Because social and behaviour change communication (SBCC) ought to be informed by evidence, accurately measuring the extent of the problem which SBCC seeks to address is a pertinent prior step to designing, integrating and scaling SBCC approaches. 
Evidence is generated from research. Much of social science research relies on self-reported data to understand the context and extent of a problem. Survey respondents may, however, not give truthful reports on sensitive questions when asked directly. With sensitive topics, such as Intimate Partner Violence (IPV) respondents may misreport their experiences because of fear or simply shame. Indirect methods are a possible solution to this problem. In this study we  apply one such indirect technique, the List Experiment also known as the Item Count Technique, to measure and characterize the experience of physical and emotional IPV. We randomized respondents to either an enumerator-led phone survey or self-administered online survey to test whether the presence of a third-party affects reporting. 
By employing such methods, we are able to investigate whether there are any inconsistencies in direct and indirect reports, and across what subgroups. In addition, we will test the validity of the technique to ensure that we are measuring what it claims to. With inconsistencies in direct and indirect reports, this research is a call to policymakers, donors and governments to scrutinize the methods that generate their evidence on the scale and exact nature of the problem they are seeking to address prior to designing SBCC interventions

Les jeunes de cette enquête sont célibataires (94%), 23% d'entre eux sont non scolarisés, et 77% de jeunes avec un niveau de collège et plus. 60% sont des garçons et 40% sont des filles. L'ensemble des jeunes disposent d'un smartphone dans 99% des cas et accèdent à internet. Sur l'ensemble des jeunes enquêtés, 44% utilisent leurs smartphones à des fins de recherches/études et uniquement le ¼  les utilisent pour chercher des information sur la SSR. Les réseaux sociaux les plus utilisés par les jeunes sont youtube avec 33% et WhatsApp et Instagram avec 17% chacun. 25% utilisent internet pour s'informer sur les DSSR mais uniquement 3% affirment qu'il s'agit d'une source crédible. 77% ont toujours des difficultés à parler aisément sur la santé sexuelle et reproductive et à cause des barrières socioculturelles dans 70%. 66% admettent avoir eu un partenaire dans leur vie déjà à l'âge de 13 pour les garçons et à 14 ans pour les filles avec un pic de fréquence à 18 ans. Parmi ces jeunes 68% ont eu des rapports sexuels contre 13% qui n'ont jamais eu. L'âge du premier rapport se situait à 15 ans pour les deux sexes et 49% uniquement affirment avoir utilisé un préservatif. Le pourcentage des IST est de 4% et des grossesses non désirées de 9%. 73% sont favorables pour une IVG et 33% préfèrent un milieu clandestin pour la réaliser. 4% ont été victimes d'harcèlement sexuel, 8% victimes de violences sexuelles et 33% victimes de violences physiques. 

Given the renewed interest in the use of participatory approaches in research and health promotion in global health, we argue the need to revisit approaches to increase the ownership that target communities have, not only over outcomes, but also process, as this will ensure histories of tokenistic participation are not revisited on new generations of communities and local actors. Our work pilots an adaptation of community conversations to drive a co-design formative phase for the implementation of community based and community led interventions to tackle under-five pneumonia and other childhood infectious disease in Nigeria. As part of our formative research stage for a cluster randomised control trial of a community intervention in Kiyawa LGA, Jigawa State, we completed 36 community conversations involving participatory tools to generate debate and discussion around key social and relational processes that would influence the success of participatory groups and action around child health. The conversations gave communities the opportunity to explore and shape the pillars of the intervention allowing for a more robust exploration of the varied dimensions of complex community health systems (incl. service users, wider communities). Furthermore, we believe this process will increase the sustainability of the intervention as it ensures local relevance to community groups prior to roll out and evaluation. We argue that our proposed method should be a mandatory stage of intervention research in complex settings, and discuss practical and ethical implications of the approach.

