Presentation on theme: "SBC Boot Camp: Planning & Implementing Social & Behavioral Change Strategies for Agriculture and NRM June 4 and June 7 Tom Davis Senior Specialist for."— Presentation transcript:
1SBC Boot Camp:Planning & Implementing Social & Behavioral Change Strategies for Agriculture and NRMJune 4 and June 7Tom DavisSenior Specialist for SBC, TOPS Project
3Agenda Pretest Review of Agenda Ruler Exercise on SBC methods and toolsLNRA & Demonstration of audience response system.Change or Die : Critical elements in helping someone to changeList of main SBC questions to examine when designing FS programs.WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know.WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW do we achieve high coverage levels of those primary actors / influencers?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality?Posttest and Satisfaction Survey
4Ruler ExerciseHow important is it to achieve excellence in the area of social and behavior change to bring about results in a food security program? (1 = not important at all; 10 = extremely important)How effective do you think your organization is in bringing about social & behavioral change? (1 = not effective at all compared to others; 10 = extremely effective compared to others)Not everyone on a FS team has SBC skills. To what degree do you think you have the skills needed to create curricula and lesson plans to help people change their attitudes and behaviors? (1 = very low level of skills; 10 = very high level of skills)
5Audience Response Demo 1. How much do you like Social & Behavioral Change?A: It’s one of my favorite things in lifeB: I like it a lotC: It’s okayD: I don’t like it very muchE: It makes me sick to my stomach.
6Audience Response Demo 2. My favorite food is a:A: Type of meatB: Type of starchC: Type of vegetableD: Type of fruitE: Other
7Thinking Fast and SlowHolding a pencil in your mouth like this will make you less likely to find cartoons funny. Use your clickersTrueFalseHolding a pencil in your mouth like this will make you more likely to find pictures of malnourished children sad.1. #1 is B, False – more likely to find them funny when your mouth is drawn into something closer to a smile.2. #2 is A, True – more likely to find them sad when your mouth is pulled down closer to a frown.Your brain not only directs your muscles according to emotions, but monitors your muscles to know the emotions you are feeling.
8Thinking Fast and SlowRepeated exposure to which of the following phrases made it more likely that people would (later) agree with the statement, “the body temperature of a chicken is 144°.” Use your clickers.A. “Red things are hot.”B. “Green things are cold.”C. “The body temperature of a chicken”“The body temperature of a chicken” – the familiarity of one phrase in the statement sufficed to make the whole statement feel familiar, and therefore true. So using some of the same structure repeatedly for facts may help to improve believability when people hear the fact for the first time.
9Methods / Tools Experience How much experience do you have with using the following SBC tools?6. Use of Motivational Interviewing for SBCA: I train others in this methodB: A lot of experienceC: Moderate experienceD: Some experience, but not muchE: No experience at all
10Methods / Tools Experience How much experience do you have with using the following SBC tools?7. Use of Peer Educators (e.g., Care Groups or Model Farmer approach)A: I train others in this methodB: A lot of experienceC: Moderate experienceD: Some experience, but not muchE: No experience at all
11For an exercise we will do later… 8. Be honest: How often did you exercise for at least 20 minutes (heart rate up, break a sweat) in the past week?A: 0 timesB: 1 timeC: 2 timesD: 3-4 timesE: 5 or more times
12Change or Die: What Doesn’t Work in Behavior Change Development in all sectors requires that people do something new/different. However…Change or Die (Alan Deutschman): People with heart disease and other critical problems were told, “you need to change, or you are going to die” – BUT, the majority still did NOT make changes in their lifestyle.Even when people are faced with “change or die” situations, they often do not change their behavior on their own. Two years after coronary bypass: 90% of people have not changed their lifestyle. 67% of US prisoners re-arrested, and 52% return to prison. 74% in U.K.What doesn’t work very well in terms of achieving behavior change:FactsFear (e.g., “scared straight”)ForceSome things that we know don’t work very well in terms of promoting behavior change:Facts (e.g., just telling mothers how malaria is transmitted)Fear (e.g., making people more afraid of diseases without improving their prevention skills)Force (e.g., having medical providers and leaders tell people that they simply have to change, and relying on the moral authority of their position or expertise … or even setting laws on something like latrine ownership when consistent and permanent enforcement is not possible.Deutschman says that the reason that people do not change is not that they do not want to change or cannot change, but that they do not understand change or have the right tools to make it happen. Looking at the four keys to change, it’s obvious that they often are not in the right “supportive environments” where change can be facilitated – where they have a group of people that inspires hope, where they have opportunities to learn and practice skills, and where they lean to reframe and tell their stories in a new way.
13Four Keys to Behavior Change New hope (“relating”)New skills (“repeating”)New thinking (“reframing”, “redirecting”)New strategies
14What works in promoting behavior change: 1. New Hope -- “Relating”: Developing a relationship with someone (a new person or a new community) you trust who gives you hope for change … and being that source of hope to others.Hope = “A emotional feeling of belief in expectation” – not necessarily rational; it’s emotional. Need to have contact with a person (not a poster, not a pamphlet) who believes and expects that you will change.Our job: Help people to regain hope through discussions, use of testimonials, stories, visits, modeling, small groups, etc.“Relating”: Developing a relationship with someone you trust who gives you hope for change.People need to form a new, emotional relationship with a person or community that inspires and sustains hope. “If you face a situation that a reasonable person would consider “hopeless,” you need the influence of seemingly “unreasonable” people to restore your hope – to make you believe that you can change and expect that you will change. One of the main reasons that people get stuck is that they lose hope (and consequently, develop poor self-efficacy and learned helplessness). A peer or someone else in their community or on your staff has to make the person believe that they can change. They need to help the person by being a partner, mentor, role model, or by providing sources of new knowledge and hope.Deutschman says in the book, “When confronted with seemingly intolerable situations and are feeling overwhelmed by tension, anxiety, and a sense of powerlessness, or when the harsh realities of our lives threaten to crush our self-esteem, our minds unconsciously activate a number of powerful, built-in, automatic psychological strategies to help us cope. We shield ourselves from the threatening or humiliating facts.” So we deceive ourselves and protect ourselves. When a person is in a seemingly hopeless situation, often he or she doesn’t need to be confronted with the facts – they need to be confronted with hope. You need someone who can inspire a new sense of hope – the belief and expectation that they can change the situation (alone or with the help of a higher power). This is what happens in the first key to change (Relate).
15What works in promoting behavior change: 2. New Skills – “Repeating”: Learning and practicing skills .. and helping others to learn and practice new skills.Our job: Helping ourselves and others to have access to training and opportunities to practice and perfect new behaviors. (Example: Practice with an ag technique.)The second thing that works in behavior change is learning and practicing skills that are needed to make the change. People need to learn new habits and skills, practice new habits and skills, and master them to make change happen. Change doesn’t just involve “selling” – it involves training.So our job is training people and giving them hands-on opportunities for “trying out” the things that we are promoting.Examples of this would be helping mothers practice preparing a balance meal, make ORS, talk to her husband about family planning; or helping farmers learn how to plant in rows, make and use compost, create better storage silos, etc. It also means learning how to “talk back to yourself” when you get discouraged.
