Participatory Communication Campaign Approaches in

Transcription

Participatory Communication Campaign
Approaches in Improving Health Practices
in India
An Impact Assessment of DFP’s Programme for Improving Mother and Child
Health in Selected States
Sponsored by:
Directorate of Field Publicity
Ministry of Information & Broadcasting
Government of India
Conducted by:
Department of Communication Research
Indian Institute of Mass Communication
Aruna Asaf Ali Marg, JNU Campus, New Delhi – 110067
Web site: www.iimc.nic.in; Email ID: decore.iimc@gmail.com
Research Team
Project Coordinator
:
Professor (Dr.) Gita Bamezai
Project Team
:
Prashant Kesharvani
B.N. Ambade
Anupriya Roy
Jyoti Ranjan Sahoo
Manushi
Shashi Chhetri
Cover Page Design
:
Shashi Chhetri
Secretarial Assistance
:
Jai Raj
General Assistance
:
Sanjay
‘It is health that is real
wealth, and not pieces of
gold or silver’
Mahatama Gandhi
Contents
Acknowledgment
i
Preface
ii-iii
Glossary
iv
Executive Summary
v-xii
Chapter 1
Participatory Communication Campaign Approaches in Improving
Health Practices in India
1-12
o
o
o
o
Introduction
Review of Literature
Aims and Objectives
Methodology
Chapter II
Impact of DFP Campaign
o
o
o
o
Socio-Demographic Profile and Entry-Exit Respondents
Changes in Behaviours Contingent upon Positive Knowledge & Attitude
Differences in Knowledge and Attitude due to Campaign
Assessment of Campaign by Health Functionaries and
Evidence from Service Utilization Data
Chapter III
Assessment of DFP Campaign Activities
o
o
o
o
13-29
30-49
Pre-Campaign Activities
Field Campaign Activities
Additional factors pertaining to campaign activities
Content analysis of campaign
Chapter IV
Charting New Frontiers and Way Forward
50-55
o Conclusions & Recommendations
Bibliography
Annexure
o Research Instruments
o Content Analysis of Print & Outdoor Material
56-57
I-XXIX
Acknowledgement
We
express our sincere gratitude to the Directorate of Field Publicity, Ministry of
Information and Broadcasting for entrusting IIMC with the onerous task of conducting this
study. The scope of this assignment was challenging since the field work spanned a vast
geographical area, encompassing eight districts in four states including the north-eastern state
of Assam. It was possible to witness the campaign in strategically important regions of the
country and visit remote villages and learn about the life that they face. Equally important was
the exposure to the work carried out by DFP personnel in these extreme and disadvantageous
situations and learning first-hand enterprising work handled by them.
We would like to acknowledge the support we got from the Delhi head-office of
Directorate of Field Publicity, especially Sri. Mohan Chandok, Director General, Sri Surenndra
Kumar, Director, Sri Naveen Joshi, Deputy Director and Sri Kaushish, Consultant. We extend
our sincere thanks to Regional Directors of DFP, Sri A. K Lakara (DFP, Ranchi), Sri Dinesh
Kumar (DFP, Guwahai), Ms Ritu Shukla (DFP, Jaipur), Sri Ajaya Upadhaya,(DFP, Bhopal)
and in charge of field units of Gumla, Kunthi in Jharkhand, Nagaon, Jorhat in Assam, Barmer,
Jodhpur in Rajasthan , Panna and Sehore in Madhya Pradesh for extending their cooperation
and sharing their views with the research team.
During the course of the field-work, women beneficiaries, officials from the health
department of the district, local health functionaries, PRI representatives from all the states
shared their experiences, views and opinion on NRHM and JSSY and their role in achieving the
goal. It was an enriching experience and these conversations with common people, men and
women and children in villages invested the field data with more substantive meaning and
wisdom. We also thank the investigators at the field level who helped in the data collection and
in providing a better understanding of the field situation.
The timely support and guidance of Mr. Suneet Tandon, Director General IIMC, Mr.
Jaideep Bhatnagar, Officer-on-Special-Duty, IIMC and his staff helped in the smooth conduction
of the study. We owe our thanks to the entire staff of the Press, Administration and Library of
IIMC for the support provided in undertaking this study.
DECORE
IIMC
i
Preface
Health
Communication is nowadays accepted as an essential component for the
successful delivery of health services. The National Rural Health Mission (NRHM) aims to
provide better quality health services, along with promoting more healthy life styles in rural
areas. This aim can be more effectively achieved if the beneficiaries themselves are able to make
informed choices while demanding health services. This interface between the people and the
health system can best be achieved and sustained through innovative communication strategies
designed to stimulate positive attitudes and behaviours. This would be in tune with the spirit of
our times, in which peoples’ participation in the process of governance is integral to the process
of democratization.
Extending the reach of the development programmes among the vast majority is the main
objective of organizations like Directorate of Field Publicity (DFP). The DFP provides yeoman
service by giving such program visibility and credibility among sections of population with
limited access to know-how and resources. The Directorate also has the ability to provide
feedback about people’s concerns to development agencies as an invaluable input in shaping
development programmes as well as mechanisms for their delivery. Communication
technologies, as an ubiquitous part of our lives today, are also becoming a reality in rural India
and contributing towards bridging urban-rural digital divide. In spite of flurry of wide-reaching
technological developments in the way we access and process information, some things do not
and will not change. These are ways in which people use interpersonal and ‘offline’
communication to seek information and deal with issues that require understanding, credibility
and confidence.
At the Indian Institute of Mass Communication, the Department of Communication
Research (DECORE) has been involved in studies that provide roadmap, as well as an
understanding about the complex world of media technologies, media content, the interplay
between these and lives of people and how society and government can use these learnings
gainfully and efficiently. Under the aegis of the Ministry of Health and Family Welfare, DFP
implemented a communication campaign for promoting mother and child health in rural and
semi-rural areas in nine states in 2011-12. As a signatory to Millennium Development Goals
(MDG), India has pledged to reduce maternal mortality and ensure child survival. This can best
be achieved if the communities, mothers and front-link workers, as well as the health system,
work in unison and acquire adequate knowledge of health and life-skills. The broad objective of
the study by IIMC was to determine the effectiveness of DFP’s communication campaigns for
promoting healthy practices among disadvantaged communities. The study also explored critical
campaign factors that determined an incremental change in knowledge, attitudes, practices and
uptake of health services in different parts of the country. The study evaluated the campaign
ii
materials and the impact of the communicative processes among beneficiaries. It aimed to
identify enablers as well as barriers – socio - cultural and systemic- which impact the relevant
health schemes.
We hope that this study will help the Ministry of Health & Family Welfare and the
Directorate of Field Publicity in process of evaluation and evolution for their strategies of
interpersonal communication. We also hope that it will be of interest and value to all who are
interested and engaged in the study and practice of communication for development.
Sunit Tandon
Director General
Dated: June 2012
iii
Glossary
DFP
M/o HF&W
JSSK
JSY
S& D
NRHM
ANM
ASHA
AWW
ANC
PHC
MGNREGA
SSA
BCC
CMP
BDO
M.O.
C.M.O.
MPW
RCH
CHC
SHG
NGO
CBO
PRI
FPAI
ICDS
LHMC
CP
UNICEF
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Directorate of Field publicity
Ministry of Health and Family welfare
Janani Shishu Suraksha Karyakram
Janani Suraksha Yojanna
Song and Drama Division
National Rural Health Mission
Auxiliary Nurse and Midwife
Accredited Social Health Activist
Anganwadi Worker
Ante Natal Care
Primary Health Centre
Mahatma Gandhi National Rural Employment Guarantee Act
Sarva Shiksha Abhiyan
Behaviour Change Communication
Common Minimum Program
Block Development Officer
Medical Officer
Chief/Medical Officer
Multi-Purpose Worker
Reproductive & Child Health
Community Health Centre
Self Help Groups
Non-Govt. Organization
Community Based Organisation
Panchayati Raj Institution
Family Planning Association of India
Integrated Child Development Services
Local Health Management Committee
Community Participation
United Nations International Children’s Emergency Fund
iv
EXECUTIVE
SUMMARY
Executive Summary
Introduction
It is well accepted that since independence the pace of development in this country had been fast
but not uniform. A large segment of rural population continues to be bereft of benefits of the
schemes targeted and designed for them due to lack of awareness and motivation. The colossal
task of overcoming social and psychological barriers in comprehension and mobilisation of
people requires building trust and credibility for the programmes. This can be achieved by
picking such communication channels that best suit the physical conditions and psychological
conditioning of people. For many years, mass media has proclaimed to have reached the masses
with the messages on health under various programmes but lacked a mechanism of assessing its
acceptability and compliance. Unlike mass media, the role of both DFP and Song and Drama
division is unique since these combine the best of mid-media and interpersonal channels to
overcome the disadvantages of the mass media in disadvantaged settings. These outfits
repeatedly undertake the elaborate process to understand, incorporate and deliver messages on
varied themes and subjects. The task of generating awareness contains essential elements of
initiating and encouraging an interpersonal dialogue/interaction with the audience and scope of
instantly ensuring the receptivity and comprehension of the message. Such efforts that are ‘built
on foundations of inter personal communication also provide hope that the knowledge
transmitted through participatory communication will translate into desired change in attitude
and health practices’.
Understanding Awareness Generation
For many years, efforts were restricted to finding the reach of the messages and lesser emphasis
was laid on assessing the impact of messages disseminated in terms of change in attitude and
practice. It was later in 1950s that the KAP survey tradition was first born in the field of
family planning and population studies. KAP surveys were designed to measure the extent to
which an obvious hostility to the idea and organisation of family planning existed among
different populations, and to provide information on the knowledge, attitudes, and practices in
family planning that could be used for programme purposes around the world (Cleland
1973, Ratcliffe 1976). The amount of studies on community perspectives and human
behaviour grew rapidly in response to the needs of the primary health care approach adopted by
international aid organisations. Hence KAP surveys today continue to be widely used to
gain information on health-seeking practices (Hausmann-Muela et al. 2003, Manderson & Aaby
1992)1 in a participatory manner to elicit participation and credibility for such programmes.
Understanding the levels of Knowledge Attitude and Practice will enable a more efficient
1
How much can a KAP survey tell us about people's knowledge, attitudes and practices? Some observations from medical
anthropology research on malaria in pregnancy in Malawi by Annika Launiala (University of Tampere and University of Kuopio, Finland).
http://www.anthropologymatters.com/index.php?journal=nth_matters &page=article&op=viewarticle&path%5b%5d=31&path%5b%5d=53
v
process of awareness creation as it will allow the program to be tailored more appropriately to
the needs of the community2.
About the IIMC Study
Innumerable campaigns have been launched to reach out to population with essential tailor made
messages intended to cause some healthier change in one’s well being. Similarly studies have
been undertaken in past to assess the outcome of campaigns but were restricted to finding the
extent of knowledge gained. ‘Such studies often lacked the critical constituent to find out the
likelihood of transformation of knowledge into action.’
The goal of health campaign devised by DFP was to generate awareness JSY, family planning
and breast feeding which would provide:
Stimulus and acceleration in the service utilization by the target groups with
reference to JSY, family planning and breast feeding
Encourage coordination among health front-line workers, block level health
officials, important community organisations and members of PRIs
Spread of NRHM programme to inaccessible areas
Keeping this mandate in view, a campaign focussing on these salient issues, especially on JSY,
was organised in nine states. The task of evaluating the campaign was guided by the objectives
to determine effectiveness of communication campaign for promoting change in (a)
knowledge (b) the attitude (c) practice and uptake of services in the area of JSY, family
planning and breastfeeding.
More specifically, IIMC study was conducted to evaluate:
1.
2.
3.
4.
5.
2
Campaign material and processes.
Feasibility of the two-step participatory communication process
Impact of such communicative process among beneficiaries.
Mapping changes occurring at KAP level among beneficiaries in three core health
areas (Institutional delivery, Family planning and Exclusive Breast Feeding).
Evaluation of competencies, enablers and barriers – socio-cultural and systemic
which impacted the health scheme.
Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study by K. Kaliyaperumal, I.E.C. Expert, Diabetic Retinopathy
Project. http://laico.org/v2020resource/files/guideline_kap_Jan_mar04.pdf
vi
Methodology
The Study stretched across 3 stages of campaign, beginning from pre campaign period, field
campaign and post campaign period. It was conducted in 3 steps, each step corresponding to
each stage of campaign. Out of nine campaign states, the evaluation was done in 4 states of
Assam, Jharkhand, Madhya Pradesh and Rajasthan.
Multi-stage Evaluation of the DFP Campaign
Stage I
Pre Campaign period
Step 1
Assessment of DFP workshop (based on workshop reports)
Stage II
Field Campaign period
Step 2
Observation of the campaign activities and eliciting response of the
target audience
Stage III
Post Campaign period
Step 3
Baseline assessment of beneficiaries, health functionaries & DFP
staff
Changes in knowledge and uptake of services
Content Analysis of Campaign material
Sample of the Study
The responses were elicited from women beneficiaries, micro-level health functionaries, DFP
officials at regional and district level, visitors at campaign site and opinion leaders of the village
where campaign was organised. This approach of collecting data from the field sites assisted in
understanding changes in attitude and perceptions of the people exposed to the campaign. Apart
from this, views and opinion on planning and organisation of the campaign was gathered to
provide clues for improvement in future campaigns.
Type of Sample
Research
tool
Sample size
Stage II: Field Campaign Period
DFP and field functionaries
IDI
1 IDI x 1 site x 8 Districts = 8
Opinion leaders at Village site
FGD
1 FGD x 1 site x 8 Districts x 6 participants = 48
Beneficiaries at Village site
FGD
1 FGD x 1 site x 8 Districts x 6 participants = 48
Entry-Exit Polls for Visitors/ beneficiaries
Questionnaire
1 site x 8 Districts x 30 Respondents =240
Beneficiaries of the campaign activities
FGD
1 FGD x 4 districts x 6 participants = 24
Micro-level health functionaries
FGD
1 FGD x 4 districts x 6 participants = 24
Opinion Leaders at Village site
FGD
1 FGD x 4 Districts x 6 participants = 24
Stage III: Post Campaign Period
Total = 8+ 48 + 48 + 240 + 24 + 24 + 24 = 416
* IDI- In Depth Interview
**FGD- Focus Group Discussion
vii
Major Findings
A.
IMPROVEMENTS IN KNOWLEDGE DUE TO CAMPAIGN
Campaign has made a significant impact on awareness generation on breast feeding, institutional
deliveries, and family planning.
Figure 1: Differences in Knowledge due to Campaign
2.5
2.2667
1.9
2
1.5333
1.375
1.5
1.2167
0.9167
1
0.5
0
Breast Feeding
Institutional Delivery
Mean Entry
B.
Family Planning
Mean Exit
DIFFERENCES IN ATTITUDE DUE TO CAMPAIGN
Major impact of the campaign is significant changes in the reported positive attitude towards
institutional delivery, and breastfeeding. As compared to institutional deliveries, the attitude
change for breastfeeding practices is greater.
Figure 2: Differences in Attitude due to Campaign
10
9
8
7
6
5
4
3
2
1
0
8.54
5.98
9.23
6.36
3.58
Attitude for Institutional
Delivery
Attitude for Breast Feeding
Mean-Entry
3.35
Negative Attitude for Family
Planning
Mean- Exit
viii
C.
FINDINGS ON KAP AND ITS IMPLICATION FOR COMMUNICATION
STRATEGY
i. Campaign had had a significant impact on awareness generation as well as on
promotion of positive attitude for breast feeding across the states. Observed relation
of 26% variance between levels of knowledge and attitude for breast feeding explains
that the prescribed route for attitude change can be tracked through awareness
generation, which also indicated that major change agent is rooted in socio-cultural
practices. Evidence suggests Jharkhand and Rajasthan require more intense and
rigorous campaign to overcome the lag between awareness and attitude which in
effect will get converted to practice.
ii. Campaign succeeded in bringing awareness about JSY programme among women
belonging to deprived sections of the society living in remote and backward areas.
Higher awareness about JSY programme has been due to the incentive for pregnant
women and ASHA.
iii. Contribution of campaign was significant in promotion of positive attitude i.e.
'institutional delivery is safe delivery'. Since the observed relationship between
knowledge and attitude was negligible for institutional deliveries, it provides a
compulsive argument to organise more focussed campaigns on knowledge generation,
attitude change, and socio-cultural barriers. Awareness generation is less likely to
lead to action unless facilitated by positive attitude of individual and an enabling
social and health system environment. Thus each area needs separate communication
strategy.
iv. The campaign had a limited impact on the uptake of family planning services. The
challenge in this case was not about generating awareness alone but utilising higher
awareness to reduce negative attitude towards family planning.
D.
SUGGESTIONS FOR IMPROVING KAP LEVELS OF BENEFICIARIES
i. Uses of ‘harm reduction’ and ‘fear appeal’ are recommended for breast feeding
programme. As ‘harm reduction strategy’, campaign could highlight for example that
‘first milk’ of mother is of utmost importance than ‘honey’ which can be given to the
child at a later stage during the occasion of “Annaprashan”. As an element of ‘fear
appeal’, the campaign should highlight ‘harmful consequences’ of not breast feeding
on the child and the mother both psychologically and physiologically.
ii. For promotion of institutional deliveries campaign should highlight that ‘celebration
of parenthood’ is incomplete without institutional deliveries, which is the key to the
safety of mother and child.
iii. For family planning programme a clearly articulated promotional programme on
‘contraceptive choices’ and ‘size of the family’ should be implemented in conjunction
ix
with access to quality services. More discreet and veiled messaging need to be
designed and promoted, which enhances the desirability of ‘small family’ as a viable
and as an alternative to ‘large size family’. More rigorous message dissemination
regarding contraceptive choices, which a couple/individual can choose from, should
form a major plank of the interpersonal communication forums.
E.
METHODS OF INFORMATION DISSEMINATION and PROGRAMME
i. There was heavy reliance on lectures/seminar as a mode of information delivery.
The pattern of lecture/seminar was not uniform across the regions. Speaker's focus
was more on health prevention activities than on promotion of available services and
its utilization. Hence, selection of speakers and choice of topics should be in
alignment with the kind of audience available. Careful and deliberate attention should
be given to selection of guest speakers, by informing them much in advance about the
campaign topics.
ii. Health Camp: Campaign in conjunction with the health camp is a viable option as it
provides an opportunity for monitoring as well as for image correction/building of the
client ministry (MOHFW). Evidence suggests that this model can be implemented
with certain riders.
iii. Village Rallies: Rally, used as an energizer method but was unable to open the
channel of communication and remained restricted to a passive communication
exercise with live models in some districts. The rally as a method of instilling interest
and curiosity of the community can at best work as a trigger.
iv. Baby Show: The baby Show activity can be used as an important strategy to reach
specific target population. For better management of the ‘baby show’ selection
criteria of the baby and number of awards should be announced in advance. As there
is an active involvement of the health department, this activity provides a chance to
identify and reach the specific target population with minimal redundancy of efforts.
v. Quiz: Quiz format was used at all sites. It was used less for information delivery and
more for ensuring receptivity & comprehension of messages. As a programme
activity, it proved effective in terms of initiating audience response and participation.
F.
FINDINGS & SUGGESTIONS FOR IMPROVING PROGRAMME PLANNING
AND EFFECTIVENESS
i. Coordination between health department and DFP: DFP should collaborate with
local health officials periodically for finalizing their activities through email and
mobile to reduce time lag and overcome the difficulty of meeting in person to sort out
issues of programme planning and management. This will also help in addressing the
local needs and customizing services to the benefit of beneficiaries. At the same time
x
health department as the client agency should promote the synchronization of their
activity with DFP.
ii. Training workshop on Message Framing and Issue of Knowledge-Transfer:
Briefings at the regional/state workshops were heavily tilted in favour of select
schemes (JSY), while emphasis on other important schemes and entitlements of the
people was toned down to their detriment. In some of the regional workshops,
speakers/trainers (health officials) were not well prepared to provide adequate
briefing even on JSY. For example, the scheme of Janani Shishu Sureksha Yojana, as
an add-on to the existing JSY, was presented as a new scheme (JSSK) which created
an ambiguous impression about JSSK as a replacement to JSY.
a. Preparing for workshop: DFP should give more attention to the organisation of
the training-workshop by identifying appropriate trainers in advance and assigning
such topics to speakers to avoid repetition or omission. To ensure availability of the
guest speakers during the training sessions an advance confirmation should be taken,
and an alternative list of speakers should be prepared to fill the gap in case of dropouts.
iii. Emphasis on community Participation: The role of PRIs under NRHM was not
elucidated, which resulted in failure to assign minor and major responsibilities to
them before and after the event. The NRHM/health Officials at the DFP workshops
should have highlighted the active role of village functionaries and opinion leaders as
crucial to continuation of the programme.
a. Strategy should align with efforts of client ministry's mandate under NRHM i.e.