Tobacco use in Bangladesh, both smoked and smokeless forms, constitutes a major health hazard with wide-ranging impact on the economy and productivity of our developing nation.  Evidence shows that family, especially parental, smoking increases the risk for adolescent smoking initiation. Bangladesh lacks local evidence to develop and implement effective Social and Behavior Change Communication Programs for tobacco control. Therefore, the study was conducted to assess the prevalence of parental tobacco use in Bangladesh and its impact among the children to pave the way in making Bangladesh Tobacco-free by 2040. The research was a cross-sectional quantitative study covering representative sample of 4043 adult males and females (aged 50+ years) with children 15+ years. Two-stage stratified cluster approach was followed to interview the respondents at household level. Statistical tests were performed to determine the association between parental tobacco use and its impact on children. Prevalence of tobacco use among study respondents was 60.9%. Statistically significant associations were found between parental tobacco use and at least one child with ever use of tobacco; in tobacco use between children who purchased tobacco products for their parents compared to those who did not; and between children's tobacco use and attraction to the parental tobacco use. Since the Tobacco Control Act respects the privacy of people and their homes, the power of Social and Behavior Change Communication (SBCC) should be optimally utilized, especially targeting parents and elders, to reduce tobacco use in the home and ensure the health of all family members. 

There is little consensus regarding methods for quantifying digital media interventions and evaluating their dose and responses. To address these gaps, this review aims to 1) systematically review and codify measures used for digital behavior change interventions, 2) evaluate the quality of reporting of dose and response, and 3) identify areas for improvement in the field.
PubMed, Embase, Scopus, Psych INFO, and PAIS were used to search the literature. Each literature was screened by two trained reviewers and disagreements were resolved through discussion. The data synthesis scheme was designed under the concept that exposure to digital interventions can be divided into 1) intended doses that were planned by the intervention, and 2) enacted doses that were completed by participants.
A total of 2,916 articles were identified and 252 articles were ultimately included for analysis. Results showed that measurements were not consistent across studies, illustrating current challenges in this field. Although most studies paid attention to rigorously quantifying outcomes, measurement of intended and enacted doses was unclear in most studies. There is a need for more prospective studies that clearly define both dose and response measures and examine the dose-response relationship. These will provide evidence for identifying the effective content and amount of intervention and offer grounds for conducting well-designed meta-analyses.
This is the first paper that reviewed the dose and response measurement of digital behavior interventions. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence on the effectiveness of digital health interventions.

There is ample evidence that antenatal care (ANC) services reduce maternal and perinatal morbidity and mortality. However, women's ability to access and use ANC services continues to be hindered by restrictive gender roles, norms, and expectations. This study used mixed methods to explore and compare how gender inequality influences access to and use of ANC in Bangladesh, Ethiopia, and Mali. Thematic analysis of 273 interviews and 81 focus groups with adolescents and adults led to the identification of key dimensions of gender inequality, including women's workloads, discriminatory gender norms, household decision-making, and mobility. These dimensions were then included in a cross-sectional survey with between 855 and 927 married women of reproductive age (15-49) with a child under two years of age. Adjusted multivariate logistic regressions were used to further investigate the relationship between these gender inequality dimensions and two outcomes: starting ANC in the first trimester and attending at least four ANC visits. Women's workloads, discriminatory gender norms, limited decision-making, and mobility restrictions emerged as important barriers to ANC utilization across settings. Contextual variations in the nature and extent to which different gender inequality dimensions influenced ANC utilization underscore the importance of developing localized solutions. Social and behavior change communication (SBCC) programs should consider utilizing gender transformative approaches to redefine women's work, address mobility restrictions, and promote positive masculinity.

UNICEF supported the design and implementation of risk communication and community engagement (RCCE) activities for COVID-19 prevention and mitigation in Ethiopia. The design of the intervention was based on rapid assessments done at the early emergence of the pandemic. The first assessment revealed misconception about transmission and prevention mechanisms. Risk perception was low as the majority (75%) believed that they couldn't get COVID-19 infection. The objectives of the RCCE intervention were thus increasing people's knowledge on preventive mechanisms and improving risk perception. SBC interventions included building capacity of community influencers, deploying volunteers, and use of mass media which reached over 46 million people in the first year and 15 million in the second.


The campaign brought changes in people's reported practices at the early stages. For example, handwashing was reported to be around 88%, Social distancing (87%), and mask wearing (91%). Changing risk perception was challenging and improvement in risk perception was slow (25% at baseline to 38% in a year). People's willingness to take COVID-19 vaccines was at 80% before vaccine introduction (December 2021) but declined to 65% after the vaccines were introduced.