16What works in promoting behavior change: 3. New Thinking -- “Reframing / Redirecting”: This means changing our “worldview” and learning how to “talk to ourselves” and others differently … and helping others to do so.Our job: Reframing what we hear and say … and helping others to do so … so it helps people to change rather than hindering us. (Example: “Small harvests are normal given the droughts we are having.”)The third thing that works in behavior change is changing one’s worldview or “reframing.” For example, coming to believe “I can make this change,” “My child can be a normal height,” or “I can have a successful harvest this year.” We need to learn new ways of thinking about our situation and our lives. “Frames” are also called “ideologies”,” “belief systems,” “conceptual frameworks,” “mindsets” or “worldviews.” People take facts and fit them into the frames that they have, and if they facts don’t fit (e.g., “All children are this short – it’s normal” or “I will always be abused”), they reject the facts.So our job is to learn to help people to reframe what they hear and say, but using the right questions and tools. For example, we will mention an SBC tool called Motivational Interviewing that helps with that. We need to convince people to think about themselves and their power to make changes differently, and help them to behave accordingly (e.g., speaking up to naysayers, speaking out at public meetings, promoting healthy practices). There are usually several different ways to interpret a set of facts, one way will often be a very optimistic, hopeful way, and the other will be a more pessimistic, doom and gloom way. We need to learn how to help people be the hopeful ones while still being realistic.We should keep in mind, though, that this reframing often only happens AFTER people have started doing something new. They first receive hope, then try out something, and then believe later on. “How we act influences what we believe and what we feel … inner faith and outer action likewise feed each other.” “The “acting as if” concept explains why repetition helps to promote reframing. … You have to do things a new way before you can think in a new way.” We are as likely to act ourselves into a way of thinking, as to think ourselves into a way of acting. Dietrich Bonhoeffer said: “Only those who obey can believe, and only those who believe can obey.”
17What works in promoting behavior change: 4. New Strategies: This means finding the barriers and enablers to change and using those to create new strategies for change, as well as using “nudges” to make it easier for people to follow through.Our job: Study what blocks and enables people to make a specific change. Find the “nudges,” too. (Example: Doing Barrier Analysis on planting sunflower.)The fourth thing that works in behavior change is discovering the barriers and enablers for a particular behavior, and use that information to create new strategies for change. We also need to use “nudges” to make it easier for people to follow through. A “nudge” is basically something we do to make it much easier for someone to do a behavior. Sometimes, there are small things – “nudges” -- that can enabler or block change. Often we can do more to facilitate good behavior by removing some small obstacle than by trying to shove people in a certain direction” For example:A study at Yale University gave seniors some persuasive education about the risks of tetanus and the importance of going to the health center to receive an inoculation. Most of the students were convinced by the lecture and said that they planned to go get the shot … but only 3% actually went and got the shot. Another set of students were given the same lecture, but were also given a copy of a campus map with the location of the health center circled. There were then asked to look at their weekly schedules, make a plan for when they would go and get the shot, and look at the map and decide what route they would take. With those “nudges,” 28% managed to show up and get their shot. Note that they were all seniors and probably new where the health center was and were not given an appointment. Still, nine times as many students got the shot with these nudges (also known as “channel factors”). A similar study was done with donation of canned goods where they found that students rated as the least altruistic donated more cans than the students rated as very generous WHEN a map and hours of the place accepting the canned goods were provided to them.We can use some simple study methods like Barrier Analysis to help find out the determinants of behaviors -- why some people will adopt a behavior and others do not. We can then use that information to help more people change. We’ll talk more about BA later.
18Other change “helpsRealize that sometimes the problem runs deeper; don’t look back – look forward.“Habits such as smoking, drinking, overeating, and venting anger are not really the “problems” for heart patients. The real problems are depression, loneliness, isolation, stress, unhappiness, powerlessness, anxiety, fear, hopelessness, and purposelessness.” Is the problem not weeding your garden enough, or that you are too tired because of the mental stress/depression of getting in fights with your spouse every day?Realize that behavior change can take a lot of “contact time.”Shoot big, not small.One small change – one behavior – may not produce visible changes in crops. And if people can’t see the change, they may not sustain the behavior. This means that we need to promote more comprehensive changes – more changes in more behaviors – that lead to changes that people can observe.Remember: “People don’t resist change; they resist being changed.”We need to accept that who we were was not “that pretty” and want to become “new creations” We resist change because it invalidates who we were – we become “erased.” But we need to change.There are a few other general things to keep in mind as your plan your behavior change strategies:One is that we need to realize that the problem sometimes run deeper than the behaviors we are seeing. Dean Ornish, the founder of one of the most effective programs to reverse heart disease, says that habits such as smoking, drinking, overeating, and venting anger are not really the “problems” for heart patients. The real problems are depression, loneliness, isolation, stress, unhappiness, powerlessness, anxiety, fear, hopelessness, and purposelessness. Our underlying problems are often not behavioral, but psychological, emotional, and spiritual. We now know that depression in women is linked with child stunting, underweight, and wasting. We’ll talk more about that later. Despite this, we should NOT focus a lot of attention on “going back” to look for first causes of these problems (e.g., therapy, analysis, talking about the history of the community). Instead, it’s better to focus on calling someone into a community that inspires hope, teaches new skills, and helps people to reframe.Realize that behavior change takes a lot of “contact time” with the person who wants to change: Dean Ornish realized that the sort of change that was necessary would not and could not happen in the eight-minute doctor’s visit. Patients were invited to attend several four-hour sessions and then weekly meetings in order to get them to change their diet, exercise, and stress management. And we know that programs that spend more time with more people (e.g., two hours with 80% of mothers every two weeks) are more successful than those that have less contact time. We need to increase our contact time with people who want to make changes.Shoot big, not small: The Ornish program for reversing heart disease found that radical, sweeping, comprehensive changes are sometimes easier for people than small, incremental ones. Ornish says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they are not eating everything that they want, but they are not making big enough changes to see an improvement in how they feel or in other measurements of success. The same can happen with farming and raising children. One small change – one behavior – may not produce visible changes in crops or child growth. And if people can’t see the change, they may not sustain the behavior. This means that we need to promote more comprehensive changes – more changes in more behaviors – that lead to changes that people can see and feel. “Short-term wins” inspire hope, encouraging people to believe that people can change while increasing their expectation that they -- and the situation -- will change. We need to do things first that require people to be involved and show the most dramatic changes.Remember: People don’t resist change; they resist being changed. (Ornish). So that means that we need to get people on board for change and pull, not push.We need to accept the fact that who we once were was “not that pretty.” And some of us are still not “very pretty.” One of the reasons that we resist change, unconsciously at least, is that it invalidates years of earlier behavior. We hate to see ourselves being erased as we become something new, even if that new person is a better person. But we usually need to become new people if we are to have healthy children, healthy gardens, and healthy communities.
