The Drum Beat 837 - Breakthrough ACTION Influence: Insights and Innovations

• 1.The Social and Behavior Change (SBC) Flow Chart Toolkit
  The SBC Flow Chart is a process developed by Breakthrough ACTION to design effective SBC activities by actively and meaningfully engaging end-users and stakeholders from start to finish, ensuring true co-creation. The three phases - Define, Design & Test, and Apply - enable project managers to more deeply explore and understand context, formulate insights that uncover new truths, build new designs with community members, and test and iterate on locally made designs. This toolkit offers guidance on how to conduct each step. It is complemented by several other resources, such as country spotlights that showcase how Breakthrough ACTION has used the SBC Flow Chart to address health problems that range from malaria and Zika to family planning (FP) and tuberculosis (TB). [Oct 2023]
   
• 2.Implementing and Innovating Upon Best Practices for Family Planning and Reproductive Health Results: Experiences from West Africa Breakthrough ACTION
  For each of three highlighted West Africa Breakthrough ACTION (WABA) activities, this report provides details on the activity's design on a general cross-country level and then shares country-specific examples to dive deeper into the activity. For example, WABA sought to improve FP by using a human-centred design (HCD) approach based on the SBC Flow Chart in Burkina Faso. This process led to the development and implementation of a set of counseling tools under the name "YASSOMA" that are designed to improve provider motivation to communicate better with one another and with their clients. Check out the WABA webpage for links to its tools and resources. [Jun 2023]
   
• 3.The Insights 101 Playbook: A Dynamic Learning Starter Kit
  by Claudia Vondrasek, Juliana Rojas, Eve Aronson, and Alessia Andena
  This resource introduces one of the key building blocks of dynamic SBC project design: research insights. Insights form part of the SBC Flow Chart, and the playbook focuses on identifying insights, articulating them, applying them in a design process, and sharing them to enhance the work of others. One example used throughout the playbook is the Nourishing Connections activity developed by Breakthrough ACTION and USAID Advancing Nutrition and tested in Nigeria. The case study looks at how the insights were derived and put into practice, leading to SBC for nutrition solutions that unleash the potential of community health workers to help improve caregivers' nutritional behaviours. [2024]
   
• 4.Increasing Case Detection of Tuberculosis in Nigeria: Design and Test Phase Report - Breakthrough ACTION Nigeria
  This report provides an overview of the HCD process used to design and test prototypes to improve TB case finding in Nigeria. During the Design & Test stage, the insights from the Define phase are used as springboards for generating ideas, and promising concepts are selected, developed, and improved through iterative cycles of prototyping, testing, and refinement. The report details the five candidate interventions, each of which seeks to address different barriers to improving case detection of TB, that were iterated and refined through rapid prototyping and testing for two weeks with members of the public. This HCD process led to the implementation of the Check Am O! Campaign. [Apr 2024]
   
• 5.Human-Centered Design to Promote a Gender-Equitable Environment for Very Young Adolescents in Indonesia - Design and Test Report: High-Fidelity Prototyping
  This report features a process overview, results, and recommendations emerging from an HCD process undertaken by Breakthrough ACTION and its partners in Indonesia. The objective of the HCD process was to design a package of solutions to create a gender-equitable environment in which very young adolescents (VYAs) can grow and thrive. In particular, the report outlines the low-, medium-, and high-fidelity Design & Test sprints undertaken as part of the HCD process, and it provides a description of the process of co-creating, prototyping, and testing behavioural interventions for VYAs and key actors in their support system (see #6, below). [Sep 2023]
   
• 6.Gender Equity Today for Youth (GET 4 Youth) Pilot Package: Creating a Gender Equitable Environment for Very Young Adolescents (VYAs)
  The GET 4 Youth pilot package, which was the product of the process described in #5 above, consists of five interventions that are designed to create opportunities for caregivers to strengthen their relationships and communication skills with their VYA children. The interventions are: multi-stakeholder forums, exhibitions, family spaces, safe schools, and interactive videos. For each of these interventions, the package looks at what the intervention is and how this solution came about in the HCD process, the rationale for this intervention, who is involved, and how it is innovative. [Dec 2023]
   