The lesson was that in outbreaks such as COVID-19, it is important to generate and utilize evidence using innovative approaches suitable for COVID like emergencies (such as mobile survey). Also important is providing comprehensive messages such as on healthy diet, mental health, preventing violence, hygiene, and childcare practices. Government leadership and ownership was important in enforcing measures introduced for the good of the public.

In Guyana, malaria incidence is highest in the remote, gold mining regions. In response, the USAID-funded Breakthrough ACTION Guyana project, Ministry of Health (MoH), Pan-American Health (PAHO) and national mining organizations partnered to improve malaria testing, treatment and prevention behaviors among gold miners. Using a collaborative and participatory approach, the consortium implemented a two-fold strategy to complement the volunteer testers providing malaria services in remote mining camps- i) a social and behavior change (SBC) campaign and ii) a continuous monitoring system to track miners' malaria-related behavior. The strategy's adaptive management experience was akin to building an airplane as you fly. The multi-channeled 'Little Mosquito Big Problem' (LMBP) campaign was based on evidence from formative research and a baseline malaria survey with miners. The continuous monitoring system included social media data analysis and regular field visits to mining camps to track campaign reach including exit interviews for all miners accessing malaria services to track their behaviors. Social media analysis revealed low miners' engagement despite good regional reach. Feedback from miners during field visits proved invaluable as miners' had limited radio exposure and watched mostly news and sports on TV, adjusting the media placement accordingly, dramatically increased recall. The exit interviews showed evidence of improved malaria-related behaviors over baseline data. The upcoming endline assessment is expected to demonstrate replicability of the strategy and corroborate preliminary findings of project impact on miners' behaviors as well as MoH capacity to implement SBC campaigns. 

The Covid-19 pandemic, and the disruptions it has caused to standard health care services like childhood vaccinations, have exacerbated the challenge of creating effective, resilient health systems. As countries begin adopting new strategies to restore services, what interventions can best strengthen health care delivery and support longer-term resilience? 
Responding to earlier health system challenges, many policymakers have invested in programs that enhance beneficiary involvement in monitoring health care provision. By strengthening the transparency of public health systems, these programs aim to empower citizens to improve the responsiveness and accountability of the health system. Over the past two decades, several programs have aimed to spark social and behavioral change by engaging communities in improving local health services. Given that beneficiaries have the most to benefit from improved health services, and that empowering local communities can in itself be an important objective, such programs have gained traction globally.
Despite the enthusiasm for this approach, recent research (including during other major health crises like the 2014 West Africa Ebola epidemic) has provided mixed evidence for the effectiveness of community monitoring programs. To design better programs that spark effective citizen action and advance health equity, it is key to understand when and why these programs have not improved health care provision.
This session will review randomized evaluations of community monitoring programs in Uganda, Sierra Leone, Tanzania, and Indonesia and potential reasons for their limited success. We will review important factors to consider when pursuing community-based programs and highlight open questions for the field. 

Changing behavior at scale while considering contextualized behavioral drivers is a significant challenge for the SBCC field. We developed a process based on a generic behavioral design paradigm, behavior-specific evidence synthesis guides, a tool to integrate global and local evidence on how to change behavior, a flowchart for directing additional formative research, and an iterative process for incorporating learnings. We evaluated the results of the training and implementation process across three countries in different settings at three different stages in the intervention design process using a mixed-methods, case study approach. Our results argue for more evaluation of behavioral design processes, theory-informed evidence synthesis guidance in standard formats, and consideration of contextualization and capacity building at sub-national levels.

Women's economic empowerment (WEE) is postulated to reduce risk for intimate partner violence (IPV); however, the relationship across contexts has proven highly variable. Increasingly, experts argue that variation may be explained in part by the setting's normative context; i.e. the gender norms and level of gender equality where a woman lives may impact whether her economic participation proves protective or risky for IPV. The most common explanation offered for this phenomenon is the concept of male backlash: men whose partners exhibit more empowerment than the typical woman may feel their masculinity is threatened and seek ways to reestablish domestic authority through violence perpetration. Using DHS data across 35 low-and middle-income countries, this study tests the hypothesis that IPV risk is higher among women who enter economic participation ahead of their peers. The study presents a measure of "going against the norm" for economic participation, termed here as "vanguard WEE." The study will present results of the prevalence of vanguard WEE across 35 low-and-middle income countries (LMICs) and across demographics within countries. Adjusted mixed effects multilevel logistic regression will be used to report the difference in log odds of an individual woman experiencing IPV associated with an increase in vanguard WEE, both across LMICs and by-country. Given the extensive interest in and donor funding for WEE programming across LMICs, an improved understanding of how WEE can increase IPV is critical. The results will highlight the importance of factoring in social norms in WEE interventions globally.

