Malaria Social And Behavior Change Communication Evidence Literature Review

"SBCC [Social and behaviour change communication] can facilitate the creation of enabling environments that support community members, fieldworkers or health providers as they seek to change or sustain health related behaviors."

The Health Communication Capacity Collaborative (HC3) at the Johns Hopkins Center for Communication Programs (CCP) consolidated evidence of the impact of SBCC interventions on malaria-related behavioural outcomes through this evidence review. "SBCC activities identified by this review have been noted in three publicly-available products - a searchable, online database summarizing SBCC interventions and the results [see related summary below], as well as fact sheets and infographics highlighting the impact of SBCC programs on malaria prevention and treatment behaviors." Articles were selected, screened, reviewed using set criteria, and outcomes reported in this document.

The document's key takeaways on evidence and trends of what SBCC approaches "most likely to lead to change in malaria prevention and treatment behaviors" and what means "strengthen research and reporting" include the following:

• Emphasising and reinforcing specific health behaviours leads to a higher programme effect - the review found that programmes that promote specific behaviours, like sleeping under insecticide-treated nets (ITNs), are more likely to achieve behaviour change than those that only raise risk perception.

• Innovative mHealth approaches - Evidence on case management behaviours suggests that SMS [short message system] texts and reminders foster an enabling environment and prompt action. Also, adherence to guidelines, performance motivation, and habit creation leading to improved outcomes can be fostered in community health workers. SMS can also be used for monitoring and evaluation of case management practices.

• Mass media - "The evidence strongly supports the use of mass media in promoting malaria prevention and treatment behaviors. While the majority of the evidence focuses on ITN use, mass media has been shown to increase the uptake of other prevention and treatment behaviors."

• Multi-channel approach - Evidence shows that combined approaches increase reach and influence. They may include: community mobilisation; information, education, and materials; and use of community health and outreach workers and health facility programmes. "In fact, evidence supports a dose-response relationship between the number of information sources to number of message recalls."

• Integrated programmes - Multi-media integration showed impact on long lasting insecticidal net (LLIN) use, malaria in pregnancy, and case management.

• SBCC programme design using context - Formative research and addressing community-specific practices and attitudes through targeted messaging prior to/alongside related programmes created messaging that "resonate[d] with the audience through their cultural, interpersonal and seasonal behaviors and priorities", resulting in better outcomes.

• Community-designed campaigns - "The evidence strongly suggests using community change agents and community leaders/influencers, as well as community mobilization and community engagement efforts, to influence behaviors."

• Case management and home management - "The evidence supports that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care-seeking behavior," including systematic referral training of village drug kit managers, community health workers (CHWs), drug vendors, etc. "Interpersonal training that emphasizes referral mechanisms should be provided to community agents." Supportive supervision of community workers resulted in rapid gains in counseling and case management. Training local mother coordinators/trainers can result in better antimalarial uptake of children under five, and better guidelines improved the correctness of malaria treatment with chloroquine at home. "Programs that increase access to and promote the proper use of RDTs [Rapid Diagnostic Tests] contribute to early detection of malaria and early treatment-seeking."

Research gaps include: 1) "a lack of understanding and precise measurements of social norms and beliefs that might have been influenced by SBCC campaigns", especially measuring normative change that came out of SBCC campaigns; 2) "identifying the gaps between access to resources for malaria-related behaviors and actual adoption and maintenance of those behaviors"; 3) "demonstrating the impact of SBCC programs on behaviors related to the prevention of malaria in pregnancy"; and 4) "adequately describing SBCC programs...."

The document's conclusion states that the evidence base is strong, but more and stronger research, including reporting programme exposure, will continue to establish the role of SBCC in malaria prevention and treatment behaviours.