evidence-based blog of Filippo Dibari

Posts Tagged ‘BCC’

Do you need to explain the importance of the first 1000 days of life to NON nutritonists? See these friendly users videos, infographics and fact sheets

In Over-nutrition, Under-nutrition on July 20, 2015 at 9:38 am

From the 1,000 Days Initiative:

From World Vision International:

From State Nutrition Uttar Pradesh:

From West Viriginia Public Broadcasting:

From WFP:

Check also:

See also the following WHO Global Nutrition Infographics & Target Policy Briefs:


These briefs are accompanied by a target tracking tool to help countries set and track progress towards reaching each of the WHA global nutrition targets.

AfroPop Music Video on Healthy Eating–through Beans!

In Under-nutrition on April 2, 2015 at 6:29 am

by Harvest Plus

Rwanda’s top musicians promote beans, a nutritious food that improves children’s and women’s health! The artistes (King James, Miss Jojo, Riderman,Tom Close, and Urban Boyz) have donated their talent for a healthier Rwanda.

Help Rwanda say goodbye to malnutrition by shring this great song!

Swahili version: click here. Download song free (mp3) here.

USAID/GAIN conference – Designing the Future of Nutrition Social and Behavior Change Communication: How to Achieve Impact at Scale

In Under-nutrition on October 31, 2014 at 10:42 am

from Cvent web site

The conference will take place the week of the coming 3rd of November in Washington. Sorry for the delayed notice.


Conference Background

GAIN and USAID, with its global nutrition project, SPRING, have joined efforts to identify strengths, gaps and opportunities to deliver high impact, cost-effective, sustainable SBCC at scale. This conference is the next step in a rigorous process that has included extensive literature reviews and technical consultations with leading SBCC experts to inform the development of an action-oriented agenda. For full details on this process, please review the event concept note below.

Download Concept Note  (PDF, 202 KB)

Background Reading

  • Population Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: A Review of the Evidence. Journal of Health Communication. Access Paper Here
  • Identifying Determinants of Effective Complementary Feeding Behaviour Change Interventions in Developing Countries. Maternal and Child Nutrition. Access Paper Here (PDF 1.67 MB)
  • Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia Findings from a Systematic Literature Review. The SPRING Project. Access Paper Here



Evidence of Effective Approaches to SBCC for Preventing and Reducing Stunting and Anemia

In Under-nutrition on October 27, 2014 at 3:28 pm

From Spring web page

(download the doc)

Evidence suggests that simply increasing knowledge and awareness of good nutrition practices rarely leads to sustained behavior change, nor is sustained change in nutrition behavior likely to be achieved through a single activity. Several specific behaviors or practices impact nutritional status during the critical first 1,000 days (pregnancy to age two), while complex, contextual determinants also influence individual decisions to consider, test, adopt and sustain a given behavior or practice. The field of Social and Behavior Change Communication (SBCC) is a collection of approaches and tools informed by behavioral theories and used to design public health interventions.

This review, part of a broader effort by SPRING to support governments and other stakeholders in their delivery of high impact nutrition practices, provides a summary of peer-reviewed evidence regarding the effectiveness of SBCC approaches to increase the uptake of three key nutrition behaviors: women’s dietary practices during pregnancy and lactation, breastfeeding practices, and complementary feeding practices. SBCC interventions have been broadly categorized into three areas: interpersonal communication; use of media; and community/social mobilization. This review also identifies gaps in the evidence and recommendations for further areas of study.

This review includes a total of 91 studies identified using the Ovid MEDLINE database. Recognizing the potential value of a broad array of study designs, results from five study types are included: reviews (including meta-analysis), randomized controlled trials, longitudinal studies, repeated cross-sectional studies, and cross-sectional studies. Excluded studies include those with data from high income countries, those published prior to 2000, those written in a language other than English, and those that focused exclusively on refinement of a research methodology. Other exclusions are noted in the text.

Each of the following sections contain interactive tables featuring the articles reviewed for this study.

