Social and Behavior Change Indicator Bank for Family Planning and Service Delivery
This family planning (FP) indicator bank is a collection of sample indicators specifically for use in social and behavior change (SBC) programs. SBC indicators for FP are often not standardized, making it difficult for smaller implementing partners to identify indicators as well as limiting cross-project and cross-country comparison of data. The purpose of this bank is to provide illustrative quality indicators specifically for global programs using SBC approaches to address FP challenges.
This indicator bank was developed using a consultative process with Breakthrough ACTION key implementing partners. This indicator bank builds on well-known indicator sources such as MEASURE Evaluation’s Family Planning and Reproductive Health (FP/RH) Indicators Database as well as from Performance Monitoring and Accountability (PMA) 2020’s recommended FP indicators. This indicator bank includes modified versions of indicators from these banks as well as additional novel indicators. Indicators should be adapted to local programmatic and cultural contexts, as necessary.
This indicator bank includes a subset of SBC indicators for service delivery. The purpose of this subset of indicators is to standardize the ways that implementers measure their SBC for service delivery activities. The majority of the service delivery indicators are for FP programs. However, the bank also includes some general SBC indicators that could be used for other types of programs. The service delivery indicators aggregate existing, validated monitoring and evaluation indicators.
How to Use this Bank
While the bank provides useful indicators for monitoring and evaluating SBC FP activities, it is not an exhaustive list. In addition, the bank includes more indicators than programs will find feasible or helpful to measure. As a result, users of the bank should select the indicators that align best with their program. Users can sort indicators by different criteria, including service delivery, and download indicators of interest. Indicators can be sorted by type; they are also searchable by key terms such as “gender” and “provider-client communication.”
Potential data sources are provided for each indicator. A data collection method should be selected based on the level of funding available to the SBC program, the capacity of data collection staff, time and what inferences or questions need to be made. For example, while client exit interviews may be a great way to monitor an SBC intervention and see if health provider counseling activities are working, it will not allow a program to generalize about the entire population living in a health clinic’s catchment area. When using these indicators, consider what data collection method best suits a program’s needs and realistically aligns with available resources and constraints.
Users of the bank should also consider that when measuring indicators focused on modern FP methods using quantitative surveys, the relevant indicator represents a composite comprised of a battery of questions specific to each individual method. Although this approach requires a greater number of questions and may increase the burden to participants, it is important to avoid a single question with jargon such as “modern contraception” that survey participants may not know. If asking a battery of questions is too burdensome, then a more generic question about FP methods, in general, may be more appropriate, losing its specificity to modern methods but more reliable and valid in the resulting data.
The database also organizes the indicators based on four levels of monitoring and evaluation along the monitoring continuum (see Figure 1).
Outputs are defined as the activities, products or services developed by the program. Outputs reflect the efforts made by the program to influence the intended audience. An example of an SBC program with community-based activities might include the number of facilitators trained to lead community-level sessions for youth in the community.
Reach and coverage are the percentage and number, respectively, of the intended population that has received, participated in, benefited from or have been exposed to the program activities. Coverage primarily refers to the number of people “covered” by the program activities. Reach refers to the percentage of the population exposed to the program and requires structured interviews like surveys.
Intermediate outcomes are “behavioral predictors” or antecedents of behavior. At the individual level, intermediate outcomes may include factors such as knowledge, attitudes, intention, self-efficacy, and so forth. At the community level, they may include leadership and participation. Indicators measuring intermediate outcomes require some type of structured interview.
Behavioral outcomes are the specific actions ideally taken by an intended audience. These outcomes refer to actual changes in behavior that are measurable (e.g., the use of FP methods). Positive behavioral outcomes such as spacing births may ultimately lead to improved maternal and child health outcomes. Behavioral outcomes are generally measured through structured interviews or surveys, but there are indirect methods such as clinic attendance records or product sales that can serve as proxies for behavior. The service delivery indicators are broken down by provider behavioral outcomes and client behavioral outcomes.
Levels of Indicator Measurement
This indicator bank groups indicators by four levels of the social-ecological framework — individual, community, health services delivery and policy and environment (see Figure 2). This is in recognition that there may be multiple influences on whether an individual performs a specific health behavior, such as interactions they may have with their partner or service provider, norms in their community, and national policies (Sallis, Owen, & Fisher, 2008; Storey and Figueroa, 2012). Addressing such influences across multiple levels can make SBC interventions more effective. Program indicators may be measured at multiple levels as well, although many are typically measured at the individual level to approximate constructs at interpersonal or community levels.
- Policy and environment – Indicators at this level monitor political will, policy changes, national coalition-building, and resource allocation that create opportunities for communities and individuals to live healthy lives.
- Health service delivery– Indicators at this level monitor the behavior of health service delivery teams in terms of their use of SBC materials.
- Community – Indicators that monitor community mobilization efforts typically fall at the community level. These include indicators about participation in community events and the role of community leaders.
