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Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
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TRAINING MANUAL
MONITORING AND EVALUATION
OF SOCIAL AND BEHAVIOR
CHANGE COMMUNICATION HEALTH
PROGRAMS
Praween K. Agrawal
Kumudha Aruldas
M.E. Khan
Subrato K. Mondal
2014
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
iv
Suggested citation: Agrawal, P.K., K. Aruldas, M.E.Khan & Subrato K. Mondal. 2014. Training
Manual on Monitoring and Evaluation of Social and Behavior Change Communication Health
Programs. New Delhi: IHBP, Population Council.
Disclaimer:
This document is made possible by the generous support of the American people through the
United States Agency for International Development (USAID) under the terms of Contract No.
AID-386-TO-11-00001. The content is the sole responsibility of the Improving Healthy Behaviors
Program (IHBP) partner Population Council, and does not necessarily reect the views of USAID
or the United States Government.
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
v
Table of Contents
List of Tables and Figures vi
Acknowledgments vii
List of abbreviations viii
Introduction 1
Module 1 Basics of Social and Behavior Change Communication 3
Module 2 Introduction to Monitoring and Evaluation 10
Module 3 Monitoring and Evaluation of SBCC Programs Through a
Logical Framework Matrix 15
Module 4 Monitoring of SBCC Programs at District and Block Levels 20
Module 5 Research Designs for Evaluating SBCC Programs 26
Module 6 Role of Qualitative Methods in Evaluating SBCC Programs 37
Module 7 Developing Terms of Reference for Evaluating SBCC Programs 48
Glossary 56
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
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List of Tables and Figures
Tables
3.1 Example of logframe for SBCC 17
4.1 Location hunt form 21
4.2 Checklist for quality assessment of group meeting conducted by CHW 22
4.3 Exit Interview form 22
4.4 SBCC activity report 24
Figures
1.1 Health Belief Model 4
1.2 Theory of reasoned action/planned behavior 4
1.3 Socio-Ecological model for change 5
1.4 Three key strategies of social behavior change communication 7
2.1 Monitoring and Evaluation Framework Example 13
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Acknowledgments
We are thankful to Rita Leavell, Director/Chief of Party of the Improving Healthy Behaviors
Program (IHBP), India/FHI360 for extending their full support to the development of this manual
on basic monitoring and evaluation of social and behavior change communication health
programs.
We especially thank and appreciate the contributions of other FHI360 colleagues, Orlando
Hernandez, Senior M&E Advisor; Phillis Kim, Project Director, Social Marketing & Communication;
and Elizabeth Ryan, Associate Director, Social Marketing & Communication, for their valuable
comments to make this manual contextual and comprehensive.
We acknowledge the contribution of Shabbir Syed Ali, Population Council, in formatting this
document.
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
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List of Abbreviations
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
BCC Behavior Change Communication
FP Family Planning
IEC Information, Education, and Communication
IHBP Improving Healthy Behaviors Program
IPC Interpersonal Communication
IUCD Intra-uterine Contraceptive Device
M&E Monitoring and Evaluation
NGO Non-governmental organization
NIHFW National Institute of Health and Family Welfare
NRHM National Rural Health Mission
SBCC Social and Behavior Change Communication
SHRC State Health Resource Center
SIHFW State Institute of Health and Family Welfare
TOR Terms of reference
TV Television
USAID United States Agency for International Development
VHSC Village Health and Sanitation Committee
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
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Introduction
Social and behavior change communication (SBCC) interventions are increasingly seen as the
key interventions for addressing social and cultural barriers and achieving goals laid out for
health programs. States have the responsibility to plan and implement SBCC activities. Focus on
mass media, community mobilization, and interpersonal communication is gaining importance
as SBCC interventions are now incorporated in the state project implementation plans (PIPs)
with increasing resource allocation to achieve the objectives. Often these interventions are not
evidence-based and, especially for mass media, it is mistakenly assumed that the interventions
will benet all equally. Though monitoring and evaluation (M&E) of the overall National Rural
Health Mission (NRHM) is considered important, M&E of SBCC interventions is limited. Lack of
trained sta to conduct and manage M&E has been a limitation in general. This demands a
serious eort to build capacity of M&E personnel to monitor and evaluate performance of SBCC
interventions in terms of reach and eectiveness among intended audiences.