Findings related to women’s dietary practices during pregnancy and lactation

Undernutrition during pregnancy and lactation is a critical determinant of maternal, neonatal, and child health outcomes. Improving dietary adequacy during pregnancy and lactation is important to help women accommodate their nutritional requirements as well as their children’s requirements during intrauterine development and while breastfeeding (Haileslassie, et al., 2013).

The body of literature on the effectiveness of SBCC to improve women’s dietary practices during pregnancy and lactation is still small (only 15 peer-reviewed studies met the inclusion criteria), but indicates that SBCC approaches can and do succeed in improving uptake of the behaviors promoted. The greatest gap in the literature was in evidence of effectiveness of SBCC in improving rest and workload during pregnancy. Given the importance of women’s dietary practices during pregnancy and lactation, the dearth of evidence is notable.

Browse this section’s interactive table of articles

Findings related to breastfeeding practices

Breastfeeding is widely recognized as one of the most costeffective investments to improve child survival (UNICEF, 2013), as well as cognitive and motor development and academic performance (Horta et al, 2013). Breastfeeding also imparts critical benefits to the woman, including natural postnatal infertility. Despite the promise of optimal breastfeeding practices, rates for WHO recommended breastfeeding practices remain low (UNICEF, 2013).

The body of literature on the effectiveness of SBCC approaches in improving breastfeeding practices is strong and broad (62 peer-reviewed studies met the inclusion criteria) and supports the claim that SBCC approaches can and do succeed in improving uptake of the behaviors promoted.

Evidence from several studies strongly suggests that increasing the number of contacts increases the positive effect of SBCC on breastfeeding practices. Greater consistency in how breastfeeding practices are measured – the definitions of indicators and the methods of data collection – exists for breastfeeding practices when compared to women’s dietary practices and complementary feeding practices, but even with globally-recognized indicators and measurement guidance, considerable variation remains.

Browse this section’s interactive table of articles

Findings related to complementary feeding practices

Timely appropriate complementary feeding are critical to a child’s growth and development and could avert millions of disability-adjusted life years, but global coverage of optimal complementary feeding practices remains low.

The evidence of the effect of SBCC on complementary feeding practices is quite broad (30 studies met the inclusion criteria) and clearly indicates that SBCC interventions can improve a wide range of complementary feeding practices. However, measures of optimal complementary feeding are so varied that it is particularly challenging to draw conclusions regarding the effectiveness of particular SBCC approaches.

Browse this section’s interactive table of articles

Common findings

The SBCC approach most used, and the only one used without other communication interventions, was interpersonal communication. While media and community/ social mobilization were used, they were always used with at least one other communication approach.

Studies included in this review employed a wide range of implementation strategies with variations in the interactions or combinations with other interventions, target groups, content, messages, scale and coverage, length and intensity, as well as context. Very little has been done to compare the effect of differences in the delivery science, particularly when implemented at scale.

The majority of the studies were implemented on a small scale, typically with fewer than 500 people per group.

Additionally, there was considerable variation in how women’s dietary practices and complementary feeding practices were defined and measured.


Evidence suggests that using multiple SBCC approaches and channels to change behaviors is more effective than using one, that targeting multiple contacts has a greater effect than targeting only the woman herself, and that more visits or contacts results in greater change. However, such comparisons are not well-tested in the literature. Very few comparisons have been made between the effect of timing of communications and what little has been done presents contradictory evidence. Unfortunately, it can be challenging to conduct such studies that compare differences in delivery and/or disaggregate single approaches within a multiapproach intervention. SBCC practitioners and researchers must assess whether that line of research is useful.

Differences in local context (including social norms, culture, and environmental factors) as well as differences in the implementation and scale of implementation also affect the success of interventions. This underscores the importance of proper context assessments, formative research and/or ethnographic study prior to SBCC implementation.

Finally, if practices and indicators are not standardized, a project may improve behaviors but it will be difficult to attribute changes in outcomes. This underscores the importance of developing practices and indicators that are globally recognized, accepted, and used by the research and program communities. At the same time, many nutrition interventions are suited to iterative programming for incremental change toward the optimal, evidence-based behaviors. This means that more easily achieved indicators (components of standardized indicators or shorter time periods) may also be needed to measure progress toward the ultimate goal of changes in the standardized indicators of behaviors.

