D ESIGNING FOR BEHAVIOR CHANGE FOR AGRICULTURE, NATUTRAL RESOURCE MANAGEMENT, HEALTH, AND NUTRITION Photos: Food for the Hungry, Helen Keller International, and Judiann McNulty THE DESIGNING FOR BEHAVIOR CHANGE CURRICULUM WAS DEVELOPED BY THE CORE GROUP SOCIAL AND BEHAVIORAL CHANGE WORKING GROUP AND LATER MODIFIED FOR MULTIPLE SECTORS BY MEMBERS OF THE FOOD SECURITY AND NUTRITION NETWORK SOCIAL & BEHAVIORAL CHANGE TASK FORCE. November 3, 2011 Version
Transcript
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Photos: Food for the Hungry, Helen Keller International, and Judiann McNulty
THE DESIGNING FOR BEHAVIOR CHANGE CURRICULUM WAS DEVELOPED BY THE CORE GROUP SOCIAL AND BEHAVIORAL CHANGE WORKING GROUP AND LATER MODIFIED FOR MULTIPLE SECTORS BY MEMBERS OF THE FOOD SECURITY AND NUTRITION NETWORK SOCIAL & BEHAVIORAL CHANGE TASK FORCE.
November 3, 2011 Version
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Acknowledgements
This updated 2011 multi-sectoral version of the curriculum was funded through the Title II TOPS project supported by USAID. The project extends its gratitude to Linda Morales (lead consultant), Tom Davis (Food for the Hungry), Bonnie Kittle (consultant), and Judiann McNulty (consultant)for their patience in reviewing multiple versions of the curriculum, for their creativity in developing new exercises, and for their resourcefulness in adapting and fine-tuning new examples for ANR projects. Special thanks go to Bonnie Kittle (consultant) for field testing the manual in Niger. In addition, the following individuals provided valuable suggestions and/or examples to complete the new version: Mary Helen Carruth (Medical Teams International), Sam Goff (Food for the Hungry), Lauren Erickson (Peace Corps/Benin), Lenette Golding (CARE International), Frederick Grant (Land O’Lakes, Inc.), Ruth Harvey (Consultant), Jennifer Nielsen (Helen Keller International), Beth Outterson (Save the Children), Nancy Tenbroek (Christian Reformed World Relief Committee), and Carolyn Wetzel (Food for the Hungry). Special thanks also goes to the CORE Social and Behavior Change (SBC) Working Group and the Technical Advisory Group (TAG) for their dedication and creativity in developing new exercises, adapting and improving existing tools, and sharing field examples for the previous 2008 version. The following individuals were instrumental in contributing their time and expertise to ensuring a quality 2008 curriculum: Linda Morales (Consultant), SBC co-chairs Will Story (Christian Reformed World Relief Committee), and Bonnie Kittle (Project Hope). In addition, input was generously provided by Ashley Aakesson (Children’s Nutrition Program of Haiti), Tom Davis (Food for the Hungry), Ann Jimerson (Academy for Educational Development), Michelle Kouletio (Concern Worldwide), Elli Leontsini (Johns Hopkins University School of Public Health), Judiann McNulty (consultant), Kati Moseley (Mercy Corps), Houkje Ross (CORE Group), Julia Rosenbaum (Academy for Educational Development), Eric Swedburg (Save the Children), Nancy TenBroek (Christian Reformed World Relief Committee), Laban Tsuma (Plan International USA), Lynette Walker (CORE Group), Monica Woldt (FANTA/AED), and Jennifer Yourkavitch (Child Survival Technical Support Plus (CSTS+) (Macro International). Special acknowledgement goes to AED for developing the BEHAVE Framework, “Exercise” Exercise, and the Doer/Non-Doer tools and numerous worksheets upon which this curriculum has been based. We have valued their close collaboration with The CORE Group to develop and test the original training curriculum. Special thanks also go to FH for developing the Barrier Analysis methodology. This training manual was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the TOPS Program, managed by Save the Children, and do not necessarily reflect the views of USAID or the United States Government. Our sincere thanks to everyone who contributed to this important tool for improving social and behavior change programming around the world.
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Introduction This field-tested, six-day training package will enable private voluntary organizations (PVOs) and partners to replicate the BEHAVE workshops conducted with CORE Group members in multiple countries and regions around the globe. The manual consolidates handouts and facilitator materials with easy-to-use training guidelines. The “Designing for Behavior Change” workshop responds to community development project managers’ and planners’ need for a practical behavioral framework that aids them in planning their projects strategically for maximum effectiveness. It is built upon the original BEHAVE Framework, developed by the Academy for Education Development (AED) and expanded upon by members of The CORE Group's SBC Working Group and the Food Security and Nutrition Network Task Force. The workshop trains participants to apply the DBC Framework to improve development programming. A Brief History: Promoting a behavioral approach for community development starting with child survival programs
This manual provides an updated curriculum to “Applying the BEHAVE Framework” published in April 2004 and the Designing for Behavior Change Curriculum, completed in 2008. The original curriculum emerged out of a long relationship between the CORE Group's Social and Behavior Change (SBC) Working Group and the CHANGE Project of the Academy for Educational Development. In 2000, the SBC Working Group set out to identify tools and to offer capacity-building opportunities that would enable PVO staff to incorporate the best of behavioral science into their project plans. Teaming up with the CHANGE Project of the Academy for Educational Development, the SBC Working Group offered several brief sessions on different aspects of behavior change during CORE Group annual meetings. One of the most useful and comprehensive tools was AED’s BEHAVE Framework. Intensive training on this framework with CORE Group members began in 2002. Over the next several years, the SBC Working Group and AED/CHANGE collaborated to conduct and adapt the workshop for field staff and headquarters
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staff to help them develop strategic behavior change strategies for Child Survival & Health projects. Regional workshops were held in South Africa, Cambodia, and Washington, DC for participants from a total of 24 countries. In 2006, the SBC Working Group started a process of reviewing experiences with the training and updated the curriculum. In 2008, an updated version was designed which added more case studies, stories and examples; clarified the difference between determinants and Bridges to Activities; incorporated the Barrier Analysis approach; added a half-day of field work using formative research; provided guidelines for selecting appropriate activities; and much more. This curriculum was further adapted following regional workshops in Mali and the US and a number of country workshops. The current 2011 version has been designed to meet the needs of Title II program managers and planners who may also wish to apply the DBC methodology to their programs. Overview of the Workshop The six-day workshop described in this facilitator’s guide gives field staff and managers the skills and tools to apply a behavioral approach to designing community development programs. The goals of the training are to:
• Build the capacity of PVO staff to plan, implement, monitor and evaluate effective behavior change strategies;
• Provide an introduction to the tools necessary for identifying Bridges to Activities that influence behavior change to ensure that behavior change activities are selected based on their potential ability to address these Bridges to Activities and to effect long-term, sustainable behavior change within the shortest time period possible;
• Increase levels of comfort with planning behavior change strategies; and • Demonstrate the use of learner centered adult education methodologies to
model how participants can replicate appropriate sections of the training for their fellow colleagues and partners.
By the end of the training, participants will have:
1) Analyzed the different components of the DBC framework and practiced completing each of these components based on real or sample data;
2) Assessed data from a Barrier Analysis or Doer/Non-Doer study to
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identify Bridges to Activities effecting behavior change in specific Priority Groups or Influencing Groups;
3) Applied the DBC framework to their own projects or to a case study to develop strategies informed by formative research results; and
4) Self-critiqued, received feedback from peers and facilitators, and improved their frameworks to improve the quality and increase the potential success of their behavior change strategies.
Getting Started
• Identifying key collaborators and a planning team. Many decisions must be made and work done leading up to the workshop, and you will find it helpful to have a team to handle many of the details. The workshop planning team should include people who are: o Familiar with the workshop material and the DBC Framework. o Familiar with the organizations that will be invited. o Knowledgeable about the training site.
• Fitting training into a broader scheme to foster a behavioral approach. This workshop makes the most sense when it is part of an organization’s broader plan to support a behavioral approach. Making sure that headquarters and field staff, managers and implementers are all familiar with the framework is a start. Following training, staff at all levels can look for ways to integrate the concepts and tools into their work.
• Selecting facilitators. Workshop facilitators should have experience in behavior change, adult education methodologies, participatory learning, and applying the DBC Framework itself. Ideally, the ratio of facilitators to participants should be at least 1:10 in order to maximize facilitator – participant interaction, especially during group work. Thus for a group of 28-30 participants, three co-facilitators are recommended.
• Selecting participants. This workshop is designed for: o Field-based program managers and behavior change officers who are
currently implementing or planning to implement community-based development programs;
o Headquarters backstops who can replicate the training in other country/project sites; and
o Local counterparts – staff from government Ministries or non-
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governmental organizations – who will be involved in designing or implementing the programs.
• Selecting a location. The workshop should be conducted in a comfortable setting, such as a conference room that is large enough for plenary sessions and for small groups to work without disturbing each other. In most of the sessions, participants will work with their small groups. Therefore, setting up permanent small groups at the beginning of the training with same group members seated at the same tables will ensure that participants are in a configuration that promotes maximum sharing, minimizes time spent reorganizing seating for small group work, and enhances learning.
• Conducting a Learning Needs and Resource Assessment. Workshop planners will benefit from learning about participants’ experience and interests prior to the workshop. Several weeks before the workshop, send a set of questions to registered participants. Members of the workshop planning team may need to follow up with participants to encourage them to submit their responses. Share participant responses with all facilitators prior to the workshop. A sample learning needs assessment for a DBC workshop is available at the end of this section.
• Preparing Materials. N e a r l y a ll the materials you need for conducting the “Designing for Behavior Change” workshop are included in this guide (with the exception of the magazine/newspaper ads that participants are asked to bring to the training and the data sets that facilitators should prepare from behaviors the participants are working on for their DBC frameworks- see sample in Reference Materials section). The Reference Materials section includes an answer key to the pre/post test, the Process of Planned Change Game (and answer key), and a key vocabulary list. You will find the following Checklists helpful as you prepare for your workshop.
• Data Collection prior to Conducting the Training. Program teams with sufficient time and human resources in the months leading up to the training may want to conduct the research (using the Barrier Analysis or another approach) to determine the most powerful determinants prior to conducting the training. The data collected prior to the training would be used by the trainees to inform a behavior change strategy. If this option is selected, either an external BC consultant or another qualified staff person will need to closely supervise the field work to ensure that the questionnaire is designed correctly, that Doers and Non-Doers are interviewed properly, and that the excel spreadsheet is used to accurately analyze the results.
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Checklist 1 - Two to three months prior to the training (or as much in advance as possible):
Form training team Draft training budget and planning timeline Send announcements to potential participants Conduct the Learning Needs & Resource Assessment Select participants Identify and reserve the workshop location Send invitations to selected participants Arrange for meals and refreshments during breaks Book lodging for out-of-town participants Arrange for travel and per diem reimbursements for out-of-town
participants Checklist 2 - Three weeks to a month before the training:
Prepare training materials (see page 10) Determine room configuration and how to accommodate small group discussions
during break-out sessions Ensure equipment is working Purchase all training related supplies (see Supply Checklist) Make arrangements for the fieldwork (transportation, permission, snacks)*
Checklist 3 - Three days to one week before the training:
Send Vocabulary List to confirmed participants and ask them to bring a magazine that shows an advertisement to the training site
If it is a regional training – ask participants to bring their IPTTs (or M&E Plans) Develop data sets based on the behaviors the trainees will use to develop the
DBC frameworks (see LNRA responses, discuss with program team- see Reference Materials section for examples)
* If possible, the site selected for the fieldwork should be within or as close as possible to the program intervention area and should not require more than 1 hour of travel time. Trainers will also need to arrange for the questionnaire to be translated into the local language (this should be done during the training). During the fieldwork, snacks and/or incentives should be provided for the workshop participants and interviewees based on the local customs in the area.
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Prepare flip charts Reference the handouts (write the numbers of the handouts which go with each
session on the flip chart for that session) Assemble participant packets (notepads, pens, name tags, etc.) Confirm participant arrival times, lodging arrangements, refreshments, travel &
per diem reimbursements Conduct a co-facilitators team building meeting: ensure that lead facilitators
are prepared for their sessions; ensure that co-facilitators know exactly how they will support the lead facilitators during each session; decide who will conduct the daily evaluations; and identify a time and place for holding facilitators’ meetings after each day’s sessions.
Supply and Equipment Checklist Supplies
1-2 pads of chart paper; 1-2 easels 2 rolls of masking tape 2 staplers with staples 1 magic marker for each participant, plus 4 for the trainer 1 notepad per participant 1 pen or pencil per participant 1 file folder or 3 ring binder per participant (for organizing the handouts if a
full curriculum isn’t provided to each participant) 1 name tag per participant Optional - 12 adhesive dots per participant Scissors 2 reams of copy paper; 1 box of file folders (100 each) 200 note cards or ‘3x5' cards (a couple of different colors, if available) Post-its (4-5 packs)
Equipment
Access to computer, printer, word processing software (necessary to print barrier analysis surveys and in case some participants prefer to rewrite their case studies on computer instead of by hand)
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List of Materials to be Printed for the Training
Day 1
Trainers Materials -
• 1 set of Stages of Change
• Optional – cell phone jammer to prevent cell phone signal from penetrating the room
For Participant Binders/Notebooks: (Please print 1 each & double-sided wherever possible)
Note: If possible, please separate each day’s handouts with a paper separator stating Day 1, Day 2, etc.
In order as they appear in the list below:
o T1 HO 11 Pre/Post Test (double-sided)
o T1 HO2 Getting to Know You (or flip chart)
o T1 HO 3 Training Goals & Objectives (or flip chart)
o T1 HO 4 Workshop Schedule (each day on flip chart)
o T3 HO 1 Blank DBC Framework
o T3 HO 2 Example: Poultry Management
o T3 HO 2 Example: Reforestation
o T3 HO2 Example: Micro-Irrigation
o T3 HO2 Example : Exclusive Breastfeeding
o T3 HO 3 Planning Guide
o T3 HO 4 Five Principles (or flip chart)
o T4 HO 1 What is a behavior? (or flip chart)
o Day 1 Feedback Form (or flip chart)
o KEY VOCABULARY (double-sided)
1 Throughout the manual T will refer to “Task” and HO refers to “Handout” (as in T1 HO1 = Task 1, Handout 1). “Task 1”
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Day 2
For Participant Binders/Notebooks: (Please print 1 each & double-sided wherever possible & in order as they appear in the list below):
o T5 HO 1 Example of Six Ways to Describe the Priority Group
o T5 HO 2 Blank worksheet: Six Ways….
o T8 HO 1 Important Determinants
o T8 HO 2 Fisherman or Oumar Determinant Story
o T8 HO 3 Linking Statements to Determinants
o Optional T8 HO 5 Global Determinants List (or flip chart)
o T9 HO 3 Writing Bridges to Activities
o T9 HO4 Matching Determinants with Bridges to Activities
o Day 2 Feedback Form (or flip chart)
Day 3
For Participant Binders/Notebooks: (Please print 1 each & double-sided wherever possible)
In order as they appear in the list below:
o T11 HO1 Five Tenets of Barrier Analysis
o T11 HO2 Seven Steps of the Barrier Analysis
o Optional Worksheet: Developing Questions about Determinants
o T11 HO3 Examples of Barrier Analysis Survey Questions
o Day 3 Feedback Form (or flip chart)
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Day 4
For Participant Binders/Notebooks: (Please print 1 each & double-sided wherever possible)
In order as they appear in the list below:
o T13 HO1 Coding guide/Tally Sheet (or flip chart)
o Optional BA / DND Data Sheets
o T14 HO1 Instructions
o Day 4 Feedback Form (or flip chart)
Day 5
For Participant Binders/Notebooks: (Please print 1 each & double-sided wherever possible)
In order as they appear in the list below:
o T16 HO1 List Of Criteria (double-sided)
o T16 HO2 Linking the Determinants with Activities
o T17 HO1 Instructions
o T18 HO1 Monitoring Indicators
o T19 HO1 Feedback (or flip chart)
Day 6
Trainers Materials – Please print 1 double-sided copy of each document per participant & place in 2 separate paper File Folders or Large Envelopes
o Pre/Post Workshop Questionnaire (double-sided) (use file from Day 1)
o Final Evaluation (double-sided)
o T 21 HO 1 Sample BC Strategy (double-sided)
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Sample WORKSHOP SCHEDULE: The workshop consists of 5.5 days with sessions that run from approximately 8:30 to 5:30 each day. Each day consists of approximately 6 – 6.5 hours of training time for a total of 27 hours of learning time.
Note: Most days start with a fun review exercise; this is meant to help facilitators establish a positive ambiance that is conducive to adult learning from the morning onward. However, since many facilitators prefer to start the afternoon with an energizer, the authors have also included a list of additional energizers and learning games in the Reference Materials section at the end of this curriculum. Time-permitting, facilitators should utilize these anytime when the participants appear drowsy or distracted. Also, in most countries, participants feel more fully involved when they are asked to lead an ice-breaker or energizer, thus facilitators should offer this opportunity to participants when appropriate.
13 Preparation and Practicum - Conducting Formative Research (includes break)
1 hr 45 min 2:45 – 4:30
E Evaluation of the Day 15 min 4:30 – 4:45
Day 4
Field Work
Conducting a Doer/Non-Doer Study (Includes 1 hr for travel time)
5-6 hr 8:00 - 1:00
LUNCH 1 hr 1:00 – 2:00 14 Compiling & Analyzing Data 1 hr 30 min 2:00 – 3:30
BREAK 15 min 3:30 – 3:45 15 Our DBC Frameworks Part 2: Identifying
the Determinants and Bridges to Activities
1 hr 15 min 3:45 - 5:00
E Evaluation of the Day 15 min 5:00 - 5:15
Day 5
16 Review Exercise: Musical Chairs 30 min 8:30 – 9:00 BREAK 15 min 10:15 – 10:30
17 Selecting Project Activities 1 hr 20 min 10:30 - 11:50 18 Monitoring the BC Strategy 45 min 11:50 – 12:35
LUNCH 1 hr 12:35 – 1:35 19 Matching Messages to Determinants and
Bridges to Activities 1 hr 1:35 – 2:35
20 Our DBC Frameworks Part III - Activities 1 hr 2:35 – 3:35
E Evaluation of the Day 15 min 3:50 - 4:05
Day 6
21 Incorporating Final Feedback to our DBCs 1 hr min 8:00 – 9:00
22 Developing the Program Strategy 1 hr 9:00 – 10:00
23 Closing Session and Wrap-Up (with Break) 1 hr 30 min 10:00 – 12:00
LUNCH
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List of Resources/Materials by Session
# p.# Task Name Materials Needed DAY 1
Registration - Pretest, Comfort Table, Dots, Vocabulary List included in the Reference Materials folder
1. Opening Session - Task 1 Handout 1 pre/post test (Answer Key included in Reference Materials folder) - Comfort Table with key & instructions and 6 adhesive dots for each person (alternative: incorporate the comfort table into the pretest as set of questions) - Task 1 Flip Chart/HO 2 - Getting to know you sheet - Flip chart - “Our Expectations” - Task 1 Flip Chart/HO 3 – Training Goals and Objectives - Task 1 Flip Chart/HO 4 – Workshop schedule - Flip chart – “Norms and Procedures” - Flip chart – “Parking Lot”
2. Introduction to Behavior Change: Our Roles & the Process of Planned Change
- Lots of wall space and tape for each group - One set of Process of Planned Change Game per group (5-6 people per group). This game includes a set of cards/sheets for steps in planned change, one set for the change agent role and one set for the community’s role. This game, along with an answer key, is available in the Reference Materials folder. - A set of the Five Stages of Change on cards (Pre- Awareness, Awareness, Preparation, Action, Maintenance) - Optional: PowerPoint slide, flip chart and/or Handout of Models of Behavior Change (Health Belief Model, Theory of Reasoned Action). These are included in the Reference Materials folder. - Vocabulary List (for those who did not receive it before the workshop). This is included in the Reference Materials folder.
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# p.# Task Name Materials Needed 3. Overview of the
Designing for Behavior Change Framework
- Flip Chart of the Designing for Behavior Change Framework (spaces with the words covered up) - Task 3 Handout 1: Blank Designing for Behavior Change (DBC) Framework - Task 3 Handout 2: Completed examples of DBC Frameworks (ANR Options: Poultry Management, Reforestation, & Micro-Irrigation, and MCHN Option: Exclusive BF) (4) - Task 3 Handout 3: Planning Guide - Steps in the DBC Process - Task 3 Handout 4: The Five Principles
4. Defining & Selecting the Behavior
- Task 4 Handout 1: What is a Behavior? (Write this on a Flip Chart as well.) - Flip chart with example behaviors as mentioned on the LNRA (some well written, some not) - Index cards with 2 - 3 interventions written on them (one per participant) - T-chart with “Easy – Hard” written at the top - Post-its and markers - Flip chart of summary points
E Evaluation - Day One Evaluation Flip Chart or Handout
DAY 2 5. Review Exercise:
Sing it! - Schedule for the day - Objectives for the day
6. The Priority and Influencing Groups
- Large DBC framework (from Task #3) - Flip chart with definitions of Priority Group and Influencing Groups - Cards indicating a behavior and Priority Group or Influencing Groups - Task 5 Flip Chart or HO 1: Six Ways to Describe your Priority groups and Influencing Groups - Task 5 Handout 2: Example of 6 ways to describe your Priority Group - Task 5 Handout 3: Describing your Priority Groups and Influencing Groups (blank) - 5 names of Priority Group (from LNRAs) and corresponding interventions
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# p.# Task Name Materials Needed 7. Our DBC
Frameworks Part 1: Describing the Behavior and Priority Group
- List of DBC groups (small groups of participants) - Flip chart with instructions for group work - Assigned Priority Groups and interventions (one per DBC group) - Blank Designing for Behavior Change Frameworks - Flip Chart size DBC frameworks for each small group with sections for Behavior and Priority Group
8. Identifying Determinants
- Sample Designing for Behavior Change Matrix, Example 1: Poultry Management (from Task #3) - Flip chart with definition of Determinants - Flip chart with example Determinants (from Task 3 Poultry Management Example) - Task 8 Handout 1: Important Determinants that Influence Behavior - Task 8 Handout 2: Stories for Explaining Determinants (Fisherman/ Oumar’s Silo) - Task 8 Handout 3: Identify the Determinant Worksheet
9 (Exercise, Exercise
- Masking tape - Flip chart - Statements pre-written on flip chart paper - Target Behavior Message on flip chart paper
E Evaluation - Day Two Evaluation Flip Chart DAY 3
10. Review of Concepts
- Ball made from flip chart paper secured with masking tape - Strips of paper with review questions written on them (facilitator should prepare the questions & attach each to the ball so that it can be easily unraveled one question at a time)
11. Bridges to Activities
-Sample Designing for Behavior Change Matrix, Example 1: Poultry Management (from Task #3) -Flip Chart with definition of Key Factor - Task 11 Handout 3: Writing Bridges to Activities
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# p.# Task Name Materials Needed 12. Formative
Research: The Barrier Analysis (Doer/Non-Doer)
-Task 12 Handout 1: Five Tenets of the Barrier Analysis
-Task 12 Handout 2: Seven Steps of the Barrier Analysis (and BA Facilitator’s Guides, if available, see “Reference Materials” section)
-Task 12 Optional Worksheet 1 - Developing Questions about Determinants
-Task 12 Handout 3: Examples of questions for each determinant category
- Blank notepaper for each small group - For alternate activity only: One set of cards with
questions about Barrier Analysis on them, and a separate set of cards with responses to those questions. 7 cards or pieces of paper, each one with one of the steps of Barrier Analysis written on it
13. Preparation and Practicum - Conducting Formative Research
- Flip chart with names of team members written on it - Specific interviewing techniques written on a piece of paper for the role play (3-4 techniques to improve upon) - Flip chart with a “Dos” and “Don’ts” T-chart - Computer, printer and paper, and stapler - Copies of questionnaires (sufficient copies for each team) - Blank notepaper for each small group - Logistics (cars to transport participants to practicum site; refreshments for participants according to project norms)
E Evaluation - Day Three Evaluation Flip Chart/Handout DAY 4
14. Compiling & Analyzing Data
- Previously prepared Flip Charts (one for each study question) with columns for coding and tallying (see Task 14 for an example) - Completed questionnaires - 2 hand calculators
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# p.# Task Name Materials Needed 15. Our DBC
Frameworks Part 2: Identifying Determinants and Bridges to Activities
- Each team’s partially completed DBC Framework - Extra blank matrices - Data from a study (real or made up); see sample data sets in Reference Materials section - Task 15 Handout 1 with instructions for this session
E Evaluation - Day Four Evaluation Flip Chart/Handout DAY 5
16. Review Exercise: Musical Chairs
- Stereo with good dancing CD - Folded strips of paper with review questions written on them (facilitator can ask the participants to write review questions) - Schedule & objectives for the day
17. Selecting Project Activities
- Task 17 Flip Chart: Questions for Small Group Discussion -Task 17 Handout 1: A List of Criteria for Selecting Activities -Task 17 Handout 2: Linking Determinants with Activities
18. Monitoring the BC Strategy
- Index cards with examples of data collection (see facilitator’s notes) - Task 19 Handout 1: Monitoring Indicators in the Behavior Change Strategy
19 Matching Messages to Determinants & Bridges to Activities
- 8 – 10 example pairs of determinants/topics or behaviors
20 Our DBC Frameworks Part 3: Planning Activities
- Each team’s partially completed framework with suggestions
- Extra blank DBC frameworks - Task 18 Flip Chart or Handout 1: Instructions - Flip chart paper for Task 18 – Activities
E Evaluation for the Day
Flip Chart of Sessions
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DAY 6
21. Incorporating Final Feedback
- Flip chart with ways to give constructive feedback - Flip chart-sized versions (or Photo copies) of all the DBC Frameworks – one per group - Task 20 Flip Chart or Handout 1: Feedback Groups- Questions
- Post workshop questionnaire (see Task 1 Handout 1) - Flip Chart paper and markers - Comfort chart and colored dots (use a different color from those used on the first day) -Workshop evaluation -Certificates and contact lists (if available)
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Conducting a Learning Needs and Resource Assessment (LNRA)
Workshop planners will benefit from learning about participant’s experience and interests prior to the workshop. Several weeks before the workshop, send a set of questions (see Sample LNRA below) to registered participants. Members of the workshop planning team may need to follow up with participants to encourage them to submit responses. Share participant responses with all facilitators prior to the workshop and make any modifications to the training curriculum (such as example behaviors) based on participant responses. SAMPLE LNRA
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Learning, Needs & Resources Assessment Workshop on Designing for Behavior Change Dear Participant, Thank you for your interest in attending Designing for Behavior Change Workshop. In order for us to better prepare this workshop to meet your needs and the needs of your organization, please take a few minutes to answer the following questions. Don’t worry, this is not a test; it’s just a way for us to ensure that the workshop fits your needs.
Please send your responses to ADD EMAIL ADDRESS HERE
Name: ________________ Position: ________________ Describe briefly how you intend to use the new knowledge/skills gained from the training over the next year: Your Native Language:
1) What do you expect to learn from participating in the workshop? (Please be
specific)
2) To what extent are you already familiar with the DBC or BEHAVE Framework?
Have you used it already? If so, what was your experience?
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3) What tools/methodologies are you currently using that have been particularly helpful in designing behavior change strategies?
4) What are the most important challenges you face in designing Behavior Change
programs?
5) What are the most important challenges you face in implementing Behavior
Change programs? 6) How do you plan to use the knowledge & skills you gain during the workshop in
your program/s? a. Designing behavior change programs b. Monitoring behavior change programs c. Increasing capacity of staff to do a and b (see above) d. Other (please specify: ____________________)
7) Will you principally be applying what you learn to new programs or an existing
one? a. New programs b. Existing program(s)
8) Please specify the most important behaviors your project is/will be promoting
(up to six). 1.
2.
3.
4.
5.
6.
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Day 1
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Task #1: Opening Session Achievement Based Objectives: By the end of this task, participants will have: • Been greeted by workshop facilitators • Provided baseline on their knowledge and comfort levels related to the DBC methodology • Described themselves • Met fellow workshop participants • Reviewed their expectations regarding this workshop • Reviewed the objectives and schedule for the workshop • Listed a set of norms for workshop participation Time: 2 hr Materials: - Task 1 Handout 1: Pre/Post Test (Answer Key included in Reference Materials
folder) - Comfort Table with instructions and 6 adhesive dots for each person
(alternative: incorporate the comfort table into the pretest as set of questions)
- Flip Chart - Getting to Know You - Flip Chart - “Our Expectations” - Flip Chart- Training Goals and Objectives - Flip Chart - Workshop schedule - Flip chart – “Norms and Procedures” - Flip chart – “Parking Lot”
Steps 1. Welcome and Introduction to the Workshop (5 min)
a. Explain that since the success of a project(s) depends on people changing their behaviors or adopting new practices (in the case of a service provider), we need to learn how to develop effective behavior change strategies. The basic purpose of the training is to learn to develop effective Designing for Behavior Change (DBC) strategies.
2. Collecting Baseline Information from the Participants (20 min)
a. Explain that before we begin the training, we would like to collect some baseline data so we can assess the effectiveness of the training when it is finished. The baseline will include a pre-test and a “Comfort Table.”
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b. Pass out a pre-test and six adhesive dots to each participant. Ask each person to complete the pre-test and then go to the Comfort Table and place a dot in each space that mostly closely reflects their current level of comfort/familiarity with the topic indicated on the table.
3. Introduction of Participants (about 3 min. per participant)
a. Write the questions for “Getting to Know You” on the flip chart b. Ask each participant to write down the responses to the questions on a
sheet of paper . c. Ask participants to introduce themselves to someone they don’t know d. Then ask each participant to introduce the person they met
Note: This is an opportunity to collect additional information about the participants that you may need for the training . Just add it to the Getting to Know You questions. 4. Expectations (10 min)
a. Show the Flip Chart entitled “Our Expectations” (Note: trainers should review the expectations from the LNRAs prior to the start of the workshop. Also, this may be a good time to discuss the difference between IEC, BCC and BC -see the Vocabulary List-especially if a trainee has mentioned "development of IEC or BCC materials as a workshop expectation).
b. Ask a volunteer to read the Flip Chart. c. Ask participants if they want to add any other expectations to the list.
5. Workshop Objectives (5 min)
a. Review “Training Goals & Objectives” written on flip chart b. Point out any of the expectations that will probably NOT be met during this
workshop. 6. Workshop Schedule (5 min)
a. “Workshop Schedule” on flip chart - review it with the participants. Discuss logistics issues (per diem, field work, meals, etc.).