Therefore, FHI 360’s Improving Healthy Behaviors Program (IHBP), funded by USAID, aims to
provide technical assistance to strengthen capacities to monitor and evaluate SBCC intervention
of public program managers at national, state and district level and across maternal health,
family planning, tuberculosis, and HIV/AIDS. The project is coordinating with National Institute
of Health and Family Welfare (NIHFW) and the State Institute of Health and Family Welfare
(SIHFW) to build the trainers’ capabilities within the state in this area. The Population Council
will train a cadre of master trainers on M&E of SBCC activities at the national and state level who
will further build capacity of sta responsible for M&E of SBCC activities within the state at the
district level.
To address the capacity-building initiative in M&E of SBCC intervention, this Training Manual on
Basic Monitoring and Evaluation of Social and Behavior Change Communication Health Programs
has been prepared. The key personnel trained in this initiative will include master trainers, state
program M&E ocers and managers, district-level ocials, and supervisors whose main job is
to monitor SBCC interventions in their geographical area of work. The extent of involvement
of these personnel in planning and executing the M&E activities varies. Therefore, the depth
of training content covered will vary depending on the level of function of the ocials and
supervisors that are trained.
The training manual is comprehensive to include various aspects of M&E. It has the following
seven modules:
Module 1: Basics of SBCC: The learning objective of Module 1 is to dierentiate between
information, education, and communication (IEC) and SBCC; orient participants on how theories
of behavior change have evolved; and provide an overview of the process used in designing an
SBCC intervention.
Module 2: Introduction to Monitoring and Evaluation: This module will helps participants
understand what monitoring and evaluation is and distinguish between process, outpu,t and
outcome indicators specic to SBCC.
Module 3: Developing Logical Framework Analysis for SBCC Programs: From Module 3,
participants will learn to develop a logical framework matrix that will guide M&E of SBCC
Training Manual on Basic MoniToring and EValuaTion oF sBcc HEalTH PrograMs
2
interventions. They will also learn to develop indicators with respect to the goal, objectives, and
activities of the SBCC program.
Module 4: Monitoring of SBCC Programs at District and Block Levels: In Module 4, the participant
will learn how to monitoring quality of SBCC activities implemented and design district- and
block-specic feedback mechanisms.
Module 5: Research Designs for Evaluating SBCC Programs: The objective of Module 5 is to
orient the participants to various evaluation approaches and frameworks, increase capacity to
design appropriate evaluation methodology, and discuss ways to overcome barriers in eective
evaluation.
Module 6: Role of Qualitative Methods in Evaluating SBCC Programs: This module will discuss
importance of qualitative approaches for monitoring and evaluation of SBCC interventions.
Participants will learn about various qualitative methods.
Module 7: Developing Terms of Reference for Evaluating SBCC Programs: Module 7 is meant
primarily for the state ocials who will learn how to develop Terms of Reference for contracting
agencies for evaluation of SBCC programs.
Overall, the training manual is organized around concepts of M&E for SBCC interventions,
presenting strengths and weakness of approaches and recommendations wherever applicable
and necessary. The manual aims to strengthen eorts of SBCC interventions by building capacity
to eectively monitor and evaluate interventions against desired outcomes and provide
learning for SBCC strategies. The guiding principles in developing this manual are the various
roles played by ocials at dierent levels within the state: block supervisors are responsible
for supervising implementation of day-to-day activities and providing feedback during weekly
and monthly meetings; district M&E ocers are responsible for collecting data to assess the
progress of interventions using output indicators and providing feedback; and the state level
ocials—in addition to monitoring— are also responsible for evaluating the programs. The
training methodology and the possible exercises that could be used to facilitate learning are
mentioned in the “Facilitator’s Guide” that accompanies this manual.
TRAINING MANUAL ON BASIC MONITORING AND EVALUATION OF SBCC HEALTH PROGRAMS
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Module 1
BASICS OF SOCIAL AND BEHAVIOR CHANGE
COMMUNICATION
Learning Objectives
By the end of this session, you will:
Know the dierence between Information, Education, and Communication and
Social and Behavior Change Communication
Be familiar with various theories of behavior change
Understand the Socio-Ecological Model for Change
What is the dierence between IEC and SBCC?
Information, Education, and Communication (IEC) is a process of providing information and
education to individuals and communities to promote healthy behaviors that are appropriate
to their context. It is believed that having correct knowledge will lead to adoption of healthy
behaviors, but the experience of IEC programs shows that knowledge is not a necessary and
sucient condition for behavior change. There are many examples that show that giving correct
knowledge does not always lead to adoption of healthy behaviors. This is because adoption
of a behavior is also inuenced by the external environment—the local context, family, and
community at large—in which the individual is placed.