19Main SBC Questions for FS Design Two-minute “buzz” then brainstorm: What are the main questions that you ask yourself when designing a food security program – or a program for one sector of a FS program – related to social & behavioral change?Main questions participants ask…
20Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know.WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability? (We will discuss this one next Tuesday. Please attend!)HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality. (We will not discuss this one, but TOPS has an online training module.)
21Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know.WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
22WHO (staff / volunteers) should give the message (and conduct the activities)? In your programs, who are the main people interacting directly with most of the beneficiaries in your projects in order to persuade them to change their behavior?(Use your clickers:)A: Your Program StaffB: Community volunteers that you trainC: Other (e.g., health facility staff; gov’t staff)
23Volunteer Peer Educators Some of the more successful behavior change programs have used volunteer peer educators …Two-minute buzz and brainstorm:What are the advantages of working with volunteer peer educators?What are the disadvantages?
24Volunteer Peer Educators Some of the most successful behavior change programs have used peer educators.Several types of volunteer peer educators:Master Farmers / (FFS) Farmer Leaders / Model FarmersCare Group VolunteersACE (Agricultural Cascade Education) Volunteers (women farmers teaching women farmers)Some advantages we will discuss:People observe peers and neighbors for cues as to how they should act.Changes in behavior and attitudes often spread through social networks..Some target “successful early adopters” rather than hubs in the social network, and have them convince others.Lots of data for success of peer education.People observe peers and neighbors for cues as to how they should act, especially “people like themselves”, and in particular in novel environments or when things changeChanges in behavior and attitudes often spread through social networks. By using people who are “hubs” in social networks, you can take advantage of this natural spread of attitudes and behavior. Changing the “hub” in the network spreads change more quickly
25Volunteer Peer Educators People observe peers and neighbors for cues as to how they should act.Where have you seen evidence of this?
26Why Peer Educators Work: Social Proof Prominent Theorists: Albert Bandura, Robert O’ConnorWhat those around us think is true is enormously important to us in deciding what we ourselves think is true.One means we use to determine what is correct is to find out what other people think is correct, especially in terms of the way we decide what constitutes correct behavior.We view a behavior as more correct in a given situation to the degree that we see others performing it.
27Click for Asch conformity experiment video Which line on the right – A, B, or C – is closest to the line on the left?C, right? Pretty obvious, right? Well, that depends.If there are two people in a room with you, and I have the first two people (that I have briefed beforehand) say that A is the closest in length, and you are that third person, you are MUCH more likely to agree with them and get it wrong.In fact, researchers found that when they repeat this with multiple cards, people answered incorrectly 74% of the time on at least one of the cards, and 28% of the people got it wrong at least once – conforming to what others said – HALF the time. This is from the “Asch conformity experiments” and these studies have been replicated in many different places. I would expect this to be even MORE true in developing countries where conformity is sometimes more highly valued.We are HIGHLY suggestible and look to others to confirm what seems obvious to us..Which line is closer in length to the line on the left: Line A, Line B, or Line C? Use your clicker…
28Social Proof: Examples, p. 1 Laugh-tracks (and Claquers for the opera) (Smyth & Fuller, 1972)Other examples:“Salting” tip jars.Billy Graham, an evangelist, finding “ringers” who come up at specified times to give witnesses, donations.Advertisers talking about “fastest-growing”, “best selling” – this “proves” it’s good by convincing us that lots of people think it’s good.Examples:Laugh-tracks (and Claquers for the opera): What do you think about it? (Smyth & Fuller, 1972)Most people think it’s stupid, phony, obvious … but it works, and it works best for poor jokes. Why?
29Social Proof examples, p. 2 Study: Researchers publicize that people in New Haven, CT, are considered charitable people. Two weeks later: Researcher calls women and ask for donations. Result?Donations increase.When it works best:People are most likely to “follow the leader (or the group)” when the situation is unclear or ambiguous.We are most likely to look to people who are “just like us” when looking for people to emulate.Exception: Will follow “authorities” even when they are not like us (at least when in their presence) (Milgram)Study: Researchers get the word out that people in New Haven, CT, are considered charitable people (e.g., via newspapers). Two weeks later, a researcher calls women and asks for donations. Result? Donations increase.When it works best:
30Social Proof examples, p. 3 Aronson & O’LearySign in shower area on how to conserve water (no water during soap-up): 6% responseWhat if one person (an accomplice) models it with their back to other students?What percentage of students do you think will conserve water now? Use your clicker:A: 6%B: 26%C: 49%D: 67%E: 100%.When new students enter showers: 49% response.If two modelers: 67%. (No punitive measures, communication – just modeling)“The Navy Shower”
31Social Proof examples, p. 4 Cialdini: Flyers under all car windows in a library parking lot.Condition #1: accomplice picks up a littered bag and throws it away as another person (subject) walks to car:What percentage of people through the flyer on the ground after seeing the person through away a littered bag? Use your clicker:A: 0%B: 22%C: 33%D: 48%E: 100%.0% of subjects throw the flyer on the ground.Cond. #2: Accomplice walks by subject but does nothing. How many throw flyer on ground? (Same responses as above, use your clicker.)33% throw the flyer on the ground. Also with no one there, but many flyers on ground, many litter. When only one flyer on the ground, much less littering.Cialdini conducted this study.Flyers under all car windows in a library parking lot.Condition #1: accomplice walks by and picks up a littered bag and throws it away as subject walks to car: No subjects throw the flyer on the ground.Condition #2: Accomplice walks by subject and does nothing. 33% throw the flyer on the ground.Second study with no accomplice. Many flyers on ground, many litter. Only one flyer littered, much less littering.
