Designing an SBCC Intervention for CHW Behavior Change

Whichever method you use, make sure you answer these fundamental questions:

• What is the performance problem? What is its level of severity and what are the causes, framed around Expectation, Ability, Opportunity and Motivation?
• Who are the groups of people affected by the problem (what types of providers, what motivations do they possess, where do they live and work, what are the psychographic details, etc.)?
• What is the broad context in which the problem exists?
• What are the factors inhibiting or facilitating behavior change among CHWs?
• What other interventions are in place or planned to address CHW behaviors?
• What are CHWs’ preferred sources of information and communication channels?

The following summarizes the key activities for the situation analysis:

1 Conduct a Review of Program Data

This includes service records, quarterly reports, policy documents and informal interview. Then develop a focused problem statement. This statement will help to ensure the intervention focuses on one specific behavioral issue at once. Example: “Community Health Workers are not consistently referring women of reproductive age for family planning services.”

2 Draft a Shared Vision

A shared vision provides a picture of what the situation will look like when the SBCC effort is completely successful. Example: “In 2020, CHWs spend time discussing methods with newly married couples and encourage them to ask questions and refer those with demonstrated need for FP services.” Guidelines on what to consider when drafting this vision.

3 Gather Information and Summarize Findings

If you chose to conduct the CHW Performance Assessment, follow the steps to gather the information and summarize your findings through the link. If you chose to rely on secondary data, follow the steps in this how-to guide for conducting a Situation Analysis using secondary data to answer the key questions about CHWs and their work environment.

Examples of secondary data you might consider to gather this information include:

Whether you use the CHW Performance Assessment or a Secondary Data Analysis, the findings of your situation analysis should be framed around the four categories of CHW performance:

• Expectation – Do CHWs understand the performance expected and the definition of quality?
• Opportunity – Do CHWs have the environment and necessary resources available to support performance?
• Ability – Do CHWs have the skills and knowledge necessary to do the tasks in his/her scope of work and feel competent in doing so?
• Motivation – Is there sufficient reward and lack of negative consequences to make CHWs want to do his/her job?

Use this Needs Summary Table from the CHW Performance Assessment to summarize the findings. Then prioritize those needs using the Prioritization Matrix and Action Tracker.

If you prioritized Expectation, Opportunity or Ability barriers, proceed to Other Resources for tools, resources and programmatic examples to improve Expectation, Opportunity and Ability performance gaps.

If you prioritized Motivation barriers, identify which motivational barriers are relevant to your CHWs and then proceed through the I-Kit to design your intervention.

The graphic below describes how to navigate the results of the Assessment or secondary analysis to use this I-Kit.

4 Review the Data

Review the data you collected through the CHW Performance Assessment or Secondary Data Analysis. Study the five categories of factors impacting CHW motivation in the Learn section. Determine which motivational factors are most relevant to the CHWs you are working with.

Situation Analysis Outputs

At the end of the situation analysis, you should have:

• Problem Statement
• Shared Vision Statement
• Analysis Findings

Record these outputs in the Step 1 section of the SBCC Strategy Template.

Resources

• Designing a Social and Behavior Change Communication Strategy Implementation Kit
• How to Conduct a Situation Analysis
• Understanding the Situation: A Practitioners Handbook