The Use of Narrative for Behavior Change in Adolescent and Youth Sexual and Reproductive Health

“Because narratives are received in the light of our own personal stories and the contexts in which we live and the youth population is made up of many diverse groups, it is important to contextualize narratives so that they resonate with the unique circumstances of the young people reached.”

This resource brief offers a summary of the discussions and recommendations emerging from a webinar and technical exchange event, which sought to explore the use of narrative or stories for behaviour change in adolescent and youth sexual and reproductive health (AYSHR). The webinar and technical exchange were co-hosted by Pathfinder International’s Evidence to Action for Strengthened Family Planning and Reproductive Health Services for Women and Girls Project (E2A), which works to address the reproductive healthcare needs of girls, women, and underserved communities around the world by increasing support, building evidence, and facilitating the scale-up of best practices that improve family planning services.

As explained in the brief, “[c]urrently, efforts to promote behavior change among young people are often fragmented by the different public health discourses and sub-disciplines of behavior change, narrative/entertainment-education, and adolescent and youth sexual and reproductive health (AYSRH). Each sub-discipline looks at the topic through its own lens, which has led “narrative + behavior change + youth” to be less than the sum of its parts." For this reason the webinar and technical exchange sought to bring together experts working in the field to explore different approaches to using narrative, and to come up with guiding principles that will improve the use of narratives to bring about behaviour change.

The document briefly discusses the speakers, the process, and the focus of the discussions in the webinar.  One person, for example, spoke about the challenges of how to increase coverage and scale up interventions, and how to engage youth in a context-specific way to address their health needs. Another speaker examined the difference among narratives that function as ads, parables, and inkblots - with the ad being the most information-driven and top-down approach, the parable serving to provide models of behaviour and response to risk, and the inkblot being most suited to dialogue and participation. Another speaker talked about what qualities make narratives especially powerful and how public health practitioners can better influence how information is received. This speaker made the point that the inkblot approach encourages youth to share their own stories, in their own words, and on their own terms, which is the foundation of effective storytelling.

Building on the discussion generated by the webinar, a technical exchange meeting was held, which allowed experts to: share, examine, and analyse approaches for using narrative to change sexual and reproductive health behaviours, and identify guiding principles that can be applied by practitioners when developing, implementing, and evaluating AYSRH programmes.  For the technical exchange, the participants were divided into three groups with each group being required to contribute a list of guiding principles that can be applied to the three stages of using narratives for behaviour-change interventions: the development of the narrative itself, the implementation of the narrative intervention, and the evaluation of how the narrative was implemented. Participants then voted on their three top choices for guiding principles under each of the three stages.

Based on these selected guiding principles, the brief offers a list of ten recommendations.  The following are just a few of the recommendations as they fall within the three stages of using narratives for behaviour-change interventions:

Developing narratives for youth: the creative process

• "Have youth engaged in a participatory manner throughout the entire development process. We know that youth respond to participatory narratives that allow them to challenge their own attitudes, values, and beliefs. Although public health practitioners are often more comfortable providing expert advice to young people, there need to be participatory discussions with youth during the narrative-development process in order for the youth to own and identify with the story and for the story to be a true vehicle for change. Through narrative, young people can explore different meanings, and they can bring different perspectives to the conversation, giving them the opportunity to dialogue cognitively and socially by tapping important affective and cultural dimensions of behavior."
• "Identify narrative type and purpose, and clearly lay out objectives and how they will benefit the target audience from the beginning, ensuring the objectives are upheld during the entire process. When using a participatory process to develop narratives, it is important to structure discussions and narrative development around objectives that clearly serve as stepping stones to achieving the desired behavior changes among the targeted population."

Using narratives for behavior change among youth

• "Have facilitators keep dialogic space open, create opportunities for the audience to share stories, and establish trust with the audience. The facilitators responsible for presenting the story will inevitably play a prominent part in how the story is received. Facilitators should be both trusted and skilled, with the ability to evoke emotions and invite reflection, rather than being bossy or demanding. Young people themselves should be considered for facilitation roles, as many young people may be more open to discussing sensitive topics with their peers."
• Ensure principles, processes, and methodologies are scalable and transferable to other contexts. Although each narrative should be contextualized so that it resonates with the target population of youth, the process of narrative development, implementation, and evaluation should follow guiding principles, such as the ones presented in this brief, so that the process can be scaled to other contexts and populations".

Evaluating narratives used to encourage behavior change among youth

• "Conduct process evaluation, not just in terms of quantities, but also in terms of quality of audience interaction with the story and with others’ response to the story.  While it is important to know who and how many people you are reaching with the narrative, it is equally, if not more important, to know how your audience is receiving the story.  Their level of engagement, affinity with content, and responses to the stories being presented will ultimately allow you to better gauge how the narrative could potentially be used as a vehicle for change. A primary audience who is more engaged will also be more likely to talk about the narrative with their friends, family, and community, potentially furthering its reach."
• Elicit and assess what participants themselves count as success. Determining the success of a narrative, particularly in a truncated timeframe, can be a challenge. Engaging the audience to determine its success - how it sparked discussions, thought processes, and ultimately changed the cultural conversation - can be indicators of success."