Are we using the right approach to change newborn care practices in the community?

Professor Zelee Hill; Dr Pauline Scheelbeek; Yashua Hamza; Professor Joanna Schellenberg

Journal article

Are we using the right approach to change newborn care practices in the community?

by Professor Zelee Hill, Dr Pauline Scheelbeek, Yashua Hamza and Professor Joanna Schellenberg

published 16 October 2020

This study provides qualitative evidence on the changing behaviours of community health workers in Ethiopia and Northern Nigeria.

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Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior.

For this study, authored by Zelee Hill et al, researchers collected qualitative data from eight sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, researchers conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and four focus group discussions each with mothers, fathers, grandmothers, and CHWs.

An analysis of the qualitative data revealed two key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy.

The study found marked differences between Ethiopia and Northern Nigeria, pointing to the importance of context in the design of counseling interventions within CHW programmes. In Ethiopia a large part of the community is exposed to consistent messages, which then proved to have an impact on behaviour change. In Nigeria, in contrast, the exposure to messages was limited and CHWs were less trusted, and behaviour change was reported less frequently.

In conclusion authors point out that they found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.

Authors

Professor Zelee Hill

Professor

Dr Pauline Scheelbeek

Research Fellow, IDEAS 2015-2016

Yashua Hamza

Childcare and Wellness Clinics

Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

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Ethiopia
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Community-based newborn care
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Fostering innovation sustainability
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Improving measurement
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Supporting local decision-making
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Tracking progress
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Understanding quality improvement
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Behaviour change
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Capacity strengthening
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Context
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Economics
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Evaluation methods
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Evidence for policy and practice
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Implementation projects
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Implementation strength

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Are we using the right approach to change newborn care practices in the community?

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