Date post: | 21-May-2015 |
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Susan Mackay, Senior C4D Specialist (Health) UNICEF
Partner Insights FAO Risk Communication Seminar
“Business unusual”
AI - What was learned (or not!)
• Multiple KAP studies conducted between 2006-2007 (Unicef research in at least 16 countries)
• Different methodology and designs made it impossible to compare or generalize results
• Interesting insights for designing communication strategies, and general planning
• However insufficient qualitative or participatory research to help address the critical „WHY‟ question
What the KAPs showed
• High awareness but low understanding
– High media coverage likely to be a significant
factor
• Low level of knowledge about
transmission (at best one or two modes of
transmission) and many „incorrect‟ beliefs
Challenges
• Rural and less educated populations less
knowledgeable and less aware
• Studies largely descriptive
– Lacking plausible explanations for
demographic variables or varying levels of
knowledge about different forms of
transmission
– Lack of nuanced analysis unfortunate as
would have been key to improving design
Impact
• Communication campaigns did contribute to
increased awareness
• Knowledge (transmission, symptoms, methods of
disposal, and prevention) increased after exposure
or participation in communication interventions eg
– Meetings and outreach activities increased perceptions
of the seriousness of AI in Laos
– Substantial knowledge increases recorded (transmission
modes and prevention) between 2006 and 2007 in
Thailand and Egypt
Significant knowledge-practice gap
• Although awareness and knowledge of prevention and transmission behavioural change was much lower
– Some actions (cooking and handwashing) easier to implement than others (biosecurity and reporting behaviours) – also linked to low perception of risk
– Need for a much deeper understanding of social, economic and political barriers to change
Risk perception
• Even though awareness and understanding increased, risk perception and sense of urgency generally remained low
• However in urban areas sudden drops in consumption reported during outbreaks – Yet in rural areas consumption even increased
suggesting low risk perception
• AI “only has relative importance”, “people are used to it”
• Lower risk perception than issues such as dengue, malaria, malnutrition, diarrheal diseases and limited access to sanitation
Challenges
• Studies identified variations in risk perception
but did not (or were not sensitive enough) to
investigate highs and lows
– a better understanding of the drivers and timings
of changing attitudes and behaviours is needed
– more „dynamic‟, innovative approaches needed to
tracking changing perceptions of risk
– need to explore relationship with media coverage
(animal and human cases) and of economic
drivers
“… tools are still needed
to address the
challenges of
communicating in these
difficult circumstances.
These tools can be
developed by looking at
alternative paradigms of
risk that exist within the
social sciences.”
Abraham, T, Bull World Health Organ 2009;87:604–607
“Psychometric
paradigm”
Slovic et al.; Covello and
Sandman
“Risk Society” Beck, Giddens etc
Strong
Epidemic
Psychology
Culture, Risk and
Blame Douglas
Social
Amplification of
Risk
(See Murdoch et al.)
But how does this translate in
low resource settings?
Behaviours
Studies showed that the four behaviours are
rarely practices in high risk communities in
„real life‟
But too much emphasis on „educating‟ rather
than finding the „locks‟ and „keys‟ to
behaviour change
– Lack of link with „programme‟ and community
developed solutions
Reality check (1)
Reality check 2
“The idea that one should have to protect oneself from one’s poultry is literally exotic”
“birds and humans have mingled for generations without any negative impact as far as they could see ….”
We must constantly work within peoples social, cultural, political and economic realities.
Reality check (2)
Reality check 1
“AI prevention and control faces formidable obstacles, including disbelief in the existence of the disease, lack of economic means to implement recommended practices, and distrust of the authorities and health services.
“It is important to distinguish between obstacles that can be addressed through communication alone, and those that need different and complementary programme interventions””
Reality check (3)
If we were starting again …
• Much more emphasis on addressing
attitudes, such as low risk perception and
stigma around reporting
• Total integration with technical programming
to reduce structural obstacles that discourage
health practices (eg grant subsidies,
economic aid to strengthen bio-security, as
well as incentives to promote community
surveillance and reporting)
Design shortcomings
• Not enough adjustment of the four key
behaviours to local settings and realities –
need for dialogue and consensus
• Initial outbreak responses were inevitably
„general‟, but later interventions should
have been more tightly focused and
nuanced to address specific needs and
concerns (or lack of!) in segmented high
risk populations
Potential solutions
Participatory approaches to build local
perspectives into design of activities and
solutions
Lessons learned
• Too much emphasis on promoting the actual behaviour but not enough on „selling‟ the benefits and / or risks eg
– Local beliefs
– Social attitudes eg stigmatization
– Agreeing feasible, low cost solutions
– Encouraging self and collective efficacy
– Credibility - understanding the context of trust in local authorities
Social determinants
• Interesting gender, religious and cultural
insights, but in many cases the data was
available only after the bulk of communication
interventions had been designed or
implemented eg
– Women primary handlers of poultry and eggs
spending more time with backyard poultry
– Men involved in handling slaughter, and cock-fighting
in particular countries
– Particular ethnic and or religious practices
Some highlights
Innovative work with schools eg. Thailand,
Indonesia, Turkey
What worked
• High level advocacy with government officials and decision makers
• Training of print and broadcast journalists at national and subnational levels
• Training frontline workers and volunteers, rapid response teams and poultry farmers
• Orientation and training of government spokespersons, school teachers and community influencers
• Folk theatre and rural media
• TV and radio campaigns featuring public service announcements
Limitations
• Frantic pace of activities
– Emergency response to outbreaks
– Pressure from donors to implement quickly
when more time was needed for participatory
research, design and implementation
– Lack of existing capacity at all levels
We were aware of most (if not all) of the
limitations at the time but limited capacity to
change course!
Institutional context
• Level of government commitment, ownership and capacity varied
• Coordinating committees a problem in some areas
• Working relationships within and between agencies varied – where it was good generally the quality of work and impact was higher
– These relationships work best where they are built in advance
• Participatory planning processes involving multiple stakeholders was greatly appreciated
Resource issues
• Some programmes had much more than
funding than they were used to, others had
to work with very limited resources
• Limited human resources within country
offices and country teams – some had to
be pulled from other teams, others had to
be recruited quickly without the necessary
experience or training
AI and Pandemic Influenza
• Much of the AI surge capacity was no longer in place when the H1N1 pandemic emerged
• Confusion about the differences between AI response and pandemic preparedness – should have been delinked!
• Much longer term investment is required in building „C4D‟ capacity – best way to be ready for an emergency
Wish list (1)
• Interagency vision and leadership required to
make long term communication investments
towards „One Health‟
• Capacity for evidence based communication
planning and implementation in all agencies
– correct balance of quantitative and qualitative
research (including PLA, rapid surveys),
implementation, monitoring and evaluation
Wish list (2)
• More emphasis on achieving change
through analysis of „locks‟ and „keys‟ to
change, as well as careful use of
appropriate risk communication approaches
for developing country settings
• Stronger partnership between the agencies
– understanding each others roles,
responsibilities, strengths and weaknesses
Thank
you