Born on Time: Using multi-pronged and comparative research to understand the potential of social and behavior change communication to prevent preterm birth

Summary:

The Born on Time (BOT) program uses social and behavior change communication (SBCC) to contribute to reductions in preterm birth (PTB) and neonatal mortality in Bangladesh, Ethiopia, and Mali. Due to the paucity of multi-sited studies exploring multilevel factors associated with PTB, we 1) describe the social and behavioral foundations of a theoretically informed, multi-pronged comparative study designed to strengthen the evidence on PTB-related SBCC approaches and 2) explore how social and behavioral theories can influence the design and analysis of SBCC research to inform evidence-based programming. This multi-pronged study draws on qualitative and quantitative data collection approaches implemented in multiple phases across three sites. The study, informed by the socio-ecological model, incorporated social and behavioral theories from the global north and south. Kincaid's bounded normative influence and Connell's theory of gender and power were integrated with the Indian Sadharanikaran theory and the African PEN3 model to include concepts of shared compassion, culture, and social identity. These perspectives influenced the study design and data analysis approaches used. Evidence from the exploratory qualitative phase informs research questions and data collection instruments employed in the subsequent mixed methods phase. Analyses are conducted to identify country-specific and cross-cutting findings. Using a description of the study design, drawing on examples from preliminary findings, we demonstrate how a theoretically informed, multi-pronged, comparative research study offers opportunities to construct a holistic picture of communities where SBCC programs work, how interventions are implemented, and results of that implementation.

Background/Objectives

Preterm birth (PTB) predicts neonatal morbidity and mortality. Bangladesh, Ethiopia, and Mali contribute 1,069,650 PTB deaths annually, and the Born on Time (BOT) program uses social and behavior change communication (SBCC) to contribute to reductions in PTB and neonatal mortality in these settings. Due to the paucity of multi-sited studies exploring multilevel factors associated with PTB, we describe the social and behavioral foundations of a theoretically informed comparative study designed to strengthen evidence on PTB-related SBCC approaches. We explore how social and behavioral theories can influence the design and analysis of SBCC research to inform evidence-based programming.

Description Of Intervention And/or Methods/Design

This multi-pronged study was designed in two phases. An exploratory qualitative phase included semi-structured interviews (n=102 per country) and focus group discussions (n=27 per country) with women of reproductive age, partners, family members, adolescent girls, and key informants to identify barriers and facilitators to PTB-related health behaviors. Lived experiences, gender dynamics, social norms, and community resources were a primary focus. In a subsequent phase, programmatic observations (n=25 per country) and qualitative interviews with implementers and beneficiaries (n=44 interviews per country) will be conducted in concert with structured quantitative interviews (n=2350 per country) with women of reproductive age, partners, and adolescents to assess exposure to SBCC activities and multilevel factors associated with PTB-related health behaviors. Evidence gathered from the exploratory phase has informed research questions and data collection in the subsequent mixed methods phase. The analytical approach is designed to examine country-specific and cross-cutting findings.

Results/Lessons Learned

This multi-pronged study, informed by the socio-ecological model, incorporated social and behavioral theories from the global north and south. Kincaid's bounded normative influence and Connell's theory of gender and power were integrated with the Indian Sadharanikaran theory and the African PEN3 model to include concepts of shared compassion, culture, and social identity. These perspectives influenced the study design by amplifying community voices and lived experiences and prioritizing social norms, gender and power, compassion, and identity. The analytical approach reinforces these theoretical foundations and is guided by a comparative exploration of the multilevel factors that influence PTB-related health behaviors, including individual factors; household dynamics; community resources; and gender and social norms. Findings from this study will be presented as evidence to illustrate how the integration of multiple social and behavioral theories can provide more nuanced understandings of PTB and the effects of SBCC programs like the BOT project.

Discussion/Implications For The Field

This multi-country, mixed methods study illustrates the importance of integrating social and behavioral theory into the design and analysis of SBCC research. Through a detailed description of the study design, drawing on examples and preliminary findings from the BOT project, we demonstrate how a theoretically informed, multi-pronged, comparative research study offers opportunities to construct a holistic picture of communities where SBCC programs like BOT work, how these interventions are implemented, and results of that implementation. Findings from this methodological approach will strengthen the global body of evidence exploring PTB across settings to inform evidence-based prevention approaches.

Abstract submitted by:

Zoe Hendrickson - JHU

Amanuel  Gidebo - World Vision

Arefin Amal Islam - Plan International

Abiy Tafesse - World Vision

Jean Pierre OKITAKOY DIOWO - Save the Children

Timothy Werwie - JHU

Nandita Kapadia Kundu - JHU