Making negotiations with support groups more action-oriented to bring about behavior change

Summary:

Mtoto Mwerevu nutrition project uses negotiation for behavior change by community health workers (CHWs) on MIYCAN, WASH, ECD, and male involvement to reduce stunting in five regions of northwestern Tanzania. The project also works with support groups through civil society organization (CSO) volunteers to conduct negotiations. Home visit negotiation led by CHWs takes caregivers through an eight-step process which includes asking about health issues, listening, discussing and suggesting practices to try, and committing to one or more small, doable action. However, negotiation led by a CSO volunteer in a support group presents challenges, because the health concerns of caregivers vary. Compared to the home visits, messages shared during support groups are rarely directive. Mtoto Mwerevu has therefore modified support group negotiation to make it more behaviorally focused. As of September 2019, action-oriented support group negotiation has been piloted in 210 out of 730 support groups. In addition, 84 CSO volunteers have been trained in this behaviorally focused group negotiation. Through scale up, it is anticipated that more caregivers will be reached and engaged. Making support groups more action-oriented modifies the negotiation steps by: 1) Asking caregivers what small practice they can try to overcome their identified health issue, 2) Having caregivers discuss each practice to ensure common understanding, 3) Encouraging caregivers try a practice of their choosing at home, 4) Saying aloud the practice, and 5) Recording committed practices for follow-up in the next session.

Background/Objectives

Over the past four years, Mtoto Mwerevu nutrition project used negotiation for behavior change during 10 million home visits by CHWs to four million beneficiaries across five regions of northwestern Tanzania, with the goal of reducing stunting by seven percent. Through 48 civil society organizations (CSOs), the project also works with selected support groups of caregivers to negotiate for behavior change on MIYCAN, WASH, ECD, and male involvement. While the objectives of support groups are multipleinform, support, and adopt new practicesmessages are rarely directive. Mtoto Mwerevu has therefore modified support group negotiation to make it more behaviorally focused.

Description Of Intervention And/or Methods/Design

Home visit negotiation led by CHWs on MIYCAN, WASH, ECD or male involvement takes caregivers through an eight-step process which includes asking about health issues, listening, discussing and suggesting practices to try, and committing to one or more small, doable action. However, negotiation led by a CSO volunteer in a support group presents challenges, because the health concerns of caregivers vary, and not all should commit to the same practice. In 2019, Mtoto Mwerevu piloted action-oriented support groups among 210 of 730 support groups which capitalize on the best elements of negotiation during home visits. Making support groups more action-oriented includes: 1) Asking caregivers what practice they can try to overcome their identified health issue, 2) Having caregivers discuss each practice to ensure common understanding, 3) Encouraging caregivers to try this practice at home, 4) Saying aloud the practice, and 5) Recording committed practices for follow-up.

Results/Lessons Learned

As of September 2019, 84 CSO volunteers have been trained in this behaviorally focused group negotiation and are expected to reach and engage with more caregivers per group session than the traditional home visits do. Processes are underway to scale up this approach to more support groups funded by the Mtoto Mwerevu project in northwestern Tanzania. Preliminary observations show that group members (caregivers) are receptive and willing to commit to individual actions, even though the setting is public. It is anticipated that through spill over effect the approach will reach even more caregivers and the public at large.

Discussion/Implications For The Field

Scientific evidence of the impact of support groups is mixed. As program planners improve upon the support group model, they will need to simultaneously address the benefits of more traditional support groups (knowledge, mutual help) and their disadvantages, including limited opportunities for individuals to commit to specific actions. Groups built on some of the same principles outlined in the CHW home visit negotiation approach may be more likely to achieve behavioral goals, but at the expense of being too directive.

Abstract submitted by:

Kerry Ann Dobie - IMA World Health

Generose Mulokozi - IMA World Health

Joseph Mugyabuso - IMA World Health

Tumaini Mikindo - PANITA - Partnership for Nutrition in Tanzania

Magreth Paul -  PANITA - Partnership for Nutrition in Tanzania

Kirk A Dearden - IMA World Health