7. Norms and Procedures (10 min)
a. Brainstorm with the group the norms and procedures the group wants to follow to create the best learning environment.
b. Record these on a flip chart.
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8. Roles of the Facilitators (5 min) a. Mention that many people may want to replicate the workshop for
their colleagues. b. Ask that participants who intend to replicate this workshop raise
their hands. c. Explain that the facilitators will be modeling the Learner-Centered Adult
Education (Vella) methodology during this workshop, and from time to time they will be making comments specifically about facilitation techniques.
Note: Set up a Flip Chart entitled “Parking Lot” for lingering questions.
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Task 1 Handout 1
PRE-/POST-WORKSHOP QUESTIONNAIRE (MULTISECTORAL) DESIGNING FOR BEHAVIOR CHANGE
Please circle the ONE best answer.
1) What elements must be considered in order to design effective behavior change strategies? a. Priority Group, Bridges to Activities, evaluation methods b. Priority Group, influencing groups, Bridges to Activities, activities, indicators c. behavior, Priority Group, Influencing Groups, the most powerful
determinants, Bridges to Activities, and activities
2) What do we need to know about the Priority Group and Influencing Groups? a. demographics, what they like to do, what they want, whether they are at the
beginning or the end of the stages of change cycle b. profession, age, marital status, family size, income, aspirations, readiness to
adopt the behavior c. what they do, what they know, feel and practice regarding the behavior,
their common desires, readiness to adopt the behavior, what keeps them from doing the behavior, demographics
3) Which of the following is a clear, well-defined behavior statement? a. Prevent drought by planting trees. b. Fisher folk have nets with smaller holes. c. Men and women keep chickens enclosed (penned up) at all times.
4) Why is it important to study the perspective of the Priority Group and Influencing Groups of a behavior change initiative? a. So that we will be able to motivate them toward the desired behavior. b. In order to convince them to increase their knowledge about the importance
of the new behavior. c. So that other programs/organizations will not have to spend additional
money to research their perspective.
5) What is the Barrier Analysis or Doer/Non-Doer Study used for? a. To learn what barriers are keeping the Doers and Non-Doers from doing the
behavior. b. To identify which people are able to do the behavior and which cannot. c. To show which determinants are the most influential in motivating or
preventing people from doing a certain behavior.
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6) What is the connection between determinants of behavior and the Bridges to Activities? a. One is bigger than the other. b. Bridges to Activities are less detailed and show the size of your target
audience. c. A Bridge to Activity is a specific description of the direction in which a
determinant will go.
7) What is the connection between determinants of behavior and the selection of an activity?
a. Selection of an activity should be based on the probability that the activity will address all of the behavioral determinants of the Priority Group.
b. The determinants of behavior may help us identify which activities will be sustainable at the community level.
c. Activities should be selected that will directly address the most powerful determinants and according to where individuals are in the stages of change.
8) What are three determinants of Behavior Change? a. Perceived consequences (positive and negative), perceived self
efficacy/skills, and perceived social norms b. Perceived action efficacy, perceived social norms, and perceived
consequences (positive and negative) c. Perceived consequences (positive and negative), perceived divine will, and
perceived social norms
9) Why is it important to identify what stage of behavior change the Priority Group is in? a. So you can plan a DBC strategy with activities that correspond to where the
majority of the Priority Group is in the process of change. b. So you know what education/awareness-raising is needed. c. To not waste time and resources.
10) What are the three most important criteria for selecting an appropriate activity? a. cost effectiveness, feasibility, sustainability b. feasibility, receptivity of the Priority Group, relevance to the determinant c. agrees with Ministry policy, sustainability, and organizational capacity
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Comfort Table
Skills Area Pre-Workshop Comfort Level
Post-Workshop ComfortLevel
1 2 3 4 5 1 2 3 4 5 Defining the priority and Influencing Groups
Writing a clear, well-defined behavior
Conducting a Doer/Non- Doer Study
Analyzing quantitative and qualitative data to determine the determinants influencing behavior change
Using specific selection criteria to choose the activities that will best address the Bridges to Activities
Note: Facilitators may want to cut and paste this comfort chart onto the pre/post-questionnaire as the first question. They can ask the participants to complete this as they enter the room at the start of the training. Once they have finished putting an X or checkmark in the column which applies to their own comfort level, they can place the adhesive dots (or simply use a felt pen) to indicate their comfort level on the flip chart-sized Comfort Table posted in the training room. Also, for more advanced groups, facilitators may wish to substitute some of the more difficult questions provided in the Reference Materials section .
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Task 1 Flip Chart or Handout 2 Task 1: Opening Session - Sample Getting to Know You Sheet NAME: COLOR or ANIMAL: Job Title and brief description: Something I love: Place I want to visit: Experiences w/ BC strategy design:
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Task 1 Flip Chart or Handout 3
Designing for Behavior Change Workshop Objectives
Achievement-Based Objectives
By the end of the training, participants will have:
1) Analyzed the different components of the Designing for Behavior Change framework and practiced completing each of these components based on real or sample data;
2) Utilized the results from formative research to identify barriers and
motivators (key determinants) effecting behavior change in a specific Priority Group and Influencing Groups;
3) Applied the DBC framework to their own projects or to a case study to
develop strategies informed by formative research results; and 4) Modified the components (the behavior statement; description of the
Priority Group; and selection of determinants, Bridges to Activities, and activities) of their DBC frameworks according to the feedback from peers and facilitators, in order to improve the quality and increase the potential success of their behavior change strategies.
13 Preparation and Practicum - Conducting Formative Research (includes break)
1 hr 45 min 2:45 – 4:30
E Evaluation of the Day 15 min 4:30 – 4:45
Day 4
Field Work
Conducting a Doer/Non-Doer Study (Includes 1 hr for travel time)
5-6 hr 8:00 - 1:00
LUNCH 1 hr 1:00 – 2:00 14 Compiling & Analyzing Data 1 hr 30 min 2:00 – 3:30
BREAK 15 min 3:30 – 3:45 15 Our DBC Frameworks Part 2: Identifying
the Determinants and Bridges to Activities
1 hr 15 min 3:45 - 5:00
E Evaluation of the Day 15 min 5:00 - 5:15
Day 5
16 Review Exercise: Musical Chairs 30 min 8:30 – 9:00 BREAK 15 min 10:15 – 10:30
17 Selecting Project Activities 1 hr 20 min 10:30 - 11:50 18 Monitoring the BC Strategy 45 min 11:50 – 12:35
LUNCH 1 hr 12:35 – 1:35 19 Matching Messages to Determinants and
Bridges to Activities 1 hr 1:35 – 2:35
20 Our DBC Frameworks Part III - Activities 1 hr 2:35 – 3:35
E Evaluation of the Day 15 min 3:50 - 4:05
Day 6
21 Incorporating Final Feedback to our DBCs 1 hr min 8:00 – 9:00
22 Developing the Program Strategy 1 hr 9:00 – 10:00
23 Closing Session and Wrap-Up (with Break) 1 hr 30 min 10:00 – 12:00
LUNCH
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Day 6
Task Session Title Duration Timeframe
21 Review Contest 30 min 8:00 – 8:30
22 Developing the Program Strategy 1 hr 8:30 – 9:30
23 Closing Session and Wrap Up 1 hr. 30 min 9:45 – 10:30
BREAK 15 min 10:30 – 10:45
23 1 hr 30 min 10:45- 12:15
LUNCH 1 hr 12:15 – 1:15
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Task #2: Introduction to Behavior Change – Our Roles and the Process of Planned Change Achievement Based Objectives: By the end of this task, participants will have: • Cooperatively ordered the steps related to the process of planned change • Identified the potential actions of the community member during this process • Recognized their role as change agents in this process
Time: 1 hour 55 min Materials: - Lots of wall space and tape for each group - One set of Process of Planned Change Game per group (5-6 people per group).
This game includes a set of cards/sheets for steps in planned change, one set for the change agent role and one set for the community members’ actions. This game, along with an answer key, is available in the Reference Materials folder. The sets of cards/sheets should be out of order when given to the participants.
- A set of the Five Stages of Change on cards (Pre-Awareness, Awareness, Preparation, Action, Maintenance)
- Optional: PowerPoint slide, flip chart and/or Handout of Models of Behavior Change (Health Belief Model, Theory of Reasoned Action). These are included in the Reference Materials folder.
- Vocabulary List (for those who did not receive it before the workshop). This is included in the Reference Materials folder.
Steps 1. Reflecting on Behavior Change (20 min)
a. Ask participants to individually remember a change they have made (or tried to make) in their own lives; then try to recall the things they did to make and secure that change. Finally, reflect on the success of the change.
b. Next, ask a few people to share their reflection asking: What was the change you made/tried to make? What did you do to facilitate the change? How easy or difficult was it? What made it easier/more difficult? How long did the change take? Were you successful in making the change? Why? Why not? (e.g. tooth brushing, cell phone adoption, hand washing with soap)
c. Point out that some change comes about easily and doesn’t need to be
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planned for; whereas other behavior changes are more difficult and need to be planned. In our jobs we are all agents of planned behavior change and – as such – we need to be cognizant of the steps in the process of planned change and our role in that process.
2. Identifying the Steps in the Process of Planned Change, Our Roles and the Community’s Role (60 min) a. Divide the participants into small groups of about 5 people each and pass out
the first set of pages in the Process of Planned Change Game (the written steps). The set of papers are now out of order. The participant’s task is to tape the steps on the wall in the order that makes sense to the group.
b. Once the group has ordered the first set of papers, pass out the second set of papers explaining that these represent the community’s action (the steps with the stick figures). They should put these papers in order underneath the steps of change they have already posted.
c. Next hand out the third set of papers explaining that these represent the role of the change agent (the steps with the woman).
d. When finished, the steps should be lined up and the corresponding roles/actions of the community and change agent underneath each step. Note: There is an answer key to the Process of Planned Change Game in the Reference Materials folder for the facilitator.
e. Once the three groups are finished, ask them to visit the other’s display and compare their results
f. The facilitator will lead a discussion of the change process asking such questions as: - What did you learn from this exercise? - Does everyone in a community or Priority Group go through the
stages of change at the same pace? - Once a person reaches a certain stage of change, do they ever
regress to a prior stage? - Does behavior change happen more effectively if it is planned or if
it is unplanned? - Do you think the changes you want your Priority Group and
Influencing Groups to make will happen during the life of the project without a structured plan?
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3. Five Stages of Behavior Change (20 min) a. Ask the participants if they have ever heard of the Five Stages of Change.
b. If so, ask them to name the stages and post the card with the name of that step. If not, then introduce the five cards with the names of the stages above the Steps in the Process of Planned Change, explaining that we need to be aware of (through formative research) the stage of behavior change that most individuals or the community is in so that we can design the most effective strategy for their needs. Make the correlation between the Five Stages of Change and the 3 sets of cards that they have just organized. Ask: Are most people aware that smoking is bad for their health? Explain that if most people in a community are already aware and knowledgeable about a problem and/or a solution, you don’t need to spend a lot of time on education and awareness-raising. Explain that baseline KPC surveys are a good tool to identify which stage of behavior change the majority of the target population is in. Once we know this, then we need to design for behavior change. To do that we will learn about a behavior change planning tool called the Designing for Behavior Change Framework.
4. (Optional step for more advanced groups) (15 min) Using the PowerPoint slides or previously prepared flip chart diagrams, take the participants through the two models explaining the key concepts of each. Mention that the Designing for Behavior Change framework is an evolution of these models.
5. Distribute the key vocabulary list (to participants who do not have their copies with them) and clarify participants’ questions.
Note: If questions will be answered during the ensuing sessions, provide a brief response and inform participants that the upcoming sessions will help to further elucidate these responses. If possible leave the Five Stages of Change taped to the wall during the workshop so we can refer back to the process later in the workshop.
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Task #3: Overview of the Designing for Behavior Change Framework Achievement Based Objectives: By the end of this task, participants will have: • Identified the different parts of the Designing for Behavior Change
Framework • Indicated the steps to follow in designing a Behavior Change strategy • Reviewed key points to consider when making the key decisions • Reviewed a completed Designing for Behavior Change Framework Time: 1 hr Materials: - Flip Chart of the Designing for Behavior Change Framework (spaces with
the words covered up) - Flip Chart with definitions of DBC terms (behavior, Priority Group etc) - Task 3 Handout 1: Blank Designing for Behavior Change (DBC) Framework - Task 3 Handout 2: Completed examples of DBC Frameworks (Poultry
- Task 3 Handout 3: Planning Guide - Steps in the DBC Process - Task 3 Handout 4: The Five Principles
Steps 1. Introduction - Elements of a Behavior Change Strategy Brainstorming: Ask the participants: Based on your current programs, what are some of the key elements you should consider when you are designing the behavior change strategy of the project? As participants mention anything related to the five decisions (behavior, Priority Group, determinants, Bridges to Activities and activities), write these down on the flip chart; or have signs prepared ahead of time on colored construction paper with the names of different components of the framework, leave some blank to write on as participants mention additional elements that are relevant; post on wall as they are mentioned. Post all valid responses (regardless of whether they are included in the DBC Framework), congratulate the participants for creating an even more detailed framework, and explain that these elements will remain in the room so that participants can compare them to the framework that we are about to introduce. (Go to Step 2)
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2. The Designing for Behavior Change (DBC) Framework a. Introduce the framework, by saying that a tool has been developed to help
us think about the different things that need to be considered when designing/reviewing a behavior change strategy; This tool is the Designing for Behavior Change Framework.
b. Show the framework on a large flip chart: Point out the different parts of the chart as you reveal each section, making reference to any corresponding responses provided by the participants in Step 1. Ask participants to follow along on their Blank DBC Framework (Task 3 Handout 1).
c. Give a brief explanation for each of the five decisions, briefly explaining a bit about each element and how they relate to each other. − Behavior: In the DBC framework, the behavior should mention who
needs to do the behavior and be written so that is shows the details including the quantity, frequency, duration, etc. It has to be very specific, measurable, and observable (e.g. Women keep chickens enclosed (penned up) at all times; Mothers plant home vegetable gardens; Farmers plant trees on the mountainsides; Children defecate in the latrine every day, etc.). A behavior is also often referred to as a "practice" and when behaviors or practices are done often enough they become a "habit" (such as "hand washing with soap" or “planting trees with the same number of seeds in each hole”, etc
− Priority and Influencing Group Description: Priority group refers to the group of people that we are encouraging to adopt the behavior. While usually the Priority Group is found in our target communities (mothers, farmers), the DBC framework can also be used to promote behaviors among service providers – either employees or volunteers (extension agents, health promoters). We define the Priority Group in six different ways which helps us know how to plan appropriate and effective program activities for them. The Influencing Group is THE group that has the most influence on the Priority Group with regard to the specific behavior. Typical there are only 1 -2 influencing groups. If their influence is very strong, we should also describe them in 6 ways. Note: in order to learn who our Influencing Groups are, we must conduct research on our Priority Group (which we will discuss later).
− Determinants: Determinants represent a person’s feelings, beliefs, or other elements within his/her environment that can support her or him to
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do a behavior, or prevent her or him from doing a behavior; we can only learn which of these are the most influential by conducting research (interviewing members of the Priority Group) (e.g. lack of access to materials to build a fence or cage for poultry).
− Bridges to Activities (which used to be called Key Factors): A Bridge to Activity is a specific description of the direction in which a determinant will go. It is both a link between the determinant and an activity, and a planned change in a determinant. (They may sound like an indicator, but they are not written with percentages and should not be confused with project indicators.) There is always at least one Bridge to Activity written for each determinant found to be important to the chosen behavior (e.g., “increasing access to low-cost fencing materials”).
− Activities: Activities are tasks that program implementers plan, organize, and/or conduct usually with the Priority Group or Influencing Groups in order to achieve something. For example, “provide a small loan to one entrepreneur per village to produce and sell quality, affordable chicken feed, and water containers made of local materials” or “work with local vendors to increase access points for purchasing wire mesh.”)
d. Distribute Task 3 Handout 2 - the completed DBC frameworks - and ask participants to refer to a specific framework, as you walk them through the example addressing any questions. (Note: facilitators can select the example they would like to review ahead of time).
e. Distribute Task 3 Handout 3 - “Planning Guide” - and review. Address participants’ questions about each step.
4. Summarize by discussing the Task 3 Handout 4 - “Five Principles.” Respond to questions.
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Task 3 Handout 1 Blank Designing for Behavior Change Framework*
Behavior1 Priority Group or Influencing Groups
Description2 Determinants 3
Bridges to Activities4 Activities5
To promote this behavior:
among this audience: (circle one) Priority Group:
Influencing Groups:
we will research these determinants: *These can only be determined after conducting research studies
and achieve these bridges to activities (priority benefits and priority barriers): 1.
2.
3.
by implementing these activities:
1.
2.
3.
1 What is the specific, feasible and effective behavior to promote? 2 Who are the Priority Groups and Influencing Groups? (Describe in six ways) 3 What are the most powerful determinants affecting this behavior with this group? (Perceived Self-efficacy/skills, Perceived Social Norms, Perceived Positive and Negative Consequences, Access, Perceived Barriers and Enablers, Cues for Action/Reminders, Perceived Susceptibility, Perceived Severity, Perceived Divine Will, Policy, & Culture) 4 What Bridges to Activities need to be achieved? 5 What activities will be implemented to address the Bridge to Activities?
* Adapted from AED’s BEHAVE Framework
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Task 3 Handout 2a
Example 1 (for ANR): Designing for Behavior Change Framework – Poultry Management
Decisions Responses Indicators Behavior
Adult men/women keep chickens enclosed (penned up) at all times. % of households with chickens enclosed (observation) Decrease in poultry losses due to wild animals or accidents. Reported increase in egg production.
Audiences Adult men and women from families participating in the food security project These families all have children under age two or a pregnant or lactating woman at project start-up. They live in rural villages and own small numbers of chickens, which currently wander freely and sleep in trees. Both men and women have attended some school. They all want food security, well-being and education for their children.
Number of families reached with poultry management training.
Determinants identified through interviews of target group.
a. Perceived negative consequences – belief that chickens will stop laying, more effort and expense to give them food and water b. Perceived positive consequences – won’t lose chickens to wild animals, less loss due to illness, chickens won’t damage crops and gardens, easy to capture them for vaccinating, can use manure for fertilizer c. Lack of access – materials to build fence or cage, cost of chicken feed
a. Improve knowledge and skills for giving chickens adequate feedstuffs and water. b. Increase understanding of the economic benefits of enclosing chickens vs. cost c. Increase access to low-cost fencing materials and skills for adapting local materials.
Activities a. Create one demonstration site per village where families can observe survival of penned chickens and ability of chickens to adapt to the enclosed environment with cost-benefits displayed. a. Meanwhile, start promoting provision of improved feed, clean water and vaccine to all poultry. a. and b. Train agriculture volunteer promoters in poultry care (feed, water, vaccine) and construction of pens and cages using locally available materials. Monitor and reinforce their ability to transmit skills to others. b. Reinforce the benefits of enclosing poultry by distributing a calendar with one benefit shown per month. c. Provide technical assistance and small loan to one entrepreneur per village to produce and sell quality, affordable chicken feed and water and feed containers made of local materials or recycled materials c. As demand increases, project agronomists will work with local vendors to sell wire mesh.
Number of successful demonstration sites implemented. Number of visitors to demonstration sites. Number of families adopting one or more improved poultry care practices aside from enclosing poultry. Number of volunteers trained in poultry management. Number of families visited by volunteers to provide learning. Number of entrepreneurs selling chicken feed. Continued availability of feed, wire mesh, and other materials in __% of communities.
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Task 3 Handout 2b Example 2 (for ANR): Designing for Behavior Change Framework - Reforestation
Decisions Responses Indicators Behavior Able-bodied adults (men and women farmers) plant trees on the mountainsides. % of households planting at least __ trees per year. % of schools planting
/maintaining trees each year. # of trees planted each year on communal land.
Priority Group
Priority Group: Able-bodied adults (men and women farmers) from all households in the target area − Minimal literacy among adults but all children attend school − Make their living from subsistence farming and seasonal migration to labor on plantations of export crops − Own less than 4 hectares of land with some access to communal land − Want their children to have a better life and work off the farm, want to end the seasonal migration, want
stable supply of staple foods. − They believe that it will take too long to see the fruits of their labor if they spend the time to plant trees.
They know that their farms are providing fewer harvest results each year. Some men and women have planted trees, but most feel it is a waste of time, effort, and resources.
− Most are in the Awareness stage, while some are in the Preparation stage. Influencing Groups: School teachers, children in school, municipal authorities
% of households reached with activities to promote tree planting. % of teachers and school children promoting tree planting % of municipalities providing free or low-cost seedlings on a permanent basis
Determinant Findings identified through interviews of target group.
a. Perceived positive consequences: Believe that planting trees leads to future firewood and building material, controls erosion and landslides, prevents climate change, can increase fruit production
b. Perceived negative consequence / risk: Believe they will lose investment of time/effort because saplings die
c. Perceived negative consequences: Believe tree planting diverts time from planting food crops, and the trees will hinder crop production by making shade and taking water.
Bridges to Activities
a. Increase the perceived benefit of planting trees by promoting fruit trees for reforestation and create additional, more immediate benefits through awards for tree planting
b. Increase skills in proper planting, techniques to lower water demand (e.g., mulching, drip irrigation), and commitment to water trees.
c. Decrease the individual time needed to plant trees. Reduce the threat to crop production by identifying other places to plant trees.
Activities
a. Work with municipal officials to: 1) Begin promoting fruit trees rather than Neem. 2) Provide awards to families who plant/maintain a certain number of trees until they are well-established. (Could also be done at community level by CDCs.) 3) Assure there is a long-range plan for financing and maintaining the municipal tree nurseries which provide free or low-cost seedlings, including those for fruit trees.
b. Conduct short demonstrations on tree-planting in each sector, including instruction in making appropriate technology containers for drip irrigation. Repeat the demonstrations in the schools when they plant trees.
c. Mobilize families to spend one day a year planting on communal mountainside land as a social event. Organize families to take turns watering and maintaining the plantings. (Could use Food for Work as an incentive for this.)
− Demonstration conducted in each sector and school in the target area before planting time each year. Training session held at regional teacher training institute.
− Number of communities holding a tree-planting festival each year. − Number of school holding a tree-planting day. − Number of seedlings that survive the dry season. − % of municipalities and/or communities that are providing recognition to
household that plant and maintain trees. − % of municipalities with established, sustainable tree nursery (has
adequate number and variety of well cared-for trees, proper maintenance, plan or income to sustain itself.)
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Task 3 Handout 2c Option 1- ANR
Example 3 (for ANR): Designing for Behavior Change Framework – Micro-Irrigation
Decisions Responses Indicators
Behavior Targeted small farmers participating in the project use micro-irrigation to plant & harvest in dry season. % of participating farmers with land and access to a water source who are using small-scale micro-irrigation.
Audiences
Priority Group: Farmers in the project area who have less than 2 hectares and are enrolled in the project. Minimal literacy among adults but all children attend school. They all want food security, well-being and education for their children. They plant staple crops, but have interest in planting new cash crops. They want to increase production and obtain more land to farm. Most do not have materials or “know-how” to set up micro-irrigation systems. They are concerned that it will cost them too much to set up an irrigation system, and they are worried about how they will feed their family if their crops fail. Many of them only water on occasion and hope for the rains during the rest of the season. The majority are in the Awareness stage. Influencing Groups: Other farmers, traditional leaders
% of farmers with land and access to an adequate water source who receive technical support from project staff or volunteers
Determinant Findings identified through interviews of target group.
a. Lack of access to materials (tubes, etc.) b. Lack of skills to construct simple systems and assess long-term viability of water source. c. Lack of skills to cultivate new crops that would be possible with irrigation and marketable. d. Perceived negative consequences (risk) – loss of investment (time, effort, money) if crops fail or if
there is no market
Bridges to Activities a. Increase access to materials through cooperative purchasing and small loans b. and c. Improve skills in: identifying adequate water sources, construction of systems, cultivation of
new crops. c. Reduce perception of risk through demonstration plots, and identification or creation of markets
Activities
a. Mobilize the farmers’ groups to organize purchase of materials as a group for a better price and to facilitate transportation (shared cost). Orient one leader from each group on where to buy materials
b. Train volunteers to assist in identifying appropriate sources of water or building tanks to capture water b. and c. During Year 1, establish demonstration plots with agriculture volunteers and organize visits by
the farmers’ groups to learn how to construct and maintain the systems and cultivate new crops. c. Project technical staff will identify markets before starting to promote new crops. Collaborate with
nutrition education component of project to promote consumption of new varieties by project families and also through social marketing in municipal market centers. (Provide samples to school children, mothers waiting at health centers, etc.)
Number of farmers’ groups purchasing materials for irrigation systems. Number of demonstration plots with irrigation established. Number of farmers who participate in educational sessions Number of volunteers trained in micro-irrigation systems and new crop cultivation. Number of new crops successfully introduced into local markets. (sales cover production costs and profit margin) Number of products for which other markets are developed.
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Task 3 Handout 2d Option 2- Health/Nutrition
Example 4 - Designing for Behavior Change Framework – Exclusive Breastfeeding
Behavior Priority Group/
Influencing Groups Determinants Bridges to Activities Activities
To promote this behavior:
Mothers exclusively breastfeed children from birth to six months of age
among this audience: Priority Group: Mothers of children 0-5m of age Description: − Burundian Mothers 16-
50 years in rural setting, majority illiterate. They work in their communities.
− They exclusively breastfeed to 4m, but give other foods at that time.
− They want to have a large and healthy child.
− After 3m, they think that they do not have enough milk.
− Majority are in partial Action Stage
Influencing Groups: Mother-in-laws and husbands.
we researched these determinants:
Perceived Social Norms Perceived Divine Will Perceived Positive/Negative Consequences
Perceived Action Efficacy
and will achieve these Bridges to Activities (priority benefits and barriers)
1. Increase the perception that
a child who is not EBF can become malnourished.
2. Increase the perception that God approves of EBF / their religious tradition is supportive of EBF.
3. Increase the perception that
their mother-in-law, husband, cousins, and mother approve of EBF.
4. Decrease the perception that a child will be hungry or lacking in nutrition if they are EBF.
by implementing these activities: 1. Invite mothers who have EBF and believe in EBF with
children with good health/weight to give testimonials on EBF at meetings in the community/health facilities (following PNC and GM/P sessions). In HF meetings, use growth charts to show the difference between several children growing well who are exclusively breastfeeding and contrast them to other children who are losing weight who are not EBF.
2. Give pastors/priests/imams sermon guides on EBF and train them in their use.
3. Develop radio spots that feature mother-in-laws, husbands and cousins encouraging mothers to EBF. Have Care Group Volunteers (CGVs) include the mother-in-law, husbands, and the grandmother when teaching mothers of young children about EBF. Promote with husbands that EBF can save their family money, and how much money they can save.
4. Explain to mothers (via CGVs and HF visits) that children cry for many reasons, and crying does not always mean the child is hungry. Use growth charts to show mothers that many children who cry a lot (identify cases ahead of time) are still growing well and therefore are not lacking adequate nutrition. Teach mothers step-by-step process for comforting a crying baby (Happiest Baby on the Block process).
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Task 3 Handout 3 Planning Guide – Steps in the Designing for Behavior Change Process
1) Define the ideal behavior (well-written behavior statement).
2) Identify and describe the priority audience (Demographics).
3) Select appropriate research methods (BA, DND, other).
4) Carry out the research (to identify the most important determinants).
5) Analyze the findings.
6) Add more detail to the definition of the priority audience (6 ways).
7) Identify the most powerful determinants that facilitate or impede the change (according to BA or DND results).
8) Describe the Influencing Groups.
9) Write the Bridges to Activities that link to the activities.
10) Choose activities for the project that address the Bridges to Activities (Criteria for Selecting…).
11) Establish indicators to monitor the effectiveness (Not described in this training).
12) Complete the behavior change strategy with details for implementation (time lines, budget, training plans, etc.).
13) If necessary (if communication type activities are identified as part of the strategy), develop Communication Plan.
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Task 3 Handout 4
1) Action is what counts (not beliefs or knowledge)
2) Know exactly who your group is and look at everything from their point of view
3) People take action when it benefits them; barriers keep people from acting
4) All your activities should maximize the most important benefits and minimize the most significant barriers
5) Base decisions on evidence, not conjecture, and keep checking
________ * The Five Principals handout is adapted from materials originally developed by AED.
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Task #4: Selecting and Defining the Feasible & Effective Behavior
Achievement Based Objectives: By the end of this task, participants will have: • Assessed the appropriateness of the behaviors they mentioned on their LNRAs • Written a well-defined behavior statement • Assessed the relative difficulty of various behaviors
Time: 2 hr 10 min Materials: - Flip Chart What is a Behavior? - Flip Chart on how to formulate a behavior statement - Flip Chart with composite indicator from IPTT - T-chart with “Easy – Hard” written at the top - Flip chart paper and markers - Flip chart of summary points - Example Indicator Performance Tracking Tables, Project Log-frames, Design
Framework, or other monitoring and evaluation table. Steps 1. Introduction (2 min)
Explain that we will now begin to examine each part of the DBC framework individually and in more detail. As we do so, we will be doing some exercises and we will be developing our own DBC frameworks.
2. The Behavior Statement (15 min) a. Point to the large DBC framework on the wall and explain that we are now
working on the first decision: What is the behavior we want to design a strategy for using the DBC framework? Ask: Why is it important that we define a behavior clearly and in a certain way? [Response: so that we all agree on what change we are striving for and we will know how to plan for and monitor the change].
b. Post the flip chart with the definition of a behavior and explain that in a DBC framework the behavior is usually formulated as follows: 1) audience, 2) action verb in present tense, and 3) the details (frequency, quantity, duration etc).
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c. Ask participants how we know which behaviors or practices their projects are promoting. [Responses should eventually lead to project indicators and the Indicator Performance Tracking Table (IPTT), log frame or results framework as a list of practices, depending on the type of project the participants are working on.]
