scholarly journals Impact of a community-based pilot intervention to tackle childhood obesity: a ‘whole-system approach’ case study

2020 ◽  
Author(s):  
Erica Wirrmann Gadsby ◽  
Sarah Hotham ◽  
Tamsyn Eida ◽  
Christopher Lawrence ◽  
Rowena Merritt
Keyword(s):  
Behaviour Change ◽  
Primary Schools ◽  
Theory Of Change ◽  
Primary School Children ◽  
Healthy Weight ◽  
Personal Factors ◽  
Process Data ◽  
Community Based ◽  
Diverse Range

Abstract Background Go-Golborne was a 3-year pilot programme to test an innovative, community-based approach to preventing overweight in children in Golborne ward, London. This paper describes the findings of the evaluation of Go-Golborne. The evaluation uses a case study design, a theory of change approach and multiple methods to assess the effectiveness of the intervention according to a range of expected outcomes and with consideration to unanticipated outcomes. The RE-AIM framework is used to synthesise findings and examine public health impact. Methods Height/weight measurements of primary school children in the six participating primary schools were recorded each year for four years. For behavioural outcomes, children aged 6-11 completed four annual on-line surveys (with a total of 4331 responses). Parents were surveyed in year 1 and year 4 (177 responses). Three focus group discussions were held with children aged 10-11 (N=21); interviews were conducted with parents (N=11), and school representatives (N=4). For other intermediate outcomes, stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N=11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. Results Go-Golborne achieved excellent reach through the engagement of a diverse range of partners and schools. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children’s behaviours, though significant or sustained changes were not evidenced by the quantitative data. Conclusions Go-Golborne is an example of a ‘whole systems approach’ to obesity at local level which helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within three years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.

scholarly journals Impact of a community-based pilot intervention to tackle childhood obesity: a ‘whole-system approach’ case study

2020 ◽  
Author(s):  
Erica Wirrmann Gadsby ◽  
Sarah Hotham ◽  
Tamsyn Eida ◽  
Christopher Lawrence ◽  
Rowena Merritt
Keyword(s):  
Behaviour Change ◽  
Primary Schools ◽  
System Approach ◽  
Theory Of Change ◽  
Healthy Weight ◽  
Personal Factors ◽  
Process Data ◽  
Community Based ◽  
Diverse Range

Abstract Background: Go-Golborne was a three-year pilot programme to test an innovative, community-based ‘whole system’ approach to preventing overweight in children in Golborne ward, London. Whilst there is a growing interest in local whole systems approaches to obesity, understandings of what they look like in practice are newly emerging. Go-Golborne was designed, implemented and evaluated within this context.Methods: The evaluation used a case-study design and theory of change approach to assess the effectiveness of the intervention. Height/weight measurements of children in the six participating primary schools were recorded annually for four years. For behavioural outcomes, children aged six-11 completed four annual on-line surveys (total 4331 responses). Parents were surveyed in year one and year four (177 responses). Three focus group discussions were held with children aged 10-11 (N=21); interviews were conducted with parents (N=11), and school representatives (N=4). Stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N=11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. The RE-AIM framework was used to synthesise findings and examine public health impact.Results: Go-Golborne reached a diverse range of partners across Golborne. Events were attended by over 3360 local children and families and all six primary schools in the ward actively engaged in activities. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children’s behaviours, though significant or sustained changes were not evidenced by the quantitative data.Conclusions: Go-Golborne helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within three years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.

scholarly journals Impact of a community-based pilot intervention to tackle childhood obesity: a ‘whole-system approach’ case study

2020 ◽  
Author(s):  
Erica Wirrmann Gadsby ◽  
Sarah Hotham ◽  
Tamsyn Eida ◽  
Christopher Lawrence ◽  
Rowena Merritt
Keyword(s):  
Behaviour Change ◽  
Primary Schools ◽  
System Approach ◽  
Theory Of Change ◽  
Healthy Weight ◽  
Personal Factors ◽  
Process Data ◽  
Community Based ◽  
Diverse Range

