This I-Kit provides step-by-step guidance on using SBCC to change provider behavior, and thereby improve client outcomes.
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
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.
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.
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.
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.
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.
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.
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.
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.
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).
This blog lists five ways to address service provider bias in family planning:
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.
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:
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.
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
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.
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.
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.