• 7.Behavioural Drivers of Child Feeding during and after Illness in the Democratic Republic of the Congo: Results from a Qualitative Study through the Lens of Behavioural Science
  by Emily Zimmerman, Madeline Kau, and Riantsoa Kanto Najaina Tovohasimbavaka, et al.
  This research was conducted as part of a behavioural design process to develop SBC solutions to improve nutrition outcomes for infants and young children in the Democratic Republic of the Congo (DRC). Findings demonstrate how poverty and food insecurity weigh particularly heavily on caregivers in South Kivu, DRC, when they consider how they can care for their sick and recovering children. The research was followed by collaborative design activities to develop solutions (e.g., facilitated peer exchange on tactics to encourage young children to eat when appetite is limited). "By addressing...behavioral and contextual drivers of health workers' and caregivers' choices, services and programs have potential to generate meaningful impact on child health and nutrition outcomes, even in highly resource constrained settings." [Dec 2023]
   
• 8.Malaria Care-seeking and Treatment Ideation among Gold Miners in Guyana
  by Bolanle Olapeju, Camille Adams, and Sean Wilson, et al.
  This study explores the relationship between gold miners' malaria-related ideation and the adoption of malaria care-seeking and treatment behaviours. Based on the findings, the National Malaria Program and Breakthrough ACTION Guyana project are implementing a mass media campaign informed by HCD to address miners' ideation related to care-seeking and treatment and to increase demand for malaria-related services. Central to the campaign is the use of a fictional miner's experience and messages to increase risk perception, malaria knowledge, prompt care-seeking, and treatment adherence, as well as other influential persons in the mining community speaking out on the need for prompt and proper care-seeking for malaria. Per the researchers, this study has implications for efforts to eliminate malaria across the Guiana Shield, including Suriname, Brazil, and Venezuela. [Jan 2022]
   
• 9."I'd Do It for My Baby": Lessons Learned from Qualitative Research on COVID-19 Vaccination among Pregnant Women in Côte d'Ivoire
  by Danielle Naugle, Natalie Tibbels, and Abdul Dosso, et al.
  To support efforts to achieve the government's goal of 70% COVID-19 vaccination coverage, Breakthrough ACTION conducted a qualitative study in three sites in Côte d'Ivoire to explore perceptions of COVID-19 vaccination. The analysis found that pregnant women and those who influence pregnant women expressed serious concerns about vaccine safety during pregnancy, while questioning the seriousness of COVID-19. Breakthrough ACTION Côte d'Ivoire presented findings and recommendations to the national vaccination task force, health district management teams, and the head of the midwives' association and has used them in a co-creation workshop with pregnant women to design interventions to promote COVID-19 vaccination among pregnant women. Click here to access campaign resources. [Nov 2023]
   
• 10.Approaching Provider Behavior Change Monitoring and Evaluation with a Social-Ecological Lens: New Frontiers Brief
  This brief explores the application of a social-ecological lens to the monitoring and evaluation (M&E) of provider behaviour change (PBC) interventions. Featuring examples from FP and reproductive health service delivery, it builds on Breakthrough ACTION's suite of PBC tools, including the Provider Behavior Ecosystem Map and the Provider Behavior Change Toolkit. It discusses insights and findings related to M&E and PBC and offers recommendations for SBC programme planners and implementers, such as: Involve providers and other key stakeholders in the development and testing of M&E approaches, methods, and tools. [Feb 2024]
   

• 11.Evaluation of the Confiance Totale Campaign in Togo: Associations Between Campaign Exposure and Family Planning Outcomes of Interest
  by Dana Loll, Hilaire Tokplo, and Timothy R. Werwie, et al.
  Based on Kincaid et al.'s ideational model of SBC interventions, the West Africa Breakthrough ACTION project developed the Confiance Totale radio campaign, which promoted couple communication about FP and planning for FP method access, use, and uptake. Following the broadcasts, the team conducted a survey among 2,200 respondents in Togo in April 2022. Campaign exposure was associated with many outcomes of interest, such as current use of a facility-dependent FP method (odds ratio (OR) = 1.77, p < .001), having spoken with one's primary partner in the past month (OR = 1.45, p < .001), and the perception of supportive FP social norms (OR = 1.68, p < .001). "[T]he consistent association between exposure to the campaign and positive ideational and behavioral variables may demonstrate the enduring effects of the campaign - even when no longer being actively broadcast." [Oct 2023]
   
