The following points should be covered: 1. PCI developed this concept initially based on research done prior to PROSHAR. Through its work and research it had discovered that the mother is often the least influential member of the family when it comes to decisions about caretaking, nutrition and health care seeking. This is particularly true in countries where females are married at very young ages. Hence MCH efforts that focus primarily on maternal knowledge and behavior will have limited impact. 2. Care Groups have been a powerful tool for behavioral change due to its broad dissemination approach and one-to-one communication strategy. However, it too is focuses exclusively on the knowledge and behavior of the mother. As such, its impact would be limited if we did not also address the knowledge and behaviors of the mother-in-law and the father. The mother-in-law in Bangladesh is a key influencer on child rearing practices - especially the first born child. The father is primarily in control of decisions about care seeking and is also responsible for food purchases. 3. Thus, based on our previous research and our experience with the Care Group model, we proposed an innovative adaptation to ensure we targeted all the key decision-makers in a consistent way and based on the role they play in caretaking.
It would be good to indicate the number of people involved with the process. We also need a clearer header – when were these results measured and for what purpose? Was this from the baseline barrier analysis?
We need a clearer header – when were these results measured and for what purpose? Did this come from the baseline barrier analysis??
1. We need to add a date for the baseline – when did it take place?
Care Group Trios: An Innovative Household Behavioral Change Model_Carolyn Kruger, Ph.D._4.23.13
April 23, 2013Carolyn Kruger, Ph.D.Senior Advisor MNCH, PCICARE GROUP TRIOS:AN INNOVATIVE HOUSEHOLDBEHAVIOR CHANGE MODELCOREGroupSpringMeeting2013
USAID/FFP: PROSHAR – “Program for Strengthening HouseholdAccess to Resources”, June 2010 to May 2015 ½ million beneficiaries (direct and indirect) in 23 unions of threeUpazilas Implementing partners include : ACDI/ VOCA; PCI; GOB; andthree partner NGOsPROSHAR OVERVIEW
SO1: Income and access tofood of poor and ultra poorhouseholds increasedSO2: “Health of pregnant & lactating women and children under 5(with particular attention to children under 2) improved”SO3: Institutions and householdsprepared to respond effectively toshocksIR. 2.1. Malnutrition preventedand treatedIR. 2.2. Improved effectivenessof health clinic servicesGoal of PROSHAR:Reduced Food InsecurityAmong Vulnerable RuralPopulations in SelectedUpazilas in Khulna DivisionIR. 1.2. Market linkagesdeveloped andstrengthenedIR. 1.1. Agriculturalproductivityincreased anddiversifiedIR. 1.3. Non-agricultureopportunities expanded anddiversifiedIR. 3.1. Disaster RiskReduction Plans(DRRPs) functionalIR. 3.2. Earlywarning systemfunctionalIR. 3.3 Increaseknowledge andskillsINTEGRATED PROGRAM DESIGN
PCI’s research showed mothers are often the leastinfluential in decisions about nutrition & health care Fathers & mothers-in-law have strongest influence onbehavior change; fathers dictate care seeking behaviors& mothers-in-law set child rearing practices PCI thus developed “CG trios” that involve fathers &mothers-in-law in order to sustainably change behaviorsDEVELOPMENT OF TRIO CONCEPT
WHO INFLUENCES BEHAVIORS?8%6%2%24%41%10%22%12%28%40%0%5%10%15%20%25%30%35%40%45%Husband Mother-in-law* Sister-in-law Neighbors No oneDisapproval of pregnant women consuming extra food during pregnancyNonDoersDoersTargeting influential people
55%20%33%12%0%12%61%57%31%14%10%4%0%10%20%30%40%50%60%70%SufficientbreastmilkFamily Support* Dont need extrafoodLess work load No expense* Baby doesnt cryPerceived self-efficacy:What made it easier for you to exclusively breastfeed?NonDoersDoersImproving the knowledge andresponsibility of family members on theimportance of EBF and their support of themotherWHAT INFLUENCES NUTRITION PRACTICES(E.G. EBF)?
Each Care Group Trio consists of 12 leaders each. Mother CGs meetmonthly. Grandmothers & Father CGs will meet every three months with themother CGs.(162 Care Group Trios total)Each paid promoteroverseesapproximately 10Care Group Trios(12 promoters total)Each supervisoroverseesapproximately threepaid promoters(4 supervisors total)SupervisorPromoterGrandmothersMothers FathersPromoterPromoterPROSHAR TRIO CARE GROUP APPROACHEach leader will meet with approximately 14 peers regularly(monthly/mothers & quarterly/fathers & grandmothers) reaching81,648 HH decision-makers
CG TRIOS MEETINGCare Group(MotherLeaders)• Mother leaders (ML) meet 2x/month• Health promoter (HP) meets with MLs 2x/month; MLs organize meeting with theirgroups the following week• Flipchart with specific health & nutrition messages usedCare Group(Grand MotherLeaders)• Grandmother leaders (GmLs) meet 1x/month• HP meets with GmLs in the first month of the quarter; GmLs meet with their groups in thefollowing two months• Flash card set is used with specific health & nutrition messagesCare Group(FatherLeaders)• Father leaders (FLs) meet 1x every two months• HP meets with the FL 1x/month; FLs meets with their groups in the following two months• Flash card set is used with specific messagesCare Group(Triosmeeting)• Every quarter HP meets with the three leader groups together• Objectives are to discuss: CG activity status; challenges; success stories; lessons learned andplans for addressing challenges
Building capacity of MLs to counsel CG participantsusing ASPIRE(ask, show, probe, inform, request, examine) – needpractice! ML uses specific CG monitoring tools – picturechecklist, registration Weak MLs are targeted for intensive one-on-onecounseling by HPs High performing CGs & families are recognized toencourage optimal behaviors at household level Fathers need flexible meeting times that don’t interferewith work scheduleTRIO IMPLEMENTATION
1. The Trio Care Group approach is a “promising practice” that makes adifference in changing behaviors among pregnant women.2. CG Trios overall have had a high level of participation (even for fathersand grandmothers who have greater participation challenges).3. Focus on household and community behavior change, not justcommunication messages.4. The three groups have different roles in the family and community –discuss and demonstrate how their roles can influence change.5. Promote the Trio groups as change agents, not just messengers.6. Provide pictures of desired mother, father, grandmother desiredbehaviors and focus on “why the behavior is healthy”.7. Promote home visits to promote healthy behavior change and focus on“why the behavior is healthy”.8. Groups should meet together to identify barriers to change, to problemsolve for solutions and to be accountable for change in their familiesand communities.LESSONS LEARNED TO DATE