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UNICEF EASTERN AND SOUTHERN AFRICA REGIONAL OFFICE
Measuring Results
in Social and Behaviour Change
Communication Programming
October 2020
Measuring Results in Social and Behaviour Change Communication Programming
Table of contents
Acronyms and abbreviations i
1 Introduction 1
2 Understanding Social and Behaviour Change communication 3
2.1 The Behavioural Drivers Model 3
2.2 The Journey to Health and Immunization 5
3 Result based management 13
3.1 Context and situation analysis 13
3.2 Causal analysis 14
3.3 Prioritization 15
3.4 Definition of priority results 15
3.5 How to formulate SBCC results and indicators: 18
3.5.1 Impact-level results and indicators 19
3.5.2 Outcome-level SBCC results and indicators 19
3.5.3 Intermediate outcome-level SBCC results and indicators 21
3.5.4 Output-level SBCC indicators 22
4 How to use the indicator lists 25
5 Appendices 29
5.1 Appendix 1: Definitions of behavioural determinants 29
5.1.1 Psychological drivers 29
5.1.2 Sociological drivers 37
5.1.3 Environmental drivers 40
5.2 Appendix 2: Exhaustive list of SBCC indicators 43
Cover Photo: © UNICEF/UN036248/Rich
i
Acronyms and abbreviations
AEFI Adverse Effects Following Immunization
ANC Antenatal care
BDM Behavioural Drivers Model
BI Behavioural Insights
C4D Communication for development
DHS Demographic and Health Surveys
EMIS Education Management Information System
EPI Expanded Programme on Immunization
ESA Eastern and Southern Africa
ESAR Eastern and Southern Africa Region
ESARO Eastern and Southern Africa Regional Office
FGM/C Female Genital Mutilation / Cutting
HCD Human-Centered Design
IDP Internally Displaced Persons
KAP Knowledge, Attitude, Practice
MENA Middle East and Northern Africa
MICS Multiple Indicator Cluster Surveys
MoRES Monitoring Results Equity System
RBM Result-based management
SBCC Social and Behaviour Change Communication
SEM Socio-Ecological Model
SitAn Situation Analysis
SMART Strategic, Measurable, Achievable, Relevant, Time-bound
SMARTER Strategic, Measurable, Aligned, Realistic, Transformative, Empowering, Reportable
ToC Theory of Change
TT Tetanus toxoid
Measuring Results in Social and Behaviour Change Communication Programming
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Measuring Results in Social and Behaviour Change Communication Programming
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©
UNICEF/UN0162343/Tremeau
1
1 Introduction
The purpose of this document is to provide some basic guidelines for the measurement of results associated
with Social and Behavioural Change Communication (SBCC) programming. In fact, both the 2016 Global C4D
Evaluation1
and the 2019 Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern
and Southern Africa Region (ESAR)2
stressed that having clearly articulated results in both Communication
for Development (C4D) and sectors’ strategic plans and frameworks remains one of the main SBCC-related
challenges.
While most Eastern and Southern African (ESA) countries have formulated indicators in their SBCC3
strategies,
there is often a disconnect between the level of change formulated in the result statement and the indicators
identified to capture the change: “As currently formulated, the indicators can only measure progress at activity
level, but cannot capture change at output or outcome-level to reflect progress in knowledge, attitudes, intent and/
or skills that would support the adoption of targeted practices.
”4
Monitoring is a key component of Result-Based Management (RBM), and provides an opportunity to track the
implementation status, to collect evidence of change (or the lack thereof) and to measure the quality of the results
of an initiative, project or programme. Monitoring allows managers to adjust interventions continuously and to
improve results through an iterative process supported by credible, evidence-based information.
Therefore, as part of the session of the 2019 ESAR UNICEF Deputy Representatives’ meeting regarding the Focus
on communication for development to accelerate shifts in social norms, behaviours and practices, it was decided
to design an Eastern and Southern Africa Regional Results-Based Management framework with an integrated
SBCC component. The present document intends to provide guidance for measuring SBCC results by taking the
most recently available UNICEF SBCC guidance documents into consideration, such as the Behavioural Drivers
Model (BDM), the social norms programming guide Everybody wants to belong, and the Journey to Health and
Immunisation framework.5
The intended audience for these guidelines is UNICEF Country Offices’ C4D programme sector and monitoring
and evaluation staff who are active in the design and implementation of the country’s programme cycle, state and
non-state partners involved in the design and implementation of SBCC programmes, and those involved in the
monitoring and evaluation of SBCC interventions.
The Measuring Results in Social and Behaviour Change Communization Programming document was developed
by Dominique Thaly, international C4D consultant recruited by UNICEF ESARO and reviewed by Natalie Fol, Helena
Ballester Bon and Massimiliano Sani from the ESARO C4D team.
1 UNICEF (2016), Communication for Development: An evaluation of UNICEF’s Capacity and Action. September 2016. Evaluation office.
2 UNICEF ESARO (2019), Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern and Southern Africa Region.
3 SBCC will be used in place of C4D when not referencing specific UNICEF C4D staff and interventions
4 UNICEF ESARO (2019), Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern and Southern Africa Region.
5 UNICEF (2019), Everybody wants to Belong. A practical guide to tackling and leveraging social norms in behaviour change programming.
UNICEF / Petit, V. (2019), The behavioural drivers model: A conceptual Framework for Social and Behaviour Change Programming. UNICEF
(2019), Draft C4D Programming Guidance. UNICEF (2018), The Journey to Health and Immunization Framework.
Measuring Results in Social and Behaviour Change Communication Programming
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Measuring Results in Social and Behaviour Change Communication Programming
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UNICEF/UN056980/Ose
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2 Understanding Social
and Behaviour Change
Communication
2.1 The Behavioural Drivers Model
Evidence show that providing individuals with the right information will rarely automatically translate into optimal
choice. People are highly emotional and influenced by their environment, by those who matter to them, and by
others they interact with. What is happening around a person matters as much as what she thinks herself (Petit,
V., BDM 2019). Therefore, SBCC strategies and interventions that focus merely on increasing the participant’s
knowledge and awareness of certain practices tend not to be effective if not complemented with other
interventions.
To bring multiple perspectives on decision-making and behavioural theories and models together, UNICEF has
developed the Behavioural Drivers Model (BDM). The BDM starts by asking the fundamental question: Why do
people do what they do? According to this model, all behavioural drivers fall into three main categories:
1. Psychology, gathering individual cognitive and emotional drivers;
2. Sociology, for determinants related to interactions within families, communities, groups and society at large;
3. Environment, for structural elements such as institutions, policies, systems and services, infrastructures,
information, etc.
Figure 1:The Behavioural Drivers Model (Petit,V. BDM 2019)
6 For definitions of factors and dimensions, see Petit, V. BDM 2019.
Under each category, the drivers are organized according to two levels of depth:6
- Level 1 drivers: the higher-level or main drivers, which are called factors;
- Level 2 drivers: each factor is unpacked into several dimensions of which it is composed.
What drives a behaviour?
PSYCHOLOGY SOCIOLOGY ENVIRONMENT
Measuring Results in Social and Behaviour Change Communication Programming
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Figure 2: Main behavioural factors and corresponding dimensions (level 1 drivers) (Petit,V. BDM 2019)
Table 1: Dimensions composing each main driver. (UNICEF 2019, Everybody wants to belong)
Factors (Level 1) Dimensions (Level 2)
Personal characteristics Age, gender, lifecycle stage, social status, education, household composition,
income / poverty level, religious affiliation, lifestyle, physiological attributes, alcohol
/ drug use, disorders.
Cognitive biaises Information avoidance; Availability heuristic; Anchoring; Messenger effect;
Confirmation and belief bias; Simplicity bias; Recency bias; Optimism bias;
Representativeness heuristic; Cognitive dissonance; Memory bias.
Interest Attention; Doability; Enjoyment; Potential gains; Perceived risks; Efforts needed;
Affordability; Appeal; Desire.
Attitude Awareness and Knowledge; Beliefs; Aspirations; Values; Intuitions; Past
experience; Emotions; Mindset.
Self-efficacy Agency; Emotional well-being; physical capacity; Skills; Confidence; Self-image;
Stress level; Fatigue; Support; Social mobility; Decision autonomy; Emotional
intelligence.
Limited rationality Self-control / Willpower; Present bias; Procrastination; Hassle factors; Habits and
status quo; Heuristics; Inconsistent commitment; Decision context/frame.
Communication
environment
Factual & scientific information; Media agenda and narrative; Social media;
Marketing, brands messaging; Public discourse and figures; Entertainment
industry; Exposure; Word of mouth.
5
Factors (Level 1) Dimensions (Level 2)
Emerging alternatives Opinion trends; Social movements; Innovations and opportunities; Publicised
change and stories; Positive deviants
Social influence &
Social norms
Reference network’s attitudes and practices; Approved behaviours – normative
expectations; Believed typical practices – empirical expectations; Social pressure
– rewards, sanctions, exceptions; Stigma and discrimination / societal views on
minorities; Sensitivity to social influence.
Meta-norms Socialization process; Gender ideologies; Power dynamics; Decision-making
patterns; Family roles and relationships; Conflict resolution; Perception of the
Child, moral norms, legal compliance.
Community dynamic Collective self-efficacy; Sense of ownership; Social Cohesion; Equity of
participation; Quality of leadership.
Governing entities Recognition of the issue; Policies and regulations; Enforcement & Security
apparatus; Fiscal measures; Grievances against authorities; Religious institutions;
Educational system; Voice and participation.
Intent Contemplation; Experiment; Relapse; Celebration, praising, ritualization, public
commitment; Advocating.
Structural barriers Living conditions; Availability, access to and quality of services & technology; Trust
in service providers; Cues to action; Traditional services; Infrastructure; Other
external factors.
Context Migration, displacement, emergency vs. development context, social / cultural and
religious context, natural events and weather.
2.2 The Journey to Health and Immunization
In areas such as health, education or child protection, in which the existence of a functional service delivery
system is a precondition for the adoption of certain practices and behaviours, an examination of the specific
enablers of and/or barriers to the demand, access to and uptake of services is crucial.
The Journey to Health and Immunization programme is an overarching framework that includes elements of
Behavioural Insights (BI) and Human-Centred Design (HCD) in an attempt to rationalize a large variety of barriers
and drivers that both caregivers and health workers encounter along their journeys to health and immunisation
(more information is available at https://www.hcd4health.org).
Challenges of demand pertain to decision making and action taking. Drivers and barriers to action can influence
caregivers in terms of whether they bring their children to health facilities, seek health services, and return to
the health facilities. Therefore, we need to acknowledge the complexity of the demand-service interactions
to understand the human factors and contexts pertaining to the challenges associated with the acceptability,
appropriateness, responsiveness and perceived quality of services.
Measuring Results in Social and Behaviour Change Communication Programming
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This model can also be applied to any sector in which the demand-service interaction plays a relevant role.
The framework places the child and his/her caregiver at the centre, covering all steps of the demand-service
loop using a life-cycle approach, from the child pre-conception (e.g.: mother attending all recommended ANC
consultations) to the reproductive age of the child (e.g.: adolescent pregnancies).
Figure 3:The journey to health and immunization framework, UNICEF 2018
As one can see from the figure above, psychological factors and dimensions as well as elements relative to
sociology or environment, like norms and values, social support and recognition, community respect and trust play
a crucial role both from the caregiver’s and the service provider’s point of view.
7
The table bellow illustrates how the BDM and the Journey to Health and Immunization are linked. The L2
dimensions in red are considered as high priority drivers.
Table 2: Links betweenThe journey to health and immunization framework and the Behavioural Drivers
Model
Steps along the
Journey
Desired skills or
behaviours along the
Journey
Associated BDM
L1 Factors /
Outcomes
Associated BDM L2 Dimensions /
Output
1. Knowledge,
awareness
and belief
CAREGIVERS
1.1.a Have practical
knowledge
N/A Awareness & Knowledge
Exposure
Marketing, brand, messaging
Collective self-efficacy
Social cohesion
1.2.a. Understand the
value of vaccination
Attitude Awareness & Knowledge
Potential gains
Information avoidance
Beliefs
Values
1.3.a. Perceive vaccination
positively
Attitude Public figures, public discourse
Communication
environment
Social media
Heuristics
1.4.a. Perceive vaccination
as a priority
Attitude Opinion trends
Governing entities Religious institutions
Attitude Moral norms
1.5.a. Do not fear side
effects
Attitude Beliefs
1.6.a. Trust vaccines Self-Efficacy (or
attitude)
Beliefs
Past experience
1.7
.a. Trust providers Trust in service
provider
Past experience
Personal characteristics
Messenger effect
18.a Trust Governing
entities
Governing entities Grievances against authorities
Legal compliance
Messenger effect
Beliefs
PROVIDERS
1.1.b. Have practical
competencies
Self-efficacy Policy and regulation
Marketing, brand, messaging
1.2.b. Have positive norms
and values towards
immunization
Attitude Beliefs
Values
Perceived risk
1.3.b. Have a positive
perception of clients
Attitude Perception of the child
Measuring Results in Social and Behaviour Change Communication Programming
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2. Intent CAREGIVERS
2.1.a. Intend to vaccinate
their children
Intent Feasibility
Perceived risk
Fatigue
Gender ideologies
Family roles and relationships
2.2.a. Report vaccination
as a social norm in
their community
Social influence
and social norms
Reference network's attitudes and
practices
Injunctive norm / normative expectation
Descriptive norm / empirical expectation
Quality of leadership
PROVIDERS
2.1.b Are motivated by
the work
Interest Social cohesion
Policies and regulations
Perceived risks
3. Preparation,
cost and effort
CAREGIVERS
3.1.a. Make a plan to
access the service
Self-efficacy Confidence
3.2.a. Take the time and
effort to access the
service
Self-efficacy Agency
Decision autonomy / Power dynamics
Support
Perceived risks
Efforts needed
Fiscal measures and incentives
PROVIDERS
3.1.b. Make a plan to get
to the vaccination
site
Self-efficacy Efforts needed
Policies and regulations
4. Point of
service
CAREGIVERS
4.1.a. Find the services
to be available,
appropriate,
convenient and of
adequate technical
quality
Structural barriers Availability, access to and quality of
services
Interest Traditional services
Decision context and frame (Ref. opt-in
v/s opt-out)
PROVIDERS
4.1.b. Receive adequate
training, job aids
and non-threatening
supportive
supervision
Governing entities Recognition of the issue
4.2.b. Are satisfied with
the workload and
the facility flow
Governing entities Policies and regulations
Steps along the
Journey
Desired skills or
behaviours along the
Journey
Associated BDM
L1 Factors /
Outcomes
Associated BDM L2 Dimensions /
Output
9
4.3.c Involve
communities in the
development of
micro plans
Community
dynamics
Equity of participation
5. Experience of
care
CAREGIVERS
5.1.a. Perceive the
experience
positively
Structural barriers Past experience
Availability, access to and quality of
services
Equity of participation
PROVIDERS
5.1.b. Feel technically
confident to provide
a positive client
experience
Self-efficacy Ref. 1.1.b
5.2.b. Have an appropriate
profile
Trust in service
provider
Ref 1.7
.a
CAREGIVERS
6.1.a. Have enough
information and
motivation to come
back for the next
visit
Ref. steps 1 and 2 Ref. steps 1 and 2
6.2.a. Share their positive
experience with
their community
Emerging
alternatives
Publicized change stories / Positive
deviants
6.3.a. Reinforce
vaccination as a
social norm
Social influence
and social norms
Ref 2.1 b
6.4.a. Are able to provide
their feedback on
the vaccination
service
Governing entities Voice and participation
Policies and regulations
PROVIDERS
6.1.b. Obtain family and
community respect
Community
dynamics
Celebration, praising
6.2.b. Prompt caregivers
to come to the next
session
Self-efficacy Cues to action
6.2.c. Inform caregivers
about possible
AEFI, how to
manage them and
when and how to
report them
Structural barriers Ref to 1.1 b
Steps along the
Journey
Desired skills or
behaviours along the
Journey
Associated BDM
L1 Factors /
Outcomes
Associated BDM L2 Dimensions /
Output
Measuring Results in Social and Behaviour Change Communication Programming
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Illustrative examples extracted from a 2019 assessment of immunization services and delivery in three major
urban Somali cities will help getting a better sense of the some of the existing challenges in ESAR:
Steps Description Examples
1. Knowledge,
attitudes,
practices
and belief
Caregivers:
• Have practical knowledge (when and where
to go, vaccination schedule, etc.)
• Understand the value of vaccination
• Perceive vaccination positively
• Perceive vaccination as a priority
• Do not fear side effects
• Trust vaccines
• Trust providers
• Trust Governing entities
Providers:
• Have practical competencies
• Have positive norms and values towards
immunization
• Have a positive perception of clients
• Poor antenatal care (ANC) practices and a
history of poor access to TT vaccinations
during pregnancy
• Mother’s poor knowledge and awareness
of vaccinations, their purpose, and their
benefits
• Mistrust of health centers
• Immunization associated with infertility and
diseases
• Providers not trained in interpersonal
communication and community
engagement
• Providers perceiving caregivers belonging to
informal urban settlement as “ignorant”
2. Intent Caregivers:
• Intend to vaccinate their children (decision-
making power, self-efficacy)
• Report vaccination as a social norm in their
community
Providers:
• Are motivated by the work
• Father’s refusal hampered mothers
decision-making power
• Divorced mothers were more likely to
complete their child’s vaccination schedule
• Traditional ritual: newborns are confined at
home for 40 days to prevent infections and
bad eye
• Role of traditional, female, and religious
leaders hampering or supporting
immunization uptake
• Providers not motivated to go to work
because of delays in the payment of their
salaries
3. Preparation,
cost and
effort
Caregivers:
• Make a plan to access the service
(transport, childcare, competing priorities,
social and opportunity costs)
• Take the time and effort to access the
service
Providers:
• Make a plan to get to the vaccination
site (preparing, getting to the clinic or
vaccination site, opportunity costs)
• Women often searching for reliable sources
of income and food when vaccination
session was scheduled.
• IDPs cannot afford paying for transportation
to facilities.
• Providers unbale to plan to get to the
vaccination site due to lack of transport
11
4. Point of
service
Caregivers:
• Find the services to be available,
appropriate, convenient and of adequate
technical quality (service hours, social
distance, waiting time)
Providers:
• Receive adequate training, job aids and non-
threatening supportive supervision
• Are satisfied with the workload and the
facility flow
• Involve communities in the development of
micro-plans
• Limited opening hours of health facilities
• EPI programs associated with outsiders and
foreigners.
• IDP mothers would like to be treated by
female community health workers.
• Large number of children coming to health
facilities did not have vaccination cards.
• Providers unable to provide quality
vaccination services due to the high number
of clients per provider
• Providers not receiving non-threatening
supportive supervision
5. Experience
of care
Caregivers:
• Perceive the experience positively
(treatment by health workers, physical
conditions, use of home-based records,
client satisfaction)
Providers:
• Feel technically confident to provide a
positive client experience (Interpersonal
communication skills, trust building, pain
mitigation, training and experience, social
distance)
• Have an appropriate profile
• Negative healthcare worker attitudes, health
staff were unwelcoming.