'community processes'. This will not only support the activity of the client ministry in
activating and revitalizing its institutional structures, such as VHSCs etc, but it would
also help in multiplying the efforts of DFP. For this process to unveil, orientation of
officers has to begin from the top and translate into clearly laid-out plans and specific
tasks.
iv. Meeting with Opinion leaders: Effort was partially fulfilled as DFP’s activities
were limited to briefing the opinion leaders about various schemes, and did not
extend beyond to developing and building consistent association. The preparation and
orientation regarding planning and designing for the campaign at the central and
regional level however failed to translate and transfer at the district levels, and
subsequently at the campaign sites.
a. A better and alternative approach could be to involve the panchayats in organizing
meetings and provide a forum of information and feedback. Encouragement can also
be given to participation of local NGO members, and development agencies and their
functionaries in such meetings as well.
xi
v. Timings of the Programme: The timings of the designated programmes should
synchronise with the availability and presence of the local population. It is
recommended that before scheduling the programme, days of weekly market,
festivals, and timing of agricultural activities should be ascertained to ensure
availability and participation of community in the programme.
vi. Inter Departmental Coordination: A mechanism for inter-departmental
coordination needs to evolve, especially with S&D and DAVP, to garner support that
will augment the effort of DFP.
As a forward movement DFP’s programme can ensure better impact if people’s
participation is not reduced to the level of a passive audience, but women and men and
youth are motivated to become part of the communication programme planning,
implementation and monitoring process for community’s ownership of the development
programmes. A participatory approach where people feel empowered to think,
rationalize, participate and express their understandings and concerns will help
programmes to gain credibility and acceptance. This precept will help in changing the
way communication programmes are conceived, designed by those who usurp the
creative process of the communities to express their ideas and in a language which is as
rich as their cultural moorings.
xii
REPORT
Chapter I
Participatory Communication Campaign Approaches in Improving
Health Practices in India
Introduction
Social change for development requires a change in archaic beliefs and practices of individuals
and communities. Empowering communities to question existing practices and seek viable
solutions in an environment characterised by socio-economic deprivation is a challenging issue
in the development process. Participatory approaches can help in raising awareness, mobilisation
and building capacity for sustainable community action. Several global initiatives as part of the
consensus building for development like the Earth Summit 1992, ICPD 1994, World Summit for
Social Development 1995, World Food Summit 1996 have recognized the significance of
communication in engendering development and social change (Balit 1999). Mass media has
been regarded as the simplest and cheapest way to reach out to a large population in a short time.
NFHS- II, III data revealed that women who were exposed to family planning messages on
television or radio were more likely to approve of family planning than women without mass
media exposure. They were also likely to discuss family planning with their husbands; and use
contraceptive measures at some time or have an intention to do so in the future (Olenick, 2000).
The use and outreach of electronic media however is limited due to various infrastructural and
socio-economic factors. The peculiarities of cultural, linguistic, regional and even semiotic
differences further complicate the problem. The successful implementation of a development
plan hinges upon customizing messages to people’s needs and the local institutional structures
(Bashirudin, 1978). In his review Costello (1977) has discussed four functions of communication
in health care: diagnosis, cooperation, counsel, and education. On the broadest level, these four
functions are still relevant in the health empowerment process, but health communication
concerns have moved well beyond this. Now role of community and its actors has been changed,
and they are no longer passive beneficiaries of health education, rather they are the co-partners of
social change.
Communication Campaign for Social and Behavior Change
Well-being and health of the people forms the main plank of the development change which can
be sustained through use of participatory communication strategies. Expectation is that this
would culminate in achieving change in health behaviours at an individual and the community
levels. Behaviour Change Communication (BCC) is a planned process that utilises interpersonal
communication, community level activities, and/or mass media to attain individual and social
change. Behaviour Change Communication was located in needs and desires of people to
achieve individual and community goals through knowledge, motivation and skill up-gradation.
A report by IIMC for Directorate of Field Publicity, Ministry of Information & Broadcasting, GOI
1
During the period of reconstruction in many erstwhile colonies, Mendelsohn (1968) had
suggested that use of mass media can be extremely powerful in involving audiences with the
abstract matters of health in an exciting personalized ways. But the evidence suggests that many
mediated health message fall short of attaining this goal. According to Levy and Windahl (1985)
failures partly occur because of the ways people ‘process the information’. According to
Elaboration Likelihood Model (ELM) given by Petty and Cacippo (1986) messages which were
processed through central route are more persuasive. Thus, the messages, which are appealing
and involve the audience for active cognitive effort, are more persuasive. From the message
designing perspective, the information processing approach has certain promises. The model has
an implication for the language and content of the campaign material. However, information
processing model and it’s over reliance on ‘cognitive effort’ as key consideration relies heavily
on an individualistic model, and there is inherent assumption of ‘rational individual’, and
negation of social context. This model has also an inbuilt assumption of an existing optimal
functional health system, which would actively respond to the generated need of the individual.
A balance between ‘over socialised’ model and ‘over rationalised model’ of man would be more
appropriate in a setting where disenfranchisement and limited access to health services can
compromise an ability to attend to innovative and alternative healthy choices.
Behaviour Change Communication (BCC) is a process that motivates people to adopt and sustain
healthy behaviours and lifestyles. Sustaining these healthy behaviours usually requires a
continuing investment in BCC as an integral part of an overall health program (Salem, Bernstein,
Sullivan, 2008). Such behaviours which are embedded in the normative practices require social
sanction for change, while those seen as ‘easy to manage and with little effort’ can ensure
individual compliance without delay. To prevent relapse and to ensure new forms of practices do
not lose their momentum, facilitation through communication channels and change
agents/partners becomes integral part of the change (Bamezai, 2010). To put all the focus on an
individual for initiating change in the community is limiting the scope of the changes itself.
SBCC (Social and Behaviour Change Communication) process effectively requires communitybased communication to mobilize public opinion, social sanction and approval for individual
behavior changes.
To build such constituencies of support and participation interpersonal and group communication
can provide avenues for people and individuals to gain confidence and credence for any new
practices. Success of Pulse Polio’s programme demonstrated effective use of social mobilization
in a campaign mode to energize the communities, instill emotive elements in the messaging and
branding the programme in terms of easy access, friendly and timely service at the door-step.
According to Salmon and Atkin (2003) there are four essential elements of campaign: (a) a
campaign is intended to generate specific outcomes or effects (b) in a relatively large number of
individuals, (c) usually within a specified period of time and (d) through an organized set of
communication activities. Campaigning is not only limited to impart any new knowledge or
2
practice, rather it is also the reinforcement of the existing but low prioritised healthy behaviour
patterns.
Building an Enabling Environment
The utmost requirement for health promotion is creating an enabling environment in which new
behaviours can be embedded for easy adoption. In 1986, Marshall Becker wrote a paper entitled
“The Tyranny of Health Promotion,” in which he critiqued the individual lifestyle approach to
health promotion and cautioned against its tendency to equate “being ill” with “being guilty” and
to substitute “personal health goals for more important, humane societal goals”. The lifestyle
approach to health promotion was criticized for turning health into a commodity, something to
be bought and sold in the marketplace, which now included not simply the physician’s office or
the hospital but also the health food store, exercise club, or stress management program
(Robertson and Minkler, 2010). An individual is likely to accept a new practice, or alter an old
practice, if the policy and legal framework, economic and socio-cultural factors all provide a
conducive (and acceptable) environment. An understanding has emerged that cultural and social
context should provide a reference point for legitimacy and acceptance of new behaviours.
Hence, BCC attempts to create an environment where positive behaviour change is acceptable,
possible and promoted (Bamezai, 2010). The ideal communication strategies do not just implore
people to change, but help them live healthier lives and in making appropriate health decisions
throughout life by building and strengthening healthy, participatory communities and effective
health care delivery systems, supported by enlightened health policy (Servaes, 2006).
Changing Meaning and Focus
There is recognition of the shortcomings of individually focused approach to health
communication/promotion. It has led to acceptance of new approaches, where there is
importance of social life and cultural rooting of individual; and actions of the individual that has
an impact on his/her health, are seen as more than the result of an individual decision to act in a
certain way. However, to understand groups of people as ‘organisms’ we needed to shift toward
understandings of the person as inextricable from their social context: the individual as a part of,
product of and producer of that context. One useful descriptive word for this approach is
‘community’. McLeroy et al. (2003) identified four types of community-based interventions:
community as the setting; community as the target for change; community as the resource and
community as agent.
The stance of BCC components today have shifted from individuals and households to
communities and the wider society; from involving beneficiaries of change to ‘partners’ in social
development; from demand creation to participation and empowerment; from top- down
channels to participatory, dialogue based learning models and from needs to rights. Sustaining
the change requires optimization of local assets in the form of material, know-how and human
resources to ensure that interventions (healthy behaviours) have fiscal viability and can easily
3
germinate in the local culture to gain acceptability and sustained practice. Mass media’s
‘multiplier effect’ was enjoined with participatory approach through engagement of local
communities and ‘target groups’ in production, distribution, interaction and evaluation of the
process of change. Primacy was given to bringing change through building consensus,
conciliation and popular consent (Bamezai, 2010).
National Rural Health Mission and Its Communication Strategies
National Rural Health Mission was need of the hour, as during post nineties the systematic
withdrawal of the state as a primary provider of health care and its dependence on market and
later its failure, had generated an utmost requirement for organized and systematic effort from
state. ‘There has been an unrepentant increase in maternal mortality among young women
between the ages of 15 to 19 due to complications of pregnancy and childbirth in the developing
countries. Evidence suggests that more number of such pregnancies is either unwanted or is a
result of indirect pressure exerted through social expectations; and absence of timely availability
of contraception and help of professional birth attendants. These deliveries result in risky
abortions, leading to morbidity and mortality. Nearly all (98%) maternal deaths occur in
developing countries where pregnant women lack access to basic health care services - before,
during and after delivery’ (WHO, 2006).
NRHM represents a major departure from the past, in that central government health financing is
now directed to the development of state health systems rather than being confined to a select
number of national health programmes. The NRHM framework shows a conscious decision to
strengthen public health systems and the role of the state as health care provider but
concomitantly recognises the need to make optimal use of the private sector to strengthen public
health systems and increase access to medical care for the poor. The NRHM is thus also about
health sector reform – or in its language – an “architectural correction” of the public health
system so as to make it “equitable, affordable and effective”. Such architectural correction is
organised around five pillars, each of which is made up of a number of overlapping core
strategies (First Common Review Mission Report, 2008).
Under NRHM communication is an integrated task which works at multiple levels from policy
making, community ownership to community counseling. NRHM has been using innovative
communication mechanisms such as branding the identity of NRHM, facilitating advocacy and
social marketing (Bamezai, 2010). NRHM has been able to position its communication
interventions at the primary health care level by creating a network of peer counsellor in the form
of ASHAs, who provide easy access to critical information. The findings of the Common Review
Report of the NRHM in Chattisgarh (First Common Review Mission Report, 2008) indicates that
the ‘Mitanin Program’ has been successful in involving the community and the PRIs by
facilitating dialogue and empowering the community to participate in health services through
Mitanin worker.
4
Need for Customised Communication Campaign
The Ministry of Health and Family Welfare Evaluation Study of the JSY in 2007 in the states of
UP, Rajasthan, MP, Orissa, Assam and West Bengal noted that there was a substantial increase
in institutional deliveries, increased utilization in ANC services and front-line health facilitators
like ANMs/ASHAs/AWWs were the main source of information of programme. The number of
beneficiaries rose from 7.39 lakhs in 2005-06 to 73.3 lakhs in 2007-08. Institutional deliveries
were 80% of the total deliveries under the JSY. However, the study showed that awareness about
the programme was low in some states particularly among rural women and the BCC
intervention was needed to emphasize the importance of institutional delivery effectively and
comprehensively. Such an intervention required greater participation of PRIs, NGOs and SHGs
in the process and full community involvement. Village bazaars, religious congregations provide
an opportunity and conducive environment for spreading the message of JSY since such venues
attract people in large numbers and are receptive to new information and can participate in
decision-making simultaneously.
The recent Programme Evaluation Report of JSY (NHSRC, 2011) states that, “About one third
of those who had home deliveries were not able to access institutions on account of not being
able to afford transport costs”. Poor service quality and high costs in institutions were also
reported as deterrents of institutional delivery. About one third had cultural preference for home
delivery and a lacked awareness about how quality care could reduce risks. At least half of these
home deliveries would become institutional deliveries if transport and quality of care improved
and another half would also require communication related to risks of pregnancy. Messages on
JSY had not reached to about 40% of those who delivered at home, and those to whom the
message has reached, the financial incentive are much better communicated than the health and
safety aspects”.
Closing the gap between knowledge and attitude regarding institutional deliveries would be one
of the ways of reducing risks and stemming the trend of high mortality. Lack of informed choice
about other health interventions can equally prove detrimental to women’s health and put at risk
the health of the infants. The stimulus to coverage of services can best be endorsed not by
mounting a series of communication activities in villages and drawing conclusions based on
overt mass approval, sanction and acceptance. Assessing the role of communication from a
perspective in which people become the arbitrator in seeking information, planning and
organizing programmes is more feasible and sustainable. The participatory approaches in
communication can serve aspirations and needs of the people living in remote and inaccessible
areas who can be best mobilized by a participatory campaign-mode approach to seek better
alternatives for healthier lives.
5
Assessing Communication Campaign Approach in Health
NRHM aims to impact various important maternal and child health indicators by implementing
health schemes such as family planning, popularly recognized as inverted red triangle, breast
feeding and institutional deliveries. As a signatory to Millennium Development Goals (MDG),
India has made a pledge to reduce maternal mortality and ensure child survival which can best be
achieved if the community, mothers and front-link workers and the health system work in
unison. Communication strategies have multi-fold purpose and can be designed in collaboration
with different partners, collaborators and the target audience to maximize the reach and impact
of the village-level programmes. Under the aegis of the Ministry of Health and Family Welfare,
the DFP planned, organized and implemented participatory communication programmes in rural
and semi-rural areas in nine states during 2011 to 2012. These activities were focused on
promotion of: (a) Institutional delivery, (b) Family planning, and (c) Exclusive Breast Feeding.
Aims & Objectives
Aim: The aim of this project by IIMC was to assess the communication campaign factors that
determined an incremental change in the (a) knowledge (b) the attitude or (c) behavioral and
uptake of services in the area of MCH.
Broad Objective: The broad objective of the study was to determine the effectiveness of the
communication campaign for promoting Mother and Child Health practices/behaviours among
the disadvantaged communities.
Specific Objectives: To assess communication of the selected health schemes1across two levels
of the campaign included:





1
Evaluation of campaign materials and processes.
Evaluation of the feasibility of the two-step participatory communication process
Evaluation of the impact of such communicative process among beneficiaries.
Mapping changes occurring at KAP level among beneficiaries in three core health areas.
(Institutional delivery, Family planning and Exclusive Breast Feeding)
Evaluation of competencies, enablers and barriers – socio-cultural and systemic which
impacted the health schemes.
These communication activities are focused on the schemes of (a) Institutional delivery, (b) Family planning,
and (c) Exclusive breast feeding.
6
Research Methodology
The study was conducted at three levels and at three stages. The chain of communication of
knowledge, and its correspondence with research is as follows:
STAGE I: PRE-CAMPAIGN PERIOD
During stage-I reports of DFP regional workshops in four states were reviewed to assess the type
and nature of training given as a preparation for the field-based participatory communication
activities and the proposed communication strategy for enlisting the support, partnership and
collaboration of different agencies at the district and village levels. At this stage primary data
was collected from health and DFP officials to understand their perspectives about health and
participatory communication interventions.
Figure 1.1
Step 1
Assessment of DFP
Workshops (Based
on DFP reports)
Step 2
Base-line assessment
of Beneficiaries,
Health Functionaries
& DFP Staff
Stage I of research: PreCampaign Period
Secondary Sources based
on WS Reports
IDIs and FGD with Women,
HF’s and DFP
Step 3
Observation of the
Campaign activities
and eliciting target
audience’s responses
Changes in Knowledge
and uptake of services
among Beneficiaries &
Health Functionaries
Stage II of research:
Field Campaign Period
Stage III of research:
Post-Campaign Period
Entry Exit Interviews:
Conducted with
beneficiaries during
Stage-II, Observation and
Content Analysis
IDI and FGDs Conducted
with beneficiaries and
Health Functionaries.
Health records analysis
of services uptake
STAGE II: FIELD CAMPAIGN PERIOD
Entry exit interviews were conducted during stage-II i.e. Field Campaign Period to measure the
changes in knowledge and attitude among the respondents. The focus was to understand the
recall and relearning on salient issues of institutional delivery programmes and other allied
programmes.
7
The training materials used during the training and campaign were reviewed and assessed for
content, quality and relevance. Content analysis was conducted on textual and audio/visual
material used to convey knowledge and understanding about technical aspects and the
information on services and entitlements to the beneficiaries. The standard of textual/ audiovisual/ audio material was determined by categorizing, evaluating and reviewing the material.
STAGE III: POST-CAMPAIGN PERIOD
Impact Assessment among Beneficiaries: The impact of the interventions in the form of
campaign, health camps and consultations with the PRIs was assessed in terms of retention of
information over time, comprehension and awareness about the schemes like JSY and
incremental changes in the uptake of services. The information was collected from two
categories of stakeholders: (a) Field-level functionaries responsible for implementing the
schemes (ASHA, ANM and other PRI functionaries), (b) Beneficiaries who attended the
activities at stage II. The purpose was to gauge the quality and quantity of knowledge
remembered and accurately reported after a period of time and making an assessment of changes
in inclination, motivation and behaviour.
METHODOLOGY2 AND SAMPLING FOR STAGES I, II AND III
Methodology and Sampling for Stage I
The DFP selected 9 states to conduct the campaign in different regions of the country. Of these 9
states, IIMC conducted research activities in 4 states, which were selected purposively.
Table 1.1 Reasons for Inclusion in sample
S.
No
State
1
1.
Assam
2.
Jharkhand
3.
Rajasthan
2
3
4
4.
2
M.P.
Reasons for Inclusion in sample
North-Eastern state, unique cultural context, historical issues with access to
institutional care.
Relatively new state infrastructure, presence of tribal population, quite serious
issues of underdevelopment.
Culturally different from much of North India, tribal population, quite serious
issues of underdevelopment
Needs inclusion in any sample evaluating communicative issues in North India.
Historical issues with underdevelopment, including education, health etc. Largest
north Indian state, covering varied cultural territory.
This is minimum risk research. Verbal consent will be obtained from participants prior to research activities.
8
Use of Multiple Research Methods
a. Review of Workshop Reports of 4 Regional Centres
b. IDI with 2 DFP officials from each region= 8 (2 IDI x 4 Regional Level briefing)
Methodology and Sampling for Stage II
The DFP provided information on the division of the state for logistical purposes, and the
campaign activity sites. On the basis of district-level information, 2 districts with the best and
low health indicators were selected (see figure 2) from each state along the following parameters:
a.
b.
c.
d.
e.
Infant Mortality Rate
Maternal Mortality Rate
Education
Life Expectancy
Income
1. From each District, one village site, based on the above stated parameters (low indices) was
selected.
Researchers from IIMC attended and observed the field campaign activity at one site in each
selected districts of the four states, therefore, a total of (1 site x 2 districts x 4 states) 8
campaign activity sites were evaluated.
