Having a great visual aid is something we all strive for, but there is also a danger of assuming the visual aid will speak for itself. There is another component in there which is the facilitator – or the one who carries the message. The way in which the facilitator USES the visual aid is in fact a great predictor of whether or not your program will succeed in changing behaviors. Today I will be sharing a method that FH is using to try to standardize how our visual aids are used. It’s a method we are still in the process of perfecting, but I’m sharing it in this forum to generate discussion and ways in which we can learn from each other.
Some backgroundIn 1999/2000 there was a series of evaluations that began to turn our attention towards not only the message, but the transmission of the message. FH took a focused look at the way we were teaching others in our health and ag programs in several countries.And what we discovered was that although there was an input of technical information, it was not being presented in a way to brings about behavior change.
Following these reports, FH hired staff to focus on material development with the intention of not only providing technical information, but doing so in a manner that encourages behavior change.Integrating what we know about behavior change, what we know about persuasion theory and adult learning to make the transmission of the messages effective.
We began using the “cues for action” in 2008 – beginning with the acronym ASPIRE and acrostic. Keep in mind all of our materials are used for small groups of 8-12 women using a flipchart. At our training in DRC, the women developed a song to help them remember the steps.We attempted in Burundi to use six words beginning with “G’s”- the six G’s ended up to be 4G and 2 K’s.
All of these steps are based upon principles of adult education and non-formal participatory learning. The A is like a LRNA (Learning Resource Needs Assessment) for the facilitator. At the start of each lesson, he opens up the discussion to hear what women are currently practicing related to the topic of today’s lesson. [Also that same as me giving a survey to find out what CORE members are doing prior to giving this session). Adult Learning theory as discussed by Jane Vella, who in turn was inspired by adult educators such as Malcolm Knowles and Paulo Freire. 20/40/80 Learners remember more when visuals are used to support the verbal presentation and best when they practice the new skill. We remember 20 percent of what we hear, 40 percent of what we hear and see, and 80 percent of what we hear, see and do.
Behavior Change theory – at least if you follow the Prochaske and DiClimente model of behavior change says that people change in stages – everyone is not at the stage of action at the moment that they sit down to hear a new message. And one of the responsibilities of a change agent – which we consider our community health workers to be – is to help others walk through the process of change overcoming barriers along the way. Finally for those of you who have heard any of Tom Davis’ presentations on persuasion, we know that people who make verbal commitments in public are more likely to remember the commitment, believe what that the practice is important and follow through on that action.
For our care groups, each Leader Mother has a flipchart. And the back of the flipchart pages as you can see there are small icons which we use as cues to help non-literate mothers follow along the steps.
The Lesson Plan was written for our trainer of trainers who are able to read and write. The lesson plans, however, also repeat the same images to help them follow along the lesson plan with the flipchart.The lesson plan includes additional information and background not written on the flipchart.
However, we discovered that the one word descriptions – ASK, SHOW, PROBE, INFORM – were changing in meaning in the translation process. In Mozambique, they translated Request commitments as Reminder – and in turn mothers were reviewing key messages.Examine commitments (the last step in ASPIRE) was translated as review – so mothers were reviewing the lesson again. Since that time, we have moved away from the key words. Also removing the word ASPIRE slowly from materials – because it simply increases confusion when it is translated into other languages. Also moving from six to four steps – combining similar steps to simplify the process. Also, need to revise and pre-test images well - Burundi
Monitoring Tool to Verify Proper Use of Participatory Cues (QIVC)
MCH Curricula: Strategies for Developing Materials_Hanold_5.11.11
Facilitation Cues for Effective BCC<br />Mitzi Hanold, MPH<br />Food for the Hungry<br />Training and Curriculum Specialist<br />
The Need Health / Ag Program Review<br />Technical Messages are repeated and known but have not led to change. <br />Root causes not addressed (beliefs, attitudes and current behaviors). <br />No verification / understanding of messages<br />Too many messages are given at once <br />Not presenting information in logical manner<br />
Action Steps<br />Hiring staff to devote to materials.<br />Development of standard guides for all trainers including the following:<br />Integration of behavior change theory<br />Integration of formative research<br />Integration of non-formal participatory methods:<br />
Beginnings ~ Facilitation Cues<br />FH begins using APSIRE (2008)<br />Ask about current practices <br />Show / introduce the new skills and practices<br />Probe about barriers to the new practices<br />Inform participants of ways to overcome these barriers <br />Request a verbal commitment in front of others<br />Examine previous commitments.<br />Small icons are used to remind low literate trainers of each step.<br />
Research behind ASPIRE<br />Ask about Current Behaviors<br />Baseline / Needs Assessment (LRNA)<br />Building on Knowledge and Experience of the participants (Adult Learning Theory) <br />Sharing Key Messages<br />Including verbal as well as activities <br />20/40/80 Rule Adult Learning Theory<br />
Research behind ASPIRE<br />Probing for barriers and helping them to overcome these barriers<br />Helping them at the current stage of change (Prochaskeand DiClemente’s)<br />Motivational Interviewing techniques of rolling with resistance – reframing<br />Requesting small, doable actions (commitments) and following up on previous commitments<br />Principles of Persuasion: Commitment and Consistency<br />Small success lead to increased self efficacy<br />Builds accountability<br />
Cues for Action (1)<br />Ask about current behaviors Share the meaning of each picture<br />
Cues for Action (2)<br />Discuss Barriers Request a Commitment<br />
Adaptation of Cues<br />Key words to short phrases<br />Remove “ASPIRE” from all materials.<br />Combine similar steps to simplify<br />Plan for regular refresher trainings<br />Ask about Current Behaviors<br />Explain Meaning of Each Picture<br />Discuss Barriers<br />Request Commitments<br />
QIVC – Checks and Balances<br />Adding facilitation cues to the supervision tool.<br />Did the facilitator ask about current behaviors?<br />Did the facilitator explain the meaning of each picture correctly?<br />Did the facilitator ask the women about barriers to the new behaviors?<br />
Take Away Message<br />Don’t assume visual aids are “enough”<br />Provide guidance documents to help facilitators facilitate change<br />Add a system of checks and balances <br />
Resources:<br />Visit the care group website for more information:<br />care groups<br />FH materials<br />to access QIVC s<br />http://www.caregroupinfo.org<br />http://www.caregroupinfo.org/docs/QIVC_Files.zip<br />