In recent years, social and behavior change (SBC) programming has experienced a notable shift away from a vertical approach focusing on one health or development topic to integrated approaches concerning multiple health or development issues or outcomes under the same program. Integrated SBC programs aim to address factors such as knowledge, attitudes, and norms pertaining to multiple health areas or development sectors in a coordinated and intentional way that influence multiple health outcomes. They have the potential to reduce duplication, lower costs, avoid missed opportunities, provide the right services and information to the right clients at the right time, and achieve better success. Such integration is already happening across many health areas/sectors, yet the evidence base to support this is limited.

At the same time, programs are often faced with the challenge of transferring knowledge into behavior. A wide variety of contextual factors influence the conditions for action (and non-action). An enabling environment brings together three interrelated groups of practices: policies, legislation, and financing; institutions, governance, and management; and social and economic factors. This enabling environment often intersects with SBC approaches, including integrated SBC. The interaction within this nexus can go both ways. The enabling environment can act on SBC approaches in a way that facilitates or creates barriers, while SBC approaches can identify areas where the enabling environment could be strengthened and then work to create a more supportive environment. Breakthrough RESEARCH has generated a portfolio of evidence to further unpack this intersection of SBC and the enabling environment and to build the evidence base for integrated SBC.

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SBC and the Enabling Environment for Family Planning

21 Mar 2023

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Foundations for Integrated SBC and the Enabling Environment


Breakthrough RESEARCH conducted mixed methods research to assess successes and challenges of integrated SBC programming, including its effectiveness on priority behaviors and cost-effectiveness in a climate-stressed setting. Breakthrough RESEARCH’s evaluation activities were intended to improve the design and implementation of SBC programming in RISE II and inform USAID’s global portfolio of integrated SBC programming.


Breakthrough RESEARCH conducted mixed methods research to inform the delivery of social and behavior change (SBC) programming, including integrated interventions to promote malaria prevention and treatment behaviors, antenatal care attendance, delivery with a skilled attendant, early and exclusive breastfeeding, child immunization, timely care-seeking for common childhood illnesses and postpartum contraceptive use. Breakthrough RESEARCH assessed the successes and challenges of integrated SBC programming including its effectiveness and cost-effectiveness.



Cost-effectiveness Analysis

Family Planning



Pregnancy and childbirth

Routine childhood immunization

Sick child care-seeking

Couples communication


Breakthrough RESEARCH is USAID’s flagship social and behavior change (SBC) research and evaluation project to drive the generation, packaging, and use of innovative SBC research to inform programming. A six-year project (2017–2023), Breakthrough RESEARCH was led by the Population Council in collaboration with our consortium partners: Tulane University, Avenir Health, Population Reference Bureau, Institute for Reproductive Health at Georgetown University, and ideas42. Our approach is to foster collaboration and shared learning, ensure SBC programs are based in ‘what works’, elevate the impact of evidence-based SBC programs, and put evidence into practice. Breakthrough RESEARCH did this by assessing the evidence, identifying priority research questions, designing, and implementing research studies to fill evidence gaps and strengthen programs, and synthesizing and packaging evidence for use.

Within the breadth of our research portfolio, Breakthrough RESEARCH has four main project legacy areas: provider behavior change; integrated SBC; advancing SBC measurement; and costing and cost-effectiveness of SBC. For each of these legacy areas, Breakthrough RESEARCH has curated a collection of resources highlighting the state-of-the-art evidence and the tools and guidance produced by the project over the past six years to advance evidence-based SBC programming.

For more information on the other legacy areas, visit the Breakthrough RESEARCH Legacy and Learning  Series page.