Turning the SBC Lens on Ourselves: Implementing as if Context Mattered Expert Consultation

Wednesday, November 28, 2018

This expert consultation started with the premise that social and behavior change (SBC) interventions often sidestep advances in public health theory and research regarding complexity and context-sensitivity. Although a growing body of literature continues to support what most SBC professionals have long known—that effective SBC interventions are those that accommodate local conditions and shifts in those conditions—many on-the-ground practices lag behind. Instead, the SBC community continues to propose and support interventions that generate checklists, field guides and other manuals based on the belief in “best practices” irrespective of context. The reasons for this gap between theory and practice is perhaps attributable the business of international public health, the desire for commensurability among projects, the dollarized unitization of results. While the need to objectively report results occurs in many professions, it seems particularly problematic in areas such as SBC that depend so heavily on complex ideas such as social cognition, group action and cultural change that resist simple quantification.

Against this backdrop, the broad question motivated the SBC Working Group to spearhead a CORE Group expert consultation bringing together this half-day consultation was, “how do we effect behavior change within the behavior change community, and if lack the professional will to do so, what is holding us back?” The consultation used George et al.’s recent article (Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes) as a springboard to discussing complexity and context, donor support and interest, project design expertise (or lack thereof), monitoring and evaluation requirements, implementer capacity and/or theoretical sophistication, apathy, etc. Co-author Eric Sarriot of Save the Children elaborated on many of the article’s points in his presentation entitled Expanding the evidence agenda for community foundations advancing maternal and child health.”  Joseph Petraglia of Syntegral and Lenette Golding of Save the Children also reviewed the Call to Action produced by CORE two years ago. That Call to Action, entitled “Complexity Matters: Aligning the Monitoring and Evaluation of Social and Behavior Change with the Realities of Implementation” concluded with a set of recommendations for both implementers and donors that were offered for the consideration by the experts in attendance. After the presentations, in small groups, participants discussed “small, doable actions” that can be undertaken to address the Call to Action recommendations to overcome the barriers to contextualizing SBC interventions. The resulting list of actions were narrowed by Golding and Petraglia and reviewed with members of the CORE Group’s M&E Working Group. A short list of ideas for products was identified and Golding and Petraglia have elaborated on the shape the products might take:

  • Short (10 pages or less) advocacy key message booklet to help guide communication with donors (ideally early/ in the beginning of a new project), support message integrity, and help to build fluency in communicating how to monitor and evaluate SBC interventions in ways that will address the complexity of both behavior and of program implementation.
  • A statement and checklist that will provide a minimum set of recommendations for reporting the process of implementing SBC interventions[1] including details about the local context, intervention(s), delivery strategy, any adjustments made in line with shifts in context, an explanation of what contributed to a change in behavior, and contradictory or negative evidence.
  • Template for exchange meetings that focus on complexity and different perspectives, ideas, and recommendations as well as provide guidance on how to conduct complexity-sensitive M&E within existing platforms.
  • Clearinghouse of key books and resources on the topic of complexity and implementation.
  • Core set of indicators related to adaptation, learning, and collaboration that can be used in proposals and workplans.

A recording of the opening session of this meeting can be found here:

Part I – https://coregroup.adobeconnect.com/ph92m54l5l04/

Part II – https://coregroup.adobeconnect.com/phkrah1vdlf3/

Part II – https://coregroup.adobeconnect.com/pblo0vj6r0go/


[1] Davidson et al. (2003) have proposed that the following should be reported (a) the content or elements of the intervention, (b) the characteristics of those delivering the intervention, (c) the characteristics of the recipients, (d) the setting (e.g., worksite), (e) the mode of delivery (e.g., face-to-face), (f) the intensity (e.g., contact time), (g) the duration (e.g., number of sessions over a given period), and (h) adherence to delivery protocols. Davidson, K. W., Goldstein, M., Kaplan, R. M., Kaufmann, P. G., Knatterund, G. L., Orleans, C. T., et al. (2003). Evidence-based behavioral medicine: What is it and how do we achieve it? Annals of Behavioral Medicine, 26, 161–171.