The Art of Asking Questions: Priority Research Areas and Approaches for Malaria Social and Behavior Change Programs

"[T]ere is a growing interest in applying approaches such as human centered design, behavioral economics to malaria SBC programs, but little is yet known of their impact and scalability."

The World Health Organization (WHO)'s Global Malaria Technical Strategy 2016-2030 called for harnessing innovation and expanding research, including to advance malaria social and behaviour change (SBC) programming. To support this call, the Roll Back Malaria Social and Behavior Change Communication (SBCC) Working Group identifies in this document 3 priority research areas and approaches to keep in mind as countries move closer to elimination. The SBCC Working Group stresses that specific research questions should be tailored to the needs of each country or programme.

Understanding factors that impede or encourage malaria-related behaviours: There are many types of behavioural factors. This document groups them in two main categories (though, in practice, these categories are fluid):

• Ideation factors refer the different types of beliefs, attitudes, perceptions, and values that affect people's behaviour. Examples include: risk perceptions, social beliefs or interactions (what the individual thinks others are actually doing [social norms] or what others think the individual should do); and how confident a person feels in performing the behaviour (self-efficacy).
• Behavioural economics (BE), also called behavioural science, holds that much of people's behaviour is influenced by subconscious biases, context, and mental "shortcuts", rather than by rational deliberation of long-term gains. Examples of BE concepts include framing (the way options are presented; people usually choose the option that is easiest or first); choice overload (giving people too many options, which makes decision-making more difficult); and availability heuristic (people's beliefs are based on what most quickly comes to mind; one example is believing that some unhealthy beliefs or practices are widespread because there are rumours/discussions about it).

Developing research questions under priority area 1 requires clarity in the behaviour of interest, the population (or audience) that should be practicing the behaviour, the context, and the behavioural factors. Figure 1 shows this process, including an example, while Table 1 presents a menu of illustrative options under each component.

Documenting implementation quality: To help inform programmatic decisions, as well as respond to donor concerns, the following are recommended: documenting aspects of implementation quality, such as data sources and processes used to design programmes; harmonisation (the consistency of messaging across platforms); the reach, frequency, and duration of activities; the focus of messaging (whether single topic, or integrated across multiple health areas); the degree of audience interaction; and the emotional/cultural resonance of the materials and activities. Table 2 illustrates some of the different channels available and the aspects of implementation. A suggested list of items to report on in malaria SBC evaluations is also provided.

Using appropriate research approaches and tools: Although randomised control trials (RCTs) are the gold standard for research design, it is usually impossible to randomly assign an individual to be exposed to SBC. However, there are existing research approaches that are useful for demonstrating the impact of SBC. They include, in brief: Approaches to establish temporality, approaches to demonstrate a dose-response relationship, approaches that provide an explanation for how change occurred, approaches that minimise the effects of non-randomisation, and approaches to reduce correlations that affect causal attribution. Details and examples can be found in the citations following each approach described. This document calls for more widespread use of these methods, also noting that additional measurement methods are needed. For example, there is also a lack of understanding and precise measurements of social norms and beliefs that SBCC campaigns might have influenced.

Click here for the 16-page document in English [PDF].
Click here for the 16-page document in French [PDF].