This paper appears to find that behaviour change is driven more by social expectations, trust in the CHW and sense of obligation than by 'knowledge of causality and perceived risks and benefits' leading to an informed decision.
CITATION: Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria
Zelee Hill, Pauline Scheelbeek, Yashua Hamza, Yared Amare, Joanna Schellenberg
Global Health: Science and Practice 2020 | Volume 8 | Number 3
ABSTRACT: Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.
SELECTED EXTRACT: 'Familiarity with the messages was important, but knowledge of the benefit of the behavior was not a prerequisite for adoption. For example, although many respondents could report that delayed bathing helped maintain warmth, several did not know the reason for the practice but still reported that they carried it out. In these cases, the trust theory was the driver of change: "I do what they told me to do..."'
I would be interested to hear from health educationalists and behaviour change practitioners on HIFA and CHIFA. In your view, are messaging and directives more important than knowledge and informed decisions? Do you see this in other aspects of health care?
It is also interesting to reflect on the sustainability or otherwise of directive versus informed appropaches.
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org