Social and Behavior Change Communication (SBCC) has evolved from earlier models of IEC and
is an evidence-based, consultative process of addressing knowledge, attitudes, and practices
through identifying, analyzing, and segmenting audiences and participants in programs and
providing them with relevant information and motivation through well-dened strategies, using
an appropriate mix of interpersonal, group, and mass media channels, including participatory
methods (McKee et al., 2002). SBCC aims to eect changes in knowledge, attitudes, and practices
and is a more comprehensive approach than IEC. SBCC involves analyzing personal, societal, and
environmental factors for sustainable change and uses strategies that inuence the physical,
socio-economic, and cultural environments to facilitate healthy norms and choices and remove
barriers to them.
Theories of Behavior Change
Health Belief Model
The Health Belief Model is a psychological model of behavior change. It is based on the
individual’s perception of acquiring a disease and its severity; analysis of benets in taking
TRAINING MANUAL ON BASIC MONITORING AND EVALUATION OF SBCC HEALTH PROGRAMS
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action to reduce the barriers in adopting healthy behavior; and relative cost benet of adopting
a healthy behavior (Figure 1.1).
FIGURE 1.2: THE THEORY OF PLANNED BEHAVIOUR
Individual
Perceived ability to
change the behavior
Societal norms
Perceived notion about
acceptability of the
behavior by the society
Individual
Attitude toward the
behavior
Intention
to change
behavior
Change in
behavior
Change in
behavior
FIGURE 1.1: THE HEALTH BELIEF MODEL
Modifying factors
Age
Gender
Knowledge
Socio-economic status
Previous experience Individual's perceived:
Benet of changing
behavior
Individual's perceived:
• Susceptibility
• Severity
• Threat
Source: Adapted from Stretcher, V., & Rosenstock, I.M. (1997). The Health Belief Model. In Glanz K., Lewis, F.M., & Rimer BV.K., (Eds). Health
Behavior and health Education: Theory, Research and Practice. San Francisco: Jossey-Bass.
Theory of Reasoned Action/Planned Behavior
The Theory of Reasoned Action, modied as Theory of Planned Behavior, is a socio-cultural
model for behavior change. In this model, the primary determinant of behavior is the individual’s
intention to perform it, which depends on the individual’s attitude toward performing the
behavior and his or her perception of the social (or normative) pressures exerted to adopt or to
not adopt the behavior (Figure 1.2).
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TRAINING MANUAL ON BASIC MONITORING AND EVALUATION OF SBCC HEALTH PROGRAMS
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* These concepts apply to all levels (people, organizations, and institutions). They were originally developed for the individual level.
Source: Adapted from McKee, Manoncourt, Chin and Camegie (2000)
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INFORMATION
Knowledge
MOTIVATION
Attitudes, Beliefs
ABILITY TO ACT
Skills, Self-Ecacy, Access
NORMS
Perceived, Sociocultural, Gender
FIGURE 1.3: THE SOCIOECOLOGICAL MODEL FOR CHANGE
Socio-Ecological Model for Change
SBCC applies a socio-ecological model that examines several levels of inuence to provide
insight on the causes of problems and nd tipping points for change. A tipping point refers
to the dynamics of social change, where trends rapidly evolve into permanent changes. It can
be driven by a naturally occurring event or a strong determinant for change—such as political
will that provides the nal push to overcome barriers to change. Tipping points describe how
momentum builds up to a point where change gains strength. It has two parts (Figure 1.3):
1. Behaviors are inuenced by personal and environmental factors and multiple levels of
inuence, which include:
• Individual(thepersonor“self”inrelationtotheprogram)
• Interpersonal(partners,familymembers,peers)
• Community(leaders,healthworkers,media,policymakers)
The immediate people of inuence are husband and other family members and peers (second
ring in gure 3). Their interactions with the individual inuence the behavior of the individual.
Both the interpersonal and community rings shape community and gender norms, access to
and demand for community resources, and existing services. The people represented in the
outer two rings are community-level inuencers, including health care providers, community
leaders, and inuencers, and others outside of the community like government ocials,
NGOs, and private providers. They exert inuence through policies and legislation, political
forces, private sector market environment, economic conditions, religion, technology, and the
natural environment.
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2. Behaviors are also inuenced by a number of cross-cutting factors (in the triangle) that
inuence the actors and structures in the rings:
• Information(knowledge,education)
• Motivation(attitudes,beliefs)
• Abilitytoact(access,self-ecacy)
• Norms(includinggendernorms)
It is on these cross-cutting factors that SBCC interventions may be able to generate change.
