Acknowledgements The TOPS Program is grateful to Bonnie Kittle (consultant) for her assistance in developing this training manual. Special thanks also go to Mary DeCoster and Claire Boswell (Food for the Hungry) for reviewing drafts and making adjustments after the initial workshop. TOPS also appreciates Mia Durairaj (Save the Children) for her superb editing. Abbreviations and Acronyms AED Academy for Educational Development ANR Agriculture and Natural Resources BA Barrier Analysis CGV Care Group Volunteer DBC Designing for Behavior Change EBF Exclusive Breast Feeding FL Farmer Leader FLG Farmer Leader Group ITN Insecticide-treated bed nets LM Leader Mother
9. Which Determinants are addressed by the Activity – Tying a bar of soap to a hand washing station? a. Self-efficacy and access b. Cue for action and self-efficacy c. Access and cue for action 10. What would be the most appropriate Bridge to Activity for the following data related to the question: Who disapproves of you applying fertilizer to your home garden? Response: My mother-in-law: Doers: 15 Non-Doers: 35 a. This is a trick question – no Bridge to Activity should be written b. Increase the perception that mothers-in-law approve of using fertilizer on home gardens c. Increase the perception of mothers-in-law that fertilizing the garden is a good thing to do Lesson 1 Handout 3: Workshop Schedule DAY 1 DAY 2 DAY 3 Lesson 1. Opening Session 1.5 hours Lesson 5. Writing Bridges to Activities 1.5 hours Lesson 6. Describing our Behavior Change Activities 3 hours Lesson 2. Overview of the DBC Framework 2 hours Lesson 6. What are Data-Driven Behavior Change Activities? 5 hours Lesson 7. Closing Session 1 hour Lesson 3. Review of Determinants of Behavior Change 1 hour Lesson 4. Interpreting Barrier Analysis Data 1 hour
Lesson 2 Handout 3: Examples of Completed Designing for Behavior Change Frameworks Example 1: Agriculture and Natural Resources (ANR) Programs: Poultry Management Behavior Priority Group or Influencing Groups Determinants Bridges to Activities Activities Targeted adult men and women who raise chickens keep them enclosed (penned up) at all times Adult men and women from families who raise chickens. These families all have children under 2 years of age or a pregnant or lactating woman at program 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. They think chickens will not have enough to eat if they are penned up, or they do not know affordable ways to make chicken coops. Most of the Priority Group is in the awareness (or “contemplation”) stage of behavior change. Perceived negative consequences: Belief that chickens will stop laying Belief that it will be more effort Belief that it will cost more to give chickens food and water Perceived positive consequences: They will not lose chickens to wild animals Less loss due to illness Chickens will not damage crops and gardens It is easy to vaccinate Farmers can use manure for fertilizer Reduce the perception that chickens will stop laying eggs if they are penned up. Increase the perception that it is worth the small extra effort/expense to care for penned up chickens. Increase the perception that it will be economically beneficial (less loss, less damage to crops, more fertilizer, etc.) to keep chickens penned up. Increase access to fencing materials and skills for adapting local materials. Increase the perception that there are inexpensive ways to feed penned up 1. 2. 3. & 5 Testimonials: Identify people who keep their chickens penned up (Doers) and create testimonials (record/video tape these so they are easily repeated) emphasizing the productivity (1) and the value of the extra effort/ expense(2) and the economic benefits (3) and the affordable ways to feed penned up chickens (5). 2. Cross Visits: Invite poultry raisers to visit people who keep their chickens penned up to discuss economical penning and feeding options. 5. Technical Support: Train agricultural extension agents in poultry care (feed, water, vaccine) and construction of enclosures using locally available materials. Collect names of people who commit to penning and arrange for agricultural
Example 2: Agriculture and Natural Resources Programs: Reforestation Behavior Priority Group Or Influencing Group Determinants Bridges To Activities Activities Targeted farmers farming on sloped land plant trees Priority Group: Adult farmers, men and women, who farm on hilly land Minimal literacy Make their living from subsistence farming and seasonal migration to labor on plantations of export crops Own less than 4 hectares of land, but some of it is hilly and some of the land is eroded 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 Believe that it will take too long to see the fruits of their labor if they spend the time to plant trees Know that their farms are providing fewer harvest results each Some have planted trees, but most feel it is a waste of time, effort, and resources Most are aware of the problem of erosion Perceived positive consequences: Believe that planting trees leads to: future firewood and building material controls erosion and landslides can increase fruit production Perceived negative consequences: Believe they will lose investment of time and effort because saplings die Believe the trees will hinder crop production by making shade and taking water 1. Reinforce the perception that there are several benefits of planting trees (i.e., firewood, building materials, erosion and landslide prevention, fruit production). 