Findings from a multi-country pilot to practice evaluation approach in the Sahel presented at the 2017 American Evaluation Association Conference.

1. Using a mixed methods approach to understand
how community video can be used to address
nutrition and hygiene behaviors:
Findings from a multi-country pilot to practice evaluation approach
in the Sahel
Leanne Dougherty, Alix Harou, Sophia Magalona

2. • Sahel context faces harsh climate conditions, food
insecurity and high levels of malnutrition
• Social and behavior change communication (SBCC)
in rural areas presents unique challenges due to
poor access to mass media
• Limited evidence on using community video
approach for maternal, infant, young child nutrition
(MIYCN) and hygiene behaviors
Background

3. • Rapid formative research
• Prioritization of video themes
• Video production training
• Adaptation of a 2-day MIYCN
and hygiene training package
• Video dissemination and data
collection training
• Production of videos
• Pretesting/finalization of
videos
• Dissemination of videos
• Home visits and follow-up
• Quality assurance/supervision
The process involved adapting the steps outlined
and the tools provided in the Community Video
for Nutrition Guide:

4. Theory of Change

5. SPRING Pilot to Practice Learning Approach
• Understand the target
audience needs and
context prior to initiating
the intervention
• Use a theory of change
approach to assess how
the pilot evolves along
the proposed pathways
• Assess impact to inform
scale-up of activities

6. Multi-Country Pilot to Practice Findings
• Seeing is Believing: Results of an innovative
community video approach to address MIYCN in
Niger
• The Father Factor: How community video can
encourage male involvement for nutrition and
hygiene behaviors in Niger
• The Influence of Social Networks on Infant and Young
Child Feeding Behaviors in Burkina Faso

7. Evaluating the effects of a community video approach:
The SPRING Experience in Niger
AEA Conference
Washington, DC
November 9, 2017
Alix Harou, SPRING/JSI

8. SPRING/Digital Green Program in Niger - 2015
The collaboration was established between
SPRING/Digital Green and 3 USAID/Niger
programs - REGIS-ER (NCBA CLUSA), LAHIA
(Save the Children) & Sawki (Mercy Corps)
Involved 80 established Hausa-
speaking community groups, in 20
villages in the Maradi Region
Focused on the development and dissemination
of 10 videos by community facilitators working
with 4 distinct groups in each participating village
Niger

9. Target Population groups included 15 to 25
members in each of the 4 distinct groups
Women of
reproductive age
(WRA) (15-49)
Key Influencers,
including
grandmothers
and other family
members
Men (25- 60+)
model husbands
selected by
health centers
Adolescent girls
(12-18) in “safe
space” programs

10. Study Objectives
1. To assess the
acceptability and
feasibility of introducing
the community video
approach
2. To determine the
effectiveness of the
approach in the Niger
context
3. To assess factors
influencing the potential
for scale-up and
sustainability

11. Quantitative Methods
Objective: to measure the effectiveness of the
facilitated videos and home visits focusing on
responsive feeding and hygiene behaviors
Methods: Three rounds of data collection - Baseline
(April 2015), Second survey (June 2015), Endline
(August 2015)
Sample: approximately 300 women with a child
between 6-23 months at each data collection point
Analysis: Bivariate analysis

12. Evaluation Results

13. Handwashing Behavior
59
48.8
14
0 20 40 60 80 100
Endline Survey
(August 2015)
Second survey (June
2015)
Baseline Survey (April
2015)
Percent of households
Having a designated place to wash hands increased from
14% to 59% after exposure to the video.

14. Handwashing Behavior

15. Handwashing Behavior

16. Responsive Feeding Behavior

17. • Findings from the quantitative surveys indicated
that the community video approach was an
effective tool for achieving MIYCN behavior change:
• Survey findings indicate that use of the community
video approach significantly increased the presence of
a handwashing station at home
• Findings for the second priority behavior studied,
responsive feeding of children 6–24 months and
feeding from a separate plate, also indicate very
promising results
Conclusions

18. Sharing findings
Seeing is Believing findings published and shared in
Niger during several events:
• Advocacy workshops led by the Niger government
and the 3N Initiative (in Niamey) and the MOH (in
Zinder)
• Sahel Resilience Learning Project (SAREL)
Learning Forum in Niger (in Niamey)
https://www.spring-nutrition.org/publications/reports/seeing-believing

19. AEA Conference
Washington, DC
November 9, 2017
Sophia Magalona, JSI, Inc.
How Community Video Encourages Male
Involvement for Better Nutrition and Hygiene
Behaviors in Niger

20. Background
• Cultural norms and practices, including polygamy,
an emphasis on male decision-making, and low
levels of literacy further contribute to inadequate
dietary intake and child illness among children
• Few women are able to seek health care for
themselves without prior consent from their
husbands (21%); or are able to make decisions
about important household purchases (20%) (DHS
2012)

21. Male Involvement
• A number of studies have found grandmothers play an
important role in determining child feeding practices
• Existing literature on the role of men in supporting
maternal and child health focuses on antenatal care
and testing for HIV/AIDS
• Few studies have explored how men can support child
health
• More research is needed to understand how spousal
communication and support from husbands can
encourage maternal, infant and young child nutrition
(MIYCN) behaviors.

