Transcript Communication for Behavioral Impact Strategy to Promote

Draft Communication for
Behavioral Impact Strategy to
Promote IYCF/Complementary
Feeding in Cambodia
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Research on IYCF
complementary feeding
 Infant and young child feeding practices
research in Cambodia 2006
 Comprehensive review of feeding practices in
children from 6 months and also explored
some of the barriers for mothers to providing
appropriate complementary foods.
 Areas highlighted for future BCC interventions
included addressing poor quality Borbor
introduced at inappropriate times with active
feeding and improved variety and quantities.
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Research location and
participants
 Research conducted by NNP with SBK
Research and Development and partners
 5 provinces of Stung Treng, Kratie, Prey Veng,
Kampot, and Battambang were selected
purposefully to be representative of the main
geographic regions of the country.
 A total of 110 mothers with children aged 0- 23
months old were interviewed regarding infant
and young child feeding practices.
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Main Findings
 For the 6-11 months old
 Infants were fed watery bobor, not energy or nutrient
dense
 Infants were fed only soup liquid with rice
 There was inadequate amount, frequency and variety
in the diet of the young children
 For the 12-23 months old
 Delayed introduction of family foods, not enough
variety in the diet
 Inadequate amount, frequency and variety in the diet
of the young children
 Child eats by him/herself or with older siblings and
does not finish meal
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Outline of the COMBI process
1. Overall Goal
2. Expected Behavioural Results/ Objective
3. SMACK (Situation Market Analysis for
Communication Keys)
4. Overall Strategy
5. COMBI Plan of Action
6. COMBI Programme Management
7. Monitoring and Evaluation
8. Implementation Plan
9. Budget
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1.Overall Goal
 To improve the feeding practices of
infants and young children, by increasing
knowledge and supporting behaviour
changes to encourage appropriate
feeding practices (timely, consistency,
quantity, quality, frequency, hygiene and
active feeding)
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2.Behavioural Objective
1.
Timely :
Start complementary feeding when the child is 6 months of age
and continue breastfeeding to two years and beyond
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2
Consistency and quality of food:
Give Bobor that is thick and has meat, fish, egg, vegetables and
oil from complete 6 months. Start each time with 2 spoons and
gradually increase quantity to a full bowel 3 times per day to one
year of age.
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2.Behavioural Objective
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Hygiene:
Wash hands and cooking equipment with soap before
preparation of Bobor and before feeding.
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4 Active feeding:
Feed children with lots of encouragement and patience actively
feeding and allowing enough time for feeding.
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Behavioural Objectives that
should be part of the
strategy?
 Sick children
 Children over one year
 Almost 63% not meeting energy requirements
 Still critical age for growth and development
 Snacks as part of healthy diet for children
less than and over one year.
 Helps to meet energy and nutrient deficit
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Time frame and
implementation choices
 Use two behavioural objectives per year and
build on the following year?
 Which ones should be prioritized for the first and
second year?
 BCC activities should be for one year with
messages continued through replacing old
practices with new behaviour and reinforcing
messages through routine IYCF counseling?
 Year one and two introduce new objectives and
in year 3 and 4 revise the changes and reinforce
the same messages again.
-
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Expected outcomes - what
should our targets be?
 What will we use as a baseline for many of the
behavioural objectives?
 CDHS information on breastfeeding and types
of foods in complementary feeding from 2005?
 What should the yearly targets be? Should
they be set?
In this way we will have possibly ….. to
X % by 2009 ( Y % by 2010 and Z % by
2011/2012 )
- By end of 2012 ....% start complementary
feeding from age 6 months, timely , quality,
consistency, hygiene, active feeding
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3. SMACK (Situation Market
Analysis for communication
keys)
Cost vs. Value Calculation