• Providers are too busy to explain
procedures
• Long waiting time
• Providers are not from the same community
as caregivers and therefore perceived as
outsiders
• It would be socially acceptable for a mother
to interact with woman providers but all
providers are men
6. After service Caregivers:
• Have enough information and motivation to
come back for the next visit
• Share their positive experience with their
community
• Reinforce vaccination as a social norm
• Are able to provide their feedback on the
vaccination service
Providers:
• Obtain family and community respect
• Prompt caregivers to come to the next
session
• Inform caregivers about possible AEFI, how
to manage them and when and how to
report them
• IDPs would like to get information about
upcoming services to IDP community days
before immunization sessions
• Poor information on side effects increases
fear of vaccinations
• Providers do not tell caregivers when
and where to bring the child to the next
vaccination session
Traditional SBCC interventions tend to focus on steps Knowledge, awareness and beliefs and Intent, mainly
through communication campaigns and the development of communication materials. However, as we can see in
the example above, barriers are present throughout the Journey.
Steps Description Examples
Measuring Results in Social and Behaviour Change Communication Programming
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Measuring Results in Social and Behaviour Change Communication Programming
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©
UNICEF/UN052547/Ayene
13
3 Result based management
Results Based Management (RBM) is a management strategy based on clearly defined accountability for results,
monitoring and self-evaluation. These traits are represented in the cycle illustrated in Figure 4.7
RBM involves
analysing the context, prioritizing based on this information and planning accordingly, implementing the plan,
monitoring and evaluating results, and learning from the outcomes of the monitoring and evaluation to adjust the
plans. The cycle iterates again, gradually approximating the results to more ambitious outcomes.
The same approach also applies to define the results for SBCC programming. In this case, the context and
situation analysis will help identify the key drivers of a specific behaviour or practice and the strategic prioritization
and planning phase will help define the key interventions to be implemented. Indicators developed around key
drivers will be monitored through baseline surveys and regular subsequent surveys in the course of programme
and/or implementation.
This paper will focus specifically on the context and situation analysis, the strategic prioritization and planning, as
well as the monitoring and evaluation stages of the RBM, as the main avenues for the definition, prioritization and
monitoring of SBCC indicators.
Figure 4: RBM Cycle
7 For more information on UNICEF RBM, see online course https://agora.unicef.org/course/info.php?id=3169
8 More information on how to conduct a context and situation analysis can be found in UNICEF MENARO (2018), Everybody wants to belong.
Practical guide for social norms programming; UNICEF MENA (2018), Measuring social and behavioural drivers of child protection issues.
Human-Centred Design formative research process https://www.hcd4health.org/process; and Implementation research in Health
3.1 Context and situation analysis8
The purpose of the context and situation analysis is to identify the main drivers and dimensions of individual
behaviours, as well as the environmental- and social determinants-related barriers both in terms of supply and
demand for specific services.
This stage should provide information on bottlenecks and drivers related to the priority behaviours to be promoted,
the analysis of social and behavioural determinants, the demand of relevant services and convenience and quality
of the offer. Likewise, the context and situation analysis should provide facts on the range of key influencers,
available C4D platforms, preferred communication modalities, existing media environment, and identification of
research gaps.
The context and situation analysis should be done through a literature review, and, if need be, formative research.
As a full-scale socio-anthropological study might not always be doable due to limited finances and time, it is
important to rely on available qualitative research done by UNICEF
, other donors organisations or in universities. If
additional qualitative data need to be collected, it is better to do it on a number of limited geographic areas where
the program is likely to start.
Strategic prioritization
and planning
Implementation
Context and Situation analysis
Learning and adjustment
Monitoring Evaluation
and Reporting
Measuring Results in Social and Behaviour Change Communication Programming
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3.2 Causal analysis
Usually, the causal analysis is undertaken using the problem tree exercise, which is an effective means for
identifying the optimal path to behavioural change, especially when a behaviour has multiple determinants (Petit,
V., BDM 2019).
The elaboration of a problem tree consists of a participatory exercise based on a statement indicating the
problem and then asking, “Why is this happening?”
. The first answer will usually reveal a symptom or several
symptoms. The question is asked again and again until the root cause of the problem is revealed. Causality
enables us to analyse and explore who is most affected by a problem, how widespread the problem is and why
that is happening. A causal analysis allows for different streams of a problem to be examined in-depth. Causes
are not linear but are often a complex interaction of multiple streams that reinforce each other. More immediate
causes are often easier to address, while more structural causes are more difficult and often longer-term but tend
to provide more sustainable solutions and results.9
The results of this participatory situation analysis should be
reflected in the strategic prioritization and planning stage.
When undertaking the analysis in the context of an intervention entailing the demand-service loop (health,
education, social protection, etc.), barriers and drivers could be categorized under each step of the Journey to
Health and Immunization Framework (knowledge awareness and belief, intent, preparation cost and effect, point
of service, experience of care, and after care) at individual, family, community, media environment, governance
and systems levels. This categorization process will aid in the identification of high priority areas and information
gaps to be addressed through deeper qualitative and/or quantitative research to ensure that programs develop
interventions to overcome these barriers and support desired behaviours.
A recommended technique to undertake deeper qualitative research is HCD investigation—a problem-driven,
iterative process that begins with understanding the human factors, programme context, and challenges
associated with the acceptability, appropriateness, responsiveness and perceived quality of services; this
technique requires working directly with the people who use the service or deliver the solution to develop new
ideas that are viable and appropriate in their context.10
Figure 5: Problem tree methodology (RBM Workshop, ESARO, 2016)
9 RBM Workshop, ESARO, 2016.
10 More information available at https://www.hcd4health.org
Problem
statement
Therefore
this happens
Therefore
this happens
Therefore
this happens
Therefore
this happens
Therefore
this happens
1. Why is that happeing?
2. Why is that happeing?
3. Why is that happeing?
4. Why is that happeing?
5. Why is that happeing?
Symptom
Symptom
Symptom
Symptom
Root
cause
15
3.3 Prioritization11
As not all deprivations or drivers can be addressed by SBCC interventions through UNICEF
, there is a need for
prioritization.
Prioritization helps UNICEF focus primarily and directly on certain aspects of the SBCC issues, the barriers and
the drivers, their causes and consequences. It clarifies aspects considered within reach and capacity of SBCC to
influence but beyond its focus and aspects that are out-of-scope of the SBCC programme. The items that are in
scope will be turned into assumptions when developing the Theory of Change (ToC), while those out of scope will
be recorded under risks.
The prioritization process should be evidence-based, participatory and iterative. The prioritization exercise can be
done after the problem analysis stage in order to prioritize issues that one wants to focus on, but it can also be
done at the solution analysis stage to prioritize solutions one wants to implement.
Figure 6: Prioritization of issues, adapted from RBM Workshop, ESARO, 2016
3.4 Definition of priority results
Priority results will be defined by transforming the problem tree into a solution tree. To produce a solution tree, the
problem statement is transformed into a positive statement. Then different layers of causes are also transformed
into positive statements. Transforming cause statements into positive statements allows for the first step in the
formulation of short-, mid- and long-term outcomes to be taken.
Figure 7:Transforming a problem tree into a solution tree (RBM Workshop, ESARO, 2016)
11 See UNICEF (2017), Result-Based Management Handbook. Working together for children. Online, accessed on January, 15, 2020: https://
www.pndajk.gov.pk/uploadfiles/downloads/RBM_Handbook_Working_Together_for_Children_July_2017.pdf
FOCUS FOCUS
SCOPE
Which aspects / drivers of the
SBC problem, its causes and
consequences will SBC focus
on directly and primarily?
Which aspects / drivers are
beyond the focus and scope
of the SBC programme?
Which aspects / drivers
are important and within
reach and capacity of SBC
programme to influence but
beyond the focus of the SBC
programme?
ProblemTree SolutionTree/Outcome chain
High prevalence of FGMC
among children less that 15 years
High prevalence of FGMC
among children less that 15 years is reduced
Families subject their children to FGMC
FGMC
practitioners
are known and
available in the
community
FGMC Practice
is passed from
generation to
generation
Practice of FGM
is interrupted
Lack of
enforcement
of laws against
FGMC
Laws against
FGMC are
enforced
FGMC is a social norm FGMC is no longer a social norm
FGMC
practitioners
are not
available in the
community
Socil and
financial cost of
FGMC is low
Socil and
financial cost of
FGMC is high
Lack of
awareness
of health and
human rights
consequences
of FGMC
Families
understand
health and
human rights
consequences
of FGMC
Community
values FGMC
and links to
marriage-ability
Community
rejects FGMC
and sanctions
families that
undertake FGM
Families do not subject their children to FGMC
Measuring Results in Social and Behaviour Change Communication Programming
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Each behaviour, factor and dimension identified during the strategic prioritization phase should be translated into at
least one result: Behaviours to be reached will be identified as outcomes; Factors will constitute the intermediary
outcomes; Dimensions will constitute outputs, and SBCC activities at each level of the socio-ecological model will
constitute the inputs.
Figure 8: Logical framework of SBCC interventions (adapted from Petit,V., BDM 2019)
Indeed, an SBCC result chain adds an additional level compared to a regular UNICEF result chain: the intermediary
outcomes.
Figure 9: Comparing regular and SBCC hierarchy of results
IMPACT IMPACT
OUTCOME
OUTCOME
OUTPUT
INTERMEDIATE
OUTPUT
OUTPUT
Regular RBM: Hierachy of Results C4D/SBCC RBM: Hierachy of Results
• Long term changes in
the rights / deprivation /
inequities in situation of
children and women
• Nationally owned
• Long term changes in the rights / deprivation / inequities in
situation of children and women
• Nationally owned
• Changes in behavior or
performance of targeted
institutions or individuals
manifesting in coverage
and equity of services /
interventions
• UNICEF contributes to
these changes
• Changes in behavior or performance of targeted institutions
or individuals manifesting in coverage and equity of services /
interventions
• UNICEF contributes to these changes
• Changes in capacity of
individuals or institutions
including new product,
skills, abilities and services
• Attributes to programme
funds and management -
therefore high degree of
accountability
• Changes in level 1 drivers or behavioral factors (psychological,
sociological and environmental factors) driving the behaviour,
i.e. changes in terms of building supportive social norms, social
influence, overall community dynamic, but also participants
attitudes, interest, self-efficacy and intent
• UNICEF contributes to these changes
• Changes level 2 drivers or behavioral dimensions, for example
at community level, the improvement of collective recognition
of the problem, the sense of ownership of the community
process, the equity of participation in deliberations, etc. as well
as change in capacities of individuals or institutions including
new products, skills, abilities and services
• Attributes to programme funds and management - therefore
high degree of accountability
17
Table 4: Examples of SBCC logical framework for behaviour change linked to use of service and for
adoption of a home-based practice.
Result levels Use of a service: Adoption of a home-based practice:
SBCC Outcome By year x, x% of pregnant women attend at
least 4 ANC visits.
By year x, x% of mothers of children under
6 months old breastfeed their babies
exclusively for the first 6 months.
SBCC
Intermediate
outcomes
By year x, x% of respondent women of
child-bearing age say that they have enough
time and financial resources to attend at
least 4 ANC visits during pregnancy.
By year x, x% of respondent women of
child-bearing age say that their husband is
providing them support to access and attend
at least 4 ANC visits.
By year x, x% of respondent women of
child-bearing age believe that they will be /
are able to breastfeed their baby exclusively
for the first six months.
By year x, x% of respondent women of
child-bearing age think that their mother-
in-law or her husband expect them to
breastfeed exclusively for the first 6 months.
SBCC Output By year x, x% of respondent women of
childbearing age know at least x advantages
of attending the 4 ANC visits.
By year x, x% of respondent women of
childbearing age say they think that more
than half of their friends attend at least 4
ANC visits.
By year x, x% of respondent men of child-
bearing age know how to support their wife
in attending at least 4 ANC visits.
By year x, x% of traditional birth attendants
report encouraging mothers and fathers to
attend at least 4 ANC visits.
By year x, x% of respondent women of
child-bearing age know that doing exclusively
breastfeeding for the first 6 months without
water is not harmful to their children.
By year x, x% of women of child-bearing age
know where they can get counselling for
breastfeeding.
By year x, x% of men of child-bearing age
think their wife should practice exclusive
breastfeeding for the first 6 months.
In order to improve the quality of SBCC indicators, in 2018 UNICEF MENARO developed monitoring tools that aim
at measuring social and behavioural drivers (factors and dimensions) and assisting country offices in collecting
evidence of their programmes’ impact.
The monitoring toolkit comprises a list of indicators for a number of pre-selected social and behavioural change
drivers on three topics: female genital mutilation and cutting, child marriage and child discipline. It also includes
generic quantitative surveys and questions based on the indicators12
. This package is currently being cognitively
tested in 9 countries across MENA, WCA and ESA regions.
In the present document, these results and indicators, that are mainly at micro level (individual and community),
will be completed with results and indicators at institutional / meso level and policy / macro level.
12 For more information and list of indicators, questions and generic surveys: see UNICEF MENA, 2018, Measuring social and behavioural
drivers of child protection issues.
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3.5 How to formulate SBCC results and indicators
A result is a describable or measurable change in state derived from a cause-and-effect relationship.
There are two ways of formulating results13
either by putting the action verb upfront (e.g. Improved retention of
female and male youth volunteers beyond high-school graduation) or in the middle (e.g. By 2022 more girls and
boys in Country X complete quality and inclusive basic education with improved learning outcomes).
Indicators are measures used to monitor progress made towards the achievement of intended results or the
application of desired processes. An indicator is neutral, does not pre-judge or set targets, is therefore “empty of
data” (RBM Workshop, ESARO, 2016).
13 RBM Workshop, ESARO, 2016
14 RBM Workshop, ESARO, 2016
15 RBM Workshop, ESARO, 2016
Example on how to formulate results and indicators (adapted from RBM Workshop, ESARO, 2016):
• Result statement (at intermediate outcome level): By 2021, 80% of respondents think that
FGM/C should be discontinued in their community
• Indicator: % of respondents who think that FGM/C should be discontinued in their community
• Baseline: 50%
• TargetYear 1: 65%
• Performance at the end ofYear 1: 67% of respondents
Table 5: Principles and quality criteria for results and indicator
Principles to formulate results14
Quality criteria for indicators15
• Clarity regarding the level: Output, intermediate-
outcome, outcome or impact and, accountabilities.
• SMARTER results: Strategic, Measurable, Aligned,
Realistic, Transformative, Empowering, Reportable.
• Coherent result chains: Applies the if-then logic;
otherwise, asking the question so what between
levels.
• Uses change language: Places emphasis on the
subject of change.
• Considers equity, human rights, gender,
determinants and risks.
• Clear relationship with issues identified in the
SitAn: Uses change language, that places emphasis
on the subject of change.
• Ratio of indicator to result: The number of
indicators for each result should be kept to a
minimum, preferably one to four, depending on the
level of the result.
• Level of indicator: The indicators should measure
the result directly or be an obvious proxy.
• Measurability of indicators: Indicators should be
SMART – Specific, Measurable, Achievable, Relevant
and Time-bound – with a clear unit of measurement
and an operational output.
• Quality of indicator: Baselines, targets and a
reliable data source must be provided for the
indicator.
19
The proposed indicators are formulated either in terms of number (Nb.) or as a ratio (%). When formulated as a
ratio, the numerator is the number of [indicator definition] and the denominator is the total number of people
interviewed. The ratio is calculated by dividing the numerator by the denominator and multiplying the result by
100. When necessary, the indicators can be disaggregated by age, religion, region, ethnicity, gender, wealth
quintile, education, and so on. For example, in the indicator “% of respondents who say female genital mutilation
(FGM)/C is not painful for the girls”
, the numerator is the number of respondents who said that FGM/C was not
painful for girls, and the denominator is the total number of people surveyed:
16 UNICEF (2019), Communication for Development Programme Guidance, Draft for Feedback only.
x 100
[Numerator] number of respondents who say FGM/C is not painful for girls
[Denominator] total number of people surveyed (respondents)
3.5.1 Impact-level results and indicators
SBCC does not have impact-level results and indicators per se, since SBCC contributes to the achievement
of sectoral results. Therefore, impact-level indicators relate to long-term changes in the rights / deprivations /
inequities in the situation of children and women to which SBCC contributes. They are to be taken from UNICEF’s
result framework and correspond to the respective sectoral impact-level indicator. Baseline, target, source of
data and frequency are examples of information that are already available at programme level. For example, the
reduction of maternal mortality is an impact-level result.
3.5.2 Outcome-level SBCC results and indicators
Outcome-level results and indicators relate to changes in behaviour or performance of targeted institutions
or individuals manifesting in coverage and equity of services / interventions. They relate to the adoption of or
deterrence from certain practices by individuals, including service providers (in health, education, protection, etc.).
They are mainly about behavioural prevalence; therefore, they are formulated with an active verb that describes
a concrete action a specific type of person or a group of persons do or don’t or what a respondent reports of
having seen or witnessed somebody else or a group of persons have done.
Possible SBCC related outcome-level results are:16
• Increased demand for existing services
• Adoption of key family and community practices
• Abandonment of harmful social norms and behaviours and/or the creation of positive ones
• Empowerment and engagement of marginalised communities and groups, including adolescents.
Typically, outcome results and indicators will be formulated as such:
• Outcome-level Result: By [date] increased Nb. or % of [population] have adopted / demanded / [action] / be in
[Improved situation]
- Outcome-level Indicator: % or Nb. of [population] have [done a specific action or not] / are [in a specific
situation;
- Outcome-level Indicator: % or Nb. of [population] who reported / heard / saw somebody else / a group of
people [did a specific action / are in a specific situation].
20
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In order to formulate best outcome-level results and indicators, it is important to have a pre-defined list of
practices or behaviours the programme wants to promote (or to deter from), for each of the participants’
categories in the socio-ecological model concerned with behavioural outcomes, that is individual, interpersonal
and community levels.
An example is FGM/C:
• Individual level:
- Result: By 2021, the percentage of girls aged 0-14 who have undergone any form of FGM/C will be
reduced by X%.
- Indicator MICS PR 11: Percentage of daughters age 0-14 years who have undergone any form of FGM/C,
as reported by mothers age 15-49 years.17
• Family level:
- Result: By 2021, the percentage of parents who engage actively against FGM/C will raise by x%.
- Indicator: % of respondents (mother or father) who report engaging actively against FGM/C within their
family.
• Community level:
- Result: By 2021, the number of communities where cutters / circumcisers do not exercise this profession
any more has risen by x.
- Indicator:
» % of communities where respondents reported that at least one cutter / circumciser in their
community does not exercise this profession (and has not been replaced by someone else);
» % of communities where respondents reported that they know at least one case where parents who
had practised FGM/C on their daughter have been reported to the relevant authority;
» % of communities where respondents reported that they have witnessed at least one leader who
stopped an FGM/C ceremony from taking place in his community;
» Nb. of FGM/C cases that have been reported to the police.
Some data for SBCC-related outcome-level indicators can be found in national surveys like Multiple Indicator
Cluster Surveys (MICS), Demographic and Health Surveys (DHS), Education Management Information Systems
(EMIS), or national statistics of different sectors. They usually give representative information at national level,
with a certain degree of disaggregation by gender, age or geographic location. While EMIS and other sectoral
information systems provide data in an annual basis, all the household survey data from MICS, DHS and others
provide data every 5 years (or more).
3.5.3 Intermediate outcome-level SBCC results and indicators
Intermediate outcome-level results to be reached are:
• Increased % of individuals with positive psychological factors toward key family and community practices;
• Increased % of individuals who actively support their relatives or friends in implementing key family and
community practices;
• Community increasingly engaged in dialogue, planning and action;
• Positive shifts in social norms.