3. Defining behaviors and writing behavior statements (1 hr 20 min) a. Divide participants into small groups and assign each group an equal number
of indicators from the IPTT (or multiple IPTTs if training includes staff from multiple projects) or from their Design Framework or M&E Plan. For each indicator, they must decide whether it describes a behavior, if it is a composite of behaviors, or it needs further definition. Help the whole group work through this example before starting their small group work. Example IPTT indicator: % of households with adequate post-harvest storage. Is this a behavior according to the definition on the flip chart? Why not? What is the behavior or behaviors underlying this indicator? [Options: “Build pest-proof post-harvest storage facilities or purchase a storage silo.” Ultimately, our goal is one of these options, so that is the behavior we want to promote.] Ask how this could be written as a behavior statement that meets the criteria on the flip chart and write the new behavior statement. (10 minutes)
The small groups continue the process of reviewing the assigned IPTT indicators, assessing them against the definition, and writing accurate behavior statements on flip chart paper. (40 minutes)
b. When the groups have finished, they will present their statements to the large group. As the small groups share, compare the various responses of fellow participants with the definition of a behavior; rewriting, if necessary. (30 minutes)
4. Behavior Scales (30 min) a. Ask the participants how many behaviors their current project is
promoting. Ask: Among all of these behaviors how should you decide for which one(s) to use the DBC framework to design a behavior change strategy? [Response: If you can’t do one for each behavior (which would
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be ideal, but difficult for most) options might be to use it for behaviors that are particularly hard to change, for behaviors that have not changed in the past despite promoting change, or for behaviors for which you are unsure of the enablers or barriers to change.]
b. Ask the participants to name a behavior from their project that would be easy to adopt. Then ask them to name one that would be hard to adopt (write these on the flip chart). Ask: Why is one hard and the other easier? When the participants explain, transform their response into the comparative phrases we are looking for and write those on the T-chart for this session. Introduce the idea that some behaviors have characteristics that make them more difficult to adopt and promote than others, and as change agents we need to keep this in mind when we are choosing the behaviors to promote. Ask: Why is this important? [Response: The harder the behavior, the more challenging it is to promote and the more time is needed.]
c. Working with the large group and continuing to use the T-chart, generate a list of characteristics that would make a behavior either easier or more difficult to adopt/promote. Write these characteristics on the T-chart.
d. For each characteristic, ask participants to also share one example of a behavior with that characteristic.
Prompt participants until all of the following behavior characteristics are listed (Use this list for the T-chart): • one time/on-going or frequent; • no skill/complex skills; • immediate positive result/delayed result(or immediate negative result); • no cost/high cost; • little time/a lot of time; • fits with social norms/against social norms; • resource always available/resources seldom available; • requires one person/requires many people; • single step/multiple steps; • low tech/high tech;
e. Wrap up this activity saying that analyzing the ease or difficulty of a behavior can help project implementers decide for which behaviors to use the DBC framework, if it can’t be done for them all.
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5. Conclusion: Conclude with a brief discussion about ways to involve the community in identifying the best ways to promote a behavior. Occasionally during the life of a project, community input into selecting the right behaviors to adopt may arise. Options for this may include using focus group discussions concerning things they want to change, or data from their community from a Positive Deviance Inquiry or Trials of Improved Practices (TIPS).
Summarize the main points of the session: WRITE THESE ON THE FLIP CHART
• People’s actions are what counts • The behavior must be observable, measurable, context-specific, feasible and contribute to a positive outcome (effective) • Use data when defining the behavior you will promote – don’t guess! • Seek community input into identifying the best ways to promote a behavior–
get buy-in right from the start!
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Task 4 Flip Chart
WHAT IS A BEHAVIOR*?
A Behavior is…
- An Action
- Observable
- Specific (time, place, quantity, duration, frequency)
- Measurable
- Feasible
- Directly linked to an improved outcome
*When a behavior is related to someone’s work (e.g., a health worker checking for danger signs in a child), it can also be called a
The Audience, Action Verb in Present Tense, the Specifics
* This handout is adapted from materials originally developed by AED.
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Daily Evaluation - Day 1 (Flip Chart2 or Form)
Please indicate below your overall satisfaction with each of the sessions that you attended today, and offer any ideas you have on how to improve these sessions.
A. Session 2 – Introduction to Behavior Change – Our Roles and the Process of
Planned Change
Very Dissatisfied Somewhat Neutral Somewhat Very Satisfied
1 2 3 4 5
Suggestions for improving this session: B. Session 3 – Overview of the Designing for Behavior Change Framework
Very Dissatisfied Somewhat Neutral Somewhat Very Satisfied
1 2 3 4 5
Suggestions for improving this session: C. Session 4 – Defining and Selecting the Feasible & Effective Behavior
Very Dissatisfied Somewhat Neutral Somewhat Very Satisfied
1 2 3 4 5
Suggestions for improving this session: D. Most useful thing about today: E. The thing I’m still confused about:
2 If using a flip chart – just write down the title of the sessions you covered that day and the scale (1 – 5) with the indicators and the last two questions.
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Day 2
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Task #5: Review Exercise – Sing It! Achievement Based Objectives: By the end of this task, participants will have: -Created and sung a song about things they learned the previous day -Reviewed the program and objectives for day Time: 40 min Materials: -Schedule for the day -Objectives for the day
Steps
1. In teams of 5 people, participants will compose a song that captures the ideas covered the day before and how they can be used in their work. Participants will have 10 minutes to compose it. Each team will perform their song for the group.
2. Review the schedule and objectives of the day with the participants.
3. Present a summary of the participants' comments from Day One's evaluation. If necessary, make adjustments in the schedule and address participants' questions.
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Task #6: The Priority and Influencing Groups Achievement Based Objectives: By the end of this task, participants will have: • Practiced identifying different points of view • Described a Priority Group and/or Influencing Groups in six ways • Described how Priority Group and Influencer characteristics influence the
choice of behavior strategy Time: 2 hr 20 min Materials: - Large DBC framework (from Task #3) - Flip chart with definitions of Priority Group and Influencing Groups - Cards indicating a behavior and Priority Group or Influencing Groups - Task 5 Handout 1: Six Ways to Describe your Priority Groups and Influencing Groups - Task 5 Handout 2: Example of 6 ways to describe your Priority Group - Task 5 Handout 3: Blank Worksheet - 6 Ways to Describe your Priority Groups - 5 names of Priority Groups (from LNRAs) and corresponding
interventions
Steps 1. Introduction (5 min)
Explain that we are continuing to work on the DBC framework. Refer the trainees back to the large DBC framework on the wall and ask them which part of the DBC framework we are now working on. [Response: Priority groups and Influencing Groups]
2. The Priority Groups and Influencing Groups(20 min)
a. Let’s look more closely at the second decision. Ask, “Who are the Priority Groups and Influencing Groups?” Refer to the flip chart with the definitions and review the meanings of both terms. Refer participants to the examples of completed DBC frameworks from Task #3.
b. Explain that the Priority Group is made up of the individuals responsible for doing the behavior. Sometimes there is confusion when the behavior is done to a child (breastfeeding, vaccination, sleeping under a mosquito net). In this case the mother or caretaker is the Priority Group.
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c. The Influencing Group is THE GROUP that most directly influences or controls the action of the Priority Group with regard to the behavior. There may be many people we would like to influence the Priority Group such as extension agents or health worker, but we need to prioritize which people are currently having the most direct influence on the Priority Group with regard to our key behavior: for example, other fellow farmers or mothers-in-law, etc.). The influencing group is identified by conducting research among the Priority Group.
3. Priority and Influencing Groups Characteristics and the Implications (60 min) a. Ask participants to refer back to the example of the completed DBC
framework and to read the description of the Priority Group. Ask them to categorize the types of information provided and write the list on the flip chart or just ask participants to respond out loud.
b. Distribute Task 5 Handout 1 - “Six Ways to describe your Priority and Influencing Groups ”. Explain that the more specifically you can describe your Priority Group and Influencing Groups the more effectively you will be able to design your intervention. There are six categories of description as shown on this handout. Explain each of the six categories, giving the definition. Ask one volunteer to read the example in the handout. While reviewing the example, point out how the Behavior Change strategy designer would take the information into consideration when designing a BC strategy. For example, if the Priority Group is not literate, then written materials should not be used. If they do not listen to the radio then this channel of communication will not be most effective. If the group is primarily Muslim, then no activities should be conducted on Friday afternoon. Also, indicate how the program planner would find this information (Demographics- DHS, Reliable Government Statistics; Common practices - Focus Group Discussions, or Observations; Common Desires - Focus Group Discussions, KII; Common Barriers - Focus Group Discussions, Barrier Analysis; What the group knows, feels, and practices regarding the behavior - Focus Group Discussions, Barrier Analysis; Stages of Change - KPC results).
c. Pass out Task 5 Handout 2, an example of 6 ways to describe your Priority Group. Invite participants to review the example and ask any questions.
d. Distribute Task 5 Handout 3. Assign pairs and ask them to think of a Priority Group they work with in their projects. Each pair will describe this group in
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as much detail as possible using all of the 6 categories. Remind them that they may not have all the information until they conduct some research.
e. Ask some participants to report out, responding to the questions: What are the characteristics of the audience and what are some of the implications that these characteristics have on the design of a BC strategy?
f. If the Influencer’s behavior is most important to the behavior change, then a DBC framework for should be developed for the Influencer alone and take priority.
4. Whose Point of View? (50 min) a. Explain that it’s not enough just to be able to describe your audiences in
detail. You also need to look at everything from the perspective/point of view of the Priority Group. Ask: Why is this important? What will happen if we don’t consider things from the Priority Group’s perspective? [Response: we will not be able to motivate them toward the desired behavior.] Discuss the fact that we often mistakenly assume that just because the project staff comes from the target country that they know the perspective of the Priority Group and Influencing Groups. Ask: Why isn’t this true? Take questions.
b. Explain that we will now practice “seeing things” from another’s “point of view”.
Option 1 - If you are doing a regional training and/or you don’t have Barrier Analysis or Doer/Non-Doer Data from the project]
Ask each participant to select a partner who they believe they have many things in common with (gender, age, education, nationality, language, ethnic group, race, interests, marital status etc) (2 min)
Once paired up – ask the participants to share information and make one list of all the things they have in common (3 min)
Post several pictures (fairly large, from the culture, of people, no/few words) around the room and assign a picture to each pair (several pairs can use one picture)
Working individually, ask each person to answer the following questions as they pertain to the picture: a) What is the person in the picture doing?
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b) What is the person in the picture thinking about? c) How is the person feeling? (5 min)
Then each individual should write down how they think the other person answered the same questions (5 min)
When the time is up each pair will share what they thought the other wrote/thought and compare with the original response noted in step 3. The pairs should discuss how easy or difficult it was to guess the other person’s point of view – even if they have a lot in common.
Point out that because it is so difficult to accurately know what someone feels about something, you cannot guess. Rather you have to ask them. This is one reason we recommend conducting formative research.
Option 2 (50 min) – If you are doing the training with people from the same project and you have Barrier Analysis or Doer/Non-Doer Data from the project] Preparation for the session requires making index cards to match the selected behaviors that have real data (from focus groups, BA, or D/ND) on what actual target audiences said. See example at the end.
Working in small groups, assign each group a typical actual3 ANR, NRM or MCH behavior (reforestation, poultry management, micro-irrigation, immunization, ORS use, complementary feeding, etc) which matches the data you have. Assign half the groups a priority audience (that also matches the data you have). Assign the other half of the groups the same ANR, NRM, or MCH behavior and an Influencing Group (also from your data).
Ask each pair to write on the handout all of the perspectives they think their audience might have about the assigned behavior (pros and cons).
Groups with the same ANR, NRM, or MCH behavior will share “the perspectives” of their audiences.
Now, pass out the cards with the actual perspectives of the audiences. Allow a few minutes for reading silently, then comparing what they thought with what is on the card. They write the information on the card in the third column on the handout. Have each group report back to the whole group. How far apart were their perceptions? Did they find any surprises?
3 This can be positive or negative, usually derived from our baseline or secondary data. What is the actual practice? Why does the audience do this?
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Discuss how they would take these perspectives into consideration when designing a BC strategy.
Whose Point of View: Option 2 Handout: Behavior: We think they… They say… Audience:
Example: Behavior: delayed introduction of solid food at about six months of age
We think they… They say…
Audience: mothers of children
1. don’t have enough food in the house to share with the child 2. the mothers don’t know that the child needs food at this age
1. The child is too messy when eating and will get their clothes dirty. We will have to change the clothes more often and do more laundry, which means carrying more water.
(The SBC strategy, in this case, was to teach the mothers to make simple bibs.) Close this activity by asking the participants: Is it okay for us to presume that we know the priority audience’s perspective? [no] Why? How do we get to know our audiences’ perspectives? [Response: by conducting research studies on the Priority Group and Influencing Groups.]
5. Summarize the main points covered during this session. (5 min) a. Describe your Priority Group with as much specificity as possible (use the
six ways). d. Design your behavior change strategy taking into consideration the group’s
characteristics. c. Look at everything from the Priority Group’s point of view. d. All decisions about the Priority Group should be based on research with the
group, not just on project staff assumptions. e. Maximize your resources by reaching the largest number of people through
the same message, materials or activities.
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Task 5 Flip Chart Priority Group = the group of people who will perform the positive behavior (e.g. farmers, mothers of children under 5, village youth). The Priority Group can be a community member (e.g., mother, farmer) or a provider of a service (e.g., Ag extension agent, microloan provider, community health worker). Influencing Groups = the groups of people who influence the Priority Group regarding the behavior; who can either support or prevent the Priority Group from adopting positive behaviors (e.g. other farmers, grandmothers, traditional healers, elders, community and religious leaders, ag extensionists, youth peers, older village youth). This group is usually identified by conducting research among the Priority Group.
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Task 5 Flip Chart Six Ways to Describe Your Priority Group
1. Demographic features
2. Something most group members DO
3. Something most group members WANT*
4. Something that keeps the group from “doing the right
thing” (barriers)
5. What the Priority Group knows, feels, and practices
regarding the behavior 6. Readiness of most group members to adopt the new
behavior (Stage of Change)
* This handout is adapted from materials originally developed by AED.
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Task 5 Handout 2- Example of Six Ways to Describe the Priority Group
2. Things that members of the Priority Group do; Common behaviors, practices
3. Things that members of the Priority Group want: Common desires
5. Know all the advantages of adding organic matter to
the soil. Usually incorporate whatever organic matter is available on the field. Feel that it is an extra burden of work to carry additional organic material to the fields and spread it when they aren’t sure it will make any difference in production.
Priority Group
2. Gather at the local shop most evenings, spend 10 hours or more in the fields, eat a very monotonous diet, mostly carbohydrate – cassava, rice, walk everywhere, too poor for transport
3. Want a better life for their children, see that schooling will lead to this, “want their children to be more intelligent”, want their family to be food secure, Want to feel they are being good providers
4. Need to investigate further, lack skills for better farming techniques, Risk averse, Tradition-bound farming techniques
6. Need to investigate but possibly in awareness or preparation
5. Priority Group and the Behavior: What the Priority Group knows, feels, and practices regarding the behavior
4. Things that prevent members of the Priority Group from “doing the right thing”: common barriers
6. Stages of Change: pre-awareness, awareness, preparation, action, maintenance
1. Farmers with less than 1 hectare of land, production is all consumed by family, have to do seasonal work off-farm for cash, speak Kiswahili, have little schooling, all ages 18-80
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Task 5 Handout 3- Blank Worksheet - Six Ways to Describe the Priority Group 57
2. Things that members of the Priority Group do; Common behaviors, practices
3. Things that members of the Priority Group want: Common desires
5.
Priority Group 2.
3.
4.
6.
5. Priority Group and the Behavior: What the Priority Group knows, feels, and practices regarding the behavior
4. Things that prevent members of the Priority Group from “doing the right thing”: common barriers
6. Stages of Change: pre-awareness, contemplation, preparation, action, maintenance
Task #6: Review Exercise – Sing It! Achievement Based Objectives: By the end of this task, participants will have: • Created and sung a song about things they learned the previous day • Reviewed the program and objectives for day
Time: 40 min Materials: - Schedule for the day - Objectives for the day
Steps
1. In teams of 5 people, participants will compose a song that captures the ideas covered the day before and how they can be used in their work. Participants will have 10 minutes to compose it. Each team will perform their song for the group.
2. Review the schedule and objectives of the day with the participants.
3. Present a summary of the participants' comments from Day One's evaluation. If necessary, make adjustments in the schedule and address participants' questions.
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Task #7: Our DBC Frameworks Part 1: Describing the Behavior and Priority Group Achievement Based Objectives: By the end of this task, participants will have: • Described their assigned Priority Group in detail • Considered which behaviors relate to the assigned intervention • Written a complete behavior statement that conforms to the guidance
provided previously Time: 1 hr Materials: - List of DBC groups - Flip chart with instructions for group work - Assigned Priority Groups and interventions (one per DBC group), use project Priority Group and intervention - Blank Designing for Behavior Change Frameworks - Flip Chart size DBC frameworks for each small group with sections for
Behavior and Priority Group Facilitator’s Notes: Situation #1: If your training group contains 2-3 participants per project from each of several different countries or regions, group them according to their projects (select interventions according to what they have written on their LNRAs). Situation #2: If participants are all from different countries, select 4-5 interventions and geographic areas according to the projects listed on the LNRAs (select those which represent interventions that the majority of the group may be interested in); let participants join their own groups (approximately 5 people per case study group). Situation #3: If all participants come from the same country or the same project, group them according to different sub-topics of the intervention. For example, if the key intervention area is Ag/NRM, you may want to group people in the following way: Group 1- Poultry Management, Group 2- Reforestation, Group 3- Protection of Endangered Species, Group 4 - Protection of Coastal areas, etc.
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Steps 1. Introduction (5 min)
Ask participants to sit in their assigned groups. Explain that in this session we will start to develop our own DBC Frameworks, which we will complete by the end of the workshop.
2. Starting Our DBC Frameworks – Behaviors and Priority Groups (40 min) a. Display the Task #7 Instructions on Flip Chart – Communicate the assigned
Priority Group and intervention to each group. b. Explain that each group will discuss the intervention provided and formulate
a behavior statement according to the definition of a well-written behavior statement. [Trainers might want to ‘approve’ the behavior selection, to make sure it allows for the best learning experience.] Ask groups to write this statement on their individual DBC Framework.
c. Ask each group to describe their Priority Group using the six descriptors discussed in Task #6 and write this on their individual DBC frameworks.
d. Pass out flip chart-sized DBC frameworks (with Behavior and Priority group sections ONLY) to each group and ask each to write their results on the flip chart and post these on the wall. Ask each group to post a comment sheet next to their DBC framework. These should be large enough so that several colleagues can write their comments with markers and they can be seen from the other side of the room.
Alternatively (for groups who write their DBC on a computer): Ask groups to record the behavior and Priority Group on their group’s electronic DBC Framework and modify Step 3 so that groups move from table to table to read the DBC on a computer and comment on each of the other groups’ frameworks. Groups should still prepare a comment sheet and place these next to their frameworks.
3. Gallery Walk sharing (15 min.) a. Invite the entire group to do a gallery walk (if using flip charts). Explain
that participants may ask for explanations from group members if necessary. Ask participants to write their comments on the comment sheet for each group. Give them guidance on how to provide feedback (for example, it is not sufficient to say, "the behavior statement is not complete", the comment should be "you may want to consider completing the
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description by adding the common desires and the stages of change," etc. In each case, encourage participants to provide suggestions for improving the framework.
b. As participants circulate, encourage the group to determine whether or not the behavior statements meet the criteria for a well-written behavior statement and if the Priority Group is described according to the 6 ways.
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Task 7 Flip Chart
Instructions for DBC Group Work
Defining the Behavior and Your Priority Group
1) Discuss the intervention and write the behavior (practice)
statement according to the definition of a well-written behavior statement: action, observable, specific, measurable, feasible, direct link to improved outcomes
2) Describe your Priority Group in 6 ways
3) Write the Priority Group’s description on your group’s Designing
for Behavior Change framework 4) Write these on a flip chart sheet/blank DBC framework
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Task #8: Identifying Determinants that Influence Behavior Achievement Based Objectives: By the end of this task, participants will have: • Reviewed a list of key determinants • Named 3 powerful determinants • Matched a determinant to a formative research statement from a Priority
Group • Identified determinants in a case study • (optional) Identified Universal Motivators used by advertisers
Time: 2 hr. Materials: - Sample Designing for Behavior Change Framework, Example 1: Poultry
Management (from Task #3) - Flip chart with definition of Determinants - Task 8 Handout 1: Important Determinants that Influence Behavior - Task 8 Handout 2: Match the Determinant - Task 8 Handout 3: Stories for Explaining Determinants (facilitator’s and participant’s versions) - Task 8 Handout 4: Examples of Universal Motivators
Steps 1. Introduction (5 min)
Ask the participants the following question: Where are we on the Designing for Behavior Change Framework? [Determinants] Explain that we are now going to discuss discovering the determinants of a given behavior: a step in the design process that we often forget, but that is central to knowing which activities and messages we need to use to change behavior.
2. What is a Determinant of Behavior? (85 min) a. Ask participants: How do you usually decide how to promote (or bring about)
a change in a behavior? (Various answers) Explain that many programs just jump from the behavior and Priority Group straight to the activities and messages, without giving much thought to why people do what they do currently and what may be preventing them from adopting the positive behavior.
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b. Review the flip chart with the definition of Determinant of Behavior. c. Ask the participants to read the definitions in Task 8 Handout 1 -
“Important Determinants that Influence Behavior” and circle one determinant that strikes him/her as having the greatest influence on behavior change. Listen to a sample from the participants. Tell the participants, "While we have a good idea that this list of determinants applies to health behaviors we do not have enough data yet to say to what extent they all apply or which ones apply to Ag/NRM behaviors."
d. Explain that social scientists have discovered that among all of the determinants, there are three that are more common and more powerful influencers of behavior change for most health behaviors. These are Perceived Self Efficacy/Skills, Perceived Social Norms, and Perceived Positive and Negative Consequences. Ask participants to underline or star these three determinants on their list of determinants.
e. In addition to these three most powerful determinants, there are several other important determinants that social scientists have discovered are important for health/nutrition behaviors. The importance of these determinants related to non-health behaviors/practices has not yet been confirmed, however. Further study is required. These determinants are Access, Perceived Barriers and Enablers. Other determinants that are useful with some behaviors in some contexts are Perceived Susceptibility, Perceived Severity, Perception of Divine Will, Cues for Action/Reminders, Policy, and Culture. Keep in mind that we are talking about perceptions. What is most important for behavior change is not whether someone actually has access to something, but their perception of their access. For that reason, most of the determinants are preceded by the word “perceived.”
f. (20 min) Distribute Task 8 Handout #2 to each participant, either working in a group (easier) or individually (harder), ask participants to read the statement in the left column and, while referring to their list of determinants (Handout 1) decide which determinant best matches the statement. Review the results explaining that sometimes more than one determinant appears to apply to the same statement. In cases like these, the Bridges to Activities will play an important role in determining which activities will best address the issue.
g. (1 hr) If participants need additional learning opportunities with determinants, use one of the stories in Task #8, Handout #3, Stories for
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Explaining Determinants. Instructions for analysis of the story are included in the handout. (These are best used with participants who learn well through reading. )
5. Optional: Universal Motivators Activity (30 min) Note: The following activity is most appropriate for projects that will work with mass media or will make Information, Education, Communication (IEC) materials for large, diverse audiences such as bill boards, pamphlets, or posters.
a. Read Box 1: Universal Motivator on Task 8 Handout 5. Ask: Do you think most people everywhere yearn for many of the items on this list? Explain that we need to consider these “Universal Motivators” when we think about the factors that influence behavior change when we work with large and diverse populations with whom we cannot do formative research. We will now do an activity to help us understand how Universal Motivators are used by advertisers to sell their products.
d. Ask participants to get out their magazine, newspaper, or photo of an advertisement. Working individually or in small groups, ask participants to examine advertisements and decide which ONE Universal Motivator the ad relates to the most. (15 min)
e. Ask different participants to show you one example for each of the Universal Motivators - holding up the advertisement for all to see.
f. Summarize by saying, "These are examples of how you can use “Universal Motivator’ to be more effective in your mass media campaigns or other messaging to diverse groups."
Note: Sometimes, motivators in one culture may actually be important barriers in other cultures; for example, some women complained that when they used soap their husbands beat them (thinking that they were using soap to be more attractive to the opposite sex and that this meant they were cheating on them); in another country, however, women mentioned that they used soap because their husbands liked the way they smelled.
g. Explain that we need to keep our eyes open for these Universal Motivators as we learn how to identify the most powerful determinants for our Priority Group. Keep in mind that these are important motivators that can help people to change their behavior. They may be revealed especially when you learn what your Priority Group sees as the advantages (positive
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consequences) and who would approve (social norms) of the behavior. However, most of the time these Universal Motivators will not be discovered in your Barrier Analysis study since both those doing and those not doing the practice may mention them in relationship to a given practice. You can still use these Universal Motivators in your messaging, however, if you can successfully link these desires of the group you are working with (e.g., farmers) with a universal motivator that they value (e.g., respect).
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Task 8 Flip Chart #1 Determinant of Behavior: A category of elements shown to motivate or impede the adoption of a behavior for a given group of people. ______________________________________________________________________
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Task 8 Handout 1 * Important Determinants that Influence Behavior
(Note: This list of determinants has been reworked since publication of the 2008 DBC training manual in order to better fit agriculture and NRM behaviors, and is somewhat different from the list of determinants used in the 2008 health & nutrition focused Barrier Analysis manual.)
The Three Most Powerful Determinants and Other Key Determinants listed below should always be explored in formative research on determinants (e.g., Barrier Analysis and Doer-Non Doer Studies). These three are more commonly found to be the most powerful for health/nutrition behaviors:
Perceived Self-efficacy/Skills (control beliefs): an individual's belief that he or she can do a particular behavior given their current knowledge and skills; the set of knowledge, skills or abilities necessary to perform a particular behavior.
Perceived Social Norms: perception that people important to an individual think that s/he should do the behavior; norms have two parts: who matters most to the person on a particular issue, and what s/he perceives those people think s/he should do.
Perceived Positive or Negative Consequences: what a person thinks will happen, either positive or negative, as a result of performing a behavior. This includes advantages (benefits)/disadvantages of the behavior, attitudes about the behavior, perceived action efficacy (whether or not the person thinks the action will be effective in overcoming a problem or accomplishing something that the person wants), and perceived positive and negative attributes of the action. Other Key Determinants:
Access: The degree of availability (to a particular audience) of the needed products (e.g., fertilizer, ITNs, condoms) or services (e.g., veterinary services, immunization posts) required to adopt a given behavior. This also includes an audience's comfort in accessing desired types of products or using a service.
Perceived Barriers: What makes it more difficult to perform a given behavior.
Perceived Enablers: What makes it easier to perform a given behavior.
Cues for Action / Reminders: The presence of reminders which help a person to remember to do a particular behavior or remember the steps involved in doing the behavior. This also includes key powerful events that triggered a behavior change
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in a person (e.g., “my brother-in-law got AIDS”; “the tsunami hit”). Examples of reminders are radio announcements reminding people of the date and location of a seedling distribution post and a sticker with the steps on how to plant a particular type of seed. Please remember that people are sometimes unaware of these cues for action.
Other Determinants:
The determinants below may be useful to explore during formative research on determinants (e.g., Barrier Analysis and Doer/Non-Doer Studies) for some behaviors (especially health behaviors) in some contexts:
Perceived Susceptibility (together with Perceived Severity, this is sometimes referred to as Perceived Risk): a person's perception of how vulnerable they feel. For example, do they feel that it’s possible that their crops could have cassava wilt? Is it possible for them to become HIV+?
Perceived Severity: Belief that the problem (which the behavior can prevent) is serious. A farmer may be more likely to take steps to prevent aflatoxin infection of stored harvest if he perceives it to be a serious problem that could cause harm. A mother may be more likely to take her child for immunizations if she believes that measles is a serious disease. (This is related to perceived consequences.)
Perception of Divine Will: a person’s belief that it is God’s will (or the gods’ will) for her/him to have the problem; and /or to overcome it. Numerous unpublished BA studies have found this determinant to be important for many behaviors (particular for health and nutrition behaviors).
Policy: laws and regulations that affect behaviors and access to products and services. For example, the presence of good land title laws (and clear title) may make it more likely for a person to take steps to improve their farm land. A policy of automatic HIV testing during antenatal visits may make it more likely for women to have HIV testing. Policy often affects “enablers,” things that make it easier to do a behavior.
Culture: the set of history, customs, lifestyles, values and practices within a self- defined group. May be associated with ethnicity or with lifestyle, such as "gay" or "youth" culture. Culture often influences perceived social norms.
* This handout is adapted from materials originally developed by AED and the FH Barrier Analysis manual.
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Task 8 Handout 2 Match the Determinant
Referring to your List of Determinants, choose the determinant which best fits the statement.
Responses from Formative Research Determinant 1. I don’t know how to plant on the contour of the land. 2. My father in law told me that using fertilizer was not worth the
money and effort. I don’t want to look foolish by doing that.
3. If I don’t burn my fields I will have more insect problems next year.
4. The wind is more likely to knock down my maize if I plant in rows.
5. They don’t sell that pesticide in my village and it’s a long walk to the district warehouse.
6. I don’t like to use the clinic because they were mean to me the last time I went.
7. Working outside the house makes it difficult to exclusively breastfeed my child.
8. I hate weeding! I’m more likely to do it when my neighbor and I do it together.
9. I was going to use that new variety of cassava, but I forgot the date of the distribution at the research farm.
10. Only children who are born small end up with malnutrition. My child was a good size, so I don’t have to worry about that.
11. "I heard that if I don’t terrace my land, I could lose topsoil. But there’s plenty of topsoil so I’m not worried about that
12. The Bible says that we should not leave our feces uncovered so my family built a latrine.
13. I took my child to be vaccinated last week, but they said they cannot open up a vial of vaccine for just one child.
14. It’s our tradition to burn field to clear them of growth to get them ready for planting.
15. It’s too difficult to only have sex with my wife.
16. My husband wants me to plant more cash crops than crops for the household consumption this year.
17. I don’t want to plant sweet potatoes this year. Last year I planted them, but everyone else did too, and the price I got for them was very low.
18. I would use family planning, but they stopped providing the type I like.
19. I want to build an improved silo this year to prevent rats. They ate a lot of my maize last year.
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Responses from Formative Research Determinant 20. Having a good animal doctor nearby made it much easier to
use animal traction to plow my fields.
21. I have heard that it’s a good idea to check my child’s breathing when he has a cold, but I forget.
22. I tried that, and it took too much time and effort.
23. Erosion only happens on farms that are on very steep hills. My land is not that steep.
24. Who cares if my child is underweight? He’s still growing and I was small at his age too.
25. It’s God’s will whether or not I have a good harvest this year, and there’s not a lot I can do about it.
26. If my child is well‐nourished, they won’t give us the free food ration, so I’m no longer breastfeeding him. The ration is worth a lot to my family.
