Revisiting Trials of Improved Practices Methodology_J.Jennings_5.10.11

253 views
198 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
253
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Innovation in 20 communities Formative research facilitated by NicaSalud Summative research by CIES
  • KPC and FGD with volunteers baseline
  • Organization: 20 communities selected using pre-established criteria Training CS and MoH team in methodology Field work planning, development of guidelines and interview techniques Invitation to community members Field work Analysis and discussion of findings: Team compiled and analyzed the information 4 session to present the results to governmental authorities in three municipalities (major office, MoH, MoEd, Police, other organizations) 35 participants 8 sessions at community level with men, women for a total of 64 participants In all the sessions participants made recommendations about strategies could be implemented to overcome barriers
  • Chose community strategies to launch BCC strategy Selection of community volunteers to become bcc counselors 8 community sessions to validate materials Selection of strategies Development of IEC materials
  • FGD and in-depth interview with men and women
  • 25 men in three municipalities Men with pregnant women’ Men whose wives where in last two weeks of pregnancy: behavior 1,2 Anecdote about the wife didn’t want to go back and wash the baby’s clothes after one months of probing phase The husband convinced it was important to participate in the ANC came to the H/U but the doctor didn’t let him in The H/U staff brainstorming how to declare “husband friendly units”. “welcome all me who love their wives”
  • Selection of men to probe the behaviors was based on the behavior that was going to be probed. For example if the behavior is to seek ANC the man was whose wife is pregnant and didn’t have ANC or was not attending follow up sessions. Men whose wife in the third trimester of pregnancy, post partum and with newborn alive. Development of materials to record the behaviors and mark the days the behavior was practiced Home visits to negotiate the behaviors: selection of 9 behaviors to be practiced 4 times each. ( minimum 3 times, max 5 times) ssess enablers, barriers to probe the behavior Use of job aids to remind the behavior and track the days and number of time the behavior was done
  • Follow up visits to assess if the behavior was done every two weeks or monthly The counselor record the days the behavior was practiced and during the session counsel the man about the benefits, and negotiate with them to try again (in the case the man hasn’t been able to practice the behavior). If the men has achieved all the days the behavior was agreed to be practice, the counselor negotiates with him a new behavior To motivate more men, those who have achieved the tasked share with other men and familiy members the experience of practicing the behavior
  • Of the 9 behaviors 6 were probed 3 times 1 five times 2 only two times Twenty five visits were done with 25 men Anecdote about the wife didn’t want to go back and wash the baby’s clothes after one months of probing phase The husband convinced it was important to participate in the ANC came to the H/U but the doctor didn’t let him in The H/U staff brainstorming how to declare “husband friendly units”. “welcome all me who love their wives”
  • Revisiting Trials of Improved Practices Methodology_J.Jennings_5.10.11