People need information that is timely, accessible, and relevant. For example, if information
about modern contraceptives and their side eects is given, some individuals or couples will
be empowered to act. Motivation is determined by attitudes, beliefs, or perceptions about
benet and risks. For example, some women may believe that intra-uterine contraceptive
What SBCC Can and Cannot Do
SBCC Can SBCC Cannot
Information
• Increase knowledge and awareness of an
issue, problem, or solution
• Counter myths and misconceptions
Motivation
• Inuence perceptions, beliefs, and
attitudes that may change social norms
• Show the benet of behavior change
• Prompt action
• Trigger an individual to adopt and
maintain a new health behavior
Ability to Act
• Demonstrate and provide an opportunity
to practice skills
• Reinforce self- and collective-ecacy
• Strengthen organizational and network
relationships
• Address barriers and systemic problems,
such as insucient access to care through
advocacy and mobilization
Norms Change
• Support or initiate norm change
• Mobilize community members or whole
social movements
• Advocate for a health or development
issue or policy
• Initiate adoption of a new policy direction
• Compensate for inadequate
infrastructure or logistics of services, lack
of access to them, or policies regulating
them
− It can, however, mobilize or advocate
for an improvement in these areas.
• Produce sustainable change without the
support of other program components
or whole programs providing services,
providing technology, and enforcing
regulations and policies
− It can, however, link with these
programs and make their work visible.
• Be equally eective in addressing issues
in dierent countries with cookie-cutter
strategies
− It can, however, provide how-to tools
and guidelines for adaptation and
tailoring toward specic audiences
and their existing assets or barriers to
change.
MODULE 1
TRAINING MANUAL ON BASIC MONITORING AND EVALUATION OF SBCC HEALTH PROGRAMS
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devices (IUCD) will move up to the heart. Such individuals could be motivated by eective
counseling with demonstration models, peer education, and even radio and TV programs.
However, for some women, motivation may not be enough to accept IUCD; they need the
self-ecacy to develop the skills to negotiate and avail themselves of IUCD services (access,
ability to act). Further, individuals may be governed by perceived norms that others follow
and socio-cultural norms that the community follows; they the same is expected of them.
There are gender norms which shape the behaviors of men and women.
How Does SBCC Work?
SBCC is a process that involves:
• Understandingthesituation
• Focusinganddesigningthestrategy
• Creatinginterventionsandmaterials
• Implementingandmonitoring
• Evaluatingandre-planning
SBCC operates through three key strategies (Figure 1.4). These include:
• Advocacy– Raising resourcesaswellas political andsocial leadership commitmentto
develop actions and goals
• Social mobilization – For wider participation, coalition building, and ownership,
including community mobilization
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Individual & Community:
Multimedia & Participatory
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PLANNING CONTINUUM SERVICES AND PRODUCTS
Source: Adapted from McKee, N. Social Mobilization and Social Marketing in Developing Communities (1992)
FIGURE 1.4: STRATEGIES OF SOCIOECOLOGICAL MODEL FOR CHANGE
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• Behavior change communication (BCC) –Using mass and social media, community-
level activities, and interpersonal communication (IPC) to bring about changes in
knowledge, attitudes, and practices among specic audiences
What is an SBCC Strategy?
The SBCC strategy is a framework indicating direction and scope of communication activities.
The development of SBCC strategies should be based on SBCC theory, research, and available
evidence that will identify the barriers and the facilitating factors for each of circles mentioned
in Figure 1.4. The SBCC strategy forms the road map for “WHAT do you want to get WHERE?” and
should focus on the following elements:
Analysis Summary
• Problemstatement
• Researchneeds
• Changestheprobleminvolves
Communication Strategy
• Targetaudiences
• Desiredchanges,barriers,facilitators,communicationobjectivesbyaudience
• Strategicapproach
• Positioning
• Keycontent
• Communicationchannels(e.g.,massmedia,mid-media,IPC),activities,andmaterials
10 Principles of SBCC
Principle 1: Follow a systematic approach
Principle 2: Use research, not assumptions to drive your program.
Principle 3: Consider the social context.
Principle 4: Keep the focus on your audience(s).
Principle 5: Use theories and models to guide decisions (e.g., the socio-ecological model).
Principle 6: Involve partners and communities throughout.
Principle 7: Set realistic communication objectives and consider cost-eectiveness.
Principle 8: Use mutually reinforcing materials and activities at many levels.
Principle 9: Choose strategies that are motivational and action-oriented.
Principle 10: Ensure quality at every step.
