Answering Critical Social and Behavior Change Questions to Advance the Field and Improve Population-Based Behavior Change

Written by: Breakthrough RESEARCH

Tremendous strides have been made in social and behavior change (SBC) programming. SBC programs “raise awareness, reduce misinformation, and address the barriers that prevent individuals, families, and communities from practicing lifesaving behaviors to improve health outcomes.”[1] Despite major successes in influencing population-level behavior change, SBC knowledge gaps still remain across health and development sectors, for example, how to adapt or scale-up programs in a cost-effective way, how to identify and address positive and negative unintended consequences, or how to assess the cost and cost-effectiveness of SBC interventions.

Breakthrough RESEARCH, with input from USAID and implementing partners, has developed a way forward for improving two important areas of SBC programming: the knowledge, attitudes, and behaviors of health care providers toward their clients and the integration of multiple health or development issues under the same SBC program.

The path forward is guided by two research and learning agendas, one for each theme noted above, that lay out a set of questions designed to help discover what we need to understand better about providers’ behaviors and integrating SBC programming. Answers to these questions can help improve the work of health care providers (e.g. public, private, and community) and make integrated programming more effective in order to have a stronger impact on behavior change.

Many efforts have been made to change providers’ behavior with interventions that address workload, compensation, knowledge, and skills, which have had mixed results. However, limited research exists on how to address behavior that may be tied to providers’ social, cultural, professional, and community backgrounds. For example, providers’ behavior can affect the quality of counseling and care they offer because they may hold certain values and beliefs that influence the care they provide.

Knowledge gaps also exist within integrated SBC programming, in which multiple health or development topics are addressed under the same program. Integrated SBC approaches have the potential to reduce duplication, lower costs, improve client satisfaction, among other benefits, but questions remain about how effective this programming is in the real-world context.

To address these gaps, Breakthrough RESEARCH worked with SBC experts across different health and development areas to develop consensus-driven research and learning agendas. For each theme, Breakthrough RESEARCH convened the experts in several forums to identify priority research questions that could address key current evidence gaps. The result is a core set of prioritized implementation science (see Box 1) questions. These questions can be answered, whether through existing programs or stand-alone studies, to address SBC integration and providers’ behavior in ways that can improve population-level behavior change. For providers’ behavior, the questions address issues, including: the types of norms that have the most influence in shaping providers’ behavior when interacting with clients; how those norms vary across health fields and geographies; and which interventions are most effective in promoting positive providers’ behavior.

Box 1. Implementation science research is a well-suited approach to address these questions because it assesses interventions that take place in “real world” settings, considering social, structural, economic and political realities from different perspectives. The implementation science approach also emphasizes research utilization – consideration of how the evidence will inform policy and programming.

For integrated SBC, the questions focus on: how conditions such as political and donor support, timing, capacity, and coordination with governments enable or hinder the design for implementation of integrated SBC programs; whether there are combined behaviors for which integrated SBC programming is most effective; how integrated programming can be more effective than programs that focus on only one health or development topic; and the cost implications of integrated versus vertical programming.

Finding answers to these questions will lead to identifying interventions that can improve both providers’ behavior and effective integrated SBC programming. In order to address these questions, we need collaboration and coordination across a range of actors (e.g. policymakers, researchers, SBC implementers and service delivery partners, and donors) and the agendas propose action items for different actors.

The Breakthrough RESEARCH team is excited to share the research and learning agendas with the broader SBC community. These priority questions can be incorporated in your own work and the outcomes can inform the global SBC evidence base. We want to hear from you so that we can learn and build the evidence to answer these key knowledge gaps collectively.