Behavior Communication in a Changing Malaria Landscape
Behavior Communication in a Changing Malaria Landscape
Evidence for malaria BCC effectiveness is growing, but more high-quality data is needed, especially as transmission dynamics change. BCC is a proven intervention, although the bulk of robust evaluations of BCC to date have been focused on other health areas, including family planning and HIV. Meta-analyses for family planning and HIV, for example, demonstrate that targeted behaviours are higher on average among those exposed to mass media interventions. Recent analyses using propensity score matching (which simulates experimental designs and produces valid causal inferences using cross-sectional datasets) have shown that net use is 10–15 percentage points higher among those exposed to malaria messages, controlling for all other factors (Boulay M, unpublished data). It is clear that BCC interventions are most effective when a combination of approaches is used, weaving together mass media, interpersonal communication and structural approaches to promote new or modified behaviours. In addition, hearing information from trusted sources has significant effects on behaviour; when combined with evidence of social norms promoted through mass media, these behaviours and attitudes are reinforced.
Solid planning must inform BCC interventions so that messages are targeted to key audiences, activities are founded on behavioural theories and formative research, and enough commodities are available to meet the demand generated in the population. The RBM Strategic Framework for Malaria Communication at the Country Level 2012–2017 lays out key steps for evidence-based, strategic behaviour change communication interventions. As countries progress towards eliminating malaria, BCC strategies will need to be updated and adapted as transmission dynamics change and perception of risk is reduced.
Additional data is needed on the effectiveness of BCC for malaria. Research will help to adapt messages and approaches to reduce audience fatigue and to promote new interventions. Malaria behaviours are not static, they change in response to new policies, interventions and messages.
Periodic national cross-sectional household surveys can provide the much-needed data on determinants of malaria behaviours, track the impact of BCC efforts, solidify and inform the evidence base, and allow us to adapt efforts to respond to a changing malaria environment. In Swaziland for example, yearly KAP studies are helping to track progress, monitor the contribution of different communication channels, and focus communication activities on the most at-risk groups. Understanding how perceptions and behaviours change over time will be one of the keys to successful malaria elimination.
Investment in high-quality malaria BCC is good practice, and should be an integral component of malaria control strategies from the start. At the same time, rigorous evaluations are needed to increase the evidence base across different transmission settings. By supporting the use of BCC and research on its effectiveness, donors can be assured of a much stronger return on their investments in malaria control. If in addition to being widely available, those commodities are used properly and consistently, control or elimination of malaria becomes a more attainable goal.
Investment Also Needed in Malaria BCC Research
Evidence for malaria BCC effectiveness is growing, but more high-quality data is needed, especially as transmission dynamics change. BCC is a proven intervention, although the bulk of robust evaluations of BCC to date have been focused on other health areas, including family planning and HIV. Meta-analyses for family planning and HIV, for example, demonstrate that targeted behaviours are higher on average among those exposed to mass media interventions. Recent analyses using propensity score matching (which simulates experimental designs and produces valid causal inferences using cross-sectional datasets) have shown that net use is 10–15 percentage points higher among those exposed to malaria messages, controlling for all other factors (Boulay M, unpublished data). It is clear that BCC interventions are most effective when a combination of approaches is used, weaving together mass media, interpersonal communication and structural approaches to promote new or modified behaviours. In addition, hearing information from trusted sources has significant effects on behaviour; when combined with evidence of social norms promoted through mass media, these behaviours and attitudes are reinforced.
Solid planning must inform BCC interventions so that messages are targeted to key audiences, activities are founded on behavioural theories and formative research, and enough commodities are available to meet the demand generated in the population. The RBM Strategic Framework for Malaria Communication at the Country Level 2012–2017 lays out key steps for evidence-based, strategic behaviour change communication interventions. As countries progress towards eliminating malaria, BCC strategies will need to be updated and adapted as transmission dynamics change and perception of risk is reduced.
Additional data is needed on the effectiveness of BCC for malaria. Research will help to adapt messages and approaches to reduce audience fatigue and to promote new interventions. Malaria behaviours are not static, they change in response to new policies, interventions and messages.
Periodic national cross-sectional household surveys can provide the much-needed data on determinants of malaria behaviours, track the impact of BCC efforts, solidify and inform the evidence base, and allow us to adapt efforts to respond to a changing malaria environment. In Swaziland for example, yearly KAP studies are helping to track progress, monitor the contribution of different communication channels, and focus communication activities on the most at-risk groups. Understanding how perceptions and behaviours change over time will be one of the keys to successful malaria elimination.
Investment in high-quality malaria BCC is good practice, and should be an integral component of malaria control strategies from the start. At the same time, rigorous evaluations are needed to increase the evidence base across different transmission settings. By supporting the use of BCC and research on its effectiveness, donors can be assured of a much stronger return on their investments in malaria control. If in addition to being widely available, those commodities are used properly and consistently, control or elimination of malaria becomes a more attainable goal.
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