32Another Reason Volunteer Peer Education Works Changes in behavior and attitudes often spread through social networks. We need to use “hubs” in social networks.Social networks are “scale free,” and look more like this…than this:…where a few people have lots of connections (the “hubs”); most people have few connections.Your social network is how you are connected to other people, and how those people are connected to others and each other. (Refer to small graphic in corner.)…where most people have similar numbers of connections.Hubs have a power law distribution…
33Social Network Analysis Findings Findings from scientific studies on social networks show that …Your friends’ friends’ friends can make you fat – or thin.Your future spouse is likely to be your friends’ friend.We influence and are influenced by people up to three degrees removed from us (friend’s friend’s friends).Here are some of the fascinating things that we are finding out about these networks:Your friends’ friends’ friends can make you fat – or thin.Your future spouse is likely to be your friends’ friend.We influence and are influenced by people up to three degrees removed from us, most of whom we do not even know. Your friend’s friend’s friends have more impact on your happiness than a lot of money in your pocket ($5,000 in the U.S.). And these are not some crazy people with eight balls saying this – Christakis is a Harvard professor and they are using the Framingham Heart Study dataset to test hypotheses.This is a graphic from one of many recent studies that show that certain behaviors and conditions spread through social networks in a measurable way up to three degrees. On this graphic, each dot represents a person, and the size of the circles are proportion to the person’s weight for height. Yellow dots are obese people and green dots are non-obese. Notice the clustering of obesity (red circle) and lower BMI folks (green circle).Happiness, voter turnout, substance abuse, and suicide are all contagious – they all spread through social networks. Like flocks of birds changing direction in unison, we are unconsciously led by the people around us. What about the behaviors that save women’s and children’s lives? There’s no reason that they would not spread like this, as well, but those behavior – to my knowledge – have not been studied.Happiness, voter turnout, substance abuse, and suicide are all “contagious,” spreading through social networks. (What about planting sunflower, EBF, using Conservation Agriculture techniques, purifying water?)
34Social NetworksAcquaintance immunization strategy: The nature of social networks (few hubs with many connections) allows for immunizing very few people (“hubs”) to prevent transmission of a disease.A localized strategy: Only need info on the randomly-selected person & his/her social connections (e.g., neighbors/friends) to identify hubs … not entire social network.= % of people to immunize to stop the epidemicWe have now learned through social network science that if you vaccinate the more highly-connected acquaintances of people (who are more likely to be “hubs” or Connectors in a social network), it dramatically reduces the number of people who need to be vaccinated in order to prevent transmission in an epidemic. In fact, the same level of protection can be achieved by using acquaintance immunization reaching less than 25% of the population as that which would be obtained if we immunized 99% of the population at random – virtually reaching everyone.(Point out on graphic:) So how do you select people with Acquaintance Immunization, you “follow the hubs.” You can randomly select a fraction of people from the population, and for each person in that fraction, you ask “Who do you know that knows more people than you do” and you immunize that friend/neighbor (i.e., social connection) … then you ask about that person, “Who knows more people than you do” and find the most connected friends/family/neighbor of that person (hub), and immunize that person.The great thing about this is that you don’t need to map out the entire social network. You just need information on the social connections of those randomly chosen people with whom you start.Now in this example, the behavior passed through this social network efficiently by acquaintance immunization was getting children immunized. But there’s no reason that the same strategy could not be used to transmit other things that move through social networks – including life-saving behaviors like exclusive breastfeeding, or having farmers use Conservation Agriculture. If you get the hubs doing something, the others are more likely to be affected. Even better if the hubs themselves can reach out to others that they know.
35Volunteer Peer Educators What can we learn from this? What does this teach us about using peer educators?If you want to help people change, identify and use the “hubs” in their social network.For behavior change, identify hubs – the well connected people – by asking the beneficiaries themselves to name the people who they trust and admire, and would want working with them to promote behaviors. Then use those people as your volunteer behavior promoters!This is what is done in some peer education models, such as Care Groups. Lots of data showing success of these peer educators (discussed later).
36Social Networks and AgIn Ag, knowing adopters can work a bit differently. Sunflower adoption study: Social Networks and Technology Adoption in Northern Mozambique (Bandiera et al.)(1) Adopters know significantly more adopters than do non-adopters. (2) The benefits of knowing adopting farmers is greater for more talkative farmers. This suggests that there is a distinct private element to information that can only be exploited through one’s own social network. This effect operates over and above any public information that may be present, as is picked up by the number of other adopters known variable.“… individual adoption decisions do depend on the adoption choices of network members and that (i) individual networks matter over and above village aggregate measures, (ii) information sharing matters (iii) the relationship between the individual probability of adoption and the number of known adopters is shaped as an inverse-U.Why do you think this happens? (Hint: It’s not that it drives down prices.)Why it’s not prices being driven down: It could be argued that an increase in the number of adopting farmers drives the price of sunflower down and hence discourages adoption. This explanation, however, is not appropriate in this context for two reasons. First, sunflower is grown for home consumption and commercialisation is currently very difficult (see Section 2). Second, even if farmers sold their output it would be unlikely that the quantity produced were large enough to affect the price.“I want to grow sunflower when some people I know are growing it .. but not when just about everyone I know is growing it.”
37Social Networks and Ag Possible reasons for the curious U-shape: Delaying adoption can be beneficial because farmers do not cultivate the new crop at date 0 when knowledge about the technology is scarce and profits low ….But delaying adoption is also costly since if Farmer X does not adopt early on, his profit at a later date may be lower than it would have been had he adopted earlier.That cost, however, decreases as the number of farmers who adopt earlier on increases. In fact, if a lot of farmers adopt at an earlier date, Farmer X ’s marginal contribution to the total stock of knowledge and hence on his profits at a later date becomes negligible.It can also be explained if we take into account that in addition to information sharing, networks provide other services (e.g., risk sharing, to insure against shocks) whose value depend on the number of adopters within the network. If a lot of farmers within the same network adopt, diversification and effective insurance within the group are greatly reduced.How can we get around this problem and turn the U into an upward arrow?
38Volunteer Peer Educators Lessons Learned:Volunteer Peer EducatorsWhen using peer educators, take into account:Beneficiaries are often in the best position to identify the “hub” in their social network. Some guidance on criteria can be provided by the NGO, but be careful that it’s not too restrictive.Remember gender: For example, “Men’s crops” vs. “women’s crops”.Sometimes a business person will be better positioned and have the right contact with beneficiaries to influence them. For example, messaging via Ag input suppliers.Sometimes knowing more adopters doesn’t lead to increased adoption (especially in Ag programs) – but it usually does.(Gender point:) MC mentioned a program that started talking about pulses as a great food crop rather than a cash crop so that women would be more in control. It’s important to think through how men and women should be approached with a given message, and choosing your peer educators and messages accordingly.
39Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know.WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
40Working with Influencers Entire session on Influencers next week.Remember influencers may vary by behavior. Who is the influencer group (who are not your primary target beneficiaries) that you usually work with the most to bring about change in your primary beneficiaries? (Use your clicker…)A: Mother-in-Laws / GrandmotherB: Spouses (husband or wife)C: Other family membersD: NeighborsD: Professionals / Experts (e.g., Doctors, Ag Extensionists):E: OthersSecond most important? (Same categories)
41Ag: Working with Influencers Several important types of influencers mentioned in the Bandiera et al sunflower study in Mozambique – Farmers were more likely to adopt sunflower production when they:Knew more adopters: Adopters knew 12 farmers growing sunflower, Non-adopters knew 7Knew family members adopting: 68% Adopters knew a family member growing sunflower vs. 40% Non-AdoptersKnew neighbors/friends adopting: 79% Adopters new a neighbor/friend growing sunflower vs. 46% Non-AdoptersKnew more church members who had adopted: 2.4 members growing sunflower known to Adopters vs. only 0.8 known to Non-Adopters.OPTIONAL:Also, in a sample from two villages where seeds had not yet been offered: Farmers said they would be more willing to adopt sunflower production if:One family member would adopt: 73%One church member would also adopt: 40%My wife would also adopt: 32%One of my neighbors/friends would also adopt: 16%One of my friends from another village would also adopt: 5%
42Working with Influencers Small group work for 10 minutes:What are the best ways you have found to reach men about topics that may not be as interesting to them (e.g., talking to men about child nutrition)?What are the best ways you have found to reach women about topics that may not be as interesting to them?How do you reach extended family members who are influencers, such as mother-in-laws and grandmothers?How do you reach people through the groups that they attend and are part of, such as churches or mosques?Report out.
43Report out: Working with Influencers What are the best ways you have found to reach men about topics that may not be as interesting to them initially (e.g., talking to men about child nutrition)?Adding content to whole community meetings (e.g., Ethiopia)Via Ag Association meetings.Via home / on-farm / garden contact.RadioMobile phones?What are the best ways you have found to reach women about topics that may not be as interesting to them initially?Adding content to savings group meetings.Via home / on-farm / garden contact. (What benefits are there of home and on-farm visits?)Take time into consideration, especially with women.Consider separate venues for women, where they are more likely to speak up.With some topics, you may be able to engage with men during a home visit (e.g., FP)… but depends on topic (e.g., maybe not BF).Radio, mobile phonesHow do you reach extended family members who are influencers, such as mother-in-laws and grandmothers?How do you reach people through the groups that they attend and are part of, such as churches or mosques?Consider sermon guides.(Radio point:) Mercy Corps implemented the “Women’s Vocational Agricultural Education and Civil Society Building Project” in Helmand, Afghanistan from 2004 to This is not an easy place to work. One of the biggest challenges working with women there was the difficulty in accessing them: Villages are far apart in a mountainous area with few roads, and many women rarely or never leave their household. To overcome this, they created a bimonthly “Women and Agriculture” radio program. The program promoting good practices in food preparation, food processing and agriculture, interspersed with traditional music selections. Representatives from the Ministry of Women’s Affairs and Ministry of Agriculture were involved in creating the content. They radio station regularly reached about 7,000 people through their broadcasts. The program was popular, and even after the program ended, the shows continued to be broadcast by the radio station. Monitoring surveys found that both men and women knew the program and had heard episodes of it.Now it’s hard to change behavior just with radio alone, but sometimes it’s your only option, and you can combine it with other approaches. Just remember: Radio is good for reaching hard to reach populations, and for reminders.
44Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know. WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
45What do methods do you use? Which of these methods have you used to decide WHICH behaviors / practices to focus the most on in a project? (Use your clickers)Focus Groups with BeneficiariesA: YesB: NoC: UnsurePositive Deviance Studies / Local Determinant of Malnutrition StudiesReview of scientific literature (e.g., efficacy studies):
46What do methods do you use? Which of these methods have you used to decide which determinants of behaviors to focus on? (e.g., perceived self-efficacy) (Use your clickers)“What the heck are determinants?”A: I don’t know much about behavioral determinantsB: I do know a lot about behavioral determinants.C: I know a moderate amount about behavioral determinants.Barrier Analysis or Doer / NonDoer AnalysisA: YesB: NoC: UnsureOther:
47An Example of Formative Research Do “Exercise” Exercise (45-55 mins)
48What works in behavior change? Findings from Powerful to Change Studies CORE SBCWG compared low and high performers for several behaviors (e.g., exclusive BF, hand washing with soap) in their Powerful to Change studies – what works?Using formative research (e.g., PD studies, Barrier Analysis, DND Studies) to find the determinants of behaviors and to choose the right messages/activities – we will talk about this now – and…Using the right coverage strategy: Using peer educators and/or systematic home visitation (through cascade-type training) to reach more people …(which we will discuss more later).The CORE Social & Behavioral Working Group has done Powerful to Change Studies where we are looking at organizations that have had the best results in terms of changing behavior (like increasing handwashing with soap from 17% to 95%) in order to identify the most effective practices. Two keys that we have found are (1) using rapid formative research to choose the best messages and activities for behavior change; and (2) reaching all of the right people through peer educators and systematic home visitation, which usually involved peer education and “cascading” – teaching a volunteer who then reaches out to a set of neighbors. We’ll talk about formative research first.
49Causality Analysis for ANR In the health and nutrition sector, practitioners sometimes do positive deviance studies (e.g., Local Determinants of Malnutrition Studies) to identify the most important things to promote. (describe)However, there are fewer defined / documented processes for doing this in Agriculture and NRM.Work in Two Small Groups for 15 minutes:What are the ways that your organization determines what are the most appropriate practices (behaviors) to focus on in Agriculture? Do you take identify what successful farmers are doing? If so, how?Have you heard of other innovative practices for identifying the best practices to promote in Agriculture /NRM?Report out.
50Method: Barrier Analysis What is it?Rapid assessment tool used to identify the most important behavioral determinants (from Health Belief and Theory of Reasoned Action models) associated with a particular behavior in Ag/NRM, Health/Nutrition, City Planning, other sectors.Used to develop more effective behavior change communication messages & activities by many organizations around the world. (Part of DBC training.)Compares Doers and NonDoers.Developed in 1990 (by Tom Davis) and modified based on AED’s BEHAVE Framework and Doer/NonDoer Analysis.Behavioral Determinants Examined with Barrier AnalysisPerceived Self-efficacy Perceived Barriers & EnablersPerceived Social Norms Perceived Susceptibility / RiskPerceived Pos./Neg Consequences Perceived SeverityAccess Perceived Action EfficacyCues for Action / Reminders Perception of Divine WillPolicy Culture
51Example of Using Formative Research to Identify Behavioral Determinants in Ag/NRM CRS’ SEGAMAYA program, two different provinces of Guatemala: San Marcos and Baja Verapaz (culturally very similar)June 2009: Staff in one area – San Marcos – received Designing for Behavior Change training, did Barrier Analysis, and developed a DBC strategy and indicators for Ag/NRM.Staff planned to replicate in the Baja Verapaz area, but got too busy responding to an emergency in another area and did NOT.Same program and monitoring system in both areas, so Baja Verapaz served as comparison area to examine results of the DBC training/strategy.
