1. Nemat Hajeebhoy Formative Research and Behaviour Change Communication National IAPSM Conference 2004 Chandigarh Nemat Hajeebhoy Aga Khan Foundation, India

2. Nemat Hajeebhoy What is Behaviour Change ? ACTION NORMS AWARENESS

3. Nemat Hajeebhoy Levels of Behaviour Change HOME COMMUNITY HEALTH CENTER/ NGO POLICY NEGOTIATE INDIVIDUAL BEHAVIOR CHANGE CHANGE COMMUNITY NORMS & PROBLEM SOLVE TRAINING & CAPACITY BUILDING ADVOCACY

4. Nemat Hajeebhoy Malnutrition & Child Mortality Others Peri-natal Complications Malaria Measles ARI Diarrhea Malnutrition 55 %

5. Nemat Hajeebhoy Food Security & Malnutrition FOOD SECURITY MALNUTRITION Availability Access Utilization

6. Nemat Hajeebhoy Food Aid ….. BCC …??? FOOD AID BCC ?

7. Nemat Hajeebhoy The goal therefore is to identify feasible, acceptable & effective strategies to improve health related behaviours with program beneficiaries playing an active role in the process

8. Nemat Hajeebhoy What is Formative Research ? It is the process of collecting information for use in developing interventions appropriate for a designated audience. The information collected guides the development or design of activities, programs and materials or products.

9. Nemat Hajeebhoy Methodology Review Conduct Exploratory research In-depth interviews Focus Group Discussions Observations 24 Hour Recall PRA Exercises Step 1 : Data Collection & Behavioural Analysis

10. Nemat Hajeebhoy Methodology: Behavioural Analysis Barriers Options Motivators

11. Nemat Hajeebhoy Methodology Review Exploratory Research Trials of Improved Practice Step 2 : Develop & Test Recommendations

12. Nemat Hajeebhoy Methodology : TIPs Also known as household trials, TIPs involve a series of visits to selected homes to test new behaviours to improve child nutrition / health.

13. Nemat Hajeebhoy Methodology: TIPs PRE TRIAL (Visit One) COUNSEL & NEGOTIATE 24 hour recall Counseling Guide POST TRIAL (Visit Two) FEEDBACK ON BEHAVIORS TRIED/NOT TRIED 24 hour recall Feedback Form TRIAL PERIOD

14. Nemat Hajeebhoy Methodology Step 3 : Revise recommendations and develop Behaviour Change Strategy BEHAVIOUR CHANGE STRATEGY AudienceMessageChannel

15. Nemat Hajeebhoy Methodology DEVELOP TOOLS Materials & Media SKILL TRAINING Monitoring & Evaluation Step 4 : Programme Implementation

16. Nemat Hajeebhoy Methodology The TIPs approach of ‘designing by dialogue’ provides professionals the opportunity to visit families, listen to what mothers and other caregivers have to say about their problems and to FIND SOLUTIONS. Professionals learn more from beneficiaries and beneficiaries have more faith in the advice they receive because they have had a chance to express themselves and feel that their particular situation has been taken into account.

17. Nemat Hajeebhoy Strengths of Formative Research  Process is flexible and can be tailored to a variety of country and program context Bridge between program planners and the community Methodology promotes an understanding of practical changes.

18. Nemat Hajeebhoy Strengths of Formative Research It develops and tests recommendations in the same household settings where behaviours need to be practised. Using these methods promotes attitudes such as willingness to learn from mothers and an understanding of practical changes to recommend

19. Nemat Hajeebhoy Strengths of Formative Research Where program personnel are directly involved it has been found to motivate health personnel to take a sincere interest in learning appropriate ways of working with caregivers to resolve feeding problems.

20. Nemat Hajeebhoy Core Team Researcher Experts Program Personnel

21. Nemat Hajeebhoy If the research is planned carefully to collect only essential information this approach can be completed relatively rapidly.

22. Nemat Hajeebhoy The ADP Jagriti / LINKAGES Experience Period :1997 - 2001 Aim : To test an innovativebehaviour change methodology that introduces or reinforces simple, culturally appropriate & nutritionally effective practices within the ADP Model

23. Nemat Hajeebhoy ADP Jagriti /LINKAGES Sehaspur Block, Dehradun Dt. Uttaranchal ~ 85,000 Population Breastfeeding Complementary Feeding

24. Nemat Hajeebhoy Programme Results %

25. Nemat Hajeebhoy Programme Results %

26. Nemat Hajeebhoy A Mother’s explanation of why breastmilk is best : “ The milk that a mother has is not just milk - it has love in it. The most important part is that the love with which a mother breastfeeds her child cannot be replicated when other (top) milk is given … there is no diet like love. Since this (breast) milk is produced at the time of birth why should we not give it… the child will not only get milk but will also get love ”