Abstract Background: Go-Golborne was a three-year pilot programme to test an innovative, community-based ‘whole system’ approach to preventing overweight in children in Golborne ward, London. Whilst there is a growing interest in local whole systems approaches to obesity, understandings of what they look like in practice are newly emerging. Go-Golborne was designed, implemented and evaluated within this context. Methods: The evaluation used a case-study design and theory of change approach to assess the effectiveness of the intervention. Height/weight measurements of children in the six participating primary schools were recorded annually for four years. For behavioural outcomes, children aged six-11 completed four annual on-line surveys (total 4331 responses). Parents were surveyed in year one and year four (177 responses). Three focus group discussions were held with children aged 10-11 (N=21); interviews were conducted with parents (N=11), and school representatives (N=4). Stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N=11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. The RE-AIM framework was used to synthesise findings and examine public health impact.Results: Go-Golborne reached a diverse range of partners across Golborne. Events were attended by over 3360 local children and families and all six primary schools in the ward actively engaged in activities. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children’s behaviours, though significant or sustained changes were not evidenced by the quantitative data.Conclusions: Go-Golborne helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within three years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.

scholarly journals Impact of a community-based pilot intervention to tackle childhood obesity: a ‘whole-system approach’ case study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
E. W. Gadsby ◽  
S. Hotham ◽  
T. Eida ◽  
C. Lawrence ◽  
R. Merritt
Keyword(s):  
Behaviour Change ◽  
Primary Schools ◽  
System Approach ◽  
Theory Of Change ◽  
Healthy Weight ◽  
Personal Factors ◽  
Process Data ◽  
Community Based ◽  
Diverse Range

Abstract Background Go-Golborne was a three-year pilot programme to test an innovative, community-based ‘whole system’ approach to preventing overweight in children in Golborne ward, London. Whilst there is a growing interest in local whole systems approaches to obesity, understandings of what they look like in practice are newly emerging. Go-Golborne was designed, implemented and evaluated within this context. Methods The evaluation used a case-study design and theory of change approach to assess the effectiveness of the intervention. Height/weight measurements of children in the six participating primary schools were recorded annually for 4 years. For behavioural outcomes, children aged six-11 completed four annual on-line surveys (total 4331 responses). Parents were surveyed in year one and year four (177 responses). Three focus group discussions were held with children aged 10–11 (N = 21); interviews were conducted with parents (N = 11), and school representatives (N = 4). Stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N = 11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. The RE-AIM framework was used to synthesise findings and examine public health impact. Results Go-Golborne reached a diverse range of partners across Golborne. Events were attended by over 3360 local children and families and all six primary schools in the ward actively engaged in activities. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children’s behaviours, though significant or sustained changes were not evidenced by the quantitative data. Conclusions Go-Golborne helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within 3 years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.

Addressing Marine Wildlife Entanglement in Derelict Fishing Nets Using Community-Based Social Marketing: Case Study and Lessons Learnt

2021 ◽  
pp. 152450042110538
Author(s):  
Maïa Sarrouf Willson ◽  
Craig Turley ◽  
Lamees A. Daar ◽  
Hussein Al Masroori ◽  
Hussain Al Muscati ◽  
...  
Keyword(s):  
Pilot Study ◽  
Behaviour Change ◽  
Social Marketing ◽  
Behavioural Change ◽  
Marine Species ◽  
Marine Biodiversity ◽  
Community Based ◽  
One To One ◽  
Marine Wildlife

