Projecting Health. Engaging communities through visual communication. Teach to Reach Summit November 2, 2015

Transcription

1 Projecting Health Engaging communities through visual communication Teach to Reach Summit November 2, 2015 Kiersten Israel-Ballard MNCHN Technical Officer

2 Innovating Approaches for Changing Behaviors

3 Innovating Approaches for Changing Behaviors

4 Projecting Health

5 Building on Partnerships: The Digital Green Agriculture Model Digital Green pioneered a videobased education model for agriculture Content created and presented by the community Focus on sharing best practices in agriculture Enabled by low-cost consumer digital video technology Scaled-up through the India government Source:

6 PATH s Projecting Health * Approach Revolutionizing behavior change communication Empowering communities to share healthy practices through an innovative, evidence-based, locally-driven approach for low-cost video production and dissemination * Also known as Digital Public Health

7 Projecting Health Model Components of the PH model: Ensure community-led video production; locally created, locally disseminated Engage communities using existing communication structures Establish a Community Advisory Board (CAB) to guide and support implementation of the model Develop video-based messages adapted to local health needs Build the capacity of community health workers to enhance the quality of message delivery Document and disseminate key learnings from model implementation Core requirements for implementation Standardized quality control systems across programs/regions Community partners and support infrastructure in place Community engagement ensured (community advisory board) Rigorous M&E systems established Page 7

8 An Advanced Approach for Greater Impact Community engagement Cost reduction Local program structure Increased reach and impact

9 Community Engagement Develop key messages Identify topic Share and discuss Adopt and discuss knowledge and practices with others Increase demand for immunization services Create storyboard and approve Produce short video Child immunized Identify local actors

10 Local Program Structure Women & Child Dep t representative Panchayati Raj Institution representatives Community health workers Media representative Community members NGO representative Education representative Healthcare functionaries

11 Increased Reach Through Hyper-Targeted Messaging

12 Project Timeline Digital Study Hall started 2005 PH Exploratory launch 2010 Pilot launched in Ethiopia 2013 Expansion and mobile phone exploration pilot; Kenya, Moz pilot Digital Green founded 2012 Feasibility study launch 2014 Endline evaluation data collected 2016 Planning for scaleup Page 12

13 Project Overview Started in 2012, current phase Uttar Pradesh, India (with pilots in Ethiopia, Mozambique and Kenya) Reach to date o o Video screenings-47,563 YouTube hits-31,534 Target direct beneficiaries: 60,000 On the ground implementation by local Community Based Organizations Hosted in Mother s Groups

14 Expanding Reach: Disseminating Projecting Health Videos via YouTube Breastfeeding (36,780 views) Optimal breastfeeding practices Exclusive breastfeeding LAM Thermal care (130 views) Thermal care overview Delay bathing Family planning (1,578 views) Permanent methods Temporary methods NSV-No scalpel vasectomy IUCD Copper-T Birth preparedness (1,140 views) Birth preparedness overview Maternal danger signs Maternal nutrition Newborn danger signs Cord care (122 views) Other (534 views) Cord care overview Myths and misconceptions Immunizations Community-based emergency transportation systems

15 Diversity in Videos

16 Theory of Change Change Levels Inputs/Activities Outputs Intermediate Outcomes Outcomes Assumptions Impact Mothers Social Network Community Video message creation Participation in mothers groups Expanded video penetration through innovative channels CHW (ASHA) training and education Community member training and education Former HW involvement CHW (ASHA) involvement # of accurate, local videos produced # of people reached through videos at mothers groups # of advice and video sharing relationships created # of additional modalities of video sharing mechanisms # of video dissemination screenings # of ASHAs trained # of community advisory boards Increase in knowledge Increase size and density of advice networks Increase in spread and memorability of messages Improved capacity of ASHAs Increased quality of mother s groups Change in perceptions of immunization Achieved through: Knowledge increased Networks expanded Community acceptance of vaccination Intention to vaccinate one s child Barriers to immunization are addressed in groups Strong linkages exist between CHWs and health system, and CHWs and community Vaccines are available Women share messages learned in groups through their networks Social network relationships can change behaviors Community is accepting of PH intervention Increase in fully immunized children in intervention areas Intervention streams legend: Communication and dialogue Planning and participation Improved service delivery, recognition and incentives

17 Formative research Collaborative implementation design with field staff and CBOs 1. Feasibility phase 2. Evaluation phase Quasiexperimental design outcome evaluation After action review and ongoing quality improvement 11/2/

18 Endline Evaluation Primary Objective: To assess the effectiveness of the PH intervention in increasing knowledge and changing practices of the women between ages 18 and 45 exposed to the video messages on key maternal and neonatal health (MNH) areas. Quasi-experimental, post-test only study design with three arms: Projecting Health video intervention Mothers group only intervention No intervention

19 Methods Household survey with structured questionnaire among women between years o Participants selected using set criteria, intervention arms recruited from participant list, and comparison arm from a household listing exercise Semi-structured interviews with community healthcare workers (ASHA) Sample size derived using a minimum sample size required with 95% level of confidence and 80% power Ethical approval from REC and the local UP-based IRB Data collected by external organization, June-July 2014

20 Selection Criteria Study arms Intervention arm (A) Projecting Health n= 309 Attributes Villages having active mothers groups which received a package of video messages and facilitated discussion on birth preparedness; breastfeeding; cord care; thermal care; and family planning through project trained ASHAs. Intervention arm (B) Standard Mother s Groups n= 321 Comparison arm (C) n= 327 Villages having active mothers groups which received messages delivered through standard discussion format from project trained ASHAs (not showing any videos) on MNH areas include birth preparedness; breastfeeding; cord care; thermal care; and family planning through project trained ASHAs. Villages that do not have any mothers groups and receive no messages from the project. Any information received is through the standard of care from the government, nongovernmental organizations and ASHAs who have not received project training.

21 Percentage of women MNH Self-Reported Practices * * 77 75* 71 * 59* * Birth preparedness Breastfeeding Family planning *p< Projecting Health (309) Standard MG (321) Comparison (327)

22 Percentage of women Birth Practices: Women Who Delivered at Home * 63* Cord care Thermal care Projecting Health (51) Standard MG (49) Comparison (72) *p<.0.001

23 Percentage of women Expanding Reach: Sharing of Key Messages Birth Cord care Thermal care Breast feeding Family planning preparedness Projecting Health (309) Standard MG (321) Comparison (327)

24 Our Vision: Integrate Projecting Health Across Programs and Scale to New Geographies and Topics Seattle team to support expansion

25 Next Steps...

26 Thank you! Contact Kiersten Israel-Ballard Technical Officer Maternal, Newborn and Child Health and Nutrition Program PATH