2. Increase the ability to properly plant, care for and protect trees (so they survive). 3. Reduce the perceived threat to crop production by showing farmers the best placement identifying other places to plant trees. 1. Plan with municipal officials to promote fruit trees rather than Neem trees; provide awards to families who plant/ maintain a certain number of trees until they are (also could be done at the community level); and assure there is a long-range plan for financing and maintaining the municipal tree nurseries that provide free or low-cost seedlings, including those for fruit trees. 2. Conduct short demonstrations on tree planting in each sector, including appropriate technology containers for drip irrigation. Repeat the demonstrations in the schools when they plant trees. 3. Mobilize families to spend one day a year planting on communal mountainside land as a social event. Organize families to take turns watering and established
Some have learned about tree planting Influencing Group: Municipal authorities maintaining the plantings (could use Food for Work as an incentive for this). Outcome Indicator: Percentage of households planting at least __ trees per year Process Indicators: Number of demonstrations conducted in each sector and school in the target area before planting time each year (training session held at a regional teacher training institute) Number of seedlings that survive the dry season
Example 3: Maternal and Child Health and Nutrition (MCHN) Programs: Exclusive Breastfeeding (EBF) Behavior Priority Group or Influencing Groups Determinants Bridges To Activities Activities Mothers only give breast milk to their children from birth to 6 months of age Priority Group: Burundian mothers with children 0–6 months of age who Live in rural setting Majority are illiterate Go to church on Sunday morning Are busy with daily household chores Want to be perceived as good mothers and wives After 3 months, they think they do not have enough milk to breastfeed Exclusively breastfeed until 4 months, but give other foods at that time Majority are in partial action stage Influencing Group: Mothers-in-law Perceived action- efficacy: Mothers don’t know the relationship between EBF and malnutrition Perceived divine will: Mothers question whether their religious leaders/ traditions support this behavior Perceived social norms: Mothers believe that their mothers, mothers-in-law do not approve of EBF Perceived negative consequences: Mothers believe 1. Increase the perception that exclusively breastfeeding a child will help prevent malnutrition. 2. Increase the perception that religious leaders approve of EBF and that their religious tradition is supportive of EBF. 3. Increase the perception that their mothers approve of EBF. 4. Decrease the perception that a child will be hungry or lacking in nutrition if they are exclusively breastfed. 1. Record/write stories about mothers with children with good health/weight who EBF and believe in EBF. Play the recording/read the testimonials on EBF during pre and postnatal consultations, home visits and growth monitoring and promotion sessions. 2. In household 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 underweight who are not EBF. 3. Create and give pastors/priests/imams sermon guides on EBF and train them in their use. 4. During home visits to pregnant women and new mothers, instruct Care Group Volunteers (CGVs) to include mothers-in-law when teaching about EBF. 5. Explain to mothers (via CGVs and home 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 a process for comforting a crying
I would use family planning, but they stopped providing the type I like. Access I want to build an improved silo this year to prevent rats. They ate a lot of my maize last year. Positive consequences Having a good animal doctor nearby made it much easier to use animal traction to plow my fields. Access I have heard that it’s a good idea to check my child’s breathing when he has a cold, but I forget how to do it. Cue for action I tried that, and it took too much time and effort. Negative consequences Erosion only happens on farms that are on very steep hills. My land is not that steep. Susceptibility Who cares if my child is a little underweight? Severity 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. Divine will 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. Policy People from our tribal group are not allowed to eat with people in that cultural group, so we didn’t go to the meeting. Culture Appendix 4. Key to Lesson 4 Handout 2: Making Sense of Data – Practice Responses Doers (%) Non-Doers (%) Gap Actionable? 1. Perceived positive consequences: What are the advantages of doing the behavior? a. Avoid diseases 90 84 b. Be clean/hygiene 76 67