Human-Centered Design (HCD) Karam 4 - English, Français interpretation Preformed Panel Presentation
Dec 06, 2022 04:50 PM - 06:15 PM(Africa/Casablanca)
20221206T1650 20221206T1815 Africa/Casablanca Better Cross-Sectoral Collaboration, Better Health Outcomes: Applications of the Circle of Care Model

When Social and Behavior Change (SBC) and Service Delivery (SD) projects work together, health outcomes improve. Until recently, partners lacked a systematic framework and a joint understanding of precisely how SBC can strengthen service delivery. The Circle of Care Model was developed to create a common reference for the integration of SBC and SD activities. This conceptual framework demonstrates how SBC can be used across the service delivery continuum – before, during, and after services – to improve health outcomes and reduce health inequities.

The Circle of Care model is human-centered, placing the needs, perspectives and wants of clients and providers at the forefront of program planning. The model shows how SBC can be used at each stage of the service delivery continuum. In the Before Stage, SBC motivates clients to access services by generating demand, creating an enabling environment, and setting supportive norms. In the During Stage, SBC improves the client-provider interaction by empowering clients, improving provider behavior, and building trust. In the After Stage, SBC boosts adherence and maintenance by enhancing follow-up, supporting behavioral maintenance, and reinforcing linkages between facilities and with communities. The end result is more effective service delivery programs that meet the needs of the audiences and contribute to improved health outcomes.

This panel highlights practical applications of the Circle of Care model and facilitates discussion around how to use the model in participants' contexts. It prompts discussion around the need for SBC and SD partnerships and collective action for improved health outcomes.

Karam 4 - English, Français interpretation International Social and Behavior Change Communication Summit info@sbccsummit.org

When Social and Behavior Change (SBC) and Service Delivery (SD) projects work together, health outcomes improve. Until recently, partners lacked a systematic framework and a joint understanding of precisely how SBC can strengthen service delivery. The Circle of Care Model was developed to create a common reference for the integration of SBC and SD activities. This conceptual framework demonstrates how SBC can be used across the service delivery continuum – before, during, and after services – to improve health outcomes and reduce health inequities.

The Circle of Care model is human-centered, placing the needs, perspectives and wants of clients and providers at the forefront of program planning. The model shows how SBC can be used at each stage of the service delivery continuum. In the Before Stage, SBC motivates clients to access services by generating demand, creating an enabling environment, and setting supportive norms. In the During Stage, SBC improves the client-provider interaction by empowering clients, improving provider behavior, and building trust. In the After Stage, SBC boosts adherence and maintenance by enhancing follow-up, supporting behavioral maintenance, and reinforcing linkages between facilities and with communities. The end result is more effective service delivery programs that meet the needs of the audiences and contribute to improved health outcomes.

This panel highlights practical applications of the Circle of Care model and facilitates discussion around how to use the model in participants' contexts. It prompts discussion around the need for SBC and SD partnerships and collective action for improved health outcomes.

Promoting Respectful Maternity Care During Labor and Delivery in Zambia and Liberia
Preformed Panel 04:45 PM - 06:15 PM (Africa/Casablanca) 2022/12/06 15:45:00 UTC - 2022/12/06 17:15:00 UTC

Mistreatment during labor and delivery is a well-established global problem, yet research on effective interventions to change provider behavior is still quite limited. This presentation will highlight solutions for provider behavior change – part of the During Stage of the Circle of Care. A four-prong set of solutions was tested in Zambia and adapted and piloted in Liberia: 1) a pain management toolkit-a range of cues and tools placed through the ward to continuously prompt supportive care 2) a provider-client promise-a list of promises read out loud to clients upon admission and signed to set boundaries around acceptable provider care and shift power imbalances, 3) a feedback box-a means to default women into evaluating their experience of care and elevate their voice, 4) a reflection workshop-a safe space for providers to discuss facility norms and build motivation and a commitment to improve client care. The results of the evaluation showed statistically significant differences between clients in the treatment and control sites related to their experiences of disrespect and abuse and pain management support received.  The package of solutions, informed by behavioral science, holds promise to positively impact the experience of care of women in labor. The solution set was feasible to implement in both Zambia and Liberia and well received by health workers, thus suggesting its promise for scale. Additional research is needed to more rigorously test impact, refine intervention design to more effectively elevate client expectations of care, and ensure acceptability and feasibility at scale.

Presenters Jana Smith
Ideas42
Co-authors
AS
Allison Schachter
AK
Ameck Kamanga
PATH
Motivating a High-risk Segment of Employed Men to Seek Care for Tuberculosis Testing through an Omni-channel Digital Intervention in Urban Southern India
Preformed Panel 04:45 PM - 06:15 PM (Africa/Casablanca) 2022/12/06 15:45:00 UTC - 2022/12/06 17:15:00 UTC

Driving early identification for infectious diseases such as tuberculosis (TB) in the Before stage of the Circle of Care is critical to effective care and reduction of community spread. For a high-risk population of urban, employed mid-age men in Southern India, low care seeking for TB is driven by symptom normalization, norms around masculinity and status, and concerns around slow, expensive or difficult-to-access services. Given that this segment has high digital access, a multilayer digital intervention was designed to counter these beliefs and enable faster care seeking. The intervention comprised a campaign via high-reach platforms such as Facebook, Whatsapp, and YouTube, interest-building interactive tools such as a chatbot, helpline, and engagement tools like a nearby facility locator, and self-assessment test for TB risk. The intervention was iteratively optimized over an 8 month period and reached 30 million non-unique individuals at a sustainable cost, with 400k engaged users. Symptom recognition targeted messaging was most effective, and different content formats performed better on different platforms. Interactive platforms saw high initial bounce rates and required design optimization to improve retention. The study yields important insights around the design of digital interventions in urban low income contexts in India, including platform and content choices. This model presents a novel approach to develop and target behavioral messaging approaches to demand generation for TB care seeking among the most vulnerable populations, and initializes a pathway to service delivery around testing and treatment in the TB Circle of Care.

The After stage in the Circle of Care for postpartum women: Lessons from Liberia, Tanzania, and Ethiopia
Preformed Panel 04:45 PM - 06:15 PM (Africa/Casablanca) 2022/12/06 15:45:00 UTC - 2022/12/06 17:15:00 UTC

The After stage of the Circle of Care applies SBC theory and practices to support clients in following through on counseling during the health contact (using contact to imply both facility and community-based health services). For postpartum family planning (PPFP) especially, there can be a lag between counseling and initiation of a method, as counseling happening during pregnancy, at childbirth or a postnatal contact may necessarily or by choice involve delayed start of contraception. Women who have not discussed PPFP with their partners frequently wish to before adopting contraception, especially where postpartum abstinence norms exist. Thus, PPFP is most effective when we embrace opportunities afforded by a continuum from antenatal to immunization visits in the extended postpartum period. In designing effective service integration, the Circle of Care guides us to anticipate women's needs at multiple visits, ideally linking FP discussions from one visit to another. Under USAID's Maternal and Child Survival Program, Jhpiego undertook several implementation research studies on PPFP in Liberia, Tanzania and Ethiopia, with varying models of PPFP integration. This presentation will tease out specific components of SBC design to support clients after a visit, facilitate self-care and encourage linkages from one visit to the next.

Presenters
AP
Anne Pfitzer
Jhpiego
Co-authors
CC
Chelsea Cooper
ideas42
,
Jhpiego
Surgo Ventures
Johns Hopkins Center for Communication Programs (CCP)
Johns Hopkins Center for Communication Programs (CCP)
 Douglas Lubowa Sebba
United Nations Children's Fund (UNICEF)
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