17 MICS 6 2019 Indicators and Definitions.
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Intermediate outcome-level SBCC indicators (as well as output indicators) are mainly declarative or self-reporting
(using verbs like think, report, say) and relate to factors identified as being crucial during the formative research
– and confirmed as such in quantitative surveys. Therefore, to formulate intermediate outcome-level indicators,
one has to refer to the relevant factor, its definition, and adapt it to the specific topic. The choice of factors to be
measured and related indicators will depend on the intermediate outcome-level result formulated in the result
tree.
Typically, an intermediate outcome-level SBCCs indicator will be formulated as such:
• % or Nb. of [category of respondent] who think / report / say that [level 1 drivers / behavioural factors related
statement];
• % or Nb. of [category of respondent] who reported / heard / saw somebody else / a group of people think /
expect them to do [approval or refusal of / an action related to level 1 drivers / behavioural factors].
Regarding the population / respondents, it is also important to include not only primary participants, but also
community-level and service provider-level participants, particularly if they have a significant influence on the
primary participants’ behaviour. In other words, if the attitudes of nurses deter mothers from visiting the health
care centre for antenatal care, or teachers’ attitudes towards disciplining children or menstrual hygiene deter
children from attending school, these factors need to be addressed. Once again, crucial factors will be identified
during the context and situation analysis and strategic prioritisation planning phases, as well as via the baseline
survey.
An example is FGM/C:
• % of respondents who say that they feel confident they can refuse to have their daughter undergo FGM/C;
• % of respondents who think that FGM/C should be discontinued in their community;
• % of respondents who say the opinion of (member of reference group) matters in deciding about practicing
FGM/C on their daughters/female household members;
• % of respondents who know some people in their reference group or community who have not practiced
FGM/C on their daughters/female household members.
3.5.4 Output-level SBCC results and indicators
Output-level SBCC indicators relate to changes in behavioural dimensions, for example at community level, the
improvement of collective recognition of the problem, the sense of ownership of the community process, the
equity of participation in deliberations, etc. as well as change in capacities of individuals or institutions including
new products, skills, abilities and services. Outputs are highly attributable to UNICEF actions and UNICEF is
accountable to them.
Output-level SBCC indicators are mainly declarative or self-reporting (using verbs like think, report, say) and relate
to crucial dimensions of each factor as identified during formative research. Therefore, to formulate output-level
SBCC indicators, one must refer to the relevant dimension, its definition, and adapt it to the specific ToC.
Output-level results to be reached are:
• Improved information, knowledge, perception for behaviour change;
• Improved self-confidence, motivation, and skills to make informed decisions and take appropriate action;
• Positive household, community and public discourse and narrative on social norms;
• Increased social non-acceptance of stigma, discrimination, violence, abuse and gender inequity;
23
• Increased peer and community support for social and behaviour change;
• Policies, plans, services increasingly responsive to community demand;
• Enhanced government capacity for planning, budgeting, monitoring and evaluating C4D;
• Empower and engage the marginalized communities and groups, including adolescents;
• Enabling policies, regulations and plans implemented.
Output-level indicators can be formulated as follows:
• % or Nb. of [population] who think / report / say that [level 2 drivers / behavioural dimension related
statement];
• % or Nb. of [population] who reported / heard / saw somebody else / a group of people think / expect them to
do [approval or refusal of / an action related to level 2 drivers / behavioural dimensions].
Once again, it is also important to include not only primary participants but also community-level and service
provider level participants, especially if they have a great influence on primary participants’ behaviour.
Taking FGM as an example:
• % of respondents who say FGM/C is not painful for the girls;
• % of respondents who say they ask (member of reference group) for advice regarding practicing FGM/C on
their daughters/female household members;
• % of respondents who report exposure to message about the abandonment of FGM/C practice via TV or radio
programs or social media in the last xxx months/weeks.
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4 How to use the indicator lists
In Appendix 2, a list of indicators for the following topics is provided:
• Sexual abuse;
• Disease outbreak;
• Birth registration;
• School dropout;
• Maternal, infant and young children feeding practices;
• HIV/AIDS;
• Immunisation.
Three other indicator lists (child discipline, child marriage and FGM / cutting) have already been developed and
tested.18
The lists in Appendix 2 were developed based on existing SBCC strategies and guidelines. Some of the
outcome-level indicators (in red) mentioned in these lists were measured using national surveys such as MICS
and DHS. Others (in bold) are already part of programme standards (RAM indicators). All other indicators are
propositions to guide the development of result chains that include SBCC results in sectoral programmes. The
indicators have been reviewed by the C4D team and sector specialists in ESARO.
The indicators are clustered according to behavioural outcomes, factors (Level 1 behavioural determinants,
intermediate outcomes) and dimensions (Level 2 behavioural determinants, output indicators). The immunisation
indicators list is organised according to the Journey to Health and Immunisation.
As these indicator lists are dynamic, the proposed indicators should be adapted to the country context. Once
the results have been selected, indicators should be selected, adapted to the country, and quantified based on
available data or on a quantitative survey conducted in the programme area. Experience of the use of these
indicators, including the questions developed pertaining to these indicators, as well as proposed changes should
be shared with ESARO to improve on these lists.
Practical information about the indicator lists:
Legend
• Indicators in bold: RAM outcome or output indicators.
• Indicators in red: Existing indicators (MICS 2019, DHS, and so on).
• In the immunisation indicators checklist: Factors and dimensions in red are considered as high priority drivers.
Reference Documents / Documents used:
• UNICEF standard (RAM) outcome indicators (Excel list);
• UNICEF standard (RAM) output indicators (Excel list);
• MICS indicators list 2019.
Sexual abuse
• UNICEF (2014), Protecting children from violence: A comprehensive evaluation of UNICEF’s strategies and
programme performance. Tanzania Country report.
• UNICEF (2015), Child Protection Resource Pack. How to Plan, Monitor and Evaluate Child Protection
Programmes.
18 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
Measuring Results in Social and Behaviour Change Communication Programming
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• UNICEF (2015), Ghana: VAC Evaluation. Ghana Case Study.
• UNICEF (2019), C4D programmes addressing violence against children. Technical guidance.
• UNICEF (2018), Preventing and Responding to Child Sexual Abuse and Exploitation. Evidence Review.
• UNICEF (2018), INSPIRE Indicator Guidance and Results Framework. Ending violence against children: How to
define and measure change.
• Darkness to light (website), The 5 Steps to Protecting Children™ forms a framework for preventing child sexual
abuse.
Immunisation
• GAVI (2019), An Atlas of Vaccine Demand. A roadmap for GAVI, government, and CSOs to immunize the never-
reached child. Draft. September 2019.
• UNICEF (2018), Human Centred Approach for Health (https://www.hcd4health.org/).
• Crocker, Buqueetal (2017), Immunization, urbanization and slums. A systematic review of factors and
interventions.
• Brewer et al. (2017), Increasing vaccination, putting psychological science into action.
• JSI (2014), Drivers of routine immunization coverage improvement in Africa: Findings from district-level case
studies.
• WHO (2013), The Guide to Tailoring Immunization Programmes (TIP).
Disease outbreak
• Republic of Sierra Leone (2014), National Communication Strategy for Ebola Response in Sierra Leone.
• Ministry of Health Liberia (2015), National Knowledge, Attitudes and Practices (KAP) Study on Ebola Virus
disease in Liberia, March 2015.
• WHO (2018), Risk communication and community engagement preparedness and readiness framework: Ebola
response in the Democratic Republic of Congo in North Kivu.
• WHO (2016), Medical Anthropology Study of the Ebola Virus Disease (EVD) Outbreak in Liberia/West
Africa.
Birth registration
• UNICEF (2013), A passport to protection. A guide to birth registration programming.
School Drop Out
• UNICEF (2013), Global Initiative on Out-of-School Children. Eastern and Southern Africa Regional Report.
• UNICEF (2019), Data Must Speak (DMS) Toolbox on Community Engagement Social Accountability (Draft).
MIYCF
• UNICEF (2018), C4D/SBCC Framework for Improving Maternal, Infant and Young Child Feeding in Ethiopia. PCI
Media.
• UNICEF (2020), Improving Young Children’s Diets during the Complementary Feeding Period. UNICEF
Programming Guidance.
• UNICEF (2016), IYCF SBCC Strategy 2016-2020. Final Draft.
• USAID / IYCN (2010), Formative assessment of infant and young child feeding practices at the community level
in Zambia.
• Jordan Ministry of Health (2013), Jordan Guidelines for Management of Acute Malnutrition.
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HIV
• The Global Fund (2011), Monitoring and Evaluation Toolkit. Part 2: HIV.
• Shisana, O, Rehle, T, Simbayi LC, Zuma, K, Jooste, S, Zungu N, Labadarios, D, Onoya, D et al. (2014), South
African National HIV Prevalence, Incidence and Behaviour Survey, 2012.
• Republic of Namibia (2009), HIV/AIDs in Namibia: Behavioral and Contextual Factors Driving the Epidemic.
• Malawi National AIDS Commission (2014), National HIV Prevention Strategy 2015-2020.
• USAID (2011), The unpeeled mango. A Qualitative Assessment of Views and Preferences concerning Voluntary
Medical Male Circumcision in Iringa Region, Tanzania.
• PSI (2019), Breaking the cycle of transmission: increasing uptake of HIV testing, prevention and linkage to
treatment among young men in South Africa.
• UNFPA (2014), UNFPA Operational Guidance for Comprehensive Sexuality Education: A Focus on Human
Rights and Gender.
If you have any questions about the use of these lists, please address them to Natalie Fol, Communication for
Development Adviser, UNICEF East and Southern Africa Regional Office – ESARO (nfol@unicef.org).
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5 Appendices
5.1 Appendix 1: Definitions of behavioural determinants
5.1.1 Psychological drivers
SEM level Factors & Dimensions19
Cognitive biases: Cognitive biases refer to the use of mental models for filtering and interpreting information,
often to make sense of the world around us. The human mind is lazy, and cognition requires various types of
shortcuts to make sense of things. These shortcuts lead to errors: We make mistakes in reasoning, evaluating
and remembering; as a result, choices are almost always based on imperfect information. Shortcuts are part of
automatic thinking (as opposed to deliberative thinking), which is when someone draws conclusions based on
limited information. People usually consider what automatically comes to mind to replace missing information,
associate the situation with what they already know, make assumptions, jump to conclusions, and eventually
make decisions based on a biased picture of a situation. This mental process is common and requires less
effort. From a social perspective, these mental models are linked to ways of thinking, often passed down across
generations, which include stereotypes and ideologies.
Individual +
interpersonal +
individual service
provider
Information avoidance: Individuals might avoid information actively and/or
unconsciously if this information can threaten their beliefs, force them to act, upset
them, or simply because they are already overloaded with information. One can
choose not to recognise and consider certain details about a subject, even when no
cost is associated with obtaining such details and there are benefits of doing so.
Individual +
interpersonal +
individual service
provider
Availability heuristic: We tend to overestimate the importance of the information
available to us. As a result, we refer to immediate examples that come to mind when
making judgements, instead of acknowledging the need for more evidence.
Individual +
interpersonal +
individual service
provider
Anchoring: This entails over-reliance on one trait of a subject or a piece of information
when making decisions. Anchoring often refers to people’s initial exposure to a piece
of information (usually a number), which serves as a reference point that influences
subsequent opinions and judgements.
Individual +
interpersonal +
individual service
provider
Messenger effect: The value we place on a piece of information is largely conditioned
by its source. The level of trust, familiarity and credibility of a communication channel
is a key driver of our receptiveness. An individual’s judgement of a subject can be
influenced by the representative of that subject rather than by the subject itself.
Individual +
interpersonal +
individual service
provider
Confirmation and belief bias: People easily ignore or criticise information that
contradicts their existing beliefs and assumptions and filter it in a way that supports
their preconceptions and suits their beliefs. This is an automatic process we use
naturally to seek affirmation of our views, which can draw us to focus on details that
are irrelevant in the larger picture.
Individual +
interpersonal +
individual service
provider
Simplicity bias: We discard specifics to form generalities, reduce events and lists to
their key elements, and favour seemingly simple options over complex, ambiguous
ones. We favour the immediate, reliable and tangible things in front of us, simplify
probabilities and numbers to make them easier to comprehend, and think we know
what others are thinking, as this tends to make life easier. We also simplify our vision
of life by projecting our current mind-set and assumptions onto the past and future.
19 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
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Individual +
interpersonal +
individual service
provider
Recency bias: By favouring the latest information, we tend to draw incorrect
conclusions by emphasising and overestimating the importance of recent events,
experiences and observations, over those in the near or distant past.
Individual +
interpersonal +
individual service
provider
Optimism bias: People tend to overestimate the likelihood of positive events
and underestimate the likelihood of negative ones, including the risks they face in
comparison to other people. Similarly, we notice flaws in others more easily than we
notice flaws in ourselves (also referred to as self-serving bias). We also imagine that
the things and people with which we are familiar or fond of are better than unfamiliar
things or people.
Individual +
interpersonal +
individual service
provider
Representativeness heuristic: We fill in characteristics based on stereotypes,
generalities and prior histories. As a result, we make judgements about people and
events based on the degree to which they resemble others.
Individual +
interpersonal +
individual service
provider
Cognitive dissonance: People experience psychological tension when they realise
that they engage in behaviours that are inconsistent with the type of person they
would like to be. The natural reaction is to reduce this tension, either by changing
attitudes and behaviours or by accepting a different self-image (which can be much
more difficult).
Individual +
interpersonal +
individual service
provider
Memory bias: What and how one remembers things is never objective. We edit and
reinforce some memories after events, store memories differently based on how they
were experienced (for example, we remember information better if we have produced
it ourselves), are more likely to regard memories associated with significant events or
emotions as being accurate, and we notice things that we have already memorised or
repeated often. In summary, cognitive biases affect the content and/or recollection of
a memory both negatively and positively.
Interest: Interest characterises how sympathetic people are to an alternative practice, how much they want
to know about it, be involved in activities concerning it, or experiment with it. This includes some cost/benefit
considerations, as well as a dimension of appeal on a more emotional level.
Individual +
interpersonal +
individual service
provider
Attention: We might or might not notice what is put in front of us. We often wrongly
assume that people are properly informed about existing options because these
options have been communicated to them. However, ensuring that people are
informed and paying attention to what is suggested, or that promoters of behaviours
manage to capture the attention of their audience, are key steps for a new behaviour
to be considered. This is made more difficult by the fact that people tend to listen only
to information that confirms their preconceptions (confirmation bias).
Individual +
interpersonal +
individual service
provider
Feasibility: This refers to the extent to which the adoption of a new behaviour
is perceived as feasible or not by a person in his or her actual situation (this is an
individual self-assessment and is non-objective).
Individual +
interpersonal +
individual service
provider
Enjoyment: This refers to the extent to which someone likes or might like doing
something and is a cognitive and affective state that follows an activity in which a
sense of pleasure was experienced. The term includes basic amusement as well as
other forms of gratification and thrills, such as the feeling of power. Being passionate
about something is a powerful driver for action. In economics, satisfaction and
happiness are sometimes referred to as ‘utility’
SEM level Factors & Dimensions19
31
Individual +
interpersonal +
individual service
provider
Potential gain/avoided losses: These refer to the benefits that a person thinks she/
he might gain from the change, particularly in the short term (rapid gains tend to be
more important in decision making). These gains are not only material, as they can
be in form of relationships, image, and so on. Gains should also be understood as
‘avoided losses’’, since a given loss is often seen as being much worse than it is,
while an equivalent gain is perceived less positively (human ‘loss aversion’).
Individual +
interpersonal +
individual service
provider
Perceived risks: This refers to the possibility that something bad might occur as a
result of the change, including but not only in terms of safety. People desire certainty
even when it is counterproductive. Being overly risk-averse is a natural human bias.
Individual +
interpersonal +
individual service
provider
Effort needed: This refers to how practical and easy it is to change to a new
behaviour. The perceived difficulty is not proportional to the likelihood of adoption, as
minor inconveniences (also known as ‘hassle factors’) might prevent us from acting in
accordance with our intentions.
Individual +
interpersonal +
individual service
provider
Affordability: This is the extent to which a person considers the change of practice
to be within his or her financial means and includes costs and possible monetary
incentives.
Individual +
interpersonal +
individual service
provider
Appeal: This indicates how attractive something is on a more emotional level. As
understood in psychology, appeal is a stimulus – visual or auditory – that influences
its targets’ attitudes towards a subject. Many types of psychological appeal have been
exploited by the advertising and marketing industries, such as fear appeal, sex appeal,
genetic fallacy, or guilt by association.
Individual +
interpersonal +
individual service
provider
Desire: This refers to a powerful feeling of craving something, or of wishing for
something to happen. This sense of longing is linked to a variety of core human
drives, such as the need to bond, to possess what we do not have, to love and
reproduce, to dominate, and the like. Desire can be either conscious or unconscious.
Attitude: Attitude is what someone thinks or feels about something. As it combines cognitive and emotional
elements, attitude defines people’s predispositions to respond positively or negatively to an idea, a situation,
or a suggested change. It is one of the key drivers of an individual’s choice of action, and is probably the most
important factor in shaping behavioural change.
Socio-economic background, religion and other individual characteristics are important drivers of attitude;
when measuring these, the demographic questions in surveys will help to cross-reference respondents’
characteristics and understand their influence more appropriately.
Individual +
interpersonal +
individual service
provider
Awareness and knowledge: These concepts are interdependent but not
interchangeable. Awareness is the consciousness of a fact (for example, being
conscious that violent discipline has negative consequences and being cognisant
that there are alternatives to it), whereas knowledge is associated with a deeper
understanding of this information (such as an appreciation of the reasons that violent
discipline is hurtful, and being able to discuss alternatives to it). It is important to bear
in mind that people tend to ignore ‘negative’ information related to their actions and
can sometimes favour prior ‘evidence’ that reaffirms their actions. Perception is highly
selective.
SEM level Factors & Dimensions19
Measuring Results in Social and Behaviour Change Communication Programming
32
Measuring Results in Social and Behaviour Change Communication Programming
32
©
UNICEF/UNI171211/Ose
33
Individual +
interpersonal +
individual service
provider
Beliefs: There are multiple types of beliefs that influence attitudes, with the main
ones being:
» Effect beliefs: considering a causality chain to be true (X leads to Y); for example,
disciplining a child physically will make her/him a good adult.
» Holding personal convictions on what ‘’needs’’ to be done in a given situation;
for example, if a woman is seen walking with another man, she needs to be
punished.
» Personal normative beliefs: beliefs about what should be, what should happen;
for example, men should be primarily responsible for the honour of the family,
women should report violence at the hands of their intimate partner to the police,
and so forth.
Beliefs are individual, but highly influenced by others. The likelihood of one person
adopting a belief increases with the number of people who already hold that belief.
Individual +
interpersonal +
individual service
provider
Aspirations: These are personal goals and dreams, the vision for the future self,
and the hope and ambition to achieve things, such as aspiring to be the best parent
possible, to be an independent woman, to be a successful student, and the like. It
reflects someone’s true desire in life.
Individual +
interpersonal +
individual service
provider
Values: Values are what we perceive as being good, right or acceptable, and entail
inner convictions of right and wrong, and of what good conscience requires. These
principles are strong drivers of standard behaviours. Individual values are directly
influenced by moral norms.
Individual +
interpersonal +
individual service
provider
Intuitions: Intuitions are instinctive feelings regarding a situation or an idea and are
often formed as a result of past experiences. Intuitions involve emotionally charged,
rapid, unconscious processes that contribute to immediate attitudes or decisions that
do not stem from reason. In other words, our brain might have already decided what
to do in a situation before analysing the options. Intuitions are one of the elements of
automatic thinking. Laws and rules target our rational brain, whereas many decisions
are made intuitively. Hunches drive many of our actions, and we often rely more on
guesses than on facts.