Background Entanglement of marine species, particularly endangered sea turtles and cetaceans, in abandoned, lost or otherwise discarded fishing gear is a major conservation concern. Focus of the Article This case study applies Community-Based Social Marketing (CBSM) to reduce marine wildlife net entanglement in the waters surrounding Masirah Island, a marine biodiversity hotspot in Oman. Importance to the Social Marketing Field The study demonstrates the use of social marketing tools in biodiversity conservation, bringing new knowledge to the cross-application of these two fields. Methods The CBSM methodology was applied to select behaviours, identify barriers and benefits, develop strategies and design a pilot study. The responsible disposal of derelict nets in skip bins was selected as the target behaviour, and a mix of behavioural change tools was applied to achieve change: convenience (installation of three skip bins), education (installation of informative signs, distribution of awareness posters, one-to-one engagement with fishers on the beaches), prompts (installation of signs and posters on vessels) and social norms (one-to-one engagement with key influencers and decision makers). The monitoring of behaviour change took place through structured observations over 23 weeks, focussing on the number of nets disposed of in the allocated skip bins. Results Results showed a low level of behaviour adoption rate by skiff and launch vessel fisheries, respectively, 5.36% and 2.58%. Positive results were observed for a short time but did not reach the estimated target value throughout the study period. Recommendations for Research Our pilot study did not lead to broad-scale implementation and we recommend further awareness and engagement with the target audience, trials of various behaviour change tools and increase field monitoring time. We further recommend the application and funding of behaviour change methods applied to fishers with the incorporation of conventional financial, conservation and regulatory tools to support resource management. Limitations Our results show that focussing on specific behaviours with appropriate measurement is both resource and time demanding to solve pressing conservation problems, particularly ones generated by complex industries such as fishing. Various lessons, useful for other social marketers, have been drawn from our evaluation of the overall study.

scholarly journals Community-Based Watershed Change: A Case Study in Eastern Congo

Forests ◽  
2019 ◽  
Vol 10 (6) ◽  
pp. 475
Author(s):  
Scott Sabin ◽  
Birori Dieudonne ◽  
John Mitchell ◽  
Jared White ◽  
Corey Chin ◽  
...  
Keyword(s):  
Well Being ◽  
Community Action ◽  
Tree Planting ◽  
Theory Of Change ◽  
Environmental Restoration ◽  
Community Forest Management ◽  
Community Based ◽  
Early Results ◽  
Eastern Congo

Conflict and environmental degradation in the Democratic Republic of the Congo are interrelated and complex. The authors conducted a case study of a community-based environmental restoration project in Eastern Congo and provide early results which suggest a link between community environmental action and multidimensional outcomes such as peace and reconciliation. The project examined in this study is based on a framework (Theory of Change) which networks communities through autonomous savings groups, churches, mosques, schools, and a community leadership network with the goal of catalyzing sustainable farming, reforestation, and community forest management. The primary project input was training, and the resulting voluntary community action included tree planting and the management of common forest areas. A mixed-methods approach was used to evaluate project results comparing two watersheds, and included a difference in differences analysis, participatory workshops, remote sensing analysis, and community activity reports. Positive change was observed in the treatment watershed in terms of ecosystem health and household economic condition. Results suggest a possible influence on peace conditions which, while fragile, offers hope for continued restorative action by communities. This study provides evidence that a community-based approach to environmental restoration may have a positive influence on multidimensional issues such as forests, watershed health, economic well-being, and peace.

scholarly journals Changes in weight status, quality of life and behaviours of South Australian primary school children: results from the Obesity Prevention and Lifestyle (OPAL) community intervention program

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lucinda Bell ◽  
Shahid Ullah ◽  
Eva Leslie ◽  
Anthea Magarey ◽  
Timothy Olds ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Obesity Prevention ◽  
School Children ◽  
Weight Status ◽  
Primary School Children ◽  
Healthy Weight ◽  
Z Score ◽  
Community Based ◽  
Bonferroni Adjustment