22. Male involvement themes

23. Study Objectives
• Objective 1: To explore the effects of the community videos
on male involvement for MIYCN behaviors
• Objective 2: To explore how spousal communication and
support for MIYCN behaviors by husbands can be
encouraged using the SPRING community video approach
• Objective 3: To assess how community members and
important influencers such as mothers-in-law perceive
changes in spousal communication and husband’s support
for MIYCN behavior after exposure to the SPRING
community video approach

24. Study Sample (in subset of 5 villages)

25. Qualitative Results

26. • Husbands reported learning
about MIYCN behaviors
through videos and recognized
that the information was
useful
• Husbands discussed the
videos with their wives mainly
in the evening or early morning
and with greater frequency
• Both husbands and wives
initiated discussions on the
videos and helped each other
understand the content
What effect did community videos have
on male involvement of MIYCN?
Before, I did not discuss with my wife,
and we did not understand each other.
But today we understand each other
perfectly. When she returns after viewing
the video, she gives me the account of all
that she has seen and I apply it because
of its advantages. It has contributed
much to the strengthening of our bond of
couple. Before, we could not discuss
more than 10 minutes together. Now we
spend over two hours chatting.” —
husband, not seen video

27. • Videos encourage couples
to share responsibility for
MIYCN
• Videos provide the extra
push towards behavior
change by reinforcing
messages from existing
channels
• The visual representation
gives men a behavior to
imitate
• Seeing the context enables
viewers to observe a
lifestyle they want to adopt
not just the behavior itself
How can community videos encourage
husbands’ involvement?

28. • Community felt the videos
helped to enable
conversations between
mothers and fathers about
child nutrition and that
these conversations had not
occurred previously
• Fathers also began
providing a greater level of
support to the mothers in
caring for the child
How do community members perceive
changes in husbands’ support for MIYCN?
“They take good care of their children.
They buy essential and nutritious foods
that they eat with their children. As soon
as the woman is pregnant, they go to the
health center and follow up as they have
been told. They are having conversations
more than before.” —mother-in-law

29. Conclusions
• Men are key influencers in MIYCN behavior adoption
• Community video encourages spousal communication and
behavior change related to MIYCN
• Women felt free to discuss the videos with their husbands
and felt the husbands were more supportive in contributing
to household work following exposure to the video
messages
• These findings were confirmed by community members and
family members, indicating that community video is a
promising approach for strengthening spousal
communication on important health issues

30. The Influence of Social Networks on Infant and Young
Child Feeding Behaviors in Burkina Faso, West Africa
Leanne Dougherty, John Snow Inc.
November 9, 2017
AEA Conference
Washington, DC

31. Background
• Social network factors associated with variety of
health behaviors.
• Social network theory and analysis used to study
health behaviors in developing countries most
notably the use of modern methods of contraception.
• Few studies have investigated whether network
characteristics might be associated with approach for
infant, young child nutrition (IYCN) behaviors

32. Context
• Community video approach introduced in
Burkina Faso seeks to improve IYCN behaviors.
• The intervention uses community videos
accompanied with facilitated discussions among
existing Mother to Mother and Care groups to
share information on behaviors.
• This presentation applies social network
analyses to understand the factors associated
with IYCN behaviors where the community video
approach is underway.

33. Three hypotheses may account for association
between communication with network
partners and IYCN outcomes
1
2
3
Structural: communicating with network partners high in
education, or experience with breastfeeding and nutrition
should provide access to resources and information useful
for making decisions about IYCN behaviors
Infrastructure: identifying a health care professional
as someone a woman has spoken to should be
associated with accessing health services.
Communication: talking about breastfeeding and
child nutrition within social networks may be associated
with improved IYCN behaviors for a variety of reasons

34. Methodology
 What
 Data part of a baseline for a pre-
post quasi experimental evaluation
 Who
 Women aged 15-49 who had a
child in the 2 years preceding the
survey (N=750)
 Where
 25 villages in Gnagna &
Komondjari Provinces in the East
region
 When
 Data collected May-June 2016
 How
o Collected data using egocentric
approach; analysis used bivariate
and logistic regression

35. Key Variables  Network Characteristics
 Structural
 Network partner education
 Network partner experience with
IYCN
 Infrastructure
 Relationship to network partner is
health worker
 Communication
 Frequency of discussion
 Network partner gave respondent
information or advice
Outcomes:
 Minimum dietary
diversity
 Early initiation of
breastfeeding
 Separate plate for child
feeding

36. Description of Network
Partners Number of Network Partners Identified
• Name one network partner: 38%
• Name two network partners: 30%
• Name three network partners: 32%
1st alter partners identified
• Female relative: 34%
• Friend: 31%
• Male relative: 22%
• Other: 8%
• Health provider: 3%
• Husband: 2%

37. Results: Structural Hypothesis

38. Results: Infrastructure Hypothesis

39. Results: Communication Hypothesis

40. Conclusion
• Structural variables (i.e. education and experience of
network partner) limited association with outcomes.
• Receiving advice about nutrition and the frequency
of advice was positively associated with outcomes.
• Infrastructure, naming a healthcare professional,
was not associated with nutrition and breastfeeding
behaviors.

41. Pilot to Practice Conclusions
• Data played a central role in shaping and refining
pilot activities.
• A strengthened data use culture enabled
sustained and continuous programmatic
improvement.
• Findings generated interest and engagement
among stakeholders, fostering an enabling
environment for scale-up.

42. Thank you