Individual +
interpersonal +
individual service
provider
Past experience: Researchers have shown that past experience helps to form
complex decisions. Memories of experiences, such as past failure and frustration with
a behaviour, or negative experiences such as poor treatment by a service provider, will
shape our attitudes towards attempting new things. At a deeper level, experiences
as a child also drive behaviour as an adult, including negative, violent or abusive
behaviours. This replication concept is paramount in most psychological schools of
thought.
Individual +
interpersonal +
individual service
provider
Moral norms: These are principles of morality that people are supposed to follow.
They are learned socially. For example, human rights, as a global doctrine, represent
the moral norms that the UN is attempting to enforce universally. The important
question here is what individuals perceive as women’s and children’s rights, as this
will condition the classification of certain practices as being inherently immoral or not
(for example, beating a woman).
SEM level Factors & Dimensions19
Measuring Results in Social and Behaviour Change Communication Programming
34
Individual +
interpersonal +
individual service
provider
Emotions: Emotions are generated subconsciously and are designed to appraise
and summarise an experience and inform action. Emotions entail a process of feeling
in which cognitive, physiological and behavioural reactions combine to respond to
a stimulus. Several decisions are informed by our emotional responses, which can
constitute a barrier to rational thinking. For example, phobias and aversions are
important mechanisms in everyday life. Another example of the power of emotions is
that identical information will trigger different attitudes if it is presented positively or
negatively.
Individual +
interpersonal +
individual service
provider
Mind-set: This refers to a person’s way of thinking and is a default attitude for
addressing various situations that create a pre-disposition to adopt or reject certain
behaviours, such as having an innovative mind-set, a conservative mind-set, a learning
and growth mind-set, and so forth.
Self-efficacy: Self-efficacy combines a person’s objective capability to perform the change proposed and her/his
belief about this ability. Positive self-efficacy is a necessary precondition to taking steps towards new practices.
As with attitude, demographics are usually a key driver of a person’s self-efficacy. For example, poverty imposes
a significant cognitive burden that makes it difficult for the poorest to think deliberately, see themselves as
capable, have faith in the possibility of change and seize opportunities. Interventions related to self-perception
can be powerful sources of change.
Individual +
interpersonal +
individual service
provider
Agency: This refers to the sense of control a person feels concerning an action and
its consequences. If the intention to perform an action appears to precede, guide and
cause the action exclusively, an individual will have a sense of agency over what s/he
has just done. If not, the resulting mismatch will prevent the individual from feeling
a sense of control over what has just occurred. A feeling of agency is the overall
feeling of control without any explicit thinking about a specific action. The judgement
of agency refers to the conceptual level of control, when an individual thinks explicitly
about initiating an action.
Individual +
interpersonal +
individual service
provider
Emotional well-being: This refers to the emotional quality of one’s everyday
experience, or the frequency and intensity of positive and negative feelings that make
one’s life pleasant or unpleasant. High levels of stress can impair our ability to make
choices and to perceive ourselves positively and as capable and can paralyse change
and the adoption of positive practices; in some instances, it can result in adoption of
negative coping mechanisms. Anxiety and mental distress are particularly common in
emergency contexts. Trauma is a significant barrier to action.
Individual +
interpersonal +
individual service
provider
Physical capacity: This refers to the strength and ability to perform essential physical
actions.
Individual +
interpersonal +
individual service
provider
Fatigue: Being tired (and hungry) depletes cognitive resources and affects our
decision making significantly.
Individual +
interpersonal +
individual service
provider
Skills: Skills refer to particular abilities and capacities to do something. Most skills
are acquired through experience and/or deliberate learning. Example of skills include
parenting techniques and positive discipline, as well as life skills such as critical
thinking or active citizenship.
Individual +
interpersonal +
individual service
provider
Decision autonomy: This refers to the ability to make one’s own decisions.
SEM level Factors & Dimensions19
35
SEM level Factors & Dimensions19
Individual +
interpersonal +
individual service
provider
Confidence: This refers to a person’s belief that she/he can succeed in creating
change, or having confidence in one’s own ability.
Individual +
interpersonal +
individual service
provider
Self-image: Many of our choices are impacted by the perception we have of
ourselves and our role in the family, community and society. This perceived identity
will often make us behave according to common stereotypes associated with
our dominant identity. This might prevent people from doing things that they are
completely capable of doing because they underestimate their abilities in accordance
with the stereotype of their group.
Individual +
interpersonal +
individual service
provider
Overall stress level: High levels of stress impair our ability to make choices,
perceive ourselves positively and capable, can paralyse change and the adoption of
positive practices and, in some instances, results in the adoption of negative coping
mechanisms. Anxiety and mental distress are particularly frequent in emergency
contexts.
Individual +
interpersonal +
individual service
provider
Support: This refers to the availability of trusted relatives or friends who encourage,
aid and protect someone when needed.
Individual +
interpersonal +
individual service
provider
Social mobility: This refers to a socio-economic process in which an individual,
family, or group moves to a new position within a social hierarchy, from job to job,
or from one social class or level to another. Social mobility is also understood as the
movement of certain categories of people from place to place. In many societies,
mobility is an issue for women in both senses of the term: They are blocked from
rising to positions of power, but might also not be free or able to leave the household,
interact with certain people, or access certain commodities and services for cultural
or safety reasons.
Individual +
interpersonal +
individual service
provider
Emotional intelligence: The ability to recognise and process one’s own emotions,
and to use them to assist thinking.
Limited rationality: People do not always make decisions that are in their best interests. There are instances
where we do not really know why we do or do not do things. One reason may be because it has always been
done like this, even if it seems irrational. Several psychological traits (such as feeling more comfortable in a set
routine, finding inaction to be easier, feeling overly positive about a choice made previously, and the like) are
part of ‘human nature’ and can be used to explain why people do not behave in the way we would predict from
a rational perspective. Limited or bounded rationality refers to this characteristic of human cognition, which is
restricted in terms of resources (thinking capacity, available input information, and the amount of time allotted).
As a result, people have a tendency to find simpler and easier ways to make decisions and to act, regardless of
intelligence. The concept of bounded rationality is very similar to that of being a cognitive miser.
Individual +
interpersonal +
individual service
provider
Self-control / Willpower: Temptations and impulses affect our decisions and actions,
including those that run counter to the path we had decided to follow and the goals
we had set. We all experience these struggles, but we do not always have equal
capacity with regard to restraining or regulating these urges.
When our mental resources are depleted (by stress or fatigue, for example), our
willpower decreases. Certain behaviours are more addictive than are others.
Measuring Results in Social and Behaviour Change Communication Programming
36
SEM level Factors & Dimensions19
Individual +
interpersonal +
individual service
provider
Present bias: People generally favour a smaller gain in the short term over a larger
gain in the future, sometimes even consciously when considering trade-offs. We
overvalue immediate rewards, which impairs our ability to make decisions to pursue
longer-term interests that would benefit us more. This has multiple consequences,
including the need to create small, rapid gains for people in the process of making a
greater change in behaviour with bigger rewards – this serves to bring aspects of the
future benefit closer to the present.
Individual +
interpersonal +
individual service
provider
Procrastination: We can be as good at delaying positive actions as we are at
indulging sudden negative impulses (‘today is not the right day, there is still time’).
Delaying decisions can be explained by the desire to use the present for more
satisfying actions, or by the complexity of making a change. In both cases, our
emotions rule and we forget about the longer-term plan, despite the cost of delayed
action. Magnifying the consequences of action or inaction with regard to what will
happen to our future selves is a classic programmatic response to this problem.
Individual +
interpersonal +
individual service
provider
Hassle factors: This term refers to minor inconveniences that prevent people from
acting. A step may require a little time, paperwork to complete, or a small investment;
these are perceived as major complications that can disproportionately prevent us
from acting.
Individual +
interpersonal +
individual service
provider
Habits and status quo: The default option for humans is usually the status quo.
We often feel more comfortable in a set routine, find inaction easier, feel overly
positive about a choice made previously, and are averse to change because it can be
risky. Many of these feelings will drive us towards inertia even if it is not in our best
interest. Moreover, a significant portion of our lives is habitual, and related actions
are often automatic and driven by specific parts of the brain, are associated with a
context or a moment or follow a ritual, and the specific purpose of these actions loses
importance. Introducing novelty into these mental patterns does not occur without
friction and disruption.
Individual +
interpersonal +
individual service
provider
Heuristics: Heuristics are cognitive shortcuts or rules of thumb that simplify
decisions. They are often grounded in cognitive biases similar to those our brains
use to filter information (see cognitive biases), and make questions easier to answer.
Since making a choice can be difficult and requires effort, we use our intuition, make
guesses, stereotype, or use what we describe as ‘common sense’ to avoid decision
fatigue.
Individual +
interpersonal +
individual service
provider
Inconsistent commitment: Behavioural consistency tends to make us feel
compelled to adhere to a decision we have made, and to continue to engage in
associated actions to maintain a positive self-image. Inconsistency can result in
negative feelings towards ourselves. Nevertheless, our commitment may weaken
for several reasons, including insufficient willpower, opposition from other people,
or the low cost of breaking the commitment. The existence of a more public, official
commitment often supports continuity.
Individual +
interpersonal +
individual service
provider
Decision context / frame: The context in which a decision is made (including
the physical place), as well as the way a decision is framed (how the options are
presented), has a strong influence on the choice of a course of action, regardless
of a rational analysis of these options. This concept is often referred to as ‘choice
architecture’.
37
Intent: The readiness to change is the core factor of the framework. When an individual is no longer reluctant to
try the new practice and, more importantly, is willing to try it, the likelihood of change increases. However, for
this intent to be converted into action, external and social factors have to be aligned in a supportive way.
Individual +
interpersonal +
individual service
provider
Contemplation: This is the stage at which the person is conscious of both the
problem and the option to change and is considering switching to the new practice,
but has not yet taken action.
Individual +
interpersonal +
individual service
provider
Experiment: This is when an individual is taking action and experimenting with
the new practice; it entails a change of behaviour in the short term, and the risk of
abandoning it.
Individual +
interpersonal +
individual service
provider
Relapse: This is when the person returns to the previous practice.
Individual +
interpersonal +
individual service
provider
Celebrations, praising, ritualisation, public commitment / social recognition /
community respect: Events and actions to celebrate successes and cultivate pride
(such as public pledges) are important because they help to create trust amongst
participants, and provide opportunities for others to adopt the change. New and
positive behaviours need to be practiced to become usual or normative. These
rewards are important to ensure that the social context is supportive and reinforces
individual choices.
5.1.2 Sociological drivers
SEM level Factors & Dimensions20
Social influence and social norms: Individual behaviours and decision making are often driven by social
factors. People are almost never fully autonomous thinkers, but are influenced by, and concerned about others’
opinions and actions. We act as members of groups. How supportive a social environment is of individual
change will sometimes condition its very possibility, particularly (but not only) when social norms are at play.
Social norms are informal group rules influenced by the beliefs that members hold about what others in the
group do and approve. Even in the absence of sanctions, which are central to social norms, such beliefs usually
also exist and influence individual practices.
Interpersonal /
Community / Service
providers’ community
Reference network’s attitude and practice: Social influence is based on the
attitudes and behaviours of those whose opinions we value, whom we consult
regarding certain issues, and those whose perceptions of us are important.
Members of this ‘’reference network’’ include peers about whom we care, as well
as influencers and gatekeepers who exert some form of power over us. People tend
to imitate the behaviours of their reference network frequently, and sometimes
automatically.
Interpersonal /
Community / Service
providers’ community
Normative expectations / injunctive norms (approved behaviours): The set of
behaviours for which a person will receive social support. In social norm terminology,
a normative expectation is what an individual thinks others in her/his group will
approve (what she/he believes others think she/he should do).
SEM level Factors & Dimensions19
20 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
Measuring Results in Social and Behaviour Change Communication Programming
38
Interpersonal /
Community / Service
providers’ community
Empirical expectations / descriptive norms (believed typical practice): The set
of behaviours that people perceive to be most common. In social norm terminology,
an empirical expectation is what an individual thinks others in his or her reference
group do. This is often the basis of misconceptions. There might be a silent majority of
people disapproving of certain practices but still complying with them based on social
misbeliefs (this discrepancy between the majority of individual attitudes and practice
is called ‘’pluralistic ignorance’’).
Interpersonal /
Community / Service
providers’ community
Social pressure rewards, sanctions, sensitivity, exceptions: Social norms exist
because of the consequences of behaving in certain ways (anticipated opinion or
reaction of others). What defines a norm is the social ‘’obligation’’ underlying it, or the
fact that people believe that compliance will condition their acceptance or rejection
by the group. On the negative side, sanctions can take many forms, such as stigma,
avoidance, insults, violence, exile, and the like. The sensitivity to sanctions is also
an important element in defining how strong the norms are. Exceptions are sets of
circumstances under which acting counter to the norm would be acceptable.
Interpersonal /
Community / Service
providers’ community
Sensitivity to social influence: This reflects the level of a person’s autonomy. In a
similar social environment, individuals are affected differently by the pressure exerted
by the group.
Interpersonal /
Community / Service
providers’ community
Stigma and discrimination / Societal views of minorities: The negative and/or
incorrect collective views and beliefs regarding certain groups of people strongly
condition their practices and the majority’s behaviour towards them, often for the
worst, leading to rejection and deprivation; for example, in rearing practices for
children with disabilities.
Meta-norms: Meta-norms are underlying ideologies and unwritten rules that are deeply entrenched in people’s
cultures and identities, and which cut across sectors and condition a large number of behaviours. The term
‘meta-norm’ was coined by Robert Axelrod specifically to designate the fact that there is an upper norm ruling
the fact that transgressors of lower-level norms are punished; in other words, a norm about norms. These meta-
norms have a strong and direct influence on individual drivers (for example, a person’s attitude or self-efficacy),
as well as an indirect one as they are expressed through several derivative social norms and practices (such
as gender inequity and patriarchy expressed through FGM, gender-based violence (GBV), child marriage, and
so on), and structural elements (such as gender ideologies and power differentials institutionalised in laws and
systems) (BDM definition).
Interpersonal /
Community / Service
providers’ community
Socialization: The process of learning to behave in a way that is acceptable to the
group based on societal beliefs, values, attitudes, and examples, through which
norms are learned and internalised by individuals. An individual’s acquisition of
habits, whether positive or negative, is due to their exposure to models that display
certain traits when solving problems and coping with the world. Early gender
socialization starts at birth and it is a process of learning cultural roles according to
one’s sex. Right from the beginning, boys and girls are treated differently and learn
the differences between boys and girls, women and men. Parents & families are
the initial agents who affect the formation of behaviours during childhood (children
are told how to dress, which activities are for them or not, what role they should
play as a boy or a girl, etc.). Peers are an additional source of influence during
adolescence and play a large role in solidifying socially accepted gender norms: boys
usually enforce toughness, competition and heterosexual prowess, whereas girls
are pressured around appearance, proper behaviour, and marriage with an emphasis
on their reproductive roles. Socialisation may also occur more passively through
role modelling: as a negative example, boys may adopt abusive behaviours after
witnessing intimate partner violence, or lose respect for their mother (and women)
after witnessing violence against her.
SEM level Factors & Dimensions20
39
Interpersonal /
Community / Service
providers’ community
Gender inequity / Gender dynamics: Many protection issues are associated with
the power and roles of men and women in society and in households, including male
authority over women, and men’s desire to control women’s sexuality. Manhood and
masculinity are used as justifications for different forms of violent behaviours. Girls
and women are considered vulnerable and thus need to be protected, which often
translates into less access to education, restrictions to travelling, and higher rates of
unemployment. Gender discrimination has deep roots and is perpetuated by leaders
and communities; it can result in behaviours related to domestic violence, sexual
harassment and abuse, early marriage, FGM and trafficking.
Interpersonal /
Community / Service
providers’ community
Decision-making patterns: How and by whom a course of action is selected in a
family or a community will have a significant impact on people’s options for alternative
behaviours. These processes can be complex depending on who voices opinions,
is consulted and valued, can oppose a decision, and who makes the final call. Older
family members can play a significant role in certain issues. In most of the Middle
East and North Africa, the preservation of the family’s reputation is seen as the
responsibility of the man; however, as the women’s honour is tied directly to the
family’s honour, it is considered the men’s right to make important decisions about
women’s lives, including controlling their female relatives’ access to the outside
world.
Interpersonal /
Community / Service
providers’ community
Family roles and relationships: Social norms related to what it means to be a
mother or a father, and to how spouses communicate between themselves and
interact with their children, are key drivers of a number of behaviours, particularly
parenting practices and the provision of care, household chores and financial
responsibilities, among others. These also impact girls and boys differently.
Interpersonal /
Community / Service
providers’ community
Conflict resolution: Typical ways of resolving family disagreements, ranging from
listening and attempting to reach a common understanding to practices of coercion.
Interpersonal /
Community / Service
providers’ community
Perception of the child: Different societies will have different perceptions of when a
human being starts and stops being considered a child, and what this means in terms
of her/his rights. This drives a number of practices at different stages of the life cycle.
Interpersonal /
Community / Service
providers’ community
Legal compliance: The enforcement of laws and regulations does not rely on
solely formal organisms, as respect for these rules requires a social norm of
legal obedience. If the belief that nobody respects the law is widespread, legal
disobedience might be the norm
Community dynamic: Community dialogue and collective action are key processes to produce change within
a community. Members of a community taking action collectively to address a common problem and improve
their lives will be a critical condition for success when the issues involved are social (in particular, driven by
social norms). The success of such processes also increases the community’s collective capacity to solve future
problems. The existence of such a dynamic (shared recognition of a problem with on-going collective discussion
or action), or the collective capacity to engage in it in its absence, are critical conditions for social change.
Interpersonal /
Community / Service
providers’ community
Collective self-efficacy: The confidence of community members that they can
succeed together. This includes the perceived capability of other community
members.
Interpersonal /
Community / Service
providers’ community
Sense of ownership: The degree to which community members think the problem
is important, perceive themselves as contributing to and being responsible for the
success of the collective change, and to which they think they will benefit from the
results.
SEM level Factors & Dimensions20
Measuring Results in Social and Behaviour Change Communication Programming
40
Interpersonal /
Community / Service
providers’ community
Social cohesion / social closeness: This refers to the sense of belonging and feeling
part of the group, the extent to which community members want to cooperate
to resolve collective issues, the level of interconnection of community members
(density of the social network), the level of division into factions, and the level of trust
in other members.
Interpersonal /
Community / Service
providers’ community
Equity of participation: The degree to which marginalised members of the
community (women, poor, ethnic groups, the youth and the elderly) can access
spaces in which issues are discussed, speak up and be involved in decision making.
Interpersonal /
Community / Service
providers’ community
Quality of leadership: The existence of effective leadership is necessary to steer the
group in the right direction and sustain the process. A ‘’good’’ leader will be popular
and trusted, will be supportive of dialogue and change, will be innovative, and will
foster inclusion.
5.1.3 Environmental drivers
SEM level Factors & Dimensions21
Communication environment: The information, opinions, arguments and stories to which we are exposed
play a significant role in shaping our attitudes and interests, as well as our behaviours in the longer term. This
communication environment is formed by multiple channels and sources. Theories and analyses have proved the
influence of mass and social media on many aspects of our lives, but our views and beliefs are also conditioned
by other sources such as the films we watch, the songs to which we listen, or the word on the street (BDM
definition).
Institutional (media) Factual and scientific information: The availability, accessibility and dissemination of
accurate and unbiased knowledge about the issue and practices at hand; this entails
understandable evidence being conveyed without feelings or opinions about it being
expressed.
