maternal or caregiver KPs and subsequently the nutrition status of infants and young children.

The Impacts of the SBCC approach and Information About Child Anemic Status on Infant Anemia: Experimental Evidence From Ghana

ObjectivesThis study sought to evaluate/investigate: (1) the impact of Social Behavioral Change Communication (SBCC) program implemented by Ghana Health Service (GHS) in collaboration with World Food Programme (WFP), (2) the effect of information provision about child’s anemic status to the mother/caregiver on child’s anemia status, and (3) the combined effect of the two interventions. MethodsData were from our own surveys conducted in August 2020 and February-March 2021 in Ashanti Region, Ghana. The sample size for the balanced panel are 238 mother-child pairs, with baseline ages of children ranging from 6 to 18 months. Eleven health facilities/Child Welfare Clinics were selected, six for the SBCC program and five for controls. The CWCs for each category (SBCC versus non-SBCC), were further grouped into two. Mothers/caregivers of one group were given objective information on her child’s anemic status while mothers in the other group did not receive such information. Linear regression model was used to assess the effects of the interventions on children’s Hb status. ResultsAfter controlling for pre-intervention status of the outcome variables, children or mothers/caregivers who received both SBCC and information on anemia status of their children had the highest mean increase in Hb (+0.81g/dL; 95% CI: 0.33, 1.29) and lowest rate of anemia (–28.8%; 95% CI: –48.3, –9.3). Provision of only SBCC to mothers/caregivers significantly improved Hb of children (+0.49g/dL; 95% CI: –0.01, 0.97) but not anemic status (P = 0.28). Likewise, there was no significant impact of provision of information only on Hb levels (P = 0.28) and anemic status (P = 0.42). ConclusionsSBCC intervention significantly increased infants’ Hb levels while provision of information on anemia alone did not significant impact on infants’ anemia status. However, conducting both interventions significantly increased infants’ Hb level and decreased infants’ anemia status, indicating that the two interventions have synergic effect. Funding SourcesGrants-in-Aid for Scientific Research (KAKENHI) Grant Number 20K20575.

“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.

Adaptive Implementation of a Community Nutrition and Asset Transfer Program during the COVID-19 Pandemic in Rural Bangladesh

ABSTRACTBackgroundReduced health and nutrition services as a result of coronavirus disease 2019 (COVID-19) measures endanger children's well-being. The Bangladesh Rajshahi Division of Maternal and Child Nutrition (BRDMCN; 2018–2020) involving social behavior change communication (SBCC) and an economic development (ED) of asset transfer was implemented.ObjectivesThis study describes how the implementation modality of the BRDMCN was adapted, and changes in the program's short/intermediate-term outcomes during the COVID-19 pandemic compared with pre-pandemic.MethodsThe following evaluation components were assessed: 1) program fidelity, 2) program reach, 3) program acceptance, 4) perceived influence of COVID-19, and 5) short-term outcomes over the 3 y. We compared the first 2 y (“pre–COVID-19,” from April 2018 through December 2019) and the final year (“during COVID-19,” from January to December 2020) for all components except for (3) and (4). Data were collected through multiple sources: reviews of program annual progress reports, monitoring records of SBCC and ED programs, and cohort surveys (n = 1094).ResultsThe percentage dose delivery of activities decreased from 66.7–118% at pre–COVID-19 to 0–90% during COVID-19. The SBCC programs were altered to reduce the frequency of activities as well as the number of participants per session. The ED program involving large group meetings was modified to include within-member meetings, individual visits of community facilitators, or virtual discussions. Production activity using received assets continued during the pandemic, with no significant reduction compared with pre–COVID-19. The percentage of children recovering from underweight after 30 d of a Positive deviance/Hearth (PD/Hearth) session, a component of the SBCC program, remained constant at 16.5–20.3 percentage points before and during the COVID-19 pandemic.ConclusionsProgram activities were scaled back and changed due to the pandemic. The BRDMCN maintained asset management and the degree of short-term outcomes over the course of a 3-y project. Further study is required to determine whether adaptive program management would achieve the long-term expected impact at a population level.