• 12.The Follow Who Know Road Campaign in Nigeria: Development, Impact, and Lessons Learned from a COVID-19 Mass Media Campaign
  This brief looks at how Nigeria's Follow Who Know Road mass media campaign was developed and implemented, from developing the creative concept to broadcasting the campaign. It also offers lessons learned that SBC practitioners can apply to their work, particularly during a public health emergency. According to the brief, a study executed between December and February 2023 showed that more than two in three unvaccinated people exposed to the campaign showed a positive change in their vaccine intentions and behaviour post-campaign. From the second wave of the study (July of 2023), four in five respondents indicated that the campaign has resulted in a positive behaviour and/or intention change towards the COVID-19 vaccine. [Nov 2023]
   
• 13.Efficacy of Cognitive Behavioral Therapy to Support Postpartum Mental Health and Family Planning in Ethiopia - Project Brief
  This project brief provides an overview of a study that was conducted to quantitatively examine the impact of participation in Breakthrough ACTION's cognitive behavioural therapy intervention in Ethiopia called Mother's Time. Cluster randomised control trial findings indicate, for example, that modern FP use increased significantly more in intervention clusters as compared to control clusters from baseline to follow-up. "The results demonstrate the importance of women's mental health as it impacts their ability to connect socially for support, engage in important discussions with their partners, and make informed decisions regarding their fertility preferences." [Jan 2024]
   
• 14.Evaluating a Youth-designed Sexual and Reproductive Health Mass and Social Media Campaign in Côte d'Ivoire: Triangulation of Three Independent Evaluations
  by Martha Silva, Dana Loll, and Rebecca Ezouatchi, et al.
  Developed and financed through Breakthrough ACTION, Merci Mon Héros (MMH) is a youth-designed multi-media campaign seeking to improve sexual and reproductive health (SRH) and FP outcomes in nine francophone countries. MMH's theory of change is based on the integrated behavioural model and the socio-ecological framework. This paper shares triangulated findings from a multi-method evaluation of the MMH campaign in Côte d'Ivoire, which found, for example, that "multiple data sources suggest that the campaign content may be encouraging people to engage in online conversation, as well as in interpersonal communication with family members and other trusted members of the community." [Sep 2023]
   
• 15.Estimating the Cost of the Design, Production, and Dissemination of Social Media Videos for Social and Behavioral Change: Evidence From Merci Mon Héros in Niger and Côte d'Ivoire
  by Michel Tchuenche, Nicole Bellows, and Erin Portillo, et al.
  This article describes a study that was conducted to capture costs associated with the design, production, and dissemination of 11 MMH videos (in French) on social media in Côte d'Ivoire and Niger. "One of the novel approaches undertaken by MMH is the collaboration with youth in the design, production, and dissemination of the MMH videos. While the counterfactual of what it would cost to design and produce MMH without the involvement with youth was not assessed in this analysis, any additional costs associated with youth-led SBC should be weighed against the economic benefits of building capacity in the next generation of SBC professionals in the region." [Nov 2021]
   
• 16.Risk Communication and Community Engagement Success Stories
  This series of success stories shares some of the SBC activities implemented under Breakthrough ACTION's Global Health Security programme, which seeks to enhance risk communication and community engagement capabilities for handling priority zoonotic diseases (PZDs) and emerging issues in 17 countries. For example, baseline and endline assessments of the "Stopping Dog Bites" campaign, led by Breakthrough ACTION in partnership with the government of Sierra Leone, demonstrated a significant increase in awareness and knowledge of rabies risks and prevention among exposed audience members, alongside tangible actions taken by community leaders to enforce proper dog care. The success of this campaign underscored the importance of tailored messaging, media diversity, community ownership, and cross-sector collaboration in achieving sustained impact in public health interventions. [May 2024]
   
• 17.Outcome Harvesting Evaluation of Social and Behavior Change Activities Focused on Zoonotic Diseases
  This report shares the results from an outcome harvesting evaluation of Breakthrough ACTION Guinea's activities to address PZDs, including COVID-19 and Ebola. It provides an overview of project activities and the multi-step outcome harvesting process used to evaluate it. The report presents and synthesises the outcomes, including the potential sustainability of the outcomes. For example, Breakthrough ACTION supported the implementation of several coordination and risk communication systems activities that led to increased International Health Regulations scores, including the development of standardised documents, support for coordination and risk communication systems meetings, and capacity building. [Nov 2023]
   

