The Added Value of Virtual Facilitator Tool as a SBCC Approach
Improving key nutrition practices requires change at the individual, household, and community levels, and in services for mothers and families—all of which must be supported by an enabling environment. Growth through Nutrition Activity includes SBCC activities as part of its strategic approach to bring about significant and sustainable improvements in maternal dietary and infant and young child feeding practices. The project works to ensure that consistent, locally adapted, actionable messages are reinforced at each level for interventions to be more likely to result in significant improvements in the short term and sustainable progress in the long term. In addition to the existing SBCC approach under Growth through Nutrition, a new tool designed to complement the ECCs called the Virtual Facilitator (VF), a pre-recorded audio message with actors modelling the desired knowledge and behaviours, is anticipated to make the SBCC program more robust and scalable. Therefore, the objective of the study is to evaluate the added value of the virtual facilitator tool to the existing ECC program for improving IYCF practice and nutritional status of women and children in Ethiopia under the Growth through Nutrition Activity program.
The study was conducted in selected districts of Amhara region (Basoliben Woreda) and Oromia region (Becho and Girar Jarso in East and West Oromia) where Growth through Nutrition Activity operates using a quasi-experimental design with a control group. The baseline data collection was conducted in Dec 2018 while the endline data collection was completed in Nov 2019. Pregnant and/or lactating women who were Growth through Nutrition Activity program beneficiaries /most vulnerable household (MVHH) members in the selected livelihood program were the study population for both study groups. In each woreda, two kebeles were selected, one kebele to receive ECC and VF and other kebele to receive ECC without VF. In the control (ECC only) group, the participants received monthly comprehensive enhanced community conversations (ECCs) meetings led by in-person Community Change Agents (CCAs) with standard module content, take- home materials with behaviors or activities to discuss and try at home with the family, and home visits scheduled by CCAs. The intervention (ECC+VF) group received all the same components as the control group, but also had the addition of the in-person ECC meetings supplemented with audio-recorded Virtual Facilitators sessions designed to complement the monthly meeting lesson or topic. The questionnaire was designed to include demographic characteristics, maternal and child health and diet indicators, water, sanitation & hygiene and gender perspectives, couple relationships and communication, all of which are targeted by the ECC and ECC+VF trainings. Significant differences within the groups is measured using chi-square test. To examine changes between groups (intervention vs control) at baseline and follow-up assessments, a difference in difference analysis was performed using generalized linear mixed model (GLMM) was fitted taking the clustering effect at kebele level into account using STATA version 15.0 (Stata Corporation, College Station, TX). A p-value of less than or equal to 0.05 was considered significant for all tests.
This study covered most of the Growth through Nutrition project activities including nutrition sensitive reproductive health care services, water, sanitation & hygiene, child health & nutrition, mother dietary diversity and child’s food group diversity, couple relationship and gender perspectives. Accordingly, positive changes have been exhibited in maternal health care service utilization, WASH, IYCF practices and women decision-making power and communication. Albeit the statistical significance, a large to moderate positive changes from baseline values were exhibited among participants in the intervention group regarding most of the outcome indicators. Therefore, it is important to strengthen the use of virtual facilitators as a modality to transmit standard nutrition messages during the ECC programs for a positive change mainly in WASH and IYCF indicators. The findings strengthen the notion that using a combination of SBCC has advantage over a single method to improve behaviour and bring about expected changes. As the findings showed varying magnitude of changes across the outcomes studied, it is also equally important to tailor the use of virtual facilitators with a focus on the indicators they positively affect more. Continuous monitoring and evaluation of the ECC implementation has also a paramount importance to ensure compliance of intervention administration in order to harness its maximum benefit