Breakthrough ACTION and USAID Advancing Nutrition partnered with communities in Kebbi State, Nigeria to think about ways to develop tools to help community health workers (CHWs) practice compassionate counseling on nutrition. Using a human-centered design approach, the two projects worked with CHWs to develop tools that are easy to use and that help build trusted connections with caregivers and their families.

The design process for these tools began with research with CHWs, caregivers, family members, and community members to better understand child feeding challenges from their perspectives. With these insights, the projects carried out an iterative design and testing process, which resulted in a set of simple tools that transform the way CHWs interact with caregivers and fellow community members around nutrition.

Nourishing Connections, the new CHW job aid, has four linked components:

  1. Empathways: Creates an empathic counseling session that shifts the experience of care so caregivers feel confident communicating their needs and trust CHW advice.
  2. Assessment: Offers questions to help CHWs and caregivers understand the current situation.
  3. Counseling Flow: Enables CHWs to focus actively on one or two topics most relevant for the caregiver at that time.
  4. Action Plan: Asks caregivers to identify specific steps they will take between counseling sessions.

The first component, Empathways, is a simple, but effective opening inspired by the Breakthrough ACTION Empathways card-based activity and Sharing Histories, a CHW learning/teaching strategy. These approaches found that when the CHW and caregiver shared some personal information that was not about the immediate issue, they began to build trust and connections. Sharing personal information also helped reduce the power imbalance between the perceived expert and the person being counseled, which further fostered compassionate care.

The use of the Empathways technique in Nigeria yielded an immediate change:

“That was the first time I was asked something during the session, and that is the first session that I think I will remember what was said.” Caregiver

“It has never been so easy to talk to them. In fact, they talked a lot.”  CHW

“This tool made my session faster because I know what I have to talk to them about. This is by far my favorite tool”. —CHW

The Nourishing Connections job aid includes the following interactive and engaging supporting tools for home visits and community activities: a price comparison, trivia, and card game. Nutrition programs can test any of these game-changing elements in their own activities. Although the tools were designed in Nigeria, Breakthrough ACTION and USAID Advancing Nutrition developed them with global adaptation in mind and encourage such adaptation.