**3.3 Formative research and social and behavior change**

Formative research is a systematic approach of inquiry and activities conducted before the commencement of a Social Behavior Change intervention. This research seeks to obtain insight into the health issue and specific behavior that a program aims to address. Formative research also seeks to identify relevant characteristics of primary and secondary audiences, the communication access available for the target population, existing habits and preferences of the people, and the various factors that hinder and/or drive behaviors within the community.

It is very important to conduct quantitative and qualitative research before the implementation of a Social and Behavior Change Communication program because without such research, it will be difficult to identify your intended audience, their current level of knowledge, the various health beliefs and attitudes, the channels through which they receive and act on information and the barriers to adopting new healthy behaviors needed for improving health and wellbeing of the population.

Formative research helps program planners to address the first three decisions in designing a Behavior Change Framework. This includes:


### **3.4 Rationale for social and behavior change in contraception**

Experience and several reports have shown that social and behavior change intervention is an effective means of scaling up contraceptive use. One of the studies that have demonstrated the implementation of this intervention is the landscape analysis demonstrated which clearly showed that social and behavior change is an essential component in achieving global development goals. The Social and Behavior Change in Family Planning Programming: Global Influence Strategy notes that "Increasing the

quality and quantity of SBC investments in FP programming will be critical for the Family Planning sector to reach its high-level goals of ensuring that 120 million additional individuals use contraceptive by 2020 and the third Sustainable Development Goal of ensuring universal access to sexual and reproductive health services and rights by 2030. Studies have shown that complementing investments in commodities and supplies with strong SBC campaigns yield higher usage." [25]. The Business Case for investing in SBC for FP shows that SBC increases the use of FP, provides a strong return on investment, and costs less than \$200 per disability-adjusted life years averted [26]. This is very important in public health as it is economic and effective in actualizing the global goal of improved access for the sexual and reproductive health of women which is also key to their improved wellbeing across the globe.

### **3.5 Implementing the social and behavior change intervention**

Social and behavior change intervention is a critical component of program design for positive impacts. USAID stated that improving the quality or coverage of healthcare products and services alone is insufficient to improve the health and wellbeing of individuals, families, and society [22]. This is because the health-seeking behaviors of individuals and communities as well as their culture are known to influence the uptake of good services and products despite their availability, accessibility, and affordability.

Changing behavior to promote a positive attitude towards health becomes very important in programs like family planning where cultural factors have limited its utilization in low and middle-income countries. Hence the need for interventions that seek to change behaviors by addressing factors such as knowledge, attitudes, and norms, known collectively as social and behavior change interventions. These interventions often complement and enhance the role played by services such as health promotion and education for health care services like family planning, antenatal care, delivery in a skilled birth attendant, and postnatal care. Social and behavior change interventions are critical to ensure that populations that are most in need can access available services and products. This is often achievable through a well-planned and systematically implemented social and behavior change intervention that is based on formative research. Through social and behavior change interventions, various organizations have been able to raise awareness, reduce misinformation, and address barriers to various life-saving and health promoting interventions among individuals, families and communities. It is an important component of successful program implementation that often ensures a positive behavior change needed to influence a specific habit for great health outcomes.

An SBC approach is a strategic, interactive process that aims to change not only individual behaviors but also social conditions. It requires understanding the situation, designing a focused strategy, developing interventions and materials, implementing, monitoring, evaluating, and adjusting. The process allows program staff, communities, and other key stakeholders to approach a problem from various angles to define key determinants (both positive and negative) of behaviors and to plan and implement a well-planned, comprehensive set of interventions that focuses on these determinants at multiple levels to achieve a health objective.

Thus, for promoting contraceptive use through social and behavior change, a well plan strategic plan that is based on formative research which identified the barriers, mode of communication to the population, and tailored messages to address specific behaviors is the means for scaling contraceptive use among women in low and

### *Scaling up Contraception through Social and Behavior Change Intervention in Low… DOI: http://dx.doi.org/10.5772/intechopen.104207*

middle-income countries like Nigeria where religious and cultural norms, as well as gaps in knowledge, continue to negate against the use of contraception among these populations. Addressing inequalities and promoting the right of women through advocacy, community engagement, community mobilization, and a social and behavior change communication approach that addresses barriers at the three levels of influence which include individual level, group, and societal level will be critical to achieving improved utilization of family planning methods despite existing oppositions from some quarters of the community.

At the individual and group levels, community health influencers and promoters can be used for a one on one and group sessions of educating individuals and families on the benefits of contraceptives and the methods available. Group sessions based on women to women support group with 5-15 members can be design to promote contraceptive use. This can be done during antenatal and post-natal care. It can also be done using a peer to peer meeting approach where contraceptives use and their importance is discussed and women are encouraged to use contraceptive methods of their choice that best suits their needs.

Advocacy visits to government, religious, traditional leaders and other key stakeholders in the community as well as the use of mass media to promote contraceptive use among women of reproductive age can go a long way in scaling up contraceptive use in low and middle income countries like Nigeria.