52San Marcos Guatemala: Use of Formative Research Decided to study key soil conservation practices.“Planting ‘live barriers’ along the edges of planting terraces” identified as the practice with the lowest adoption rate, despite requiring only labor and local, free plant material.San Marcos area: Participated in a Designing for Behavior Change (DBC) Workshop and Conducted a shorter version of the Barrier Analysis Survey.In comparison area (Baja Verapaz), determined strategy and messaging using their past experiences in the area, etc. (No formative research.)Found that: (1) most farmers (Doers and NonDoers) fully understood the benefits of the practice, BUT (2) Doers worked together to plant the barriers, and (3) Doers liked the practice because they did not lose plantings due to drought (key advan.).San Marcos Strategy focused on organizing farmers to work together on each other’s land during the off-season to plant the barriers.Farmers groups brainstormed to develop strategies to prevent loss of plants due to drought.
53Results: Number of Hectares Planted with Live Barriers Used DBC/BAAnd this is what they saw in terms of results, the hectares planted with live barriers: The red line is Baja Verapaz where they did not apply social & behavioral change tools, and the blue line is San Marcos where they did apply the tools.Didn’t use DBC/BA
54Focus Group CommentsTo staff: Overall, was the (DBC) training and development of a BC strategy helpful?“Yes, this completely changed our way of thinking. We no longer think in terms of “we” and “them”, rather we are a team with the participants in finding solutions to the barriers.”“It never occurred to us before [the training] to figure out the barriers or what makes people want to change. We wasted so much time and energy repeating the benefits over and over, then, feeling frustrated because no one adopted the new practices.”What was the most useful part of the (DBC) training?“Going to the field to do the Doer/Non-doer [smaller BA] Surveys. Until we saw those responses, we thought we knew our target farmers and what they think. It was incredibly revealing.”“Understanding the wide range of factors [determinants] that influence adoption of practices.”Here is some of what they heard when they asked staff about using these SBC tools.
55Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know. WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
56Using Volunteers to Achieve Coverage Two-min buzz and brainstorm: What are the different ways that you reach beneficiaries? Through what means and groups?Ethiopia Mothers Groups example:Visited Mother’s Clubs in Ethiopia – Excellent process.What’s the coverage? “Unknown.”Effective coverage level: 4% of mothers“Yes, but these mothers will talk to their friends”. Only partially true.For high levels of BC to happen:Need an organized plan for coverage.Define how many and which households or mothers or farmers each Volunteer will be expected to reach. Shoot for 80% or more [why].Give them behavior promotion (teaching) materials.Monitor your coverage.(Ask the question about ways they reach beneficiaries and write responses on newsprint.)Explain the evaluation of FH/Ethiopia many, many years ago.) (1) Visited Mother’s Clubs – good participation by members, good educational materials, good content. (2) Asked how many mothers were reached through the Mothers Clubs: Not known. [How many of you know what your coverage level is of beneficiaries? How many you regularly reach, at least once a month, with high quality behavior change promotion?] (3) We calculated the total number of mothers of young children in the area, and added up the number reached through the clubs. (4) The total effective coverage level was 4% … “yes but these mothers will talk to their friends”. It’s true that some people pass on some information to their friends informally, but if you really want to make behavior change happen, you better have a more organized plan for how that transfer will happen. One way to do that is by defining how many and which households or mothers or farmers each Volunteer will be expected to reach, and give them behavior promotion (teaching) materials that they can use for that purpose. And monitor your coverage.
57Types of Formed Groups for Behavior Change Farmer Field School groupsFarmers AssociationsMother-to-Mother Support GroupsCare Groups (seeMothers’ ClubsCascade Groups (like Care Groups, but multi-sector)Others?
58Who is Using Care Groups and where are they being used? BangladeshBoliviaBurkina FasoBurundiCambodiaDRCEthiopiaGuatemalaHaitiIndonesiaKenyaLiberiaMalawiMozambiqueNigerPeruPhilippinesRwandaSierra LeoneZambiaACDI/VOCAADRAAfricareAmerican Red CrossCAREConcern WorldwideCatholic Relief ServicesCuramericasEmmanuel InternationalFood for the HungryFuture GenerationsGOALInternational AidInternational Medical CorpsInternational Rescue CommitteeMedical Teams InterenationalPathfinderPLANSalvation Army World ServiceSave the ChildrenWorld ReliefWorld VisionThere are at least 22 international NGOs using Care Groups in at least 20 countries. There are probably other national groups using them, as well, but we are unable to track that as easily.
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60Success of Volunteer Peer Educators: Care Groups
61Care Groups Outperform in Behavior Change: Indicator Gap Closure: CSHGP Care Group Projects vs. Non-CG Project AveragesGap closure range in non-CG projects ~25 – 45%(Avg. = 37%)Here’s the best proof I’ve seen of the effectiveness of peer educator programs. This is data on Care Groups.On this slide, we have compared how child survival projects perform on 14 different RapidCATCH indicators. One of these is an impact indicator (underweight), but most are results-level behavioral indicators or coverage indicators.The bars show the amount of gap closure for each indicator. For example, if you started at 20% EBF and increased that to 40%, you would have closed 20 of 80 possible points – that 25% gap closure. Looking at gap closure is one of the best ways to compare performance across projects.The red bars show the average indicator gap closure for each of these indicators for 58 child survival projects NOT using CGs ending between 2003 and 2009.The white bars show the average indicator gap closure for each of these indicators for 9 Care Group projects. What do you note about the difference?Care Groups projects out-performed the average child survival project in terms of indicator gap closure on all indicators except HWWS where there was a slight non-significant difference. The average gap closure was in the 35-70% range for the nine Care Group projects as compared with 25-45% with all the other CSHGP projects.There were only 9 CG projects to compare, but the difference between those 9 projects and the 58 other projects is statistically-significant for EBF.So what this shows is that Care Groups – a peer education model – are outperforming the other methods we generally use for behavior change. We are still looking for other similarities among more successful programs, but this is an important one.Gap closure range for Care Group projects: ~35 – 70%(Avg = 57%)
62When Peer Education Doesn’t Work The impact of mother to mother support [MTMSG] on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala (Dearden et al, 2002)Purpose of Study: To assess the impact that a peer education program had on early initiation of BF and EBF in peri-urban Guatemala City. Two intervention communities, two control communities.At follow-up (12m):Change over time in early initiation of BF in program communities was not significantly different from the change in control communities.Communitywide rates of EBF did not change significantly from baseline to follow-up.Only 31% of mothers in pgm communities said counselors had advised them about BF.Only 21% had received a home visitOnly 16% reported attending a support group.Of the mothers in the program communities who both received home visits and attended support groups, 45% of them exclusively breast-fed, compared to 14% of women in program communities who did not participate in those two activities. Conclusion: No population-level effect seen, but attending the peer groups helped increase EBF rates for those who participated. Peer support works, but it’s important to achieve high levels of coverage if you want population-level change! (Don’t expect population-level behavior only 31% coverage.)Let’s look at one of the few studies I found on the MTMSG model, this one with randomization in the design. Let’s see if we can identify what would have had to change to make this a successful program.