A challenge in creating effective social and behavior change communication (SBCC) for zoonotic diseases is the need to promote multiple prevention behaviors. While epidemiological data and quantitative surveys offer important information for programs, data elicited from participatory qualitative research techniques and analyzed can provide in-depth insights. Involving stakeholders, including representatives from various government agencies and other local partners, in the analysis of data also yields contextually relevant insights with more practical applications. 
In September/October 2019, this study (n=229) employed participatory qualitative research techniques to identify ways to enhance SBCC for priority zoonotic diseases in three regions in Guinea – Conakry, Nzérékoré, and Kankan. Data collection explored risk perceptions among community/opinion leaders, animal handlers, health providers, veterinarians, and men and women from general community members. Participatory qualitative research techniques (i.e., free listing, pile sorting) elicited rich insights from participants. Data analysis, which included a participatory process of inductive and deductive coding, engaged local stakeholders to yield findings grounded in the local context.
Future SBCC programmatic research efforts should consider incorporating such data collection and data analysis techniques in order to obtain deeper insights. Although the presentation is specific to a study about zoonotic diseases, the insights gained about the techniques may also be relevant to SBCC professionals working in other health or development areas of interest. 

Little is known about the effectiveness of social media behavior change communication campaigns for medium-term social good outcomes. This study presents results of two experimental trials evaluating the impact of a malaria prevention Facebook campaign in India, 1-to-4 months after ad exposure. The first is a cluster RCT that evaluated a "real world" campaign, where experimental groups were assigned at the district level and survey respondents were independently recruited in 80 districts in 3 high-burden states (n=15,878). While this intervention increased the use of bed nets among individuals living in concrete houses, the campaign was ineffective for households living in non-concrete dwellings, where malaria risk is higher. Consistently, analysis of administrative district-level health facility data shows that urban monthly incidence decreased by 0.7-1.3 percentage points after the ad campaign. By contrast, rural incidence was not affected. To shed light on the potential reasons, we experimentally varied exposure to the same ads at the individual level in a second trial (n=4,908), using the remarketing tools of the ad platform. We find that bed net use increased among respondents living in both types of households. We conclude that ad content itself is effective, yet the "real world" campaigns might not reach vulnerable subgroups without additional effort. We propose some techniques like Facebook's Lookalike Audience tool to improve targeting of campaigns to maximize impact in subpopulations of interest.

Rabies is the second most important priority zoonotic disease (PZD) in Sierra Leone. There is little information about community-level perceptions and behaviors that influence rabies risk in Sierra Leone, and community needs for effective rabies prevention and control. Understanding community needs and their resources and capital for supporting a comprehensive rabies control program can guide development of behavior change interventions and facilitate community engagement with social and behavior change (SBC) programs. 
Formative research was conducted to understand the socio-cultural context of rabies in Sierra Leone. Fifteen focus groups were conducted with children and adults in five constituencies and 16 communities of Bombali District. This analysis explores the question: What are the perceived community needs for rabies prevention and risk reduction, and how may they inform design of a communication campaign for rabies prevention? Data analysis was coded to organize the data into themes and relationships. 
Perceived community needs for SBC messages included: education, guidelines for safe human-animal interactions, responsible animal ownership, vaccines and medicines, access to trained animal health workers including new cadres of animal health workers, and regulatory and reporting structures for risk incidents. The findings reinforce the need for an intersectoral approach to rabies prevention that includes communities, health, education, and agriculture sectors, and supply chain management. The findings support also the WHO guiding framework for global action to eliminate rabies, specifically understanding socio-cultural context for behavior change, increasing awareness and knowledge, strengthening animal and public health systems, and intersectoral partnership and coordination.

