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  • Service Providers as an Audience for Behavior Change

Service Providers as an Audience for Behavior Change

Service providers, whether facility or community based, are a key link between communities and health systems. A provider’s direct interactions with clients means they play a crucial role as facilitator and potential barrier to their clients adopting healthy behaviors. A service provider’s opinions and biases, attitudes and behaviors, capacity and skills, and working conditions can influence their ability or motivation to deliver quality services. Such barriers may be outcomes of individual, interpersonal, organizational, and institutional factors.

It is critical to understand a provider’s barriers to performing their tasks, as well as the ways in which those barriers impact their clients. Social and behavior change (SBC) approaches can help identify and address factors that lead to provider-side barriers to quality service delivery. SBC theories provide insight into the values, social norms, skills, knowledge, and structural context that may influence a provider’s actions.  

In this Breakthrough ACTION Trending Topic, we focus on service providers as an audience for SBC interventions. The Trending Topic includes peer-reviewed literature and program examples from projects such as Transform/PHARE, which has applied SBC techniques such as barriers analysis, identifying positive deviants, and advanced audience segmentation to provider behavior change. It also highlights several resources that support the design and planning of provider behavior change interventions.

We welcome your contributions to this topic - if you have additional resources to share, please send them to the Compass curator, Susan Leibtag, susan.leibtag@jhu.edu.


Peer-Reviewed Literature

  • Wright, Patricia, et al. A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State. Journal of Rural Health 2013 Fall; 29(4): 420–431.
  • Factors Impacting the effectiveness of community health worker behavior change, Health communication Capacity Collaborative (HC3), 2013.
  • Grimshaw, Jeremy, et al. Changing Provider Behavior: An Overview of Systematic Reviews of Interventions. Medical Care, Vol 39, No. 8 August 2001.
  • Nxumalo, Nonhlanhla, et al. Community health workers, recipients’ experiences and constraints to care in South Africa – a pathway to trust. AID Care, Vol 28, 2016.
  • Franco, Lynne Miller, et al. Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. Social Science and Medicine, Volume 58, Issue 2, January 2004, Pages 343-355
  • Jenkins, Rachel, et al. Exploring the perspectives and experiences of health workers at primary health facilities in Kenya following training. International Journal of Mental Health Systems, 20137:6.
  • Cattamanchi, Adithya, et al. Health worker perspectives on barriers to delivery of routine tuberculosis diagnostic evaluation services in Uganda: a qualitative study to guide clinic-based interventions. BMC Health Services Research, 2015; 15: 10.
  • Chamberlain, Sarah. Training and equipping frontline health workers with mobile health education tools. Vodafone Limited.

Cover photo: A male community health worker (Village Health Team or VHT) in Uganda demonstrates the injectable contraceptive. © 2014 PATH/Will Boase, Courtesy of Photoshare

 
 

Resources

  • Tools
  • Examples

Provider Behavior Change Implementation Kit

This I-Kit provides step-by-step guidance on using SBCC to change provider behavior, and thereby improve client outcomes. 

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Service Communication Implementation Kit

This I-Kit aims to help service delivery project managers effectively use service communication to enhance the impact of their project. This I-Kit can be used to help increase demand for and uptake of services, and improve consistent long-term maintenance of healthy behaviors.

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Provider Behavior Change Toolkit

Provider Behavior Change Communications (PBCC) are one-to-one interactions between PSI representatives and providers that are designed to positively influence provider behaviors by offering individualized solutions to both needs and barriers to behavior change.  This toolkit follows best practices from the pharmaceutical industry.

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PBCC Program Self-Assessment Tool

This self-assessment tool is part of PSI’s Provider Behavior Change Toolkit. Program managers can use the questions to identify initial or ongoing needs for successfully implementing a Provider Behavior Change Communications program.

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A Practical Guide to Conducting a Barrier Analysis

This is a training curriculum that builds skills to plan and carry out a Barrier Analysis survey. The very practical, hands-on learning exercises help learners to answer the most common and frequently perplexing questions that arise during implementation.