27. People from our tribal group are not allowed to eat with people in that cultural group, so we didn’t go to the meeting.
Story #1: Practice Identifying Determinants The Fisherman Who Ran Out of Excuses Before He Ran Out of Time by Tom Davis
[Facilitators Notes: Have one participant read the story below in sections (in each language by language group if multiple language groups are present). Pause after each section to ask the questions shown. If participants have trouble answering particular questions, re‐read a paragraph of the story, give them clues and repeat the question. Sometimes participants spend too much time discussing specific messages related to the topic. If this occurs, remind them that the purpose here is to concentrate on the determinants in the story rather than on whether the methods used by the promoter were the most appropriate. This is why the example is about smoking, rather than on a topic that participants are likely to be working on in their programs. The focus should be on the determinants.]
Part I
One day in January in Hula Hula, an old fisherman walked merrily up the hill by the house of the Health Promoter, Raffaella. He was smoking a cigarette. Raffaella remembered her own father’s painful death from cancer due to his smoking, and she resolved to do something about it in her community. Raffaella talked to the old fisherman from her yard for a while and then told him that he really should stop smoking because it could give him cancer. The old fisherman said, “I’ll never get cancer. The people in my family are very hardy and healthy.” So Raffaella explained to him how anyone who smokes has a higher risk of getting cancer.
In February, the old fisherman walked by Raffaella’s house again. Raffaella saw that he was still smoking and mentioned to him that he could get emphysema from smoking, too. The old fisherman laughed and said, “Well, I don’t even know what emphysema is, but I’m sure it won’t be anything that I can’t handle even if I do get it.” So Raffaella explained to him what a terrible disease emphysema is. Raffaella realized that she needed to do more than just talk to the fisherman if she wanted to do something about cancer. She worked with the local community leaders to create and display several posters in local gathering places that pointed out the health hazards of smoking. She was also successful in getting community leaders to agree to not allow smoking during official community meetings.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
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a. We have heard the first part of the story. At this point, what are the reasons that the old fisherman not stop smoking? [Write their responses on newsprint or a blackboard. Assure that they mention: “(1) He did not think he could get cancer” and “(2) He thought that diseases caused by smoking were not that serious.”
b. With which determinants (from Task #8, Handout #1) are these two reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:]
(1) He did not think he could get cancer: Perceived Susceptibility. (2) He thought that diseases caused by smoking were not that serious: Perceived
Severity. [You could also accept Perceived Consequences, as Perceived Severity is a specific type of perceived consequence.]
[Read the next part of the story below.]
Part II
March came and the old fisherman came puffing up the hill and puffed a ‘hello’ to Raffaella. Raffaella asked him if the cancer had set in yet. The old fisherman said, “I don’t have it yet, but if I’m supposed to get it, I’m sure I will whether or not I quit smoking. I’ve smoked all my life!” So Raffaella explained to him how quitting smoking at any age could make him live longer.
In April, the old man slowly walked up the hill, coughing and hacking. He knew Raffaella was going to ask him, so he called out before she could ask, “No I haven’t stopped smoking, but I want to. And I did try! It’s just too hard!” So Raffaella explained to him some ways to stop smoking more easily.
In May, the old man took forever to get up the hill since he was breathing like a mule loaded with salt. Raffaella asked him, “Are you still smoking?” and he said, “Well, I finally gave them up on Wednesday... but over the weekend I forgot that I wasn’t smoking anymore, saw a pack on the table and lit one up! I just can’t remember that I don’t smoke!” So Raffaella explained to him that he should get rid of all the cigarettes and ashtrays to “remind him” that he doesn’t smoke.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
c. We have now heard the second part of the story. At this point, what are the reasons that the old fisherman has not stopped smoking? [Write their responses on newsprint or a blackboard. Assure that they mention: (3) He thought that if he quit smoking, he would get cancer anyway; (4) He thought that it was too difficult to stop the habit; and (5) He “forgot” that he had quit smoking.
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d. With which determinants (from Task #8, Handout #1) are these three reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:]
(3) He thought that if he quit smoking, he would get cancer anyway: Perceived Consequences. (This specific consequence is sometimes referred to as perceived action efficacy.)
(4) He thought that it was too difficult to stop the habit: Perceived self-efficacy/Skills;
(5) He “forgot” that he had quit smoking: Cues for Action / Reminders
[Read the next part of the story below.]
Part III
In June, the old man had to stop three times coming up the hill since he was breathing so hard. Raffaella said, “You STILL haven’t given them up?!” and the old man said, “Well, it would be a lot easier if all my friends didn’t smoke! Every time I see them, it makes me start up again!” So Raffaella explained to him that he needed to either find friends that didn’t smoke or convince his smoking friends to give it up, too. Raffaella met with the old fisherman and his friends and, with Raffaella’s help, they began a support group to help each other stop smoking.
In July, the old man had to stop five times coming up the hill. He called out to Raffaella: “Don’t tell me anything else. I know that it must be God’s will for me to smoke and die of smoking since I can’t seem to stop.” Raffaella called the old man over for coffee, and read to him from the Bible where it says that our bodies are temples (1 Cor 6:19-20). She explained that the Bible says it was not God’s will that he die of his habit (Isa 65:20). She agreed that he probably could not stop on his own, though, and that he did indeed need God’s help to do it. She suggested that he pray to God for strength to quit, and for more ideas on how to do it.
In August, the old fisherman climbed the mountain very happily as if he were a young man again! He called to Raffaella, “I’m no longer a smoker and neither are my friends! I convinced them that with the money we would save by giving up smoking, we could form a fishing cooperative. Now, none of us are smokers. Thanks a lot, Raffaella!! I thank God that I ran out of excuses before I ran out of time!” The fisherman regained his energy and died at 95 years old.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
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e. We have now heard the last part of the story. At this point, what are the two reasons that the old fisherman has not stopped smoking? [Write their responses on newsprint or a blackboard. Assure that they mention: (6) All of his friends smoked; (7) He believed that it was God’s will that he smoke and get cancer.
f. With which determinants (from Task #8, Handout #1) are these two reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:]
(6) All of his friends smoked: Perceived Social Norms (7) He believed that it was God’s will that he smoke and get cancer: Perception of
Divine Will.
g. What did the old fisherman do to finally stop smoking? (8) He convinced his friends that they could save money by forming a fishing
cooperative.
h. What determinant is associated with this? Perceived Positive Consequences (and it also may have been associated with
some Big Benefits like success and status)
i. In addition to using appropriate behavior change messages, what other activities did Raffaella and the fisherman initiate that may have helped the old fisherman to stop smoking?
-February: Raffaella engaged in consciousness raising and changing community norms by getting community leaders to agree to not allow smoking during official community meetings.
-February/May: Raffaella used “environmental controls” by having the fisherman get rid of old packs of cigarettes and ashtrays to remove cues that make him want to smoke.
-June: Raffaella started a stop smoking support group for the fisherman and his friends.
-August: The old fisherman and his friends started a fishing cooperative (an alternate activity) using the money they saved on cigarettes.
j. [Explain:] We need to explore whether each of these possible determinants (“barriers” and “enablers”) are affecting behaviors that we are promoting. Any one of them (or a combination) can either keep hinder or help a person to adopt a given behavior.
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Task 8 Handout 3 (Participant’s Version)
The Fisherman Who Ran Out of Excuses Before He Ran Out of Time by Tom Davis Instructions to Reader – Read the story and respond to the questions following each of the three parts.
Part I
One day in January in Hula Hula, an old fisherman walked merrily up the hill by the house of the Health Promoter, Raffaella. He was smoking a cigarette. Raffaella remembered her own father’s painful death from cancer due to his smoking, and she resolved to do something about it in her community. Raffaella talked to the old fisherman from her yard for a while and then told him that he really should stop smoking because it could give him cancer. The old fisherman said, “I’ll never get cancer. The people in my family are very hardy and healthy.” So Raffaella explained to him how anyone who smokes has a higher risk of getting cancer.
In February, the old fisherman walked by Raffaella’s house again. Raffaella saw that he was still smoking and mentioned to him that he could get emphysema from smoking, too. The old fisherman laughed and said, “Well, I don’t even know what emphysema is, but I’m sure it won’t be anything that I can’t handle even if I do get it.” So Raffaella explained to him what a terrible disease emphysema is. Raffaella realized that she needed to do more than just talk to the fisherman if she wanted to do something about cancer. She worked with the local community leaders to create and display several posters in local gathering places that pointed out the health hazards of smoking. She was also successful in getting community leaders to agree to not allow smoking during official community meetings.
a. At this point, what are the reasons that the old fisherman had not stopped smoking?
b. With which determinants (from Task #8, Handout #1) are these two reasons associated?
Part II
March came and the old fisherman came puffing up the hill and puffed a ‘hello’ to Raffaella. Raffaella asked him if the cancer had set in yet. The old fisherman said, “I don’t have it yet, but if I’m supposed to get it, I’m sure I will whether or not I quit smoking. I’ve smoked all my life!” So Raffaella explained to him how quitting smoking at any age could make him live longer.
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In April, the old man slowly walked up the hill, coughing and hacking. He knew Raffaella was going to ask him, so he called out before she could ask, “No I haven’t stopped smoking, but I want to. And I did try! It’s just too hard!” So Raffaella explained to him some ways to stop smoking more easily.
In May, the old man took forever to get up the hill since he was breathing like a mule loaded with salt. Raffaella asked him, “Are you still smoking?” and he said, “Well, I finally gave them up on Wednesday... but over the weekend I forgot that I wasn’t smoking anymore, saw a pack on the table and lit one up! I just can’t remember that I don’t smoke!” So Raffaella explained to him that he should get rid of all the cigarettes and ashtrays to “remind him” that he doesn’t smoke.
c. At this point, what are the reasons that the old fisherman not stop smoking?
d. With which determinants (from Task #8, Handout #1) are these three reasons associated?
Part III
In June, the old man had to stop three times coming up the hill since he was breathing so hard. Raffaella said, “You STILL haven’t given them up?!” and the old man said, “Well, it would be a lot easier if all my friends didn’t smoke! Every time I see them, it makes me start up again!” So Raffaella explained to him that he needed to either find friends that didn’t smoke or convince his smoking friends to give it up, too. Raffaella met with the old fisherman and his friends and, with Raffaella’s help, they began a support group to help each other stop smoking.
In July, the old man had to stop five times coming up the hill. He called out to Raffaella: “Don’t tell me anything else. I know that it must be God’s will for me to smoke and die of smoking since I can’t seem to stop.” Raffaella called the old man over for coffee, and read to him from the Bible where it says that our bodies are temples (1 Cor 6:19-20). She explained that the Bible says it was not God’s will that he die of his habit (Isa 65:20). She agreed that he probably could not stop on his own, though, and that he did indeed need God’s help to do it. She suggested that he pray to God for strength to quit, and for more ideas on how to do it.
In August, the old fisherman climbed the mountain very happily as if he were a young man again! He called to Raffaella, “I’m no longer a smoker and neither are my friends! I convinced them that with the money we would save by giving up smoking, we could form a fishing cooperative. Now, none of us are smokers. Thanks a lot, Raffaella!! I thank God that I ran out of excuses before I ran out of time!” The fisherman regained his energy and died at 95 years old.
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e. At this point, what are the two reasons that the old fisherman did not stop smoking?
f. With which determinants (from Task #8, Handout #1) are these two reasons associated?
g. What did the old fisherman do to finally stop smoking?
h. What determinant is associated with this?
i. In addition to using appropriate behavior change messages, what other activities did Raffaella and the fisherman initiate that may have helped the old fisherman to stop smoking?
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Task 8 Handout 3 (Facilitator’s Version)
Alternate Story #2 Why Oumar Built the Silo
by Carolyn Wetzel [Have one participant read the story below in sections (in each language by language group if multiple language groups are present). Pause after each section to ask the questions shown. If participants have trouble answering particular questions, re‐read a paragraph of the story, give them clues and repeat the question. Sometimes participants spend too much time discussing specific messages related to the topic. If this occurs, remind them that the purpose here is to concentrate on the determinants in the story rather than on whether the methods used by the promoter were the most appropriate.]
Part I
One evening about three weeks after Oumar had finished planting his maize crop (when the maize was about shin high), his neighbor Ali came to visit. Last year, Oumar had planted maize, but unfortunately had lost about 1/3 of his entire harvest to rats and insects. The two men sat by the fire, drank tea and talked about what was happening in the village. Ali was a younger man and the leader of Oumar’s Farmer Field Group. Ali had just returned from a training led by a government extension worker in the nearby town. Ali spoke excitedly about new ways he had learned to reduce post-harvest losses by treating and drying grains and then storing them in mud silos. Ali told Oumar that he could retain about 25-50% more of his maize crop to consume and sell if he started practicing these new ways of drying, treating and storing grain. Oumar didn’t want to be rude to his visiting neighbor so he offered him another cup of tea and smiled skeptically.
Even though Oumar had lost about a third of his harvest last year, he thought it was because he had not taken precautions, such as giving offerings to the gods, and not harvesting at exactly the right time of the month.
The following week, Oumar attended Ali’s Farmer Field Group meeting. Ali explained to Oumar that the rat and insect situation in this community was not due to the lack of offerings or the time of the month he harvested. The other farmers in the meeting agreed. Ali told the group that – despite the rat and insect problem – it was possible that not one head of maize would be lost after harvest if proper storage techniques were adopted. He said that losing maize after harvest was a post-harvest loss and it could be prevented with special treatment and silos. It had never occurred to Oumar that there
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were other reasons for the loss, and that there were other ways to prevent rats or pests from destroying part of his crop.
Still, Oumar was doubtful that an old farmer like himself, who had stored grain the same way since some of these other farmers were at their mothers’ breasts, could ever prevent rats or insects from eating his maize after harvest. He wasn’t young like Ali, he had never learned how to make these special silos, and he didn’t know how to read and he didn’t get to go to fancy trainings and learn from educated government extension workers.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
a. We have heard the first part of the story. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses? [Write their responses on newsprint or a blackboard. Assure that they mention: (1) He did not think that post-harvest loss could be prevented by building silos or treatment of crops, and (2) He thought that he was too old to learn the new behavior. He believed he could only do the behavior if he knew how to read or was taught by the government extension worker.”
b. With which determinants (from Task #8, Handout #1) are these two reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:] (1) He did not think that post-harvest loss could be prevented by building silos or
treatment of crops: Perceived Consequences (sometimes referred to as “perceived action efficacy,” as well).
(2) He thought he could not create the silos and was too old and illiterate to learn how: Perceived Self-efficacy / Skills.
[Read the next part of the story below.]
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Part II
Six weeks later, Oumar’s maize had grown up to his chest, and it was time for another Farmer Field Group meeting. Ali demonstrated to all the group members how to dry maize and treat it with ash made from dead mango limbs. Then he showed the group members how to build a storage silo made out of mud. For homework, he asked each of the group members to make a mud storage silo and to scavenge dead mango limbs to make ash so that each farmer could apply it to his or her dried maize at harvest time. Oumar chuckled to himself imaging what his neighbors would do if he tried to build a strange looking mud silo in front of his house. He knew his neighbors would bewitch him for trying to get ahead and considering himself so fancy and educated. He also knew he would never hear the end of it from his dear wife if he spent half the day scavenging mango limbs to make ash that promised to magically prevent insects from eating his maize. He decided to not build a silo or use the mango ash.
Then one day, a few months later, Oumar found half of the sweet potatoes he was storing in a sack in his straw barn had been eaten by rats. He was so upset he decided to go back to the Farmer Field Group and listen to Ali’s advice.
This time the group was meeting at Oumar’s neighbor house, Hamidou. Much to Oumar’s surprise, Hamidou had built a mud silo. As Oumar approached the mud silo, he couldn’t tell what was inside or if Hamidou had enough food or not. How he envied such privacy. No one was laughing at Hamidou for loosing half his sweet potatoes! Enoch shared with the group that one of the best things about the mud silo was that he could just put the grain, tubers or vegetables in the silo and no longer had to buy gunny sacks. Oumar looked inside the silo and saw it was full of sweet potatoes! All the potatoes were dry and untouched by rats or pests.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
c. We have now heard the second part of the story. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses? [Write their responses on newsprint or a blackboard. Assure that they mention:] (1) He thought his wife and neighbors would speak badly of him and bewitch him. (2) He thought his wife would complain. (3) He didn’t believe the mango ash could prevent insects from eating his maize.
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d. With which determinants (from Task #8, Handout #1) are these three reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:] (1) He thought his neighbors would speak badly of him and bewitch him: Perceived
(Negative) Consequences. (Participants may mention “Perceived Social Norms.” If so, point out that this was not a person who was important to Oumar, and he was less concerned with what the neighbors would say and think about him as he was about what they would do (bewitching him), so it’s best to categorize this as a Perceived Negative Consequences.)
(2) He thought his dear wife would complain: Perceived Social Norms. He was afraid that someone important to him would think poorly of him, and let him know it.
(3) He didn’t believe the mango ash would prevent insects from eating his maize: Perceived (Negative) Consequences (This specific consequence is sometimes referred to as perceived action efficacy.)
e. What happened that helped Oumar to dry and treat his grain and store it in a mud silo to prevent post-harvest losses? Which determinants are the reasons associated with? (1) He was reminded of the need for the behavior change when half his sweet potato
crop was eaten by rats: Cues for Action / Reminders (2) Oumar saw that mud silos allowed for privacy, saved money by eliminating the need
to buy gunny sacks and the mud silo and mango ash kept stored food dry and free of pests: Perceived Positive Consequences
[Read the next part of the story below.]
Part III
After the meeting Ali asked Oumar if he would be willing to try building a silo and dry and treat his maize crop before putting it in the silo. Oumar told Ali that he could see the mud silo worked for sweet potatoes, but he didn’t believe it could keep mold, mice and rats out of stored maize since they could still enter through the top of the silo. He complained that the clay needed to make the silo was a day’s walk away and he couldn’t afford to be away from his farm that long. Even if he could get the clay how would an old man like him know how to fashion a mud silo? And last but not least, Oumar knew he couldn’t do it because he had forgotten to scavenge the dead mango limbs to make the ash needed to treat the maize, and there were no mango trees near his land.
Ali had ideas for how to solve all these barriers. He convinced Oumar to send his donkey along with a neighbor to the place where clay is collected. For a small fee, the neighbor loaded Oumar’s donkey with the special clay needed to make the silo. Then Ali spent an
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afternoon teaching Oumar how to fashion the silo. And last but not least, Ali gave Oumar some of his mango ash needed to treat the maize on the condition that Oumar would make mango ash for him next season. Oumar was still angry enough about all the sweet potatoes he lost to try something as crazy and risky as these strange new ideas that Ali was promoting.
Seven months later, Oumar had more maize in his mud silo then he’d ever had so many months after the harvest. He hadn’t lost a single ear of maize to pests or rodents. Seeing this made Oumar realize that he had been losing more grain than he thought to insects and rats. By maintaining more of his harvest, Oumar and his wife were able to sell more of it and finally send their daughters to school, something that he had always wanted to do.
[Process this part of the story using the questions and information below. Refer participants to the list of determinants in Task #8, Handout #1.]
f. We have now heard the third part of the story. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses? [Write their responses on newsprint or a blackboard. Assure that they mention:] (1) He didn’t think the mud silo would keep pests or mold from destroying maize; (2) He didn’t have easy access to the clay; (3) He didn’t have access to the mango limbs needed to make ash to treat the maize.
g. With which determinants (from Task #8, Handout #1) are these three reasons associated? [Write their responses on the newsprint or blackboard. Assure that they say:]
(1): He didn’t think the mud silo would keep pests or mold from destroying maize Perceived (Negative) Consequences. (This specific consequence is sometimes referred to as perceived action efficacy.)
(2 & 3): He didn’t have ready access to the clay or mango limbs needed to make ash: Access
[Read the next part of the story below.]
h. What happened that helped Oumar to dry and treat his grain and store it in a mud silo to prevent post-harvest losses? Which determinants are the reasons associated with?
(1) Another man helped Oumar to collect the clay: Access (also can accept “perceived enablers”, but explain that this particular enabler has to do specifically with being able to access a needed product, so it’s best to categorize it as Access).
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(2) Ali taught Oumar to fashion the silo: Perceived Self-efficacy / Skills
(3) Ali lent Oumar the ash he needed: Access (also accept “perceived enablers”, but explain that this particular enabler has to do specifically with Access, so it’s better to categorize it that way)
i. What happened as a consequence of adopting the new practices that will probably help Oumar to continue to practice them?
(1) He retained a lot more of his harvest, realized just how much maize he was losing to rats and insects, and was able to sell more maize. By doing that, he was able to send their daughters to school, something that he had always wanted to do. This is a Perceived (Positive) Consequence that was valuable to him, and should help him to maintain the new practices.
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Task 8 Handout 3 (Participant’s Version)
Alternate Story #2 Why Oumar Built the Silo
by Carolyn Wetzel
Part I
One evening about three weeks after Oumar had finished planting his maize crop (when the maize was about shin high), his neighbor Ali came to visit. Last year, Oumar had planted maize, but unfortunately had lost about 1/3 of his entire harvest to rats and insects. The two men sat by the fire, drank tea and talked about what was happening in the village. Ali was a younger man and the leader of Oumar’s Farmer Field Group. Ali had just returned from a training led by a government extension worker in the nearby town. Ali spoke excitedly about new ways he had learned to reduce post-harvest losses by treating and drying grains and then storing them in mud silos. Ali told Oumar that he could retain about 25-50% more of his maize crop to consume and sell if he started practicing these new ways of drying, treating and storing grain. Oumar didn’t want to be rude to his visiting neighbor so he offered him another cup of tea and smiled skeptically.
Even though Oumar had lost about a third of his harvest last year, he thought it was because he had not taken precautions, such as giving offerings to the gods, and not harvesting at exactly the right time of the month.
The following week, Oumar attended Ali’s Farmer Field Group meeting. Ali explained to Oumar that the rat and insect situation in this community was not due to the lack of offerings or the time of the month he harvested. The other farmers in the meeting agreed. Ali told the group that – despite the rat and insect problem – it was possible that not one head of maize would be lost after harvest if proper storage techniques were adopted. He said that loosing maize after harvest was a post-harvest loss and it could be prevented with special treatment and silos. It had never occurred to Oumar that there were other reasons for the loss, and that there were other ways to prevent rats or pests from destroying part of his crop.
Still, Oumar was doubtful that an old farmer like himself, who had stored grain the same way since some of these other farmers were at their mothers’ breasts, could ever prevent rats or insects from eating his maize after harvest. He wasn’t young like Ali, he had never
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learned how to make these special silos, and he didn’t know how to read and he didn’t get to go to fancy trainings and learn from educated government extension workers.
a. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses?
b. With which determinants (from Task #8, Handout #1) are these two reasons associated?
Part II
Six weeks later, Oumar’s maize had grown up to his chest, and it was time for another Farmer Field Group meeting. Ali demonstrated to all the group members how to dry maize and treat it with ash made from dead mango limbs. Then he showed the group members how to build a storage silo made out of mud. For homework, he asked each of the group members to make a mud storage silo and to scavenge dead mango limbs to make ash so that each farmer could apply it to his or her dried maize at harvest time. Oumar chuckled to himself imaging what his neighbors would do if he tried to build a strange looking mud silo in front of his house. He knew his neighbors would bewitch him for trying to get ahead and considering himself so fancy and educated. He also knew he would never hear the end of it from his dear wife if he spent half the day scavenging mango limbs to make ash that promised to magically prevent insects from eating his maize. He decided to not build a silo or use the insecticide.
Then one day, a few months later, Oumar found half of the sweet potatoes he was storing in a sack in his straw barn had been eaten by rats. He was so upset he decided to go back to the Farmer Field Group and listen to Ali’s advice.
This time the group was meeting at Oumar’s neighbor house, Hamidou. Much to Oumar’s surprise, Hamidou had built a mud silo. As Oumar approached the mud silo, he couldn’t tell what was inside or if Hamidou had enough food or not. How he envied such privacy. No one was laughing at Hamidou for loosing half his sweet potatoes! Enoch shared with the group that one of the best things about the mud silo was that he could just put the grain, tubers or vegetables in the silo and no longer had to buy gunny sacks. Oumar looked inside the silo and saw it was full of sweet potatoes! All the potatoes were dry and untouched by rats or pests.
c. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses?
d. With which determinants (from Task #8, Handout #1) are these three reasons associated?
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e. What happened that helped Oumar to dry and treat his grain and store it in a mud silo to prevent post-harvest losses? Which determinants are the reasons associated with?
Part III
After the meeting Ali asked Oumar if he would be willing to try building a silo and dry and treat his maize crop before putting it in the silo. Oumar told Ali that he could see the mud silo worked for sweet potatoes, but he didn’t believe it could keep mold, mice and rats out of stored maize since they could still enter through the top of the silo. He complained that the clay needed to make the silo was a day’s walk away and he couldn’t afford to be away from his farm that long. Even if he could get the clay how would an old man like him know how to fashion a mud silo? And last but not least, Oumar knew he couldn’t do it because he had forgotten to scavenge the dead mango limbs to make the ash needed to treat the maize, and there were no mango trees near his land.
Ali had ideas for how to solve all these barriers. He convinced Oumar to send his donkey along with a neighbor to the place where clay is collected. For a small fee, the neighbor loaded Oumar’s donkey with the special clay needed to make the silo. Then Ali spent an afternoon teaching Oumar how to fashion the silo. And last but not least, Ali gave Oumar some of his mango ash needed to treat the maize on the condition that Oumar would make mango ash for him next season. Oumar was still angry enough about all the sweet potatoes he lost to try something as crazy and risky as these strange new ideas that Ali was promoting.
Seven months later, Oumar had more maize in his mud silo then he’d ever had so many months after the harvest. He hadn’t lost a single ear of maize to pests or rodents. Seeing this made Oumar realize that he had been losing more grain than he thought to insects and rats. By maintaining more of his harvest, Oumar and his wife were able to sell more of it and finally send their daughters to school, something that he had always wanted to do.
f. At this point, what are the reasons that Oumar would not try the new behaviors to prevent post-harvest losses?
g. With which determinants (from Task #8, Handout #1) are these three reasons associated?
h. What happened that helped Oumar to dry and treat his grain and store it in a mud silo to prevent post-harvest losses? Which determinants are the reasons associated with?
i. What happened as a consequence of adopting the new practices that will probably help Oumar to continue to practice them?
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Task 8 Handout 5*
Box 1: UNIVERSAL MOTIVATORS
1. LOVE 7. POSITIVE SELF IMAGE 2 RECOGNITION 8. SOCIAL ACCEPTANCE 3 PLEASURE 9. COMFORT 4 FREEDOM 10. PEACE OF MIND 5 SUCCESS 11. STATUS 6 SECURITY 12. POWER
* This handout is adapted from materials originally developed by AED.
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Task #10: Exercise, Exercise Achievement Based Objectives: By the end of this task, participants will have: • Demonstrated that one’s behaviors do not always match what they know or
believe • Analyzed the fact that raising awareness or increasing knowledge is often not
sufficient to bring about behavior change • Discussed new ways of describing or defining the target audience • Deduced the importance of targets of opportunity and the necessity of
conducting research studies (especially BA and DND studies). Time: 1 hr Materials: - Masking tape - Flip chart - Statements pre-written on flip chart paper - Target Behavior Message on flip chart paper (see below)
Steps 1. Explain that project implementers need to conduct in-depth audience research
in each community as part of the baseline data survey and continuously throughout the life of the project. If used during project design, the research studies can be useful in helping project designers narrow down the list of behaviors to target once the research has been completed.
2. Explain that for this exercise, they (the participants) will each play two different roles: a community health promoter and a community member. Point out the behavior change goal written on the flip chart paper.
3. Tell the participants that before we decide how to address that goal, we’re going to undertake some audience research—involving all of you as research participants!
4. Ask someone to remove the first blank sheet from each of the three stacks of papers taped to the flip chart or wall. Explain that three different knowledge statements are posted on the walls. Have a participant read them out loud (see Flip Chart instructions below).
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5. Ask the participants to stand near the statement that most approximates their knowledge levels. When participants have settled next to a statement, ask: What do you notice about the groups? How many are in each group? Other observations: Demographic observations? By profession? Gender? Age? Nationality? Language group? Region? Other?
6. Tell participants “You’ve just divided yourselves into segments, or subgroups of the community, according to your stated knowledge level about exercise.”
7. Tell the participants “We will now see what happens when we look at your beliefs.”
8. Ask someone to remove the knowledge statement from each of the three stacks of papers to reveal the belief statement. Have a participant read them out loud.
9. Ask the participants to stand near the statement that most approximates their belief levels. When participants have settled next to a statement, ask: What do you notice about the groups? What differences do you see? Other observations?
10. Tell the participants “We will now see what happens when we look at your behaviors.”
11. Ask a participant to remove the belief statements from each of the three stacks of papers to reveal the action statements. Ask participants to read the action statements and reposition themselves according to what they actually did (i.e. their behaviors).
12. Ask participants “What differences do you see? Demographic observations? By profession? Gender? Age? To what extent did your knowledge and belief predict your behavior?”
13. Stress that what we know and believe is often quite different from what we do. Introduce the terms “Doer” and “non-Doer.” Explain that identifying Doers and non-Doers is an important part of this type of research.
14. While participants are still standing in their groups, ask “If you had to pick one audience segment to work with first, which group would you pick?” Introduce the term of ‘target of opportunity’, i.e. looking at groups that may initially be more prone to change. This may be people with the greatest desire to change due to vulnerability, or those for whom the transition would not be difficult. Ask “How else might you use this information in a BC program?” (identification of a Positive Deviant)
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15. Now ask participants: What did you learn about prioritizing? Suggest that it is not always necessary or practical to divide by socio-demographic characteristics.
16. Ask participants: What have we learned from this exercise? Help to draw out the following themes:
• What people do doesn’t always reflect what they know or believe. That’s obvious to all of us when we think about our own actions, but sometimes when we’re planning health promotion, we forget this basic tenet.
• Which would remind us that just giving people information is generally not enough—even convincing them of a new belief may not move people to take a beneficial action.
• It’s helpful for us in public health to identify the competing behaviors that are making appeals to our audience.
• What new ways of segmenting become apparent? • Marketers look for targets of opportunity, that is: Where can I get the
biggest bang for the buck (i.e. have the greatest impact from my investment)? Consider that we may be more successful at moving the “sometimes exercise” people to the goal than getting the “almost never exercise” people all the way there.