• 18.SBC Learning Central: Reflections on Impact
  * Sharpen Skills, Expand Knowledge, Drive Impact: SBC Learning Central Is Empowering Global Changemakers, by Lisa Mwaikambo - Breakthrough ACTION launched SBC Learning Central in 2023 to provide public health professionals with knowledge and skills to incorporate the spectrum of SBC methodologies into their work. As of May 2024, the platform offers more than 40 online courses and seven toolkits, half of which are available in French, and nearly 4,500 registered users from 131 countries have earned 4,860 certificates. With 85% of survey respondents reporting that they have applied the knowledge they gained from the courses in their work, the platform "demonstrates its efficacy as a transformative educational resource" by enhancing participants' understanding of behavioural and social science as applied to global health. [May 2024]
  * Learn Better. Learn Together., by Lisa Mwaikambo and Meei Child - Six months after the launch of SBC Learning Central, Breakthrough ACTION tested the effectiveness of a cohort-based learning approach. Participants reported they strongly agreed or agreed that the blended learning sessions were a useful supplement to the online course. One said, "The knowledge which I gained during the course will be used in a capacity building program with field staff and subsequently with engaging boys and men." [Jun 2024]
   
• 19.Media Epidemiology, Infodemic Management, and Social and Behavior Change (EIS) Fellowship Program: A Media Health Preparedness Training for Current and Future Outbreaks
  This report describes the Media Epidemiology, Infodemic Management, and Social and Behavior Change Fellowship Program, a collaboration between the Nigeria Centre for Disease Control and Prevention, the African Field Epidemiology Network, and Breakthrough ACTION in Nigeria. The 9-month fellowship programme is designed to equip media professionals with essential skills in basic epidemiology, infodemic management, and SBC to effectively communicate health information during disease outbreaks - ultimately enhancing Nigeria's outbreak preparedness and response capabilities. [May 2024]
   
• 20.The Community Health Worker Malaria Social and Behavior Change Toolkit
  Developed by the RBM Partnership to End Malaria Social and Behaviour Change Working Group in collaboration with Breakthrough ACTION, this toolkit provides guidance on how to incorporate SBC content into community health worker (CHW) training and materials in the context of malaria prevention programmes. "CHWs can use SBC approaches to help families and communities better understand malaria (what they know), improve attitudes toward malaria behaviours (how they feel), shift perceptions about malaria (how they understand or interpret something), and shift social norms (what they believe is acceptable). This process leads to sustainable, long-lasting change to meet the goal of ending malaria." [Apr 2024]
   

• 21.Elevating Social and Behavior Change as an Essential Component of Family Planning Programs
  by Joanna Skinner, Hope Hempstone, and Laura Raney, et al.
  According to this reflection piece, global and national strategies to increase FP use often fail to sufficiently acknowledge the role of SBC, even though "[e]valuations consistently show that the higher the level of exposure to SBC interventions, the greater the increase in contraceptive use..." The commentary explains why a more intentional focus on the science of human behaviour could help advance the achievement of global, regional, and national FP goals. [Jul 2021]
   
• 22.Strengthening Social and Behavior Change for Family Planning in Fragile and Humanitarian Crisis Settings: A Landscape Analysis and Recommendations
  This report summarises the findings and insights from a Breakthrough ACTION landscape assessment on the resources and evidence that exist for FP SBC in fragile and humanitarian settings. It also includes recommendations for strengthening FP SBC in these contexts, such as: Advocate for longer funding cycles in humanitarian settings, including funding for SBC for FP in fragile and humanitarian contexts. [Apr 2024]
   
• 23.Social and Behavior Change for Family Planning User Journey Tool
  This resource has been designed to be used as an advocacy tool to encourage decision-makers to invest in SBC within FP programming. It is intended to be used by SBC advocates to communicate the need for SBC in an easy-to-grasp visual format. Its premise: "The evidence base is large and growing: Social and behavior change can overcome barriers to family planning uptake and is cost-effective." [2023]
   

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