Figure 1.2
9
2. As per the Terms of reference following sessions were organized by the DFP in different
sites consisting of:
Session I
Session II
Session III
3.
Meeting with Opinion Leaders
Rally in the Village
Interactive session with potential beneficiaries/ common people
Information from the existing Records of MCH at the Block/PHC/Village level was
collected for assessment of changes in the service coverage/uptake before and after the
campaign.
Following Tools were used for compiling the data:
a) Observation Reports of all the three sessions (Meeting with Opinion leaders, meeting
with beneficiaries and rally/social mobilization activity at the village level) = 8 (1x 8
campaign activity sites)
b) IDIs were conducted with significant briefers from DFP and field functionaries at the
District level = 2 IDIs x 8 Districts = 8 FGDs/16 IDIs
c) FGD with opinion leaders = 8 (1 x 8 campaign activity sites)
d) FGD was conducted with potential beneficiaries/ common people=8 (1 FGD x
8 campaign activity sites) = 8 FGDs
e) Entry-exit polls was conducted to provide a rapid gauge of new learning=240
respondents (30 x 8 campaign activity sites).
f) Health Records- MCH data was gathered from local health functionaries, including
examination of Records/Registers of MCH status and services at CHC/PHC.
g) FGDs with ANM/ASHA/AWW/VHC members=1 FGD x 8 campaign activity sites = 8
FGDs with outreach workers at each site.
Methodology and Sampling for Post Campaign at Stage III
Researchers conducted the following stage 3 research activities to determine the overall impact
of the two-step communicative process in three selected areas of MCH. In the Post-Campaign
period, the retention of information and attitude or behavior change was assessed. The impact of
the two-step communication process over time was mapped by conducting interviews in
consultation with:
(a) Micro-level functionaries who were responsible for implementing the schemes- ASHA,
ANM, any other PRI functionaries,
(b) Beneficiaries who attended the activities in stage II.
10
This post-campaign assessment was conducted two months after the campaign activities during
stage II in the selected states. Local health functionaries provided contact of beneficiaries who
attended the activities at stage II. At this stage, 4 districts in each state were selected for post
campaign assessment for following survey and data collection:
a. 1 FGD with beneficiaries at 4 sites: 4 (1 FGD x 4 campaign activity sites) = 4 FGDs
b. 1 FGD with micro-level health functionaries: (1 FGD x 4 campaign activity sites) =4
FGDs
Table 1.2 Total Sample at National, Regional and District Level
Type of Sample
Research Tools
Total Sample Size
Stage II: Field Campaign Period
1
Significant briefers among DFP and
1
field functionaries at district briefings
IDI
1 IDI x 1 site x 8 Districts = 8 IDIs
2
3
2
Opinion leaders at Village site
FGD
3
Beneficiaries at Village site
FGD
Entry-Exit Polls with common people/
4
beneficiaries (participants of the
4
Rally/Social Mobilisation Efforts)
Stage III: Post Campaign Period
Beneficiaries
5
of the campaign
5 activities in stage II
Micro-level
6
health functionaries
6 responsible for implementation
7 Opinion Leaders at Village site
* IDI- In Depth Interview
Questionnaire
1FGD x 1site x 8 Districts x 6
participants = 48 participants
1 FGD x 1 site x 8 Districts x 6
participants = 48 participants
1 site x 8 Districts x 30 Respondents
= 240 Respondents
FGD
1
FGD x 4 districts x 6
participants = 24 Participants
FGD
1
FGD x 4 districts x 6
participants = 24 Participants
FGD
1 FGD x 4 Districts x 6 participants =
24 Participants
Total = 8+ 48 + 48 + 240 + 24 + 24 + 24 = 416
**FGD- Focus Group Discussion
Primary Sources of Data
Both Qualitative and Quantitative techniques were used to collect the data that formed the basis
of research:
i. Interview Schedules: For in-depth interviews with Health/DFP officials.
ii.
Content Analysis: To review the quality and relevance of material used for training
across two-steps of the communication process, and also to assess the publicity material
distributed at stage II.
iii.
Focus Group method: FGD with specialized groups comprising of DFP officials and
field functionaries, common people/beneficiaries, and micro level health functionaries.
iv.
Entry-Exit Poll: For common people/ beneficiaries at district level briefings.
v.
Questionnaire: Baseline information will be gathered with a questionnaire.
11
vi.
Observation Reports: On-the-spot evaluation of organization, people’ response,
conditions, and presentation of knowledge over the two steps of the process.
Secondary Data Sources
In addition to the survey and qualitative information, information based on the health records
maintained at the CHC/District and by the front-line workers (ANM/ASHA, AWW and self-help
groups) were collected during the campaign at the third stage of the campaign.
Data Analysis
Data analysis involved both qualitative and quantitative approaches. The collected information
on profile of the respondents, knowledge and attitude towards health seeking behavior and
practices were analyzed by using descriptive and inferential statistics3. Composite scores of
studied dimension were computed, and all the analysis was done on means of computed scores.
Inferential statistics like T-test4, Analysis of Variance (ANOVA) 5 and Correlation 6 were used to
infer the changes and relations with in variables. For qualitative data content and thematic
analysis was done.
3
Inferential statistics tries to infer from the sample data what the population might think. Or, inferential
statistics is used to make judgments of the probability that an observed difference between groups is a
dependable one or one that might have happened by chance in this study. Thus, we used inferential statistics to
make inferences from our data to more general conditions.
4
T-test assesses whether means of two groups are statistically different or not. It also helps to identify to
measure the variation of two different sample mean and the mean difference and also comparing the means of
two samples (or treatments), even they have different number of replicates. It is appropriate to analysis of two
groups when randomized experimental design is followed.
5
ANOVA intends to measure the variation (Sum of Square), the variance (Mean Square) are given for the within
and the between groups; as well as F value and the significance of F (Sig.) describes the difference between two
variables. The factorial experimental designs are usually analyzed with the Analysis of Variance (ANOVA)
Model.
6
Correlation helps to identify the degree of relationship between two variables whether there is a perfect
positive co-relation, perfect negative co-relation or no co-relation.
12
Chapter II
Impact of DFP Campaign
This chapter provides an assessment of the impact of the campaign activities undertaken by DFP
in rural areas. The communication campaign has been evaluated in terms of its effectiveness in
creating awareness among the prospective beneficiaries about selected healthcare services,
entitlements under each of the health schemes and how to access these facilities. These special
communication campaigns at the grassroots level were organized in the selected villages from
October, 2011 to February, 2012 by the unit in-charge of DFP across 9 states, out of which four
states were monitored and assessed for this impact study i.e. Assam, Jharkhand, Rajasthan and
M.P (refer table-2.1). Specific dates were fixed for conduction of these community-based
campaign activities by DFP in the selected districts and villages. On the ground assessment of
several activities were conducted before, during the campaign and after an intervening interval,
based on a check-list, focus-group discussion and entry and exit interviews with the audience of
these activities.
Table-2.1 Schedule of DFP Campaign
Name of State
Jharkhand
Assam
Rajasthan
M.P
Name of District
Gumla
Khunti
Nagaon
Jorhat
Jodhpur
Barmer
Panna
Sehore
Name of Village
Palkot
4th Jan,
2012
Khunti
6th Jan,
2012
Jhumarmor
7th Jan,
2012
Namdeuli
10th Jan,
2012
Sathin
17th Jan,
2012
Kaprau
19th Jan,
2012
Udla
7th Feb,
2012
Dobra
15th Feb,
2012
Campaign
organized (date)
SECTION I: SOCIO-DEMOGRAPHIC PROFILE OF ENTRY-EXIT RESPONDENTS
The people in the reproductive age (18-40 years) group were the target population of the DFP
campaign. In some villages people from the late reproductive age group (40 years and above)
were part of the audience group. Those belonging to late-reproductive group are also important
stakeholders and make decisions in decisive matters relating to family size and in granting
permission to women of the household to access and avail immunization, family planning and
ANC services. Among the auedience who participated in these communication activities larger
proportion (63%) were female, and less than half (36%) were male. As women are the
beneficiaries of JSY scheme, and also the target population for breast feeding, their presence in
high numbers and involvement in the campaign activities was evident.. Significantly, in all the
states the largest group comprised of women as the audience, especially in Jharkhand, followed
by Assam, MP and Rajasthan.
13
Figure 2.1 Age and Gender Profile of Entry-Exit Respondents
Majority of the women interviewed were not only housewives but were involved in some type of
economic activity as well. While majority had some type of education, only 30 per cent did not
have any formal education, whereas 30% had studied in school up to class eighth.
14
Figure 2.2 Patterns of Media and Mobile Use (Multiple Responses)
90.0
Assam
Jharkhand
80.0
Rajasthan
M.P.
70.0
60.0
63.3
80.0
40.0
83.3
50.0
46.7
26.7
0.0
TV
Radio
3.3
10.0
26.7
16.7
10.0
23.3
36.7
16.7
10.0
33.3
20.0
20.0
40.0
30.0
Newspaper
Mobile Phones
Significant patterns and changes were evident in the use of media across all the states with TV as
the preferred choice as compared to other media. Of immense value was the availability and use
of mobile phone in all states and its ubiquitous presence parallel to that of TV. In some states
access to mobile phones was higher than TV and other media, especially in Jharkhand and
Assam. Among all mass media, TV was a preferred medium, with an exception in Rajasthan
(20%), wherein at least one third respondents owned and watched TV to fulfill their need for
information and entertainment. As compared to other states, media consumption in Assam,
especially use of TV and Radio was higher. Rajasthan had comparatively lower media
penetration, even use of TV and Radio was much lower than other states. Readership for
newspapers was at a nascent stage and low in use across all the states. More than 45% of
respondents, with the highest (80%) in Assam, were using mobile phones for their day to day
communication activities. Overall, the use of mass media in rural areas has not become of such
significance even today. Hence, interpersonal and ground-level communication activities assume
a primary role in building awareness and participation of communities in the development
process, especially in promoting health.
SECTION II: CHANGES IN BEHAVIOURS CONTINGENT UPON POSITIVE
KNOWLEDGE AND ATTITUDE
Evidence of cause and effect relationship between the exposure to campaign programmes and
change in health practices thereafter is limited since it is also contingent on consistent exposure
and concomitant changes in the availability and quality of services. There is however significant
proof of direct correlation-ship between exposure to messages leading to higher awareness
among the target audience. Socio-cultural barriers, semiotic complexities in meaning of
15
messages for individuals and communities can stall and prevent assimilation of favorable attitude
and practice thereafter. As the study result (refer table 2.2) suggests that there is a symbiotic and
complex relationship between knowledge and attitude as in the context of breast-feeding
practices as well. Its knowledge is situated in the cultural practices which are entrenched in the
attitude towards feeding of the child. Any displacement of the negative or neutral attitude would
require a well-developed strategy altogether. Relationship between knowledge and attitude
explains nearly 26% (R2 =.25907) of variance, particularly when any increase in the knowledge
would lead to the attitude change. But in the case of other programmatic interventions, the
relationship between knowledge and attitude is not so straight; since there are various
moderator/mediator variables like social, cultural or institutional which affect the relationship.
Especially in the case of institutional deliveries the relationship is negligible. Evidence suggests
that it is desirable that separate strategies should be framed for information, awareness and
cultivating positive attitudes towards institutional deliveries. It is to identify such contextual
factors which can facilitate attitude change and help in developing communication strategies for
creation of an enabling environment for behavior change.
Table-2.2: Observed Relationship between Knowledge and Attitude for Three Studied
Dimensions
Thematic Area
Correlation
Knowledge-Breast Feeding
Attitude- Breast Feeding
Knowledge-Institutional Delivery
Attitude-Institutional Delivery
Knowledge-Family Planning
Negative Attitude- Family Planning
** Significant at .01 level
.509**
.007
-.127
SECTION-III: DIFFERENCES IN KNOWLEDGE AND ATTITUDE DUE TO
CAMPAIGN
As the focus of the DFP activities was to promote core and critical services and facilities like
institutional deliveries, breast feeding and family planning, the results are presented accordingly.
As part of the communication programme, messages on these core areas were given in all the
states which were verified by developing message content list for each study sites. As we have
seen in the previous section that a complex relationship exists between knowledge and attitude.
Hence, a systematic effort was undertaken to determine an overall impact on knowledge and
attitude on the above-said dimension, as well as an analysis to ascertain regional variations. The
7
R2 is coefficient of determination
16
statistical results presented, provide evidence of the effect of DFP campaign on knowledge and
attitude of the beneficiaries.
2.3.1 Improvements in Knowledge due to Campaign
Campaign has made a significant impact on awareness generation on breast feeding, institutional
deliveries, and family planning.
Figure 2.3 Differences in Knowledge due to Campaign
2.5
Mean…
Mean Exit
1.9
2.2667
2
1.5333
1.375
1.5
1.2167
0.9167
1
0.5
0
Breast Feeding
Family Planning
Recall test8 shows an improvement in means above .61 with the highest .89 which is also
significant at .01 level (refer table 2.3).
Significant changes have been achieved in the knowledge regarding advantages of breast feeding
and family planning practices as a result of the campaign. It is important to recognize that there
has been more systematic and sustained effort on these practices in the past as well. Thus, past
exposures could have helped the audience in recalling and relearning. These changes could also
be explained by the manner in which people’s action is not solely dependent on health services
but can be practiced by their own volition. On breast feeding there is highest improvement, this
activity, if based on complete information and can be carried out by the individual without any
interface from the health department.
Table 2.3 Differences in Knowledge due to Campaign
Mean
Entry
Exit
Mean
Diff.
Std.
Deviation
t-value
Min.
Max.
Breast Feeding
1.3750
2.2667
.89167
1.32078
7.395**
.00
3.00
.9167
1.5333
.61667
.96304
7.014**
.00
2.00
Family Planning
1.2167
1.9000
.68333
1.16665
6.416**
.00
3.00
Knowledge
* Significant at 0.01 level
8
Exit test is the test of immediate recall.
17
In section two we have seen that there is a significant correlation between information and
attitude change on this dimension, stimulated by self-decision of the individual. What is
important for facilitation of this activity is identification of socio-cultural practices, which can
act as a barrier. If barriers are deeply rooted in cultural practices, as is the common practice of
offering honey, it is desirable that we should follow the ‘harm reduction’ strategy. The campaign
should highlight that ‘first milk’ of mother is of utmost importance than ‘honey’ which can be
given to the child at a later stage such as “Annaprashan”. It is desirable that campaign should
align its activity with socio-cultural factors and messages should be rooted in the local language
and visual imagery.
In sharp contrast, promotion of institutional deliveries (JSY) depends on the availability and
quality of health facilities; wherein reliance on cooperation of health functionaries becomes
crucial during the delivery and post-delivery period. From mothers’ and family’s perspective,
the JSY programme replaces family and community interdependence with an impersonal and
alien environment of the hospital and with no ‘apparent advantages’. The positive side of the
campaign is that there is a significant improvement in awareness about institutional deliveries.
FGDs with women at all studied sites also show that they were aware of institutional deliveries
and had an inclination to choose institutional over home deliveries since provision of free
medicine and post-natal treatment in the hospitals at the nearest CHC or district hospital was
made available at no cost by the government. To suggest that decision to avail such services at
the government health facilities was prompted by lure of incentives would be to discount the
impact of educating women and their families and other stakeholders in villages about the longterm and additional health benefits which would accrue by choosing a hospital-based delivery.
Women in these sites were of the opinion that risks of infection and post-delivery complication
could be forestalled as a result of such a decision. Timely availability of transport and timetaken to reach the nearest health facilities are consequential factors for institutional deliveries
especially in hard to reach areas. Prospects of the programme creating a momentum based on its
performance are promising, since an individual’s access to the health facility, even for the first
time, would be of a crucial consequence for building faith and credence for the health services.
His/her continuance would depend upon his/her experience with the health department,
cooperation of health functionaries, and sustenance of the communication activities. Matching of
words with performance lends credence to the other services and builds confidence with the
system and builds loyalists as well. Communication of complete and customized information,
assurance of quality services by the health providers, and mitigation of concerns of people would
help in reducing the gap between knowledge, attitude and behaviours.
2.3.2 Differences in Knowledge due to Campaign and Study State
There is no significant interaction effect (campaign*state), which indicates that there is
uniformity in improvement in terms of differences due to campaign; it has made somewhat
similar impact on each study sites. But results presented here bring evidence for greater insight
18
and learning for undertaking communication programmes in future with adequate prior planning,
formative research and good management and collaborative programme implementation.
Figure 2.4 Level of Knowledge at Study Sites
4.5
Mean Exit
4
Mean Entry
Breast Feeding
2.2
2.0333
1.2667
0.9
Rajasthan
M.P
1.5667
0.8333
Assam
Jharkhand
1.8667
1.3667
0.8333
0.5667
Rajasthan
Assam
M.P.
Rajasthan
Jharkhand
Assam
0
M.P
0.8
Jharkhand
1.4667
1.6333
0.9
0.5
1.3
1
1.6667
1.5
1.5
1.3667
2.1
2
1.8
2.5
1.9
2.1667
2.4
3
2.4
3.5
Family Planning
The baseline data results indicate regional variation in existing knowledge, while simultaneously
showing regional variations in improvement in KAP which can act as a projection for future
course of action and help in designing messages and programmes which address local conditions
and concerns. It is evident that Rajasthan, MP, and Jharkhand require rigorous campaign for JSY
to improve institutional deliveries, as their entry and exit means are comparatively lower.
However, Assam has shown marked improvement, but it needs further stimulus for an overall
achievement. Any improvement in institutional delivery as a result of the campaign will require
sustenance and a readiness from health facility/department to make quality services available.
User’s experience with health system will be the key for his/her continuance and the health
system needs to cash on the very first opportunity in terms of demand generation through the
campaign.
19
Table 2.4 Differences in Knowledge due to Interaction of Campaign in Selected States
F9
Mean
Knowledge
Breast Feeding
Institutional
Delivery
Family Planning
Selected States
Assam
Entry
1.6667
Exit
2.4000
Jharkhand
1.3000
2.4000
Rajasthan
.9000
2.1000
M.P.
1.6333
2.1667
Total
1.3750
2.2667
Assam
1.4667
1.9000
Jharkhand
.8000
1.3667
Rajasthan
.5667
1.5000
M.P
.8333
1.3667
Total
Assam
.9167
1.5333
1.8667
2.2000
Jharkhand
.8333
1.5667
Rajasthan
.9000
1.8000
M.P
1.2667
.2167
2.0333
1.9000
Total
1.703
1.568
1.32
Among the programmes campaigned, special attention to breast feeding programme is required
in Rajasthan where such practices were not found to be consistent and frequent. The
communication campaign strategy has to identify the social-cultural factors, which work as
impediments in making healthy choices by the individual, family and communities. Evidence
also suggests that other states, especially Jharkhand, need rigorous campaign not only for
‘benefits of breast feeding’, but also for ‘ill-effects of not breast feeding’. In this case it is
suggested that ‘fear appeal’ can be used to highlight ‘harmful consequences of not breast
feeding’ on the child and the mother.
Among the selected states, Rajasthan and Jharkhand require rigorous campaign on promotion of
family planning programme. There are systemic variables affecting the programme and its
outcome, but the communication programme needs sustained efforts because of two reasons:
First, each year a certain proportion of population enters the reproductive age, thus educating
them about contraceptive choices should be the utmost priority. Secondly, consistent and
continuous promotion of small family size is necessary to motivate those in early reproductive
age group. In terms of adopting a strategic approach, a clearly articulated promotional
programme should be implemented in conjunction with access to quality services, and in making
decisions regarding contraceptive choices and size of the family. As there are some socio9
F value shown here is for interaction effect of within and between variables. In this case campaign is
within variable and state is between variable.
20
cultural barriers for what constitutes ‘size of the family’, it is desirable that covert message
should be given to make small family as a viable and an alternative to ‘large size family’. More
vigorous message dissemination regarding contraceptive choices which a couple/individual can
choose from should form a major plank of the campaign through interpersonal communication
forums. Delinking of these two activities -small family norm and contraception programme will
help in reducing the barriers and apathy and in reaching the target population, which will serve
the purpose of a viable ‘size of family’ in the long run.
