|Effective Communications for Nutrition in Primary Health Care (UNU, 1988, 208 pages)|
|6. A general approach to behaviour change|
As mentioned earlier, there are three worksheets:
They are to be used in the order listed here. The first worksheet leads us through describing the existing and desired systems and helps us identify the discrepancies between them. The second worksheet identifies a single discrepancy and the possible interventions for dealing with it and prompts us to make judgements bearing on the importance and feasibility of the discrepancy and the potential interventions and to assign numerical values to those judgements. The numerical values can then be aggregated as a basis for helping us select which potential interventions to select for our programme. The third worksheet prompts us to formulate the specific details for an intervention requiring the targets to learn either new skills or new thoughts.
The Family Nutrition Performance System Worksheet
Before we can go from here to there, we need to determine in a useful manner where "here" is and where "there" is. In this case, however, we are not going from one "here" to one "there." Since we are dealing with a performance system with many characteristics, we will be going from many "heres" to many "theres." The difference between each "here" and its corresponding "there" specifies the discrepancies we need to consider addressing in our interventions. Sometimes there may be no discrepancy between a given "here" and its corresponding "there." Sometimes there may be substantial discrepancies, but not all need be critical.
The worksheet prompts us to describe the relevant characteristics of the existing system and those of the desired system where it differs from the existing system. Characteristics of the existing system are entered in the left-hand column and those of the desired system in the righthand column.
At the top of the first page of the worksheet, you can specify the targets of concern. For instance, you may not be concerned with the effect of the system on all the members of the family, but only on children from birth to age six. This will remind you to describe the system as it bears on these targets.
The worksheet is divided into seven sections: an initial section that addresses overall system characteristics and one section for each of the six system functions. However, you may want to add more functions or delete some of mine for a particular application.
Each of the seven sections asks you to state the goals either for the overall system or for a given function. If you are specifying the goals for the existing system or one of its functions, specify the goals actually perceived by the people who make up the system. If there are conflicts among different roles in the system regarding its goals, be sure to identify them.
The second part of the overall system section asks you to list the functions that make up the system. I have listed the six that I suggest are appropriate. This is your first opportunity to add or delete functions if you wish. Or you can throw mine out altogether and make up your own.
The third part asks you to list the components of the system. I have listed some possibilities for you to consider. You should also note what each component does in the system. For instance, feeding of small children might be done by the children's mother, or by her mother or mother-in-law, or by an older daughter, or by all of them under different conditions.
Next describe the environment in which the system operates. Again, I have suggested some things for you to consider. Try to identify and characterize all those aspects of the environment that could in any way affect the operation of the system.
Finally, list the resources available to the system for it to operate as it exists now and resources that are available to it but not used appropriately. For instance, green leafy vegetables may be available but not be used in feeding children.
The worksheet section for each function will prompt you to provide information in four categories: the goals, processes (skills), obstacles, and consequences appropriate to the function. In each case, I have listed some things you might consider.
Under goals list the goals for the function. In some cases, these function goals may be the same as some of the system goals. In other cases, they may be a subordinate aspect of a system goal. l have listed some goals you might consider for each function. You can choose whatever seems appropriate or add in goals of your own.
Under processes (skills) list the kinds of things a person has to be able to do in order to achieve the goals of the function. There are some possibilities for you to consider for each function.
Under obstacles list the kinds of things that interfere with the accomplishment of the goals by the processes. I believe that you will need to identify obstacles only for the existing system. I cannot think of an instance where you would want to introduce an obstacle in the desired system.
Under consequences there are two conditions to consider: (1) what are the consequences when they do it right? and (2) what are the consequences when they do not do it? Remember, we are concerned with fairly immediate consequences to the performer of the action that affect the likelihood that he will perform appropriately in the future.
Obviously, you will describe a piece of the existing system before you describe the corresponding piece of the desired system. I would recommend that you describe all parts of the existing system before you even think about any part of the desired system. The parts are interrelated. You cannot really plan a new system on a piecemeal basis. You will probably find that you will revise your description of the desired system many times before you are finally satisfied with it.
The Discrepancy/Intervention Summary Worksheet
Once you have finished describing both the existing and desired systems, you will be in a better position to identify the discrepancies between the two. Not every difference has to be considered as a separate discrepancy. You may want to combine several differences between the existing and desired system into a single discrepancy. Do whatever seems to make sense in your situation.
