MCH Curricula: Strategies for Developing Materials_Racine_5.11.11


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  • Process for determining a target group’s reaction to and understanding of messages or information before materials are finalized Goal is to ensure the materials convey information in a way audience members endorse During pretesting, members of the target group are asked to react to d raft materials. Their responses are analyzed, then the materials are revised. Pretesting may be conducted several times before final materials are produced. If people do not understand the materials, or do not like them or do not know how to use them the message is lost. It is easier to change materials before they are finalized than to find out that the materials are inappropriate after a large investment of time and expense.
  • Print materials (brochures, posters, flyers) Job aids (counseling cards, tools) – for job aids, it is important to test with both health workers and the clients they will use the materials with Training curricula Logos Songs Games Radio programs
  • Pretesting lets you know if your messages and materials are appropriate. It helps ensure that your materials contain understandable language, appropriate illustrations and effective messages. Pretesting with your target group can tell you whether the language, pictures, music and messages in your materials are: Understandable – both the content and how the content is presented; not too many messages; text can be read easily Relevant – the target audience thinks the message or information is for them; they can identify with the materials Culturally appropriate Believable and realistic Acceptable to the audience Visually appealing – catches the target audience’s attention Informative Motivating – encourage people to act (do the desired behavior)
  • Pretesting can save the project money and time by assuring that the target group understands materials and responds favorably to the messages. Correcting controversial or ineffective materials after they have been produced is very expensive and time-consuming. The number of people may vary according to your situation. However, in many cases ten to twenty individual interviews will give you adequate information. If you are using the focus group discussion method, two to four focus groups with eight to ten people will probably give you enough feedback. Use convenience sample to identify target audience Focus group discussion or individual interviews 10-20 individual interviews or Two-four focus groups with 8-10 people For training curricula you can conduct a TOT and incorporate participants’ feedback. This also helps for participants to feel like part of the process and create a sense of ownership.
  • These two publications, which are both available online, provide step-by-step guidance for conducting pretests. They include sample interview and focus group discussion guides and instructions and forms to help with analysis. While both were developed for HIV/AIDS projects the content can be used with maternal and child health programs.
  • After 2008 hurricanes USAID mission in Haiti requested IYCN provide TA to Ministry of Health and MSH and partners to…
  • 2009 IYCN completes qualitative research on infant and young child feeding practices (IYCF) 1) complement other research, 2) guide IYCN’s next steps in supporting the improvement of nutrition in Haiti.
  • -A cost-related decision. -Pretest images and layout only with mothers and grandmothers
  • -Controversial/new information, complicated) *Used cards during counseling sessions 1 week prior pretest for feedback Team leader conducted KIGs with health care workers in each one of three communities
  • -(mothers, or grandmothers, or community health agents) -Cards 7, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 24, 25, 26, 28.
  • Pretesting conducted in two different sessions with different participants. Each team responsible for 4 focus groups and 2 key informant groups.
  • Cards A and B pretested in one community with one audience. Cards C and D pretested with a second audience. Cards E and F with a third audience.
  • -(assisted in note taking) -Introduction to IYCF materials linked to IYCF norms in Haiti. Review each counseling card - Pretesting protocol, including methodology (methods, tools, participants) training team, coordination of pretesting exercise, conduct KIGs with health workers
  • Containing key messages related to national norms.