2.3.3 Differences in Knowledge based on Stand-alone Campaign v/s Campaign with
Health Camp
This analysis has been undertaken with
the purpose to determine what changes
accrue if information and such services
are delivered simultaneously; secondly
what effect health camp can have on the
knowledge and uptake of services if it is
made as a standard activity.
Health Camp in Assam
Table 2.5 Differences in Knowledge due to interaction of Campaign with Health Camp
Mean
Knowledge
Beast Feeding
Family Planning
Health Camps
Health Camp
No Health Camp
Total
Health Camp
No Health Camp
Total
Health Camp
No Health Camp
Total
Entry
1.4167
1.3333
1.3750
1.0500
.7833
.9167
1.3833
1.0500
1.2167
Exit
2.1000
2.4333
2.2667
1.5833
1.4833
1.5333
1.9167
1.8833
1.9000
F
2.000
.898
3.037*
The result (Table 2.5) suggests that in absolute term means of exit and entry interviews both are
higher. Thus it is showing relatively a lower improvement as compared to the other phenomenon
i.e. no health camp sites. Definitely health camp will distract the attention of the audience, but it
has certain advantages: first it can act as a means for monitoring the campaign activity, and
address the local concern of the health department; secondly, it can help in priming a readiness to
receive the information; third it gives an opportunity to the audience to interact and avail certain
services. Thus, it can act as a window of opportunity to the health department for changing and
21
correcting people’s perception about the apathy of the health system in reaching out to them. To
make health camps function both as a single window for provision of health services and as a
stimulus for mobilizing the people, it is desirable that more organized efforts is brought into
preparation and allotting time for the health camp as part of the scheduled communication
activities.
The health camps should be organized in such a
way that people attend the information session
and then proceed for health camp to reduce the
distraction effect of the health camp. To achieve
this coordination between health department and
DFP, collaboration with local officials of health
department should become primary, before
finalizing their activities. At the same time
health department as client agency should
promote the synchronization of their activity
with DFP.
Health Camp in Sehore, MP
2.3.4 Differences in Attitude due to Campaign
What can be termed as a major impact of the campaign is significant changes in the reported
positive attitude towards institutional delivery, and breastfeeding (refer table 2.6). As compared
to institutional deliveries, the attitude change for breastfeeding is greater. Result supports the
findings of section two, which clearly identifies the complex inter-relation between knowledge
and attitude. Favorable attitude towards institutional deliveries connotes that campaign was able
to provide further impetus to the incomplete or deficient information regarding JSY though,
besides such services offered under JSY, monetary incentive had a role in shaping this attitude.
Interviews with the women and PRIs provide evidence that all of them knew about the monetary
incentive. In terms of learning, the campaign should highlight that ‘celebration of parenthood’ is
incomplete without institutional deliveries, which is the key to the safety of mother and child.
Table 2.6 Differences in Attitude due to Campaign
Attitude
Attitude for Institutional Delivery
Attitude for
Breast Feeding
Negative
Attitude for
Family Planning
MeanEntry
5.98
MeanExit
36
Mean
Difference
.37
Std.
Deviation
1.954
8.54
23
.69
3.58
35
-.23
t value
Min. Max.
2.103*
3
9
2.80993
2.696**
4
12
1.477
1.75
2
6
** Significant at 0.01 level
22
A significant finding is non-significant effect of campaign on negative attitude towards family
planning. The challenge is of converting knowledge improvement on family planning dimension
into more uptake of such services which however has been forestalled by limited reduction in the
negative attitude. The result poses two important questions: is there problem in the overall
strategy; and second, have the strategies failed to address the effects/concerns arising due to
systemic/contextual variables, which have countered our efforts. In more explicit ways, is the
health department reluctant to cater to other health needs of its beneficiary, or
ANM/MPW/MOIC is too preoccupied to meet their family planning targets/RCH targets, or their
concern is limited to permanent sterilization methods. An increasing realization has surfaced
which underscores the fact that patients/people are not passive beneficiaries, and they cannot be
treated or seen as new targets for different service.
Secondly, FGDs with women showed that behavior of health functionaries and AWW was not
found without bias and discrimination based on caste, class and gender. Many times denial of
services was based on the caste of the beneficiary. In Sehore, Barmer and Jodhpur women
expostulated about several instances of the treatment and neglect by even grassroots health
functionaries like ASHA who rarely visited them in their village. Caste of the beneficiary is an
important consideration at Aaganwadi as well. If the AWW is from a higher caste, her behavior
is characterized by caste prejudices and she would serve food to children from the lower caste
from a distance, expect them to bring their own plates and wash them after use. If women have
raised their voices against AWW, ASHA and ANM, they usually stop providing services to this
group of women. Thus, their disadvantageous position does not allow them to remonstrate about
such conditional access to services or even for their misdemeanor.
2.3.5 Differences in Attitude due to Campaign and State
There is significant interaction effect (State*Campaign) on breast feeding and institutional
delivery programme, which provides an evidence that differences in attitude due to campaign on
is not uniform across the states. Interaction of context and intervention (campaign) shapes the
effect of the campaign since local conditions also influence the receptivity and determine the
practice. All states showed an incremental favorable attitude towards the institutional delivery
programme except in MP. M.P. has shown a decline in positive attitude, which is contrary to the
mandate of the campaign. Reasons for decline could be more than one and could be attributed to
message framing, perceived meaning of the message and the projection of such information.
However, what is promising, are the changes not only in the dimension of knowledge, but also in
changes in attitude. In the light of the result of the section II, evidence suggests that current
strategies are able to address and impinge on other mediating/moderating factors necessary for
attitude change.
The most significant result is visible on the dimension of breast feeding. What is promising is
significant attitude change for breast feeding practices in Jharkhand and Rajasthan. For the
sustenance of the attitude, these areas need periodic intervention through ground-level
23
promotional activities and channels, as their media-use suggests that there is low penetration of
TV, Radio, and Newspaper.
Table 2.7 Differences in Attitude due to Interaction of Campaign and State
Selected State
Within Variable
Between variable
Assam
Jharkhand
Attitude
for
Rajasthan
M.P
Attitude
Feeding
for
Breast
Mean
Entry
Exit
6.10
6.47
5.67
6.77
5.87
6.20
6.30
6.00
Total
5.98
6.36
Assam
8.47
7.80
Jharkhand
7.70
10.30
Rajasthan
8.53
9.33
M.P.
9.47
9.50
Total
8.54
9.23
Assam
3.26
3.20
Jharkhand
3.33
3.33
Negative Attitude for
Rajasthan
Family Planning
M.P
3.93
3.47
3.80
3.40
3.58
3.35
Total
F10
2.685*
9.035**
.774
** Significant at 0.01 Level
These results point towards a thorough review of communication strategy for family planning,
but also review the ground level activities related with it. Campaign based on a revised
communication strategy and image correction is a need of hour for these areas.
SECTION IV:
WOMEN
EVIDENCE FROM IN-DEPTH INTERVIEWS (IDIs) WITH
IDIs with women were conducted prior to campaign, and two months after the campaign.
Women have shown favorable attitude for institutional deliveries, and this attitude was found
consistent even after an interim period after the campaign. Awareness about monetary incentive
10
F value shown here is for interaction of within and between variables only. To ascertain source of variance
please see the mean values
24
among women also lends support to the sustenance of preferential attitude towards changing
traditional practices if better alternative services are offered and fears are allayed of negative
consequences.
IDI With Women in Rajasthan
Figure 2.5 Women’s Opinion about Place of Delivery
90
83.3
80
70
60
76.7
50
40
Pre Campaign
30
Post Campaign
20
10
18.3
16.7
0
Home Delivery
Opinion about Place of Delivery
SECTION V: ASSESSMENT OF CAMPAIGN BY HEALTH FUNCTIONARIES AND
EVIDENCE FROM SERVICE UTILIZATION DATA
Views of health functionaries i.e. Medical Officers (MO), Multi-Purpose Workers (MPW),
Auxiliary Nurse Midwife (ANM) were ascertained on the health conditions of the women and
uptake of FP and MCH services in the
selected districts and villages. In-depth
interviews were also conducted with
Anganawadi
Workers
(AWW)
and
Accredited Social Health Activists (ASHA),
who assist and facilitate women in the early
reproductive age to access government health
facilities. Information was collected from
these health functionaries to estimate existing
perception, attitude and uptake of JSY, Breast
feeding and Family Planning services since
these services formed the fulcrum of the
DFP’s communication campaign.
IDI with Health functionary in Assam
25
Information
was
also
collected to assess the
‘DFP campaign has motivated people. There is impact, which has
impact of the campaign on
resulted in change in their knowledge and attitude. Now there are
their understanding about
asking, clearing their doubts and accessing health facilities’.
key health schemes and
AWW, Gumla, Jharkhand during the post campaign period
women’s awareness about
recall of messages delivered
and awareness level among
the beneficiaries and local health officials awareness about the program under JSSY and JSSK,
barriers and difficulties in accessing health facilities and media use by women and the innovative
strategies adopted for the programmes.
Perceived Changes in Health Seeking Behavior
Health functionaries found changes in attitude of beneficiaries towards accessing health facilities
under different schemes. After the campaign beneficiaries were keen to learn more about
different schemes and were open about discussing their doubts on the different health related
issues. According to AWW in Gumla, Jharkhand, ‘such programs motivate people. “Earlier I
used to give my own example for family planning, now it is easier for me to convince them”. In
Assam, it was found that people turned up to get clarifications of their doubts on sterilization
process. In Rajasthan, it was observed that DFP campaign had helped people to think about their
health and encouraged to seek help of health functionaries to clarify of their queries on different
issues.
According to Multi Purpose Worker (MPW) in Panna, M.P. ‘Earlier I was facing problem in
motivating people regarding family planning methods but after the campaign, it made people
more aware about family planning methods and helped them in clearing their doubts. What is
significant is change in their perception regarding my role’. According to health officials, an
increase in use of health services by pregnant women such as 3 ANC checks up, asking for IFA
tablets and getting immunized has become more common. In contrast, according to MPW, CHC,
Powai, MP, there was no significant change on uptake of family planning services and breast
feeding due to several misconceptions and cultural/traditional beliefs. Perceptions of health
functionaries were indicative of the fact that the communication campaign had effects on health
behavior, particularly among rural people. Evidence suggests that more programmes should be
organized to sustain these definite and observed changes.
Awareness about Schemes among Grass Root Level Functionaries
Awareness about JSY and JSSK
“We are given training and get awareness on the relevant
and entitlement provided under
information for the local beneficiaries on family planning,
these schemes among health
immunization, institutional delivery etc.
functionaries and worker is
Smt. Mithlesh Raja,AWW, Udla, Panna, M.P.
26
crucial since they are supposed to facilitate and extend health benefits to the beneficiaries at
grass root level. It was found that ANM, AWW and ASHA were aware about the messages, but
few of them were unable to discuss about entitlements under JSY and JSSK. Lack of knowledge
about entitlements affects service delivery for the beneficiaries. There is a need for awareness
generation of functionaries at grass root.
Physical Barriers: An Important Mediator in Accessing Health Facilities
Tough terrain, lack of available infrastructure and transport facilities have an important
mediating role in accessing health facilities. It is widely accepted among health functionaries that
these barriers demotivate both them and the beneficiaries in availing services. In most of the
study sites, hospital is situated far from the villages and due to Kachha road or tough terrain
ambulance fail to reach at the time of delivery.
Service Utilization Data
Data related with service utilization (3 ANC checkups, Institutional Deliveries, Home Deliveries,
T.T-II, and IFA Tablets) was collected from the health records available with the health
functionaries for the period of eight months i.e. four months before the campaign and four
months after the campaign. To bring homogeneity and rule out the impact of seasonality, ratio
has been calculated. For ANC services, number of women registered with health facilities was
taken as a base for the calculation of compliance ratio on three programme dimensions
(presented below). Available data has certain limitation, as in certain places women registered
themselves at later stage and utilized certain services during that period, thereby shoring up the
ratios. Similarly, for delivery total number of deliveries was taken as a base for calculation.
Thus, cumulative ratio of first four months and after four months was compared and plotted
below to show the trend.
Table 2.8 Changes in Service Utilization for ANC services after the Campaign
Indicators
Observed Changes after the DFP Program
Assam
Jharkhand
M.P
Rajasthan
Jorhat
Nagaon Gumla Khunti Sehore Panna Barmer Jodhpur
3 ANC Check Ups
T.T-II
I.F.A Tablets
Indicates decrease in the utilization of the service
Indicates increase in the utilization of service
27
Table 2.9 Changes in Service Utilization for Delivery services after the Campaign
Indicators
Observed Changes after the DFP Program
Assam
Jharkhand
M.P
Rajasthan
Jorhat
Nagaon Gumla Khunti Sehore Panna Barmer Jodhpur
Institutional
Delivery
Home Deliveries
-
It is visible that DFP Program has some impact on the service utilization as there is an increase in
utilization of various services in five districts. In Jodhpur, Panna, Jorhat and Nagaon decrease in
service utilization of ANC services was found in general. What is important here is to recognize
that there is a decline in number of home deliveries in 5 districts, whereas in Sehore, Panna and
Barmer an increase in the number of home deliveries has been found. In Panna, Sehore and
Barmer simultaneously a decrease in institutional deliveries was evident.
FGDs with Women Beneficiaries
28
IDI with Beneficiaries and Health Functionaries
29
Chapter III
Assessment of DFP Campaign Activities
This chapter, presented as a critical assessment of DFP’s campaign activities, is divided into two
sections: the first section provides an assessment of pre-campaign activities, and the second
section is an appraisal of campaign-day activities.
SECTION I: PRE – CAMPAIGN ACTIVITIES
The pre-campaign process, undertaken as a preparation for the communication activities, was the
fulcrum of the campaign in the villages which required strategic planning and systematic
enunciation of roles and responsibilities of each partner agency. These planned activities are
congruent to efforts under NRHM (National Rural Health Mission) to reduce maternal and child
mortality, promote family planning and enhance the role of PRIs in health services as part of the
community process. At another level, association of PRIs and other village functionaries, with
DFP’s ground-level programme, would strengthen the efforts of NRHM under community
processes, which involve participation of community members at various level of planning and
management of health services. In this regard the action plan of DFP was very well
conceptualised and visualised.
An assessment of pre-campaign programme is based on an evaluation of workshops organised by
DFP at the state/regional level in different regions of the country. These workshops were
organised by the Regional Directorates with various stakeholders (NRHM and state government
officials, political and media representatives) to ensure a coordinated effort among all agencies
working at the state and district level. This partnership was expected to boost the reach and
effectiveness of the communication campaign in priority rural areas. As a measure to provide
crucial advantage and facilitate implementation of programmes in remote and disadvantage
settings, DFP garnered support and participation of administrative and political representatives,
apart from NRHM and other health officials at the workshop. To ensure credibility and support
for DFP’s initiative, extensive coverage of the DFP workshops in the regional, state and local
media was a significant step in this direction.
The workshops formed an integral part of the planning process across all regional and district
headquarters in orienting district DFP officials with the priority programmes under NRHM and
drawing up plans for implementation of the campaign.
30
The workshops enabled formulation of the following strategic design:
1.
Identification of the Target audience:
The main focus of the programme was to promote awareness and motivate women in the
reproductive age and their family since individual behaviour change is influenced by peer and
community/caste imperatives. The talks and discussion held with the health officials during the
workshops concentrated mostly on JSY and various components of the programme. However,
the briefings at the workshops toned down the emphasis on other important schemes and
entitlements of the people, and role of PRIs under NRHM. The NRHM/health Officials at the
DFP workshops should have highlighted the active role of village functionaries, and opinion
leaders since it would have further buttressed in devising appropriate communication strategy for
the target population.
2.
Designing Appropriate Message
The salient messages identified for dissemination, as part of the campaign activities, focused
primarily around Janani Suresksha Yojana (JSY) to the exclusion of other associated and priority
entitlements. The speakers from the health department restricted their presentation to JSY to the
exclusion of other schemes. In some of the regional workshops, speakers/trainers (health
officials) were not well prepared to provide adequate briefing even on JSY. For example, the
scheme of Shishu Sureksha Yojana, as an add-on to the existing JSY, was presented as a new
scheme (JSSK) and created an ambiguous impression among the DFP officials that JSSK was a
replacement to JSY.
The information about JSSK as a complement JSY scheme, and the additional payment to the
mother for her nutritional diet and for recuperation post-delivery was not emphasised. The
training workshops should have highlighted not only conditional payment as an entitlement, but
other key features of JSSK i.e. free medicines, foods, and facility for transport for the mother
before, during and post deliverry as a continuum of support. These topics were however
perfunctorily treated at the workshops.
No substantive information was provided about imperatives of advocacy initiatives by opinion
leaders as part of the field campaign activities and the crucial role PRIs were expected to play in
sustaining the programme. This would have formed the basis for collating and designing the
requisite information to devise the strategy for co-opting PRI leaders and in organising and
framing the issues for the 'meetings with opinion leaders'. At second level, since this group was
to play the role of a multiplier of DFP efforts and radiate the efforts of DFP in villages, this
potential was not adequately tapped.
31
Display of Messages In
32
3.
Participatory Training For learning
Another important issue was of the process of transfer of knowledge from top to the district-level
functionaries with same potency and intent for effective translation of ideas into sustainable
results at the grassroots level. As participants of the workshop, DFP’s field publicity officers,
had the onerous task of transferring knowledge to their other associates, collaborators and
partners with same intent and purpose. If certain issues are not made as the focal points, chances
of dilution and loss of meaning will occur in any transaction process. Filling the wide gap,
between the communication content at the regional workshop and truncated version at the local
level, would have ensured matching 'vision of top with action at bottom level'.
Field level functionaries opined that training at the DFP Regional Workshops helped them in
better planning. Thus, it is desirable that they should not only impart information but should be
oriented and trained in transfer of knowledge in a participatory manner to elicit ready
cooperation and alignment of local leaders with larger goals of the programme. As part of the
workshop preparation, DFP should have given more attention to the organisation of the trainingworkshop by identifying appropriate trainers in advance and assigning such topics to speakers to
avoid repetition or omission. Secondly, to ensure availability of the guest speaker confirmation
should be taken in advance, and alternative list of speakers should be prepared to fill the gap if
any speaker drops out. Such detailed preparation for the workshop would train the DFP district
teams adequately about the scope of the campaign.
Restricting the scope of the programme to purely passing information or putting an assembly of
activities would be compromising the comprehensive implications and prospects of the
programme. To delimit the scope of the programme would attribute failure about an
understanding of the NRHM programme and ill-prepare the district DFP team to organise a wellcoordinated and customised programme. In those states where well-organised and coordinated
workshops were conducted, it resulted in successful campaign activities in the villages.
4.
Preparation for the Planned Activities
All the states followed a common design and frame-work for the field-level campaign which
comprised of meeting with opinion leaders, rally and mass mobilisation through community
meetings. The field level activities were dependent on pre-campaign activities and any lapses at
this level could have had a ripple effect on the campaign. A common framework of activities
followed by DFP in all the states had an advantage since it ensured uniformity in the delivery of
the programme messages across the country and concomitantly in allocation of budget for such
programmes. However, it is more feasible to allow state-level variations in customizing the
programme design and content which can adapt to district specific requirements. These factors
are geographical distances, social-cultural practices and programme imperatives which are
significant determinants in organisation of village-level programmes. Neglect of these factors
can impinge on the quality of the campaign programmes.
33
Efforts to coordinate activity with health department have had dual advantages for the DFP: one
of keeping the ‘client’ department in the loop of ongoing activities and secondly of providing
them critical and meaningful feedback periodically. It also ensured support of the client
department (MOHFW) at the top level for rolling out the campaign at different levels and
provided credibility to the DFP’s initiative. In some state-level workshops the emphasis on
developing linkages with the health system was handled in a lackadaisical manner which resulted
in disjunction between promotion of health, demand generation and availability of services at the
campaign sites.
Better Inter-departmental coordination between Directorate of Field Publicity, Song and Drama
Division and DAVP for strengthening the campaign efforts is a primary requisite. Each unit
should supplement efforts of others, which would involve their active participation in planning,
and supplementing DFP’s efforts through organisation of community-based edutainment
programmes.