Abstract Background Childhood obesity is a serious public health concern worldwide. Community-based obesity prevention interventions offer promise due to their focus on the broader social, cultural and environmental contexts rather than individual behaviour change and their potential for sustainability and scalability. This paper aims to determine the effectiveness of a South Australian community-based, multi-setting, multi-strategy intervention, OPAL (Obesity Prevention and Lifestyle), in increasing healthy weight prevalence in 9 to 11-year-olds. Methods A quasi-experimental repeated cross-sectional design was employed. This paper reports on the anthropometric, health-related quality of life (HRQoL) and behaviour outcomes of primary school children (9–11 years) after 2–3 years of intervention delivery. Consenting children from primary schools (20 intervention communities, INT; 20 matched comparison communities, COMP) completed self-report questionnaires on diet, activity and screen time behaviours. HRQoL was measured using the Child Health Utility 9D. Body Mass Index (BMI) z-score and weight status were determined from children’s measured height and weight. A multilevel mixed-effects model, accounting for clustering in schools, was implemented to determine intervention effect. Sequential Bonferroni adjustment was used to allow for multiple comparisons of the secondary outcomes. Results At baseline and final, respectively, 2611 and 1873 children completed questionnaires and 2353 and 1760 had anthropometric measures taken. The prevalence of children with healthy weight did not significantly change over time in INT (OR 1.11, 95%CI 0.92–1.35, p = 0.27) or COMP (OR 0.85, 95%CI 0.68–1.06, p = 0.14). Although changes in the likelihood of obesity, BMI z-score and HRQoL favoured the INT group, the differences were not significant after Bonferroni adjustment. There were also no significant differences between groups at final for behavioural outcomes. Conclusions OPAL did not have a significant impact on the proportion of 9 to 11-year-olds in the healthy weight range, nor children’s BMI z-score, HRQoL and behaviours. Long-term, flexible community-based program evaluation approaches are required . Trial registration ACTRN12616000477426 (12th April 2016, retrospectively registered).

scholarly journals Sociomathematical Worlds: the Social World of Children's Mathematical Learning in the Middle Primary Years

2021 ◽  
Author(s):  
◽  
Fiona Walls
Keyword(s):  
Social Interactions ◽  
Everyday Life ◽  
Learning Environments ◽  
Primary Schools ◽  
Teaching And Learning ◽  
Primary School Children ◽  
Mathematical Learning ◽  
Mathematical Teaching ◽  
The Social

<p>This thesis presents the findings of a project that explored the ways in which primary school children developed understandings about mathematics, mathematical 'learning' and 'knowing' and themselves as learners of mathematics. The research aimed to describe the children's mathematical learning environments, to explore the ways in which children made meaning about mathematics through social interactions within these environments, and to identify elements of these environments that appeared to enhance or inhibit the children's learning of mathematics. Located within the body of literature that takes a sociocultural view of teaching and learning, the study adopted the theoretical framework of symbolic interactionism because of its usefulness in explaining how, through the social interactions of everyday life, an individual constructs and reconstructs personal versions of 'reality', including a sense of identity. Through this lens, familiar objects, routine events and everyday language surrounding the teaching and learning of mathematics were examined for their significance to young learners. The concept of the sociomathematical world was created and developed to describe the mathematical environment of the child as positioned within wider social networks. The sociomathematical world of the child was seen as the world of everyday life, the arena in which the child, through regular and routine interactions with others, negotiated meanings about, and made personal sense of, mathematics. The research focussed on ten case study children - four girls and six boys - all attending different schools, and selected randomly from the primary schools in the Wellington region of New Zealand. For three years, from the beginning of their third year at school to the end of their fifth, the children were regularly interviewed and observed in their classrooms. Other key participants in their sociomathematical worlds were also interviewed, including families, teachers, principals, and classmates. Evidence of teaching and learning was also gathered from children's books and assessment records, and linked to local and global curriculum documentation. A cumulative picture was compiled of the mathematical teaching and learning environments of these ten children. Originally intended to be presented as separate biographies, the data were instead collated and reported according to the four distinctive recurring themes that emerged from the findings: the emphasis of speed in mathematics teaching and learning; identification and differentiation based on socially constructed perceptions of mathematical 'ability'; the establishment of 'doing maths' as solo written work; the presentation of mathematics as consisting of 'correct' and non-negotiable facts and procedures. These dominant approaches to teaching and learning of mathematics were found to conform to deeply entrenched traditions, in which the learner was viewed as the passive recipient of, rather than an active participant in, education in general and mathematics education in particular. It was found that these taken-for-granted pedagogical cultures were not explicitly supported by the official curriculum. Marked negative effects of these common teaching practices were commonly observed: alienation, marginalisation and impoverished learning. These impacts were experienced in varying forms and at varying times, by all the case study children, suggesting that changed views of mathematics and of mathematical teaching and learning are needed if the learning potential of all children is to be fully realised.</p>

