Social, Behavioural and Community Engagement Interventions for Reproductive Health

Social norms in the community for RMNCH

Social norms / normative beliefs in the community in relation RMNCH, particularly related to care practices and care-seeking. 

Couple / mothers / mothers-in law /parent-child communication

Communication between women and their partners / mothers / mothers-in-law in the household about RMNCH-related issues, particularly related to care practices and care-seeking

Parent and caregiver communication and interaction with children in their care 

Parenting skills

Parenting style and parenting skills of parents and caregivers.

Joint decision-making in the household

Joint decision-making by members of the household (e.g. woman and her partner) on RMNCH-related issues, particularly related to care practices and care-seeking. 

Household environmental practices

Individual / household adoption and use of environmental/infrastructure interventions to address for example, air pollution (e.g. cook stoves), mosquito breeding (covering containers), water, sanitation and hygiene (e.g. latrines; water jars) etc. 

Routine care-seeking behaviour

Routine care-seeking by individuals and caregivers, such as antenatal care, postnatal care, skilled care at birth, family planning, childhood immunization, etc.   

Care-seeking for complications/illness

Individual and caregiver care-seeking for illness and complications, such as childhood illness, complications during pregnancy and childbirth, etc. 

Perception of quality of care / Satisfaction with services

Individual and community satisfaction with quality of care provided.

Individual and community satisfaction with provider communication and/or level of respect shown for their choices and preferences.

Provider communication and engagement skills

Health service provider interpersonal and intercultural competencies, counselling skills, skills in community participation and engagement.

Community capacity

In addition to outcomes for care-seeking behaviour and quality, other outcomes for community capacity include:

Capacity for collective action:

1. Learning opportunities and skills development
2. Resource mobilization
3. Leadership
4. Partnerships/linkages/networking
5. Participatory decision-making
6. Sense of community
7. Communication
8. Organizational development

Participation in planning and programmes

In addition to outcomes for community capacity and social accountability, other outcomes for community participation in planning and programmes include: programme design and service delivery that responds to the priorities and needs of communities.

Social accountability

In addition to outcomes for community capacity and community participation in planning and programmes, other social accountability outcomes include: improved efficiency of service delivery, governance processes and resource allocation decisions, or claiming rights.

Maternal, newborn and child mortality

Maternal, newborn and/or child mortality.

Child growth and development

Physical, socio-emotional, language and cognitive development, nutrition.

Gender equity / status of women

Changes in gender relations (positive or negative) between men and women, and between girls and boys.

Cost

Examination of the cost of interventions.

Knowledge and attitudes of individuals and households

Knowledge and attitudes of individuals and members of the household regarding care practices (self-care and caregiver) and care-seeking behaviour 

Knowledge and attitudes of health providers for community engagement

Health provider knowledge and attitudes regarding communication, health education and community engagement, including:

-       community participation and engagement

-       interpersonal communication

-       intercultural skills

-       gender and human rights

-       counselling 

Caregiver practices

Prevention and treatment practices by caregivers for children under their care.

Maternal, newborn and child morbidity and disability

Maternal, newborn and child morbidity and / or disability.

Family planning method use

Current or planned use of family planning method to avoid or delay pregnancy

Social cohesion

Group-based Livelihood Interventions in LMICs

Home visits

The primary objective of home visits is to bring RMNCH education, information and counselling directly to the home via a health professional or trained volunteer/ peer. Contact with the household may be provided face-to-face or indirectly by phone. Those delivering the household outreach may be physicians, nurses, midwives, paraprofessionals, traditional providers, cadres, trained peer-educators, other health workers and volunteers.

These types of interventions may include the provision of print or electronic materials as part of the home visit. They also often include an element of training for the provider undertaking the household outreach / home visits.

Facility-based Interpersonal Communication (IPC)

These interventions involve a health professional of some kind providing RMNCH education, information and/or counselling one-on-one to individuals in a facility, such as a health centre. As above a key element of these interventions is the face-to-face interaction between the health professional and clients and may also include the provision of written and electronic educational aids, such as pamphlets, posters, cd rom etc.

These types of interventions may include the provision of print or electronic materials as part of the facility interpersonal communication and counselling. They also often include an element of training for the provider undertaking the interpersonal communication.