• This activity points us toward the value of doing research studies.
EVALUATION OF THE DAY
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Flip Charts - The “Exercise” Exercise
Behavior Change Goal: All adults will engage in at least 30 minutes of moderate physical exercise 4-6 times a week. Three SETS of flip charts are needed for this game. Each Set has three pages as follows and page 1 should be on top of page 2 which is on top of page 3 for all sets. A blank sheet should be taped on top of page 1, so all pages are hidden. Tape them to the wall so it is easy to remove each page as they are revealed. Set 1 p. 1: I know that getting exercise is very important. I have read multiple studies that prove it. I have also heard many advertisements promoting good health through exercise. p. 2: I believe that getting exercise is very important. I think that everyone should exercise regularly, at least four times a week. p.3: Last week, I exercised between 4-6 times for 30 minutes at a time. Set 2 p. 1: I have heard only that exercising can reduce your chance of heart disease. p. 2: I believe exercise is somewhat important; most people should exercise 1-2 times a week. p. 3: I exercised at least twice last week. Set 3 p. 1: I know that many people are in shape because they exercise, but I’m not sure how they do it p.2: I think that we get enough exercise with the routine activities of the day. p3: I did not do any exercise last week. .
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DAY 3
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Task #10: Review Exercise – Unraveling the Ball (Review of Concepts )
Achievement Based Objectives: By the end of this task, participants will have: • Reviewed key concepts from Day 2 • Reviewed the program and objectives for Day 3
Time: 30 min Materials: - Ball made from flip chart paper secured with masking tape - Strips of paper with review questions written on them (facilitator
should prepare the questions & attach each to the ball so that they can be easily detached one question at a time). Note: See sample list of questions at the end of the session or ask participants to make up their own questions the previous night.
- Schedule & objectives for the day
Steps 1. Ask participants to form a circle.
2. Explain, “As the ball is thrown to you, you must each pull off one strip of paper and answer the question written on it; after you respond, please throw the ball to someone else. You can ask others for help in answering the question if necessary.”
3. Begin the game with a lively toss to a participant and continue the game until all of the questions have been unraveled & responded to. If incorrect or incomplete responses are given, ask participants to help their team mate.
4. Review the schedule and objectives of the day with the participants.
5. Go over the evaluation of day two; if necessary; address any difficult concepts and/or questions.
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Sample Review Questions – Day 3 Review Exercise
1. Name the five columns on the DBC Framework 2. What does DBC stand for? 3. Name five characteristics of a Behavior. 4. Name three ways to describe your Priority Group. 5. What is the Priority Group? 6. What is the recommended sample size for a Barrier Analysis study? 7. What do we mean by: Know exactly who your group is, and look at everything
from their point of view? 8. Why is it necessary to describe the Priority Group in detail? 9. Why do we need to identify the determinants of a behavior?
10. What do we mean by Perceived positive Consequences? 11. What do we mean by: Action is what counts? 12. Which of the determinants are the “most powerful”? 13. What is the difference between action efficacy and self efficacy? 14. Why do we need to write Bridges to Activities? 15. What is the most important lesson from the Exercise, Exercise activity? 16. What are Bridges to Activities? 17. Why can’t we guess what the Priority Group feels and thinks? 18. Name four determinants. 19. In a DBC framework, can a determinant have more than one Bridge to
Activity? 20. Who are the Priority Groups in your project?
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Task #11: Writing the Bridges to Activities4 Achievement Based Objectives: By the end of this task, participants will have: • Matched Bridges to Activities with determinants • Written Bridges to Activities for a list of determinants related to a behavior
Time: 1hr 30 min Materials: - Sample Designing for Behavior Change Framework, Example 1: Poultry
Management (from Task #3) - Flip chart with definition of Bridges to Activities - Flip chart with example Determinants and Bridges to Activities (from
Task 3 Poultry Management Example) - Task 11 Handout 1: Matching Bridges to Activities to Determinants - Task 11 Handout 2: Writing Bridges to Activities from Determinants
Steps 1. Introduction (5 min) Ask the participants to identify where we are on the DBC
framework. [Bridges to Activities]. Explain that we are now going to learn what Bridges to Activities are and how to write them and how to use them.
2. What is a Bridge to Activity? (45 min) a. Show the flip chart with the definition of a Bridge to Activity. Explain that
a Bridge to Activity is a specific description of the direction in which a determinant will go. It is both a link between the determinant and an activity, and a planned change in a determinant. There is usually one Bridge to Activity for each determinant found to be important to the chosen behavior.
3. Ask: Why isn’t it possible to just write activities based on knowledge of the determinants and skip writing Bridges to Activities? [because you don’t know yet what do about the determinants; what aspect of the determinants you need to develop activities around.] For example; if your formative research said that Access was an important determinant, without looking further at the results you might develop an activity for the wrong type of access. Explain that Bridges to Activities are usually derived from the results of formative research.
4 Called “Key Factors” in previous versions of the DBC training manual, this term was changed in the 2011 manual to help learners better understand the meaning of this term.
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4. Show Flip Chart 2 and ask participants to look back at Task 3 and the completed DBC framework on Poultry Management and read the determinants and matching Bridges to Activities. Emphasize that the Bridge to Activity often tells us if we will “increase, improve, reduce or decrease” something. It tells us in what direction we want to affect the determinant.
5. Explain that Bridges to Activities are often written using the word “perception” since most all of the determinants are the priority audience’s perception of something. Explain that some people are tempted to write activities in the place of Bridges to Activities; but they are not the same thing. Bridges to Activities are more general and allow the designer to select among many possible activities.
6. Divide the participants into small groups and ask them to look at Task 8 Handout 2 – Match the Determinant. Explain that the statements in the left column are results of formative research for which Bridges to Activities need to be written. Assign specific statements to each small group and ask them to write a Bridge to Activity for each assigned statement. Review with entire group and correct. Take questions.
7. Optional - If additional work is needed on Bridges to Activities use Task 9 Handout 1 - “Writing Bridges to Activities from Determinants.” Assign each group a behavior and a Priority Group which they can write at the top of the worksheet. Ask each group to write Bridges to Activities for as many determinants as possible for the assigned behavior. In order to do this exercise you need to imagine what the priority audience might have said on the formative research. When they are finished, ask them to exchange their papers with another group and discuss. We will hear from a sample of participants.
8. Close the session by emphasizing that while writing Bridges to Activities can seem challenging at first, once you have conducted your formative research, which guides the writing of Bridges to Activities, it becomes easier. Keep in mind, however, that Bridges to Activities are the link between the determinants and activities, NOT the activities themselves.
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Task 9 Chart #1
Bridges to Activities: A specific description of the direction in which a determinant will go. A Bridge to Activity is a link between the determinant and an activity; it is a planned change in a determinant.
Task 9 Flip Chart #2 Behavior: Adult men and women from families participating in the project, keep chickens enclosed (penned up) at all times.
Determinants Bridges to Activities
Perceived Negative Consequences
Increase the perception that hens will have as good/better laying if penned up. Improve knowledge and skills of farmers in giving chickens adequate feedstuffs and water so they continue laying. Increase % of famers who are convinced that any added expense / effort for penning is cost-effective.
Perceived Positive Consequences
Increase the perception that there are many benefits to enclosing chickens; for example, decreases losses due to wild animals, illness; decreases crop/garden losses due to chickens; makes vaccinating them easier; and provides useful manure.
Access Increase availability of low-cost fencing materials and chicken feed
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(Optional) Task 9 Handout 1 Writing Bridges to Activities from Determinants
Instructions: For each determinant write at least one Bridge to Activity related to the selected behavior. Exchange your completed work sheet with another group. Provide suggestions (critique) the other group’s work.
Determinant Bridge to Activity Perceived Self-efficacy, Skills
Perceived Social Norms
Perceived Positive Consequences
Perceived Negative Consequences
Access
Perceived Barriers
Perceived Enablers
Cues for Action / Reminders
Perceived Susceptibility
Perceived Severity
Perception of Divine Will
Policy
Culture
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Task #12: Formative Research to Find Key Determinants: Barrier Analysis and Doer/Non-Doer Studies
Achievement Based Objectives: By the end of this task, participants will have:
• Examined the 7 steps involved in conducting a Barrier Analysis • Practiced developing questions for use in a Barrier Analysis • Developed a questionnaire for use in a Barrier Analysis Survey • Discussed the Doer/Non-Doer Study as a shorter form of Barrier Analysis
Time: 2 hr 15 min Materials:
- Task 12 Handout 1: Five Tenets of the Barrier Analysis - Task 12 Handout 2: Seven Steps of the Barrier Analysis (and BA Facilitator’s
Guides, if available, see “Reference Materials” section) - Task 12 Optional Worksheet 1 - Developing Questions about Determinants - Task 12 Handout 3: Examples of questions for each determinant category - Task 12 Handout 4: Example BA Questionnaire - Blank notepaper for each small group
Facilitator’s Notes: Step 6: The behavior(s) included in the group work during this exercise should be selected directly from the projects that participants are working on – from the Learning Needs and Resources Assessment, for example. Facilitators should also consult with in-country staff and conference organizers in advance to determine which behavior to use to ensure that participants will be able to find both Doers and Non-Doers and that the field work will be the most beneficial for the widest range of participants.
Alternately, if the group has participants from different programs/countries, facilitators can assign one of the behaviors listed below: 1) Households keep chickens enclosed (penned up) at all times. 2) Children < 2 years of age sleep under insecticide treated bed nets every night. 3) Families will plant home vegetable gardens. 4) Mothers wash their hands after attending to a child who has defecated, after
defecating, before cooking, and before eating. 5) Farmers plant trees to reforest the mountainsides.
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Steps 1. Introduction to Barrier Analysis (10 min)
a. Ask: In the earlier example you gave of your efforts to change, what obstacles or barriers to behavior change did you encounter? Did you know in advance that these would be barriers? How does knowing that the barriers/obstacles to behavior change help us to promote change? [Response: allows us to work on removing the barriers] What about enablers? Did you know in advance what things would make it easier to make a change? How does knowing the enablers to behavior change help us to promote change? [Response: allows us to promote enablers to make it easier for more people to make the change.]
b. Ask participants: Have you ever done a survey to identify barriers and enablers? If the response is yes, ask 1-2 participants to share their experiences and focus on the steps they used in conducting the research and analyzing the data. Explain Barrier Analysis (using the key points below). As you explain the process, mention where the participant’s experiences with discovering barriers and enablers fits in.
• A Barrier Analysis is a survey that focuses on identifying what is
preventing the Priority Group from adopting the behavior, as well as identifying enablers of the behavior. To identify the key barriers and enablers, the priority audience is asked a series of questions to identify up to 11 potential determinants (most of which are “barriers”) that can block people from taking action. There are three determinants which should always be explored, and eight others that may be useful to explore for many behaviors in some contexts. (See Task 8, Handout 1). The questions also identify what the respondent feels are the key benefits (positive consequences) of an action. These can then be used as “promoters” to “sell” a behavior during behavior promotion activities and messaging. The results of the questions are compared amongst groups of people who already have adopted the new behavior - we call these people “Doers” - and people who haven’t yet adopted the new behavior – called the “Non-Doers.” By comparing these two groups, we can see which behavioral determinants seem to be the most important.
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• All too often, program planners’ focus on increasing knowledge about
the benefits – but lack of knowledge is not usually the biggest barrier. BA surveys enables us to break out of our default mode to consider what factors really make the difference between those who do the behavior and those who do not. Program implementers have learned over the years, that helping people overcome key barriers to behavior change may be one of the most effective ways to help them change their behaviors (some examples of barriers: poor transportation, unsupportive spouse or mother-in- law, fear of negative consequences due to cultural taboos, etc).
2. Five Tenets of the Barrier Analysis (10 min) a. Ask participants to take a few moments to read silently the Task 12 Handout
1 – “Five Tenets of the Barrier Analysis”. Ask participants to underline points that seem important or particularly relevant to them. Ask a few participants to comment. Respond to questions and let participants know that you will be discussing BA in more detail.
3. Introduction to Barrier Analysis - What is it? (30 min) Describe the BA while referring to the following elements and write the questions on the flip chart as you discuss (or use the alternate exercise mentioned at the end of this session):
a. How is Doer / Non-Doer Analysis different from Barrier Analysis? Doer/Non-Doer Analysis is very similar to Barrier Analysis, as they both focus on comparing Doers and non-Doers. The Doer/Non-Doer Survey focuses on 5 determinants, and six questions: Perceived Positive and Negative Consequences (what are the advantages and disadvantages of the behavior), Perceived Social Norms (who approves and disapproves of the behavior), and Perceived Barriers and Enablers (what makes it easier and harder), and. The original Doer/Non-Doer Analysis methodology recommended a different sample size and form of analysis, but we recommend using the same analysis as used with Barrier Analysis if you choose to do Doer/Non-Doer Analysis. Doer/Non-Doer Analysis can take a bit less time given that it involves fewer questions, but it is important to assure that you are not leaving out potentially important determinants of
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the behavior under study. When in doubt, use Barrier Analysis and explore the full set of determinants that you think may influence the behavior you are studying.
b. How many determinants are explored in Barrier Analysis? Barrier Analysis examines up to eleven potential behavioral determinants. Ask the participants to refer to their list of determinants in Task 8 Handout 1 to see the determinants that can be explored with Barrier Analysis. Among them are: Perceived Self-efficacy / Skills, Perceived Social Norms, and Perceived Consequences. It is best to measure as many of the determinants as possible so as not to miss important determinants that may be driving the behavior. It is difficult to know ahead of time which determinants will turn out to be important ones.
c. Who is interviewed? In BA, the questions are asked of individuals from the Priority Group; their responses are compared based on whether they are Doers or Non-Doers. (If they practice the behavior, they are considered “Doers”).
d. Who interviews Doers? Non-Doers? All interviewers should be trained in Barrier Analysis. It is best to have all interviewers interview some Doers and some Non-Doers (rather than having a given interviewer interview only Doers or only Non-Doers). This helps to avoid finding trends that are purely a result of how a particular interviewer asked the question or recorded the responses. If you have one person interviewing and one person recording the responses, be sure to have the two swap roles during the survey.
e. Can the same person be interviewed concerning more than one behavior? If you are conducting more than one Barrier Analysis at the same time, it is best to avoid asking the same person about multiple behaviors. Doing so can lead to over-taxing the respondent, and lead to their providing incomplete or not well thought out responses as they grow weary of being interviewed.
f. What sample size should be used? A sample size of 45 or more individual interviews of Doers, and 45 or more individual interviews with Non-Doers usually gives the best results in Barrier Analysis. [Note to facilitator only: This is based the results of using a sample size calculator for case-control type studies with a p0 value of 0.25, a Relative Risk of 3.0, an alpha error of 5%, and a power of 80%.]
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Interviewing more than 45 & 45 often identifies very small differences between the two groups – differences in determinants which should probably be ignored given their limited correlation with the behavior. If you interview less than 45 & 45, you run the risk of not finding enough important differences between Doers and Non-Doers on which to base your activities and messaging.) If it is impossible to find 45 Doers and 45 Non-Doers, you may still find some significant results. If you cannot find 45 of one group (e.g., Doers), it may be helpful to do more interviews of the other group (e.g., Non-Doers) in order to find statistically-significant differences between the two groups (e.g., interviewing 30 Doers and 60 Non-Doers).
g. What type of sampling should be used? This study is similar to a case-control study, so it is not necessary to have as rigorous a sampling method or to use population-based sampling like you would for other types of surveys (e.g., KPC surveys). However, in order for your results to be representative of most of the people in the area, it is good to draw your respondents from different communities. For example, in order to obtain 45 Doers and 45 Non-Doers, it would be good to interview 5 Doers and 5 Non-Doers from each of nine different communities rather than selecting them all from the same community.
h. How long does a typical BA study take? Compared to some other qualitative investigation methods (e.g., focus groups), Barrier Analysis requires more human and financial resources to conduct since it requires a larger sample size. Compared to some other quantitative investigation methods (e.g., KPC surveys), BA should require less human and financial resources. Nonetheless, if the target population is accessible (and both Doers & Non-Doers can be easily identified), surveying to investigate one behavior can be done with two teams of three people in about two days (visiting 2-3 communities per day per team with about 10 interviews per community). This is in addition to the training time and about one to two days for tabulation, analysis, and planning activities and messages.
i. When in the project life cycle should Barrier Analysis be used?: Barrier Analysis can be used at project start-up (for example prior to detailed implementation planning) which is the ideal time to plan a behavior change strategy, or at midterm or final evaluation for a project which will have a follow-on if a BC strategy is needed or needs adjustment at that time. In addition, some organizations conduct a BA periodically in order to
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research many behaviors during a longer project. (For example, Food for the Hungry sometimes conducts a BA on one key behavior they intend to promote through Care Groups [e.g., exclusive breastfeeding] before each 4-month behavior promotion module.)
j. How reliable are the findings? Because BA identifies statistically-significant differences between Doers and Non-Doers, it is very probable that the determinants found to be different between the two groups are true differences (not just due to chance). The determinants identified have less than a 5% probability of being due to chance (i.e., p < 0.05).
k. How are results analyzed? A questionnaire is developed and administered to Doers and Non-Doers (usually equal numbers of both). The results are tabulated manually on newsprint using a coding guide and the percentage calculated using a simple calculator. Those responses with a 15 point difference or higher indicate the most significant Determinants and Bridges to Activities. It’s important to note that the percentages of Doers or percentages of Non-Doers giving a particular response alone (or even the total combined) are NOT meaningful – it’s the difference between the two groups that matters. And sometimes a minority of both Doers and Non-Doers will give a particular response – but the difference between them is large enough to indicate an important determinant.
The results can also be entered into an Excel table specially created for finding differences between the two groups (Doers and Non-Doers). The Excel spreadsheet calculates the percentages of Doers and Non-Doers who gave each response, and identifies differences that are statistically-significant. By using the spreadsheet, you are more likely to find more statistically-significant differences between Doers and Non-Doers (as compared with just looking for 15-point differences between Doers and Non-Doers). It also shows the magnitude of each determinant (e.g. “Doers were 7 times more likely to say that their husband approved of the behavior than Non-Doers.”) The Excel spreadsheet can be downloaded (as of July 2011) from:
A document explaining how to use the BA tabulation sheet can be found here: http://www.caregroupinfo.org/BA_Analysis_Excel_Sheet_Tab_Sheet_Explanation_Sept_2010.doc
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Future updates to the BA Tabulation Table and instructions will be posted on this page: http://www.caregroupinfo.org/blog/narrated-presentations-on-care-groups-and-care-group-tools/planning-m-e-tools
l. Are qualitative methods sometimes used after a BA study?: Yes, qualitative methods can be useful to use to follow-up after a BA study. For example, if we learn from a question about Perceived Negative Consequences that farmers perceive the promoted behavior will actually make their harvest smaller then we need to do follow- up focus groups to find out where that belief comes from, why they think that happens, and how they think that happens. (How and why questions are often best explored using qualitative rather than quantitative methods.) Similarly, if many people answer that it's more difficult to eat protein-rich foods because of the cost, then we need to learn what the actual cost is and what they are willing to pay, what else they are spending money on that could be foregone to buy the protein-rich food, whether the Doers are more affluent, etc. While BA should help you identify the most important barriers and enablers, it may not be enough to find what truly motivates people, including the “Big Benefits.” Therefore, it can be useful to follow-up this approach with focus group discussions (FGDs) or a Participatory Learning and Action (PLA) activity. (In the section on questionnaire development, however, we will mention a question that you can put at the end of your questionnaire to look into “Big Benefits”.) Also, using TIPS, FGDs, PLA and other qualitative methods can be useful for studying enablers and barriers when a BA study is not possible due to lack of Doers. For example, when you are introducing a behavior that is new to an area (e.g. solar water disinfection, use of Zinc), you may not find any Doers at the beginning.
m. Is Barrier Analysis a quantitative method, qualitative method, or both? Barrier Analysis is both qualitative and quantitative. It has open-ended elements that help us to explore and describe how the two groups think (which makes them qualitative in nature), but it also has quantitative elements (e.g. the statistical comparison of Doers and Non-Doers) which allow us to say which differences are important. Since Barrier Analysis does not measure prevalence of a particular belief, most people do not think of it as quantitative; however, quantitative information is being collected (e.g., which group gave a particular response more often).
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4. Identifying Doers and Non-Doers (10 min) a. Explain: Often, one of the most difficult steps in conducting a Barrier
Analysis is identifying enough Doers, so let’s brainstorm for a moment… (Ask:) • What are some of the ways we might be able to rapidly identify
Doers and Non-Doers? For example in the case of “Households keep chickens enclosed” – How would you describe a “Doer?” Now, how would we find or identify who is a real “Doer”?
• What do we do when people are “on the borderline”? How do we decide if they are a Doer or a Non-Doer? (e.g., slept under an ITN 4 out of 7 nights this week [but not last night]; planted trees last year [but not this year] to reforest the mountainsides)
• What question(s) should we ask to distinguish Doers from Non-Doers? (Mention that these questions are called “behavior questions.” For example, “What food or drink did you provide your baby with during the last 24 hours?” “Did you plant any trees in the past year on the hilly land that you own? How many?”)
• Point out that they need to think about to what degree the behavior is done, how often it is done, etc., when deciding on who will be called a Doer. It is important to not be so strict in your definition that you cannot find any Doers, or so loose in your definition that you cannot find any Non-Doers. Looking for people who “keep all of their chickens enclosed all the time” (the “perfect” behavior) will give different results from those who “keep most of their chickens enclosed most of the time” (a “looser” definition). The same holds true for those who “sometimes have their youngest child sleep under an ITN” and those who “had their youngest child sleep under an ITN last night.”
• Encourage participants to avoid vague wording (e.g., “often”, “usually”) in the behavior question.
• Remind participants that the way you formulate the Behavior Question does NOT change the definition of the ideal behavior (on the DBC framework).
a. Explain: Often, researchers must “draw a line” to divide Doers from Non- Doers, and if the question is phrased slightly differently, respondents may be categorized differently. That does not mean, necessarily, that one measure is better than another. It demonstrates, though, the care that
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researchers must take in consistently defining Doers and Non-Doers. For example, in a National Hand-washing Campaign in Senegal, it was difficult to identify actual “Doers” (those that washed their hands with soap during each of the 4 critical moments), thus the team agreed to relax the criteria for Doers to categorize them as those who washed their hands with soap during at least 2 of the 4 critical moments. Note: In many cases, you will need to conduct some direct observation of your behavior to be certain that Doers are not just telling you what they think you want to hear.
b. Give the following two examples of a behavior question: • Using price information: “During the last planting season, did you
increase or decrease the area planted to any of your current crops? (If yes:) Why did you change the area planted? (Doers are those farmers who mention that it was changed on the basis of price information that the farmer received before the planting season. Non-Doers are those who did not change the area planted, or changed it for other reasons.) Obviously, this one would only be used/studied in a year when crop prices have changed enough to promote this practice.)
• Use of improved seeds: “During the last planting season, what type of seeds did you use? From where did you get them?” (Doers are those farmers who say they used improved seeds during the last planting season. Non-Doers are those who do not.)
• ITNs: “Do you have any bed nets in your house? (If yes:) Is it a permanent net, or has it been dipped in the last 6 months? Who slept under the net last night? (Doers are those mothers of preschool children who mention that their child slept under a treated or long lasting insecticide treated net last night. Non-Doers are mothers of preschool children who either do not have a net, or have one but the preschool child chosen (NAME) did not sleep under it.)
c. Select several participants and ask them to suggest a behavior statement from their projects or from the following topic areas, and to explain who would be the Doer and Non-Doer: • Use of animal fertilizer. • Planting on the contour on hilly land to avoid erosion. • Immediate breastfeeding. • Regular weeding of strawberries
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5. Introduction to the Process: Seven Steps to Conducting a Barrier Analysis (10 min) a. Distribute the 7 cards or pieces of paper (each one with one of the steps
written on it) to 7 volunteers. Ask the volunteers to arrange themselves in the correct order according to the way the steps should be conducted. Tell them that they can ask for help from the other participants if they wish.
b. Once the participants have put themselves in order, ask the rest of the participants if they are in agreement or would like to change anything.
c. Once the group is satisfied with their order, assure that they are in the correct order and rearrange them if necessary. Explain each step (see details in handout below) and respond to questions. Ask: When during the process of doing a DBC framework should the BA be conducted? Refer participants to Task 11 Handout 2 – “Seven Steps of the Barrier Analysis”. Thank the volunteers.
6. Designing the questions/coding guide (35min)
a. Explain: In preparation for our fieldwork, we will now develop the Doer/Non-Doerquestionnaire(s) we will use during tomorrow’s field work5. Distribute or ask participants to refer to Task 12 Handout 3 – sample questions and Task 12 Handout 4 – example BA Questionnaire, Planting on the Contour of the Land.
b. Divide the group into subgroups of 3-4 people. Assign an appropriate behavior from the group’s project to all of the subgroups and ask them to write this on the worksheet. Ask the groups to identify the Priority Group related to this behavior and write this in the space provided. Also discuss and write in the behavior question(s): How will we know this person is a Doer or a Non-Doer?
c. Assign each group two to three determinants. Ask each subgroup to write two questions for their assigned determinants. Participants can use Task 12, Optional Worksheet 1 to complete this Step.
d. Walk participants through an example using the questions on the Flip Chart.
5 If you are conducting a regional training where there is no common project, you can conduct a mock Barrier Analysis study by developing a questionnaire for a behavior like tooth brushing and interview people in the venue of the training. Even if you cannot get the desired sample size you can demonstrate to trainees how the tabulation is done and analyzed and interpreted.
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Note: It will be easier and less time-consuming for the group to use the same behavior such as “farmers will increase or decrease the area planted to any of their current crops based on price information” or “mothers will feed their children foods rich in Vitamin A”, or “pregnant women will make at least 4 prenatal visits during their pregnancy”, etc.
7. Sharing questions (20 min) a. Mention that in the interest of time, for the field work we will focus only on
the three determinant categories used in the Doer/Non-Doer (DND) Study (Perceived Positive and Negative Consequences, Perceived Social Norms, and Perceived Barriers and Enablers). In your programs, time and budget permitting, it is advisable to conduct a full Barrier Analysis (which uses questions from more determinant categories (up to 11 depending on the context and behavior promoted). This is why we explained each of the determinant categories.
b. Ask a couple of participants what questions they came up with to determine if the person is a Doer or a Non-Doer. Discuss these and write the agreed upon “behavior question” at the top of a large flip chart that will be transformed into a sample questionnaire.
c. Ask a representative from each team to share their questions with the plenary group. As this is done, walk participants through the process of developing the questionnaire using the large flip chart sheet (see BA Facilitator’s guide pp. 65- 66). (Optional) If sufficient laptops are available, facilitators may wish to provide the trainees with a template for the questionnaire and have them fill in the blank spaces with their behaviors and the questions related to the determinant categories.
Note: It will be helpful and time-saving to have a volunteer (perhaps an Administrative Assistant) type up the questions that the group selects during the plenary. This person may want to use the questionnaire template found in the Reference Materials folder. Facilitators should ensure that this person is able to follow the discussion without difficulties. After the session, facilitators should check the questionnaires, finalize, and make sufficient copies (including extras) for participants to use during the following day’s field work. All translations of questions should be verified by the facilitators in collaboration with field staff. Each team of participants will be asked to interview 5 Doers and 5 Non-Doers; thus, you will need at least 10 copies (plus a few extras) of the questionnaire
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for each team.
8. Address participants’ questions and explain that the next session will give us a chance to practice using our questionnaire before we conduct the field work. (10 min)
Useful Reference Materials
Barrier Analysis: Davis Jr., Thomas, P., (2004). Barrier Analysis Facilitator’s Guide: A Tool for Improving Behavior Change Communication in Child Survival and Community Development Programs, Washington, DC: Food for the Hungry. The guide can be downloaded at: http://barrieranalysis.fhi.net/annex/Barrier_Analysis_Facilitator_Guide.pdf
There’s a narrated overview presentation on BA here (turn on your speakers or use a headset): http://caregroupinfo.org/vids/bavid/player.html
See also Food for the Hungry’s webpage on Barrier Analysis: http://barrieranalysis.fhi.net/how_to/how_to_conduct_barrier_analysis.htm Note: This website (which is no longer updated) mentions using focus group discussions as an option for conducting Barrier Analysis. It is difficult to identify real differences between Doers and Non-Doers using focus groups. Comparing responses on questionnaires used in individual interviews is a much more reliable way to collect the data. Based on their experience using the methodology in numerous countries, Food for the Hungry (and many of their colleagues working in Ag, health and development) no longer recommend use of focus groups in Barrier Analysis. This and other changes to the Barrier Analysis Facilitator’s Guide are explained in the preface to the second printing, available here: www.caregroupinfo.org/docs/BA_Preface_to_Second_Printing.doc See also the Academy for Educational Development’s website on the Change Project: http://www.changeproject.org/tools/xchangetools/tx_Doer_Non-Doer_tool.html
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Task 11, Handout 1
The Five Tenets of the Barrier Analysis
1. Just because a person knows what he/she should do does NOT mean that he/she will do it. Other factors influence our decisions. Having knowledge about the positive consequences of a behavior is only one factor. People often learn about a behavior long before they are willing to adopt it.
2. Just because a person wants to do a behavior does NOT mean that he/she will do it. Sometimes we are blocked and cannot do what we truly want to do and know we need to do (e.g., for lack of time, money). In addition, people often do not seek help from others (e.g., friends, health providers, God) to overcome a problem or change a habit.
3. Just because a person fears a given outcome does not mean they will take action to prevent it. Many times we try to increase the level of FEAR that a person has in order to get him/her to do a preventive action. However, sometimes the problem is too much rather than too little fear of the problem or disease. For example, we may talk about the danger of cancer to get someone to get tested for cancer, or the danger of rats to convince a person to build an improved silo. However, studies have shown that sometimes too much fear can keep a person from doing something (e.g., getting tested for cancer when they would “just as soon not know”).
4. Many of the actions that people engage in to improve their lives are NOT necessarily done for the reasons that we promote. It is possible to encourage a person to do something that improves his/her life for reasons that are not directed at improving agricultural productivity or health (e.g., building a silo so nosy neighbors don’t see how much you are harvesting; washing yourself with soap in order to smell good). We need to find reasons that motivate (or would motivate) people to do something that will improve their lives or well-being.
