The Value-Add of Community Video in Changing Nutrition and Hygiene Behaviors: Evidence from a Comparative Study in Senegal

"...findings show that community video is an exciting, feasible, and effective social and behavior change communication (SBCC) approach that has the power to change social norms and behaviors."

At the request of the United States Agency for International Development (USAID) Mission in Senegal, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project began work in that country in November 2015 to address challenges around optimal nutrition, especially for women and children. SPRING worked with local communications and media partners to create what was intended to be informative, engaging, and culturally appropriate content on nutrition- and hygiene-related practices. This report presents findings from a quantitative study assessing the effectiveness of SPRING/Digital Green (DG)'s community media approach and the value of the community video intervention for improving nutrition and hygiene behaviours in Senegal.

SPRING's package of interventions, which centred on working with agricultural networks to increase demand for and access to key inputs and services to support nutrition-sensitive agriculture, included use of community media. In addition to using community radio to promote desired behaviours, SPRING developed a "Community Video for Nutrition" approach informed by Bandura's theory for social learning as well as the socioecological model. The approach engages communities during the design, production, and dissemination stages to create contextualised videos that promote a variety of multi-sectoral nutrition-specific and nutrition-sensitive behaviours. In line with DG's approach, community members were selected to star in the videos, creating ties to the community and increasing the likelihood that viewers would both identify with the messages and adopt the promoted behaviours. Trained mediators disseminated these locally produced videos using portable pico projectors to promote optimal nutrition and hygiene practices while also addressing underlying gender considerations. The videos were viewed by community leaders, women with children under two years of age, and members of agricultural producer networks. The viewings were followed by lively group discussions and in some cases, follow-up home visits.

Between March and August 2017, SPRING/DG implemented the community video approach across 104 villages in Senegal's Kaolack, Fatick, and Kaffrine regions, making 24,489 contacts with the 10 videos produced. Researchers used a pre-post quasi-experimental study design, administering cross-sectional surveys at two points in time: a baseline survey prior to radio and video exposure and an endline survey 10 months late. Ten villages received the community video intervention with follow-up home visits, in addition to SPRING-supported community radio programming; 10 villages received the community video intervention without follow-up home visits and radio programming; and the final 10 villages received community radio programming only.

Summary of results:

• Breastfeeding: Both community radio and community video were effective in improving knowledge about breastfeeding, but an improvement in the actual practice of early breastfeeding initiation was only seen in the villages where SPRING implemented community video. At endline, there was no improvement in the control villages, but there was a significant increase from 65.4% to 86.1% in the intervention villages.
• Minimum acceptable diet (MAD): Results indicate that community radio and community video were associated with statistically significant increases in MAD for children ages 6-23 months, though the increase in the intervention villages (11.8% at baseline to 61.8% at endline) was more than twice that seen in the control villages (16.2% to 34.6%).
• Eating from a separate plate: Following exposure to radio and community video, there was no significant increase among women who agreed that children should be fed from a separate plate in the control villages, but there were statistically significant increases to a near universal rate in the intervention villages. While the percentage of women who fed their child from a separate plate during the last meal increased from 62.7% to 73.7% in the control villages, it increased from 54.4% to 90.2% in the intervention villages.
• Handwashing: The percentage of women who knew at least one critical moment for handwashing decreased in the control villages and stayed the same in the intervention villages at endline. While there were virtually no fixed handwashing stations in intervention or control villages at baseline, 41% of the intervention households had handwashing stations at endline, the vast majority of which were tippy taps. No improvement was seen in the control villages.

In short, community video showcased positive role modeling of recommended behaviours to help stimulate behaviour change. This storytelling model facilitated learning of new concepts, as well as communication among village peers, to catalyse behaviour change. Two principal lessons can be drawn from this study:

1. The community video approach was effective even without follow-up home visits: The researchers were unable to conduct the quantitative analysis comparing the effectiveness of screening of the films and engaging in a facilitated group discussion with the gold standard approach that includes follow-up home visits, due to difficulties in properly scaling home visits. Despite this, they consider the fact that disseminators were unsuccessful in conducting household visits among at least 50% of the target homes a telling finding. For projects that utilise volunteer mediators, as is the case in Senegal, the time opportunity cost for conducting home visits may be too high to scale or sustain, and this simpler approach may provide a more practical option where time and budget constraints are significant.
2. Using multiple communication channels to reiterate key messages supports desired behaviour change: For certain indicators, endline results showed improvements in control villages, which only received SPRING-supported nutrition- and hygiene-related radio broadcasts. These results show that radio is an excellent way to share information broadly and begin to catalyse change through targeted messages. The addition of community video, as a more direct communication channel, enhances results by reinforcing key messages heard elsewhere.