SECTION II: FIELD CAMPAIGN ACTIVITIES
This section provides brief assessment of campaign activities undertaken by DFP in the rural
areas. The three sub-sections provide an overview of the three-tiered Communication Campaign
based on the observation of ‘Session I- Meeting with Opinion Leaders’, ‘Session II-Organizing a
Rally of People/Beneficiaries’, and ‘Session III- Edutainment programme with potential
beneficiaries/community group:
Session I: Meeting with Opinion Leaders
The objective of the ‘Meeting with Opinion Leaders’ comprising of Panchayat, SHG members
and leaders of the community was expected to create informed facilitators, who could lend
legitimacy and multiply the efforts of DFP. The vision was to strengthen the advocacy initiative
of opinion leaders. But this effort was partially fulfilled as DFP’s role and responsibilities was
consigned to briefing the opinion leaders about various schemes but did not extend beyond to
developing and building consistent association. The resultant inadequate turnout of beneficiaries
and uneven presence of opinion leaders/PRI members /village health and sanitation committee
(VHSC) members at the campaign sites points to lack of adequate preparedness about effective
mobilization and in building a participatory mechanism for sustainable response. Except at one
site in Assam where 6 PRI members were present prior to the programme, in other states limited
participation of PRI representatives was in evidence. This was corroborated by the observation
reports and interviews with DFP personnel who assigned limited role to PRI functionaries and
perceived them as passive ‘organizers of the event or gatherer of crowd’. Limited appreciation
of the larger and consistent mediation role of the panchayats and other opinion leaders with the
health workers/officials was evident.
34
Meeting with O”pinion Leaders – Banner seen in MP and Meething in Rajasthan
This could be attributed to lack of clarity on how these change agents could work in conjunction
with DFP even after the culmination of the DFP’s present campaign. Keeping in touch with the
villagers on regular basis is often not possible due to organizational and logistical problems;
hence local bodies can share the responsibility of monitoring change in knowledge, attitude and
practices and keep DFP updated. Concerted efforts would be required to inform/discuss with
village health and sanitation committee members and Gram Panchayat members
(institutionalised bodies under NRHM) the prospects of facilitating and channelizing the
feedback from community groups to the relevant departments and officials. DFP's efforts can
activate these committees and provide a channel of communication for further dialogue and
action. This mechanism between PRI representatives and DFP officials in some measure was
visible in selected places, especially in Barmer District in Rajasthan.
Following activities were carried out by DFP in each study sites.
Table 3.1 Activities Conducted at Various Study Sites
Districts
Gumla Khunti Nagaon Jorhat Jodhpur Barmer Panna Sehore
Rally
√
√
√
√
√
√
√
√
Lecture/Quiz
√
√
√
√
√
√
√
√
Film Show
X
X
X
X
√
√
X
√
Health Check-up
X
X
√
√
X
√
X
√
Session II: Rally of People/Beneficiaries
Session II activities were carried out at each and every campaign site though with varying degree
of success. Rally was one of the major activities for two reasons (i) it provided ample
35
opportunity for participation of large number of people, (ii) rallies added visibility to the
campaign due to movement and presence of mass of people. In all the districts, both students
from the local schools assembled at the venue wearing the T shirts with NRHM logo, distributed
by the DFP officials. Except in Jharkhand, in other three states, rally attracted few community
members and did not generate much enthusiasm, except for the children who found it as novel
and as an opportunity to do something different from their routine. In Jorhat, Nagaon and
Barmer rally was taken to the lanes of the village, in other places it was showcased only on the
road-side. Participants of the rally were primarily
the schoolchildren while community members
were conspicuous by their absence in the rally.
Led by a DFP member, the rally moved on the
designated routes through the village with
children carrying some messages on the banners
and placards. The leader also shouted slogans
which were repeated by the students, but this
feature did not remain constant throughout the
rally. Duration of the event (rally) was not
uniform across the states or even districts i.e. it
varied from half an hour to an hour. It was
noticed that rally did not gather crowd during its
movement and community members did not
show any interest or curiosity in the rally.
Rally in Jodhpur, Rajasthan
More efforts are required to garner social support through greater participation of Panchayat and
NGOs for 'mobilising the mobilisers'. Since village rallies were primarily used to create a
sense of heightened activity with students and children, better and alternative approaches should
be mounted to involve the panchayats. Rally was used as an energizer method but was unable to
open the channel of communication and remained restricted to a passive communication exercise
with live models in some districts. The rallies as a method of instilling interest and curiosity of
the community can at best work as a trigger. Generating an interest in the programme at the
initial stages, the processions can at best be a rallying point for diverse groups in the villages,
and give visibility to the issues. To ascribe a greater role by making rallies as the central point of
activities would be a failure to assess that these have a limited role and the entire programme’s
success should not be hinged upon it.
Attendance at the rallies and at the community meetings was also affected by the prior
engagement of the local people. The timings of the designated programmes should be such that
these activities synchronise with the availability and presence of the local population.
At one site (Khunti) DFP’s programme clashed with the local weekly haat (market), which
resulted in poor attendance of women and youth during the campaign. Before scheduling the
36
programme, days of weekly market, festivals, and timing of agricultural activities should be
ascertained to ensure availability and participation of community in the programme.
Assam- Nagaon and Jorhat
37
Jharkhand – Gumla and Khunti
MP – Panna and Sehore
38
Rajasthan – Jodhpur and Barmer
39
Session III: With Beneficiaries/Community groups
1.
Lecture and Quiz
To reduce all communication interventions to the level of item-wise activities by DFP would be
trimming-down the larger perspective of mobilising people for social change and improving
health status. Various programmes were clubbed together to reach the target audience. Heavy
reliance on lecture delivery with quiz was used as a primary method to spread the message
among diverse audience groups across the state. The main constituent of the lectures delivered
were messages on JSY and JSSK, especially the focus was on cash incentives and institutional
benefits. The pattern of lecture/seminar was not uniform; it depended upon the DFP and health
experts’ own orientation to subjects at hand to make the messages sound resilient and meaningful
for a diverse groups. The compilation of messages delivered in each district showed
commonality in themes, but differences associated with socio-cultural barriers were evident in
the way people responded to such schemes of cash incentives. Addressing the local issues was a
prime concern at all places, and audience were encouraged to seek the help of ASHA, ANMS
and village health committees, but no platform was provided for listening to concerns of the
effected target population . Participants of the quiz were primarily school children and ASHAs,
whereas women in the reproductive age (target population) were largely conspicuous by their
absence. This reflects DFP’s preconceived notion that receptivity of messages would be faster
among ASHAs and they would be better positioned to take home messages directly to the target
audience.
Assam
40
Jharkhand
Lecture giving is an art, and selection of speakers and choice of topics should be in alignment
with the kind of audience available. At some locations the Guest speakers had little time to
prepare for the session which reflected in the delivery of the message and had less significant
impression on the audience. Careful and deliberate attention should be given to preparation in
selection of guest speakers, by giving them advance notice about the campaign topics. Thus at
some places session was extended to 3-4 hours, and some places it was of a short duration.
Speaker's focus was more on health prevention activities than on available services and
promotion of its utilization. Places where quiz was part of ongoing lecture, audience enjoyed the
session more as compared to the places, where quiz was organized as a standalone activity at the
end.
Encouragement should be given to participation of local NGO members, and PRI functionaries
in such meetings as well. They should be co-opted and briefed in advance about focus of the
campaign to provide a local connect, but should not be given a free run either to use it as a
platform for self-serving agenda. At selected sites traditional and folk media were used with
great success since interplay of drama and songs was able to entertain the audience and involve
them in the story since it bore similarities to their life conditions in the village. For effective use
of this medium, it would have been appropriate if the play had used a device (used in tele-serials
by inviting suggestions from the audience about how the story should develop) of inviting
suggestions of the community members/villagers regarding the way the drama should end. This
method would have been effective for a number of reasons. 1) It is entertaining, 2), it encourages
participation and 3) it clearly reflects participants’ attitude and perception.
41
MP
Rajasthan
42
Quiz - Prize Distribution
2.
Healthy Baby Contest and Health Camps
Healthy baby contest is a participatory method to create awareness among mothers about post
natal care and award recognition to mothers for the child-care. Baby shows provided an
opportunity to engage with specific target population i.e. mother/reproductive age group, but this
activity was organized only atGumala. In Gumala, Sahiyas had informed mothers about baby
43
show in advance. Thus some women even traveled up to 17 kms to reach the campaign site and
assembled at the venue before the start of the event. The baby Show activity can be used as an
important strategy to reach specific target population. For better management of the ‘baby show’
selection criteria of the baby and number of awards should be announced in advance. Secondly,
as there is an active involvement of the health department, this activity provides a chance to
identify and reach the specific target population with minimal redundancy of efforts.
Health Camps
In the conduction of health camps, the turn-out of people is better and there is an immediate
fulfilment of the need of direct access to the health department experts at the door-step. Out of 8
study sites health camp was organised at 4 sites. Some features of the health camp were (i)
collection of blood samples for test of malaria, (ii) health check up, (iii) free distribution of
medicine, and (iv) Immunization. Places, wherever health camp was organised along with the
DFP activity, it managed to attract more people. The joint activity with the health department
had a better impact as compared to the places, where DFP activity was standalone. It was not
limited to attracting just more number of people; but at these places people had better recall of
the message. This collaborative activity (between DFP and the Health department) also helped in
priming and in absorbing more information and served the dual purpose: of monitoring by the
client organisation and in bringing services to the target population. As part of the campaign, the
44
health camps helped in building trust among the target population for the service provider and an
associated link and alignment with the messages disseminated through the rallies.
SECTION III: ADDITIONAL FACTORS PERTAINING TO CAMPAIGN
ACTIVITIES
1.
Audience Composition and Density
The audience largely comprised of either too young audience (students) or married men and
women in their late reproductive age than those who were just married or were in their early
reproductive age. Presence of pregnant and lactating women was found more in districts where
baby show and health camps were organized. In Jorhat and Sehore more number of women
gathered since local NGOs working for women were involved in garnering support and for
enlisting their participation. A skeletal crowd gathered in village Kunthi, as community members
were out to fetch groceries from the local ‘haat’, which clashed with the schedule of the
campaign activities.
A floating audience was also found at all places since rallies and health camp had resulted in
constant movement at the venue of those who were from the neighboring places. In Nagaon, the
seating arrangement was done inside a hall which was largely occupied by the health and NGO
workers, thus limited seats were left for the villagers, who either hesitated to sit with them or
were more interested in free health check up. In Jodhpur, hall of Gram Sabha Bhawan was used,
which had a seating capacity of 80-90 persons. As men preferred sitting near the door, thus their
seating arrangement restricted the entry of women in the hall. Dispersal of audience was seen at
Jodhpur and Nagaon, where many women with infants left the hall before the programme ended.
The proportion of women in both districts was one-third of men.
2.
Audience Response
Audience response is a key indicator of degree of participation and comprehension of any
programme’s success. During the community sessions, audience expressed their reaction by way
of clapping, laughing, showing non verbal signs of awareness in abundant measure, or by asking
of questions or simply leaving the venue. The audience responded and applauded in ample
measure during the quiz and the song and drama show. The interaction was highest during
discussions between the audience and the moderator who usually happened to be the DFP or
health expert.
3.
Display of Messages
Apart from the key message delivered during the programme, display of posters, charts, wall
writings, banners on relevant themes and messages were put up at vantage positions to draw
attention of the community. There were two categories of materials on display: materials
45
developed specifically and used for the campaign, and another category materials which already
existed at the programme venue. The display of both categories of campaign materials was not
uniform among all the districts and these varied in terms of number as well as messages. In
Sehore, MP, an appropriate banner on JSY messages was designed and put up by MP regional
DFP unit, while other places did not customize the message and visuals as per the needs of the
local audience.
According to the planned budget, first category of material consisted of T shirts and Caps with
NRHM logo and prizes/awards (T-shirts, clocks, thermometers, umbrellas and dictionaries). In
Assam T-shirts and caps were worn by students, NGO workers and health workers at the time of
rally, seminar and quizzes, which added color to the programme. It was observed that the
attraction of the material distributed, prizes /awards and refreshment diverted the attention and
focus from the main programme messages disseminated through various activities. The placards
with NRHM messages and slogans held by the rally participants were readable only at a distance
of 15 ft and less since the typeface of such messages were not large and distinct. Slogans were
repeated throughout the rally which added excitement to the event. In MP, instead of placards,
banners were held by participants, which were bigger in size, colorful, readable and displayed
the messages on immunization, iron tablets, breast feeding etc.
4.
Display Sites
The selected venues such as CHC, School, Anganwadi centres had some charts and posters on
immunization, breast feeding, family planning. At Gumla, a small A4 size notice about the
‘Mamta Vaahan’ with mobile phone number was put up on the day of the programme which
showed inadequate preparation for the campaign. Banners on ‘hum do hamare do’, ‘Health of
mother’, ‘get nutritious food’ were put up in Sehore. The posters were put up largely inside the
pandal where the programmes were to be conducted. By delimiting the outdoor media (posters
and banners) within the confines of the venue of the proramme limited the exposure to the
messages. Appropriately if these were displayed and put up at strategic places where the target
population converges it would have served some tangible purpose.
Wall writings and posters were used more commonly than banners or hoardings. Text size on
wall writings was larger and readable than those on posters. Wall writings were more attractive
and are more durable which gives them an edge in being used more commonly than non-durable
material like posters, banners and print material. Some posters were loaded with too many
messages of JSSY, which distracted attention and consequently restricted comprehension.
Display of single message as wall writings and posters would have facilitated better
understanding of the message among visitors to these venues. A mix of numerous messages,
information and slogans visibly looked attractive but shifted the focus of the campaign.
46
SECTION IV: CONTENT ANALYSIS OF CAMPAIGN MATERIAL
Message dissemination is a vital component of the campaign in providing the content, visual
appeal and emotive feel to the formation as well as delivery of important programmes. On the
campaign day various publicity materials such as posters and banners were displayed which
conveyed messages on various aspects of NRHM. Since the purpose of the campaign was to
promote utilisation of Institutional services for child birth and family planning methods, the
content of these print and outdoor materials was analysed to assess their suitability in consonance
with the objectives and focus of the campaign.
Print and Outdoor Material
Content analysis of the distributed printed material (Brochures, Leaflets and Booklets) provided
an estimation of the appeal of the content i.e. the strength of the message and its nature. These
materials were assessed on the parameters and standards of design as well their contextual appeal
based on the current socio-cultural factors. These parameters were studied primarily from the
point of view of the audiences’ capacity for identifying with the information given,
comprehension of language and its meaning and therefore the content analyses were undertaken
with following objectives:
1. Suitability and appropriateness in terms of information and target audience.
2. Assess appeal of the material in terms of text and visual effects for easy comprehension
and relevance
Methodology
A total of 31 printed materials were selected as sample for assessing their quality and relevance
in making the campaign achieve its objective. These materials were analysed on the following
parameters:
1.
2.
3.
4.
5.
6.
Content,
Appeal factor (based on fear, reward, future promise and choices)
Relevance of the subject matter/topic to the campaign
Good Presentation in terms of balanced mix of visuals and text
Suitability for the target population
Utility as a training, informative, educative or display material
Findings
Distribution of Material: Distribution of material was not even among states. Jharkhand lagged
far behind others. DFP’s efforts to produce material in Assamese language were evident. MP is
the only state where leaflet on JSY was prepared customized to the local needs. Fewer materials
on JSY were distributed to the audience at the campaign sites, which may raise doubts on efforts
47
put in to develop material on topics that was the major thrust of the campaign. The reasons
ascertained was that DFP laid larger stress on oral/verbal dissemination of messages during the
campaign. Much effort was seen in utilizing lecture, seminar, quiz, group discussion formats to
communicate information on JSY, JSSY to audiences. It cannot be ignored that explanation of
details of programme, repetition of vital messages was possible only through face to face
interaction; hence lesser publicity of JSY through print material did not dampen the effect of the
campaign. Secondly, as per mandate by Ministry of Health, fund was allocated for publishing
material on health issues/problems other than JSSY as well. Print material on other core areas of
Family Planning, Immunization, breast feeding and Communicable diseases were distributed to
people as well.
Considering the magnitude of the goal for the client ministry and DFP, the material distributed
on major health messages was far too less. Overall only 20 Brochures, 8 pamphlets and 3
booklets on the various health issues were distributed across all states, Maximum of 12 print
materials were distributed in Madhya Pradesh followed by 11 in Rajasthan , 6 in Assam and
further low of only 2 in Jharkhand.
Issuing Agency: Print material on various health issues were produced and distributed in
sampled states by agencies: DFP, MoH&FW and Unicef. Though the specialization lies with the
client ministry, more material developed by DFP was distributed. In all the states, 19 materials
by the DFP, 10 by NRHM and 2 by UNICEF were distributed.
Since population is a challenging issue in India, materials on Family Planning are being
distributed. For this campaign, 9 out of 20 contained messages on family planning methods
followed by Dengu, Chikanguniya, Iodized Salt, Female Feticide, H1N1, Iron Tablets and
ICDS. Immunization (7) stood third in position among the subject catered to followed by
NRHM & Bharat Nirman Abhiyan and JSY at fourth and fifth position respectively.
Language: In Rajasthan and Madhya Pradesh all print material were distributed in Hindi
language whereas, in Assam use of both English and Assamese language was common.
Target Audience: The content largely targeted people in general. Within general masses,
mothers, children, married women and men and health providers were targeted for specific
information.
The content in brochures on breast feeding targeted mothers and brochures on NSV was meant
for both married men and health providers. Similarly information on IUCD was designed
keeping in mind the requirement of both married women and health providers. There was clear
difference between content for men or women and those for health providers. Leaflets on ICDS
have specifically targeted women and child both.
48
Visual Appeal of the material: Visual appeal was assessed in terms of layout and design which
included size of material, number of folds, font size, number of colours used, text and visual ratio
and photographs. Brochures, leaflets and booklets are printed on both sides using combination
of different font sizes for visual appeal.
Photos Added to Appeal: Photographs in good number occupied substantial space in brochures.
Those on family planning depicted procedures of using IUCD, NSV and methods, small and
happy family, health functionaries counseling women, precautions and after care etc supported
the text and facilitated understanding of information therein. Similarly in other Brochures and
leaflets on communicable diseases, immunization, iodated salt, NRHM etc, photographs have
been selected with care and appropriateness and reflect similar meaning as the text. However,
there are lesser number of Visuals is used in leaflets compared to brochures.
Value Addition with Slogans: A slogan is a memorable motto or phrase used in to ensure recall
and triggering as a reminder of more information and as a repetitive expression of an idea or
purpose. Crystal defined slogans as “"A forceful, catchy, mind-grabbing utterance which will
rally people to buy something or behave in a certain way." (Crystal).
A variety of printed materials were used but the emphasis on core programmes was missing and
it added to overload of too many messages for dissemination. Among the materials brochure was
widely used and with good effect in terms of its visual appeal. It emerged as the best material as
it comprehensively provided information on several issues. However, such material is of greater
value where recipients are front-line workers, associated partners. For the community where
literacy is still an issue, especially among women, such brochures will have limited validity.
Such material should be used to train and as a repository of information among the development
agencies since information helps in preparing and in discussing salient points during meetings
with target audience in villages. They were distributed in large number in all the states. On the
other hand Leaflets are good for focused and specific issues customised as per the local context
and these were used in Rajasthan and Madhya Pradesh in good measure. All the materials used
were in colours with an ideal combination of font as both colour and font play an important role
in attracting attention. Overall it was found that a significant material was distributed by DFP,
followed by NRHM and UNICEF.
49
Chapter IV
Charting New Frontiers an Way Forward
This chapter provides an overview of the impact of the DFP’s Campaign in different parts of the
country. Major findings have been summarized by elucidating the success and challenges in the
form of recommendations. At the outset the assessment of the campaign programme must be
made with a proviso that expectation of success based on “one stand-alone activity” would be
turning the empirical evidence upside down since no single activity through any method or
device can change the stranglehold of age-old practices and deficiencies in the system of delivery
at the grassroots level.