Institutional (media) Media agenda and narrative: The way media outlets determine what is newsworthy,
and how the facts and stories will be framed to cover a given topic. Narratives are
rarely neutral, and influence the audience’s attitude considerably.
Interpersonal +
community +
institutional (media)
Social media: Social media is an unpredictable and unregulated space in which
the audience is not in a passive position, but is also a content creator, and users
can interact and collaborate with each other. Contrary to the ‘’mainstream media’’,
authoritative voices, previously unknown and sometimes without proven expertise,
can emerge organically and generate powerful opinion trends and groups. Opinions
relayed on social media fall within an individual’s own social network (a group of
individuals within the user’s ‘’bubble’’, which can distort the perception of what is the
most prevalent opinion).
Institutional (media) +
service providers from
private sector
Marketing brand messaging: Companies promote messages and ideas in favour of
their economic success, and campaign to create more appeal. The most popular and
trusted brands, with large audiences and which benefit from a positive image, can
have a dramatic influence the way consumers perceive certain products, ideas and
situations, thus changing their decisions and behaviours in the long term.
Community +
institutional + policy
Public figures, public discourse: The messages most commonly spread in the
communication environment, on-going public debates, and the positions of people
who have a significant effect on influencing the opinions of the general public.
21 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
SEM level Factors & Dimensions20
Communication for Development Monitoring and Evaluation Framework
Communication for Development Monitoring and Evaluation Framework
Communication for Development Monitoring and Evaluation Framework
Communication for Development Monitoring and Evaluation Framework
Communication for Development Monitoring and Evaluation Framework
Communication for Development Monitoring and Evaluation Framework

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Communication for Development Monitoring and Evaluation Framework

  • 1. a UNICEF EASTERN AND SOUTHERN AFRICA REGIONAL OFFICE Measuring Results in Social and Behaviour Change Communication Programming October 2020
  • 2. Measuring Results in Social and Behaviour Change Communication Programming Table of contents Acronyms and abbreviations i 1 Introduction 1 2 Understanding Social and Behaviour Change communication 3 2.1 The Behavioural Drivers Model 3 2.2 The Journey to Health and Immunization 5 3 Result based management 13 3.1 Context and situation analysis 13 3.2 Causal analysis 14 3.3 Prioritization 15 3.4 Definition of priority results 15 3.5 How to formulate SBCC results and indicators: 18 3.5.1 Impact-level results and indicators 19 3.5.2 Outcome-level SBCC results and indicators 19 3.5.3 Intermediate outcome-level SBCC results and indicators 21 3.5.4 Output-level SBCC indicators 22 4 How to use the indicator lists 25 5 Appendices 29 5.1 Appendix 1: Definitions of behavioural determinants 29 5.1.1 Psychological drivers 29 5.1.2 Sociological drivers 37 5.1.3 Environmental drivers 40 5.2 Appendix 2: Exhaustive list of SBCC indicators 43 Cover Photo: © UNICEF/UN036248/Rich
  • 3. i Acronyms and abbreviations AEFI Adverse Effects Following Immunization ANC Antenatal care BDM Behavioural Drivers Model BI Behavioural Insights C4D Communication for development DHS Demographic and Health Surveys EMIS Education Management Information System EPI Expanded Programme on Immunization ESA Eastern and Southern Africa ESAR Eastern and Southern Africa Region ESARO Eastern and Southern Africa Regional Office FGM/C Female Genital Mutilation / Cutting HCD Human-Centered Design IDP Internally Displaced Persons KAP Knowledge, Attitude, Practice MENA Middle East and Northern Africa MICS Multiple Indicator Cluster Surveys MoRES Monitoring Results Equity System RBM Result-based management SBCC Social and Behaviour Change Communication SEM Socio-Ecological Model SitAn Situation Analysis SMART Strategic, Measurable, Achievable, Relevant, Time-bound SMARTER Strategic, Measurable, Aligned, Realistic, Transformative, Empowering, Reportable ToC Theory of Change TT Tetanus toxoid
  • 4. Measuring Results in Social and Behaviour Change Communication Programming ii Measuring Results in Social and Behaviour Change Communication Programming ii © UNICEF/UN0162343/Tremeau
  • 5. 1 1 Introduction The purpose of this document is to provide some basic guidelines for the measurement of results associated with Social and Behavioural Change Communication (SBCC) programming. In fact, both the 2016 Global C4D Evaluation1 and the 2019 Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern and Southern Africa Region (ESAR)2 stressed that having clearly articulated results in both Communication for Development (C4D) and sectors’ strategic plans and frameworks remains one of the main SBCC-related challenges. While most Eastern and Southern African (ESA) countries have formulated indicators in their SBCC3 strategies, there is often a disconnect between the level of change formulated in the result statement and the indicators identified to capture the change: “As currently formulated, the indicators can only measure progress at activity level, but cannot capture change at output or outcome-level to reflect progress in knowledge, attitudes, intent and/ or skills that would support the adoption of targeted practices. ”4 Monitoring is a key component of Result-Based Management (RBM), and provides an opportunity to track the implementation status, to collect evidence of change (or the lack thereof) and to measure the quality of the results of an initiative, project or programme. Monitoring allows managers to adjust interventions continuously and to improve results through an iterative process supported by credible, evidence-based information. Therefore, as part of the session of the 2019 ESAR UNICEF Deputy Representatives’ meeting regarding the Focus on communication for development to accelerate shifts in social norms, behaviours and practices, it was decided to design an Eastern and Southern Africa Regional Results-Based Management framework with an integrated SBCC component. The present document intends to provide guidance for measuring SBCC results by taking the most recently available UNICEF SBCC guidance documents into consideration, such as the Behavioural Drivers Model (BDM), the social norms programming guide Everybody wants to belong, and the Journey to Health and Immunisation framework.5 The intended audience for these guidelines is UNICEF Country Offices’ C4D programme sector and monitoring and evaluation staff who are active in the design and implementation of the country’s programme cycle, state and non-state partners involved in the design and implementation of SBCC programmes, and those involved in the monitoring and evaluation of SBCC interventions. The Measuring Results in Social and Behaviour Change Communization Programming document was developed by Dominique Thaly, international C4D consultant recruited by UNICEF ESARO and reviewed by Natalie Fol, Helena Ballester Bon and Massimiliano Sani from the ESARO C4D team. 1 UNICEF (2016), Communication for Development: An evaluation of UNICEF’s Capacity and Action. September 2016. Evaluation office. 2 UNICEF ESARO (2019), Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern and Southern Africa Region. 3 SBCC will be used in place of C4D when not referencing specific UNICEF C4D staff and interventions 4 UNICEF ESARO (2019), Diagnostic Assessment of C4D Programming and Operational Structures in the Eastern and Southern Africa Region. 5 UNICEF (2019), Everybody wants to Belong. A practical guide to tackling and leveraging social norms in behaviour change programming. UNICEF / Petit, V. (2019), The behavioural drivers model: A conceptual Framework for Social and Behaviour Change Programming. UNICEF (2019), Draft C4D Programming Guidance. UNICEF (2018), The Journey to Health and Immunization Framework.
  • 6. Measuring Results in Social and Behaviour Change Communication Programming 2 Measuring Results in Social and Behaviour Change Communication Programming 2 © UNICEF/UN056980/Ose
  • 7. 3 2 Understanding Social and Behaviour Change Communication 2.1 The Behavioural Drivers Model Evidence show that providing individuals with the right information will rarely automatically translate into optimal choice. People are highly emotional and influenced by their environment, by those who matter to them, and by others they interact with. What is happening around a person matters as much as what she thinks herself (Petit, V., BDM 2019). Therefore, SBCC strategies and interventions that focus merely on increasing the participant’s knowledge and awareness of certain practices tend not to be effective if not complemented with other interventions. To bring multiple perspectives on decision-making and behavioural theories and models together, UNICEF has developed the Behavioural Drivers Model (BDM). The BDM starts by asking the fundamental question: Why do people do what they do? According to this model, all behavioural drivers fall into three main categories: 1. Psychology, gathering individual cognitive and emotional drivers; 2. Sociology, for determinants related to interactions within families, communities, groups and society at large; 3. Environment, for structural elements such as institutions, policies, systems and services, infrastructures, information, etc. Figure 1:The Behavioural Drivers Model (Petit,V. BDM 2019) 6 For definitions of factors and dimensions, see Petit, V. BDM 2019. Under each category, the drivers are organized according to two levels of depth:6 - Level 1 drivers: the higher-level or main drivers, which are called factors; - Level 2 drivers: each factor is unpacked into several dimensions of which it is composed. What drives a behaviour? PSYCHOLOGY SOCIOLOGY ENVIRONMENT
  • 8. Measuring Results in Social and Behaviour Change Communication Programming 4 Figure 2: Main behavioural factors and corresponding dimensions (level 1 drivers) (Petit,V. BDM 2019) Table 1: Dimensions composing each main driver. (UNICEF 2019, Everybody wants to belong) Factors (Level 1) Dimensions (Level 2) Personal characteristics Age, gender, lifecycle stage, social status, education, household composition, income / poverty level, religious affiliation, lifestyle, physiological attributes, alcohol / drug use, disorders. Cognitive biaises Information avoidance; Availability heuristic; Anchoring; Messenger effect; Confirmation and belief bias; Simplicity bias; Recency bias; Optimism bias; Representativeness heuristic; Cognitive dissonance; Memory bias. Interest Attention; Doability; Enjoyment; Potential gains; Perceived risks; Efforts needed; Affordability; Appeal; Desire. Attitude Awareness and Knowledge; Beliefs; Aspirations; Values; Intuitions; Past experience; Emotions; Mindset. Self-efficacy Agency; Emotional well-being; physical capacity; Skills; Confidence; Self-image; Stress level; Fatigue; Support; Social mobility; Decision autonomy; Emotional intelligence. Limited rationality Self-control / Willpower; Present bias; Procrastination; Hassle factors; Habits and status quo; Heuristics; Inconsistent commitment; Decision context/frame. Communication environment Factual & scientific information; Media agenda and narrative; Social media; Marketing, brands messaging; Public discourse and figures; Entertainment industry; Exposure; Word of mouth.
  • 9. 5 Factors (Level 1) Dimensions (Level 2) Emerging alternatives Opinion trends; Social movements; Innovations and opportunities; Publicised change and stories; Positive deviants Social influence & Social norms Reference network’s attitudes and practices; Approved behaviours – normative expectations; Believed typical practices – empirical expectations; Social pressure – rewards, sanctions, exceptions; Stigma and discrimination / societal views on minorities; Sensitivity to social influence. Meta-norms Socialization process; Gender ideologies; Power dynamics; Decision-making patterns; Family roles and relationships; Conflict resolution; Perception of the Child, moral norms, legal compliance. Community dynamic Collective self-efficacy; Sense of ownership; Social Cohesion; Equity of participation; Quality of leadership. Governing entities Recognition of the issue; Policies and regulations; Enforcement & Security apparatus; Fiscal measures; Grievances against authorities; Religious institutions; Educational system; Voice and participation. Intent Contemplation; Experiment; Relapse; Celebration, praising, ritualization, public commitment; Advocating. Structural barriers Living conditions; Availability, access to and quality of services & technology; Trust in service providers; Cues to action; Traditional services; Infrastructure; Other external factors. Context Migration, displacement, emergency vs. development context, social / cultural and religious context, natural events and weather. 2.2 The Journey to Health and Immunization In areas such as health, education or child protection, in which the existence of a functional service delivery system is a precondition for the adoption of certain practices and behaviours, an examination of the specific enablers of and/or barriers to the demand, access to and uptake of services is crucial. The Journey to Health and Immunization programme is an overarching framework that includes elements of Behavioural Insights (BI) and Human-Centred Design (HCD) in an attempt to rationalize a large variety of barriers and drivers that both caregivers and health workers encounter along their journeys to health and immunisation (more information is available at https://www.hcd4health.org). Challenges of demand pertain to decision making and action taking. Drivers and barriers to action can influence caregivers in terms of whether they bring their children to health facilities, seek health services, and return to the health facilities. Therefore, we need to acknowledge the complexity of the demand-service interactions to understand the human factors and contexts pertaining to the challenges associated with the acceptability, appropriateness, responsiveness and perceived quality of services.
  • 10. Measuring Results in Social and Behaviour Change Communication Programming 6 This model can also be applied to any sector in which the demand-service interaction plays a relevant role. The framework places the child and his/her caregiver at the centre, covering all steps of the demand-service loop using a life-cycle approach, from the child pre-conception (e.g.: mother attending all recommended ANC consultations) to the reproductive age of the child (e.g.: adolescent pregnancies). Figure 3:The journey to health and immunization framework, UNICEF 2018 As one can see from the figure above, psychological factors and dimensions as well as elements relative to sociology or environment, like norms and values, social support and recognition, community respect and trust play a crucial role both from the caregiver’s and the service provider’s point of view.
  • 11. 7 The table bellow illustrates how the BDM and the Journey to Health and Immunization are linked. The L2 dimensions in red are considered as high priority drivers. Table 2: Links betweenThe journey to health and immunization framework and the Behavioural Drivers Model Steps along the Journey Desired skills or behaviours along the Journey Associated BDM L1 Factors / Outcomes Associated BDM L2 Dimensions / Output 1. Knowledge, awareness and belief CAREGIVERS 1.1.a Have practical knowledge N/A Awareness & Knowledge Exposure Marketing, brand, messaging Collective self-efficacy Social cohesion 1.2.a. Understand the value of vaccination Attitude Awareness & Knowledge Potential gains Information avoidance Beliefs Values 1.3.a. Perceive vaccination positively Attitude Public figures, public discourse Communication environment Social media Heuristics 1.4.a. Perceive vaccination as a priority Attitude Opinion trends Governing entities Religious institutions Attitude Moral norms 1.5.a. Do not fear side effects Attitude Beliefs 1.6.a. Trust vaccines Self-Efficacy (or attitude) Beliefs Past experience 1.7 .a. Trust providers Trust in service provider Past experience Personal characteristics Messenger effect 18.a Trust Governing entities Governing entities Grievances against authorities Legal compliance Messenger effect Beliefs PROVIDERS 1.1.b. Have practical competencies Self-efficacy Policy and regulation Marketing, brand, messaging 1.2.b. Have positive norms and values towards immunization Attitude Beliefs Values Perceived risk 1.3.b. Have a positive perception of clients Attitude Perception of the child
  • 12. Measuring Results in Social and Behaviour Change Communication Programming 8 2. Intent CAREGIVERS 2.1.a. Intend to vaccinate their children Intent Feasibility Perceived risk Fatigue Gender ideologies Family roles and relationships 2.2.a. Report vaccination as a social norm in their community Social influence and social norms Reference network's attitudes and practices Injunctive norm / normative expectation Descriptive norm / empirical expectation Quality of leadership PROVIDERS 2.1.b Are motivated by the work Interest Social cohesion Policies and regulations Perceived risks 3. Preparation, cost and effort CAREGIVERS 3.1.a. Make a plan to access the service Self-efficacy Confidence 3.2.a. Take the time and effort to access the service Self-efficacy Agency Decision autonomy / Power dynamics Support Perceived risks Efforts needed Fiscal measures and incentives PROVIDERS 3.1.b. Make a plan to get to the vaccination site Self-efficacy Efforts needed Policies and regulations 4. Point of service CAREGIVERS 4.1.a. Find the services to be available, appropriate, convenient and of adequate technical quality Structural barriers Availability, access to and quality of services Interest Traditional services Decision context and frame (Ref. opt-in v/s opt-out) PROVIDERS 4.1.b. Receive adequate training, job aids and non-threatening supportive supervision Governing entities Recognition of the issue 4.2.b. Are satisfied with the workload and the facility flow Governing entities Policies and regulations Steps along the Journey Desired skills or behaviours along the Journey Associated BDM L1 Factors / Outcomes Associated BDM L2 Dimensions / Output
  • 13. 9 4.3.c Involve communities in the development of micro plans Community dynamics Equity of participation 5. Experience of care CAREGIVERS 5.1.a. Perceive the experience positively Structural barriers Past experience Availability, access to and quality of services Equity of participation PROVIDERS 5.1.b. Feel technically confident to provide a positive client experience Self-efficacy Ref. 1.1.b 5.2.b. Have an appropriate profile Trust in service provider Ref 1.7 .a CAREGIVERS 6.1.a. Have enough information and motivation to come back for the next visit Ref. steps 1 and 2 Ref. steps 1 and 2 6.2.a. Share their positive experience with their community Emerging alternatives Publicized change stories / Positive deviants 6.3.a. Reinforce vaccination as a social norm Social influence and social norms Ref 2.1 b 6.4.a. Are able to provide their feedback on the vaccination service Governing entities Voice and participation Policies and regulations PROVIDERS 6.1.b. Obtain family and community respect Community dynamics Celebration, praising 6.2.b. Prompt caregivers to come to the next session Self-efficacy Cues to action 6.2.c. Inform caregivers about possible AEFI, how to manage them and when and how to report them Structural barriers Ref to 1.1 b Steps along the Journey Desired skills or behaviours along the Journey Associated BDM L1 Factors / Outcomes Associated BDM L2 Dimensions / Output
  • 14. Measuring Results in Social and Behaviour Change Communication Programming 10 Illustrative examples extracted from a 2019 assessment of immunization services and delivery in three major urban Somali cities will help getting a better sense of the some of the existing challenges in ESAR: Steps Description Examples 1. Knowledge, attitudes, practices and belief Caregivers: • Have practical knowledge (when and where to go, vaccination schedule, etc.) • Understand the value of vaccination • Perceive vaccination positively • Perceive vaccination as a priority • Do not fear side effects • Trust vaccines • Trust providers • Trust Governing entities Providers: • Have practical competencies • Have positive norms and values towards immunization • Have a positive perception of clients • Poor antenatal care (ANC) practices and a history of poor access to TT vaccinations during pregnancy • Mother’s poor knowledge and awareness of vaccinations, their purpose, and their benefits • Mistrust of health centers • Immunization associated with infertility and diseases • Providers not trained in interpersonal communication and community engagement • Providers perceiving caregivers belonging to informal urban settlement as “ignorant” 2. Intent Caregivers: • Intend to vaccinate their children (decision- making power, self-efficacy) • Report vaccination as a social norm in their community Providers: • Are motivated by the work • Father’s refusal hampered mothers decision-making power • Divorced mothers were more likely to complete their child’s vaccination schedule • Traditional ritual: newborns are confined at home for 40 days to prevent infections and bad eye • Role of traditional, female, and religious leaders hampering or supporting immunization uptake • Providers not motivated to go to work because of delays in the payment of their salaries 3. Preparation, cost and effort Caregivers: • Make a plan to access the service (transport, childcare, competing priorities, social and opportunity costs) • Take the time and effort to access the service Providers: • Make a plan to get to the vaccination site (preparing, getting to the clinic or vaccination site, opportunity costs) • Women often searching for reliable sources of income and food when vaccination session was scheduled. • IDPs cannot afford paying for transportation to facilities. • Providers unbale to plan to get to the vaccination site due to lack of transport
  • 15. 11 4. Point of service Caregivers: • Find the services to be available, appropriate, convenient and of adequate technical quality (service hours, social distance, waiting time) Providers: • Receive adequate training, job aids and non- threatening supportive supervision • Are satisfied with the workload and the facility flow • Involve communities in the development of micro-plans • Limited opening hours of health facilities • EPI programs associated with outsiders and foreigners. • IDP mothers would like to be treated by female community health workers. • Large number of children coming to health facilities did not have vaccination cards. • Providers unable to provide quality vaccination services due to the high number of clients per provider • Providers not receiving non-threatening supportive supervision 5. Experience of care Caregivers: • Perceive the experience positively (treatment by health workers, physical conditions, use of home-based records, client satisfaction) Providers: • Feel technically confident to provide a positive client experience (Interpersonal communication skills, trust building, pain mitigation, training and experience, social distance) • Have an appropriate profile • Negative healthcare worker attitudes, health staff were unwelcoming. • Providers are too busy to explain procedures • Long waiting time • Providers are not from the same community as caregivers and therefore perceived as outsiders • It would be socially acceptable for a mother to interact with woman providers but all providers are men 6. After service Caregivers: • Have enough information and motivation to come back for the next visit • Share their positive experience with their community • Reinforce vaccination as a social norm • Are able to provide their feedback on the vaccination service Providers: • Obtain family and community respect • Prompt caregivers to come to the next session • Inform caregivers about possible AEFI, how to manage them and when and how to report them • IDPs would like to get information about upcoming services to IDP community days before immunization sessions • Poor information on side effects increases fear of vaccinations • Providers do not tell caregivers when and where to bring the child to the next vaccination session Traditional SBCC interventions tend to focus on steps Knowledge, awareness and beliefs and Intent, mainly through communication campaigns and the development of communication materials. However, as we can see in the example above, barriers are present throughout the Journey. Steps Description Examples