scholarly journals Community-based nutrition-sensitive approach to address short-term hunger and undernutrition among primary school children in rural areas in a developing country setting: lessons from North and North-Eastern Uganda

BMC Nutrition ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Samuel Elolu ◽  
Duncan Ongeng
Keyword(s):  
Primary School ◽  
School Children ◽  
Rural Women ◽  
Rural Areas ◽  
Primary Schools ◽  
School Administrators ◽  
Primary School Children ◽  
Short Term ◽  
Community Based ◽  
Nutrition Sensitive

Abstract Background Undernutrition in childhood is an important factor that greatly impedes the achievement of full human potential at adulthood. Despite increased enrolment of pupils in primary schools in developing countries, short-term hunger and undernutrition continue to impact negatively on school attendance, retention and education outcomes in economically disadvantaged rural areas. This study examined the feasibility of a community-based participatory action research approach building capacity of rural women food vendors to use local food resources to produce nutritionally enhanced food products for primary school feeding in rural localities in a developing country setting. Methods Mixed methods approach incorporating focus group discussions (FGDs) to evaluate parents’ and school administrators’ perceptions of the community-based approach, participatory experimental improvement of nutritional quality of an energy-based cassava product (gari) involving community women food vendors, and cross-sectional acceptability assessment of improved products among rural primary school children. Qualitative content analysis, one-way analysis of variance and correlation analysis was used to analyse FGD data, compare nutritional profile and consumer sensory profile of different products, and examine associations between sensory attributes and acceptability of the products, respectively. Results The approach of using local food resources to produce nutritious products targeting school feeding was strongly recognised by parents, school administrators, teachers and small scale rural women food vendors as an adoptable nutrition-sensitive means of addressing short-term hunger among primary school children in rural settings. The action research resulted in a highly accepted nutritionally enhanced product (consisting of cassava, soy and silver fish) exhibiting superior nutritional properties (23.29% protein, 90.5 g/100 g calcium, 4.5 g/100 g zinc, 11.6 g/100 g iron, 40.40 g/100 g phosphorus, 61.57 μg/100 g vitamin A) compared to the original energy-dominated cassava product (2.18% Protein, 55.6 g/100 g calcium, 1.2 g/100 g zinc, 4.4 g/100 g iron, 6.6 g/100 g phosphorus, 11.23 μg/100 g vitamin A) (p < 0.05). Nutritional computation revealed that serving 120 g of the new product would suffice to meet 30% of the recommended dietary allowance for essential nutrients that children should receive from school meals. Conclusion Community-level nutrition-sensitive innovation using local foods resources offers the opportunity for rural women food vendors to contribute to addressing short-term hunger and undernutrition challenges in primary schools in economically-disadvantaged localities in developing countries.

scholarly journals Sociomathematical Worlds: the Social World of Children's Mathematical Learning in the Middle Primary Years

2021 ◽  
Author(s):  
◽  
Fiona Walls
Keyword(s):  
Social Interactions ◽  
Everyday Life ◽  
Learning Environments ◽  
Primary Schools ◽  
Teaching And Learning ◽  
Primary School Children ◽  
Mathematical Learning ◽  
Mathematical Teaching ◽  
The Social

