Revisiting Trials of Improved Practices Methodology_Del Rosso_5.10.11
Trials of Improved Practices (TIPs)CORE Group Spring MeetingJoy Miller Del RossoThe Manoff GroupMay 10, 2011
About TIPS True/FalseTIPS is a relatively new qualitative research techniqueTIPs is a stand-alone formative research techniqueThe concept of TIPs was drawn from commercial marketresearchTIPs is a technique that can be implemented by almostanyoneTIPs should always be implemented through a series of threehousehold visitsThe “results” obtained through the TIPs trials are highlypredictive of actual behavior change
Pre-launch consumer market product research › “will people in the market buy/use it?” Behavioral psychology—motivators and barriers to changing behaviors › what are the factors that have helped facilitate practicing a behavior and what are the factors that make a behavior difficult to do?
Understand the behavior in natural context Participants have specialized knowledge of what works best for them Research is a negotiation between investigator and participant People asked to change their behaviors should have a say in what that behavior is
Indonesia Nutrition Communication and Behavior Change Project (1979) › Researchers visited homes to conduct in- depth, open-ended interviews with mothers › Reached agreement with mothers on what dietary changes would improve her child’s nutrient intake—based on dietary recall outcomes and age of the child › Researchers returned in a week to see if the mother had tried out the practice, modified it and if she liked it, etc.
Trying potential program actions before part of program Learning in advance if lack of resources was a significant limitation Providing opportunity to offer suggestions based on something concrete/participants had actually tried rather than something hypothetical
TIPs for Nutrition Situational Analysis TIPS Focus Group Discussion In-Depth Interviews other formative research Determine Test Design Behavioral Feasible Behavioral Priorities Behaviors StrategyIssue/ IdentifyProblem “Ideal” Behaviors or Essential Nutrition Actions Implementation
Compliance TIPs: basic practices or products have been determined and TIPs identifies ways to facilitate series of behaviors Negotiation TIPs: mainly used in maternal and infant feeding—identifies best choices among a number of different actions that could yield nutrition benefits
Problem: Pregnant women were not taking their iron pills TIPS Learning: Remembering to take an iron pill every day was an unanticipated problem Strategy: Needed to come up with way to remind women to take their pills
Problem: Program was promoting consumption of dark green leafy vegetables and trying to convince mothers that young children could digest them. TIPs Learning: Mothers were only concerned about digestibility for children 5-12 months. The main barrier for mothers; they thought children did not like dark green leafy vegetables. Strategy: Identify and promote ways to make dark green leafy vegetables more appetizing.
Problem: None of the children in the TIPs trial from 6-23 months had adequate calorie intake. TIPs Learning: Almost all of the mothers rejected the advice to make complementary food thicker. But almost all of the mothers accepted the idea of adding a little palm oil, ground nuts or other nutrient- dense food; this had same nutritional benefit. Strategy: Change the message
Initial Visit Counseling Visit Follow-up Visit (Day 1) (Day 2) (Day 6-10)Background Feedback on Changes since last visitinformation practices 24-hour recallFeeding practices Recommendations Outcome and response24-hour recall and initial response to trialFood frequency (of Negotiation and Modificationsother regularly motivation Adoption of practiceconsumed foods) Discussion with others, if needed Agreement on specific practices to try
Ensures participant group input in program planning Focuses on behaviors, not just knowledge and on the program, not just research Allows determination of feasible (not ideal) behaviors Ability to make much more specific recommendations
Preliminary technically acceptable solutions to problems Understanding of current problems to help guide technically appropriate responses Length of trial must match nature of behaviors to be changed Able household researchers—capacity to negotiate
About TIPS True/FalseTIPS is a relatively new qualitative research technique FTIPs is a stand-alone formative research technique FThe concept of TIPs was drawn from commercial market TresearchTIPs is a technique that can be implemented by almost FanyoneTIPs should always be implemented through a series of three Fhousehold visitsThe “results” obtained through the TIPs trials are highly Tpredictive of actual behavior change