Other areas particularly important for future evaluations and operations research include:

  • the effect of targeting multiple audiences or influencers of the behaviors being promoted, rather than focusing on one target population;
  • the effect of the same SBCC intervention implemented in different contexts (social and environmental);
  • the effectiveness of different approaches (including intensity and targeting) for different behaviors;
  • the cost and cost effectiveness of various SBCC approaches (particularly as it relates to scalability); and
  • the effectiveness and sustainability of these approaches when implemented at scale.

World Bank Nut tool kit: Using Communication to Improve Nutrition

In Over-nutrition, Under-nutrition on September 28, 2014 at 10:21 am

from World Bank web page


This guide offers and approach that should help Task Managers plan more effective nutrition projects. Although malnutrition clearly is a complex problem, in many circumstances it is possible for programs to improve nutritional status by helping families make small but important improvements in child feeding and maternal nutrition that require little if any additional food or major hardware investments. The investments are primarily in human resource development–in changing attitudes and behaviors among policy makers, health care or agricultural agents, and mothers and other persons in communities and households.

The approach described is social marketing, as applied to defining. promoting and making the practice of the key behaviors easier (with or without the presence of a tangible product). Many of its techniques are from social learning theory, which stresses the interplay of behavior, the environment, and people’s cognitive processes. This approach is at the heart of a broad program strategy to improve practices.

This is a general guide for the World Bank Task Manager. It is not a complete “do-it-yourself” manual. Expert assistance is recommended for many project planning missions and is needed at various strategic points during planning and implementation.

Introduction and Table of Contents (PDF 20 Kbytes)

Chapter 1- Communication that Improves Nutrition  (PDF 46 Kbytes)

Chapter 2- Planning and Implementing Communication for Behavior Change  (PDF 82 Kbytes)

Chapter 3- Managing Communication for Behavior Change  (PDF 49 Kbytes)

Chapter 4- Challenges in Implementing Effective Communication for Behavior Change  (PDF 29 Kbytes)


Appendix A- Examples of Nutrition CBC Projects that had Measurable Impact  (PDF 17 Kbytes)

Appendix B- Improving Child Feeding Practices: Lessons Learned (PDF 40 Kbytes)

Appendix C- Improving the Effectiveness of Iron Supplementation for Pregnant Women  (PDF 12 Kbytes)

Appendix D- General Guidelines for Media Selection and Use  (PDF 14 Kbytes)

Appendix E- Working with Private Sector Agencies (PDF 11 Kbytes)

Appendix F- Terms of Reference for CBC Consultants  (PDF 10 Kbytes)


References  (PDF 22 Kbytes)
To obtain the Toolkit or individual tools, please contact the Nutrition Advisory Service by sending an e-mail to nutrition@worldbank.org


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Influencing Behaviour Change for Better Child Nutrition in Ghana

In Under-nutrition on September 28, 2014 at 8:50 am

from Schools & Health web site

A new behavioural change communication (BCC) campaign is currently underway in Ghana to encourage schoolchildren to eat nutritious meals and to take on good hygiene habits.

As part of the campaign, representatives from 13 NGOs in Ghana were recently trained by Imperial College London’s Partnership for Child Development​ (PCD) to deliver good nutrition and hygiene messages across 395 communities in Ghana – targeting community events, churches, mosques and other locations.

During the training PCD outlined how materials such as t-shirts and posters should be used by campaign volunteers in communities to encourage nutritious eating habits, diet diversification and good health and hygiene of schoolchildren and their families.

By taking a Training of Trainers (ToTs) approach the lessons learnt by the NGO representatives are to be taught to community based volunteers who will spread nutrition messages to a vast audience across the 395 communities.

The workshops also looked at furthering the campaign through media engagement and how NGOs should report back on campaign outcomes for enhanced learning on what works and what areas are in need of strengthening, so that good nutrition and hygiene messages can be promoted in the best way possible.