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Barrier Analysis Facilitator’s Guide

The Barrier Analysis tool is a rapid assessment tool used in community health and other community development projects to better identify barriers to behavior change that would have a significant positive impact on the health, nutrition, or well-being of targeted groups in a project area. 

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Barrier Analysis Questionnaires

This webpage offers  close to 50 sample Barrier Analysis (BA) Questionnaires as well as guidance on how to adapt these questionnaires as references for BA implementers. The questionnaires address behaviors in the areas of maternal and child nutrition, health, water youth, and sanitation and agriculture.

 

View Resource

How to Develop SBCC Creative Materials

Materials are a primary means by which health programs deliver social and behavior change communication (SBCC) messages. There are many types of SBCC materials, including printed brochures, the script for a television advertisement, a guide for facilitating a group discussion, a Facebook page or an Internet-based game. Materials development brings together the most effective messages with materials for the best combination of channels – the channel mix - in order to reach and influence the priority audiences.

How to Conduct a Pretest

Pretesting is the process of bringing together members of the priority audience to react to the components of a communication campaign before they are produced in final form. Pre-testing measures the reaction of the selected group of individuals and helps determine whether the priority audience will find the components - usually draft materials understandable, believable and appealing.

How to Conduct a Root Cause Analysis

A root cause analysis is a process used to identify the primary source of a problem. In social and behavior change communication (SBCC), a root cause analysis is used to examine why there is a difference between the desired state of a health or social issue (vision) and what is happening now (current situation).

Five Ways to Address Provider Bias in Family Planning

This blog lists five ways to address service provider bias in family planning:

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Defining and Advancing Gender-Competent Family Planning Service Providers: A Competency Framework and Technical Brief

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Insights for Provider Behavior Change from Qualitative Research in Nairobi

Kenya

In 2018, Save the Children conducted qualitative research to better understand the influence of social norms on a health worker’s decision to provide contraceptive services to adolescents.

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Improving Provider Behavior Change Communication and IPC

During implementation of its Women's Health Project, Population Services International (PSI)  identified several challenges relating to provider behavior relating to IUDs.

These challenges resulted in lower performance by network providers and lower productivity among IPC agents.

They included:

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Performance Improvement Recognition: Private Providers of Reproductive Health Services in Peru

Peru

This report identifies the types of recognition mechanisms private providers prefer and provides recommendations for Peru and other countries on implementing a quality improvement  program with a recognition component.

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NURHI Distance Education Videos for Providers

Nigeria

NURHI (the Nigerian Urgan Health Initiative) launched the Interactive Health Education (iHED) system in November 2013 to provide a platform from which providers (midwives and doctors), primarily within family planning clients and integration points, can access relevant video-based educational content and resources from Android based smart phones

View Resource

inSCALE Mobile Technology - Enhancing Community Health Worker Performance and Motivation

Uganda

This is an introductory video to the inSCALE project in Uganda, which was created to  make the work of community health workers (CHWs) easier.  Using cell phones, they share the data they've collected at the end of the week, speak regularly to their supervisors and colleagues, and use innovative app-based tools to improve their performance.  

View Resource

Beyond Bias Literature Review and Expert Interviews on Provider Bias in the Provision of Youth Contraceptive Services:

Pakistan
Burkina
Tanzania
The purpose of this review is to provide a comprehensive assessment of what is known about provider bias in the provision of reproductive health services to adolescents, with the ultimate aim to inform interventions that improve the demand and delivery of a full range of contraceptive methods.
 
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Beyond Bias: Provider Survey and Segmentation Findings

Pakistan
Burkina
Tanzania
Pathfinder International worked with Camber Collective, YLabs, and Behavioral Economics in Reproductive Health (BERI) to implement the 3-year project (November 2016 - October 2019) to better understand and address provider bias.
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This website is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Breakthrough-ACTION Project, supported by USAID’s Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-17-00017 with the Johns Hopkins University.

Breakthrough-ACTION is based at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU∙CCP). The contents of this website are the sole responsibility of JHU∙CCP. The information provided on this website is not official U.S. Government information and does not necessarily represent the views or positions of USAID, the United States Government, or The Johns Hopkins University.

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