5. If you do not choose the right behavior to promote, increasing adoption won’t make much difference. Barrier Analysis will only help you to increase the percentage of people who adopt a behavior you want to promote. But if the behavior you plan to promote does not have that much effect on an outcome (e.g., agricultural productivity, child malnutrition) then do not expect BA to help you. Changing a few of the right behaviors can often drive a lot of change. There are other tools and information that you should be using, as well, to assure that you are picking the right behaviors to promote (e.g., positive deviance inquiries, scientific effectiveness studies).
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Task 11, Handout 2
The Seven Steps of Barrier Analysis
1. Define the Goal, Behavior and Priority Group -what you want to happen as a result of your BC strategy. For example, “increase the percentage of maize farmers who use organic fertilizer”, “increase the number of women of reproductive age who receive prenatal care during the first trimester”, etc.
2. Develop the Behavior Question: This non-leading question (or set of questions) will help you determine if a respondent is a Doer or a Non-Doer. For example, “During the last planting season, what type of seeds did you use? From where did you get them?” Researchers must be consistent in how they define Doers & Non-Doers during a study.
3. Develop Questions about Determinants and Pretest Questionnaire: Identify 1-2 questions for each of the determinant categories (see Task 8, Handout 1) and prepare the questionnaires/coding guides with potential responses. (Take care: this is one of the most difficult steps!) Test the questionnaire on a few members of the Priority Group to assure the questions are understandable.
4. Organize the Data Collection: Decide in what sites (e.g., community gardens, clinics) you may find Doers & Non- Doers or in which communities you will conduct interviews. Seek authorization from appropriate Influencing Groups (village chief, clinic managers, etc.). Practice interviewing using the questionnaire. Make sufficient copies of the questionnaires. Arrange transportation to interviewing locales.
5. Collect Field Data for Barrier Analysis: Conduct at least 45 interviews of Priority Group members who are “Doers” of the behavior, and at least 45 interviews with “Non-Doers” who do not do the behavior. Record the responses on the questionnaire. Specify any “other” responses – write them in the respondent’s words.
6. Organize and Analyze the Results: Prepare the coding guides. Work in a group to tabulate results from each interviewer on newsprint. Enter the tabulated results in the Excel BA Tabulation Sheet. Compare the answers of the Doers and Non- Doers for each question/response. Look for statistically-significant differences between the Doers and Non-Doers using the Excel sheet. For statistically-significant differences, note the level of association (Odds Ratio column) between the response and the behavior.
7. Use the Results of Barrier Analysis: After analyzing your data, decide what changes you need to make in your program design. (Write these planned changes as Bridges to Activities.) Which determinants must be addressed through your activities? Which messages should be used? How will you address the Influencing Groups? Decide how to monitor changes in the determinants during the life of your project.
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Task 11 Handout 3
Sample Questions for Barrier Analysis*
Determinants Sample Barrier Analysis Questions to Use
Perceived Self-efficacy / Skills
Are you able to use organic fertilizer on your maize crop given your current knowledge, skills, time, and money?
Are you able to exclusively breastfeed your child given your current knowledge, skills, and time?
Perceived Social Norms
Do (or would) most of the people you know approve of your using organic fertilizer on your maize crop?
Who approves/supports (or would approve/support) your decision to use organic fertilizer on your maize crop? Who would disapprove?
Do (or would) most of the people you know approve of your exclusively breastfeeding (NAME OF CHILD)?
Who approves / supports (or would approve/support) your decision to exclusively breastfeed (NAME)? Who would disapprove?
Perceived Positive Consequences
What are (or would be) the advantages/ benefits of using organic fertilizer on your maize crop?
What are (or would be) the advantages/benefits of exclusively breastfeeding (NAME)?
Perceived Negative Consequences
What are (or would be) the disadvantages of using organic fertilizer on your maize crop?
What are (or would be) the disadvantages of exclusively breastfeeding (NAME)?
Would giving only breast milk to your child help him/her to avoid getting diarrhea and other illnesses?
Access
How difficult is it for you to get the materials needed in order to use organic fertilizer on your maize crop?
How difficult is it for you to get to the local clinic when your child has diarrhea? How do you feel about how you are treated when you visit that clinic?
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Determinants Sample Barrier Analysis Questions to Use
Perceived Barriers and Enablers
What makes it easier (or would make it easier) for you to use organic fertilizer on your maize crop? What makes it difficult (or would make it difficult)?
What makes it easier (or would make it easier) for you to give only breastmilk to your infant less than 6 months? What makes it difficult?
Perceived Cues for Action / Reminders
Is it easy to remember the date and location of the monthly seedling distribution?
Is it easy to remember the date and location of the immunization post where you need to take your child for vaccines?
Was there any particular event that made you decide to start use organic fertilizer? (Doers only)
Perceived Susceptibility (Perceived Risk)
Do you think that you may have a problem with losing some of your yield during the coming year due to rats or insects?
Do you think you are the type of person who could get AIDS?
Perceived Severity
How serious a problem is it if your crops become contaminated with aflatoxin?
How serious a problem is malnutrition in children compared to other problems that they could get?
Perceived Divine Will
Do you think that God (or the gods) want(s) you to burn your fields after the harvest?
Is it God’s will that infants get diarrhea and other illnesses?
Policy
Are there any laws or policies that make it more likely that you will burn your fields after the harvest? (Make it less likely?)
Are there any laws or policies that make it more likely that you will immunize your child?
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Determinants Sample Barrier Analysis Questions to Use
Culture
Are there any cultural rules / taboos against use of organic fertilizer? (In favor of it?) Do you believe in those taboos?
Are there any cultural rules / taboos against immediate breastfeeding? (In favor of it?) Do you believe in those taboos?
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Task 12 - Handout 4, Example BA Questionnaire
Barrier Analysis Questionnaire on Planting on the Contour of the Land
for use with Farmers Interviewer’s Name: ___________________ Questionnaire No.: ______
Age of interviewee: ____ years Main language interviewee speaks: ____________
Gender of interviewee: Male Female Language of Interview: ____________
Discuss CONFIDENTIALITY: • Purpose of study • They can choose to participate or not participate in the study. No services will
be withheld nor will they be discriminated against if they choose not to participate.
• Everything they say will be held in strict confidence and will not be shared with anyone else.
• Ask the person if they wish to participate. If not, thank them for their time.
(Doer/Non-Doer Screening Questions) 1. Do you farm any farmland that is on an incline (hilly)?
1. Yes 2. No End interview and look for another farmer 3. Don’t Know / Won’t say End interview and look for another farmer
2. (Explain terracing to the interviewee.) Do you plant on the contour of the land on at
least half of the inclined farmland that you farm? 1. Yes 2. No 3. Do not know / no response End interview and look for another farmer
1. To be a Doer, the farmer must say Yes to question #1, AND Yes to
question #2. Please interview farmers who meet these conditions, but do not tell them that they are a Doer.
2. To be a Non-Doer, the farmer must say Yes to question #1, and No to question #2. Please interview farmers who meet these conditions, but do not tell them that they are a Non-Doer.
3. If the farmer gives response #2 or #3 to question #1, or response #3 to question #2, s/he is neither a Doer or Non-Doer Do not interview him/her.
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EXPLAIN: We are conducting this study to better understand why some farmers plant on the contour of the land on most of their inclined (hilly) farmland and others do not. (Ask the person to explain “planting on the contour of the land.” If they do not know what it is, explain it to them before proceeding.)
(Perceived Self-efficacy / Skills) 3. With your present knowledge, money, time, and skills, do you think that you could
plant on the contour of the land on the inclined farmland that you farm over the next year?
1. Yes 2. Possibly 3. No 4. Don’t Know
(Perceived Positive and Negative Consequences) 4a. Doers: What are the advantages of planting on the contour of the land on your
inclined farmland? 4b. Non-Doers: What would be the advantages of planting on the contour of the
land on your inclined farmland? (Write all responses below. Probe with “What else?”) 5a. Doers: What are the disadvantages of planting on the contour of the land on
your inclined farmland? 5b. Non-Doers: What would be the disadvantages of planting on the contour of
the land on your inclined farmland? (Write all responses below. Probe with “What else?”) (Perceived Enablers & Barriers / Self-efficacy) 6a. Doers: What makes it easier for you to plan on the contour of the land on your
inclined farmland? 6b. Non-Doers: What would make it easier for you to plant on the contour of the
land on your inclined farmland? (Write all responses below. Probe with “What else?”) 7a. Doers: What makes it more difficult for you to plant on the contour of the land
on your inclined farmland? 7b. Non-Doers: What would make it more difficult for you to plant on the contour
of the land on your inclined farmland? (Write all responses below. Probe with “What else?”)
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(Perceived Social Norms – Who Approves / Supports) 8a. Doers: Do most of the people that you know approve of your planting on the
contour of the land on your inclined farmland? 8b. Non-Doers: Would most of the people that you know approve of your planting on
the contour of the land on your inclined farmland? 1. Yes 2. Possibly 3. No 4. Don’t Know / Won’t say
9a. Doers: Who are the people that approve of your planting on the contour of the land on your inclined farmland?
9b. Non-Doers: Who are the people that would approve of your planting on the contour of the land on your inclined farmland?
(Write all responses below. Probe with “Who else?”) 9a. Doers: Who are the people that disapprove of your planting on the contour of
the land on your inclined farmland? 9b. Non-Doers: Who are the people that would disapprove of your planting on the
contour of the land on your inclined farmland? (Write all responses below. Probe with “Who else?”) (Perceived Access) 10a. Doers: How difficult is it (or was it) to get the materials and services needed to
plant on the contour of the land on your inclined farmland? 10b. Non-Doers: How difficult would it be to get the materials and services needed
to plant on the contour of the land on your inclined farmland? 1. Very difficult 2. Somewhat difficult 3. Not difficult at all. 4. Don’t Know / Won’t say
(Perceived Susceptibility / Perceived Risk) 11a. Doers: How likely is it that you would lose a lot of topsoil if you did not plant on
the contour of the land on your inclined farmland? 11b. Non-Doers: How likely is it that you could lose a lot of topsoil if you do not plant
on the contour of the land on your inclined farmland? Very likely, somewhat likely, or not likely at all?
1. Very likely 2. Somewhat likely 3. Not likely at all. 4. Don’t Know / Won’t say
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(Perceived Severity) 12. How bad of a problem would it be for you if you lost more topsoil? A very bad
problem, somewhat bad problem, or not a problem at all? 1. Very bad problem 2. Somewhat bad problem 3. Not a bad problem at all 4. Don’t Know / Won’t say
(Perception of Divine Will) 13a. Doers: Do you think that God (or the gods) approves of your planting on the
contour of the land on your inclined farmland? 13b. Non-Doers: Do you think that God (or the gods) would approve of your
planting on the contour of the land on your inclined farmland? 1. Yes 2. No 3. Don’t Know / Won’t say
(Policy) 14a. Doers: Were there any community laws or rules in place that you know of that
made it more likely that you plant on the contour of the land on your inclined farmland?
14b. Non-Doers: Are there any community laws or rules in place that you know of that make it more likely that you will plant on the contour of the land on your inclined farmland?
1. Yes 2. No 3. Don’t Know / Won’t say
(Culture) 15. Are there any cultural rules or taboos that you know of for or against planting on
the contour of the land on your inclined farmland? 1. Yes 2. No 3. Don’t Know / Won’t say
(Optional question on Universal Motivators – can be asked in focus groups instead) 16. What do you want most in life? (Write all responses below. Probe with “What else?”)
THANK THE RESPONDENT FOR HIS OR HER TIME!
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Task #13: Preparation and Practicum6 – Conducting Formative Research Achievement Based Objectives: By the end of this task, participants will have: • Finalized the Doer/Non-Doer Study questions • Critiqued a role play on interviewing techniques • Listed do’s and don’ts of interviewing • Practiced posing the survey questions • Discussed logistics and details of the field work • Conducted field work
Time: 1 hr 45 min preparation and 4-6 hr for field work (depending on actual travel time to & from field worksite)
Materials: - Flip chart with names of team members written on it - Specific interviewing techniques written on a piece of paper for the role play
(3-4 techniques to improve upon, see Note below) - Flip chart with a “Dos” and “Don’ts” T-chart - Computer, printer and paper, and stapler - Copies of questionnaires (sufficient copies for each team) - Blank notepaper for each small group - Logistics (cars to transport participants to practicum site; refreshments for
participants according to project norms)
Facilitator’s Notes: Step 3: If you finish the questionnaire the previous day or before lunch today, ask three volunteers if they will help present a role play. Provide them with a copy of the question-naire as soon as it is available and explain that you would like them to demonstrate some interviewing techniques (ask the volunteers to do nearly everything correctly, but to demonstrate 3-4 techniques to be improved upon that are not necessarily easy for the participants to identify [e.g., leading, putting the question into own words, failing to establish eye contact].) If the questionnaire is not ready by lunch today, then use the alternative Step 3 to help participants brainstorm good and bad interviewing techniques. Facilitators should consult with in-country staff to establish teams for the field work. For example, it may be helpful to have a project staff member paired with a representative from one of the project’s partners; and for mentoring purposes, it may help to pair a stronger interviewer with one who may be less experienced. 6 If the training is regional, and there is no project to visit, the Barrier Analysis practicum can be done among the staff of the training venue using a generic behavior such as brushing one’s teeth at least twice a day.
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Steps 1. Introduction (5 min)
Explain that now that we have developed our Doer/Non-Doer (DND) study questions, we need to review them with the entire group. Then, we need to translate them into the local language so we all are asking the same questions using the same exact words.
2. Reviewing the questionnaire (35 min) a. Divide participants into the pairs for conducting the DND in the field
(according to the flip chart) and distribute the draft questionnaire to each team.
b. Working in the large group, read each question aloud and ask the participants if the question is clear. Are there any terms that might be confusing? Is there a simpler, clearer way to pose the same question? Ask the teams to share any terms or wording they feel should be improved upon and ask everyone to make these changes on their own copies of the questionnaires.
c. Emphasize: When you conduct the real BA or DND in your project zone, you should first pre-test the questionnaire with people that are similar to those in your Priority Group - this will help you ensure that the questions are easily understood by the Priority Group. In the interest of time, we will not do that during our workshop; however, it is an important step.
d. Question by question, ask the participants how they will ask the question in the local language and come to a consensus about the translation. If possible, have someone who is fluent in the language, and can write it accurately, type in the agreed upon local language translations on to the master questionnaire. As soon as the questionnaire is finalized in both international and local language, print out enough copies for the field work.
3. Interviewing Techniques (45 min) a. Tell the participants that it isn’t enough for the questionnaire to be correct.
The interview techniques must also be appropriate. b. Invite the role play volunteers to demonstrate interviewing techniques (see
Facilitator’s Notes). Tell participants that the role play is to help them identify positive techniques of interviewing.
c. Thank the volunteers and ask a few participants to comment on what they
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saw as examples of effective interviewing techniques. Note these on the flip chart under “Dos.”
d. Ask participants to name common mistakes an interviewer might make. Note these on the flip chart under “Don’ts.”
Alternative: If the questionnaire is not ready for the role play, skip Steps 3b through 3d and ask if anyone has had experience in conducting surveys. If so, ask them to offer some ‘do’s’ and ‘don’ts’ for interviewing and list these on a flip chart using a T-chart. Continue on to Step 3e.
e. Offer the following tips, if they are not mentioned by participants: - Provide an appropriate introduction using customary greetings. - Ask the respondent if they are willing to participate in the survey. - Try to find a quiet place to conduct the survey where you won’t be
disturbed or overheard. - Determine early on if the person is a Priority Group member, if not, thank
them & move on. - Ask questions to determine if they are a Doer or a Non-Doer (ask open-
ended questions to determine this); for example, “do you use something to help your maize crops grow better?“ If the response is, “yes”, ask: “what?” If they say “fertilizer”, ask: “what type?” instead of: “Do you use organic fertilizer on your maize crops?” Ask: “where do you keep your chickens?” If they say: “outside”, ask: “where exactly?” instead of “Do you keep your chickens penned up?” or ask: “What did you give your baby during the last 24 hours?” instead of “Do you only provide your baby with breast milk?” or “How many visits did you make to the clinic during your last pregnancy?” instead of “Did you make 4 prenatal visits during your last pregnancy?”
- Speak loudly and clearly. - Make appropriate eye contact. - Encourage/thank participants for their responses (Show respect for
every answer they provide). - Use the child’s name when asking questions related to under fives. - Be faithful to the question, repeat it slowly if the respondent does not
answer; do not interpret the question. - Say “anything else?” if the question may have more than 1 response.
f. Explain that we will now practice incorporating these techniques into our own interviewing practices by conducting our own role plays. In your same pairs, role play a conversation between an interviewer and the interviewee. Please
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make sure that both of you get a chance to role play the interviewer. g. As role plays are being conducted, the facilitator will circulate and help
ensure that effective techniques are reinforced and inappropriate ones are improved upon.
4. Instructions for field work & questions (20 min) a. Show the flip chart indicating which participants have been assigned to work
together in field work teams. b. With the large group, review the location of the survey and explain why this
site was chosen. Explain what the participants can expect when they arrive at the site (will the interviews be conducted going from door to door, or has someone gone ahead to “organize” the women to be ready in one spot?) Explain how the participants will get there and when they will leave. Discuss the roles and responsibilities of each of the team members, what materials they will each have, etc. Answer any questions that come up.
c. Remind participants: • Because this is a “practice DND,” we will not focus on the appropriate
numbers for our sample size, but instead try to better understand and practice the methodology. For our field work purposes, each team should try to interview at least 5 Doers & 5 Non-Doers. If you finish ahead of time, before the scheduled time for pick-up, and have checked and organized your notes, please try to interview more people.
• Please rotate roles so that each person gets an opportunity to practice being the interviewer and the note taker.
• Please (both team members) review your questionnaires for accuracy and legibility after each interview.
• When you have completed your interviews, organized and reviewed your questionnaires, please return to the pick-up location on time (feel free to conduct additional interviews if time allows).
Evaluation of the Day
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Day 4
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Task #14: Compiling and Analyzing the Data Achievement Based Objectives: By the end of this task, participants will have: • Reviewed and organized the results from their field work • Developed a coding guide based on responses given during the field work • Compiled their responses onto a summary tally sheet • Entered summarized data on the Barrier Analysis Tabulation Worksheet (Excel) • Analyzed the biggest differences between Doers and Non-Doers using the BA
Tabulation Worksheet Time: 1 hr 30 min Materials: -Previously prepared Flip Charts (one for each question) with columns for coding and tallying (see Task 14 Handout 1 for an example) -Completed questionnaires -Task 14 Handout 1: Coding Guide/Tally Sheets for participants -1 hand calculator -Computer (optional for using the BA spread sheet) -Barrier Analysis Tabulation Worksheet (Excel): Download from http://www.caregroupinfo.org/BA_Tab_Table_Eng_9_30_10.xls Optional: Sample Barrier Analysis data sheets in Reference Materials folder Facilitator’s Notes: Have the participants sit at tables that are placed in a circle or “U” so that everyone can see everyone else and the facilitator can be easily seen by all.
Steps 1. Introduction (5 min)
a. Remind the participants of where we are among the seven steps in the BA [Response: Step 6: Organize and analyze the results of the BA.]
b. Ask participants to review their questionnaires and ensure that their notes are legible.
2. Organizing the Questionnaires for Tabulation (10 min) a. Ask the participants to clear everything off their table tops to make room
for the questionnaires. b. Ask participants to identify the Doers and the Non-Doers and write “D” or
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“ND” at the top of each page accordingly. c. Ask participants to separate the Doer questionnaires from the Non-Doer
questionnaires and put them in separate piles. d. Collect the piles of Doer and Non-Doer surveys and distribute the Doer
surveys evenly amongst the participants. There will be several questionnaires per participant. Participants should place the questionnaires so that it is easy to read the responses to the first question from each questionnaire at the same time. Note: a word of caution here, since it may be difficult for one participant to work on more than 4 questionnaires at a time; facilitators may want to do this part in two rounds (two for the Doers and two for the Non-Doers depending on the total number of people conducting the coding and tabulation.
e. Count and record the total number of Doers on the Flip Chart.
3. Build the Coding Guide and Tabulating the Study Results (50 mins) a. Display the first page of the Coding Guide/Tally Sheet as a Flip chart and
explain it to the participants. Explain that we will now jointly tabulate by hand, all of the results of the survey they conducted, first for the Doers and then for the Non-Doers.
b. Start with the first question. Ask the participants to look at the questionnaires in front of them and read (silently) the responses, looking for similar responses. Start with the first person in the circle, asking them to say out loud all of the responses that respondents mentioned for that question. Then ask the second participant to mention any other responses on their questionnaires that are not already on the list. Repeat this with each participant until all responses are listed for that particular question. For responses that are very similar, you may list several of the similar responses on the same row (e.g., it’s too hot / heat / too warm). Only do this for responses where you are reasonably certain the respondents were referring to the same thing. At the end of this process, you will have a newsprint with the question at the top, responses in the first column, a column for putting in the number of Doers who gave the response, and a column for putting in the number of Non-Doers who gave the response. For example, for the behavior of: “pregnant women will make at least 4 pre- natal visits during their pregnancies,” potential responses for the question “What are the disadvantages of …?” might be:
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• the Health Center too far/ distance to clinic / too far • Husband would hit me if I went; Husband thinks I will be tested
without my consent • no money to go / cost / expensive
c. Now you are ready to tabulate the results of the first question. Refer to the first response on the flip chart (for the first question), and ask each participant to read the responses on the questionnaires in front of him/her and to show you, by holding up fingers, how many Doers responded with the same or very similar response. If there were no respondents who gave the response, they should hold up a closed fist (so that you have confirmation of zero responses). Ask all participants to look at you when they are done counting. (This avoids having people holding up fingers while they are still counting.) Once everyone is looking up and is holding up a hand, count the fingers and note the number on the flipchart under the Doers column.
d. Read the second response, and have participants indicate how many people gave that response by holding up fingers (or a fist). Repeat this process for each response on the tally sheet until all are tabulated.
e. Based on the total number of Doers and Non-Doers calculated at the beginning of the session, calculate the percentages for each of the more common responses given on the flipchart. Record this on the flipchart before going on to the next determinant question.
f. Repeat steps b, c, d and e above with the second and subsequent questions. Use a new newsprint for each question. (If doing a full Barrier Analysis, there will be some closed-ended questions. For those, you can just copy off the response categories on the questionnaire onto the Coding Guide / Tally Sheet and then count fingers.)
g. Once all questions have been tabulated for Doers, collect the Doers questionnaires. Distribute the Non-Doers questionnaires giving several to each participant.
h. For the Non-Doers, the process should be easier. Put up the Coding Guide / Tally Sheet for the first question. Ask the first participant (in the circle) to add any responses to the coding guide that are not already listed. Do this for all participants until all responses are listed.
i. Tabulate the responses for the first question for Non-Doers, having people indicate the number of responses by holding up fingers (or a fist) and putting tallies into the Non-Doers column.
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j. Repeat this process until all questions have been tallied for Non-Doers. Note: Since errors in tallying are common, especially at first, facilitators can also do the tally in a notebook (where corrections are easier) rather than on the flip chart. The final tally for each response can then be written on the flip chart for all to see, and the percentage calculated.
4. Quick Manual Analysis of Results (30 min) a. Once the Coding Guide/Tally Sheet is completed and percentages have been
calculated, explain that the responses that show the biggest gaps between Doers and Non-Doers reveal areas where the project probably needs to work – these are considered the most powerful determinants. Explain that most important determinants will be identified using the BA Tabulation Table (Excel sheet), as well as their degree of importance. At this point, however, we can look for responses where the difference between the percentage of Doers and percentage of Non-Doers giving the same response was 15 percentage points or more.
b. Ask participants to identify the gaps between Doers & Non-Doers that are more than 15 percentage points. Note: If results show many responses with a 15 point difference or more, participants should focus on those with the largest gap. Ask if any participants can say what these results tell us about our Bridges to Activities. Give examples from the data, if necessary. Discuss what programmatic decisions project staff might take based on the data.
c. Point out any barriers mentioned by Doers that didn’t really hold them back from adopting the practice. Ask participants, “Why do you think Doers mentioned this barrier more than Non-Doers? What would we need to do about this one?” Explain that when Doers mention a barrier more than Non-Doers, it may be that they have only discovered a barrier once they began practicing the behavior. This is helpful for us to know – not in terms of how we promote the behavior, but in terms of the counseling given to people who are recent adopters of the behavior. For example, a farmer may not have perceived time commitment as an initial barrier to adopting integrated pest management (IPM), but after doing it for awhile, he perceives that to be a negative aspect of IPM (e.g., frequent re-application of bio-pesticides during the rainy season). Project staff would then focus on encouraging recent adopters of IPM and to help them to see the future benefit of continuing to
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use IPM and helping them to mitigate any common and time-consuming problems that arise from using IPM. For example, extensionists may promote the use of soap to the bio-pesticide so that re-application does not need to be done as frequently.
d. Point out any enablers that the Non-Doers mentioned more than Doers. Ask participants, “Why do you think Non-Doers mentioned this enabler more than Non-Doers? What would we need to do about this one?” Explain that sometimes Non-Doers imagine benefits of a behavior (that they have not yet adopted) that do not materialize once they adopt the behavior. For example, Non-Doer youth have sometimes mentioned “gaining the respect of their parents” more than Doers concerning sexual abstinence. This may reflect the fact that some parents do not support their children in abstinence (or delay of sexual debut) as much as they imagine. Some parents worry if their children do not have romantic interests, and some youth postpone romantic relationships after making a commitment to abstinence. In this case, it is best to not use those advantages when promoting the behavior as people will quickly learn that those expected advantages will not materialize.
e. Wrap up by explaining that not all 15 point differences between Doers and Non-Doers are true differences (some are due to chance) and that there are some differences of less than 15 points which are true differences, as well. There is a more valid way of identifying which responses are most significant. This is done by using an Excel sheet that allows you to look for statistically-significant differences between the Doers and Non-Doers and tells you how much more likely a Doer or Non-Doer is to give a particular response. Knowing that, it will be easier to decide which determinants deserve more attention. We will talk about that process in the next step.
Note: If the number of Doers and Non‐Doers interviewed the practicum is small (n < 20), it may be
difficult to see any large (15 point or more) differences between Doers and Non‐Doers. In this
case, after completing step a above, facilitators can use the data set in the Reference Materials
folder to help participants learn to analyze the data. To use this data set, ask participants to look
for differences between Doers and Non‐Doers of 15 or more points then review and discuss the
data and decide what the data means (refer to Steps b, c, & d above). Discuss what programmatic
decisions project staff might take based on the data.
5. For teaching computerized data entry and analysis (which is more precise), see instructions in Annex 5.
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Task 14 Handout 1/Flip Chart
Example Tally Sheets of Results for Doer/Non-Doer Study IDEAL BEHAVIOR: __________________________________
Perceived Positive Consequences – What are the advantages of doing the behavior? Responses # Doers Doers % # Non-Doers Non-Doers %
Perceived Negative Consequences – What are the disadvantages of doing the behavior? Responses # Doers Doers % # Non-Doers Non-Doers %
Perceived Enablers / Self-Efficacy – Makes it Easier to do the behavior? Responses # Doers Doers % # Non-Doers Non-Doers %
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Perceived Barriers / Self-Efficacy – What makes it more Difficult to do the behavior?
Responses # Doers Doers % # Non-Doers Non-Doers %
Perceived Social Norms – Who would Approve/Support you doing the behavior?
Responses # Doers Doers % # Non-Doers Non-Doers %
Perceived Social Norms – Who would Disapprove/Does not Support you doing the behavior?
Responses # Doers Doers % # Non-Doers Non-Doers %
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Task #15: Our DBC Frameworks Part 2: Identifying the Determinants and Bridges to Activities, Feedback Groups I
Achievement Based Objectives: By the end of this task, participants will have: • Reviewed a set of data from a BA or DND study • Identified the most important determinants for their behavior and priority • group • Identified the Influencer(s) • Written 3 – 4 priority Bridges to Activities for their DBC framework
related to the determinants identified • Reviewed fellow participants’ DBC frameworks • Provided constructive feedback on their DBC frameworks Time: 1 hr 15 min Materials: - Each team’s partially completed DBC Framework - Extra blank matrices - Data from a study (real or made up) - Task 15 Handout 1 with instructions for this session - Flip chart with ways to give constructive feedback (see Flip Chart 1 below) - Flip chart version of each group’s DBC framework taped to the wall - Flip chart with Review Questions (see Flip Chart 2 below)
Facilitator’s Notes: If you don’t have real data to use for this session, then you can use Task 14 Handout 1 to create fictional data for each behavior and Priority Group selected in Task #7.
Steps 1. Ask participants to sit with the DBC groups that were assigned previously in
Task #7.
2. Pass out data from mock (or real) study results. Explain that this is the data from your Priority Group and this shows the results from a DND or BA study. Note: If your training participants have collected data by doing the DND, and the behavior corresponds to one of the group’s frameworks, then this group should use this real data to continue to develop their framework.
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3. Distribute Task 15 Handout 1 with the instructions for this session. Read aloud and review. Address participants’ questions. Emphasize that each group should use the data sheets provided to identify the determinants and the Bridges to Activities.
4. Allow the groups to work on their DBC Framework; circulate to provide assistance where needed. After about 50 minutes, ask the groups to post their completed frameworks and the data set used to identify the Determinants.
Ask each group to post a “feedback/suggestion sheet” (with their group’s number or name) next to their DBC framework poster or on the table next to the group’s master framework. The suggestion sheets will remain next to the posters or on the tables as groups move around the room.
5. Providing Constructive Feedback and Feedback Questions
a. Explain that we are now going to benefit from our colleagues’ review and feedback of our DBC frameworks. Explain that this is a good way to improve our DBC strategies and make sure that we are being clear. But, before we get started, we want to introduce a new way of giving constructive feedback and provide you with some Feedback Questions.
b. Review the process to be followed for giving constructive feedback with the large group (written and oral) referencing the Flip Chart. Respond to questions.
c. Emphasize that when giving suggestions, the participants should start their sentence with “How about…?” or “What if…?”. In order to focus on the positive, and avoid unnecessarily long explanations, those receiving feedback should not justify what they did or defend their choices, they should just say thank you.
d. Ask volunteers to read the Review Questions (on Flip Chart) and answer participants’ questions.
6. DBC Review (20 min.) a. Ask each group to examine the posted DBC framework of every other group
in 15 – 20 minute intervals, providing written feedback in response to the Review Questions and following the constructive feedback guidelines. Each group should give feedback on each DBC framework.
b. Facilitators should keep track of time and tell the groups when to move on to
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the next group’s framework, making sure that each group reviews every framework.
c. Once the groups have finished providing feedback to each other, invite them to return to their places and read their colleagues’ comments. Ask a couple of volunteers from different groups to share their most helpful suggestions or to ask for clarification on any comments.
