Enhancing Food Security & Nutrition through Social Behavior Change

1. Food Security & Nutrition NetworkSocial & Behavioral Change Task ForceMeeting #3 March 25, 2011

2. Agenda • Welcome and Introductions (10 mins) • Powerful to Change presentation (30 mins) • Presentation on Seeds for Change (20 mins) • Review of previous mtg: Updated Action Steps (find IMT) and narrow Core Competencies list to 10. (25 mins) • Propose SBC skill-building sessions for the FSNN Spring Meetings and Beyond (15 mins) • SBCTF Member Presentations suggestions (10 mins) • Other items?

3. Why not Seeds for Change • “In early stages and not yet reporting actual results” • “Happy to fully discuss our methodology, the principles, theories and approaches we apply, but we haven't shared the actual tools that we use in our projects.” • Willing to present once they have results and something that they can share.

4. Welcome / Intros • Introductions, especially of new members • This call: 90 mins. • Please sign up for FSNN Spring Meeting! May 9th … link: http://coregroup.memberlodge.org/meetingregistration?eventId=278059&EventViewMode=EventDetails

5. Powerful to Change Behaviors Evaluation of Exclusive Breastfeeding Practices in 12 CSHGP Projects By the CORE SBC Working Group Michelle KouletioAbigail BeesonWill Story Presented by Marilyn Patton

6. Overview of Evaluation Methodology 18 CSHGP projects with EBF identified Reviewed baseline, midterm, final reports Interviewed key staff Calculated “difference index” to identify high and low performing projects (= Final EBF rate – Baseline EBF rate) Calculated “Performance index” (= difference index/ (100%-baseline))

7. Summary of Results High Performing CSHGP demonstrated: 1) strong technical support in social and behavior change; 2) quality formative research informing the breastfeeding promotion strategy; 3) use of the BEHAVE Framework / DBC in developing the social and behavior change strategy; 4) implementation closely following the design; and 5) more frequent and comprehensive monitoring and evaluation, using feedback from monitoring to adjust the project strategy and implementation.

8. Discussion of Results

9. 1) strong technical support in social and behavior change; Five of the six high performing projects received technical support and training in social and behavior change and/or the BEHAVE Framework, while the remaining project received training in communication skills and counseling.

10. 2) quality formative research informing the breastfeeding promotion strategy; Five of the six high performing projects used three or more forms of research, such as focus group discussions, Barrier Analysis, Doer/Non-doer Analysis, key informant interviews, Positive Deviance Inquiry, measuring key determinants through a KPC survey, and health worker attitude survey.

11. 2) cont. Five of the six high performing projects conducted Doer/Non-doer Analysis studies or used a similar method such as Barrier Analysis compared with only two low performing projects. Four out of the six high performing projects conducted qualitative research with influential groups including men, mothers in law, and health facility staff.

12. 3) use of the BEHAVE Framework in developing the social and behavior change strategy; Three high performing projects also used the Health Belief Model, Bandura’s Theory of Reasoned Action or Stages of Changes to inform their strategies .

13. 4) implementation closely following the design; and • High performing projects targeted an average of four key determinants per project, while low performing projects targeted an average of two key determinants • All six high performing projects suggested they had addressed key determinants with appropriate activities

14. 4 cont. Five high-performing projects utilized support groups / cascade groups to promote exclusive breastfeeding, three of which used the Care Group model and the other two the support group model promoted within the Baby Friendly Hospital Initiative

15. 5) more frequent and comprehensive monitoring and evaluation, using feedback from monitoring to adjust the project strategy and implementation. • High performing projects used a combination of methods, including measuring rates of EBF and quality of implementation of and household coverage of project activities. • High performing projects monitored the strategy 2-4 times per year.

16. 4. Updated Actions Steps & Core Competencies Discussion:Proposed Action Steps • Define SBC core competencies. (Today) • Find out what FS practitioners are currently doing in social & behavioral change. Use interviews as well as online surveys, and review of (successful) MYAP final evaluations (ask FANTA2) to identify IMTs. This includes what is being promoted as well as how. (Next few mtgs.) • Build some skills now: Ours (TF) and other FS practitioners. (Today and future mtgs) • Decide how to know which SBC IMT and promoted practices/options work best. • Determine which SBC IMTs work best for different contexts, and which combinations of IMT work best. Determine current gaps in SBC programming. • Disseminate the best SBC information products, methods and tools.

