projecting health - teach to...
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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
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Innovating Approaches for Changing Behaviors
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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
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Building on Partnerships: The Digital Green Agriculture Model
PATH’s Projecting Health* Approach
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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
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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
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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
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Increased Reach Through Hyper-Targeted Messaging
Project Timeline
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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
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Expanding Reach: Disseminating Projecting Health Videos via YouTube
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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
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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
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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
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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
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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.
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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
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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
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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
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Seattle team to support
expansion
Next Steps . . .
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ContactKiersten Israel-Ballard
Technical Officer
Maternal, Newborn and Child Health and Nutrition Program PATH
Thank you!
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