The results should be viewed as a result of one single day’s effort to garner support, mobilise
disparate groups under the banner of health to conduct activities in remote and against heavy
odds, comprising of apathy, alienation and infrastructural constraints. Secondly, in the light of
limitations imposed, as a result of deficient human resources within DFP, the task of
campaigning becomes more challenging.
A third related factor which provides a strong reason for supporting the DFP activity and efforts,
is of lay in media use in such disadvantageous regions which are bereft of any other source of
information. Except in Assam, other states have relatively low use of mass media, especially TV,
radio and newspaper.
Hence, such stark conditions provide a strong case for use of DFP machinery for health
promotional activities in regions which have limited exposure to mass media and experience
constraints in using media services because of infrastructural lag. As efforts of DFP are not
supplemented by other media, there is need of periodic campaigning in innovative ways to keep
attention of the people riveted on the health issues as a life-style and healthy option.
For periodic campaigning 'edutainment' and ‘covert messaging’ can work as a good model for
diverting attention from the product to possibilities of changes and a new experience through
practice of new and improved behaviours. Here lessons from campaigning of successful
commercial products and services can be borrowed to understand how people can be motivated
with support by addressing their concerns (as part of the participatory process) and by showing
alternative lifestyles as a result of changes in practice.
Communication of complete and customized information, assurance of quality services by the
health providers, and mitigation of concerns of people would help in reducing the gap between
knowledge, attitude and behaviours.
50
TEXT BOXES BELOW PROVIDE OVERVIEW OF LESSONS LEARNT AND
CHALLENGES UNDER EACH THEME
Breast Feeding
Campaign has had a significant impact on awareness generation as well as on promotion of
positive attitude for breast feeding across the states. Beside this, observed relation between
levels of knowledge and attitude shows that prescribed route for attitude change can be tracked
through awareness generation. As observed relation is only explaining 26% of variance, thus
major change agent is rooted in socio-cultural practices. Evidence suggests Jharkhand and
Rajasthan require more intense and rigorous campaign to overcome the lag between awareness
and attitude which in effect will get converted into practice.
In terms of communication strategies, uses of ‘harm reduction’ and ‘fear appeal’ in messaging
are recommended. As ‘harm reduction strategy’, the campaign could highlight, for example,
that ‘first milk’ of mother is of utmost importance than ‘honey’ which can be given to the child
at a later stage during the occasion of “Annaprashan” i.e. first feed comprising of cereals. As an
element of ‘fear appeal’, the campaign should highlight ‘harmful consequences’ of not breast
feeding for the child and the mother, psychologically and physiologically.
Institutional Deliveries
DFP’s Communication Campaign has succeeded in bringing awareness about JSY programme
among women of marginal communities and those living in remote and backward areas. Higher
awareness about JSY programme has been due to the incentive for pregnant women and ASHA
worker, but simultaneously the campaign has made significant contribution in conveying
messages among the target population that 'institutional delivery is safe delivery'.
This element of assurance and assuaging the fears and uncertainties in messaging is more relevant
in acceptance and in reducing misconceptions circulating around such incentive-based
programmes. Equally significant has been greater understanding about the programme. If there is
a rollback of the incentive, sustenance of this pro-social attitude will help in improving the reach
and efficacy of primary health services. But this sustenance needs continued and improved effort
by DFP and support by the client ministry. Rajasthan, MP, and Jharkhand require rigorous
campaign for JSY to improve institutional deliveries. However, Assam has shown marked
improvement, but it needs further stimulus for an overall achievement.
In case of institutional deliveries the observed relationship between knowledge and attitude is
negligible. It makes for a compulsive argument to organise separate campaigns focussed on
knowledge generation, attitude change, and socio-cultural barriers. Awareness generation will not
lead to action unless facilitated by building a positive attitude of individual and an enabling social
and health system environment. Thus each area needs separate communication strategy.
It is recommended that the campaign should highlight that ‘celebration of parenthood’ is
incomplete without institutional deliveries, and is key to the safety of mother and child. Second, it
also requires adequate services and a readiness from health facility/department to make quality
services available. User’s experience with health system will be the key for his/her continuance
and compliance.
51
Family Planning
The campaign had a limited impact on uptake of family planning services. The results are not
unexpected since in these regions the family planning services are at a nascent stage and are
difficult to access. The challenge here is not about awareness generation but converting higher
awareness into reduction of negative attitude for family planning. These results point towards a
need for thorough review not only of communication strategy for family planning, but also for
related ground level activities.
In terms of communication strategies, a clearly articulated promotional programme on
‘contraceptive choices’ and ‘size of the family’ should be implemented in conjunction with access
to quality services. . Existing socio-cultural barriers about what constitutes ‘size of the family
‘makes it imperative to plan for more discreet and veiled messaging to be designed and promoted
which enhances the desirability of ‘small family’ as a viable and as an alternative to ‘large size
family’. More vigorous message dissemination regarding contraceptive choices, which a
couple/individual can choose from, should form a major plank of the interpersonal
communication forums. Delinking of these two activities ‘small family norm’ and ‘contraception
programme’ will help in reducing the barriers and apathy and in reach and access the target
population, which will serve the purpose of a viable ‘size of family’ in the long run.
Health Camp
Campaign in conjunction with the health camp is a viable option as it provides an opportunity for
monitoring as well as for image correction/building of the client ministry (MOHFW). Evidence
suggests that this model can be implemented with certain riders. The health camps should be
organized in such a way that people first attend the activity session where information about the
scheme and the entitlements are shared. Thereafter, they should be directed to the health camp to
reduce the ‘distraction effect’ induced by easy access to services at the health camp. To establish
this coordination between health department and DFP on such issues, DFP should collaborate
with local health officials periodically for finalizing their activities through email and mobile to
reduce time lag and overcome time-lag and distance to sort out issues of programme planning and
management. This will also help in addressing the local needs and customizing services to the
benefit of beneficiaries. At the same time health department, as the client agency, should promote
the synchronization of their activity with DFP. This sets the agenda for greater coordination,
partnership and ownership of the activities planned in the selected sites.
52
Pre-Campaign DFP Activities
(i)
Conceptualization and Planning Programme Activities
Planned health promotion activities are congruent to efforts of ‘community processes under
NRHM (National Rural Health Mission). Association of PRIs and other village
functionaries, with DFP’s ground-level programme, will strengthen the efforts of NRHM
under community processes, which require participation of community members at various
level of planning and management of health services. The action plan of DFP was very
well conceptualised and visualised since it identified various stakeholders (Media, NGOs,
PRI, health functionaries, and political party representatives) who would provide efficient
and viable support and partnership at the grassroots level.
(ii)
Training, Message Framing, and Issue of Knowledge-Transfer During
Workshop
Briefings at the regional/state workshops were heavily tilted in favour of select schemes
(JSY), while emphasis on other important schemes and entitlements of the people was
toned down to their detriment. The role of PRIs under NRHM was not elucidated which
resulted in failure to assign minor and major responsibilities to them during pre and post
event period. The NRHM/health Officials at the DFP workshops should have highlighted
the active role of village functionaries and opinion leaders as crucial to continuation of the
programme.
Strategy should be aligned with efforts of client ministry's mandate under NRHM i.e.
'community processes'. This will not only support the activity of the client ministry in
activating and revitalizing its institutional structures, such as VHSCs etc, but it would also
help in multiplying the efforts of DFP. For this process to unveil, orientation of officers
has to begin from the top and translate into clearly laid-out plans and specific tasks.
In some of the regional workshops, speakers/trainers (health officials) were not well
prepared to provide adequate briefing even on JSY. For example, the scheme of Janani
Shishu Sureksha Yojana, as an add-on to the existing JSY, was presented as a new scheme
(JSSK) which created an ambiguous impression about JSSK as a replacement to JSY. As
part of the workshop preparation, DFP should have given more attention to the organisation
of the training-workshop by identifying appropriate trainers in advance and assigning such
topics to speakers to avoid repetition or omission.
Secondly, to ensure availability of the guest speakers during the training sessions, an
advance confirmation should be taken, and an alternative list of speakers should be
prepared to fill the gap in case of drop-outs.
53
Campaign Activities
(i)
With opinion leaders
Effort was partially fulfilled as DFP’s activities were limited to briefing the opinion leaders
about various schemes, and did not extend beyond to developing and building consistent
association. This resulted in inadequate preparation during pre-campaign activities. The
preparation and orientation regarding planning and designing for the campaign at the
central and regional level however failed to translate at the district levels, and subsequently
at the campaign sites. Reorientation of the training schedule should follow a cascading
structure and this system requires an innovation and reorientation.
(ii)
Rallies
Village rallies were used to create a sense of heightened activity with students and children.
Rally as an energizer method however was unable to open the channel of communication
and remained restricted to a passive communication exercise with live models in some
districts. The rally as a method of instilling interest and curiosity of the community can at
best work as a trigger. A better and alternative approach could be to involve the panchayats
in organizing meetings and provide a forum of information and feedback.
Encouragement can also be given to participation of local NGO members, and development
agencies and their functionaries in such meetings as well. They should be co-opted and
briefed in advance about focus of the campaign to provide a local connect, but should not
be given a free run either to use it as a platform for self-serving agenda.
(iii)
Timings of the Programme
The timings of the designated programmes should be synchronised with the availability and
presence of the local population. It is recommended that before scheduling the programme,
days of weekly market, festivals, and timing of agricultural activities should be ascertained
to ensure availability and participation of community in the programme.
(iv)
Method of Information Dissemination
There is a heavy reliance on lectures as a mode of information delivery. The pattern of
lecture/seminar was not uniform across the regions and; it was heavily depended upon DFP
and health experts’ own orientation to subjects at hand to make the messages sound
resilient and meaningful for diverse groups. Speaker's focus was more on health prevention
activities than on promotion of available services and its utilization. This was quite obvious
at village level where speakers provided information which was not customized as per the
needs of the audience and was delivered in a lecture mode.
54
Lecture giving is an art, and selection of speakers and choice of topics should be in
alignment with the kind of audience available. Careful and deliberate attention should be
given to preparation in selection of guest speakers, by giving them advance notice about the
campaign topics.
(v)
Baby Show
The Baby Show activity can be used as an important strategy to reach specific target
population. For better management of the ‘baby show’ selection criteria of the baby and
number of awards should be announced in advance. Secondly, as there is an active
involvement of the health department, this activity provides a chance to identify and reach
the specific target population with minimal redundancy of efforts.
(vi)
Inter Departmental Coordination
DFP has to evolve mechanism for inter-departmental coordination especially with Song and
Drama and DAVP. There support will augment the efforts of DFP.
In final assessment, DFP’s programmes were a well coordinated and planned series of
programmes in regions where access to government programmes and services is limited and
poses innumerable challenges. Taking information to such settings and enlisting the support of
the local agencies like PRIs, NGOs, front-line workers like ANM, AWW and ASHA, augurs
well since this is one step towards a participatory and inclusive approach.
As a forward movement DFP’s programme can ensure better impact if people’s participation is
not reduced to the level of being, passive audience but women and men and youth are motivated
to become part of the communication programme planning, implementation and monitoring
process for community’s ownership of the development programmes.
Final Note
Although formative research is an accepted practice, it is not always carried out since campaign
planners believe they know their audience well, have material already produced, or feel pressed
for time or when media producers feel it is their right to maintain ‘control over messages’ (Bela
Mody, 2003). A participatory approach where people feel empowered to think, rationalize,
participate and express their understandings and concerns will help outreach programme to gain
credibility and attain acceptance. This precept will help in changing the way communication
programmes are conceived, designed by those who usurp the creative process of the communities
to express their ideas and in a language which is as rich as their cultural moorings.
55
Bibliography
Bibliography
1.
Bashiruddin, S. (1978). Prospects for Communication Planning in – an Overview in Peter
Habermann and Guy de Fontgalland (eds). Development Communication–Rhetoric and
Reality. Singapore: AMIC.
2.
Bamezai, Gita (2010). Behavior Change Communication Framework. Paper Prepared for
Population Council of India.
3.
Becker, M. H., Haefner, D. P., and Maiman, L. A. (1977). The Health Belief Model in
the Prediction of Dietary Compliance: A Field Experiment. Journal of Health and Social
Behaviour, 1977, 18, 348–366.
4.
Communication for Sustainable Development, FAO Communication for Development
Group. Accessed at http://www.fao.org/SD/dim_kn1/docs/kn1_060602d1_en.pdf
5.
Levy, M. R., & Windahl, S. (1985). The concept of audience activity. In K. E.
Rosengren, L. A. Wenner, & P. Palmgreen (Eds.), Media gratifications research: Current
perspectives (pp. 109-122). Beverly Hills, CA: Sage.
6.
Levy, M. R. & Windahl, S. (1984). Audience activity and gratifications:A conceptual
clarification and exploration. Communication Research, 11, 51-78.
7.
McLeroy, K.R., Norton, B.L., Kegler, M.C., Burdine, J.N. and Sumaya, C.V. (2003).
Community-based interventions. American Journal of Public Health, 93(4), 529– 33.
8.
Mendelsohn, H. (1968). Which shall it be: mass education or mass persuasion for health?
American Journal of Public Health, 58, 131-137.
9.
Mody, Bella, ed. (2003). International Development Communication: A 21st Century
Perspective. New Delhi: Sage Publication
10.
Ministry of Health and Family Welfare. (2005). Framework for Implementation. New
Delhi, Government of India
11.
MOHFW, (2005). Framework for Implementation. New Delhi: Government of India.
12.
MOHFW, (2005). NRHM Mission Document. New Delhi: Government of India.
13.
MOHFW, (2007). First Common Review Mission. New Delhi: Government of India.
14.
National Health Systems Resource Centre. (2011). Programme Evaluation of Janani
Suraksha Yojana. Government of India.
15.
Olenick I. (2000). Women’s Exposure to Mass Media Is Linked to Attitudes toward
Contraception in Pakistan, India and Bangladesh. International Family Planning
Perspectives, 26, 48–50.
56
16.
Petty, R. E., & Cacioppo, J. T. (1986). Communication and Persuasion: Central and
Peripheral Routes to Attitude Change. New York: Springer-Verlag.
17.
Robertson, A. and Minkler, M. (1994). New health promotion movement: a critical
examination. Health Education and Behavior, 21, 295– 312.
18.
Rogers E. M., Singhal A., (2001). India's Communication Revolution: From Bullock
Carts to Cyber Marts. New Delhi: Sage Publications.
19.
Salem R.M., Bernstein J., Sullivan T.M., Lande R., (2008). Communication for Better
Health. Population Reports. Series J: Family Planning Programs, Jan ;(56),1-27.
20.
Salmon, Charles T. & Atkin, Charles (2004). Using Media Campaigns for Health
Promotion. In Thompson, Teresa L., Dorsey, Alicia M., Miller, Katherine I. & Parrott,
Roxanne (Eds). Handbook of Health Communication. London: Lawrence Erlbaum
Associates, Publishers
21.
Servaes J., Malikhao, P. (2004). Communication and Sustainable Development. Rome:
FAO.
22.
Servaes, J., ed. (2008). Communication for Development and Social Change. New Delhi:
Sage Publications.
57
Annexure
A. Research Instruments
-
Interview Schedule for DFP Officials
Entry & Exit Questionnaires
IDI with Health Implementers
IDI for Opinion leaders
IDI for Women
FGD for Women
B. Table: Content Analysis of Print Campaign Material
Research Instrument No. 1
Participatory Communication Campaign Approaches in Improving Health Practices in India
A Project for conducting an Impact Assessment of DFP’s programme for improving Mother and Child Health
Village
District
State
Date of interview:
Interview Schedule No.
(Please seek concurrence of the official before beginning the interview and assure the concerned respondent that the
identity will not be revealed and information given will be used only for drawing overall inferences about the
program and will have no reflection on him/her in their personal capacity.)
Section 1
Personal Information
1.1
Name: (Optional) _____________________________________________________________
1.2
Designation_________________________________________________________________
1.3
Place of Current posting: HQ
1.4
Job responsibility: Program
1.5
Number of years associated with DFP:
1. Less than 5 years
Regional Office
Coordination
2. 6-10 years
3. 10-15 years
1.6
Educational Qualification:
1.7
Training received on communication media in last 2 years
Training
Level (National/State)
State Office
Administration
4. 15-20 years
District Level
Technical
5. More than 20 years
Topics/themes covered
1
2
3
4
Section II
2.1
Program Information
Are you aware of the Janani Shishu Suraksha Yojana?
1. Yes
2.1.1
1
2
3
4
5
6
7
2. No
If yes please indicate the main message delivered by DFP in the above mentioned program
JSY relates to institutional deliveries
Delivery by trained team of health worker and doctor
Compensation to mother during delivery
It motivates mother for breastfeeding
It informs them about family planning
About neo-natal deaths
Any other
I
2.2
What according to you will be the most effective media to communicate this program?
(Fill the appropriate number in the bracket)
1. Very Effective 2. Effective 3. Less Effective 4. Not Effective
Radio
2.3
Films
Face to Face
None of these
Any other:
What media strategies you suggest so that this program can reach out to maximum beneficiaries?
(Number of pregnant and expectant mothers in village)
______________________________________________________________________________________
______________________________________________________________________________________
Section III
3.1
TV
Program Strategy Methods used
Which is the most effective media to communicate the program?
Write: 1 Very Effective 2. Effective
3. Less Effective
4. Not Effective
Effectiveness
Activities
Film Shows
Drama
Celebrity Endorsement
Music Concert
Ballet
Folk Dance
Seminar
Group Discussions
Radio Talk
Any Other (Specify)
3.2
What new innovations are being used by DFP to actively encourage and mobilize people especially
pregnant woman to take part in the JSY Scheme.
_____________________________________________________________________________________
3.3
Can observed changes (in attitudes, capacities, institutions etc) be linked to the campaign’s
interventions?
1. Yes
2. No
3.4
In how far is the campaign making a significant contribution to broader and longer-term
development impact? Is the campaign strategy and management steering towards impact?
_____________________________________________________________________________________
3.5
Has the campaign successfully built or strengthened an enabling environment ( policies, people’s
attitudes etc)?
_____________________________________________________________________________________
3.6
Are the campaign results, achievements and benefits likely to be sustainable? Yes No
_____________________________________________________________________________________
3.7
Can the campaign approach or results be replicated or scaled up by national partners or other
actors? Is this likely to happen? What would support their replication and scaling up?
_____________________________________________________________________________________
II
3.8
Can any unintended or unexpected positive or negative effects be observed as a consequence of the
DFP’s interventions?
1. Yes
2. No
3.8.1
If so, how has the campaign strategy been adjusted?
_____________________________________________________________________________________
3.8.2
Have positive effects been integrated into the campaign strategy?
_____________________________________________________________________________________
3.8.3
Has the strategy been adjusted to minimize negative effects?
_____________________________________________________________________________________
3.9
Should there be a second phase of the campaign to consolidate achievements?
1. Yes
2. No
People’s participation and Feedback
Section IV
4.1
In your opinion what approaches/methods are most effective in reaching and seeking participation of
the community? (Can select more than one option)
S. No.
1
2
3
4
5
6
4.2
Personal visits
Holding meetings in villages
Meeting the leaders only
Use of Public meetings
Movie show
Any other (Specicy)
How effective is interpersonal communication/oral/face to face interaction towards increasing
people’s participation in programs?
1. Very Effective
4.3
2. Somewhat Effective
3. Negligible
4. Not at all
Is taking feedback from people about their reaction towards these programs, is a routine and
essential part of the program implementation?
1. Yes
2. No
3. Sometimes
4.3.1
If yes, what is the nature of feedback?
(i)
People ask for more information on programs through personal contact
(ii)
Received complaints from community from time to time
(iii)
Receive requests from community for more efforts from our side
(iv)
Receive letters from community on which we take action
(v)
DFP refers complainant to the concerned department.
4.4
Do you or your staff regularly follow-up to assess the impact of your efforts?
1. Yes
2. No
4.4.1
If yes, then how? Describe three methods.
_____________________________________________________________________________________
III
4.5
What challenges do you face while ensuring participation of the people in all these programs?