17. Next step, #2 • Find out what FS practitioners are currently doing in social & behavioral change … Please (1) fill out the IMT survey using the link below and (2) ask SBC practitioners that you know to fill out the survey using this link. • http://www.surveymonkey.com/s/JQ9QFML • Decide who will contact who now (e.g., Tom will contact Will Story and DBC consultants).

18. IMT Review Process • Decided which IMT to review first (next meetings): Considered -- PDQ, PD for Ag, CGs for Ag, Homestead Food Production, IYCN Ag & nutrition, CLTS, AED’s SCALE (Beh change for Ag), PHAST, BA adaptation for agricultural technology. • Need to talk to Ag people to find out what SBC methods they think work (using different language like “ag extension, FFLGs”): Survey? Interviews?. • Suggested Review Process: • Presentation on purpose of each IMT / How it’s used (by field / HQ users) • Gather case histories / results / user comments and ratings • Look at behavior change strategy (from DBC). Look at MYAPs concurrently. • Identify key behaviors with other WGs/TFs. • Decide what needs to be done to improve the tool or make it easier to use in different contexts (including translation), and do that. • Develop a tool to look at behaviors and which activities/messages can be used for a particular determinant (and indicators related to those. Avoid “magic bullet syndrome.” • Focus on 1-2 best IMT for early training (May)? • Modify the tool as needed for further dissemination

19. Top Ten Core Competencies 57% responded Preparing for Organizational Change – Setting the Stage 1. Convincing staff of the need to change from information-only campaigns and the attitude-behavior & economic self-interest approaches to behavior change to more robust SBC change strategies. (9) (This could include helping staff to understand the key concepts or theories behind behavior change.) Defining what we are going to change 2. Given limited resources and using baseline assessments and other data [5]), prioritizing behaviors to change. (7) Conducting SBC Formative Research 3. Conducting qualitative and quantitative formative studies to understand how and why people do behaviors including identifying and prioritizing key determinants of behaviors / barriers & enablers to change [9]), and knowing how to change them. (13)

20. Top Ten Core Competencies SBC Coverage, Messaging and Implementation Activities 4. Choosing the best BCC coverage strategies and using them (e.g., Care Groups, Farmer Field Schools, Cascade Groups, other “block leaders”). (6) 5. Segmenting audiences (priority and influencing groups): Deciding who to target with SBC messages/ activities (5) and identifying the right people and channels to use to give messages credibility and coverage. [4] 6. Choosing and prioritizing messages / activities to target key determinants of priority behaviors.(6) 7. Properly sequencing behaviorsfor change (e.g., starting with changes that are more visible, easier for people, requires smaller commitments). (4) 8. Working with agencies to encourage mechanisms of accountability by service providers and to address barriers to service use/delivery (4)

21. Top Ten Core Competencies Monitoring 9. Monitoring quality of BCC activities. (5) General 10. Determine which SBC IMTs are most acceptable to targeted groups, and work best together / complement each other given a particular cultural context. (6)

22. Rating of Core Competencies Covered by other Working Groups: • 24. Monitoring changes in knowledge, attitudes, behaviors, coverage, and verification of practices. (4) Not Chosen (review): • 21. Using community mobilization / organization techniques, and determining the best techniques for the context. (Only 3 votes, but gets at the “S” in SBC; would provide more guidance on working with community leadership structures.) • 17. Producing BCC curricula / creating lesson plans for behavior change agents. (only 3 votes)

23. 5. SBC skill-building sessions for the FSNN Spring Mtg • Probably two 90-minute concurrent sessions in May. • (Note: Funding available for separate HQ training [this year] and Regional TOTs [Year 2] on multisectoral version of Designing for Behavior Change. ShortMs-DBC session planned for May 9 focusing on BA for Ag and NRM (Judiann McNulty) • Consider core competencies and survey results on IMT use to choose these. SBC Core Competencies Overview as a session? • Brainstorm possible session(s).

24. 6. SBCTF Member Presentations • Brainstorm list of presentations by you (SBCTF members) and others for next meetings. Try to focus on IMTs that are connected to each Core Competency. (Vote later via SurveyMonkey to prioritize.) • Tom: Agricultural Cascade Extension (ACE) model (promising, not proven); Barrier Analysis; Local Determinants of Malnutrition Studies; Care Groups, including social networking adaptation; Persuasion principles;

25. 7. Other agenda items