  • 16. Measuring Results in Social and Behaviour Change Communication Programming 12 Measuring Results in Social and Behaviour Change Communication Programming 12 © UNICEF/UN052547/Ayene
  • 17. 13 3 Result based management Results Based Management (RBM) is a management strategy based on clearly defined accountability for results, monitoring and self-evaluation. These traits are represented in the cycle illustrated in Figure 4.7 RBM involves analysing the context, prioritizing based on this information and planning accordingly, implementing the plan, monitoring and evaluating results, and learning from the outcomes of the monitoring and evaluation to adjust the plans. The cycle iterates again, gradually approximating the results to more ambitious outcomes. The same approach also applies to define the results for SBCC programming. In this case, the context and situation analysis will help identify the key drivers of a specific behaviour or practice and the strategic prioritization and planning phase will help define the key interventions to be implemented. Indicators developed around key drivers will be monitored through baseline surveys and regular subsequent surveys in the course of programme and/or implementation. This paper will focus specifically on the context and situation analysis, the strategic prioritization and planning, as well as the monitoring and evaluation stages of the RBM, as the main avenues for the definition, prioritization and monitoring of SBCC indicators. Figure 4: RBM Cycle 7 For more information on UNICEF RBM, see online course https://agora.unicef.org/course/info.php?id=3169 8 More information on how to conduct a context and situation analysis can be found in UNICEF MENARO (2018), Everybody wants to belong. Practical guide for social norms programming; UNICEF MENA (2018), Measuring social and behavioural drivers of child protection issues. Human-Centred Design formative research process https://www.hcd4health.org/process; and Implementation research in Health 3.1 Context and situation analysis8 The purpose of the context and situation analysis is to identify the main drivers and dimensions of individual behaviours, as well as the environmental- and social determinants-related barriers both in terms of supply and demand for specific services. This stage should provide information on bottlenecks and drivers related to the priority behaviours to be promoted, the analysis of social and behavioural determinants, the demand of relevant services and convenience and quality of the offer. Likewise, the context and situation analysis should provide facts on the range of key influencers, available C4D platforms, preferred communication modalities, existing media environment, and identification of research gaps. The context and situation analysis should be done through a literature review, and, if need be, formative research. As a full-scale socio-anthropological study might not always be doable due to limited finances and time, it is important to rely on available qualitative research done by UNICEF , other donors organisations or in universities. If additional qualitative data need to be collected, it is better to do it on a number of limited geographic areas where the program is likely to start. Strategic prioritization and planning Implementation Context and Situation analysis Learning and adjustment Monitoring Evaluation and Reporting
  • 18. Measuring Results in Social and Behaviour Change Communication Programming 14 3.2 Causal analysis Usually, the causal analysis is undertaken using the problem tree exercise, which is an effective means for identifying the optimal path to behavioural change, especially when a behaviour has multiple determinants (Petit, V., BDM 2019). The elaboration of a problem tree consists of a participatory exercise based on a statement indicating the problem and then asking, “Why is this happening?” . The first answer will usually reveal a symptom or several symptoms. The question is asked again and again until the root cause of the problem is revealed. Causality enables us to analyse and explore who is most affected by a problem, how widespread the problem is and why that is happening. A causal analysis allows for different streams of a problem to be examined in-depth. Causes are not linear but are often a complex interaction of multiple streams that reinforce each other. More immediate causes are often easier to address, while more structural causes are more difficult and often longer-term but tend to provide more sustainable solutions and results.9 The results of this participatory situation analysis should be reflected in the strategic prioritization and planning stage. When undertaking the analysis in the context of an intervention entailing the demand-service loop (health, education, social protection, etc.), barriers and drivers could be categorized under each step of the Journey to Health and Immunization Framework (knowledge awareness and belief, intent, preparation cost and effect, point of service, experience of care, and after care) at individual, family, community, media environment, governance and systems levels. This categorization process will aid in the identification of high priority areas and information gaps to be addressed through deeper qualitative and/or quantitative research to ensure that programs develop interventions to overcome these barriers and support desired behaviours. A recommended technique to undertake deeper qualitative research is HCD investigation—a problem-driven, iterative process that begins with understanding the human factors, programme context, and challenges associated with the acceptability, appropriateness, responsiveness and perceived quality of services; this technique requires working directly with the people who use the service or deliver the solution to develop new ideas that are viable and appropriate in their context.10 Figure 5: Problem tree methodology (RBM Workshop, ESARO, 2016) 9 RBM Workshop, ESARO, 2016. 10 More information available at https://www.hcd4health.org Problem statement Therefore this happens Therefore this happens Therefore this happens Therefore this happens Therefore this happens 1. Why is that happeing? 2. Why is that happeing? 3. Why is that happeing? 4. Why is that happeing? 5. Why is that happeing? Symptom Symptom Symptom Symptom Root cause
  • 19. 15 3.3 Prioritization11 As not all deprivations or drivers can be addressed by SBCC interventions through UNICEF , there is a need for prioritization. Prioritization helps UNICEF focus primarily and directly on certain aspects of the SBCC issues, the barriers and the drivers, their causes and consequences. It clarifies aspects considered within reach and capacity of SBCC to influence but beyond its focus and aspects that are out-of-scope of the SBCC programme. The items that are in scope will be turned into assumptions when developing the Theory of Change (ToC), while those out of scope will be recorded under risks. The prioritization process should be evidence-based, participatory and iterative. The prioritization exercise can be done after the problem analysis stage in order to prioritize issues that one wants to focus on, but it can also be done at the solution analysis stage to prioritize solutions one wants to implement. Figure 6: Prioritization of issues, adapted from RBM Workshop, ESARO, 2016 3.4 Definition of priority results Priority results will be defined by transforming the problem tree into a solution tree. To produce a solution tree, the problem statement is transformed into a positive statement. Then different layers of causes are also transformed into positive statements. Transforming cause statements into positive statements allows for the first step in the formulation of short-, mid- and long-term outcomes to be taken. Figure 7:Transforming a problem tree into a solution tree (RBM Workshop, ESARO, 2016) 11 See UNICEF (2017), Result-Based Management Handbook. Working together for children. Online, accessed on January, 15, 2020: https:// www.pndajk.gov.pk/uploadfiles/downloads/RBM_Handbook_Working_Together_for_Children_July_2017.pdf FOCUS FOCUS SCOPE Which aspects / drivers of the SBC problem, its causes and consequences will SBC focus on directly and primarily? Which aspects / drivers are beyond the focus and scope of the SBC programme? Which aspects / drivers are important and within reach and capacity of SBC programme to influence but beyond the focus of the SBC programme? ProblemTree SolutionTree/Outcome chain High prevalence of FGMC among children less that 15 years High prevalence of FGMC among children less that 15 years is reduced Families subject their children to FGMC FGMC practitioners are known and available in the community FGMC Practice is passed from generation to generation Practice of FGM is interrupted Lack of enforcement of laws against FGMC Laws against FGMC are enforced FGMC is a social norm FGMC is no longer a social norm FGMC practitioners are not available in the community Socil and financial cost of FGMC is low Socil and financial cost of FGMC is high Lack of awareness of health and human rights consequences of FGMC Families understand health and human rights consequences of FGMC Community values FGMC and links to marriage-ability Community rejects FGMC and sanctions families that undertake FGM Families do not subject their children to FGMC
  • 20. Measuring Results in Social and Behaviour Change Communication Programming 16 Each behaviour, factor and dimension identified during the strategic prioritization phase should be translated into at least one result: Behaviours to be reached will be identified as outcomes; Factors will constitute the intermediary outcomes; Dimensions will constitute outputs, and SBCC activities at each level of the socio-ecological model will constitute the inputs. Figure 8: Logical framework of SBCC interventions (adapted from Petit,V., BDM 2019) Indeed, an SBCC result chain adds an additional level compared to a regular UNICEF result chain: the intermediary outcomes. Figure 9: Comparing regular and SBCC hierarchy of results IMPACT IMPACT OUTCOME OUTCOME OUTPUT INTERMEDIATE OUTPUT OUTPUT Regular RBM: Hierachy of Results C4D/SBCC RBM: Hierachy of Results • Long term changes in the rights / deprivation / inequities in situation of children and women • Nationally owned • Long term changes in the rights / deprivation / inequities in situation of children and women • Nationally owned • Changes in behavior or performance of targeted institutions or individuals manifesting in coverage and equity of services / interventions • UNICEF contributes to these changes • Changes in behavior or performance of targeted institutions or individuals manifesting in coverage and equity of services / interventions • UNICEF contributes to these changes • Changes in capacity of individuals or institutions including new product, skills, abilities and services • Attributes to programme funds and management - therefore high degree of accountability • Changes in level 1 drivers or behavioral factors (psychological, sociological and environmental factors) driving the behaviour, i.e. changes in terms of building supportive social norms, social influence, overall community dynamic, but also participants attitudes, interest, self-efficacy and intent • UNICEF contributes to these changes • Changes level 2 drivers or behavioral dimensions, for example at community level, the improvement of collective recognition of the problem, the sense of ownership of the community process, the equity of participation in deliberations, etc. as well as change in capacities of individuals or institutions including new products, skills, abilities and services • Attributes to programme funds and management - therefore high degree of accountability
  • 21. 17 Table 4: Examples of SBCC logical framework for behaviour change linked to use of service and for adoption of a home-based practice. Result levels Use of a service: Adoption of a home-based practice: SBCC Outcome By year x, x% of pregnant women attend at least 4 ANC visits. By year x, x% of mothers of children under 6 months old breastfeed their babies exclusively for the first 6 months. SBCC Intermediate outcomes By year x, x% of respondent women of child-bearing age say that they have enough time and financial resources to attend at least 4 ANC visits during pregnancy. By year x, x% of respondent women of child-bearing age say that their husband is providing them support to access and attend at least 4 ANC visits. By year x, x% of respondent women of child-bearing age believe that they will be / are able to breastfeed their baby exclusively for the first six months. By year x, x% of respondent women of child-bearing age think that their mother- in-law or her husband expect them to breastfeed exclusively for the first 6 months. SBCC Output By year x, x% of respondent women of childbearing age know at least x advantages of attending the 4 ANC visits. By year x, x% of respondent women of childbearing age say they think that more than half of their friends attend at least 4 ANC visits. By year x, x% of respondent men of child- bearing age know how to support their wife in attending at least 4 ANC visits. By year x, x% of traditional birth attendants report encouraging mothers and fathers to attend at least 4 ANC visits. By year x, x% of respondent women of child-bearing age know that doing exclusively breastfeeding for the first 6 months without water is not harmful to their children. By year x, x% of women of child-bearing age know where they can get counselling for breastfeeding. By year x, x% of men of child-bearing age think their wife should practice exclusive breastfeeding for the first 6 months. In order to improve the quality of SBCC indicators, in 2018 UNICEF MENARO developed monitoring tools that aim at measuring social and behavioural drivers (factors and dimensions) and assisting country offices in collecting evidence of their programmes’ impact. The monitoring toolkit comprises a list of indicators for a number of pre-selected social and behavioural change drivers on three topics: female genital mutilation and cutting, child marriage and child discipline. It also includes generic quantitative surveys and questions based on the indicators12 . This package is currently being cognitively tested in 9 countries across MENA, WCA and ESA regions. In the present document, these results and indicators, that are mainly at micro level (individual and community), will be completed with results and indicators at institutional / meso level and policy / macro level. 12 For more information and list of indicators, questions and generic surveys: see UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
  • 22. Measuring Results in Social and Behaviour Change Communication Programming 18 3.5 How to formulate SBCC results and indicators A result is a describable or measurable change in state derived from a cause-and-effect relationship. There are two ways of formulating results13 either by putting the action verb upfront (e.g. Improved retention of female and male youth volunteers beyond high-school graduation) or in the middle (e.g. By 2022 more girls and boys in Country X complete quality and inclusive basic education with improved learning outcomes). Indicators are measures used to monitor progress made towards the achievement of intended results or the application of desired processes. An indicator is neutral, does not pre-judge or set targets, is therefore “empty of data” (RBM Workshop, ESARO, 2016). 13 RBM Workshop, ESARO, 2016 14 RBM Workshop, ESARO, 2016 15 RBM Workshop, ESARO, 2016 Example on how to formulate results and indicators (adapted from RBM Workshop, ESARO, 2016): • Result statement (at intermediate outcome level): By 2021, 80% of respondents think that FGM/C should be discontinued in their community • Indicator: % of respondents who think that FGM/C should be discontinued in their community • Baseline: 50% • TargetYear 1: 65% • Performance at the end ofYear 1: 67% of respondents Table 5: Principles and quality criteria for results and indicator Principles to formulate results14 Quality criteria for indicators15 • Clarity regarding the level: Output, intermediate- outcome, outcome or impact and, accountabilities. • SMARTER results: Strategic, Measurable, Aligned, Realistic, Transformative, Empowering, Reportable. • Coherent result chains: Applies the if-then logic; otherwise, asking the question so what between levels. • Uses change language: Places emphasis on the subject of change. • Considers equity, human rights, gender, determinants and risks. • Clear relationship with issues identified in the SitAn: Uses change language, that places emphasis on the subject of change. • Ratio of indicator to result: The number of indicators for each result should be kept to a minimum, preferably one to four, depending on the level of the result. • Level of indicator: The indicators should measure the result directly or be an obvious proxy. • Measurability of indicators: Indicators should be SMART – Specific, Measurable, Achievable, Relevant and Time-bound – with a clear unit of measurement and an operational output. • Quality of indicator: Baselines, targets and a reliable data source must be provided for the indicator.
  • 23. 19 The proposed indicators are formulated either in terms of number (Nb.) or as a ratio (%). When formulated as a ratio, the numerator is the number of [indicator definition] and the denominator is the total number of people interviewed. The ratio is calculated by dividing the numerator by the denominator and multiplying the result by 100. When necessary, the indicators can be disaggregated by age, religion, region, ethnicity, gender, wealth quintile, education, and so on. For example, in the indicator “% of respondents who say female genital mutilation (FGM)/C is not painful for the girls” , the numerator is the number of respondents who said that FGM/C was not painful for girls, and the denominator is the total number of people surveyed: 16 UNICEF (2019), Communication for Development Programme Guidance, Draft for Feedback only. x 100 [Numerator] number of respondents who say FGM/C is not painful for girls [Denominator] total number of people surveyed (respondents) 3.5.1 Impact-level results and indicators SBCC does not have impact-level results and indicators per se, since SBCC contributes to the achievement of sectoral results. Therefore, impact-level indicators relate to long-term changes in the rights / deprivations / inequities in the situation of children and women to which SBCC contributes. They are to be taken from UNICEF’s result framework and correspond to the respective sectoral impact-level indicator. Baseline, target, source of data and frequency are examples of information that are already available at programme level. For example, the reduction of maternal mortality is an impact-level result. 3.5.2 Outcome-level SBCC results and indicators Outcome-level results and indicators relate to changes in behaviour or performance of targeted institutions or individuals manifesting in coverage and equity of services / interventions. They relate to the adoption of or deterrence from certain practices by individuals, including service providers (in health, education, protection, etc.). They are mainly about behavioural prevalence; therefore, they are formulated with an active verb that describes a concrete action a specific type of person or a group of persons do or don’t or what a respondent reports of having seen or witnessed somebody else or a group of persons have done. Possible SBCC related outcome-level results are:16 • Increased demand for existing services • Adoption of key family and community practices • Abandonment of harmful social norms and behaviours and/or the creation of positive ones • Empowerment and engagement of marginalised communities and groups, including adolescents. Typically, outcome results and indicators will be formulated as such: • Outcome-level Result: By [date] increased Nb. or % of [population] have adopted / demanded / [action] / be in [Improved situation] - Outcome-level Indicator: % or Nb. of [population] have [done a specific action or not] / are [in a specific situation; - Outcome-level Indicator: % or Nb. of [population] who reported / heard / saw somebody else / a group of people [did a specific action / are in a specific situation].
  • 24. 20 Measuring Results in Social and Behaviour Change Communication Programming © UNICEF/UN030147/Rich 20
  • 25. 21 In order to formulate best outcome-level results and indicators, it is important to have a pre-defined list of practices or behaviours the programme wants to promote (or to deter from), for each of the participants’ categories in the socio-ecological model concerned with behavioural outcomes, that is individual, interpersonal and community levels. An example is FGM/C: • Individual level: - Result: By 2021, the percentage of girls aged 0-14 who have undergone any form of FGM/C will be reduced by X%. - Indicator MICS PR 11: Percentage of daughters age 0-14 years who have undergone any form of FGM/C, as reported by mothers age 15-49 years.17 • Family level: - Result: By 2021, the percentage of parents who engage actively against FGM/C will raise by x%. - Indicator: % of respondents (mother or father) who report engaging actively against FGM/C within their family. • Community level: - Result: By 2021, the number of communities where cutters / circumcisers do not exercise this profession any more has risen by x. - Indicator: » % of communities where respondents reported that at least one cutter / circumciser in their community does not exercise this profession (and has not been replaced by someone else); » % of communities where respondents reported that they know at least one case where parents who had practised FGM/C on their daughter have been reported to the relevant authority; » % of communities where respondents reported that they have witnessed at least one leader who stopped an FGM/C ceremony from taking place in his community; » Nb. of FGM/C cases that have been reported to the police. Some data for SBCC-related outcome-level indicators can be found in national surveys like Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), Education Management Information Systems (EMIS), or national statistics of different sectors. They usually give representative information at national level, with a certain degree of disaggregation by gender, age or geographic location. While EMIS and other sectoral information systems provide data in an annual basis, all the household survey data from MICS, DHS and others provide data every 5 years (or more). 3.5.3 Intermediate outcome-level SBCC results and indicators Intermediate outcome-level results to be reached are: • Increased % of individuals with positive psychological factors toward key family and community practices; • Increased % of individuals who actively support their relatives or friends in implementing key family and community practices; • Community increasingly engaged in dialogue, planning and action; • Positive shifts in social norms. 17 MICS 6 2019 Indicators and Definitions.
