Getting the Story Right: My Mindset Shift at the International SBCC Summit

I’ve worked in the field of reproductive health and family planning communications for about a decade. But it wasn’t until yesterday that I saw the deep, true relevance of my greatest passions—journalism and storytelling—to the scientific process of monitoring, evaluation, reporting, and analysis.

This mindset shift occurred at an apt time: during the 2nd International Social and Behavior Change Communication (SBCC) Summit. Positive shifts in attitudes—to spur healthier behaviors—is of course the aim of the social and behavior change field. And I was a success story.

I had been asked to present the Evidence to Action Project’s University Leadership for Change in Sexual and Reproductive Health Program (ULC)on behalf of my colleague, Regina Benevides, on a panel entitled “Should We Be Asking ‘What Worked?’ Adaptation, Scale-up and Complexity-Aware Evaluation.” I sat on the panel with Joseph Petraglia of Syntegral, an expert in complex systems and program adaptation, and Tilly Gurman of Johns Hopkins Center for Communication Programs, who has vast expertise in patient-provider communication, mixed methods research, and program evaluation.

Joseph talked about how to address complexity in public health and SBC through a process of adapting interventions to meet the unique needs of people in different contexts. He demonstrated how a Context of Implementation and Adaptation analysis—or COIA—could be used to assist prospective adapters of interventions better anticipate adaptation challenges by understanding how the original “model” intervention evolved over the course of its implementation. Tilly presented an innovative evaluation method called Outcome Harvesting. Outcome Harvesting is a retrospective data collection and documentation methodology that starts from an intervention’s outcome and works in reverse to tell the full story behind why the intervention succeeded or not, and the outcomes that resulted.

I focused on how E2A’s University Leadership for Change in Sexual and Reproductive Health (ULC) project in Niger had applied ExpandNet“systematic approach to scale-up” tools to ensure that we knew the ULC story before scaling  it up—what had worked in Niamey, capital of Niger, and what might work if we were to scale up the intervention in different regions. Would we see the same positive shifts in young people’s perceptions of sexual and reproductive health and uptake of those services if we applied the ULC intervention package in new areas of Niger?

To find out, E2A embarked on a systematic—and in many ways, journalistic—expedition.  In collaboration with the students from Abdou Moumouni who served as peer leaders and “Sexual and Reproductive Health (SRH) champions” in Niger, we interviewed youth, their providers, government officials, and university administrators to learn about successes and shortfalls of the pilot in Niamey and about the context for delivering quality sexual and reproductive health services to youth through universities in the three outlying areas of Maradi, Tahoua, and Zinder.

The interviews were meant to respond to our toughest questions: Could we “faithfully” replicate what was done in Niamey? Or did we need to make evidence-based adaptations? Would ULC be relevant in the three new areas, or not relevant at all?

What our informants told us was that ULC had good chance of meeting youth’s imminent SRH needs in the three new contexts.

But we still didn’t know for sure.

For three months thereafter, we tested the feasibility of the ULC interventions outside of Niamey. We trained a cadre of university students as leaders to lead behavior-change activities with their peers. We assessed the state of how the public and university health system was operating in the new regions. We facilitated the creation of a committee of students, university administrators, university health providers, and public health and higher education officials to supervise, monitor, and make decisions about how the activities should be led.

In undertaking this process, we found that some adjustments needed to be made. Capacities of the three new university health centers would need to be enhanced to serve youth with a full range of contraceptives and quality SRH services. The behavior-change activities would need to be modified to be less resource intensive. But the main components and principles of ULC would remain—youth leadership and youth-led behavior-change activities, equity, a co-management committee to instill ownership, and youth-friendly services

As it turns out, I think we got the story right. Although E2A support has come to an end, ULC continues to help young women, with the support of the young men in their lives, to work toward improved sexual and reproductive health through open dialogue on sensitive topics and access to quality services, in Niamey, Tahoua, Maradi, and Zinder.

And the government thinks so too. The package of ULC interventions has been added to the National Adolescent and Youth Sexual and Reproductive Health Strategic Plan as an evidence-based practice and the Ministry of Public Health recently recommended the ULC intervention package to the West African Health Organization as a best practice that could be used in the region to improve young people’s sexual and reproductive health.

Pathfinder is now working through its Resilience in the Sahel Enhanced Program in Zinder to move ULC interventions from the university to communities. But first, we are working with Syntegral to conduct systematic documentation and testing to understand the context for implementation and adaptation—to get the story right.

Like all mindset shifts, mine at the SBCC Summit arose from a complex array of factors related to my own personal experiences, new knowledge I had gained, and reflection and dialogue with my colleagues. My mindset shift pushed me to see more similarities between journalism and storytelling, and monitoring, evaluation, documentation, and analysis, than differences, and how the two fields can work together for positive change.

Laurel Lundstrom is the Communications Manager for the Evidence to Action Project.