Group IPC - any setting

Group-based interventions involve the provision of RMNCH information, education and/or counselling in a group-setting rather than one-to-one. Interventions can include meetings with a select group (e.g. pregnant women), village health clubs, community dialogue, client-provider forums, workshops, fairs and other events in different settings such as schools, health facilities and community settings., These interventions may also include the provision of written and electronic educational aids, such as pamphlets, posters, video etc. Those delivering the group-based interventions may be physicians, nurses, midwives, paraprofessionals, traditional providers, cadres, trained teachers, trained peer-educators, other health workers and volunteers.

These types of interventions may include the provision of print or electronic materials as part of the group interpersonal communication and counselling. They also often include an element of training for the provider undertaking the interpersonal communication.

Mass media and entertainment education

Mass media refers to the use of a diverse set of technologies including the internet, television, print materials (e.g. newspapers, posters and leaflets), film and radio, that are capable of simultaneously—almost instantaneously—reaching audiences on a large scale, often over considerable distance. Such media may or may not have interactive capabilities. Mass media programs are often theory-based and target a large population.

For the purpose of this EGM, mass media also includes other types of written materials such as a letter to parents or spouse, pamphlet on breastfeeding and MNCH booklets and home based records. Like print materials, these can serve to inform, remind, educate and motivate people about specific RMNCH topics.

Mass media are often used to deliver entertainment-education programmes or materials. These interventions have educational, motivational or persuasive messages delivered through an entertaining format, such as a radio health drama or health messages inserted into the storyline of a popular television programme. These interventions can use film, television, radio, comic books, traditional storytelling forms, as well as the internet to provide information and messages.  

Social media and m-health

These interventions refer to a variety of web-based and mobile technologies and software applications permit users to engage in dialogue with each other, often over great distances and share information. These interventions may take an individual, one to one approach, (e.g. SMS reminder of an upcoming appointment) or attempt to connect with people on a large scale (e.g. social media).

Interventions can include:

-          mHealth/mobile phone such as smartphone/ feature phone/tablet/personal data assistant (PDA) /other mobile devices, Short Message Service (SMS), Multimedia Messaging Service (MMS), Interactive Voice Response (IVR)

-          Helpline, hotlines

-          eHealth/eLearning/websites

-          Information Communication Technology

-          Digital Media

-          Social Media (e.g. Facebook and Twitter)

Social marketing

Social marketing strategies use marketing concepts — product design, appropriate pricing, sales and distribution, and communications — to influence behaviours that benefit individuals and communities. Social marketing involves coordinating many communication forms and approaches to reinforce and complement each other. These can include:

-       advertising

-       social franchising

-       public relations

-       internet communication

-       community mobilization

-       counselling

-       print and electronic materials

-       network marketing

Demand-side financing

Demand‐side financing offers a supplementary model to supply-side financing of health care in which some funds are instead channelled through, or to, prospective users. Demand side financing schemes to increase maternity healthcare utilization and promote maternal, perinatal, neonatal and infant health outcomes include: 

-       unconditional cash transfers

-       conditional cash transfers

-       short-term payment to offset costs of access

-       vouchers for maternity services

-       vouchers for merit goods

Community-based health insurance

Community-based health insurance schemes are a form of micro-insurance used to help low-income households manage risks and reduce their vulnerability in the face of financial shock. Other schemes can include rural health insurance, mutual health insurance, revolving drug funds and community involvement in user-fee management. 

Community mobilization

Interventions to encourage community, individuals, groups (including in schools), or organizations to plan, carry out, and evaluate activities on a participatory and sustained basis to improve their health and other needs. Community mobilization can often also involve use of the following activities: 

-participatory learning and action cycles (e.g. women’s groups)

-community dialogue and working with community leaders, religious leaders, health service providers, Traditional Birth Attendants (TBA

-participatory research and assessment

-rapid rural appraisal

-strength based strategies such as positive deviance approaches

-community advocacy activities

-community organized transport schemes

-engaging school children as agents of change

Community participation and social accountability

Activities to create ongoing relationships between community members and health service delivery. The objective is to institutionalize community participation in decision-making within health services and programmes, for example through village health committees

Provider training and service delivery adjustments

Provider training focuses on the training of health providers, and other service providers, such as teachers and pharmacists, in skills and techniques related to communication, health education and community engagement for example (3):

-       community participation and engagement

-       interpersonal communication

-       intercultural skills

-       gender and human rights

-       counselling

Service delivery adjustments are the changes made to service delivery and programmes in response to community perceptions of quality of care or to improve community perceptions of quality of care.