    1. 1. <ul><li>Gender responsive programming </li></ul><ul><li>Changing men’s support to women during pregnancy, delivery, and post-partum. </li></ul><ul><li>Use of a modified TIPS methodology </li></ul><ul><li>Elena McEwan, MD </li></ul><ul><li>Senior Technical Adviser </li></ul><ul><li>Catholic Relief Services </li></ul><ul><li>Core Spring meeting, May 2011 </li></ul>
    2. 2. What is a key problem in seeking care?
    3. 3. <ul><li>Step 1 : Gather information on: </li></ul><ul><li>existing knowledge and decision-making, </li></ul><ul><li>Motivation and perceived benefits of recommended practices </li></ul><ul><li>Possible barriers to recommended practices </li></ul>Step 1 Focus Group Discussion <ul><li>14 FGD: </li></ul><ul><li>80 men with pregnant wives </li></ul><ul><li>16 men with postpartum wives. </li></ul><ul><li>16 postpartum women </li></ul><ul><li>36 men with children age 40 days to 2 yr </li></ul>Home visits with individual interviews, husband and wife 32 interviews in 16 homes with children age 0 to 40 days
    4. 4. <ul><li>Step 2 : </li></ul><ul><li>a) Debrief and analyze information </li></ul><ul><li>b) Develop community “counseling” strategies </li></ul>Step 2 We can take care of our newborn during the day and the night
    5. 5. Motivation for recommended practices <ul><li>Child will grow up to have more love for the father than is typical. </li></ul><ul><li>Newborn will be healthy and the family will save money not treating sickness. </li></ul><ul><li>Infant will grow easily and be happy. </li></ul>After work, I find time to share quality time with my family
    6. 6. Potential barriers to male supportive care practices <ul><li>Potential barriers: </li></ul><ul><li>Don’t know how to do it </li></ul><ul><li>Lack of communication with wife regarding pregnancy </li></ul><ul><li>Lack of motivation due to feeling left out by the health staff during care </li></ul><ul><li>They feel embarrassed to be seen by other women when taking care of the newborns </li></ul>
    7. 7. Developing community counseling strategies <ul><li>During pregnancy : </li></ul><ul><li>Collect firewood and water. </li></ul><ul><li>Support wife with household work </li></ul><ul><li>Go with wife during at least 3 ANC visits and </li></ul><ul><li>Ask questions during care. </li></ul><ul><li>During childbirth and delivery : </li></ul><ul><li>Find someone to take care of the house while he goes with wife to HU for delivery. </li></ul><ul><li>Assist wife to go to maternity house 2 weeks before delivery. </li></ul><ul><li>Go with wife to HU and stay in room during labor and delivery. </li></ul><ul><li>Agree with wife to stay at the maternity waiting home seven days post partum. </li></ul><ul><li>During post-partum period : </li></ul><ul><li>Alternating take care of newborn during the day and the night. </li></ul><ul><li>After work, feed other children (one snack and dinner). </li></ul>
    8. 8. <ul><li>Step 3 : </li></ul><ul><li>Negotiate </li></ul><ul><li>“ trial” practices </li></ul><ul><li>(3 men per each practice) </li></ul><ul><li>Note: Negotiation done at group level </li></ul>Step 3
    9. 9. <ul><li>Step 4 : </li></ul><ul><li>Follow up home visits to gather information on experience with trial practice: results, response, reactions </li></ul>Step 4: Results, response, reactions
    10. 10. Step 4: Gather results <ul><li>During pregnancy: </li></ul><ul><li>Collect firewood and water. </li></ul><ul><ul><ul><li>76% ( practiced at least 4 times) </li></ul></ul></ul><ul><li>Support wife with household work. </li></ul><ul><ul><ul><li>100% (practiced at least 4 times) </li></ul></ul></ul><ul><li>Go with wife during ANC visits and ask questions. </li></ul><ul><ul><ul><li>66% (practiced at least during 3 ANC visits) </li></ul></ul></ul>
    11. 11. Step 4: Gather results (continued) <ul><li>During childbirth and delivery : </li></ul><ul><li>Find someone to take care of the house while he goes with wife to HU for delivery. </li></ul><ul><ul><ul><li>80% practiced </li></ul></ul></ul><ul><li>Assist wife to go to maternity house 2 weeks before delivery. </li></ul><ul><ul><ul><li>50% practiced </li></ul></ul></ul><ul><li>Go with wife to HU and stay in room during labor and delivery. </li></ul><ul><ul><ul><li>40% practiced </li></ul></ul></ul><ul><li>Agree with wife to stay at the maternity waiting home seven days post partum. </li></ul><ul><ul><ul><li>75% practiced </li></ul></ul></ul>
    12. 12. <ul><li>During post-partum period : </li></ul><ul><li>Alternating with wife taking care of the newborn during the day and the night. </li></ul><ul><ul><ul><li>71% practiced at least 4 times </li></ul></ul></ul><ul><li>After work, feed other children (one snack and dinner). </li></ul><ul><ul><ul><li>98% practiced at least 4 times </li></ul></ul></ul>Step 4: Gather results (continued)
    13. 13. <ul><li>Step 5 : Recommendations for the program </li></ul><ul><li>Changes in recommended practices are feasible. </li></ul><ul><li>It will be possible to overcome resistance encountered. </li></ul><ul><li>It is critical to involve the Ministry of Health personnel in support of recommended practices that involve Health Units / Hospitals. </li></ul>Step 5
    14. 14. Thank you!

    ×