Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia

"Evidence suggests that using multiple SBCC approaches and channels to change behaviors is more effective than using one, that targeting multiple contacts has a greater effect than targeting only the woman herself, and that more visits or contacts results in greater change."

This 116-page literature review presents and discusses summaries of 91 peer-reviewed studies related to the effectiveness of social and behaviour change communication (SBCC) approaches to increase the uptake of three key nutrition behaviours: women's dietary practices during pregnancy and lactation, breastfeeding practices, and complementary feeding practices. The interactive literature review was conducted as part of the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) programme, and is intended to support governments and other stakeholders in their delivery of high impact nutrition practices. The review also identifies gaps in the evidence and offers recommendations for further areas of study.

The 91 studies were identified using the United States National Library of Medicine biomedical database (NLM®) Ovid MEDLINE between May-December 2012, based on search parameters aligned to: practices or behaviours promoted, the SBCC approach utilised, and the study design. Studies with data from high income countries, those published prior to 2000, and those written in a language other than English were excluded from this review. The literature review broadly categorised the SBCC interventions into three areas of work: interpersonal communication, use of media, and community/social mobilisation.

The finding are organised into 3 key sections:

Findings related to women's dietary practices during pregnancy and lactation
According to the report, only 15 peer-reviewed studies included in the literature review focussed on the effectiveness of SBCC to improve women's dietary practices during pregnancy and lactation, pointing to a lack of evidence available to fully understand SBCC outcomes in this area. However evidence "indicates that SBCC approaches can and do succeed in improving uptake of the behaviors promoted." One area where more evidence is needed in particular is in improving rest and workload during pregnancy. Due to the relatively limited body of evidence on this topic and the lack of standardisation in the way research related to SBCC is designed and described, "it is challenging to make conclusions beyond the fact that projects with SBCC result in uptake of promoted practices.

Findings related to breastfeeding practices
This section reviews the effectiveness of SBCC approaches on improving breastfeeding practices. The report explains that the rates for WHO recommended breastfeeding practices - initiation of breastfeeding within one hour after birth, exclusive breastfeeding through six months of age, and continued breastfeeding until 24 months of age - remain low. The body of literature on the effectiveness of SBCC approaches in improving breastfeeding practices is strong and broad (62 peer-reviewed studies in this review) and "supports the claim that SBCC approaches can and do succeed in improving uptake of the behaviors promoted." Moreover, "evidence from several studies strongly suggests that increasing the number of contacts increases the positive effect of SBCC on breastfeeding practices." Reflecting on the approaches used, it was found that among 42 studies reporting statistically significant results, "40 included interpersonal communication (IPC) approaches, 19 included some form of media, and 10 included community/social mobilization." The most common form of IPC was one-on-one counselling in the home, small media was the most commonly used media approach, and gathering of issues groups was the most commonly used community/social mobilization approach.

Findings related to complementary feeding practices
This chapter focuses on the effectiveness SBCC approaches to improve complementary feeding practices of children ages 6 to 24 months. The review included 30 studies which "clearly indicates that SBCC interventions can improve a wide range of complementary feeding practices." All of the studies reporting statistically significant results targeted the mother, and more than half also addressed other audiences or influencers (no studies were identified that compared the effect of targeting one vs. multiple audiences or of targeting different audiences.) However, authors noted that "the measures of optimal complementary feeding are so varied that it is particularly challenging to draw conclusions regarding the effectiveness of particular SBCC approaches."

The review concludes that there is significant evidence to demonstrate the effectiveness of SBCC on nutritional outcomes. Unfortunately, differences in delivery, local context, indicators, implementation and scale of implementation, and key definitions are so varied that it is challenging to attribute changes in outcomes. It is suggested that future evaluations and operations research include strategies to better understand the effect of promoting behaviours to multiple audiences or influencers, the effect of the same SBCC intervention implemented in different contexts, and the effectiveness of different approaches for different behaviours, among other considerations.