- Individual – Indicators that monitor change at the individual level include those that measure recall of messages, knowledge, self-efficacy, intention, behavior, perceived social norms, and attitudes for clients and providers. They also include proxy indicators for the health service delivery and community levels such as perceptions of health provider communication and competence or perceptions of community social norms.
SBC for Service Delivery
SBC for service delivery refers to using SBC processes and techniques to motivate and increase uptake and/or maintenance of health service-related behaviors among intended audiences. The Circle of Care is a holistic model that shows how SBC can be applied across the service continuum—before, during, and after services—to improve health outcomes. SBC for service delivery is distinguished by its focus on service interactions: the use of SBC to motivate clients to access services (before services); to improve the client-provider interaction (during services); and to boost adherence and maintenance (after services). The concept includes considerations of social and cultural norms that impact service use (or non-use) and delivery, the physical environment in which services are delivered, and the communication that takes place between a client and provider. Users of this indicator bank should note that, while client behaviors can be influenced by service interactions, they are also influenced by factors outside of service delivery.
The Circle of Care
The Circle of Care model (see Figure 3) is a framework for understanding how SBC interventions can be used along the service delivery continuum—before, during and after services. Three key principles guide this model:
- Promoting effective coordination among SBC and service delivery partners—encourages a common understanding for program planning, message development, intervention approaches, and monitoring and evaluation
- Segmenting, prioritizing, and profiling key audiences—helps to understand the intended audience and their specific needs, values, and barriers to change
- Addressing providers as a behavior change audience—ensures providers are seen as individuals who have needs and barriers to adopting desired behaviors related to their performance.
All of the SBC for service delivery indicators in this bank are classified by stage of the Circle of Care: before, during, after, or cross-cutting. Read more about the Circle of Care.
|wdt_ID||Construct||Indicator||Indicator Type||Indicator Level||Potential disaggregation||Potential data source(s)||Calculation (if applicable)||Source web link||Circle of Care stage||Service Delivery Indicators Only||Additional Key Search Term(s)|
|1||Support of FP collaboration and coordination||Number of meetings that foster technical FP coordination and collaboration between country partners||Output||Policy and environment||None||Program records||No||process|
|2||Development of FP communication materials||Number of communication materials developed for FP in the last 12 months (or a specific reference period)||Output||Health service delivery||By type of materials (e.g., print, billboard, mobile application)||Program records||No||process|
|3||Dissemination of FP communication materials||Number of communication FP materials disseminated in the last 12 months (or a specific reference period)||Output||Community; Health service delivery||By geographic area and type of material (e.g., print, billboard, mobile application)||Program records||No||process|
|4||Dissemination of FP mass media messages||Number of times FP messages were aired on television or radio in the last 12 months (or a specific reference period)||Output||Community||By radio or television||Program records||No||mass media, broadcasting, process|
|5||Dissemination of FP mass media messages||Percentage of FP broadcasts aired at the requested time||Output||Community||By radio or television||Program records (e.g. broadcast logs)||Numerator: Number of FP broadcasts that aired at the requested time
Denominator: Total number of FP broadcasts requested to be aired at a specific time
|No||mass media, television, radio, process|
|6||Implementation of SBC FP interventions||Number of SBC interventions implemented to support or improve FP services||Output||Community; Health service delivery||None||Tacit knowledge of implementing staff||Before||Yes||process|
|7||Community-level FP activities||Number of community-level activities for FP conducted in project sites||Output||Community||By geographic area, type of activity (e.g. community dialogues, support groups, commodity distribution, household visits, mobile clinics)||Program records||No||process|
|9||FP provider training||Number of service providers trained in interpersonal communication for FP counseling||Reach-coverage||Health service delivery||By type of provider (community- or facility-based), sex||Program records||Before||Yes||provider counseling, provider-client communication|
|10||Reach of FP advocacy||Number of decision makers reached with FP advocacy activities||Reach-coverage||Policy and environment||By type of decision maker (e.g., politician, health facility administrator, religious leader)||Program records||No|
Comments or Questions?
Comments and questions on the indicator bank should be sent to Dr. Tilly Gurman (firstname.lastname@example.org), Breakthrough ACTION Senior Research and Evaluation Officer, Johns Hopkins Center for Communication Programs.
Sallis, J.F., Owen, N., Fisher, E.B. (2008). Ecological models of health behavior. In Glanz, K., Rimer, B.K., Viswanath, K. (Eds.) Health Behavior and Health Education; Theory, Research, and Practice (4th edition), (pg. 46). San Francisco, CA: Jossey-Bass. Storey, D., Figueroa, M.E. (2012). Toward a Global Theory of Health Behavior and Social Change. In R. Obregon & S. Waisbord (Ed.), The Handbook of Global Health Communication, (pp.78). West Sussex, UK: John Wiley & Sons. McLeroy, K.R., Bibeau, D., Steckler, A., Glanz K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15 (4):351-377.