Next Steps

In addition to targeting the community, PCD is also carrying out the BCC campaign at the school level where selected teachers will be trained and equipped with influencing manuals and wall charts. Educational jingles are also to be aired on selected radio stations throughout the project’s districts.
The BCC campaign feeds into Ghana’s Home Grown School Feeding ​(HGSF) programme which sees that food for school meals is procured from local smallholder farmers – enabling children to be better able to learn in schools and farmers to be secured of a livelihood.

Click here​ to read more about Ghana’s HGSF programme.

Formative assessment to design the packaging of a lipid-based nutrient supplement for a home fortification program to improve the nutritional status of young children in the Democratic Republic of Congo

In Under-nutrition on September 7, 2013 at 1:35 pm


From the  Home Fortification Technical Advisory Group (HF-TAG)



The Democratic Republic of Congo (DRC) is a vast country with more than 66 million inhabitants. Despite being one of largest reserves of natural resources in the world, child survival remains of concern in DRC. Based upon the preliminary results of the 2010 MICS Survey (Multiple Indicators Cluster Survey), National rates of malnutrition are high: wasting (9%), stunting (43%) and underweight (24%). In an effort to combat malnutrition UNICEF has implemented a 3- year Infant and Young Child Feeding IYCF strategy that integrates IYCF counseling (based on the WHO Ten Guiding Principles) in the Minimum Health Package. An important component of the DRC UNICEF 3-year IYCF strategy is a pilot program that will provide counseling to pregnant women, IYCF counseling, community messages, and a small quantity (20g per day) lipid based nutrient supplement (LNS) for infants (daily for children 6-12 months of age), using the existing health care infrastructure. The pilot program will be implemented in Kasenga health zone (HZ) and pending the results of the pilot program, the enhanced IYCF program will be scaled up to other HZ’s in DRC.

The goal of the program is to improve the nutritional status of children aged 0-12 months of age in Kasenga Health zone by reducing the prevalence of anemia, vitamin A deficiency and improving infant and young child feeding practices through the delivery of key messages and the distribution of lipid based nutritional supplements (LNS) (for children 6-12 months of age). The purpose of this present document is to describe the process to design the packaging of the LNS product that will be distributed as part of the pilot project.

In October 2010 an initial formative assessment was conducted to guide the design of the proposed packaging of an LNS product, to be used in in the pilot program. A second formative assessment, conducted in June 2011, re-tested the design elements of the packaging and tested the concept of providing the LNS in a multi sachet strip. The results of this second formative study were used to finalize the package and branding of the LNS. This report presents the results of the second formative study.

The specific aim of the second formative assessment was to determine which name, color, general style, and images communicate important product-related messages and would maximize the appropriate use of the product in an area with low literacy levels.

A study protocol was developed by CDC and Nutriset describing the methodology and tools that would be used in the formative assessment. Focus group discussions (FGD) and key interviews (KI) were the primary methods chosen to collect the data.

Data was collected in two locations of Lubumbashi, Katanga region: Mabaya, a rural village and Kipushi, a peri-urban area.

Results show that the majority of the study participants read the different images on the multi sachet strip as a story line. The images were interpreted as a series of events that must happen in a child’s life to ensure that the child stays healthy and develops well. The messages of washing the child’s hands, feeding the child with breastmilk and enriching complementary foods are seen as necessary elements in order to have a playful and active child. Participants retained

the main messages that the strip should convey: child care, product use, target group, as well as potential product benefits.

All participants recognized the mother and the children in the images as “Congolese” and “African”. Green and brown were identified as suitable colors for the LNS packaging and were associated with qualities such as health, growth, and development of the child. White could add a positive association by making a link to the milk content of the product.

The participants preferred the names Kulazuri (eating well) and Afiabora (good health) for the LNS. After further discussion of the name options with the field team and UNICEF staff a combination of the first two name proposals was found “Kulabora” (eating better).

The results from this formative study were used to finalize the design of the LNS product, which is currently being distributed in Kasenga health zone.

– See more at: http://hftag.gainhealth.org/resources/formative-assessment-design-packaging-lipid-based-nutrient-supplement-home-fortification-p#sthash.MvLVxabW.dpuf

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