Popular Opinion Leaders Changing communities one person at a time. The Health Marketing Initiative

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1 P R O M I S I N G A P P R O A C H E S The Health Marketing Initiative The AFFORD Initiative is a five year, USAID-funded program that uses innovative marketing approaches to improve Ugandans heath. The Initiative focuses on four areas: HIV/AIDS, malaria, family planning, and child health. AFFORD also expands markets for health products and services, improves product distribution, and encourages community action on health. Popular Opinion Leaders Changing communities one person at a time 1

2 P O P U L A R O P I N I O N L E A D E R S Popular Opinion Leaders Changing communities one person at a time Every community has leaders whose words and actions command attention. When directed toward positive health behaviors, community leaders can help reduce the number of new cases of such illnesses as malaria, diarrhea, and HIV/AIDS. Through the provision of accurate information, they can also help reduce the severity of disease. AFFORD developed the Popular Opinion Leaders (POL) Intervention to harness the power of local leaders to heal their communities. The Communication for Development Foundation Uganda (CDFU) implemented this program. Key innovation Partnering with civil society organizations, districts, and communities, AFFORD identified and trained trusted community leaders to act as role models for positive health behaviors and to communicate accurate health information with their peers. Through personal contact with friends and neighbors, a cadre of Popular Opinion Leaders models the healthy behaviors promoted on the Good Life television and radio programs. Popular Opinion Leaders also use their social networks to support community mobilization activities, including distribution of AFFORD s health products. Juliet talks to her neighbours about family planning Why it works Community leaders impact social norms. Studies show that people s attitudes and behaviors are greatly affected by their peers. During the formative study phase, AFFORD researchers noted that Ugandans often feel distrustful of outside knowledge. Strong peer influence and misgivings about outside information led AFFORD to design a program of behavior change based on the influence of trusted community members. Peer education conveys health information effectively. The process of peer education involves trained people helping their peers make healthy decisions. Through peer education, Popular Opinion Leaders: Provide accurate and relevant information Create motivation for change Demonstrate needed skills Refer people for services Peer education can be part of informal and organized activities, for instance, during a visit to someone s home, after religious services, or in casual conversations with friends. Trained Popular Opinion Leaders are a lasting resource. As trusted sources of health information, Popular Opinion Leaders are an enduring local resource. Investment in training Opinion Leaders pays off as influential people are often stable members of their communities. 2

3 Popular Opinion Leader Profile Name: Kasaali Juliet Sex: Female Age: 45 Home: Nyendo, Masaka District Profession: Retired primary school teacher In her neighborhood, Juliet is best known as a radio show host on Equator FM, a local station. Since Juliet s community selected her as a Popular Opinion Leader, she has been speaking out on local health issues and using her radio program to share new ideas she has picked up as a Popular Opinion Leader. When asked why she does this work, Juliet says: I live in a place surrounded by lodges and a slum, all with unhealthy conditions. There are many cases of HIV, malaria, unwanted pregnancy, and diarrhoea. Many community members take these diseases for granted, and many are unaware of health services available within our community. If I talk to my neighbours and friends about health issues and refer them for services, I feel I am contributing in a very important way. Where we are now AFFORD has trained 695 Popular Opinion Leaders in 17 districts as peer educators. These individuals have supported a number of AFFORD s community-based activities, such as long-lasting insecticide treated net distribution, mobilization for immunization, and maternal education in antenatal care clinics. External Evaluation: In 2007, Wilsken Agencies conducted an evaluation of the Popular Opinion Leaders performance using focus group discussions and in-depth interviews. While many community members did not recognize the title Popular Opinion Leader, they did perceive those individuals as trustworthy, reliable, and useful sources of health information who have a positive impact. Taken from the study, the quotes below demonstrate these feelings: Trustworthy: I trust Miss... because she is the woman I can approach any time in case of any problem and keep my secrets. Reliable: She is the only woman we have in this area who talks about health issues. Useful: They always check on us, and ask about our condition even about the children. If they need a blood test they advise you on that, so by the time you hear it from the radio, she has already told you what to do. Positive impact: If you follow what they have taught you, you don t fall sick. Small groups discuss their community s challenges during a training in Kanungu district. 3

4 P O P U L A R O P I N I O N L E A D E R S How we did it 1) Identified community leaders. Popular Opinion Leaders come from all walks of life. Their common denominator is the respect and trust of their peers. Together with district leaders and community-based organizations, AFFORD and CDFU began by orienting communities to the intervention and then asking them to identify respected individuals to serve as Popular Opinion Leaders. 2) Developed participatory training materials. Communication for Development Foundation Uganda (CDFU), a member of the AFFORD consortium, led the development of a peer education curriculum which emphasized a participatory approach. The curriculum is accompanied by a handbook containing Frequently Asked Questions and key information about AFFORD s health products and services. 3) Trained selected Leaders. Together with district personnel, AFFORD and CDFU identified potential trainers from partner organizations in the community. CDFU then facilitated a Training of Trainers workshop where participants learned critical health information as well as group facilitation techniques. After this preparation, trainers began to conduct peer education training with Popular Opinion Leaders throughout the district. 4) Created lasting, powerful networks. Popular Opinion Leaders developed productive relationships with AFFORD through monthly and quarterly meetings, refresher trainings, and by supporting AFFORD s community mobilization activities. They received educational reference materials like newsletters, leaflets, and binders with health information, as well as t-shirts and caps that identify them as Popular Opinion Leaders. Challenges In some districts, health services are virtually inaccessible, diminishing the value of referrals to them; and At times, individuals referred to health centers do not receive satisfactory services and blame the Popular Opinion Leaders, even though the quality of services provided is out of their control. What we have learned Curriculum Topics Effective Communication Gender and Health Malaria HIV Prevention AIDS Palliative Care Family Planning Pregnancy Child Health Social Mapping Programs can successfully motivate community volunteers without monetary rewards by providing regular oversight and clothing that identifies participants like t-shirts and caps. Communities own the intervention by selecting Popular Opinion Leaders themselves, and are more receptive to accompanying health messages, products, and services; and Involving district staff, local leaders, and CBOs increases the acceptance and sustainability of such community-based interventions. 4

5 What s next As vital links to communities, Popular Opinion Leaders will become front line advocates for Good Life messages and products. The shift in emphasis will be reflected in their new title the Good Life Team. To tighten the connection between desirable health behaviors and specific products, AFFORD will train Popular Opinion Leaders to be community sales representatives. A Popular Opinion Leader shares her experience during a quarterly meeting in Mbale district. The AFFORD Consortium The Johns Hopkins Bloomberg School of Public Health Center for Communication Programs Aclaim Africa Ltd. Communication for Development Foundation Uganda Futures Group International Malaria Consortium PULSE Communication Ltd. 5