Social and Behavior Change Indicator Bank for Family Planning

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.

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 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.

Indicator Types

The database also organizes the indicators based on four levels of monitoring and evaluation along the monitoring continuum (see Figure 1).

Monitoring continuum

Figure 1: Monitoring continuum

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.

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.

Potential levels of influence on family planning behaviors

Figure 2: Potential levels of influence on family planning behaviors

  • 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 would include indicators that measure recall of messages, knowledge, self-efficacy, intention, behavior, perceived social norms, and attitudes. 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.

Indicator Bank

wdt_ID Construct Indicator Indicator Type Indicator Level Additional Key Search Term(s) Potential disaggregation Potential data source(s) Calculation (if applicable)
1 Support of FP collaboration and coordination Number of meetings that foster technical FP coordination and collaboration between country partners Output Policy and environment process None Program records
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 process By type of materials (e.g., print, billboard, mobile application) Program records
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 process By geographic area and type of material (e.g., print, billboard, mobile application) Program records
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 mass media, broadcasting, process By radio or television Program records
5 Dissemination of FP mass media messages Percentage of FP broadcasts aired at the requested time Output Community mass media, television, radio, process 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
6 Implementation of SBC FP interventions Number of SBC interventions implemented to support or improve FP services Output Community; Health service delivery process None Tacit knowledge of implementing staff
7 Community-level FP activities Number of community-level activities for FP conducted in project sites Output Community process By geographic area, type of activity (e.g., community dialogues, support groups, commodity distribution, household visits, mobile clinics) Program records
8 FP provider training Number of service providers trained in interpersonal communication for FP counseling Reach-coverage Health service delivery provider counseling, provider-client communication By type of provider (community- or facility-based), sex Program records
9 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
10 Dissemination of FP communication materials to service providers Number of service providers who received FP communication materials Reach-Coverage Health service delivery By geographic area, type of provider (community- vs. facility-based), type of materials (e.g., print, billboard, mobile application) Program records

*These indicators may measure change at either the individual or community level depending on the intended audience. If the indicator measures change among the primary intended audience (e.g., women of reproductive age, adolescent females), then the indicator represents change at the individual level. At the same time, if the indicator measures change among a secondary intended audience (e.g., religious leaders, mothers-in-law), then the indicator represents change at the community level.

Comments or Questions?

Comments and questions on the indicator bank should be sent to Dr. Tilly Gurman (tgurman@jhu.edu), Breakthrough ACTION Senior Research and Evaluation Officer, Johns Hopkins Center for Communication Programs.

References

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.