<p>This thesis presents the findings of a project that explored the ways in which primary school children developed understandings about mathematics, mathematical 'learning' and 'knowing' and themselves as learners of mathematics. The research aimed to describe the children's mathematical learning environments, to explore the ways in which children made meaning about mathematics through social interactions within these environments, and to identify elements of these environments that appeared to enhance or inhibit the children's learning of mathematics. Located within the body of literature that takes a sociocultural view of teaching and learning, the study adopted the theoretical framework of symbolic interactionism because of its usefulness in explaining how, through the social interactions of everyday life, an individual constructs and reconstructs personal versions of 'reality', including a sense of identity. Through this lens, familiar objects, routine events and everyday language surrounding the teaching and learning of mathematics were examined for their significance to young learners. The concept of the sociomathematical world was created and developed to describe the mathematical environment of the child as positioned within wider social networks. The sociomathematical world of the child was seen as the world of everyday life, the arena in which the child, through regular and routine interactions with others, negotiated meanings about, and made personal sense of, mathematics. The research focussed on ten case study children - four girls and six boys - all attending different schools, and selected randomly from the primary schools in the Wellington region of New Zealand. For three years, from the beginning of their third year at school to the end of their fifth, the children were regularly interviewed and observed in their classrooms. Other key participants in their sociomathematical worlds were also interviewed, including families, teachers, principals, and classmates. Evidence of teaching and learning was also gathered from children's books and assessment records, and linked to local and global curriculum documentation. A cumulative picture was compiled of the mathematical teaching and learning environments of these ten children. Originally intended to be presented as separate biographies, the data were instead collated and reported according to the four distinctive recurring themes that emerged from the findings: the emphasis of speed in mathematics teaching and learning; identification and differentiation based on socially constructed perceptions of mathematical 'ability'; the establishment of 'doing maths' as solo written work; the presentation of mathematics as consisting of 'correct' and non-negotiable facts and procedures. These dominant approaches to teaching and learning of mathematics were found to conform to deeply entrenched traditions, in which the learner was viewed as the passive recipient of, rather than an active participant in, education in general and mathematics education in particular. It was found that these taken-for-granted pedagogical cultures were not explicitly supported by the official curriculum. Marked negative effects of these common teaching practices were commonly observed: alienation, marginalisation and impoverished learning. These impacts were experienced in varying forms and at varying times, by all the case study children, suggesting that changed views of mathematics and of mathematical teaching and learning are needed if the learning potential of all children is to be fully realised.</p>

scholarly journals Developing Behaviour Change Interventions for Improving Access to Health and Hygiene for People with Disabilities: Two Case Studies from Nepal and Malawi

2018 ◽  
Vol 15 (12) ◽  
pp. 2746 ◽  
Author(s):  
Jane Wilbur ◽  
Tess Bright ◽  
Thérèse Mahon ◽  
Shaffa Hameed ◽  
Belen Torondel ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Access To Health Care ◽  
Complex Interventions ◽  
People With Disabilities ◽  
Theory Of Change ◽  
Middle Income ◽  
Behaviour Change Interventions ◽  
Menstrual Hygiene ◽  
Access To Health

Limited evidence exists about how to design interventions to improve access to health care for people with disabilities in low and middle-income countries (LMICs). This paper documents the development of two behaviour change interventions. Case study one outlines the design of an intervention to improve uptake of referral for ear and hearing services for children in Malawi. Case study two describes the design of an intervention to improve menstrual hygiene management for people with intellectual impairments in Nepal. Both followed existing approaches—Medical Research Council Guidance for developing and evaluating complex interventions and Behaviour Centred Design. The purpose is to demonstrate how these frameworks can be applied, to document the interventions developed, and encourage further initiatives to advance health services targeting people with disabilities. Important components of the intervention design process were: (1) systematic reviews and formative research ensure that interventions designed are relevant to current discourse, practice and context; (2) people with disabilities and their family/carers must be at the heart of the process; (3) applying the theory of change approach and testing it helps understand links between inputs and required behaviour change, as well as ensuring that the interventions are relevant to local contexts; (4) involving creative experts may lead to the development of more engaging and appealing interventions. Further evidence is needed on the effectiveness of these types of interventions for people with disabilities to ensure that no one is left behind.

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