projecting health - teach to...

Projecting Health

Engaging communities through visual communication

Teach to Reach Summit

November 2, 2015

Kiersten Israel-Ballard

MNCHN Technical Officer

Innovating Approaches for Changing Behaviors

11/2/2015

Innovating Approaches for Changing Behaviors

11/2/2015

11/2/2015

Projecting Health

Digital Green pioneered a video-based education model for agriculture

• Content created and presented by the community

• Focus on sharing best practices in agriculture

• Enabled by low-cost consumer digital video technology

• Scaled-up through the India government

Source: www.digitalgreen.org

11/2/2015

Building on Partnerships: The Digital Green Agriculture Model

PATH’s Projecting Health* Approach

11/2/2015

Empowering communities to share healthy practices through an innovative, evidence-based, locally-driven approach for low-cost video production and

dissemination

* Also known as Digital Public Health

Revolutionizing behavior change communication

Projecting Health Model

11/2/2015Page 7

Components of the PH model:

• Ensure community-led video production; locally created, locally disseminated

• Engage communities using existing communication structures

• Establish a Community Advisory Board (CAB) to guide and support implementation of the model

• Develop video-based messages adapted to local health needs

• Build the capacity of community health workers to enhance the quality of message delivery

• Document and disseminate key learnings from model implementation

Core requirements for implementation

• Standardized quality control systems across programs/regions

• Community partners and support infrastructure in place

• Community engagement ensured (community advisory board)

• Rigorous M&E systems established

11/2/2015

An Advanced Approach for Greater Impact

Community engagement

Cost reduction

Local program structure

Increased reach and impact

Identify topic

Share and discuss

Produce short video

Identify local actors

Create storyboard

and approve

Develop key messages

Adopt and discussknowledge and

practices with others

Increase demand for immunization

services

Child immunized

Community Engagement

Panchayati Raj Institution

representatives

Community health workers

Community members

Healthcare functionaries

Education representative

NGO representative

Media representative

Women & Child Dep’t

representative

Local Program Structure

11/2/2015

Increased Reach Through Hyper-Targeted Messaging

Project Timeline

11/2/2015Page 12

2014

Endlineevaluation data

collected

PH Exploratory launch

2012

Feasibility study launch

2010

Expansion and mobile phone exploration

pilot; Kenya, Moz pilot

2015

Pilot launched in Ethiopia

2013

2016

Planning for scale-up

2007Digital Green

founded

2005

Digital Study Hall started

Project Overview

• Started in 2012, current phase 2015-2017

• Uttar Pradesh, India (with pilots in Ethiopia, Mozambique and Kenya)

• Reach to date

o Video screenings-47,563

o YouTube hits-31,534

• Target direct beneficiaries: 60,000

• On the ground implementation by local Community Based Organizations

• Hosted in Mother’s Groups

11/2/2015

Expanding Reach: Disseminating Projecting Health Videos via YouTube

11/2/2015

Birth preparedness (1,140 views)

•Birth preparedness overview

•Maternal danger signs

•Maternal nutrition

•Newborn danger signs

Breastfeeding (36,780 views)•Optimal breastfeeding practices

•Exclusive breastfeeding

•LAM

Other (534 views)•Immunizations

•Community-based emergency transportation systems

Family planning (1,578 views)•Permanent methods

•Temporary methods

•NSV-No scalpel vasectomy

•IUCD Copper-T

Thermal care (130 views)•Thermal care overview

•Delay bathing

Cord care (122 views)

•Cord care overview

•Myths and misconceptions

Diversity in Videos

11/2/2015

Change

Levels

Mothers

Social

Network

Community

Communication and

dialogue

Planning and participation Improved service delivery, recognition

and incentives

Intervention streams legend:

Inputs/Activities Outputs Intermediate Outcomes

Outcomes Assumptions Impact

Expanded video penetration through innovative channels

Participation in mothers’ groups

Video message creation

CHW (ASHA) training and education

Community member training and education

Former HW involvement

CHW (ASHA) involvement

# of accurate,

local videos produced

# of people reached through videos at mothers’ groups

# of ASHAs trained

# of video dissemination screenings

Increased quality of

mother’s groups

Improved capacity

of ASHAs

Increase in spread

and memorability

of messages

Achieved through:

Knowledge increased

Networks expanded

Community acceptance

of vaccination

Barriers to

immunization are

addressed in

groups

Strong linkages

exist between

CHWs and health

system, and

CHWs and

community

Women share messages learned in groups through

their networks

Increase in

fully im

mu

nized

child

ren in

interven

tion

areas

Inte

ntio

n to

va

ccin

ate

one

’s c

hild

Increase size and

density of advice

networks

# of advice and

video sharing

relationships

created

# of community

advisory boards

Change in

perceptions of

immunization

Social network

relationships can

change

behaviors

# of additional

modalities of

video sharing

mechanisms

Community is

accepting of PH

intervention

Increase in

knowledge

Vaccines are

available

Theory of Change

11/2/2015

Formative research

Collaborative implementationdesign with field staff and CBOs

1. Feasibility phase

2. Evaluation phase

Quasi-experimentaldesign

outcomeevaluation

After action review and ongoing quality improvement

Endline Evaluation

Primary Objective:

To assess the effectiveness of the PH intervention in increasing knowledge and changing practices of the women between ages 18 and 45 exposed to the video messages on key maternal and neonatal health (MNH) areas.

Quasi-experimental, post-test only study design with three arms:• Projecting Health video intervention

• Mothers’ group only intervention

• No intervention

11/2/2015

Methods

• Household survey with structured questionnaire among women between 18-45 years

o Participants selected using set criteria, intervention arms recruited from participant list, and comparison arm from a household listing exercise

• Semi-structured interviews with community healthcare workers (ASHA)

• Sample size derived using a minimum sample size required with 95% level of confidence and 80% power

• Ethical approval from REC and the local UP-based IRB

• Data collected by external organization, June-July 2014

11/2/2015

Selection Criteria

Study arms AttributesIntervention arm (A)

Projecting Health

n= 309

Villages having active mothers’ groups which received a

package of video messages and facilitated discussion on birth

preparedness; breastfeeding; cord care; thermal care; and

family planning through project trained ASHAs.

Intervention arm (B)

Standard Mother’s Groups

n= 321

Villages having active mothers’ groups which received

messages delivered through standard discussion format from

project trained ASHAs (not showing any videos) on MNH

areas include birth preparedness; breastfeeding; cord care;

thermal care; and family planning through project trained

ASHAs.

Comparison arm (C)

n= 327

Villages that do not have any mothers’ groups and receive no

messages from the project. Any information received is

through the standard of care from the government, non-

governmental organizations and ASHAs who have not

received project training.

11/2/2015

11/2/2015

MNH Self-Reported Practices

*

*

*

Pe

rce

nta

ge o

f w

om

en

84*

75*

58

77

59*

50

71

4954

0

10

20

30

40

50

60

70

80

90

100

Birth preparedness Breastfeeding Family planning

Projecting Health (309) Standard MG (321) Comparison (327)*p<.0.001

Birth Practices:Women Who Delivered at Home

11/2/2015

82*

63*

46.9

32.7

45.8

29.2

0

10

20

30

40

50

60

70

80

90

100

Cord care Thermal care

Projecting Health (51) Standard MG (49) Comparison (72)

Pe

rce

nta

ge o

f w

om

en

*p<.0.001

Expanding Reach: Sharing of Key Messages

11/2/2015

77 74 75 73 75

6460 61 61 59

4339 39 39 42

0

10

20

30

40

50

60

70

80

90

100

Birthpreparedness

Cord care Thermal care Breast feeding Family planning

Projecting Health (309) Standard MG (321) Comparison (327)

Pe

rce

nta

ge o

f w

om

en

Our Vision: Integrate Projecting Health Across Programs and Scale to New Geographies and Topics

11/2/2015

Seattle team to support

expansion

Next Steps . . .

11/2/2015

ContactKiersten Israel-Ballard

Technical Officer

Maternal, Newborn and Child Health and Nutrition Program PATH

kisrael-ballard@path.org

Thank you!

11/2/2015