This presentation is for practitioners who design (or want to design) norms-shifting SBCC programs. Using pictures and stories, this presentation will outline best practices from successful SBCC programs that applied social norms to the design and implementation of programs across different media and development topics. First, this presentation will discuss Tékponon Jikuagou, a community-based SBCC program designed to address unmet need for family planning in Benin and Mali. Second, this program will discuss a multimedia based SBCC program designed to address child marriage in Nepal. The presentation will highlight several lessons learned for social norms and SBCC programming from these examples such as: how practitioners need a firm understanding of the theories of social norms to apply principles to programs from the very beginning; how social norms should not be thought of as a programmatic outcome, but rather as a reciprocal part of an SBCC program's lifecycle; and how many practitioners are already experts on social norms and have been designing programs to shift social norms for years. Practitioners have been largely removed from the larger conversations about SBCC and social norms, which have mainly focused on research and evaluation. This presentation will demonstrate how measuring social norms in evaluation is futile if programmers and researchers are not on the same page from the beginning. For summit attendees interested in shifting social norms in SBCC, this presentation will provide clear takeaways for program design and practice. 

Capacity strengthening of local institutions has been increasingly recognized as a cornerstone practice of sustainable social and behavior change (SBC). However, assessing SBC capacities at the individual, organizational, and systems level has proven difficult in low- and middle-income countries. Through the Resilience in the Sahel Enhanced II (RISE II) project, Breakthrough ACTION has an objective of enhancing the existing SBC capacities of local health and development organizations in Burkina Faso and Niger. Using a modified version of the SBC Check-in tool combined with a Most Significant Change (MSC) approach, Breakthrough ACTION assessed partner organizations' capacities to plan, implement, and evaluate SBC activities. Findings from the modified tool were then used to develop custom "coaching plans", by which the Breakthrough ACTION team adopted a tailored capacity strengthening approach to address the needs of each organization. During implementation of the coaching plan, qualitative data collected using an MSC approach served as a feedback mechanism to adapt programming as organizational needs and priorities changed. This approach may serve as a promising example of collaboration and data utilization in SBC capacity strengthening.

To nurture new voices, you must find and listen to new voices. Story sourcing enriches formative research by venturing beyond the issues that are the immediate focus of a program to seek out, recognize, and learn new voices within the community. 



Story Sourcing is a semi-formal formative research process that uses journalistic techniques to gather stories directly from the audience of interest. Story sourcers (called Story Scouts) are local journalists who uncover anecdotes from daily life within the community that can provide nuanced context that supports the design of compelling and memorable SBCC programs. Stories gathered give an honest and unvarnished voice to those that SBCC programs aim to impact.



Effective SBCC programs resonate with the audience and are based on ideas and themes that have meaning to them. Stories help uncover those ideas and themes and open the audience's imagination to the possible. The discovery of these kinds of stories is at the heart of Story Sourcing. 



Seeking out stories within the community exposes unique community dynamics: a beloved folktale told to children, favorite films and why, stories of how religion influences daily life; it also opens personal stories that shape how people see themselves and what motivates them on a deeper level. These stories amplify and contextualize more formal quantitative and qualitative formative research. They also become a core repository of content for SBCC programs, such as media campaigns, EE programming, and live events.

Background: Female genital mutilation/cutting (FGM/C) is a human rights violation perpetrated against women and girls. Currently, research on explanatory pathways connecting predictors to FGM/C among girls, including the role national anti-FGM/C laws play on those mechanisms, is limited. Kenya has enacted a comprehensive anti-FGM/C law and was used to examine explanatory pathways for FGM/C, especially before and after the law.
Methods: Kenya Demographic and Health Surveys from 2008-9 and 2014 were used to assess whether predictors, household decision-making, regular media exposure, belief that FGM/C is a religious requirement (FGM/C belief), and women's FGM/C status, influenced whether a woman had any daughters with FGM/C (daughters' FGM/C), via women's attitude on FGM/C continuation (FGM/C attitude). The law's moderating effect was subsequently explored through multiple group (pre-law/post-law) path analysis.
Results: FGM/C belief and women's FGM/C status were related to daughters' FGM/C and both relationships were mediated via FGM/C attitude. These total and indirect effects remained significant pre- and post-law. Regular media exposure had significant indirect and total effects on daughters' FGM/C, post-law. There was support for the modifying effect of law on certain predictors, as total effects of women's FGM/C status and regular media exposure differed significantly pre- to post-law.
Conclusions: Shifting harmful beliefs regarding religion and FGM/C, targeting women with FGM/C, and using media to promote anti-FGM/C attitudes may enhance prevention efforts. Kenya's comprehensive law positively influences FGM/C pathways. Although comparative analyses are needed, stronger national legislation may be a key avenue towards FGM/C elimination.