Fill out a Discrepancy/Intervention Summary Worksheet for each discrepancy you identify. Write the description of the discrepancy in the space at the top of the worksheet. Enter the potential interventions that you are considering for eliminating the discrepancy in the body of the worksheet. There are two kinds of interventions for you to consider: (1) interventions that will require people to learn new skills or new ways of thinking about some particular thing and (2) changes that can be made in the environment. Describe each potential intervention in the appropriate part of the worksheet.
When you have finished identifying all the discrepancies between the existing and desired systems and have filled out a Discrepancy/Intervention Summary Worksheet on each one, you will then need to make judgements about how critical each discrepancy is and about the importance and feasibility of each potential intervention. Try to get the most appropriate people available to make each kind of judgement. For instance, policy-makers may be most appropriate for judging how critical the discrepancies are, and programme planners and field-workers for judging the importance of a potential intervention to a given discrepancy and for judging the feasibility of each potential discrepancy. You can have several people involved in each judgement on a group basis or you can obtain individual judgements and average them. You can have several different kinds of people involved in the same judgements and even give their judgements different weights, but generally it is best to keep the judgement process clean and simple.
Ask all the judges to assign values between I and 10 to express the criticalness of a discrepancy or the importance or feasibility of a potential intervention, with I representing the lowest value on each characteristic and 10 the highest value.
To obtain an overall value for each potential intervention, simply multiply the three separate sets of values; that is, multiply the critical value of the discrepancy by the importance and feasibility values of the potential intervention. This total value can be used as a guide in selecting which potential interventions to select for implementation. The higher the total value, the more significant the intervention.
If you want to learn more about how to assign and aggregate values in making judgements about characteristics of programmes, this process is called Multiattribute Utility Technology (MAUT) and has been principally developed by Ward Edwards .
The New Skills/Thoughts Interventions Worksheet
This worksheet will guide through formulating interventions that require people to learn new skills or new ways of thinking about something. It is modelled on the components of a module listed in the first part of this presentation. It asks you to specify how the intervention will do each of the following:
The answers to the preceding questions specify the content of the communications that will make up the interventions. We also need to know something about the effects of the interventions on the system- both immediate and remote effects. The anticipated effects of the interventions allow us to manage and evaluate the project better and make corrections en route if necessary.
The last part of this worksheet is concerned with the development and delivery of the communications. I have suggested some questions that need to be addressed. You may want to add other questions that fit your own situation better.
1. W. Edwards and J.R. Newman, Multiattribute Evaluation (Sage Publications, Beverly Hills, Calif., 1982).
APPENDIX 1. The Family Nutrition Performance System Worksheet
|OVERALL GOALS |
|FUNCTION NO. 1: PLAN MEALS
|PROCESSES (SKILLS) |
|FUNCTION NO. 2: PROCURE FOODS
|PROCESSES (SKILLS) |
|FUNCTION NO. 3: STORE FOODS
|PROCESSES (SKILLS) |
|FUNCTION NO. 4: PREPARE
Food preparation skillscutting, chopping, mixing, kneading, washing.
Food cooking skills
Meal preparation coordination skills.
Prepare and add spices, oils, condiments
|FUNCTION NO. 5: SERVE MEALS
|PROCESSES (SKILLS) |
|FUNCTION NO. 6: CLEAN UP AFTER MEALS
|PROCESSES (SKILLS) |
APPENDIX 2. The Discrepancy/lntervention Summary Worksheet
APPENDIX 3. The New Skills/Thoughts Interventions Worksheet
SET PERFORMANCE CONTEXTS
Describe the contexts:
How will the targets be told about the contexts?
MODEL THE PERFORMANCE (DEMONSTRATE)
Do they need to see it done?
How will it be shown to them?
Are there natural signals for the performance? What are they?
Do they need other signals? Describe them.
How will the signals be conveyed?
Do they need to be told or shown exactly what to do step-by-step? How?
How will they know if they have done it right? Who or what will provide?
Do they know how to fix their own performance errors? If not, how will they be told?
What positive consequences are appropriate and feasible?
How will they be delivered?
What immediate effects are anticipated?
What remote effects are anticipated?
DEVELOPMENT OF INTERVENTION
What needs to be developed? Who will develop each part?
How will it be tried out and revised?
How will each part of the intervention be produced? Who will do it?
DELIVERY OF INTERVENTION
Who will identify the targets? What guidelines will be used?
Is baseline monitoring of targets appropriate? Who will do it? How?
Who will monitor the targets during the programme? How?
What kinds of things might go wrong? How will they be handled?
What kinds of modifications might be necessary in the conduct of the intervention? Who will decide? How? What guidelines?