63Reasons for SuccessWhat do you think are the probable reasons for the success of the Care Group model?:Care Groups are built on the shoulders of other models (e.g., MTMSGs). They uses peer educators and choose people who are most likely to be “hubs” in their social network (and hence influential).The model is well defined in order to assure high coverage– Ratios between the # of Promoters and # of groups, # of volunteers per group, # of HH/beneficiaries per volunteer, and much more is defined. See (Handout)Whatever groups you use, be deliberate about these ratios and the structure. Look for ways to have high-quality coverage of 80% or more of beneficiaries at least monthly, and measure coverage.
64Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know. WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
65General FactorsPlease participate in the Tuesday session where we will discuss this question on general factors:Triggering Hope: Motivating for Change in an Environment of Dependency, Disincentives and Despair (Tues, 11:00-12:30)
66Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO do we work with / talk to aside from our primary beneficiaries?: Working with other influencers. Who influences and how to know. WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
67SBC TechniquesTOPS and the FSN Network SBC Task Force will be creating an SBC Toolkit over the next year. The toolkit will include a wider variety of SBC techniques taught through a five-day training. Three regional and three country-level trainings will be offered on the toolkit. Sign up!Some of the tools in the SBC Toolkit:Non-formal education methods (Stories, songs, testimonials)Negotiation skillsListening and feedback skillsPersuasion techniques (Online training modules available now:)Emotion-based counselingSupport group facilitation"Story Editing" techniquesMotivational Interviewing techniques Looking at one of one of these techniques today: Motivational Interviewing (sign up for the training for more!)
68What is Motivational Interviewing? Motivational Interviewing is a form of counseling (usually individual, but can be used in groups) that helps people change their behaviorsIt is useful for behavior promotion and counseling when people are ambivalent about changing their behavior.It has been shown to be successful in a developing country setting when applied by non-professional counselors.
69Motivational Interviewing Trial, Zambia Behavior promotion messages (to use a chlorine solution to purify water) were delivered using MI by neighborhood health committee (NHC) volunteers in weekly visits that were minutes long.An Intervention group received Motivational Interviewing along with education.A Comparison group received education only.In a field trial of MI in Zambia, Motivational Interviewing was used to promote water purification with a chlorine solution. Nurses trained in MI taught Neighborhood Health Committee Volunteers how to use MI in a 10 hour course. These volunteers then visited homes weekly for minutes. Areas were randomized. In the intervention group of areas, they used MI. In the control area, they used traditional promotion methods (e.g., talking about the benefits of using the chlorine solution, talking about how to use it, etc.)
70Disinfectant Present in Stored Water Here are some of the results. The green bars are baseline, and the blue bars are final. The first set of bars shows that the households that received Motivational Interviewing were much more likely to use the disinfectant solution in their water than the households that received traditional behavior promotion.
71Bottles of Disinfectant Sold/HH (MI vs. Ed. Only), ’98-’99 Zambia MI Study:Bottles of Disinfectant Sold/HH (MI vs. Ed. Only), ’98-’99The researchers found that the group that received MI bought 77% more bottles of the disinfectant per household than the Education only group (p<0.001). 94% of the variance in sales ratios was attributable to the use of MI. These differences were sustained over the eight-months of the trial. Diarrheal incidence was reduced, as well.
72Other MI StudiesThevos A, Quick R, and Yanduli V. “Motivational Interviewing enhances the adoption of water disinfection practices in Zambia.” Health Promotion International ; 15(3):Thevos, A.K., Kaona, F. A. D., Siajunza, M.T., & Quick, R.E. “Adoption of safe water behaviors in Zambia: Comparing educational and motivational approaches.” Education for Health. (2000); 13(3):Carey, M. and Lewis, B. “Motivational Strategies Can Enhance HIV Risk Reduction Programs.” AIDS and Behavior. 1999; 3(4): 269 – 276.There are hundreds of studies on the effectiveness of MI in changing behavior. Here are a few of them, including the write-up of the study in Zambia we just examined.
73Another Reason I Like MI Here’s another reason I like MI. I might be dead now without it. This was me about six years ago.When FH was receiving training in MI, I served as the “guinea pig”, having the trainer ask me questions about a problem I had. I weighed 133 kilos. This is me six years ago. The questions that she used helped me to see how what I was doing was not in line with what I believed, and to see where I was headed was not a place I wanted to go. As a result of just that one-day training, I started down a new path, and lost about 47 kilos (100 pounds). It’s a powerful method when used right.
74#1: Express Understanding There are four main principles of MI…#1: Express UnderstandingRealize (and act like) ambivalence [mixed feelings] is normalUse reflective listening“Accepting the person for who they are” helps facilitate changeThis does not mean you must agree with or endorse their attitude or behavior “It is okay to feel confused about this issue.”
75#2: “Develop Difference” (Discovering Conflicting Self-beliefs) Realize that change is motivated by perceived differences between one’s present behavior and one’s personal values or goals. (So you use questions to help bring these out so the person can see the gap.)“I want to lose weight” (but I eat fried food every meal)“My wife is important to me” (but I beat her every week)“I want better crops” (but I never try anything new)The person you are talking to needs to discover and present their own arguments in favor of change.
76#3: Roll with Resistance Avoid arguing for changeArguing with the promoter / extensionist is a sign that the person is far from change.Instead, invite a new perspective on the issueResistance is a signal to you (as a change agent) to respond differently.“Take what you want and leave the rest.” (Who can argue with that?)
77#4: Support Self-Efficacy A person must believe they can change before change is possible.Need to help the person increase their self-efficacyHelp people draw on hope as a personal resource for changeYour (stated) belief in the person’s ability to change can be a self-fulfilling prophecy.
78The MI Process: A Quick Overview Assess importance of the behavior to the person and their level of confidence in doing the behaviorExplore the importance of the behavior to the person and their personal values andbuild their confidenceExchange InformationUse:Open QuestionsAffirmationReflective ListeningSummarizingReduce ResistanceGo through the diagram.Explain that the full training takes a longer time. We will focus on a couple of key skills: Asesssing the important of the behavior and level of confidence, and encouraging Change Talk.Encourage Change TalkHelp the Person Develop a Change Plan
79Assessing Importance & Confidence scales Two things that need to be assessed early in MI: Importance and Confidence.(Demonstrate with a volunteer: Choose a behavior)(Establish rapport. Talk about the behavior you want to promote, or the problem that they want to rid themselves of. Get some details of their history with the behavior or problem.)(Say:) Let’s say this line I’ve drawn represents how important you feel it is to you to ___________. Down here (1) means it’s not important to you at all, and up here (10) means the most important thing to you in life. How important is _____ to you right now? (Point to line)(Say:) Now let’s say this line represents how confident you are in your ability to ____________. Down here (1) means you are not confident at all that you can do it, and up here (10) means that you are extremely confident that you could do it. How confident are you in your ability to ________ right now? (Point to line)(I would then use questions to explore importance, confidence, and personal values. For example: “What are some of the things that are most important in life to you right now?”)Have a participant volunteer: I need a volunteer who would be willing to talk with me in a motivational interview. You first need to think of something that you would like to do differently in life, or something that is a problem for you right now that you can talk about in front of others. It should be something that you are ambivalent about – something that you have mixed feelings about.It could be giving up a health problem (e.g., smoking), or starting a healthy habit (e.g., exercising three times a week for 30 mins or more), or going back to college.(After choosing person and behavior, use the questions, drawing the scales on a newsprint.)(Explain next step: Exploring importance, confidence, and personal values. Ask the question on personal values.)Have the person remain up front (but they can sit down) while I explain the next step.