Evaluation of the Day
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Task 15 Handout 1 Instructions – Working on our DBC Framework Identifying Determinants and Bridges to Activities Your team has a single behavior to promote with a single Priority Group. You will now work together to:
(A) identify the most important determinants related to this behavior and this Priority Group from the data sets provided (or from the real data you have just collected);
(B) propose several Bridges to Activities that you believe are the most
important in helping this group to adopt this behavior; and (C) identify the Influencing Groups.
The following steps will help you organize your time: 1. Review the data from the Coding Guide/Tally Sheets for your behavior and
Priority Group. 2. Identify the responses where the gaps between the Doers and Non-Doers
are more than 15 percentage points. For the group that is using the real data from the DND study just conducted, confirm the results by checking the Barrier Analysis Tabulation table (Excel spread sheet, if available).
3. Identify the 2-3 determinants that are the most important and write these
on the DBC Framework in the appropriate column. Refer to the list of important determinants from Task 13.
4. Referring back to the session on how to write Bridges to Activities, now
write 1-2 Bridges to Activities for each of the most important determinants onto the “Bridges to Activities” column of your team’s DBC Framework.
Feedback providers say: How about…? or What if…? Receivers say: Thank you!
Task 15. Flip Chart 2 – Review Questions – I
What’s good about the plan?
How could the team improve the plan? “How about…? What if…”
o How clear is the Priority Group description? o How well defined is the behavior?
o Does the data support the choice of determinants?
o How closely do selected Bridges to Activities relate to the selected
determinants and the research (DND or BA) results?
o How well written are the Bridges to Activities?
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Day 5
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Task #16: Review Exercise – Musical Chairs Achievement Based Objectives: By the end of this task, participants will have: • Reviewed key concepts from Day 3 and 4 • Reviewed the program and objectives for Day 5
Time: 30 min Materials: - Stereo with good dancing CD - Blank index cards for writing review questions - Schedule & objectives for the day
Steps 1. Ask participants to each write one review question on an index card and return
to the trainer.
2. Ask participants to form a circle with their chairs and stand inside the circle.
2. Explain, “I’m going to hand out these strips of paper with review questions written on them to a few of you; please pass these strips of paper to the colleague next to you as you dance to the music – this requires a bit of coordination, you must continue dancing as you pass the papers around the circle!” (Alternatively, the trainer asks the first review question, and there after the ‘sitting out” trainee, ask the subsequent question.)
3. Before starting the music (or alternately, singing), remove one chair from the circle.
4. Stop the music after a short interlude (or stop singing), whoever remains standing must answer the question (if s/he does not have a piece of paper, s/he can choose one from a seated colleague).
5. Take away 2-3 more chairs each time & shorten intervals between the music until all the questions have been answered. If incorrect or incomplete responses are given, ask participants to help their team mate.
6. Review the schedule and objectives of the day with the participants.
7. Provide a brief summary of the results from the evaluation of day one. Ask participants for additional information or clarification, necessary. Address any confusion, concerns or suggestions by the participants and thank them for completing their daily evaluations.
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Task #17: Selecting Project Activities Achievement Based Objectives: By the end of this task, the participants will have: • Identified a list of activities that may be used to address various barriers and
influencing factors for Priority Groups. • Reviewed the concept that behavior change often requires more than
increasing knowledge and an understanding of advantages of the behavior. • Applied selection criteria to determine the appropriateness of an activity. • Assessed which part of the process of planned behavior change an
activity addresses. Time: 1 hr 20 min Materials: - Task 17 Flip Chart: Questions for Small Group Discussion - Task 17 Handout 1: A List of Criteria for Selecting Activities - Task 17 Handout 2: Linking Determinants with Activities - Post-its (each table should receive a stack of 3-4 different colors)
Steps 1. Introduction (5 min)
Point to the large DBC framework and show participants the place indicating “Activities.” Explain that we will now be learning how to select the most effective activities to address the Bridges to Activities identified in the Barrier Analysis (formative research).
2. Expanding the list of activities (20 min) a. Explain that now we are beginning to develop the element of the framework
requiring us to use our creativity – Activities. Many of you have a great deal of experience in developing and implementing various activities, so let’s first begin by brainstorming in pairs. Of course, most of our projects require training and some type of education sessions with our Priority Groups, so let’s think of other activities that we use besides these common ones. What are some of the activities you have used in the past or have heard about besides training or education? Especially think about addressing Bridges to Activities. Now, please turn to your partner and list activities other than training or education.
b. Ask pairs to join together to form small groups; small groups then use the flip chart paper to write down different activities. Ask groups to identify
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and write on the flip chart what Determinant and Bridges to Activities the activity addresses (increased availability to post natal care/access, decreased stock outs of contraceptives/ policies, increased perception that the mother can make ORS/self-efficacy, increased perception that using fertilizer will increase yield/perceived consequences, increased perception that other farmers will approve of fencing in cattle during the rainy season/perceived social norms, etc.) and where in the process of planned change this activity would fall.
c. Ask participants to place their flip chart on the wall d. Ask a volunteer do a Gallery Walk (circulate around the room) to observe the
different group’s work. e. After 10 min. ask 1 participant to read one example activity (an unusual one
that isn’t training) from each group for a different determinant/Bridge to Activities.
f. Ask participants what questions they have and if they would like to add additional brief explanations to their activities.
3. Why Choose These Types of Activities? Small Group Discussion (50 min) a. Ask participants: What are some of the criteria you use when choosing
activities? b. Mention that now we are going to distribute a couple of job aids that may
include some of the same criteria you mentioned (if not, we might want to add them). You may well see some criteria that you had not previously considered.
c. Distribute Task 16 Handouts 1-2, “A List of Criteria”, and “Linking Determinants with Activities”. Ask for volunteers to read the instructions and the questions on the flip chart: “Questions for Small Group Discussions”. Address participants’ questions.
d. After about 25 min., ask a volunteer from each group to share their observations about the utility of the handouts and how they responded to the questions on the flip chart – “Questions for Small Group Discussions”. Address participants’ questions.
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4. Wrap Up (5 min) a. Close the session by making the point that we are often tempted to design
activities that focus on increasing knowledge or simply listing advantages of a behavior, but we need to keep in mind that depending on where individuals are in the stages of change – and depending on what the Bridges to Activities are – other activities may be much more appropriate and more effective as catalysts for long-term behavior change.
b. Encourage participants to use their set of handouts when they are deciding upon which activities will be most appropriate for addressing the factors influencing behavior change.
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Task 17 Flip Chart 1
Questions for Small Group Discussion- How to Select the RightActivities
Instructions: 1. In your small group review the 2 handouts, A List of Criteria to Assist in the
Selection of Appropriate Activities, and Linking Determinants with Activities.
2. Select one of the activities that someone in your group mentioned during the previous exercise or that is being currently conducted in one of your projects.
3. Using the following questions, analyze the selection of this activity according to the criteria listed on the two handouts.
Questions: 1. What determinant(s) does the activity address?
2. How does the activity respond to the “Must Have” list? How many of the “Must Have” categories does the activity respond to?
3. How does the activity respond to the “Good to Have” list? How many of the “Good to Have” categories does the activity respond to?
4. Based on your discussion with your small group members, would you select the same activity? Why? Why not?
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Task 17 Handout 1
A List of Criteria to Assist in the Selection of Appropriate Activities The following list of criteria are designed to help you come to consensus on the activities that best address the Bridges to Activities you have selected. Depending on the context of your behavior change intervention, you may want to add criteria to this list.
You MUST HAVE these three criteria for an activity to succeed. If the activity you have proposed meets all three of the following criteria, then you should move forward with that activity. However, if one of the three criteria is absent, then you should consider a different activity.
Feasibility: the activity is capable of being implemented within the ecological and geographical context by most of the people in the Priority Group. For example, daily meetings for farmers and their families may be inappropriate in areas with highly dispersed populations; monthly meetings might be more feasible.
Receptivity of Priority Group: the activity is appropriate within the cultural and social context. For example, working with young extension agents to deliver improved farming technique messages in an area where most people seek agriculture advice from village elders may not result in reaching the Priority Group.
Relevance to the Bridges to Activities: the activity directly addresses the Bridges to Activities of behavior change. For example, if the Bridge to Activity is “increase availability of quality seeds” and the activity focuses on an increase in knowledge about fertilizers, behavior change may not occur because the Bridge to Activity was not addressed by the activity.
It would be GOOD TO HAVE the following criteria for an activity to succeed. You do not need to address all of these criteria, simply choose the criteria that are most important to your context.
Cost effectiveness: the activity produces optimum results for the amount of money spent. When choosing between multiple activities, select the activity that will achieve the desired results for the least amount of money.
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Reach, Equity, Coverage: the activity reaches a high proportion of beneficiaries in an equitable way. Choose an activity that has the potential to reach large numbers of beneficiaries, including the most vulnerable.
Delivery systems: the activity utilizes a functional infrastructure. For example, conservation extension workers who have experience and have gained the community’s trust in delivering messages on improved farming and resource management might be a valuable delivery system for promoting improved seeds and improved farming tools.
Ministry Policy: the activity is coordinated with the current Ministry policy in the area. If the activity is not favorable within the current policy environment, it may be important to advocate for policy change before implementation.
Multiple Bridges to Activities addressed: one activity addresses multiple determinants of behavior change. For example, a demonstration of how to make charcoal from solid waste (cow dung, soil, papers, pieces of wood, sawdust, cereal husks) can give mothers the skills and self-efficacy to prepare affordable charcoal to use for fuel while presenting the possible additional activities that can be done in the time saved from fetching firewood from the national park (income-generating activities, for example), thus addressing determinants of: access, perceived positive consequences, perceived self-efficacy, and action-efficacy. (Solid-waste charcoal is a viable source of fuel for those who cannot afford fuel-efficient stoves or other traditional charcoal).
Organizational capacity: the NGO or the community has the capacity to implement the activity. For example, building hand washing stations next to latrines to ensure hand washing after defecation might not be effective if the community or NGO does not have the capacity to maintain the water supply.
Resources available: The specific human or material resources that are necessary in order to be effective are available in the project area. For example, using radio messages to inform people about where they can trade in their old nets for the 3” mesh gill nets would not be advisable in areas where few people have access to radios.
Scalability: the activity can be scaled-up cost effectively. For example, if an NGO has a cadre of wildlife rangers and the Government is committed to staffing national parks and conducting group discussions with traditional leaders regarding
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wildlife protection and alternative livelihood options, they can work together to preserve wildlife corridors. If an NGO has a cadre of coastal management workers and the local hotels want to protect the beach for tourism, they might team together to protect the sea turtles during mating season. Since the hotel represents the business sector, this type of joint partnership has the potential for being scaled-up as a business venture in other areas for sister hotels also seeking to assure the protection of the wildlife attractions their clients are most interested in coming to see.
Sustainability: the activity will contribute to sustaining behavior change. For example, distributing sapling fruit trees without informing the Priority Group about the maintenance of saplings and/or without addressing the perceived negative consequences of planting trees, will not lead to sustained long-term care for the saplings.
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Task 17 Handout 2
Linking Determinants with Activities7
DETERMINANT OF BEHAVIOR CHANGE
EXAMPLE ACTIVITIES EXAMPLE ACTIVITIES
NUTRITION AGRICULTURE / NRM
Access - Gardening tools distribution - Outreach growth monitoring and
promotion activities
- Distribution of improved seeds/fertilizer/gardening/farming implements
- Persuade local shops to sell seeds and implements.
- Ag volunteers will buy quality seed in bulk to re-package and sell to farmers in affordable quantities.
- Road repair to improve access to markets
Perceived Social Norms - perception that people important to an individual think that s/he should do the behavior
- Recruit/train well respected traditional healers to screen for malnutrition and provide nutrition counseling to mothers.
- Recruit grandmothers to become advocates for ENA as they are respected leaders within the family especially on child care and nutrition.
- Form Modern Farmer Groups where groups of farmers agree to try out new techniques.
- Orient village elders and farmers’ wives to the benefits of adopting the new practices
- Award ceremonies by local authorities for increased production, successful new crops, or best produce or livestock.
Perceived positive / negative consequences – what a person thinks will happen, either positive or negative,
- Make examples of exclusively breastfed infants in communities to show that no harm comes and infants indeed have less illness and better weight gain.
- Cooking demonstrations with
- Cross visits among farmers to see results
- Demonstration plots to show the consequences of the new practice
- Farmers try new crop or practice on a very small scale
7 To save space, the Bridges to Activities were omitted from his handout.
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DETERMINANT OF BEHAVIOR CHANGE
EXAMPLE ACTIVITIES EXAMPLE ACTIVITIES
NUTRITION AGRICULTURE / NRM
as a result of performing a behavior
HFP ingredients; for example: eggs in particular, to show mothers that children 6-11m could digest animal-source foods contrary to local beliefs
the first time to minimize risk.
Cues for Action whether or not a person can remember to do a particular behavior or remember the steps involved in doing it.
- Tying soap from string next to tippy-tap to remind people to wash with soap.
- Memory aid showing the distance between planted rows
- Organized visit by extension worker to remind farmers about ‘next steps’
Perceived severity belief that the problem is serious.
- Having mothers count # of malnourished children who had diarrhea in the past month and compare that to the # of well-nourished children who had diarrhea in the past month
- Walk around the community to identify amount of land that has eroded over the past 5 yrs and is no longer cultivatable;
- Analysis of increasing ‘hunger period’
Perceived susceptibility / risk - a person’s perception of how vulnerable they feel
- Community growth monitoring showing what percent of the community of children is malnourished – results shared with mothers and fathers
- Organize discussion with older farmers/herders to remind current farmers/herders of the negative changes that have occurred over the last decade and how practically no one in the community has been able to avoid the problems.
Perceived Divine Will – a person’s belief that it is God’s (or the gods’) will for her/him to have the problem or to overcome it.
- Work with religious leaders to gain support for equal feeding practices regardless of gender;
- Work with religious leaders to help farmers realize that the weather is a scientific phenomenon and not an act of God. (same with insect infestation)
Perceived action efficacy – belief that
- Positive Deviance/Hearth – since most children will gain
- Crop comparisons – comparing yields using improved seed and
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DETERMINANT OF BEHAVIOR CHANGE
EXAMPLE ACTIVITIES EXAMPLE ACTIVITIES
NUTRITION AGRICULTURE / NRM
the action is actually effective in addressing the problem
weight and change their demeanor during the initial 2 week session.
traditional seed; using new fertilizer and traditional fertilizer
- Compare soils with the use or not of organic material;
- Demonstration plots show that simple irrigation systems make it possible to harvest a crop in dry season.
- Establish systems to monitor and evaluate the results of new practices and share these widely to ‘prove’ the positive results of specific new practices; for example, survival rates in herds that have been vaccinated;
Perceived self-efficacy/skills – an individual’s belief that he or she can do a particular behavior; the set of skills or abilities necessary to perform a particular behavior
- Breastfeeding support groups where mothers help each other overcome BF difficulties
- Also PD/Hearth since mothers learn active feeding techniques
- Demonstration and hands-on practice to apply new skills such as tree planting, installing drip irrigation, etc.
Policy – laws and regulations that affect behaviors and access to products and services.
- Work with Ministries of Industries and local consumers groups to pass regulations requiring and providing standards for the fortification of cooking oil with vitamin A and flour with iron, zinc and B vitamins.
- Controls and regulations on pesticides that limit the import of illegal products;
- Legislation on the use of water to benefit all population:
- Rules for animal circulation to prevent spread of disease;
- Policies to favor marketing of local production over imports.
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Task #18: Monitoring the Behavior Change Strategy Achievement Based Objectives: By the end of this task, participants will have: • Identified some tools that could be used to monitor BC strategy implementation • Decided the most appropriate frequency for monitoring a behavior
change strategy (make distinction between BC strategy and the Behavior, itself)
• Practiced making decisions based on the data collected from a BC monitoring system
Time: 45 min Materials: - Index cards with examples of data collection (see facilitator’s notes) - Task 18 Handout 1: Monitoring Indicators in the Behavior Change Strategy
Note: While of utmost importance to program managers, the topic of Monitoring and Evaluating Behavior Change Strategies is beyond the scope of this training; the writers of this curriculum have thus condensed this session to present a few key concepts.
Steps 1. Introduction (5 min)
Explain: Just as we need a system to measure the other aspects of our community development projects, we also need to monitor the progress of our Behavior Change Strategy. A monitoring system of a Behavior Change Strategy is one that allows you to measure/track progress of the implementation and effectiveness of your BC strategy. It is a part of your overall monitoring system – not separate from it. In this way, to the extent possible project designers should use measurement means that already exist, such as annual KPC surveys (e.g., using LQAS), Ag extension records, and clinic records (for health and nutrition).
2. Identifying Monitoring Tools (20 min) a. Divide participants into small groups, distribute index cards (3-4) with
examples of data collection tools (see below) to each group; group members will discuss the ways these tools could be used to measure/track implementation and/or effectiveness of a behavior change strategy.
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b. Ask each group to present one or two tools (avoiding repetition) and how the tool could be used.
Note: Example tools (in addition to the KPC and LQAS): • For health/nutrition: Child registers (vaccination rates), growth cards,
exit interviews (perceived & actual quality of service), attendance lists (support groups), various clinic records (facility births, PNC) verbal autopsy reports, listener surveys (mass media education), minutes from meetings, Quality Improvement & Verification Checklists, etc.
• For ANR: Input sales records (e.g., fertilizer, pesticides), field observation checklists, distribution records, inventory records, market availability of certain crops, supervision forms, attendance lists for Farmer Field Schools, listener surveys (mass media), minutes from meetings, Community Development Worker QIV Checklists (see www.caregroupinfo.org/docs/CDW_Practice_Promotion_QIVC_(English).doc.
1. Frequency of Monitoring (10 min) Ask: Do all behaviors, activities, outcomes, etc. need to be monitored at
the same frequency? [no…] Why? Why not? What factors influence the timing of monitoring activities? Brainstorm with the large group and write the group’s ideas on a flip chart. [Responses may include: correspondence with project-wide monitoring system; frequency of the planned activity to change behavior; difficulty of the behavior to change; availability of staff; etc.]
3. “Monitoring Indicators in the BC Strategy” (5 min) Explain the diagram on Task 18 Handout 1 and respond to participants’
questions/concerns. Emphasize that if both the priority and Influencing Groups are being reached, and activities implemented (with quality – see outcome indicators), but the behavior is not changing, then program planners should: o reassess the appropriateness of the activity selected first, then o reassess Bridges to Activities through research studies on determinants.
4. (Optional) For those who wish to develop their skills in M & E of Behavior Change strategies, facilitators may want to refer to the optional worksheet “Monitoring the Behavior Change Strategy” in the Reference Materials section.
5. Wrap up/Summary (5 min.) Summarize the three main ideas of Tools, Frequency of Monitoring, and Data based Decision-Making. Address participants’ questions.
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Task 18 Handout 1
Monitoring Indicators in the Behavior Change Strategy
Audience (Priority Group and Influencing Groups) indicators (process) are monitored
by routine data collection system (e.g. monitoring)
Activity Indicators (process & outcome), are monitored with the help of the
routine information data collection or occasional rapid surveys
monitored through KPC and could be checked annually through LQAS or
Sentinel Site samples If audiences are being reached, and activities implemented (with quality- see outcome indicators) but behavior is not changing, Then,
Reassess the appropriateness of the activity selected first, Then,
Reassess Bridges to Activities through research studies of determinants.
If audiences are being reached, and activities implemented (with quality), and behavior is changing, there is no need to monitor or reassess Bridges to Activities.
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Task # 19: Matching Messages to Determinants
Achievement Based Objectives: By the end of this task, participants will have:
• analyzed the source and effectiveness of current messaging practices • recognized that messages that are based on determinants will be more effective • practiced developing messages based on determinants Time: 1 hr.
Materials:
- 8 – 10 example pairs of determinants/topics or behaviors
Steps
1. Introduction – Now that we are almost done with our DBC frameworks, let’s take some time to discuss messages. By now, I am sure you are convinced that knowledge alone will not result in behavior change. However, it’s also important to know that not all messages are designed to simply give people facts (e.g., advantages of a behavior). Messages can be used to convince people of many things (e.g., that most people approve of a particular behavior). I also know that your projects probably rely a lot on messaging and some of you already have communication strategies. Is that right? So let’s discuss how formative research may/should inform your messages.
2. Source of Messages – Ask: Where do typical messages come from- the messages you usually see/use in a project? [Facts for Life, Ministry of Health, Min. of Agriculture, Min of Nat. Resources] And what is the content of these messages typically? What are these messages designed to do? [They are directives about what to do. They are designed to inform someone about the importance and advantages of doing something.] What are some examples of your typical messages? [plant trees, use fertilizer for a better harvest, small families are better, sleep under an ITN to avoid malaria] Now that you know about determinants and Bridges to Activities, how effective do you think these types of messages are/will be all by themselves? [not very, limited] What stage of change are these types of messages directed towards? [pre awareness, usually] Do you think these types of messages are likely to promote behavior change by themselves? [no]
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3. New Source of Messages – Ask: If we conclude that the old types of messages are not likely to result in behavior change, how do you think we can use the results of our formative research to develop more effective messages? [base the messages on the determinants and Bridges to Activities]
Note to Trainer: If you did a mock D/ND or BA as part of the training then ask the participants how the results of the formative research they did would influence the messages they might create to promote the behavior. Give an example by coupling a determinant with a behavior for example:
Perceived Divine Will/latrine use: The Bible says, “As part of your equipment have something to dig with, and when you relieve yourself, dig a hole and cover up your excrement.” (Deuteronomy 23:13) So everyone who believes the Bible should cover their excrement – using latrines is a great way to do that!
4. Divide the group into sub groups of 4-5 people and give each group two
examples of determinants and topics (or behaviors) relevant to their projects (see below for some examples). On a flip chart, each group should write the typical message associated with that topic or behavior and then the new additional message that reflects the determinant.
a. Groups post their flip charts b. Participants do a gallery walk to view other group’s work
5. Trainer wraps up the session by emphasizing that the formative research
and knowledge of determinants and Bridges to Activities should be used in our messaging and communication plans to make them more effective in promoting behavior change.
Example determinants/topics/behaviors (giving topics only will be more difficult; giving the behaviors will be easier). Perc. Social Norms/exclusive breastfeeding Perc. Self-efficacy/complementary feeding Perc. Barriers/poultry penning (keeping chickens in enclosures) Perc. Enablers/planting trees
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Task #20: Our DBC Frameworks Part 3: Planning Activities (Indicators and Messages) Achievement Based Objectives: By the end of this task, participants will have: • Reviewed and revised (if necessary) the first 4 columns of their DBC
framework. • Selected activities that address the Bridges to Activities on their frameworks. • Applied specific selection criteria before choosing each activity on their
framework. • Described the content of the activities in sufficient detail so that the link to
Bridges to Activities is clear. • Developed a mix of activities that together address all Bridges to Activities.
o (optional) Written indicators for the Behavior, Priority Group, and Activities o (optional) Written Determinant-driven Messages
Time: 1 hr Materials: - Each team’s partially completed framework with suggested revisions
from feedback groups - Extra blank DBC frameworks - Task 20 Handout 1: Instructions - Flip chart paper for Task 20 – Activities
Steps 1. Introduction (5 min)
During this session we will continue to develop our DBC frameworks. Please review your work thus far & determine if any revisions are necessary; also, please complete the last row entitled “Activities.”
2. Planning activities – Your DBC Frameworks (55 min)
a. Pass out Task 20 Handout 1 – “Feedback Group Instructions.” Review I with participants and clarify tasks (participants will consider the Bridges to Activities they identified from Task #15 and transfer these directly onto their team’s DBC framework).
b. Ask participants to identify the activities they feel best address the Bridges to Activities based on an analysis of the criteria on the handouts distributed during the previous session.
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c. (Optional) For more advanced groups, ask them to also write indicators for The Behavior, the Priority Group, and Activities; and to write any Determinant – driven Messages that are appropriate to their activity.
d. Explain that they will have 55 min. to work in their teams to complete the activities and incorporate onto their frameworks. Assure that the participants mention both activities that happen at the individual/household level and others that happen within the broader community or institution level (e.g. Ministry Of Agriculture, Education, etc.)
e. Ask the teams to post the flip charts (or hand in their individual frameworks when they have completed their task).
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Task 20 Handout 1 Feedback Group Instructions
1. Review the data from your summary data sheets and the determinants and
Bridges to Activities you have chosen (from Task #14). 2. For each Bridge to Activity select and briefly describe the activity you will
undertake to reinforce the benefits, remove or diminish the barriers or otherwise address the Bridge to Activity.
Example 1: Behavior: Fishermen of Buyuni village use pit latrines instead of defecating
on the beach. Bridges to Activities: a. increase fishermen’s perception that constructing pit latrines is simple b. increase the perception of fishermen that by using the latrine (and not
the beach) their health and environment will improve c. increase access to pit latrines by fishermen of Buyuni village d. increase image that good Muslims do not defecate on the beach or in
other areas of natural beauty Activities: a. Conduct demonstration of latrine construction showing that villages can
easily learn how to make the latrines b. Broadcast radio programs where fishermen talk about how they have less
stomach problems and diarrhea since they began using latrines, and how they are happy with the way the beach looks.
c. Contract local micro-finance organizations to provide preferential access to low-interest loans to fishermen who decide to construct latrines
d. Organize activities with local Muslim leaders that utilize passages from the Quran (e.g., vs. 5:6) to discuss the importance of cleanliness for Muslims and promote the image of a good Muslim being one who does not defecate on the beach
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Example 2: Behavior: Men and women farmers stop farming in critical wildlife
corridors linking Tarangire and Lake Manyara National Parks. Bridges to Activities: a. increase farmers’ perception of the negative consequences of continuing
cultivation on a wildlife corridor b. increase positive perception of the existing policies on creation of
wildlife corridors c. increase positive perception that wildlife corridors on community land can
have compatible and sustainable uses other than farming. Activities: a. Utilize the village assembly forum to convince people of the negative
consequences of cultivating on a wildlife corridor (through skits created by local farmers), to encourage people to respect wildlife corridors, and to inform them about the available compatible and sustainable land uses other than farming. Work with the Minister of Agriculture & Natural Resources to establish a penalty for those who cultivate on a wildlife corridor
b. Set up a cash easement scheme for people observing policies and laws established to safeguard wildlife corridors.
c. [See “a” above.]
3. Make sure that you have picked an activity mix that:
a. Reaches enough people in the Priority Group & the Influencing Groups b. Makes a clear call to action for each group c. Addresses all the Bridges to Activities d. Minimizes barriers while maximizing benefits e. Works together f. Fits your budget
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Task 20 Handout 2 Feedback Groups - Questions
1. What’s good about the plan?
2. How could the team improve the plan?
• How detailed and pertinent is the Priority Group description? Does this information help inform the behavior change strategy?
• How well defined is the behavior? Is it clear enough? Detailed enough to measure?
• How accurately were the most important determinants selected? Does the data support this selection?
• How closely do selected Bridges to Activities relate to the determinants? Are the Bridges to Activities different from activities? Do they tell you what should be done about the determinant?
• Are activities described by type & content? Is it clear what’s to be done?
• How well does the activities mix address all Bridges to Activities?
• How confident do you feel that the activities will help group members adopt the behavior?
Evaluation of the Day
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Day 6
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Task #21: Feedback Groups Achievement Based Objectives: By the end of this task, participants will have:
• Finalized the information on their DBC framework • Reviewed fellow participants’ DBC frameworks • Provided constructive feedback on DBC frameworks • Identified a determinant and corresponding Bridge to Activity on another
group’s DBC framework • Offered suggestions for improvement for each of the other group’s DBC
framework using a guide Time: 1 hr Materials: - Flip chart with ways to give constructive feedback (see Task #14) - Photo copies of all the DBC Frameworks – one per group (or flip chart sized frameworks) - Task 21 Handout 1: Feedback Groups – Questions
Steps 1. Ask the participants to sit in their DBC framework groups. 2. Share the purpose of this session and the specific objectives. 3. Ask participants to finalize the information on their frameworks taking into
account all of the suggestions for improvement they have received. Tell the groups they will have approximately 15 – 20 min. to complete their frameworks and post them on the wall.
4. Show the flip chart with the ways to give constructive feedback (Task #14), read the key questions (Task#19 Handout 1) and answer questions. Emphasize that when giving suggestions the participants should start their sentence with “How about…?” Or “What if…” in order to focus on the positive elements and avoid unnecessarily long explanations.
5. After 20 minutes, ask each group to review each team’s DBC Framework and provide constructive feedback.
6. Co-facilitators should also circulate and make note of things such as well defined Priority Groups; completely defined behaviors; unusual Bridges to Activities; and clearly matched activities.
7. After the gallery walk, facilitate a discussion of the findings of the group, including participants’ observations regarding strengths of each framework and any suggestions for improvement.
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Task #22: Developing Program Strategies Achievement Based Objectives: By the end of this task, participants will have: • Reviewed a sample BC strategy • Discussed how to transform several DBC frameworks into a cohesive overall project strategy
Time: 1 hr Materials: - Task #22 Handout 1 – Sample BC Strategy and Workplan
Steps 1. Ask participants, “How would you take the frameworks and work them into an
overall project strategy?”
2. What additional information would you need to add to the DBC frameworks to transform them into a more complete project strategy?
3. How would you get this information?
4. Say, “Let’s look at an example”. Ask participants to refer to Task #21 Handout 1 Sample BC Strategy. What additional information is included in the strategy document? Where do you think the project team found this information? What additional information do you feel they still need to add? Where will they get this?
5. Summarize by saying, “Once we have identified our priority behaviors, we can develop the DBC frameworks based on results from our Barrier Analyses or Doer Non-Doer studies. A strategy is an approach which takes into account the types of groups you will work with, the ensemble of activities, and any synergies between activities (for example, if community theater is being used to address the barrier of fear of side effects for family planning methods use, then it can also be used for reinforcing other key messages –nutrition, women’s rights, etc.) A strategy is comprised of a compilation of several activities each of which is designed to break down a barrier or to reinforce an enabler (minimize barriers and maximize benefits); this can only be determined through research. Once we add information such as responsible parties, timeframes, resources, M & E methods and indicators, etc. we have transformed our strategy into a workplan.”
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Behavior Change Strategy and Implementation Plan Behavior Exclusive Breastfeeding
Timeframe Priority Group Behavior
Bridges to Activities (&
Determ.)