Please state at least three major such barriers/roadblocks at:
I) Department Level_________________________________________________________________
II) Community Level_________________________________________________________________
III) Personal Level___________________________________________________________________
4.6
What are the benefits of reaching out to people through traditional methods/mass media such
methods in the face of increasing use of information technology like internet and mobile?
1.___________________________________________________
2.___________________________________________________
3._____________________________________________________
4.7
Does internet and mobile have a role to play in overcoming difficulties of reaching out to people in
villages and remote areas?
1. Yes
2. No
4.8
What are the measures adopted by you to identify communication needs, objectives and activities in
the area?
_____________________________________________________________________________________
4.9
How can we improve the quality of DFP’s communication campaigns planning and management?
_____________________________________________________________________________________
**********************
IV
Entry & Exit Interviews
Directorate of Field Publicity (DFP), a media unit of Ministry of Information and Broadcasting, New Delhi is
organising campaign of events to propagate messages on NRHM & JSSY (National Rural Health Mission, Janani
Shishu Suraksha Yojana) in all states of the country. Indian Institute of Mass Communication, M/o I&B, New Delhi
is conducting research to assess the reach of messages on Maternal and child health, family planning, etc and change
in knowledge, attitude and practices of target population towards improving the status of health.
I am ................. (Name) and as a part of this study, I want your consent in asking you few questions about the
government health programmes and the campaign. This will take maximum 10-15 minutes. Your responses are
important to us. Can you spare few minutes for this. Your views will be kept confidential and will be utilised only
for study purposes.
Date of interview:
Interview Schedule No.
Village
District
State
ENTRY INTERVIEW
Section I
Profile
1
Name
2
Age (In Years)
3
Gender
1. Male
2. Female
4
Marital Status
1. Married
2. Unmarried
5
Education:
6
Occupation
7
Personal Income, if any (In Rs.)
8
Age when got married
9
Children (If yes, No. of Children)
1 Yes
9.1
Age of Eldest and Youngest child
Eldest
10
Belong to this village
1 Yes
10.1
If No, Name of the Village
11
Youngest
2. No
Media Use
1. TV
12
No. of Children:
2. No
2. Radio
Health Seeking Behavior
1. Visits Govt. hospitals
4. Uses Home remedies
Section II
3. Newspaper
4. Mobile phones
2.Visits Private hospitals
5. Consults ISM practitioner
5. Movies
3. Both Govt. and Private
Recall/Earlier exposure to such programme:
2.1.
Have you attended any event organised by DFP earlier?
1. Yes
2. No
2.2.
If yes, what kind of program (Exhibition/Film show/Talks/Rallies) was it?
____________________________________________________________________________________________________________
V
2.3.
What was the theme of the program?
S. No
Theme
Health and Hygiene
1
Development related (Employment related, infrastructure, agriculture
2
etc)
Flagship
programmes (like MGNREGA, SSA, CMP etc)
3
National Integration & Communal harmony
4
Iodized Salt
5
Family Planning
6
Farming,
7
Vaccination
8
Training for rural youth
9
Janani Suraksha Yojana (JSY)
10
Education
11
Any other (Please specify)
12
Write 1 for Yes 2 for No
Section III. Source of Information/Publicity about the present Campaign/ program:
3.1.
How did you come to know about this even/tprogram?
1. Through Panchayat and village functionaries
2. Through friend/ family
3. Announcement on loudspeaker
4. I was passing by this place & stopped to see
5. DFP
6. Health functionaries (ANM/ASHA/AWW)
7. Any other (Please specify) ______________________________________________________________
3.2.
What are you expecting from the programme?
1. Entertainment
2. Information
3. Both
4. Any other _______________________
Section IV: Knowledge and Practice
4.1
Are you aware of Janani Suraksha Yojana?
1. Yes
2. No
4.2 If Yes, what do you know about it?
S.
Themes
No.
1
Child Marriage
What is the Legal Age for marriage of boys and girls in India
2
Maternal Health
Pregnancy at early age can affect woman’ health adversely
3
Immunization
Immunization helps in fighting childhood diseases
It is necessary to follow the immunization chart
4
Breast feeding
An infant must be breastfed within half an hour of his/her birth
Breast milk is the healthiest food for infants
The first produce of breast is most nutritious
4
Female Foeticide
Boys and girls should be treated equal
Sex determination test is unethical and punishable
There are laws to punish guilty of this crime
5
Institutional
Institutional deliveries are safe for mother and child
Deliveries
Govt. gives incentives for institutional deliveries
6
Family Planning
Reducing gap between children increases risk of infant death
Male sterilization does not affect manhood or virility among males
Smaller family means good quality of life
1 For Aware
2 for Not Aware
VI
7
Communicable
Disease
Stagnant water allows breeding of mosquitoes
4.3
Give your opinion about following statements:
S.
No.
Statements
1 For Agree
2 For Disagree
3 For partially Agree
1
Mother and child not allowed to go out for 40 days after delivery
2
It is important to keep baby warm after birth
3
Deliveries at home is not risky for mother and child
4
Anemia in women is common and does not cause complication during delivery
5
Mothers giving birth to baby girls are given no attention
6
Mothers are responsible for giving birth to baby girls
7
Breast milk immediately after birth should be avoided for 3 days
8
Infant should be given honey and water after birth
9
Child fed on breast milk is healthier and more intelligent
10
Breast feeding helps mother in regaining health faster after delivery
11
Breast feeding increases milk output among women
12
Male child is necessary for a complete family
13
Males sterilization affects manhood or virility
14
Bigger family means more hands to earn
15
Sons take care of parents more than daughters
16
Bringing a girl child is a burden
17
Boys take forward the name of the family
18
Having girls means fear of safely and dignity
19
Child marriage is necessary to avoid dowry system
20
Infant and maternal mortality are ill effects of Child marriage
Note: Ensure the exit interview with the same respondent.
EXIT INTERVIEW
Section V
Recall and Comprehension
5.1
What did you see/attend today?
______________________________________________________________________________________
5.2
S.
No
1
2
3
4
5
6
7
8
9
10
11
12
What was the theme of the program?
Theme
5.3
Write 1 for Yes
2 for No
Health and Hygiene
Development related (Employment related, infrastructure, agriculture etc)
Flagship programmes (like MGNREGA, SSA, CMP etc)
National Integration & Communal harmony
Iodized Salt
Family Planning
Farming,
Vaccination
Training for rural youth
Janani Suraksha Yojana (JSY)
Education
Any other (Please specify)
Did you understand the message delivered?
1. Fully
2. Somewhat
3. Not at all
VII
5.4
If the answer is ‘somewhat’ or ‘not at all’, what are the reasons?
1. Subject was not clear
2. No prior introduction to subject
3. Subject not relevant to us
4. Information was given through songs so it was not clear.
5. Did not understand the language/dialect
6. The sound system was not good, could not hear the songs/dialogues
7. Crowd was too much, could not see
8. Performance was not entertaining
9. Was late for the show/ did not see the whole show
10. Any other _______________________________________________________
5.5.
Recall of the themes and messages
S.
No.
1
2
3
Themes
Child Marriage
Maternal Health
Immunization
4
Breast feeding
4
Female Foeticide
5
Institutional
Deliveries
6
Family Planning
7
Communicable
Disease
1 For Aware
2 for Not Aware
5.6
Were these messages being conveyed earlier to people in this village?
1. Yes
2.No
5.6.1
If yes, what was the medium/source?______________________________________________________
5.7
Give your opinion on following:
Statements
1
2
3
4
5
6
7
8
9
10
11
1 = Agree
2 = Disagree
3 = Partially Agree
Mother and child not allowed to go out for 40 days after delivery
It is important to keep baby warm after birth
Deliveries at home is not risky for mother and child
Anemia in women is common and does not cause complication during delivery
Mothers giving birth to baby girls are given no attention
Mothers are responsible for giving birth to baby girls
Breast milk immediately after birth should be avoided for 3 days
Infant should be given honey and water after birth
Child fed on breast milk is healthier and more intelligent
Breast feeding helps mother in regaining health faster after delivery
Breast feeding increases milk output among women
VIII
12
13
14
15
16
17
18
19
20
Male child is necessary for a complete family
Males sterilization affects manhood or virility
Bigger family means more hands to earn
Sons take care of parents more than daughters
Bringing a girl child is a burden
Boys take forward the name of the family
Having girls means fear of safely and dignity
Child marriage is necessary to avoid dowry system
Infant and maternal mortality are ill effects of Child marriage
Section VI
6.1
S. No.
1
2
3
4
5
6
7
6.2
Liking for the Programme:
How did you find the arrangement for the programme? (put the rating against each response)
(Give ratings: 1.Good,
2. Ok
3. Bad)
Rating
Reasons for not liking
Venue
Timing of the program
Space
Sitting Arrangement
Lights
Sound/Music
Any Other
Did you like the program you attended just now?
1. To large extent
2. To some extent
3. Not at all
6.3
Did any official approach you during the program?
1. Yes
2.No
6.4
Did you seek any clarification regarding Govt. programmes, during the program?
1. Yes
2.No
If yes,
A). What was the doubt/question?
_____________________________________________________________________________________________________________________
B). Who responded your query?
____________________________________________________________________________________________________________________
Section VII
Suggestions on Theme and programme
7.1
Do you think such themes / messages are good for improving the health of people in the village?
1. Yes
2.No
3. Can’t say
7.2
What would be most effective way of generating
your village?
1. Film shows
2. Song and drama
5. Exhibition
6. Printed material
9. Interpersonal Communication
11 Panchayat meetings
13 Training by Anganwadi Centers
7.3
awareness/involving people and bringing change in
3. TV
4. Radio
7. Hoardings/ posters
8. Traditional folk media
10. Regular health camps in schools and PHC
12. Door to door visit by the health workers
14 Other _____________________
Please give suggestions to improve or make such programmes more effective.
________________________________________________________________________________________________________________________________________________
**********************
IX
Research Instrument No.4
IDI with Health Implementers
Name of the village:_______________
District:_____________
State: _______________________
A. Profile:
1.
Name __________________________
2.
3.
Do you belong to this village:
3.1
If yes, (Please give name of the village) _______________________________________________
3.2
Since how long you have been in this village_____________________________________
1. Yes
Age
_________
2. No
We want to thank you for taking the time to meet us today. We would like to talk to you about your experiences as
ANM/ASHA/AWW/VHC/SHG. Specifically, as one of the components of our overall program evaluation we are
assessing program effectiveness in order to collect data that can be used in future interventions.
The interview should take less than an hour. We will be recording the session because we don’t want to miss any of
your comments. All responses will be kept confidential. This means that your interview responses will only be
shared with research team members and we will ensure that any information we include in our report does not
identify you as the respondent. Remember, you don’t have to talk about anything you don’t want to and you may
end the interview at any time.
1)
Are there any questions about what has just been explained to you?
2)
Are you willing to participate in this interview?
Interviewee
Section I
1.1
Witness
Date
General Information
How frequently you visit this village?
___________________________________________________________________________________________________________________________
1.2
How many villages you look after/visit:
___________________________________________________________________________________________________________________________
1.3
How many ANM/ASHA work in your team________________________________________________
1.4
Did you attend any training/ orientation in near past?
1.5
Did you attend any training/ orientation in near past?
1. Yes
2. No
1.5.1
If yes. Give details__________________________________________________________________
1.6
What is the role of following under JSY scheme?

ANM _________________________________________________________________________

ASHA_________________________________________________________________________

AWW_________________________________________________________________________

VHC__________________________________________________________________________

SHG __________________________________________________________________________
X
1.7
Has your role changed after JSY came into being?
___________________________________________________________________________________________________________________________
1.8
What changes do you find/see after JSY was introduced in this village,





Increased use of services by pregnant women
Increased knowledge of villagers
Decrease in no. of women dying during pregnancy
Less neo-natal deaths
Increase in no. of children for immunization
1.4
Your job is quite challenging, how do you think you are helping in bringing changes in the practices
such as institutional delivery, breast feeding and family planning? Please explain.
_____________________________________________________________________________________
1.5
Had there been any increase in the number of pregnant women taken to the health center for
delivery?
1. Yes
2. No
If yes. Approx how much________________________________________________________________
1.6
In your opinion is JSY able to influence the family health behaviors/practices have?
1. Yes
1.6.1
2. No
3. Don’t Know
If yes, what changes do you see
1) Age of marriage________________
2) Small family norm______________
3) Spacing _______________________
Section II
Barriers
2.1
What do you think is the key element of JSY-institutional deliveries, breastfeeding or immunization?
______________________________________________________________________________________
2.2
Why do you think so?
______________________________________________________________________________________
2.3
What do you think are the main reasons why people don’t prefer institutional delivery?
1) Home is convenient
2) Not required since pregnancy was normal
3) Cost of institutional delivery
4) Delivery institution is far off
5) Nobody to take them to hospital for delivery
6) Untimely delivery
7) Family objects to institutional delivery
8) Any other (Specify)___________________________________________
2.4
What is the structure of families in this village?
1) Joint family
2) Nuclear family
2.5
Who in the family takes decision regarding important issues such as childbirth or number of children
in family?
______________________________________________________________________________________
XI
2.6
Do the people of this village practice family planning?
1. Yes
2. No
2.6.1
If No, Why do they prefer to have large family?
______________________________________________________________________________________
2.7
What kind of health facility they prefer for / trust for childbirth & why?
1) Institutional/Government facility_________________________________________________________
2) Accredited Private facilities _____________________________________________________________
3) Private facilities ______________________________________________________________________
2.8
Incase of emergency how do you take pregnant mothers to nearest health facility
______________________________________________________________________________________
2.9
Percentage of children under 3 year’s breastfed within one hour of birth
______________________________________________________________________________________
2.10
Do you receive queries regarding breastfeeding?
1. Yes
2. No
2.11
What are the major issues because of which women don’t breast feed?
1) Mothers are not healthy/weak
2) Family/ mother don’t consider breast milk good for infants
3) They consider formula food like Cerelac and Farex to be better
4) Difficulties- Breast Abscess
5) Mother don’t produce enough milk
6) Women are figure conscious
7) Any other (specify)____________________________________________________________________
2.11
Do you take infants / newborn babies for routine immunization?
1. Yes
2. No
2.11.1
If No, then who does?___________________________________________________________________
2.11.2
If Yes,
a) Do mothers bring their child for immunization on their own?___________________________________
b) What information you share with beneficiaries?______________________________________________
c) In what way do you convince and mobilize mothers for immunization?___________________________
3
3.11
How do you check dropouts of immunization?
______________________________________________________________________________________
______________________________________________________________________________________
4
4.11
What percentage of children 12-23 months fully immunized (BCG, measles, and 3 doses each of
polio/DPT)
______________________________________________________________________________________
______________________________________________________________________________________
Section III
Communication
3
3.1
What are the factors responsible for the pregnant women not to avail medical facility?
______________________________________________________________________________________
XII
3.2
What rumors and misconceptions are prevalent related to various programs (Immunization, JSY or
ANC and institutional delivery, contraception especially vasectomy)
______________________________________________________________________________________
3.3
Who are the detractors who do not allow women to access health care during pregnancy?
a) Family
b) Cultural setup
c) Money
d) Lack of awareness
e) Psychological reasons
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
3.4
Who can best motivate people/women and their families to come forward and avail health services
and practice dos and don’ts for child and maternal health?
______________________________________________________________________________________
3.5
What are the other possible methods to motivate pregnant women for institutional delivery and
breast feeding?
______________________________________________________________________________________
Section IV
4.1
Government’s policy
What are the methods are adopted for popularizing the scheme among pregnant women and their
families?
1) Is there?
2) What is it?
3) Have you helped?
4) How does it motivate?
5) Does JSY incentive offered to pregnant women motivate them for institutional delivery?
______________________________________________________________________________________
Section V
5.1
Indicators of quality
Do people in this village are interested for information on sterilization?
1. Yes
2. No
5.1.1
If yes, then who (M/F)________________________
5.1.2
Who among the family go for sterilization process? (Husband/wife)
Section VI
Strategies to improvise
6.1
What strategies, interventions, tools should be discontinued? Why?
_________________________________________________________________________________
6.2
Do you find awareness generating activities to be adequate?
1. Yes
6.3
2. No
3. Cant say
What is your suggestion to generate awareness about these schemes?
_________________________________________________________________________________
_________________________________________________________________________________
**********************
XIII
IDI for Opinion leaders
Name of the village:_______________
District:_____________
State: _______________
A. Profile:
1.
Name __________________________
3.
Do you belong to this village:
3.1
3.2
1. Yes
2.
Age _________
2. No
If No, (Please give name of the village) ____________________________________________
Since how long you have been in this village________________________________________
We want to thank you for taking the time to meet us today. We would like to talk to you about your experiences as
ANM/ASHA/AWW/VHC/SHG. Specifically, as one of the components of our overall program evaluation we are
assessing program effectiveness in order to collect data that can be used in future interventions.
The interview should take less than an hour. We will be recording the session because we don’t want to miss any of
your comments. All responses will be kept confidential. This means that your interview responses will only be
shared with research team members and we will ensure that any information we include in our report does not
identify you as the respondent. Remember, you don’t have to talk about anything you don’t want to and you may
end the interview at any time.
1)
Are there any questions about what has just been explained to you?
2)
Are you willing to participate in this interview?
Interviewee
Witness
Section I
1.1.1
Date
General Information
How frequently you visit this village?
____________________________________________________________________________________________________________
1.2
How many villages you look after/visit:
____________________________________________________________________________________________________________
1.3
What changes do you find/see after JSY was introduced in this village,





1.4
Increased use of services by pregnant women
Increased knowledge of villagers
Decrease in no. of women dying during pregnancy
Less neo-natal deaths
Increase in no. of children for immunization
Your job is quite challenging, how do you think you are helping in bringing changes in the
practices such as institutional delivery, breast feeding and family planning? Please explain.
___________________________________________________________________________________________________________
1.5
Had there been any increase in the number of pregnant women taken to the health center for
delivery?
1. Yes
2. No
If yes. approx how much_________________________________________________________________
XIV
1.6
In your opinion is JSY able to influence the family health behaviors/practices have?
1. Yes
1.6.1
2. No
3. Don’t Know
If yes, what changes do you see
1) Age of marriage_______________________________________________________________________
2) Small family norm_____________________________________________________________________
3) Spacing _____________________________________________________________________________
Section II
Barriers
2.1
What do you think is the key element of JSY-institutional deliveries, breastfeeding or immunization?
____________________________________________________________________________________
2.3
Why do you think so?
______________________________________________________________________________________
2.3
What do you think are the main reasons why people don’t prefer institutional delivery?
1) Home is convenient
2) Not required since pregnancy was normal
3) Cost of institutional delivery
4) Delivery institution is far off
5) Nobody to take them to hospital for delivery
6) Untimely delivery
7) Family objects to institutional delivery
8) Any other (Specify)___________________________________________
2.4
What is the structure of families in this village?
1) Joint family
2) Nuclear family
2.5
Who in the family takes decision regarding important issues such as childbirth or number of children
in family?
______________________________________________________________________________________
2.6
Do the people of this village practice family planning?
1. Yes
2. No
2.6.1
If No, Why do they prefer to have large family?
______________________________________________________________________________________
2.7
What kind of health facility they prefer for / trust for childbirth & why?
1) Institutional/Government facility_________________________________________________________
2) Accredited Private facilities _____________________________________________________________
3) Private facilities ______________________________________________________________________
2.8
Incase of emergency how do you take pregnant mothers to nearest health facility
______________________________________________________________________________________
2.9
Percentage of children under 3 year’s breastfed within one hour of birth
______________________________________________________________________________________
2.10
What are the major issues because of which women don’t breast feed?
1) Mothers are not healthy/weak
2) Family/ mother don’t consider breast milk good for infants
XV
3) They consider formula food like Cerelac and Farex to be better
4) Difficulties- Breast Abscess
5) Mother don’t produce enough milk
6) Women are figure conscious
7) Any other (specify)____________________________________________________________________
2.11
Do you take infants / newborn babies for routine immunization?
1. Yes
2. No
2.11.1
If No, then who does?___________________________________________________________________
2.11.2
If Yes,
a) Do mothers bring their child for immunization on their own?