80Use OARSOARS = Open Questions, Affirmation, Reflections, and SummarizingExample of Open Question: “Tell me about a time when you changed something in your life and were proud of it.”(Explain OARS first and then demonstrate OARS.)Use the open-ended question.Respond with affirmations.Use reflective listeningSummarize at the end.
81Affirmations An affirmation is a compliment! Examples: Praise positive behaviors.Support the person as they describe difficult situations.Examples:“That must have been a difficult thing to change. It sounds like you are a person with a lot of fortitude.”“That situation must have been very painful for you, but you managed to get through it.”
82ReflectionsSeveral different types of reflections: Simple, Amplified, Double-sided. We will just talk about the simple one.A simple reflection is just repeating back what the person said.DO NOT ARGUE OR DEBATE with the person.This is the same as paraphrasing.Condense your response so that it is shorter than what they said.These are statements, not questions.You can reflect emotions, too.If you want to move the conversation along, add something – take a chance!Examples:“So you had a difficult time using that new agriculture technique the first time, and now you don’t know if it’s worth trying again.”“So your mother-in-law is concerned that your child will not get enough milk if you only give him breastmilk.”Amplifed: “So if you gave your child only breastmilk, he might starve.”Double-sided: “So you would like to try conservation agriculture, but your father-in-law doesn’t like the idea.”
83SummarizingMake a summary statement that encompasses everything that was said.Summarizing can be helpful when you want to move in a new direction. Still: Don’t argue or give advice.Examples:“This has been a really difficult year for you. You lost most of your harvest due to insects that got into your storage shed. Now you are trying to decide what to do differently, but you don’t have much money.”“You are feeling a lot of pressure to give your 4m old child some food. Your mother-in-law says that if you give him some food, he will cry less. You are not sure if that will help, because the doctor said that you should wait or he will get diarrhea.”
84Change Talk in MIChange Talk is like a green traffic signal: it tells you to keep moving forward!Listen for Change Talk and encourage it!
85Four Kinds of Change Talk There are FOUR KINDS of Change Talk we want to hear.Disadvantages of Maintaining the Current (negative) Behavior“Since I don’t have an improved silo, more of my harvest is eaten by insects and rodents.”“When I hit my wife, her mother gets mad at me and yells a lot.”Advantages of Change (to the new healthy behavior)“It would be great to not have to worry about losing so much of my harvest.”Optimism about Change“I think I could do it if I tried, and if I convinced some friends to try it too.”Intention to Change“I think I could at least try to use conservation agriculture techniques on one part of my land and see how it goes.”“Maybe next month, I could try that out … at least for that month.”
86How to Encourage Change Talk Through open-ended questions:What worries you about continuing to store your crops the way you do now? (THEY state disadvantages of current behavior)If you did decide to use fertilizer, what would be good about it? (THEY state advantages of new behavior)If you resolved to build an improved silo, what about you makes you think you could be successful? (THEY voice optimism for change)So what are you thinking about using conservation agriculture at this point? (They state intention to change)
87How to Encourage Change Talk By asking for more detailsIn what ways do you think your friends would like / support your decision to use conservation agriculture techniques?You mentioned there was a time when you did use fertilizer on your crops, and it worked. Tell me more about that time, and your reasons for doing that.What other difficult decisions have you made in your life?
88How to Encourage Change Talk By asking about extreme situations:What is your biggest concern about crop loss in the long run? What could happen if you don’t get it under control?What consequences of not having your chickens immunized do you know of, even if you don’t think they could happen to you?If you were completely successful at conservation agriculture, what are the positive things you think would happen?
89How to Encourage Change Talk Explore the past and the futureBefore you had these worries about your losing your crops to drought, what was your life like?If you continue on as you are now, what do you think will happen? Tell me what life will be like for you in five years if nothing changes.Think back to when you first started farming. How did you feel about being a farmer?How would you like things to be in your future concerning your land and yields? Tell me about the best possible future you can imagine.
90How to Encourage Change Talk Explore Goals and ValuesWhat is most important to you in your marriage? What about your marriage is worth preserving?(If the person is religious:) What does your faith tell you about what you should do?What does a healthy garden look like to you? What are the qualities that you would want in your garden?What do you think is the right thing to concerning faithfulness in marriage?
91Which of These Indicate a Person is Ready to Change? Asking about changeTrying out a change behaviorArguing against changeFeeling a sense of loss and resignationIncreased talk about the problemFeeling peaceful and calmImagining difficulties if a change were madeBlaming others for the problemDiscussing the advantages of changeExpressing hope for the futureSaying the problem isn’t that badKnowing what you do about MI and change talk, which of these things indicate a person is ready to change?Why?
92Small Group ActivityWork in small groups (15 mins) to come up with sample Change Talk questions in the four areas concerning a particular behavior:Disadvantages of Maintaining a Current (negative) BehaviorAdvantages of Change (to a new healthy behavior)Optimism about Change (in general, or for a particular behavior)Intention to Change (for a particular behavior)(Report out.)
93Main SBC Questions for FS Design Additional questions we will discuss:WHO (staff / volunteers) should give the message / do the activities that lead to behavior change in beneficiaries?WHO should we work with / talk to aside from those primary actors (e.g., influencers)?WHICH behaviors should we focus on? Which determinants of behaviors should we focus on?HOW can we achieve high coverage levels of those primary actors / influencers?HOW: What other general factors might we need to change in order to see high levels of behavior change, and sustainability?HOW: Which evidence-based SBC techniques should we use to achieve adoption?HOW do we assure quality.
94Assuring QualityFor the TOPS / FSN Network online training on Quality Improvement and Verification Checklists, please use this link:
95Posttest and Satisfaction Survey You have 20 minutes to complete the posttest and satisfaction survey
96This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID) Office of Food for Peace. The contents are the responsibility of Food for the Hungry and do not necessarily reflect the views of USAID or the United States Government.