  • -Keeps discussions under 2 hours, allows all images to be pretested with all audiences
  • MCH Curricula: Strategies for Developing Materials_Racine_5.11.11

    1. 1. May 11, 2011 Pretesting infant and young child feeding counseling cards in Haiti Nicole Racine Infant & Young Child Nutrition (IYCN) Project
    2. 2. Pretesting <ul><li>Determine target group’s reaction to messages or information before materials are finalized. </li></ul><ul><li>Ensure the materials convey information in a way audience members endorse. </li></ul>Photo: Mike Wang/PATH
    3. 3. All products benefit from pretesting
    4. 4. Why pretest? <ul><li>Understandable </li></ul><ul><li>Relevant </li></ul><ul><li>Culturally appropriate </li></ul><ul><li>Believable and realistic </li></ul><ul><li>Acceptable to the audience </li></ul><ul><li>Visually appealing </li></ul><ul><li>Informative </li></ul><ul><li>Motivating </li></ul>Photo: MOHSW Lesotho
    5. 5. Pretesting doesn’t need to be complicated and time consuming <ul><li>Convenience sample. </li></ul><ul><li>10-20 individual interviews. </li></ul><ul><li>Two to four focus groups with 8-10 people. </li></ul>Photo: Faith Thuita/PATH
    6. 6. Tools Available from
    7. 7. IYCN objectives in Haiti <ul><li>Strengthen community health agents’ (CHA) activities to prevent malnutrition in hurricane-affected areas. </li></ul><ul><li>Strengthen community-based nutritional support to families with children under two. </li></ul><ul><li>Improve programs, develop an infant and young child feeding training update for CHAs, and create job aids. </li></ul>Photo: Nicole Racine
    8. 8. Feeding problems to address <ul><li>Low rate of exclusive breastfeeding. </li></ul><ul><li>Timing of introduction of complementary feeding. </li></ul><ul><li>Poor quality and type of food introduced. </li></ul><ul><li>Influence of grandmothers and others. </li></ul><ul><li>Hygiene. </li></ul>Photo: Nicole Racine
    9. 9. <ul><li>Primary audiences: Mothers of infants under two, health care workers, community health agents. </li></ul><ul><li>Secondary audiences: Grandmothers, children under two. </li></ul><ul><li>Selected communities: 1 urban site, 1 semi-urban site, 1 rural site. </li></ul>Methodology Photo: Nicole Racine
    10. 10. Methodology <ul><li>Focus group discussion (8-12 participants) </li></ul><ul><ul><li>Pretest images and layout only with mothers and grandmothers. </li></ul></ul><ul><li>Key informant group (4-5 participants) </li></ul><ul><ul><li>Pretest images, layout, and key messages. </li></ul></ul><ul><ul><li>CHAs: same cards as focus group discussion. </li></ul></ul><ul><ul><li>Health care workers: more in-depth guide for selected cards. </li></ul></ul>
    11. 11. Rationale for sampling plan and site selection for pretesting <ul><li>Mothers, CHAs, and grandmothers </li></ul><ul><ul><li>Nine “complicated” cards pretested with all. </li></ul></ul><ul><ul><li>Twenty-one others with only one of the audiences in each community. </li></ul></ul><ul><li>Health care workers </li></ul><ul><ul><li>Seventeen cards discussed in more depth. </li></ul></ul>
    12. 12. Pretesting plan Methodology Set pretested URBAN Set pretested PERI-URBAN Set pretested RURAL DAY 1 Morning 1 FGD (mothers) A C E Afternoon 1 FGD (mothers) B D F DAY 2 Morning 1 KIG (community health agents) C E A Afternoon 1 KIG (community health agents) D F B DAY 3 Morning 1 FGD (grandmothers) E A C Afternoon 1 FGD (grandmothers) F B D
    13. 13. Separating the images SET Card #, pretested in only one group Card #, pretested in all groups A 1, 4, 7, 10, 13 6, 11, 12 B 16, 19, 22, 25, 28 24, 26, 27 C 2, 5, 8, 11, 14 6, 12, 19 D 17, 20, 23, 26, 29 22, 24, 25, 27 E 3, 6, 9, 12, 15 11, 19, 22 F 18, 21, 24, 27, 30, cover, positive counseling card 25, 26
    14. 14. Selection and training of research team <ul><li>Facilitator/moderator, note taker, ministry person as observer. </li></ul><ul><li>Experienced researchers selected. </li></ul><ul><li>One-day training session. </li></ul><ul><li>Team leader. </li></ul>Photo: Nicole Racine
    15. 15. Realistic images
    16. 16. Understandable
    17. 17. Avoiding confusion
    18. 18. Incorporating stakeholder feedback
    19. 19. Successful collaborations <ul><li>Developed consensus with the Ministry of Health to produce a single set of Creole-language IYCF counseling cards. </li></ul><ul><li>Involving the Ministry early on in all activities was key. </li></ul>Photo: UNICEF
    20. 20. Challenges <ul><li>Enhancing CHA activities to better address major behavioral barriers, prioritize prevention activities. </li></ul><ul><li>Turnover of trained personnel. </li></ul><ul><li>CHA task shifting. </li></ul><ul><li>Involving other community agents. </li></ul><ul><li>Identifying other sources for printing of additional counseling cards. </li></ul>
    21. 21. Lessons learned <ul><li>Separating images is a good practice. </li></ul><ul><li>Visit each site and recruit focus group participants ahead of time. </li></ul><ul><li>Review notes with research team following each group discussion. </li></ul>Photo: Ludmillo Pierre
    22. 22. Thank you Photo: Nicole Racine Please visit