This document discusses the design and implementation of a Social and Behavior Change Communication (SBCC) strategy to promote nutrition and hygiene practices as part of an agricultural intervention in Sierra Leone. It describes how SBCC was used to influence behaviors related to fish consumption, production, and hygiene along the fish value chain. A five-step process was used: 1) defining problems, 2) framing with theory, 3) designing materials with partners, 4) implementing and monitoring activities, and 5) evaluating objectives. The strategy targeted multiple audiences at national, community, and household levels using various communication channels and materials.

1. Integrating nutrition education &
Social and Behavior Change
Communication (SBCC) into an
agricultural intervention:
lessons from Sierra Leone
Monica Pasqualino
PhD Candidate
Johns Hopkins Bloomberg School of Public Health
mpasqua2@jhmi.edu

2. What is Social and Behavior Change Communication (SBCC)?
• SBCC is the use of communication to change behaviors by positively
influencing knowledge, attitudes and social norms.
• SBCC reaches multiple levels of society by coordinating messaging across a
variety of communication channels.
• Evidence indicates that SBCC is effective in
promoting healthy behaviors, including:
• Women’s dietary practices during
pregnancy & lactation
• Breastfeeding practices
• Infant and young child feeding practices
• Approaches may include:
• Interpersonal communication
• Mass media
• Community mobilization
• Advocacy

3. Linking agriculture & nutrition
Choices that impact child and maternal nutrition are made throughout these pathways:
SBCC & nutrition education can influence these choices so that individuals take on
healthier behaviors.

4. Designing an
SBCC
strategy in
Sierra Leone

5. Background
• Sierra Leone emerged from a
10-year Civil War in 2002
• In 2014, it was affected by the
Ebola Virus Disease outbreak
• Food insecurity &
malnutrition are national
concerns
• There is growth potential in
aquaculture & fisheries
52%
of the
population lives
in poverty
22%
of the
population is
undernourished
29%
of children under
5 are stunted
WorldFish is working to scale
up aquaculture under a USAID-
funded Feed the Future project

6. The Scaling Up Aquaculture project
• Project aims:
• Improve agricultural productivity
• Expand markets & trade
• Improve access to diverse and quality foods
• Improve nutrition-related behaviors
The SBCC strategy
• Priority behaviors:
• Increased household fish consumption, with a focus on the first
1000 days
• Proper personal hygiene practices undertaken by actors along
the fish value chain
• Proper hygiene practices undertaken in the production,
harvesting, processing, trading, storing, preparation, &
consumption of fish

7. Designing & implementing an SBCC intervention
SBCC interventions are grounded in theory, designed using data, and
measured to show evidence of their impact.
High-quality SBCC has four key characteristics:
SYSTEMATIC EVIDENCE-BASED PARTICIPATORY CAPACITY
STRENGTHENING

8. Step 1: Define & understand the problem you want to solve
• Problem 1: Although fish is an important part of the Sierra
Leonean diet, the quantity & quality of fish consumed is low,
particularly among women and children.
• Problem 2: Poor hygiene practices throughout the fish value chain
compromise the contribution of fish to household food and
nutrition security.
Methods utilized:
1. Review of existing data
2. Causal analysis of malnutrition at the community level
3. Key informant interviews with relevant stakeholders
4. Focus group discussions
5. Direct observations

9. Step 2: Use theory to frame the program design
• In Sierra Leone, the project used the
socio-ecological model to frame the
strategy.
• There are numerous theories relating
to health behavior change. It is also
possible to construct a framework
taking constructs & concepts from
multiple theories to develop a unique
strategy that fits within the context.
Socio-ecological model

10. Step 3: Design communication products with program
partners & audiences
• Partner collaboration with:
• Helen Keller International
• SPRING
• Ministry of Health & Sanitation
• Ministry of Agriculture, Forestry & Food Security
• Methods to inform preliminary design:
• Review of existing data & materials
• Key informant interviews
• Focus group discussions
• Direct observations
• Radio shows
• Methods to inform final design:
• Pretesting
• Revisions

11. Step 4: Implement & monitor program activities
Target audience Activities Materials Implementing partner
National/district level
Policymakers, national and district
governmental & non-governmental staff,
private sector
Workshops
Agriculture & Nutrition Fairs
World Food Day
World Breastfeeding Week
Policy
Poster, banners, brochures
Farmer demonstrations
Cooking competitions
Government, NGO partners,
WorldFish
Community level
Communities (mass outreach) Radio shows
TV shows
Video viewings
Frequently Asked Questions
Story telling
Video plot lines
Partners (HKI) with technical
support from WorldFish
Mother Support Groups Cooking demonstrations
Story telling
Role playing
Counseling cards
Illustrations, posters
Recipes
Videos
Partners (HKI)
Market women, traders, and fish sellers
associations
Radio shows
SMS messaging
Identifying “model market women”
Storytelling, role playing
Posters placed in markets
Stickers of “fine” raw and dried fish
Partners (HKI), WorldFish
Household/Individual level
Fish farmers Trainings
Checklists
Workshops
Story telling and role playing
Video viewing and discussions
Cluster Farmer Connector Field Manual
Illustrations
Seasonal food availability calendar
Videos
WorldFish
Caregivers Cooking demonstrations
IYCF counseling
“Role models”
SMS messaging
Counseling cards
Posters
Stickers to put on cell phones
WorldFish and partners (HKI)

12. Step 5: Evaluate the program against objectives
Example: Evaluating SBCC on increasing fish in child’s diet
Types of measures Constructs/indicators
1. Process evaluation Reach: # of individuals who heard messages on
fish consumption
Dose: # of messages individuals remember
Fidelity: extent to which individuals respond to
messages
2. Psychosocial impact Caregivers’ knowledge of health benefits of fish
Caregivers’ self-efficacy of preparing fish porridges
for children
Intention to incorporate more fish in child’s diet
3. Behavioral impact Frequency with which children are fed fish
Quantity of fish fed to children a day
4. Health outcomes Child anthropometric measurements
5. Other outcomes Sustainability: ability of caregivers to continue
feeding practices without the intervention

13. Tools and
resources

14. • Johns Hopkins Center for Communication Programs
• Many resources available from their work in 29 countries
• https://ccp.jhu.edu/
• SPRING
• Strategic Agenda for Nutrition SBCC
• Evidence of Effective Approaches to SBCC for Preventing and Reducing
Stunting and Anemia
• https://www.spring-nutrition.org/technical-areas/sbcc
• Alive & Thrive
• Successful scaling up IYCF programs in Bangladesh, Vietnam and Ethiopia
• http://aliveandthrive.org/
• 2018 International SBCC Summit
• Theme: Entertainment Education
• https://sbccsummit.org/

15. Key points
• Using multiple SBCC approaches & channels is
most effective.
• Differences in local context, implementation
methods and scale affect success.
• Utilizing indicators that are standardized and
globally recognized is critical.
• Future research can explore the:
• sustainability of SBCC approaches when scaled-up.
• cost effectiveness of various approaches.
• effect of the same SBCC intervention implemented in
different contexts.
• effect of targeting multiple audiences, rather than
focusing on one target population.

16. “Fish for we all.
We all for eat fish.”
Fish for everyone. Everyone will eat fish.
– Daniel S. Lebbie, farmer, Kabaray community
Tonkolili District, Sierra Leone