背景:尼日利亚的产妇,新生,儿童健康和营养(MNCH+N)成果跻身世界最贫穷之列。吸引传统和宗教领袖在促进相关行为方面显示出希望。TheBreakthroughACTION/NigeriaprojectworkedwithleadersinnorthernNigeriatoimpleasetheAdvocacyCoreGroup(ACG)model,一种旨在影响社区规范和促进MNCH+N行为吸收的社会和行为改变(SBC)方法。模型的定性评估为SBC方法增强综合健康行为提供了证据。
方法:这项定性研究于2021年5月在尼日利亚的包奇州和索科托州进行。它涉及51次深入访谈和24次焦点小组讨论。该研究基于社会规范探索(SNE)技术,以检查ACG模型背景下影响行为变化的规范因素。数据分析采用反身性专题分析方法。从所有相关机构获得了伦理批准,并从参与者那里获得了知情同意。
结果:ACG模型对MNCH+N的摄取行为至关重要。ACG成员的影响在地理上有所不同,在索科托州观察到的影响更大。改善MNCH+N结果的规范性障碍包括与计划生育的宗教冲突,在怀孕期间偏爱传统护理,关于纯母乳喂养(EBF)的错误信息,和基于性别的暴力导致妇女的决策。研究表明,在规范转变方面取得了积极进展,但EBF和GBV规范显示出较慢的变化。卫生系统面临更广泛的挑战,例如服务不足,医疗保健提供者的消极态度,劳动力短缺,阻碍获得护理。
结论:ACG模型提高了对健康问题的认识,并促进了潜在的规范转变。然而,观察到EBF和GBV规范的变化较慢,并报告了广泛的卫生系统挑战.该模型似乎是一个有希望的策略,可以进一步推动SBC获得更好的健康结果,尤其是与供应方干预相结合的地方。
BACKGROUND: Nigeria\'s Maternal, newborn, and child health and nutrition (MNCH+N) outcomes rank among the world\'s poorest. Engaging traditional and religious leaders shows promise in promoting related behaviors. The Breakthrough ACTION/Nigeria project worked with leaders in northern Nigeria to implement the Advocacy Core Group (ACG) model, a social and behavior change (SBC) approach aimed at influencing community norms and promoting uptake of MNCH+N behaviors. Qualitative assessment of the model contributes to evidence on SBC approaches for enhancing integrated health behaviors.
METHODS: This qualitative study was conducted in Nigeria\'s Bauchi and Sokoto states in May 2021. It involved 51 in-depth interviews and 24 focus group discussions. The study was grounded in the social norms exploration (SNE) technique to examine normative factors influencing behavior change within the ACG model context. Data analysis used a reflexive thematic analysis approach. Ethical approvals were received from all involved institutions and informed consent was obtained from participants.
RESULTS: The ACG model was vital in the uptake of MNCH+N behaviors. The influence of ACG members varied geographically with greater impact observed in Sokoto State. Normative barriers to improving MNCH+N outcomes included perceived religious conflicts with family planning, preference for traditional care in pregnancy, misinformation on exclusive breastfeeding (EBF), and gender-based violence resulting from women\'s decision-making. The study demonstrated positive progress in norm shifting, but EBF and GBV norms showed slower changes. Broader challenges within the health system, such as inadequate services, negative attitudes of healthcare providers, and workforce shortages, hindered access to care.
CONCLUSIONS: The ACG model increased awareness of health issues and contributed to potential normative shifts. However, slower changes were observed for EBF and GBV norms and broad health system challenges were reported. The model appears to be a promising strategy to further drive SBC for better health outcomes, especially where it is combined with supply-side interventions.