  • 26. Measuring Results in Social and Behaviour Change Communication Programming 22 Intermediate outcome-level SBCC indicators (as well as output indicators) are mainly declarative or self-reporting (using verbs like think, report, say) and relate to factors identified as being crucial during the formative research – and confirmed as such in quantitative surveys. Therefore, to formulate intermediate outcome-level indicators, one has to refer to the relevant factor, its definition, and adapt it to the specific topic. The choice of factors to be measured and related indicators will depend on the intermediate outcome-level result formulated in the result tree. Typically, an intermediate outcome-level SBCCs indicator will be formulated as such: • % or Nb. of [category of respondent] who think / report / say that [level 1 drivers / behavioural factors related statement]; • % or Nb. of [category of respondent] who reported / heard / saw somebody else / a group of people think / expect them to do [approval or refusal of / an action related to level 1 drivers / behavioural factors]. Regarding the population / respondents, it is also important to include not only primary participants, but also community-level and service provider-level participants, particularly if they have a significant influence on the primary participants’ behaviour. In other words, if the attitudes of nurses deter mothers from visiting the health care centre for antenatal care, or teachers’ attitudes towards disciplining children or menstrual hygiene deter children from attending school, these factors need to be addressed. Once again, crucial factors will be identified during the context and situation analysis and strategic prioritisation planning phases, as well as via the baseline survey. An example is FGM/C: • % of respondents who say that they feel confident they can refuse to have their daughter undergo FGM/C; • % of respondents who think that FGM/C should be discontinued in their community; • % of respondents who say the opinion of (member of reference group) matters in deciding about practicing FGM/C on their daughters/female household members; • % of respondents who know some people in their reference group or community who have not practiced FGM/C on their daughters/female household members. 3.5.4 Output-level SBCC results and indicators Output-level SBCC indicators relate to changes in behavioural dimensions, for example at community level, the improvement of collective recognition of the problem, the sense of ownership of the community process, the equity of participation in deliberations, etc. as well as change in capacities of individuals or institutions including new products, skills, abilities and services. Outputs are highly attributable to UNICEF actions and UNICEF is accountable to them. Output-level SBCC indicators are mainly declarative or self-reporting (using verbs like think, report, say) and relate to crucial dimensions of each factor as identified during formative research. Therefore, to formulate output-level SBCC indicators, one must refer to the relevant dimension, its definition, and adapt it to the specific ToC. Output-level results to be reached are: • Improved information, knowledge, perception for behaviour change; • Improved self-confidence, motivation, and skills to make informed decisions and take appropriate action; • Positive household, community and public discourse and narrative on social norms; • Increased social non-acceptance of stigma, discrimination, violence, abuse and gender inequity;
  • 27. 23 • Increased peer and community support for social and behaviour change; • Policies, plans, services increasingly responsive to community demand; • Enhanced government capacity for planning, budgeting, monitoring and evaluating C4D; • Empower and engage the marginalized communities and groups, including adolescents; • Enabling policies, regulations and plans implemented. Output-level indicators can be formulated as follows: • % or Nb. of [population] who think / report / say that [level 2 drivers / behavioural dimension related statement]; • % or Nb. of [population] who reported / heard / saw somebody else / a group of people think / expect them to do [approval or refusal of / an action related to level 2 drivers / behavioural dimensions]. Once again, it is also important to include not only primary participants but also community-level and service provider level participants, especially if they have a great influence on primary participants’ behaviour. Taking FGM as an example: • % of respondents who say FGM/C is not painful for the girls; • % of respondents who say they ask (member of reference group) for advice regarding practicing FGM/C on their daughters/female household members; • % of respondents who report exposure to message about the abandonment of FGM/C practice via TV or radio programs or social media in the last xxx months/weeks.
  • 28. Measuring Results in Social and Behaviour Change Communication Programming 24 Measuring Results in Social and Behaviour Change Communication Programming 24 © UNICEF/UN0311779/Kokic
  • 29. 25 4 How to use the indicator lists In Appendix 2, a list of indicators for the following topics is provided: • Sexual abuse; • Disease outbreak; • Birth registration; • School dropout; • Maternal, infant and young children feeding practices; • HIV/AIDS; • Immunisation. Three other indicator lists (child discipline, child marriage and FGM / cutting) have already been developed and tested.18 The lists in Appendix 2 were developed based on existing SBCC strategies and guidelines. Some of the outcome-level indicators (in red) mentioned in these lists were measured using national surveys such as MICS and DHS. Others (in bold) are already part of programme standards (RAM indicators). All other indicators are propositions to guide the development of result chains that include SBCC results in sectoral programmes. The indicators have been reviewed by the C4D team and sector specialists in ESARO. The indicators are clustered according to behavioural outcomes, factors (Level 1 behavioural determinants, intermediate outcomes) and dimensions (Level 2 behavioural determinants, output indicators). The immunisation indicators list is organised according to the Journey to Health and Immunisation. As these indicator lists are dynamic, the proposed indicators should be adapted to the country context. Once the results have been selected, indicators should be selected, adapted to the country, and quantified based on available data or on a quantitative survey conducted in the programme area. Experience of the use of these indicators, including the questions developed pertaining to these indicators, as well as proposed changes should be shared with ESARO to improve on these lists. Practical information about the indicator lists: Legend • Indicators in bold: RAM outcome or output indicators. • Indicators in red: Existing indicators (MICS 2019, DHS, and so on). • In the immunisation indicators checklist: Factors and dimensions in red are considered as high priority drivers. Reference Documents / Documents used: • UNICEF standard (RAM) outcome indicators (Excel list); • UNICEF standard (RAM) output indicators (Excel list); • MICS indicators list 2019. Sexual abuse • UNICEF (2014), Protecting children from violence: A comprehensive evaluation of UNICEF’s strategies and programme performance. Tanzania Country report. • UNICEF (2015), Child Protection Resource Pack. How to Plan, Monitor and Evaluate Child Protection Programmes. 18 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
  • 30. Measuring Results in Social and Behaviour Change Communication Programming 26 • UNICEF (2015), Ghana: VAC Evaluation. Ghana Case Study. • UNICEF (2019), C4D programmes addressing violence against children. Technical guidance. • UNICEF (2018), Preventing and Responding to Child Sexual Abuse and Exploitation. Evidence Review. • UNICEF (2018), INSPIRE Indicator Guidance and Results Framework. Ending violence against children: How to define and measure change. • Darkness to light (website), The 5 Steps to Protecting Children™ forms a framework for preventing child sexual abuse. Immunisation • GAVI (2019), An Atlas of Vaccine Demand. A roadmap for GAVI, government, and CSOs to immunize the never- reached child. Draft. September 2019. • UNICEF (2018), Human Centred Approach for Health (https://www.hcd4health.org/). • Crocker, Buqueetal (2017), Immunization, urbanization and slums. A systematic review of factors and interventions. • Brewer et al. (2017), Increasing vaccination, putting psychological science into action. • JSI (2014), Drivers of routine immunization coverage improvement in Africa: Findings from district-level case studies. • WHO (2013), The Guide to Tailoring Immunization Programmes (TIP). Disease outbreak • Republic of Sierra Leone (2014), National Communication Strategy for Ebola Response in Sierra Leone. • Ministry of Health Liberia (2015), National Knowledge, Attitudes and Practices (KAP) Study on Ebola Virus disease in Liberia, March 2015. • WHO (2018), Risk communication and community engagement preparedness and readiness framework: Ebola response in the Democratic Republic of Congo in North Kivu. • WHO (2016), Medical Anthropology Study of the Ebola Virus Disease (EVD) Outbreak in Liberia/West Africa. Birth registration • UNICEF (2013), A passport to protection. A guide to birth registration programming. School Drop Out • UNICEF (2013), Global Initiative on Out-of-School Children. Eastern and Southern Africa Regional Report. • UNICEF (2019), Data Must Speak (DMS) Toolbox on Community Engagement Social Accountability (Draft). MIYCF • UNICEF (2018), C4D/SBCC Framework for Improving Maternal, Infant and Young Child Feeding in Ethiopia. PCI Media. • UNICEF (2020), Improving Young Children’s Diets during the Complementary Feeding Period. UNICEF Programming Guidance. • UNICEF (2016), IYCF SBCC Strategy 2016-2020. Final Draft. • USAID / IYCN (2010), Formative assessment of infant and young child feeding practices at the community level in Zambia. • Jordan Ministry of Health (2013), Jordan Guidelines for Management of Acute Malnutrition.
  • 31. 27 HIV • The Global Fund (2011), Monitoring and Evaluation Toolkit. Part 2: HIV. • Shisana, O, Rehle, T, Simbayi LC, Zuma, K, Jooste, S, Zungu N, Labadarios, D, Onoya, D et al. (2014), South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. • Republic of Namibia (2009), HIV/AIDs in Namibia: Behavioral and Contextual Factors Driving the Epidemic. • Malawi National AIDS Commission (2014), National HIV Prevention Strategy 2015-2020. • USAID (2011), The unpeeled mango. A Qualitative Assessment of Views and Preferences concerning Voluntary Medical Male Circumcision in Iringa Region, Tanzania. • PSI (2019), Breaking the cycle of transmission: increasing uptake of HIV testing, prevention and linkage to treatment among young men in South Africa. • UNFPA (2014), UNFPA Operational Guidance for Comprehensive Sexuality Education: A Focus on Human Rights and Gender. If you have any questions about the use of these lists, please address them to Natalie Fol, Communication for Development Adviser, UNICEF East and Southern Africa Regional Office – ESARO (nfol@unicef.org).
  • 32. Measuring Results in Social and Behaviour Change Communication Programming 28 Measuring Results in Social and Behaviour Change Communication Programming 28 © UNICEF/UN0271249/Tremeau
  • 33. 29 5 Appendices 5.1 Appendix 1: Definitions of behavioural determinants 5.1.1 Psychological drivers SEM level Factors & Dimensions19 Cognitive biases: Cognitive biases refer to the use of mental models for filtering and interpreting information, often to make sense of the world around us. The human mind is lazy, and cognition requires various types of shortcuts to make sense of things. These shortcuts lead to errors: We make mistakes in reasoning, evaluating and remembering; as a result, choices are almost always based on imperfect information. Shortcuts are part of automatic thinking (as opposed to deliberative thinking), which is when someone draws conclusions based on limited information. People usually consider what automatically comes to mind to replace missing information, associate the situation with what they already know, make assumptions, jump to conclusions, and eventually make decisions based on a biased picture of a situation. This mental process is common and requires less effort. From a social perspective, these mental models are linked to ways of thinking, often passed down across generations, which include stereotypes and ideologies. Individual + interpersonal + individual service provider Information avoidance: Individuals might avoid information actively and/or unconsciously if this information can threaten their beliefs, force them to act, upset them, or simply because they are already overloaded with information. One can choose not to recognise and consider certain details about a subject, even when no cost is associated with obtaining such details and there are benefits of doing so. Individual + interpersonal + individual service provider Availability heuristic: We tend to overestimate the importance of the information available to us. As a result, we refer to immediate examples that come to mind when making judgements, instead of acknowledging the need for more evidence. Individual + interpersonal + individual service provider Anchoring: This entails over-reliance on one trait of a subject or a piece of information when making decisions. Anchoring often refers to people’s initial exposure to a piece of information (usually a number), which serves as a reference point that influences subsequent opinions and judgements. Individual + interpersonal + individual service provider Messenger effect: The value we place on a piece of information is largely conditioned by its source. The level of trust, familiarity and credibility of a communication channel is a key driver of our receptiveness. An individual’s judgement of a subject can be influenced by the representative of that subject rather than by the subject itself. Individual + interpersonal + individual service provider Confirmation and belief bias: People easily ignore or criticise information that contradicts their existing beliefs and assumptions and filter it in a way that supports their preconceptions and suits their beliefs. This is an automatic process we use naturally to seek affirmation of our views, which can draw us to focus on details that are irrelevant in the larger picture. Individual + interpersonal + individual service provider Simplicity bias: We discard specifics to form generalities, reduce events and lists to their key elements, and favour seemingly simple options over complex, ambiguous ones. We favour the immediate, reliable and tangible things in front of us, simplify probabilities and numbers to make them easier to comprehend, and think we know what others are thinking, as this tends to make life easier. We also simplify our vision of life by projecting our current mind-set and assumptions onto the past and future. 19 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
  • 34. Measuring Results in Social and Behaviour Change Communication Programming 30 Individual + interpersonal + individual service provider Recency bias: By favouring the latest information, we tend to draw incorrect conclusions by emphasising and overestimating the importance of recent events, experiences and observations, over those in the near or distant past. Individual + interpersonal + individual service provider Optimism bias: People tend to overestimate the likelihood of positive events and underestimate the likelihood of negative ones, including the risks they face in comparison to other people. Similarly, we notice flaws in others more easily than we notice flaws in ourselves (also referred to as self-serving bias). We also imagine that the things and people with which we are familiar or fond of are better than unfamiliar things or people. Individual + interpersonal + individual service provider Representativeness heuristic: We fill in characteristics based on stereotypes, generalities and prior histories. As a result, we make judgements about people and events based on the degree to which they resemble others. Individual + interpersonal + individual service provider Cognitive dissonance: People experience psychological tension when they realise that they engage in behaviours that are inconsistent with the type of person they would like to be. The natural reaction is to reduce this tension, either by changing attitudes and behaviours or by accepting a different self-image (which can be much more difficult). Individual + interpersonal + individual service provider Memory bias: What and how one remembers things is never objective. We edit and reinforce some memories after events, store memories differently based on how they were experienced (for example, we remember information better if we have produced it ourselves), are more likely to regard memories associated with significant events or emotions as being accurate, and we notice things that we have already memorised or repeated often. In summary, cognitive biases affect the content and/or recollection of a memory both negatively and positively. Interest: Interest characterises how sympathetic people are to an alternative practice, how much they want to know about it, be involved in activities concerning it, or experiment with it. This includes some cost/benefit considerations, as well as a dimension of appeal on a more emotional level. Individual + interpersonal + individual service provider Attention: We might or might not notice what is put in front of us. We often wrongly assume that people are properly informed about existing options because these options have been communicated to them. However, ensuring that people are informed and paying attention to what is suggested, or that promoters of behaviours manage to capture the attention of their audience, are key steps for a new behaviour to be considered. This is made more difficult by the fact that people tend to listen only to information that confirms their preconceptions (confirmation bias). Individual + interpersonal + individual service provider Feasibility: This refers to the extent to which the adoption of a new behaviour is perceived as feasible or not by a person in his or her actual situation (this is an individual self-assessment and is non-objective). Individual + interpersonal + individual service provider Enjoyment: This refers to the extent to which someone likes or might like doing something and is a cognitive and affective state that follows an activity in which a sense of pleasure was experienced. The term includes basic amusement as well as other forms of gratification and thrills, such as the feeling of power. Being passionate about something is a powerful driver for action. In economics, satisfaction and happiness are sometimes referred to as ‘utility’ SEM level Factors & Dimensions19
  • 35. 31 Individual + interpersonal + individual service provider Potential gain/avoided losses: These refer to the benefits that a person thinks she/ he might gain from the change, particularly in the short term (rapid gains tend to be more important in decision making). These gains are not only material, as they can be in form of relationships, image, and so on. Gains should also be understood as ‘avoided losses’’, since a given loss is often seen as being much worse than it is, while an equivalent gain is perceived less positively (human ‘loss aversion’). Individual + interpersonal + individual service provider Perceived risks: This refers to the possibility that something bad might occur as a result of the change, including but not only in terms of safety. People desire certainty even when it is counterproductive. Being overly risk-averse is a natural human bias. Individual + interpersonal + individual service provider Effort needed: This refers to how practical and easy it is to change to a new behaviour. The perceived difficulty is not proportional to the likelihood of adoption, as minor inconveniences (also known as ‘hassle factors’) might prevent us from acting in accordance with our intentions. Individual + interpersonal + individual service provider Affordability: This is the extent to which a person considers the change of practice to be within his or her financial means and includes costs and possible monetary incentives. Individual + interpersonal + individual service provider Appeal: This indicates how attractive something is on a more emotional level. As understood in psychology, appeal is a stimulus – visual or auditory – that influences its targets’ attitudes towards a subject. Many types of psychological appeal have been exploited by the advertising and marketing industries, such as fear appeal, sex appeal, genetic fallacy, or guilt by association. Individual + interpersonal + individual service provider Desire: This refers to a powerful feeling of craving something, or of wishing for something to happen. This sense of longing is linked to a variety of core human drives, such as the need to bond, to possess what we do not have, to love and reproduce, to dominate, and the like. Desire can be either conscious or unconscious. Attitude: Attitude is what someone thinks or feels about something. As it combines cognitive and emotional elements, attitude defines people’s predispositions to respond positively or negatively to an idea, a situation, or a suggested change. It is one of the key drivers of an individual’s choice of action, and is probably the most important factor in shaping behavioural change. Socio-economic background, religion and other individual characteristics are important drivers of attitude; when measuring these, the demographic questions in surveys will help to cross-reference respondents’ characteristics and understand their influence more appropriately. Individual + interpersonal + individual service provider Awareness and knowledge: These concepts are interdependent but not interchangeable. Awareness is the consciousness of a fact (for example, being conscious that violent discipline has negative consequences and being cognisant that there are alternatives to it), whereas knowledge is associated with a deeper understanding of this information (such as an appreciation of the reasons that violent discipline is hurtful, and being able to discuss alternatives to it). It is important to bear in mind that people tend to ignore ‘negative’ information related to their actions and can sometimes favour prior ‘evidence’ that reaffirms their actions. Perception is highly selective. SEM level Factors & Dimensions19
  • 36. Measuring Results in Social and Behaviour Change Communication Programming 32 Measuring Results in Social and Behaviour Change Communication Programming 32 © UNICEF/UNI171211/Ose
  • 37. 33 Individual + interpersonal + individual service provider Beliefs: There are multiple types of beliefs that influence attitudes, with the main ones being: » Effect beliefs: considering a causality chain to be true (X leads to Y); for example, disciplining a child physically will make her/him a good adult. » Holding personal convictions on what ‘’needs’’ to be done in a given situation; for example, if a woman is seen walking with another man, she needs to be punished. » Personal normative beliefs: beliefs about what should be, what should happen; for example, men should be primarily responsible for the honour of the family, women should report violence at the hands of their intimate partner to the police, and so forth. Beliefs are individual, but highly influenced by others. The likelihood of one person adopting a belief increases with the number of people who already hold that belief. Individual + interpersonal + individual service provider Aspirations: These are personal goals and dreams, the vision for the future self, and the hope and ambition to achieve things, such as aspiring to be the best parent possible, to be an independent woman, to be a successful student, and the like. It reflects someone’s true desire in life. Individual + interpersonal + individual service provider Values: Values are what we perceive as being good, right or acceptable, and entail inner convictions of right and wrong, and of what good conscience requires. These principles are strong drivers of standard behaviours. Individual values are directly influenced by moral norms. Individual + interpersonal + individual service provider Intuitions: Intuitions are instinctive feelings regarding a situation or an idea and are often formed as a result of past experiences. Intuitions involve emotionally charged, rapid, unconscious processes that contribute to immediate attitudes or decisions that do not stem from reason. In other words, our brain might have already decided what to do in a situation before analysing the options. Intuitions are one of the elements of automatic thinking. Laws and rules target our rational brain, whereas many decisions are made intuitively. Hunches drive many of our actions, and we often rely more on guesses than on facts. Individual + interpersonal + individual service provider Past experience: Researchers have shown that past experience helps to form complex decisions. Memories of experiences, such as past failure and frustration with a behaviour, or negative experiences such as poor treatment by a service provider, will shape our attitudes towards attempting new things. At a deeper level, experiences as a child also drive behaviour as an adult, including negative, violent or abusive behaviours. This replication concept is paramount in most psychological schools of thought. Individual + interpersonal + individual service provider Moral norms: These are principles of morality that people are supposed to follow. They are learned socially. For example, human rights, as a global doctrine, represent the moral norms that the UN is attempting to enforce universally. The important question here is what individuals perceive as women’s and children’s rights, as this will condition the classification of certain practices as being inherently immoral or not (for example, beating a woman). SEM level Factors & Dimensions19
  • 38. Measuring Results in Social and Behaviour Change Communication Programming 34 Individual + interpersonal + individual service provider Emotions: Emotions are generated subconsciously and are designed to appraise and summarise an experience and inform action. Emotions entail a process of feeling in which cognitive, physiological and behavioural reactions combine to respond to a stimulus. Several decisions are informed by our emotional responses, which can constitute a barrier to rational thinking. For example, phobias and aversions are important mechanisms in everyday life. Another example of the power of emotions is that identical information will trigger different attitudes if it is presented positively or negatively. Individual + interpersonal + individual service provider Mind-set: This refers to a person’s way of thinking and is a default attitude for addressing various situations that create a pre-disposition to adopt or reject certain behaviours, such as having an innovative mind-set, a conservative mind-set, a learning and growth mind-set, and so forth. Self-efficacy: Self-efficacy combines a person’s objective capability to perform the change proposed and her/his belief about this ability. Positive self-efficacy is a necessary precondition to taking steps towards new practices. As with attitude, demographics are usually a key driver of a person’s self-efficacy. For example, poverty imposes a significant cognitive burden that makes it difficult for the poorest to think deliberately, see themselves as capable, have faith in the possibility of change and seize opportunities. Interventions related to self-perception can be powerful sources of change. Individual + interpersonal + individual service provider Agency: This refers to the sense of control a person feels concerning an action and its consequences. If the intention to perform an action appears to precede, guide and cause the action exclusively, an individual will have a sense of agency over what s/he has just done. If not, the resulting mismatch will prevent the individual from feeling a sense of control over what has just occurred. A feeling of agency is the overall feeling of control without any explicit thinking about a specific action. The judgement of agency refers to the conceptual level of control, when an individual thinks explicitly about initiating an action. Individual + interpersonal + individual service provider Emotional well-being: This refers to the emotional quality of one’s everyday experience, or the frequency and intensity of positive and negative feelings that make one’s life pleasant or unpleasant. High levels of stress can impair our ability to make choices and to perceive ourselves positively and as capable and can paralyse change and the adoption of positive practices; in some instances, it can result in adoption of negative coping mechanisms. Anxiety and mental distress are particularly common in emergency contexts. Trauma is a significant barrier to action. Individual + interpersonal + individual service provider Physical capacity: This refers to the strength and ability to perform essential physical actions. Individual + interpersonal + individual service provider Fatigue: Being tired (and hungry) depletes cognitive resources and affects our decision making significantly. Individual + interpersonal + individual service provider Skills: Skills refer to particular abilities and capacities to do something. Most skills are acquired through experience and/or deliberate learning. Example of skills include parenting techniques and positive discipline, as well as life skills such as critical thinking or active citizenship. Individual + interpersonal + individual service provider Decision autonomy: This refers to the ability to make one’s own decisions. SEM level Factors & Dimensions19
  • 39. 35 SEM level Factors & Dimensions19 Individual + interpersonal + individual service provider Confidence: This refers to a person’s belief that she/he can succeed in creating change, or having confidence in one’s own ability. Individual + interpersonal + individual service provider Self-image: Many of our choices are impacted by the perception we have of ourselves and our role in the family, community and society. This perceived identity will often make us behave according to common stereotypes associated with our dominant identity. This might prevent people from doing things that they are completely capable of doing because they underestimate their abilities in accordance with the stereotype of their group. Individual + interpersonal + individual service provider Overall stress level: High levels of stress impair our ability to make choices, perceive ourselves positively and capable, can paralyse change and the adoption of positive practices and, in some instances, results in the adoption of negative coping mechanisms. Anxiety and mental distress are particularly frequent in emergency contexts. Individual + interpersonal + individual service provider Support: This refers to the availability of trusted relatives or friends who encourage, aid and protect someone when needed. Individual + interpersonal + individual service provider Social mobility: This refers to a socio-economic process in which an individual, family, or group moves to a new position within a social hierarchy, from job to job, or from one social class or level to another. Social mobility is also understood as the movement of certain categories of people from place to place. In many societies, mobility is an issue for women in both senses of the term: They are blocked from rising to positions of power, but might also not be free or able to leave the household, interact with certain people, or access certain commodities and services for cultural or safety reasons. Individual + interpersonal + individual service provider Emotional intelligence: The ability to recognise and process one’s own emotions, and to use them to assist thinking. Limited rationality: People do not always make decisions that are in their best interests. There are instances where we do not really know why we do or do not do things. One reason may be because it has always been done like this, even if it seems irrational. Several psychological traits (such as feeling more comfortable in a set routine, finding inaction to be easier, feeling overly positive about a choice made previously, and the like) are part of ‘human nature’ and can be used to explain why people do not behave in the way we would predict from a rational perspective. Limited or bounded rationality refers to this characteristic of human cognition, which is restricted in terms of resources (thinking capacity, available input information, and the amount of time allotted). As a result, people have a tendency to find simpler and easier ways to make decisions and to act, regardless of intelligence. The concept of bounded rationality is very similar to that of being a cognitive miser. Individual + interpersonal + individual service provider Self-control / Willpower: Temptations and impulses affect our decisions and actions, including those that run counter to the path we had decided to follow and the goals we had set. We all experience these struggles, but we do not always have equal capacity with regard to restraining or regulating these urges. When our mental resources are depleted (by stress or fatigue, for example), our willpower decreases. Certain behaviours are more addictive than are others.