Activities/
Implementers M & E Indicators
Q1 Q2 Q3 Q4
Skills/Knowledge/Resource or Training Required
Women (15-45 yrs); especially pregnant women and women with babies < 6 months; only youth 16-20 yrs old know how to read & write and many still live with their parents. Oldest are non-literate.; majority are farmers & merchants, speak Swahili; many live in remote communities far from a HC. Youth have 1 – 2 children & the oldest have 5 – 8 children; low economic status.
Women exclusively breastfeed their babies (each time the baby wants to suckle) during the 1st 6 months.
Increase the perception of moms that EBF is very effective to prevent diarrhea & other diseases, & ensures healthy growth and development (Perceived Action Efficacy)
4.1 PD moms bring their healthy babies to Prospective Mommies Clubs; they discuss EBF, its challenges & how they overcame them; focus on the effectiveness of EBF in preventing diarrhea, ARI & other diseases, of colostrum as babies 1st immunization, of BM as complete nutrition & EBF as a stimulus for healthy growth & brain development; train mothers in milk extraction
# of new clubs established per AS every 3 months (target: 4 new clubs/AS/yr = 27 X 4 =108/yr) # of club members/club (target: 86 clubs w/8-10 members/yr) # of clubs meeting each month in which a EBF related topic was discussed & women were given specific messages to transmit to others & to implement (Target: 54 clubs/yr)
X X X X Resource Materials: World Vision-Haiti Curriculum for Mothers Clubs (Dr. Lesly Michaud); Food for the Hungry? + LM’s list of tips for clubs, list of topics/ice breakers, needs assessment Steps: select women leaders to coordinate clubs
Increase the perception of women that everyone is in agreement with their EBF (Perceived Social Norms)
4.2 Utilize theater group to implement EBF sketches : key topics: everyone is in agreement with the mom who wants to EBF her baby; advantages of EBF; challenges & how to overcome them; how to support moms in EBF
# of performances followed by Q&A session including key messages on EBF (Target: 2 performances per Qtr per year per troupe)
X
X
X
See above (FP- Activity 1.2).
Reinforce perception of women that by eating well, they will have sufficient milk for EBF (Self-efficacy)
4.3 At monthly Rally Posts, AS introduces PD EFB mom who shares her experiences re: how to increase nutritional intake during pregnancy & breastfeeding & the results
# of Rally posts held in which key messages on EBF were provided by PD breastfeeding mom- Target: 6 posts /year/site
X X
X X Resource required: 1 page illustrated handout of project’s key EBF messages (see Activities)- to be developed
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Task #23: Closing Session and Wrap Up
Achievement Based Objectives: By the end of this task, participants will have: • Assessed achievement of their expectations • Evaluated their comfort levels in terms of certain key skill areas • Made conclusions according to the overall results of the group on the comfort chart • Described succinctly the value of the workshop to themselves and to
their organizations • Identified next steps they will take to begin applying what they have learned • Received recognition of their participation in the workshop
Time: 1 hr 30 min Materials: - Workshop evaluation form - Post workshop questionnaire (see Task 1 Handout 1) - Flip Chart paper and markers - Comfort chart and 6 colored dots per participant (if possible, use a
different color from those used on the first day) - Certificates and contact lists (if available)
Steps 1. Explain the objectives of this session and pass out the forms (workshop
evaluation, post-test) and the colored dots. Review all of the forms and answer any questions. Explain that it’s not necessary to put names on any of the forms. Explain to participants that as they complete their post-workshop questionnaire, they should take their colored dots and place them on the Comfort Level Chart.
2. Ask participants to share their plans for using the framework. Ask participants, in thinking about your own project and the limits of staff, time, and resources, when do you see yourself and colleagues using this framework? (Encourage participants to be specific, not just say during proposal development, baseline, DIP development, MTE, FE, etc.). While participants are sharing their plans, one of the facilitators or a volunteer can tally up the Post-test results and share these with the participants. Note: facilitators can post the Pre-test results and post-test results next to each other enabling participants to compare their scores.
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3. Ask participants to list three action items that are relevant to this training that they plan to do within the next 2 months.
4. Ask participants, “Who would be willing to be a mentor to someone else in the group?” “Who would like to have a mentor?” As participants raise their hands, ask them to pair up and make a note of each others’ names and contact information.
5. Ask participants to stand by the Comfort Level Chart and invite them to comment on the differences in the comfort levels post-workshop & pre- workshop. Are there any big surprises? Disappointments? Why?
6. Hand out certificates and congratulate the participants. Distribute contact lists and any final materials.
7. Provide participants with the following resources: - Food Security and Nutrition Network News (newsletter): Email to
subscribe, [email protected]. - Food Security and Nutrition Network SBC Task Force Listserv (email
[email protected] to subscribe) - Food Security and Nutrition Network website:
www.foodsecuritynetwork.org - DBC Curriculum authors: Tom Davis ([email protected]), Bonnie Kittle
- CORE Social and Behavior Change Working Group technical updates: http://www.coregroup.org/our-technical-work/working-groups/social-and-behavior-change
- CORE SBC Working Group Listserve (email [email protected] to join) - Barrier Analysis manual and online training: http://barrieranalysis.fhi.net/ - Barrier Analysis narrated presentation:
http://caregroupinfo.org/vids/bavid/player.html - Other behavior change narrated presentations:
1. Please check the box that most closely reflects your opinion.
Workshop Processes and Facilitator Strongly agree Agree Disagree Strongly
disagree The objectives of the workshop were clearly stated.
The workshop was presented in an organized and interesting manner.
The workshop was relevant to my work.
The facilitator showed sensitivity to my issues, needs, and concerns.
All members of the group were encouraged to participate.
I acquired new skills at this workshop that I can apply directly to my job.
I was satisfied with the quality of the materials distributed at this workshop.
2. Overall, how satisfied were you with the workshop?
Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
3. To what extent do you expect this workshop to make a difference in the way you
design, implement, and/or evaluate effective, behavior change projects? No difference Some difference Substantial difference
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4. To what extent do you feel that you will be able to apply the ideas and strategies from this workshop in your work?
Not at all Somewhat Completely Don’t know
5. What I liked most about the workshop was: 6. Would you recommend this workshop to a colleague?
Yes Yes, under some circumstances: (specify) No
Why or why not?
Additional comments:
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Reference Materials
Materials include:
Annex 1. Key Vocabulary Annex 2. Comfort Table (opening session) Annex 3. Answers to Pre/Post Test Annex 4. Stages of Change Game (for Session 2) Annex 5. For Computerized Analysis of Barrier Analysis (Session 14) Annex 6. Sample Data Set
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Annex 1.
KEY VOCABULARY- DESIGNING FOR BEHAVIOR CHANGE
Note: This vocabulary list should be sent to participants prior to the training and distributed registration.
The definitions listed for the terms below are meant to be understood in the context of developing, implementing, monitoring and evaluating a behavior-centered strategy such as one developed using the Designing for Behavior Change Framework.
The terms are divided into different categories so that a user can explore a category of particular interest rather than having to have a specific term in mind.
1.Behavioral Theory
Activities- tasks that program implementers plan, organize, and/or conduct with the priority or Influencing Groups in order to achieve something; for example organizing Farmer Field School meetings or mother’s group meetings; holding malaria prevention health fairs; doing irrigation demonstrations; providing counseling sessions; demonstrating how to make ORS. Activities should be selected to specifically address Bridges to Activities, in other words to reduce the most powerful barriers and increase the most powerful enablers (see Bridges to Activities).
Barrier-a determinant that prevents a person from doing a behavior (see Determinants)
Behavior- a physical action that is specific, measurable, takes place at a specific time and place, with duration and frequency. Changing knowledge, belief, or attitudes toward a behavior is often not enough to change the actual behavior-the action an individual performs.
Behavior Change (BC) Strategies or Behavior Centered Approaches (BCA)- program strategies in which all program activities, not just communication activities, are designed to reduce key (prioritized) barriers, and increase key enablers, to empower Priority Group members to perform positive behaviors. This approach focuses on issues like infrastructure, economic barriers or motivators,
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and other determinants besides knowledge and attitudes.
The DBC framework is a tool for designing BC or BCA strategies; it encourages program planners to consider the full complement of program options/activities often needed for change. Ideally program participants are partners in making the 5 program decisions included in the DBC framework.
Behavior Change Communication (BCC)- communication activities which are designed to address Bridges to Activities and determinants of behavior change by reducing key barriers, and increasing enablers. Communication activities are only necessary when the majority of the Priority Group has limited knowledge about the behavior. BCC activities, alone, generally will not lead to a change in behavior.
Benefit-the reason an individual chooses to perform a behavior. Benefits can be physical or intangible, real or perceived. For example, a tangible benefit of regular exercise is losing weight. An intangible benefit of regular exercise is feeling better about oneself. A perceived benefit of regular exercise is being more like a role model or celebrity.
Current practice- the behavior – or series of behaviors – being practiced by the Priority group at a point in time related to a health outcome. The current practice should move toward the ideal practice over the life of a health project. (see Priority group, Ideal practice)
Designing for Behavior Change (DBC) framework- a tool to help health program designers make key program decisions that will enable the designer to develop a comprehensive and effective behavior change strategy, resulting in increased adoption of positive behaviors among program participants. The five decisions are Behavior, Priority Group and Influencing Groups, Determinants, Bridges to Activities, and Activities (defined below). The DBC framework is built upon the BEHAVE Framework, developed by the Academy for Education Development.
Determinants- determinants are a person’s feelings, beliefs, or other elements within his/her environment that can support her or him to do a behavior, or prevent her or him from doing a behavior. See Task 8 Handout 1 – “Some Determinants That Influence Behavior” – for definitions of some common determinants. (see Benefit, Motivator/Enabler, Barrier, Key factor).
Emphasis or Key or Priority Behaviors- the specific behaviors promoted by a program to achieve the project objectives. They should be empirically proven to have a direct, positive impact on the well being of program participants or their
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productivity (e.g., increased yield). They should also be feasible for program participants to perform, in terms of social acceptability, money, time, skills, and other resources (see Feasible practice).
Exchange principle- the benefit that an individual gets from performing a behavior must be greater than the cost he or she perceives for doing it. Promoting benefits that matter to members of the Priority group (not just those benefits that matter to program designers) is essential to increasing positive behaviors. (see Benefit)
Feasible practice- the behavior, or series of behaviors, that the Priority group is able to do at a point in time given existing knowledge, skills, time, and resources (including program inputs). Sometimes the feasible practice is the same as the Ideal practice; sometimes it is between the Current practice and Ideal practice. (see Ideal practice, Current practice).
Influencing Groups- The group of people who – to a large degree – control or strongly influence the Priority group, who can either support or prevent the Priority group from adopting positive behaviors (e.g. fathers, older women, traditional healers, Ag extensionists, community and religious leaders)
Health education- a program strategy in which an “expert” transfers knowledge and skills related to specific health outcomes to program participants. The connotation of this phrase has come to be a top-down, hierarchical process where participants are passive “vessels” to be filled by the “experts”. Better term: Health promotion.
Ideal practice- the behavior, or series of behaviors, that according to current evidence would have the optimal impact on a health outcome if performed by the Priority group (see Priority group).
Influencing Group (also called Influencing Groups)- the group of people who influence the Priority group, who can either support or prevent the Priority group from adopting positive behaviors (e.g. fathers, older women, traditional healers, community and religious leaders)
Information, Education, and Communication (IEC)- a program strategy in which program staff and partners engage in a dialogue with Priority and Influencing Groups about the behaviors promoted by the program. The focus of this strategy is on changing knowledge, beliefs, and attitudes about key or emphasis behaviors. A more participatory connotation than Health education, IEC, alone, generally will not lead to a change in behavior.
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Key factor- is a specific motivator that influences this group to adopt or not to adopt the behavior (see Formative research, Consultative research, Program participants).
Motivator or Enabler- a determinant that supports a person to perform a behavior. (see Determinants)
Priority group- the group of people who perform the positive behaviors promoted through a program. Priority groups can be those with certain demographic characteristics (age, gender, level of education), or who are most affected by a condition (HIV/AIDS, poverty), or who are most at risk of negative health outcomes (children under 5, pregnant women, out of school youth). In child survival programs, often mothers or caretakers of children under 5.
Social marketing- a program strategy in which commercial marketing techniques are used to promote program behaviors to Priority and Influencing Groups. II. Gathering Data for Program Decisions
Appreciative inquiry- a research process that starts with the assumption that resources already exist within individuals, households, and communities to achieve program objectives and goals. To illustrate, a “needs assessment”, which is not a method of appreciative inquiry, is immediately biased to identify gaps, whereas a “capacity assessment”, which is a method of appreciative inquiry, biases the inquiry team to identify existing resources as well as gaps.
Appreciative inquiry fights against the tendency for program staff to perceive communities as a collection of problems to address rather than groups and individuals who are partners in the project process. (See Capacity assessment, Needs assessment, Positive deviance inquiry)
Barrier Analysis - a research method to identify those determinants which are most likely to prevent – or enable – Priority Groups from doing key behaviors promoted by a project. Responses to survey questions from Doers and Non-Doers are compared. Helps to prioritize barriers and enablers so program designers can focus project resources on the most influential ones. (See Barriers, Doer/non- Doer analysis)
Capacity assessment- a research method, usually focused at the group level, to determine existing strengths which a group brings to a project as well as areas where a group needs assistance to develop skills. For example, a capacity
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assessment may find that an organization is strong at mobilizing volunteer efforts or financial resources, but weak in record keeping or evaluating impacts of projects.
Confidentiality- if a research participant is giving project staff information that could be damaging to the participant if known to his or her community or government, project staff must take every precaution to ensure that specific information gathered through the research cannot be tied to specific research participants. This can be done by ensuring privacy during interviews, using false names in research notes, and by not reporting identifying characteristics of participants in reports (for example, quoting a “prominent community member” rather than “the headman of village Y”). The right to confidentiality is just one of a number of human rights that project staff must be aware of before conducting research in communities, including the right of refusal to participate in research.
Consultative research- a process of data gathering using any method, during any phase of the project. The term “consultative” implies that individuals and groups in the community are partners in the gathering and use of the data, rather than simply “subjects” of the research.
Doer/Non-Doer Study - a research method used to compare individuals or groups in a community who practice a key behavior (Doers) with those who do not practice that behavior (non-Doers). The questions used are a subset of those used in Barrier Analysis. Once program planners know the difference between Doers and non-Doers, they can focus resources on reducing those differences, supporting Non-Doers to become Doers.
Focus group discussion- a discussion among 6-12 people who are similar in some characteristic relevant to a program (e.g., gender and age, number of children, role in the community) about issues related to one specific topic. The facilitator of a focus group encourages all participants to talk to each other, and brings the conversation back to a central topic if it wanders too far off. This method is good at gathering general information about current practices, knowledge, beliefs, and similarities and differences in a community around one topic.
Formative research- a process of data gathering, using any method, during the early phases of a project. Data gathered during formative research feeds into the design of the project, for example, by helping designers to answer the five questions of the DBC framework.
Interview- a research method in which one person is asked questions about one or
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more related topics in a private setting. Sometimes called in-depth interview, key informant interview, or individual interview. This method is useful for getting detailed information about current practices, and when the topic is personally or politically sensitive.
Needs assessment- a research method, usually focused at the group level, that identifies the gaps in a group’s skills, infrastructure, or resources that can be strengthened during a project.
Observation- a research method where actual practices of Priority Group or Influencing Groups are seen and heard by researchers. Observations can either be spontaneous and general, such as a household visit to observe hygiene and sanitation practices of a family over the course of a day, or planned and specific, such as asking a mother to show researchers the correct way to wash her hands and then observing her.
Operations research- a process of data gathering that is planned over the course of a project to test a certain approach, strategy, or technology. May have objectives separate from those of the project.
Positive deviance inquiry- a research method where researchers learn transferable, specific behaviors that are already happening in a community, from “positive deviant” individuals in that community. For example, poor mothers with healthy and well fed 2 year olds in a community with many sick and malnourished 2 year olds are positive deviants. By talking with and observing these “positive deviant” mothers, researchers can learn what specific practices result in better outcomes for their children, and then promote these practices through a project.
Rapid Rural Appraisal or Participatory Learning Appraisal or Participatory Rural Appraisal- these are related clusters of research methods, each with a different philosophy and use, that were designed to ensure that the voices of more powerless groups in a community are heard in the program design or evaluation process. These methods include many that are visual in nature, so that illiterate as well as literate individuals can participate fully in the research. Specific methods include focus group discussions, social mapping, wealth ranking, Venn diagrams, and card sorts/cluster analysis.
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Situational analysis- a broad data gathering process happening early in the program design whereby the general characteristics of a community and the problems to be addressed through specific projects are determined.
Survey- a research method involving a questionnaire centered around a programmatic issue or issues, administered to a random sample of community members who meet specific characteristics (for example, all mothers, or youth between the ages of 15 and 19). The results are analyzed and presented quantitatively. Many different sampling methods are possible, including 30-cluster random sampling and Lot Quality Assurance Sampling (LQAS).
Trials of improved practices (TIPS)- a research method in which individuals or groups in the community are asked to try key behaviors which are going to be promoted by the project for a specific length of time. After the trial, TIPS participants are interviewed to learn whether they were able to perform the behavior consistently, what made it easier or harder, and what if any benefits they perceived from doing the behavior.
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Annex 2. Comfort Table for use in Opening Session
Skills Area Pre-Workshop Comfort Level
Post-Workshop Comfort Level
1 2 3 4 5 1 2 3 4 5 Defining the priority and Influencing Groups of a behavior change strategy
Writing a clear, well-defined behavior
Conducting a Doer/Non- Doer Study
Analyzing quantitative and qualitative data to determine the determinants influencing behavior change
Using specific selection criteria to choose the activities that will best address the Bridges to Activities
Monitoring and evaluating behavior change strategies
Note: Facilitators may want to cut and paste this comfort chart onto the pre/post-questionnaire as the first question. They can ask the participants to complete this as they enter the room at the start of the training. Once they have finished putting an X or checkmark in the column which applies to their own comfort level, they can place the adhesive dots (or simply use a felt pen) to indicate their comfort level on the flip chart-sized Comfort Table posted in the training room.
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Annex 3
Answer Key for the DESIGNING FOR BEHAVIOR CHANGE
PRE-/POST-WORKSHOP QUESTIONNAIRE
1. c 2. c 3. c 4. a 5. c 6. c 7. c 8. a 9. a 10. b
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Annex 4. Stages of Change Game
For Session #2
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Identify the
Problem
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I don’t see a problem
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I will facilitate an activity to help the participants identify the problem
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Study the Alternatives and
look for more information
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There might be a problem,
but I need more information
and alternatives
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I will facilitate an activity to help the participants identify alternatives for solving the problem and provide them with additional information
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Obtain new skills and access to resources and
support
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I’m ready to try something new but there are obstacles
conflicting values
Lack of Social Support
Lack of Resources Fear of Failure and Conflicting
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I will facilitate an activity to help the participants identify how to overcome the obstacles and organize access to resources
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Try out the new
Practice
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I am trying the new practice but I’m still not 100% certain of the outcome
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I will facilitate a discussion on the benefits of adopting the new practice and the consequences of not using it, to encourage permanent change.
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Reflect on and reinforce the New
Practice
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With support and encouragement from my family and community I can succeed.
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Continued reinforcement and support are needed for change to be permanent.
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Continue the practice with
support
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I need to keep trying until the change becomes a habit because I believe the change
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Monitor the change to provide needed support and information
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Celebrate Your Success
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Yes! I can do it!
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Recognize and Celebrate the Success of a Positive Change in Behavior
There might be a problem but I need more information and alternatives.
I’m ready to try something new but there are obstacles.
I am trying the new practice but I’m still not 100% certain of the outcome.
With support and encouragement from my family and community I can succeed.
I need to keep trying until the change becomes a habit because I believe the change is positive.
Yes! I can do it!
Change Agent
I will facilitate an activity to help the participants identify the problem.
I will facilitate an activity to help the participants identify alternatives for solving the problem and provide them with additional information.
I will facilitate an activity to help the participants identify how to overcome the obstacles and organize access to resources.
I will facilitate a discussion on the benefits of adopting the new practice and the consequences of not using it, to encourage permanent change.
Continued reinforcement and support are needed for change to be permanent.
Monitor the change to provide needed support and information.
Recognize and celebrate the success of a positive change in behavior.
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Annex 5.
Task 14. For Computerized Analysis of Barrier Analysis
Computerized Data Entry and Analysis of Results (30 mins)
a. The most valid way of identifying which responses are most significant is by using an Excel sheet that allows you to look for statistically-significant differences between the Doers and Non-Doers and tells you how much more likely a Doer or Non-Doer is to give a particular response. This spreadsheet calculates what is known as an Odds Ratio, looking for associations between particular responses and whether a person is a Doer or Non-Doer. In order to do this, you will first need to download this special Barrier Analysis Tabulation Table from here:
http://www.caregroupinfo.org/BA_Tab_Table_Eng_9_30_10.xls (Note: If the do not find the file, it has been updated, and will be available
on this page: http://www.caregroupinfo.org/blog/narrated-presentations-on-care-groups-and-care-group-tools/planning-m-e-tools)
NOTE: There are three worksheets in the BA Tabulation Table (Excel). The first sheet (BA Results, Area 1) is used when only one study in one area is being done. If you wish to conduct two studies on the same behavior in two separate areas, you will use the first sheet for the first area (BA Results, Area 1) and the second sheet (BA Results, Area 2) for the second. The third sheet, “Result BA, Total, Two Areas” adds the responses from the two different areas so that they can be analyzed together. For the practicum and for most studies, you will only need to use the first sheet. You should only enter data in the green‐shaded cells. The other cells are password protected to avoid inadvertent changes to the many complex formulas. However, if you do need to make changes to the form, use the password “corecore” to unprotect it.
b. Enter the sample size for Doers and Non-Doers interviewed at the top of the spreadsheet (cells B4 and B5). Usually there should be about 45 Doers and 45 Non-Doers.
c. Enter the response categories in the green cells of Column A from the tabulation table you created on newsprint for each of the open-ended questions (e.g., “Makes it Easier,” “Makes it Difficult”). You do not need to include response categories that were hardly ever mentioned by either Doers or Non-Doers since the chance of these being different is very low.
d. Enter the number of Doers and Non-Doers who gave each of those responses in Columns B and C.
e. If you used any closed-ended questions (e.g., questions on “Perceived Severity”, “Access”), you can enter the number of Doers and Non-Doers who
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gave each response to those closed-ended questions further down the sheet. (For the short practicum, you will most likely not use these questions.)
f. Columns D through P will calculate automatically. g. Optional: If you enter data for Area 2, response categories used for Area 1
will show up automatically for Area 2. Add any additional responses that were mentioned in Area 2 below those response categories that show up automatically. Enter the number of Doers and Non-Doers who gave each response. This will allow the third sheet (which combines the data from both areas) to work properly.
h. Now it’s time to analyze the data. Look at Column I: Odds Ratio – this column tells you how many times more likely it is that Doers mention a behavioral determinant as compared to a Non-Doer (or the converse, how many times more likely it is that Non-Doers mention a determinant as compared to Doers). The further away from “1” this number is, the more important the determinant.
i. Look at the p-value to decide if the response is important. The p-value is found in column M. If the p-value is less than 0.05, it should display in a blue font. A p-value of less than 0.05 means that the difference between Doers and Non-Doers is probably not due to chance (i.e., a statistically-significant, “real” difference). If the p-value is not in blue font (and hence not less than 0.05), ignore the determinant regardless of what the odds ratio is. In that case, there may not be a real difference between Doers and Non-Doers. If the p-value is in a blue font (and less than 0.05), there is a real difference between Doers and Non-Doers, and you should proceed to the next step to see how big a difference there is. EXAMPLE: Let’s say that under “Things that make it Easier,” the p-values for “Knowing where to buy soap” and “Owning a basin” are 0.138 and 0.20. Neither of those numbers are less than 0.05, so you can ignore those two responses. Let’s say that for, “Having lots of water,” the p-value is 0.00016, which is less than 0.05, so it’s an important determinant.
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NOTE: When using sample sizes less than the recommended minimum of 45 Doers and 45 Non‐Doers, you may find that no responses show a p‐value of less than 0.05. In that case, you could include any responses with a p‐value of less than 0.10 or even 0.20, but by doing that, it will be more likely that you will be focusing on determinants that are not really important but are just due to chance. How likely is it that a determinant with a 0.20 p‐value is purely due to chance? About 20%, or 1 in 5. And it would be a shame to concentrate a lot of effort on a determinant that is not really important. For that reason, we do not recommend using samples smaller than 45 Doers and 45 Non‐Doers.
j. Now you need to decide how important the determinant is by looking at the odds ratio (OR).
i. If the odds ratio is greater than one: Doers are more likely to have mentioned a particular response than the Non-Doers. To see how much more likely Doers were to mention the response as compared with Doers when the odds ratio is greater than one, simply look at the Odds Ratio. EXAMPLE: Let’s say that for “Husband encourages me to buy soap,” the p-value is less than 0.05 (so it’s an important response, not due to chance). The OR = 5. That means that Doers are 5 times more likely to mention “Husband encourages me to buy soap” than the Doers. How would you use this data? One thing you could do is to try to increase the proportion of men who encourage their wives to buy soap by explaining to men the benefits of their wives using soap, focusing on things that you believe (or have found through conversations) are important to them (e.g., fewer medical bills because of less diarrhea, having their wives and children smell really good, cleaner food preparation).
ii. If the odds ratio is less than one: When the odds ratio is less than one, it means that Non-Doers are more likely to have given a particular response in comparison to Doers. EXAMPLE: Let’s say that mothers say “Having little water,” as something that makes handwashing with soap more difficult, and the p-value is less than 0.05 so it’s an important response. The OR = 0.33, less than 1.0, so Non-Doers are more likely to say it. You need to take the inverse of this number first – Divide 1 / 0.33 which gives 3.0.
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This means that Non-Doers are 3 times more likely to mention “Having little water” as something that makes hand washing with soap more difficult for Non-Doers. How would you use this data? One thing you might do is to promote Tippy Taps, use of ash, or something else that makes it easier to wash hands in less water.
k. If either Doers or Non-Doers have a percentage of 0% (in columns G and F respectively), and the p-value is < 0.05, you cannot use the odds ratio to decide how big of a difference there is between Doers and Non-Doers. Let’s say that you for who approves, mothers say “Mother-in-law,” and the OR column shows “0.00,” because the Non-Doer percentage is 0%. (The OR may show as “#DIV/!” when the Doer percentage is 0%, meaning that it cannot calculate the OR because it would mean dividing a number by zero.) To decide if this response is important, we will look at the percentage point difference between Doers and Non-Doers. If there is a 20 percentage point or more difference between Doers and Non-Doers, we will consider that the result is important. EXAMPLE: Let’s say that 51% of Doers say that “My Mother-in-law” approves of them washing their hands with soap, where 0% of Non-Doers mention this. This difference is greater than 20 percentage points, so we will consider that one to be important. How would you use this data? Since it appears that having a mother-in-laws’ approval is very, very important, we would focus on convincing mother-in-laws of the importance of washing hands with soap so that they can encourage their daughter-in-laws to do so.
Please note that in Columns N and P, the spreadsheet gives a textual interpretation of the OR when the p-value is < 0.05 (e.g., “Non-Doers are 2.9 more likely to give this response than Doers”). (Take questions.)
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Annex 6.
Sample Data Set Note: This is an example data set for terracing land to preserve soil and peri-natal visits. Trainers will need to create their own data sets however for this training if real data from a BA or Doer/Non-Doer does not already exist. Data sets will be most useful if they are based on the behaviors the project is promoting (see LNRAs).
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Barrier Analysis Sample Data: Terracing Land to Preserve Soil
Responses # Doers
% Doers
# Non-Doers
% Non-Doers
Behavior: Terracing land to preserve soil.
Perceived Self-efficacy / Skills – [Can you terrace your land with your current knowledge, money, and skills?]
Yes 36 80% 29 64% No 9 20% 16% 36% Perceived Positive Consequences – Advantages Increased rain that soaks into soil (percolation) 28 62% 18 40% Improved soil fertility 18 40% 30 67% Conserves soil / less run off 38 84% 36 80% Perceived Negative Consequences - Disadvantages Takes a lot of time 13 29% 24 53% Take a lot of physical effort 19 42% 26 58% My neighbors won’t terrace their land. 9 20% 15 33% Perceived Enablers / Self-Efficacy – Makes it Easier Doing it together in a group 36 80% 21 47% Having a drummer/singer (Konbit leader) 37 82% 31 69% If my neighbors up the mountain did it 5 11% 7 16% Perceived Barriers / Self-Efficacy – More Difficult My neighbors up the mountain don’t do it / neighbors don’t agree to do it with me 7 16% 12 27%
I know how to do it, but my neighbors don’t 2 4% 6 13% Having to haul rocks too far. 25 56% 34 76% Don’t have access to the grass for the boundary 17 38% 23 51% Perceived Social Norms – Who Approves/Supports People down the mountain whose crops flood 9 20% 15 33% The gov’t extensionist 27 60% 33 73% Everyone 31 69% 25 56%
Perceived Social Norms – Who Disapproves/Does not Support
My sons (more work for them) 20 44% 27 60% People who don’t know about terracing 18 40% 11 24% My spouse/wife/husband wife (more work for her) 21 47% 9 20% Perceived Social Norms – Do most people approve Yes 37 82% 33 73%
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Responses # Doers
% Doers
# Non-Doers
% Non-Doers
Behavior: Terracing land to preserve soil. No 8 18% 12 27%
Perceived Access – How difficult is it to get the materials or services needed for the behavior / relationship with providers
Not difficult at all 34 76% 27 60% Perceived Cues for Action / Reminders (Not asked) Perceived Susceptibility /Perceived Risk: [How likely is it that you could lose a lot of topsoil if you did not terrace your land?]
Very likely 39 87% 31 69% Somewhat likely 5 11% 9 20% Not likely at all 1 2% 5 11% Perceived Severity [How big of a problem would it be for you if you lost more topsoil?]
Very bad problem 31 69% 25 56% Somewhat bad problem 8 18% 11 24% Not a problem at all 6 13% 9 20% Perceived Divine Will [Do you think God approves of you terracing your land?]
Yes 38 84% 31 69% No 7 16% 14 31% Policy [Are there any community laws or rules in place that make it more likely that you will terrace your land?]
Yes 4 9% 7 16% No 41 91% 38 84% Culture [Are there any cultural rules or taboos for or against terracing your land?]
