Stimulating Behavior Changes In and Through Community Health Workers

Thirst for Knowledge… Hunger for Change?

FT5 (Foundation Team) is embarking on an exciting ride as Nuru begins its expansion throughout the Kuria West District. This week I meet our new Health Field Officers who will oversee and train Health Reps on the basics of malaria, diarrheal diseases, RTI and other health topics.  In turn, the Health Reps will become members of our 2nd and 3rd Community Health Worker (CHW) units, impart their knowledge to their farmer groups, who train their families…you get the idea.

During their training I was taken aback by their eagerness to participate and learn despite the meeting length and proximity to distractions. I was even more amazed by the knowledge they already possessed.  It was clear that our veteran officers have a keen eye for talent and had found the community members who had some type of health background.  Pleased to see these newbies have a vested interest, we reviewed the curriculum they would be teaching. They nailed the majority of the interactive questions, even stating the sex and genus of the mosquito that transmits malaria (female Anopheles).  I was so excited I could hardly contain myself!

I was surrounded by the future of the organization— incredibly knowledgeable leaders who will guide the reps and serve as the stellar role models they already are. The perfect start! Then my excitement fizzled (just slightly) when at the end of the training we asked who used a mosquito net, boiled their water, and washed their hands after using the latrine.

Silence. Stillness.

Slightly discouraged, but still optimistic, I couldn’t resist acknowledging that they had just correctly outlined how to prevent the most common and deadly diseases, but weren’t acting on the knowledge they possess. Seeing as we had developed a good rapport during our shared time in the blistering sun, the response was jovial with smiles indicating slight embarrassment, followed by promises to exude the role model characteristics that are actually required of their position.

Of course, I believe that their behavior can change (I wouldn’t be here if I didn’t). However, it made increasingly apparent the challenges hindering even the best intentions. It has long been documented in public health practices that knowledge, in itself, is not enough to influence change on a large scale. The correlation between knowledge and risk-reduction practices is not that positive slope you might imagine.

Think about your worst habit. You know it is bad for you. Depending on the vice it could actually be killing you despite your awareness. You want to stop, but you can’t, or won’t. What are some of the reasons you still indulge this habit? What would need to happen for you to finally kick it?

A number of behavior change theories have been developed and tested to help us understand what truly stimulates change. (I know this may seem overly academic, but check them out, you may be surprised what insight they provide to your decision-making processes.)

Some of the tipping points are:

– Perceived self-efficacy
– Social norms
– The perceived ability to maintain the new behavior
– Perceived benefits (not necessarily health related)
– A call to action
– The perceived severity of the consequences should the change not be made. (Proven to be least important factor!)

In our community those perceived (and real) barriers vary from cash poverty, which can prevent the initial investment in preventative measures like buying a net, distances to clean water sources, and knowing someone who has contracted malaria despite taking precautions.

How this relates to our CHWs:
Though we must ensure the appropriate and correct information circulates from our Field Staff to Health Reps/CHWs to the households, that is not all that needs to happen. We are currently exploring creative ways of using effective behavior change communication to have non-invasive repetition of messaging, increase the sentiment of health ownership, influence social norms to include positive health behaviors, and integrate strategies to guarantee the desired behaviors are easier and less expensive than the current behavior.

Your ideas are most welcome!