Field observations and conversations suggests
that individuals will follow-through with the
recommended behaviour if in their cost vs.
value calculation
it is worth it to invest the effort and bear the
“cost” in carrying out the behaviour in relation
to the value of what they receive in …
in relation to what other “competition” (is in the 12
environment or “market place.”)
Timely :Start complementary feeding when
the child is 6 months of age and continue
breastfeeding to two years and beyond
 We have no information on the
motivators or barriers to starting timely
complementary feeding.
 The only intervention in the research was
attempting to encourage mothers to
express breastmilk but this was difficult
for mothers to do and not seen as
possible the mothers needed a lot of
education and counselling
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Consistency and quality of food: Give Bobor that is
thick and has meat, fish, egg, vegetables and oil
from complete 6 months. Start each time with 2
spoons and gradually increase quantity to a full
bowel 3 times per day to one year of age.
Obstacles for Behavioural Change
Resources
 Buying meats or fish is expensive and mother doesn’t have enough
money.
 Its common practice in the villages to eat 2 main meals in a day,
normally just lunch and dinner
 Sometimes family is eating dry food like fried fish with no
vegetables,
 If mother goes to the field, its not possible to achieve.
Child Health
 Children are too small and risk of choking on enriched Borbor.
 Think some vegetables/foods cause diarrhoea/sickness
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Hygiene: Wash hands and cooking
equipment with soap before
preparation of Bobor and before
feeding.
 Unhygienic feeding behaviours such as not
washing the hands before feeding the child or
preparing food, using unclean utensils and not
washing the vegetables or fruits was observed
during the trial. In addition only a minority of
homes had latrines.
 We have no information on the motivators or
barriers to improving hygienic practices from
this research.
 ? Other research in Cambodia
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Active feeding: Feed children with lots
of encouragement and patience actively
feeding and allowing enough time for
feeding.
General findings on feeding practices
 When to feed child: 79% give food when
cry or express hunger, only 12% have
fixed schedule for feeding.
 48% of mothers said full “when the child
stops eating or spits out the food” or when
they ask for water (10%) and start to play
or stop crying (11%).
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Active feeding: Feed children with lots
of encouragement and patience actively
feeding and allowing enough time for
feeding.
Obstacles for Behavioural Change
 When child becomes sick they eat very little.
 Mothers working in the field.
 If child spits out food it was assumed they didn’t like it
or was full.
 Child vomits after food so mother afraid to force the
child as small stomach.
 Mothers think that quantities/bowel of food is too much
for their children to eat "I was afraid that when he ate
more, his stomach would get big and burst because my
child is still small"
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4. Overall Strategy
 Behavioural Objectives (after SMACK )
 Communication strategy
1 -Administrative mobilization/Public Relations :
2-Community Mobilization
3.Advertising and promotion
4.Personal Selling
5.Point-of-Service promotion
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5.COMBI Plan of Action .
1. Administrative mobilization
/Public Relations
2.Community Mobilization
3.Advertising
4.Personal Selling
5.Point-of-Service promotion
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Messages
 The messages need to address both the
Head (logic) and Heart (emotional)
dimension of the Cost vs. Value
calculation.
 On the value side,
-……………………
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2¦
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Communication Actions
-
-
Design a new logo, Gingle, Slogan and
branding them for
the recommended behaviour.
To be used on all materials dealing with
this plan.
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1 -Administrative
mobilization/Public Relations :
-Memos
-partnership session
-staff meeting ,radio /TV ,news
papers,
-community meeting/discussion etc
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2-Community Mobilization :
-Community meeting and events
-Mass media
-traditional media
- Concert …
- with supporting materials
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3.Advertising and promotion :
-Selecting an “advertising agency”,
- Confirm agreement on style of advertising
- Develop content of the advertisements for radio,
television, with reference to the behavioural
themes .
-News papers
-Billboards
-Banners
-Flipcharts, leaflets, booklets, Flyers , cap,
stickers, brochures, banners, T-shirts…
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4.Personal Selling :
 Plan IPC and other communication activities at community
level with PHD &OD (by NNP and partners)
 Develop training materials (by NNP and partners )
 conducting training need assessment
 develop appropriate training curriculum
 for training of trainer to PHD and OD staff
 for step down training to health centre staff and MSG.
 Conduct training of trainer to PHD and OD staff to targets
provinces (by NNP and partners )
 Conduct step down training to HC staff & MSG
(by PHD and OD with support from NNP and partners)
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- Mother support group , VHSG, and others
volunteers.
education at village or home to mothers and
caretakers
… with supporting materials e.g.Print
materials …,TV/Radio spot .., which covers
the behavioural theme to caretakers
- Mother is most important decision maker for
deciding what foods to give to the child and
when both parents work the grandmother often
becomes the caretaker.
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5.Point-of-Service promotion
- Display posters in the waiting area, which
messages similar to those of TV/radio
spots.
- Billboards
- Banners
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6. COMBI Programme
Management .
 NNP and partners
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7.Monitoring & Evaluation
A-Monitoring




Random check by NNP and partner for the
activities carried out by PHD, OD and MSG.
Random check by PHD and OD for the
activities implemented by health centre.
Field observations and KAP SV
Small tracking surveys of mass media
activities twice a year (mid year and end
year) in the targeted provinces.
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B-Evaluation
 Conduct a final KAP( knowledge ,attitude ,practice)
surveys on CF
 by NNP and partners to targeted provinces and
other provinces.
 Mothers ,care givers target group
…
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8- Implementation Plan
4 year Duration
 From 2009 -2012
 Implementers & Partners:
 NNP and NGOs , IOs, UNs
 PHDs, PHPUs, ODs, HCs, MSG in targeted
- Media
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Operational Plan
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9.Budget :
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Next steps for IYCF BCC
strategy
1. Finalize messages and field test
2. Develop operational plan and budget
requests with all involved partners
3. Share the strategy, operational plan and
field tested messages with N TWG
4. Develop materials as identified in the
strategy
5. Disseminate/broadcast/use the new
materials
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