Social and Behavior Change

The A&T framework. Click image for full view.

Application of the A&T Framework has resulted in rapid, large scale improvement of maternal, infant, and young child nutrition (MIYCN) practices. From the initial in-country efforts (2009-2014) of direct implementation of interpersonal communication, community mobilization, and mass communication strategies, to the current (2014-present) focus on technical assistance and capacity-building for sustainable SBC approaches, A&T strives to further positive change in MIYCN behaviors at the individual and community levels.

A&T’s SBC process is built on evidence-based principles of behavioral science, systems approaches, and social marketing. Our approach differs by context but always includes:

  • Using data to establish a baseline and make strategic adjustments to program design, including use of situational and landscape assessments, qualitative and implementation research, health services utilization reviews, and media audits.
  • Prioritizing feasible actions and addressing the underlying evidence-based determinants for driving behavior.
  • Engaging local partners in creating high-level campaigns and communication materials that fit program objectives and leverage emotional appeals.
  • Focusing on quality improvement and systems strengthening through support of training packages, performance monitoring, and supportive supervision for frontline workers
  • Applying policy advocacy strategies; recognizing that supportive environments for optimum MIYCN practices are the foundation for individual behavior change.

Since 2009, A&T has demonstrated that SBC for nutrition can be achieved at-scale, reaching millions of mothers and community members.

  • In Bangladesh and Viet Nam, a greater proportion of mothers practiced the recommended behaviors when they had face-to-face contact with frontline workers in coordination with mass media messages, than did mothers who only saw the TV spots.
  • Two-thirds of mothers exposed to a breastfeeding campaign in Viet Nam responded that exclusive breastfeeding was the norm compared to less than one-half of those not exposed. During the campaign’s first year, exclusive breastfeeding rose from 26 to 48 percent.
  • Strengthening the nutrition-agriculture connection has been a priority for A&T in Ethiopia. Between 2014-2017, A&T and partners worked to train over 300 agriculture extension workers (AEWs) in child feeding in the Amhara region. There was a 10-percentage point increase in the number of families reporting that they received child feeding information at an AEW visit following the intervention.
  • Efforts to apply the A&T Framework to Africa (Burkina Faso) resulted in an increase in the rate of early initiation of breastfeeding (within one hour) from 41 to 77 percent in the A&T intervention areas.

Through nine years of SBC programming, A&T has identified key learnings:

  • Partnership and coordination are essential. When multiple partners use complementary intervention approaches, societal norms begin to shift and large scale reach is more attainable.
  • Operating within multiple levels of a community to address barriers to improved child feeding was an effective approach. Engagement with religious and community leaders on optimum infant and young child feeding (IYCF) messaging served to amplify the direct communication to mothers, fathers, and grandmothers.
  • Improving frontline worker performance needs more than training and a flipchart. A reasonable workload, performance recognition, and sustained supportive supervision are key. A systems approach is essential to address considerations for financing, partnerships, and logistics support.