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

Author(s):  
Jane Wilbur ◽  
Tess Bright ◽  
Thérèse Mahon ◽  
Shaffa Hameed ◽  
Belen Torondel ◽  
...  

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.

Author(s):  
Stine Hellum Braathen ◽  
Lifah Sanudi ◽  
Leslie Swartz ◽  
Thomas Jürgens ◽  
Hastings T Banda ◽  
...  

2017 ◽  
Vol 39 (2) ◽  
pp. 221-236 ◽  
Author(s):  
Bodille Arensman ◽  
Cornelie van Waegeningh ◽  
Margit van Wessel

Theory of change (ToC) is currently the approach for the evaluation and planning of international development programs. This approach is considered especially suitable for complex interventions. We question this assumption and argue that ToC’s focus on cause–effect logic and intended outcomes does not do justice to the recursive nature of complex interventions such as advocacy. Supported by our work as evaluators, and specifically our case study of an advocacy program on child rights, we illustrate how advocacy evolves through recursive interactions, with outcomes that are emergent rather than predictable. We propose putting “practices of change” at the center by emphasizing human interactions, using the analytical lenses of strategies as practice and recursiveness. This provides room for emergent outcomes and implies a different use of ToC. In this article, we make a clear distinction between theoretical reality models and the real world of practices.


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