  • 40. Measuring Results in Social and Behaviour Change Communication Programming 36 SEM level Factors & Dimensions19 Individual + interpersonal + individual service provider Present bias: People generally favour a smaller gain in the short term over a larger gain in the future, sometimes even consciously when considering trade-offs. We overvalue immediate rewards, which impairs our ability to make decisions to pursue longer-term interests that would benefit us more. This has multiple consequences, including the need to create small, rapid gains for people in the process of making a greater change in behaviour with bigger rewards – this serves to bring aspects of the future benefit closer to the present. Individual + interpersonal + individual service provider Procrastination: We can be as good at delaying positive actions as we are at indulging sudden negative impulses (‘today is not the right day, there is still time’). Delaying decisions can be explained by the desire to use the present for more satisfying actions, or by the complexity of making a change. In both cases, our emotions rule and we forget about the longer-term plan, despite the cost of delayed action. Magnifying the consequences of action or inaction with regard to what will happen to our future selves is a classic programmatic response to this problem. Individual + interpersonal + individual service provider Hassle factors: This term refers to minor inconveniences that prevent people from acting. A step may require a little time, paperwork to complete, or a small investment; these are perceived as major complications that can disproportionately prevent us from acting. Individual + interpersonal + individual service provider Habits and status quo: The default option for humans is usually the status quo. We often feel more comfortable in a set routine, find inaction easier, feel overly positive about a choice made previously, and are averse to change because it can be risky. Many of these feelings will drive us towards inertia even if it is not in our best interest. Moreover, a significant portion of our lives is habitual, and related actions are often automatic and driven by specific parts of the brain, are associated with a context or a moment or follow a ritual, and the specific purpose of these actions loses importance. Introducing novelty into these mental patterns does not occur without friction and disruption. Individual + interpersonal + individual service provider Heuristics: Heuristics are cognitive shortcuts or rules of thumb that simplify decisions. They are often grounded in cognitive biases similar to those our brains use to filter information (see cognitive biases), and make questions easier to answer. Since making a choice can be difficult and requires effort, we use our intuition, make guesses, stereotype, or use what we describe as ‘common sense’ to avoid decision fatigue. Individual + interpersonal + individual service provider Inconsistent commitment: Behavioural consistency tends to make us feel compelled to adhere to a decision we have made, and to continue to engage in associated actions to maintain a positive self-image. Inconsistency can result in negative feelings towards ourselves. Nevertheless, our commitment may weaken for several reasons, including insufficient willpower, opposition from other people, or the low cost of breaking the commitment. The existence of a more public, official commitment often supports continuity. Individual + interpersonal + individual service provider Decision context / frame: The context in which a decision is made (including the physical place), as well as the way a decision is framed (how the options are presented), has a strong influence on the choice of a course of action, regardless of a rational analysis of these options. This concept is often referred to as ‘choice architecture’.
  • 41. 37 Intent: The readiness to change is the core factor of the framework. When an individual is no longer reluctant to try the new practice and, more importantly, is willing to try it, the likelihood of change increases. However, for this intent to be converted into action, external and social factors have to be aligned in a supportive way. Individual + interpersonal + individual service provider Contemplation: This is the stage at which the person is conscious of both the problem and the option to change and is considering switching to the new practice, but has not yet taken action. Individual + interpersonal + individual service provider Experiment: This is when an individual is taking action and experimenting with the new practice; it entails a change of behaviour in the short term, and the risk of abandoning it. Individual + interpersonal + individual service provider Relapse: This is when the person returns to the previous practice. Individual + interpersonal + individual service provider Celebrations, praising, ritualisation, public commitment / social recognition / community respect: Events and actions to celebrate successes and cultivate pride (such as public pledges) are important because they help to create trust amongst participants, and provide opportunities for others to adopt the change. New and positive behaviours need to be practiced to become usual or normative. These rewards are important to ensure that the social context is supportive and reinforces individual choices. 5.1.2 Sociological drivers SEM level Factors & Dimensions20 Social influence and social norms: Individual behaviours and decision making are often driven by social factors. People are almost never fully autonomous thinkers, but are influenced by, and concerned about others’ opinions and actions. We act as members of groups. How supportive a social environment is of individual change will sometimes condition its very possibility, particularly (but not only) when social norms are at play. Social norms are informal group rules influenced by the beliefs that members hold about what others in the group do and approve. Even in the absence of sanctions, which are central to social norms, such beliefs usually also exist and influence individual practices. Interpersonal / Community / Service providers’ community Reference network’s attitude and practice: Social influence is based on the attitudes and behaviours of those whose opinions we value, whom we consult regarding certain issues, and those whose perceptions of us are important. Members of this ‘’reference network’’ include peers about whom we care, as well as influencers and gatekeepers who exert some form of power over us. People tend to imitate the behaviours of their reference network frequently, and sometimes automatically. Interpersonal / Community / Service providers’ community Normative expectations / injunctive norms (approved behaviours): The set of behaviours for which a person will receive social support. In social norm terminology, a normative expectation is what an individual thinks others in her/his group will approve (what she/he believes others think she/he should do). SEM level Factors & Dimensions19 20 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues.
  • 42. Measuring Results in Social and Behaviour Change Communication Programming 38 Interpersonal / Community / Service providers’ community Empirical expectations / descriptive norms (believed typical practice): The set of behaviours that people perceive to be most common. In social norm terminology, an empirical expectation is what an individual thinks others in his or her reference group do. This is often the basis of misconceptions. There might be a silent majority of people disapproving of certain practices but still complying with them based on social misbeliefs (this discrepancy between the majority of individual attitudes and practice is called ‘’pluralistic ignorance’’). Interpersonal / Community / Service providers’ community Social pressure rewards, sanctions, sensitivity, exceptions: Social norms exist because of the consequences of behaving in certain ways (anticipated opinion or reaction of others). What defines a norm is the social ‘’obligation’’ underlying it, or the fact that people believe that compliance will condition their acceptance or rejection by the group. On the negative side, sanctions can take many forms, such as stigma, avoidance, insults, violence, exile, and the like. The sensitivity to sanctions is also an important element in defining how strong the norms are. Exceptions are sets of circumstances under which acting counter to the norm would be acceptable. Interpersonal / Community / Service providers’ community Sensitivity to social influence: This reflects the level of a person’s autonomy. In a similar social environment, individuals are affected differently by the pressure exerted by the group. Interpersonal / Community / Service providers’ community Stigma and discrimination / Societal views of minorities: The negative and/or incorrect collective views and beliefs regarding certain groups of people strongly condition their practices and the majority’s behaviour towards them, often for the worst, leading to rejection and deprivation; for example, in rearing practices for children with disabilities. Meta-norms: Meta-norms are underlying ideologies and unwritten rules that are deeply entrenched in people’s cultures and identities, and which cut across sectors and condition a large number of behaviours. The term ‘meta-norm’ was coined by Robert Axelrod specifically to designate the fact that there is an upper norm ruling the fact that transgressors of lower-level norms are punished; in other words, a norm about norms. These meta- norms have a strong and direct influence on individual drivers (for example, a person’s attitude or self-efficacy), as well as an indirect one as they are expressed through several derivative social norms and practices (such as gender inequity and patriarchy expressed through FGM, gender-based violence (GBV), child marriage, and so on), and structural elements (such as gender ideologies and power differentials institutionalised in laws and systems) (BDM definition). Interpersonal / Community / Service providers’ community Socialization: The process of learning to behave in a way that is acceptable to the group based on societal beliefs, values, attitudes, and examples, through which norms are learned and internalised by individuals. An individual’s acquisition of habits, whether positive or negative, is due to their exposure to models that display certain traits when solving problems and coping with the world. Early gender socialization starts at birth and it is a process of learning cultural roles according to one’s sex. Right from the beginning, boys and girls are treated differently and learn the differences between boys and girls, women and men. Parents & families are the initial agents who affect the formation of behaviours during childhood (children are told how to dress, which activities are for them or not, what role they should play as a boy or a girl, etc.). Peers are an additional source of influence during adolescence and play a large role in solidifying socially accepted gender norms: boys usually enforce toughness, competition and heterosexual prowess, whereas girls are pressured around appearance, proper behaviour, and marriage with an emphasis on their reproductive roles. Socialisation may also occur more passively through role modelling: as a negative example, boys may adopt abusive behaviours after witnessing intimate partner violence, or lose respect for their mother (and women) after witnessing violence against her. SEM level Factors & Dimensions20
  • 43. 39 Interpersonal / Community / Service providers’ community Gender inequity / Gender dynamics: Many protection issues are associated with the power and roles of men and women in society and in households, including male authority over women, and men’s desire to control women’s sexuality. Manhood and masculinity are used as justifications for different forms of violent behaviours. Girls and women are considered vulnerable and thus need to be protected, which often translates into less access to education, restrictions to travelling, and higher rates of unemployment. Gender discrimination has deep roots and is perpetuated by leaders and communities; it can result in behaviours related to domestic violence, sexual harassment and abuse, early marriage, FGM and trafficking. Interpersonal / Community / Service providers’ community Decision-making patterns: How and by whom a course of action is selected in a family or a community will have a significant impact on people’s options for alternative behaviours. These processes can be complex depending on who voices opinions, is consulted and valued, can oppose a decision, and who makes the final call. Older family members can play a significant role in certain issues. In most of the Middle East and North Africa, the preservation of the family’s reputation is seen as the responsibility of the man; however, as the women’s honour is tied directly to the family’s honour, it is considered the men’s right to make important decisions about women’s lives, including controlling their female relatives’ access to the outside world. Interpersonal / Community / Service providers’ community Family roles and relationships: Social norms related to what it means to be a mother or a father, and to how spouses communicate between themselves and interact with their children, are key drivers of a number of behaviours, particularly parenting practices and the provision of care, household chores and financial responsibilities, among others. These also impact girls and boys differently. Interpersonal / Community / Service providers’ community Conflict resolution: Typical ways of resolving family disagreements, ranging from listening and attempting to reach a common understanding to practices of coercion. Interpersonal / Community / Service providers’ community Perception of the child: Different societies will have different perceptions of when a human being starts and stops being considered a child, and what this means in terms of her/his rights. This drives a number of practices at different stages of the life cycle. Interpersonal / Community / Service providers’ community Legal compliance: The enforcement of laws and regulations does not rely on solely formal organisms, as respect for these rules requires a social norm of legal obedience. If the belief that nobody respects the law is widespread, legal disobedience might be the norm Community dynamic: Community dialogue and collective action are key processes to produce change within a community. Members of a community taking action collectively to address a common problem and improve their lives will be a critical condition for success when the issues involved are social (in particular, driven by social norms). The success of such processes also increases the community’s collective capacity to solve future problems. The existence of such a dynamic (shared recognition of a problem with on-going collective discussion or action), or the collective capacity to engage in it in its absence, are critical conditions for social change. Interpersonal / Community / Service providers’ community Collective self-efficacy: The confidence of community members that they can succeed together. This includes the perceived capability of other community members. Interpersonal / Community / Service providers’ community Sense of ownership: The degree to which community members think the problem is important, perceive themselves as contributing to and being responsible for the success of the collective change, and to which they think they will benefit from the results. SEM level Factors & Dimensions20
  • 44. Measuring Results in Social and Behaviour Change Communication Programming 40 Interpersonal / Community / Service providers’ community Social cohesion / social closeness: This refers to the sense of belonging and feeling part of the group, the extent to which community members want to cooperate to resolve collective issues, the level of interconnection of community members (density of the social network), the level of division into factions, and the level of trust in other members. Interpersonal / Community / Service providers’ community Equity of participation: The degree to which marginalised members of the community (women, poor, ethnic groups, the youth and the elderly) can access spaces in which issues are discussed, speak up and be involved in decision making. Interpersonal / Community / Service providers’ community Quality of leadership: The existence of effective leadership is necessary to steer the group in the right direction and sustain the process. A ‘’good’’ leader will be popular and trusted, will be supportive of dialogue and change, will be innovative, and will foster inclusion. 5.1.3 Environmental drivers SEM level Factors & Dimensions21 Communication environment: The information, opinions, arguments and stories to which we are exposed play a significant role in shaping our attitudes and interests, as well as our behaviours in the longer term. This communication environment is formed by multiple channels and sources. Theories and analyses have proved the influence of mass and social media on many aspects of our lives, but our views and beliefs are also conditioned by other sources such as the films we watch, the songs to which we listen, or the word on the street (BDM definition). Institutional (media) Factual and scientific information: The availability, accessibility and dissemination of accurate and unbiased knowledge about the issue and practices at hand; this entails understandable evidence being conveyed without feelings or opinions about it being expressed. Institutional (media) Media agenda and narrative: The way media outlets determine what is newsworthy, and how the facts and stories will be framed to cover a given topic. Narratives are rarely neutral, and influence the audience’s attitude considerably. Interpersonal + community + institutional (media) Social media: Social media is an unpredictable and unregulated space in which the audience is not in a passive position, but is also a content creator, and users can interact and collaborate with each other. Contrary to the ‘’mainstream media’’, authoritative voices, previously unknown and sometimes without proven expertise, can emerge organically and generate powerful opinion trends and groups. Opinions relayed on social media fall within an individual’s own social network (a group of individuals within the user’s ‘’bubble’’, which can distort the perception of what is the most prevalent opinion). Institutional (media) + service providers from private sector Marketing brand messaging: Companies promote messages and ideas in favour of their economic success, and campaign to create more appeal. The most popular and trusted brands, with large audiences and which benefit from a positive image, can have a dramatic influence the way consumers perceive certain products, ideas and situations, thus changing their decisions and behaviours in the long term. Community + institutional + policy Public figures, public discourse: The messages most commonly spread in the communication environment, on-going public debates, and the positions of people who have a significant effect on influencing the opinions of the general public. 21 UNICEF MENA, 2018, Measuring social and behavioural drivers of child protection issues. SEM level Factors & Dimensions20