______________________________________________________________________________________
b) What information you share with beneficiaries?
______________________________________________________________________________________
c) In what way do you convince and mobilize mothers for immunization?
______________________________________________________________________________________
2.12 How do you check dropouts of immunization?
______________________________________________________________________________________
2.13
What percentage of children 12-23 months fully immunized (BCG, measles, and 3 doses each of
polio/DPT)
______________________________________________________________________________________
Section III
Communication
3.1
What are the factors responsible for the pregnant women not to avail medical facility?
______________________________________________________________________________________
3.2
What rumors and misconceptions are prevalent related to various programs (Immunization, JSY or
ANC and institutional delivery, contraception especially vasectomy)
______________________________________________________________________________________
3.3
Who are the detractors who do not allow women to access health care during pregnancy?
a) Family
b) Cultural setup
c) Money
d) Lack of awareness
e) Psychological reasons
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
: ________________________________________________________
3.4
Who can best motivate people/women and their families to come forward and avail health services
and practice dos and don’ts for child and maternal health?
______________________________________________________________________________________
3.5
What are the other possible methods to motivate pregnant women for institutional delivery and
breast feeding?
______________________________________________________________________________________
XVI
Section IV
4.1
Government’s policy
What are the methods are adopted for popularizing the scheme among pregnant women and their
families?
1) Is there?
2) What is it?
3) Have you helped?
4) How does it motivate?
5) Does JSY incentive offered to pregnant women motivate them for institutional delivery?
______________________________________________________________________________________
Section V
Indicators of quality
5.1
Do people in this village are interested for information on sterilization?
1. Yes
2. No
5.1.1
If yes, then who (M/F)________________
5.1.2
Who among the family go for sterilization process? (Husband/wife)
Section VI
Strategies to improvise
6.1
What strategies, interventions, tools should be discontinued? Why?
______________________________________________________________________________________
6.2
Do you find awareness generating activities to be adequate?
1. Yes
2. No
3. Cant say
6.3
What is your suggestion to generate awareness about these schemes?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
***********************
XVII
IDI for Women
Village
District
State
Note for the researcher
1. Profile of beneficiaries (women in reproductive years, 18-40) will be be asked before Interview begins
2. Make the interviewee comfortable. Inform them that their views and opinions will be used only for the
study and all personal details will be kept confidential
3. Listen for inconsistent comments and probe for understanding.
4. Listen for vague or cryptic comments and seek clarification.
Section I A
Profile
1
Name
2
Age (In Years)
3
Education:
(Please tick mark the appropriate answer)
4
Occupation
5.
6
7
7.1
8
8.1
8.2
8.2.1
8.3
8.4
9.
9.1
9.2
9.2.1
10.
10.1
Personal Income, if any
Age when got married
Children (If yes, No. of Children)
Age of Eldest and Youngest child
Pregnant
If yes, month of Pregnancy
Taking iron Supplements
Name of the Supplements
ANC visits
Assisted by any ANM/ASHA
Whether Lactating
If yes, Age of child (In months)
If No, Have you breast fed earlier
If yes, when did you stop breast feeding
your
(Record
age of the child)
Placechild
of Delivery
ofthe
birth
If at hospital, Who took you there?
1. Cant Read or Write
3. Formal Education
2. Cant Read and Write
4. No formal Education
1. Housewife
2. Employed 3. Self Employed
4. Any other (Specify)_________________________
1 Yes
Eldest
1 Yes
2 No
1 Yes
2 No
1 Yes
1 Yes
1 Yes
2 No
2 No
2 No
1 Yes
2 No
1. At home
No. of Children:
Youngest
2 No
2. At hospital
Section I B
1.
Media Use
1. TV
2.
2. Radio
Health Seeking Behavior
1. Visits Govt. hospitals
4. Uses Home remedies
3. Newspaper
4. Mobile phones
2.Visits Private hospitals
5. Consults ISM practitioner
5. Movies
3. Both Govt. and Private
XVIII
Section II A
Family health behaviors/practices
2.1
Who in family looks/looked after you or gives/gave suggestions during pregnancy?
______________________________________________________________________________________
2.2
Do you agree that health of a mother is necessary to bear healthy child?
1. Yes
2.3
2. No
3. Can’t Say
Do you agree that having frequent pregnancies can make women unhealthy?
1. Yes
2. No
3. Can’t Say
2.4
According to you how much difference (in years) is ideal between two children?
____________________________________________________________________________________
2.5
Did you ever discuss with your husband/family members about keeping space between 2 children?
1. Yes
2.5.1
2. No
If yes, are you aware of family planning methods?
1. Yes
1)
2)
3)
Section II B
2.6
2. No
What is legal age for marriage in India?___________________________________________
Do you agree that getting pregnant at early age is not good for health of women?
1. Yes
2. No
In your opinion what is better:
1. Deliveries at home ……
2. Deliveries at hospitals……
Awareness about Family Planning Program
Have you agree with ‘ small family is happy family’slogan?
1. Yes
2. No
2.7
How do you identify ‘hum do hamare do’ slogan with?
__________________________________________________________________________________
2.8
Are you aware of Governments family planning program?
1. Yes
2.9
2. No
3. Can’t Say
How did you come to know about this Family welfare program?
1. TV
2. Radio
3. Newspaper
4. Posters
6. ANMs/ASHA 7. Neighbours
8. Friends
2.10
Are you aware of any family planning method?
1. Yes
2.11
2. No
3. Can’t Say
Have you heard of vasectomy? (Explain vasectomy)
1. Yes
2.12
5. Programs (Films, Group Discussions)
2. No
Which of the following family planning methods you have heard of?
1) Mala D
2) I pill
3) IUD: Copper T4) Vasectomy
5) Condoms
XIX
2.13
If yes to Vasectomy, are you aware that vasectomy is done free of cost at govt. hospitals?
1. Yes
2.14
2. No
Are you aware that Vasectomy couples are rewarded by the government?
1. Yes
2.15
2. No
Do you know anyone in the village being rewarded?
1. Yes
Section IIC
2.16
2. No
Knowledge & Practices: Breast Feeding
Do you agree that mother’s milk is the healthiest form of food for babies?
3. Can’t Say (For any answer, ask for reasons)
2) OK
3) Alternative food for infant
5) Insufficient
6) Any Other (Specify)________________
1. Yes
2. No
1) Best milk for infants
4) Not good for infants
2.17
How long should mothers breast feed their infants
1) Up to 3 months
2.18
2) Anything else (specify)…………………
2. No
If yes, what are the reasons?
1. Greater immune health
2. It is nutritious
4. So that infant gets warmth of her mother 5. All are true
2.20
3. It saves infant from getting infections
6. All are false
Do you believe that breast feeding acts as a family planning method to avoid pregnancies?
1. Yes
2.21
4) Till mother is able to feed
Do you know that an infant must be breastfed within half an hour of his/her birth
1. Yes
2.19.1
3) Till infant gets teeth
When a child is born, what is the first thing that is fed to him/her?
1) Breast milk
2.19
2) Up to 6 months
2. No
Have you seen any advt. on breast feeding anywhere?
1. Yes
2. No
2.21.1
If yes, ask for details.
______________________________________________________________________________________
2.22
Has anyone advised you/ anyone in the family to breast feed your child?
1. Yes
2. No
2.22.1
If yes, who____________________________________________________________________________
2.23
Have you/anyone in the family ever discontinued breast feeding?
1. Yes
2.23.1
2. No
If yes, what are the reasons?
______________________________________________________________________________________
XX
Section III
3.1
days?
Awareness about Health facilities and services:
Do you know that Government is providing medical facilities to newborn and his mother for 30
1. Yes
2. No.
a. Are these medical facilities free?
b. Required to pay for the medicines
c. Required to pay both for the facilities and medicines
3.2
2. No
IF YES, for how much time:
1) Full day 24 Hrs.
3.3
2. No
2. No
If yes, what was the name of vaccination________________________________________________
1. Yes
3.9
2. No
Did you get your child vaccinated?
1. Yes
3.8
2. No
Did you get yourself vaccinated during pregnancy?
1. Yes
3.7
2. No
Do you know that MTP (GIVE FULL FORM) facility is available in Primary Health centers and
Regional health center?
1. Yes
3.6
3) From Morning 9 AM to 9 PM
Do you know that pregnant women are given travel allowance to reach hospitals?
1. Yes
3.5
2) From Morning 9 AM to 5 PM
Has anyone in the village availed this facility?
1. Yes
3.4
2. No
Has your child given Polio drops?
1. Yes
2. No
3.10
If yes, did you go to health centre?
1. Yes
2. No
3.11
If yes, did anyone come to your village/house to give polio drops?
1. Yes
3.12
2. No
2. No
2. No
Do you have these facilities in your village?
1. Yes
3.2.1
1. Yes
1. Yes
1. Yes
2. No
In your opinion Has JSY ( Janani Suraksha yojana) brought about any change in the health
practices:
At your family level____________________________________________________________________
___________________________________________________________________________________________________________________
At village level_______________________________________________________________________
___________________________________________________________________________________________________________________
*************************
XXI
FGD for Women
Place________________________
Date__________________
No. f participants_____________
Note for the researcher
Before the FGD
5. Make sure you have all required materials-FGD themes, pens, extra sheets of paper, gifts for the
participants.
6. Profile of participants (women in reproductive years, 18-40) will be be asked before FGD begins,
participants usually disperse soon after the FGD gets over. Use tick mark in all boxes)
7. Make the participants comfortable. Inform them that their views and opinions will be used only for the
study and all personal details will be kept confidential
During FGD
1. Encourage participants to speak one at a time, and it may be preferable for participants to identify
themselves before they speak.
2. Make sure that you only facilitate the discussion. Allow free conversation.
3. As participants arrive, greet guests make small talks but avoid the topic of the focus group. This is to assess
the communication styles of the participants.
4. Listen for inconsistent comments and probe for understanding.
5. Listen for vague or cryptic comments and seek clarification.
6. Consider asking each participant a final preference question.
7. Offer a summary of key questions and seek confirmation.
Section 1A
Discuss the common social beliefs/ myths and customs of people on health of a woman in
general. Start by asking, who according to you is a healthy women/mother?
Section 1B
-
Discuss how pregnancies, early or late can affect the health of a woman
Why monitoring of women’s health during pregnancy is important
People’s myths and views about deliveries at home and institutionalized deliveries.
Discuss social beliefs of people towards early age marriage
Section 1C
-
Discuss about importance of keeping space between 2 children
How it effects health of a mother
How spacing can be achieved
What are the common family planning methods they know about and practice
Reasons for not using Family planning methods
Availability of methods at sub-centre, in the village, any other place
Section 1D
-
Discuss importance of breast feeding
Changing attitude towards breast feeding (Myths about breast feeding)
Diet of lactating women (food that boost)
XXII
Section 2A
Section 2B
Section 3A
Section 3B
-
Discuss the role of health functionaries/implementers in generating awareness among people
about new programmes /schemes
What kind of services do ASHA, AWW, ANM provide to beneficiaries
Who among them is the most valued and why
Are their services regular and unbiased
Their interpersonal & communication skills
Discuss the factors acting as barriers to change in the attitude of people in the village in
context to
Social system, prejudices, myths etc
Family structure
Decision making powers within the family
Status of women
Lack of education- lack of educational facilities
Lack of initiative of local governance in making govt. programme reach villages
Limited sources of information
How to minimize barriers
Discuss the campaign which they have attended recently on health
What was the theme
What were the messages conveyed during the campaign
What they liked/disliked about it
Effectiveness of the campaign (Appeal, language, comprehension, format of campaign)
What action have they taken
Do they need such events in future too? Why
What to do to make such events more attractive and attentive
Discuss the suggestions to improve access to information
Which media method will be more effective
What to do to come out from the family level barriers
****************************
(Thank the participants)
Comments:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
XXIII
Observation Sheet
Directorate of Field Publicity (DFP), a media unit of Ministry of Information and Broadcasting, New Delhi is
oraganising campaign to propagate messages on NRHM & JSSY ( National Rural Health Mission, Janani Shishu
Suraksha Yojana) in all states of the country. Indian Institute of Mass Communication, M/o I&B , New Delhi is
conducting research to assess the reach of messages on Maternal and child health, family planning , etc and change
in knowledge , attitude and practices of target population towards improving the status of health.
Date
:……………………………
State :……………………………
District :……………………………
Gram Panchayat :…………….……...
1)
2)
Type of Event: Gram Sabha / Meeting/ Rally / Film show
a) Time of starting…………………
b) Time of end of event.....………………
c) Time of starting observation……
d) Time of finishing observation…………
Section A
A1
Block: …………………..…………..
Village /Site of Event………………..
Field Publicity/ campaign material
Observe and write the topic/subject/ message of the material seen/ distributed at the event site
Material
Poster
Banner
Handout
Film
Slogan
Hoarding/sign board
fliers
kisoks
brochure
Other (specify)
Section B
B1
Audience/Participants:
Composition- Kindly record approximate number of:
Married males
Unmarried women
College going students
B2
Subject:
Unmarried males
Children
Old and aged persons
What is the Density of the crowd?
1. Very less
2. Average
At the start of event
3. Heavy
Middle of the event
Married women
School going students
4. Scattered
End of the event
XXIV
B3
S. No.
1
2
3
4
Did the crowd disperse during the event?
Did the crowd move around to see the whole
site ofthey
eventcarrying any publicity material with
Were
them
at
time
of leaving
Did theythe
stop
to ask
questions at
helpdesk/information
desk
Did they at any point of
time
applauded/clapped?.....what was it
What was the crowd doing
5
Audience response to event: ….. …. …
What was attracting the crowd most?
what per cent of the village population turned up
for the event ( ask any villager)
How were people reaching the site
Was any pregnant women present at the event
What was done to attract the crowd
6
7
8
9
10
11
Section C
D1
Constantly moving
around
Involved Attentive
Describe
Describe
Yes
Describe
NA
NA
NA
NA
Constantly
sitting
Bored
Constantly
standing
Distracted
No
NA
Activities at the Site of Event:
Observe and list all activities organized by the DFP unit/
others? (describe)
Who were the main audience/participants of the activity
Did the activity involve/ allow interaction with the
audience?
Were people passing by stop to see the activity?
Observe and list the stalls put up
Which stall had the maximum crowd
Which stall had most women
Were any two activities happening simultaneously?
Any Group discussion happened
Any desk to answer people’s questions
Any film show
Section D
Response ( tick mark or describe )
Yes
No
Yes
No
Yes
No
Yes
No
List here
Write here
Yes
Yes
List here
Describe stall
Describe stall
Yes
Yes
Yes
Yes
No
NA
No
NA
No
No
No
No
NA
NA
NA
NA
Information Dissemination:
Observe and record the information on the three health schemes:
1. Institutional delivery
Type of material displayed on this topic
Where was the material displayed
What was /were the message/s
Was the message readable
Any slogan /song heard on loudspeakers
Any slogan /song seen written anywhere
Any material distributed
Any film shown on this topic
Write here
At lamp posts
Yes
Yes
If yes, what was it?
Yes
If yes, take picture of it
Yes
If yes, collect samples
Yes
Duration?
Message?
No
No
No
No
No
Any celebrity?
XXV
Any advertisement/spot shown
2. Family Planning
3. Breast feeding
Section E
Yes
Message?
Any celebrity?
No
Duration?
Write here
At lamp posts
Yes
Yes
Yes
Yes
Yes
Duration?
Yes
Message?
Any celebrity?
No
No
No
No
No
Any celebrity?
No
Duration?
Write here
At lamp posts
Yes
Yes
Yes
Yes
Yes
Duration?
Yes
Message?
Any celebrity?
No
No
Number
Yes
Yes
Yes
Yes
Number
Yes
Yes
Yes
Yes
Number
Yes
Yes
Yes
Yes
Name
No
No
No
No
Name
No
No
No
No
Name
No
No
No
No
No
No
No
Any celebrity?
No
Duration?
Presence of Officials
1. DFP officials present
Were present till the end of event?
Interacted with people
Did they have fixed place to sit
Were they moving around
2. Health officials present
3. Gram panchayat members present
XXVI
Section F
F1
Physical/Logistical arrangements
Observe and record the quality of items listed in the table
Sound system
Audible
Stage/elevated area
Yes
Lighting arrangement
Yes
Help desk/ Information Desk
Yes
Projection screen
Yes
Section G
Themes and messages delivered during the program
S.
No.
1
2
3
Child Marriage
Maternal Health
Immunization
4
Breast feeding
4
Female Foeticide
5
Institutional
Deliveries
Family Planning
6
7
Not audible
No
No
No
No
Themes
Communicable
Disease
Observer’s comment and overall assessment
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Observer’s sign_____________________
Date ____________________________
****************************
XXVII
B.
Table Content analysis of Print Material on Health Issues
Material
Immunization
Leaflet
Brochures
State
No
Specific topic
Issuing agency
Target
Pregnant
Women
Pregnant
Rajasthan
1
-
DFP
MP
1
-
DFP
Jharkhand
Assam
-
Hepatitis B
NRHM & IEC dept.
Rajasthan
2
Complete Immunization chart
NRHM
MP
1
NRHM
jharkhand
1
NRHM
Assam
1
Complete Immunization chart and
time table
NRHM
3
IUCD-380A
DFP
IUCD-380A
DFP
NSV
IUCD-380A
NRHM
DFP
IUCD-380A
DFP
women
General
Mother &
child
Mother &
child
Mother &
child
Mother &
child
Language
Hindi
local
Hindi
-
Hindi
Hindi
Hindi
English
Family Planning
Rajasthan
3
Brochures
MP
NSV
Jharkhand
3
NRHM
-
Assam
-
Beneficiaries
Health
providers
Hindi
Beneficiaries
Health
providers
General
General
Hindi
Hindi
Hindi
Hindi
Assamese
English
NSV1
NSV 2
NRHM
IUCD-380A
DFP
Health
providers
English
DFP
General
Hindi
DFP
General
Hindi
DFP
General
Hindi
Overall NRHM
Rajasthan
1
MP
2
Brochures
Jharkhand
Assam
Booklet
-
Rajasthan
1
MP
1
Jharkhand
Assam
1
Right age of marriage,
Birth & Care of newly of infants,
Identify the Foeticide of child,
Safe maternity, Safe Delivery,
Care of adult child
Control over birth of children
Institutional Delivery, JSY, Iron
Tablets, Immunization, Family
Planning, and Permanent ways of
Family Planning
Bharat Nirman Schemes
(Water, Road, Indira Awas,
National Social Help Prog.,
MGNREGA, SSA, JSY, Midday,
ICDS and Samagra Sawachta
Abhiyan
Health and Family welfare
(Slogan) Gagar me Sagar
-
-
-
(DFP)
General
Hindi
(DFP)
General
Hindi
(DFP)
General
Hindi
XXVIII
Other health problem/diseases
3
Rajasthan
Leaflet
Brochures
Jharkhand
Assam
Rajasthan
MP
Jharkhand
1
1
Iodine Salt
H1N1
DFP
Unicef
General
General
General
General
Women &
child
General
General
Assam
1
Iron Tablets and Nutritious Food
NRHM
General
1
-
Payment on Delivery under JSY
-
2
MP
Rajasthan
MP
Leaflet
Jharkhand
Assam
Breast Feeding
Brochures
Chikanguniya and Dengue
Iodised Salt
Female Foeticide
H1N1
DFP
DFP
DFP
Unicef
ICDS
Unicef
-
-
-
DFP
-
Rajasthan
-
-
DFP
MP
-
-
DFP
Jharkhand
-
-
Assam
1
-
National Breast Feeding Week
-
General
Pregnant
Women
Pregnant
women
Mother of
child
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Assamese
English
Hindi
Assamese
JSY
Rajasthan
Leaflet
MP
Jharkhand
Assam
Total
1
31
Payment on Delivery under JSY
-
DFP
-
Pregnant
women
-
Hindi
-
XXIX
Department of Communication Research
Aruna Asaf Ali Marg, JNU Campus, New Delhi – 110067
Web site: www.iimc.nic.in; Email ID: decore.iimc@gmail.com

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