Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria

Abstract

In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently.

Abstract

Key Findings

• In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers (CHWs) drove behav-ior change.

• In Nigeria, exposure to messages was limited, CHW were less trusted, and behavior change was reported less frequently.

Key Implications

• The role of saturation and trust in behavior change in Ethiopia suggests that CHW counseling interventions should not be assumed to work through didactic provision of messages that focus on the behavior benefits.

• In settings with low coverage of CHW visits, low levels of message reinforcement from other sources, and low trust in CHWs, achieving behavior change may be difficult, even among people who receive visits.

ABSTRACT

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. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 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. We 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.