A recent outbreak of Ebola (EVD) in Guinea in 2021 was found to be genetically linked to the 2014–2016 EVD outbreak and could be from a previous infection from an EVD survivor. Knowledge of the potential origin of the outbreak spread through some communities, heightening EVD survivors' fears of increased stigma and ostracization. This qualitative study used focus group discussions among EVD survivors living in Bomabli and Kenema districts in Sierra Leone. Sites and participants were were based on high prevalence of EVD survivor residents identified through collaboration with Sierra Leone Association fo Ebola Survivors (SLAES) and district health staff. The study aimed to increase understanding of EVD survivors' perceptions of risk, psychosocial needs, concerns around health and stigma, and relationships with others including health workers. Participants described psychosocial health issues attributed to both EVD and being a survivor of EVD. They reported several anxieties and fears, ranging from daily worries to severe depression and stress and mental health disorders. Persistent poor health after recovery and inability to work were common sources of distress and anxiety for many EVD survivors. EVD survivors reported persistent stigma from their communities and healthcare workers, also causing mental stress. The news of recent EVD cases in Guinea caused much anxiety among survivors. Interventions that facilitate stronger bonds between survivors and their communities may improve supportive mechanisms for EVD survivors. Interventions for health providers may include frank discussions about personal beliefs, fears, and biases that impact provision of good quality, person-centered, and respectful care.

While there is growing research interest in measuring social norms to plan and evaluate SBCC programs, there are few studies that have tested the psychometric structure and properties of social norms measurement items. This presentation will share results from a project designed to answer the research question: what is the latent factor structure of commonly used quantitative social norms measurement items and are they consistent over time? This project utilized data from two quantitative, cross-sectional studies in Zambia: from an initial study in 2019 (results of which were included in a 2020 SBCC Summit Poster) and an identical, replication study in spring 2022, both with items sourced from the literature to measure social norms regarding family planning.  For study 1, exploratory factor analysis and estimates of scale reliability were conducted to understand the properties and structure of social norms items. For study 2, confirmatory factor analysis was conducted to determine if the properties and structure of social norms items were consistent over time. Results for both studies will be presented to the audience in an easy-to-understand manner, such as how specific items were asked so that attendees can leave the session with a "menu" of validated, quantitative tools they can immediately apply to SBCC projects and research that seek to form norms-shifting interventions or measure norms change over time. This presentation will add to the ongoing conversation regarding how to quantitatively measure social norms and help establish and standardize tools for the broader field of SBCC.  

This abstract describes the gender equity landscape among adolescents in Bong, Bomi, and Gbarpolu. Data was collected through a USAID funded social and behavior change project Breakthrough ACTION, which implemented a baseline study looking at priority behaviors across various health issues. This examination of gender equity in Liberia was a part of a larger quantitative, cross-sectional household integrated health survey conducted among married/in union adolescent girls (15-19 years) and unmarried adolescents (girls and boys 15-19 years). Sample size consisted of 385 female and 388 male adolescents from Bong, 203 female and 190 male adolescents from Bomi, and 193 female and 296 male adolescents from Gbarpolu. There are four Gender-Equitable Men subscales-- sexual relationships, reproductive health, domestic chores and daily life, and partner violence. Each subscale is divided into 3 categories: 0–33 indicates low support; 34–66 indicates moderate support; and 67–100 shows strong support for inequitable gender norms. 

Results indicate that continued and improved messaging is needed to address medium to high support for gender inequitable norms by both adolescent boys and girls in multiple areas: within the household, within sexual relationships, related to partner violence especially among adolescent boys, and when discussing reproductive health issues, especially among adolescent girls.