Practical Application of Behavioral Change Theory in Ethiopia

Background

CARE implemented the Farta Child Survival Project (FCSP) 2002-2007. This abstract elaborates on Behaviour change theories and the example of the successful FCSP whose approaches illustrate the theories in practice on the ground in regard to changing a whole community's maternal and Child Health norms.

Project design

FCSP used the local authorities and transformed them into health promoters. Priests from the Ethiopian Orthodox Church disseminated health messages in a culturally-adapted manner after church services and on home visits (e.g. breastfeeding messages were integrated into stories from the Bible: ‘after giving birth Mary put Jesus to the breast and gave him milk and nothing but milk for the first six month of his life'). Mothers were gathered in Mother-to-Mother support groups led by a positive deviant trained mother. Mothers resistant to change were followed by ‘their' priest. Priests regularly supported/taught each other and linked to the formal health system. All health promoters met monthly to share experiences and decide on next month's messages together facilitated by the frontline health worker.

The project evaluations captured qualitative data in cross-sectional surveys and applied quantitative data collection approaches (key-informant interviews and Focus group discussions).

Outcome and Challenges

The Knowledge, Attitudes and Practices survey showed a considerable improvement on nearly all indicators monitored, (e.g. vaccination rates increased from 17 to 70 etc

The main challenge was the low managerial capacity of the Ethiopian church and the local health system at the beginning of the project.

Conclusions ; the AID/W funded highly successful project reduced child mortality by transforming community norms on infant and child nutrition and vaccination and increasing access to the formal health system. The project is a perfect example of social cognitive theory and social challenge approach in practice.

The behaviour change strategy applied took into account the traditional leadership structure, provided support to enhance self-confidence to change behaviour of mothers and health promoters; it challenged community norms successfully and new behaviours were instituted in time to bring about better health outcomes. The project is sustainable due to the adopted new behaviours preserving children's and mothers' health.