Seeing Is Believing: Evidence from a Community Video Approach for Nutrition and Hygiene Behaviors

"The use of video as a SBCC medium offers several advantages when working in rural communities, such as more standardized content with fewer inconsistencies across educators and high receptivity and understanding among low-literacy populations."

This report presents findings from a mixed-methods evaluation to assess the acceptability and effectiveness of a community video pilot initiative in Niger to address maternal, infant, and young child nutrition (MIYCN) and hygiene behaviours. The study further explores the factors influencing the potential to scale up the intervention and sustain activities. The goal of the project, which was implemented by the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project and Digital Green (DG), was to contribute to a decrease in childhood illnesses caused by poor handwashing and to support improved dietary intake through an increase in the use of responsive feeding practices.

The project involved working with four select communities to develop and disseminate videos focused on 10 identified MIYCN and hygiene themes, such as dietary diversity, handwashing, exclusive breastfeeding, and complementary feeding practices, including responsive feeding of young children using a separate dish. Members from the community perform as actors, or "stars", in the videos to highlight the behaviour they are seeking to promote. These videos are then presented during monthly community meetings, accompanied by facilitated discussions. In addition to sharing videos with existing community groups, the mediators screened videos for four groups of influencers, including mothers-in-law, husbands, and co-wives (for more information, see Related Summaries below).

The following is the extracted executive summary:

“Located in the Sahel, Niger is characterized by harsh climate conditions that contribute to structural food crises and high rates of severe acute malnutrition among children. The people of Niger have experienced frequent shocks, such as conflict, drought, and food shortages, which will likely worsen as a result of climate change and expanding population. With 43.9 percent of children under five years stunted, the country needs to introduce approaches that produce rapid results. Addressing the nutrition, health, and livelihoods needs of communities in Niger requires a rapid and flexible communication approach that can be adapted to contextual needs at the community level. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, funded by the U.S. Agency for International Development (USAID), is a five-year project committed to reducing anemia and stunting among women and young children through the expansion of effective social and behavior change communication (SBCC) and nutrition-sensitive programs at scale.

Following a successful collaboration in India, SPRING and Digital Green (DG) have built partnerships with existing community groups and introduced an innovative community media approach in Niger. The SPRING/DG pilot intervention in Niger aims to contribute to a decrease in childhood illnesses caused by poor handwashing, and to support improved dietary intake through an increase in the use of responsive feeding practices. The approach enables rural communities to create and share videos that promote high-impact maternal, infant, and young child nutrition (MIYCN) and hygiene behaviors.

This report presents results from a mixed-methods evaluation on the acceptability, effectiveness, and scalability of the SPRING and DG community-led video approach on MIYCN and hygiene behaviors in Niger.

Research Questions
The evaluation seeks to answer the following research questions:

• What were the experiences and perspectives of participating beneficiaries and mediators in terms of the acceptability of the community video program? How feasible did they find implementation?
• What was the effect of the SPRING/DG approach in terms of changing knowledge, attitudes, and adoption of handwashing and responsive feeding behaviors in the target group? Did knowledge and behavior adoption diminish/increase over time?
• What is the cost per adoption of behavior and cost per person reached in the SPRING/DG pilot intervention areas? What is the cost of scaling up the intervention to new communities or introducing new videos?

Methods
Our evaluation applied a mixed-methods study design. Quantitative surveys measured the effectiveness of the interventions and were administered at three time periods: prior to video exposure (baseline), four to eight weeks following video exposure (second survey), and three to four months following video exposure (endline) to test sustainability of adoption. Focus group discussions (FGDs) assessed acceptability, as well as the potential to scale up and sustain the intervention. We collected cost data to determine the cost per beneficiary reached and behavior changed as well as to determine what resources would be required to scale up the intervention.

Results

Feasibility and Acceptability of the Community Video Approach
Findings from the FGDs were promising and indicated that community members, including women of reproductive age (WRA), men, and adolescents, perceived the community video approach was an acceptable and feasible tool to support behavior change. Program beneficiaries noted that the scheduling and duration of the video viewing were appropriate. However, due to the high levels of interest, at times the viewing area became hot and crowded and there were not enough places to sit. Overall, women felt a connection to the stories shared and felt that the visual presentation helped facilitate an understanding of the messages beyond what had previously been shared verbally. Findings from the FGDs also indicated that the videos had generated excitement that was translating into changes in social norms. Pilot intervention beneficiaries and mediators found that participation in the activities helped to elevate their social status, with other community members consulting them about the messages shared through the videos and home visits. Pilot intervention beneficiaries and mediators also acknowledged the importance of the home visits, stating that the visits helped to reinforce the understanding of messages shared during the video viewing and also offered an opportunity to share the information with influencers in the household, including husbands and mothers-in-law. Women also noted that the pilot intervention’s emphasis on inviting influencers to the video viewings was helpful since this provided the women with additional support in convincing household members who may be resistant to behavior change. 

Effectiveness of the Community Video Approach
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 increased the presence of a handwashing station at home (as demonstrated in the videos) from 14 percent at baseline to 59 percent one to two months after the video was shown. In addition, the percentage of households with a handwashing station with soap and water, indicating regular use, increased from 73.8 percent to 96.2 percent.

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. After watching the video, the percentage of children within arm’s reach of a responsible person at the last meal increased from 65 percent to 80 percent. The percentage of women who fed their child from a separate plate increased from 70 percent to 97 percent.

Cost of Implementing the Community Video Approach
Our analysis determined the cost per beneficiary reached to be approximately US$16.19 per person. Based on the numbers of beneficiaries whose behaviors changed, we determined the cost per handwashing adoption of behavior changed to be US$28.91 per beneficiary and US$36.24 per beneficiary who “adopted” the behavior of maintaining a separate plate for the child. Cost estimates for scale-up included a small stipend increase for the project mediators and were extrapolated for two scenarios to determine the added costs associated with expanding the intervention from 1,500 beneficiaries to 7,500 beneficiaries. Using the existing 10 videos produced by the proof of concept, we estimated the cost to scale up the program at US$277,169. As a result, the cost per beneficiary fell to US$3.73 per person reached, US$6.60 for per handwashing station behavior changed, and US$8.27 for the separate plate behavior changed. A second scenario estimated the costs of expanding the intervention to 7,500 beneficiaries and producing new video content. The costs associated with the second scenario were US$304,887. As a result, the cost per beneficiary would be US$4.13 per person reached, US$7.26 for the handwashing station behavior changed, and US$9.10 for the separate plate behavior changed.

Conclusion
The SPRING/DG collaboration in Niger shows that the approach can be implemented successfully in the resilience context of Niger. Results from the mixed-methods evaluation highlight the potential of the community video approach as an innovative and effective approach for fostering both social and individual nutrition and hygiene-related behavior change. Overall, evaluation results show that using multiple channels for disseminating messages and engaging with key influencers is a promising approach to empower women, men, and communities to improve their health through improved nutrition and hygiene behaviors."