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In summary, SBCC
• Has evolved from IEC and BCC and employs a more comprehensive approach
• Refers to socio-ecological and physiological factors in planning a behavior change
communication program
• Is the systematic application of interactive theory- and research-driven communication
processes and strategies that address change at individual, community, and societal
levels
• Is a process, uses a socio-ecological model, and operates through three key strategies—
advocacy, social mobilization, and BCC
References
Bandura, A., C. Pastorelli, C. Barbaranelli, and G.V. Caprara. 1999. Self-Ecacy Path-ways to
Childhood Depression. Journal of Personal and Social Psychology, 76:2, pp. 258-269.
Janz, N.K., and M.H. Becker. 1984. The Health Belief Model: A Decade Later. Health Education
Quarterly, 11:1 (Review), pp.1-47.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision
Processes, 50, p. 179-211.
Kelly, J. 1995. Changing HIV Risk Behavior: Practical Strategies. The Guilford Press, New York.
McKee, N., Manoncourt, E., Chin, S.Y. and Carnegie, R. (eds.). 2000. Involving People, Evolving
Behavior. New York: UNICEF, Penang, Malaysia: Southbound.
Rosenstock, I. M., V.J. Strecher, and M.H. Becker. 1988. Social Learning Theory and the Health
Belief Model. Health Education Quarterly, 15, pp. 175-183.
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Module 2
INTRODUCTION TO MONITORING AND EVALUATION
Learning Objectives
By the end of this session, you will be able to:
Dene monitoring and evaluation and explain how they dier
Describe types of indicators
Identify characteristics of a good indicator
What is Monitoring and Evaluation?
Monitoring
Monitoring is systematic and purposeful observation and timely data collection to check
if program activities are being implemented as planned in terms of frequency, timing, and
sequence, if applicable. More precisely, monitoring tracks and measures program activities to
answer what activities are done, where, with whom, when, and how many?
Monitoring is used to track changes in program performance over time against measurable
indicators dened well in advance. Its purpose is to permit stakeholders to make informed
decisions regarding the implementation and performance of programs and the ecient use
of resources. Monitoring is done internally often by program managers themselves or by
concerned program monitoring sta. Monitoring helps to establish controls to ensure that
implementation is on track and moving toward achieving the objectives of the program.
Therefore, it is a continuous day-to-day management process of checking, analyzing, and giving
feedback about program activity and resource allocation plans.
Monitoring of SBCC programs involves routine data collection—both quantitative and qualitative
measurements—and analysis to check process and outputs to provide timely answers to such
questions as:
• Arethecommunicationactivitiesbeingimplementedasplanned?
• Isthequalityofimplementationgood?
• Arethematerials, channels, and equipmentused to communicatemessages culturally
acceptable and eective?
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In summary, monitoring for SBCC programs:
• Tracks changes in program performance over time against measurable indicators
• Is a continuous process of checking and analyzing the implementation process
• Involves routine data collection of both quantitative and qualitative measures
• Informs stakeholders about the progress, thus facilitating informed decision making
during implementation.
Evaluation
Evaluation is a systematic process that attempts to determine objectively relevance, eectiveness,
and impact of activities in relation to the intended objectives. It measures how well the program
activities have met expected objectives and/or the extent to which changes in outcomes can
be attributed to the program or intervention. Evaluation also provides insights into the future of
a program, for both implementers and donors, in terms of sustainability, scalability, and policy
implications. Therefore, evaluation diers from monitoring in terms of timing and focus and
level of details of outcome of the program.
Evaluations can be conducted during the project period or at the end of the project period
depending on the purpose of the evaluation. Unlike monitoring, evaluation involves data
collection at discrete points in time e.g., through baseline, midline, and endline surveys.
Evaluation requires a comparison of measureable changes in the level/prevalence of the
outcome variables before and after the SBCC interventions. In evaluation of SBCC interventions,
evaluation seeks to determine:
• Whetherthe SBCCinterventionachieveditsobjectiveofadoptionof desiredbehaviors
and or outcome indicators identied in the program
• Extentthatequityandgenderhasbeenaddressedinthecampaignandwithwhateects
• Extentthatthechangescouldbesustained,areeconomicallyviable,andcouldbescaled
up
Beside these key measures of SBCC eect, evaluation also could provide insight on those issues
which have or could have direct bearing on outcomes or impact:
• WhetherbarrierstosocialandbehaviorchangeisreducedbySBCCinterventions
• ThereachofSBCCprogram,especiallyamongintendedaudience
• Inthelongterm,theextentofdiusioneectsthathelpedadoptionofthebehaviorin
larger community
• Theroleplayedbythepredictorsoffacilitatingfactorstobehaviorchange
In summary, evaluation of SBCC programs:
• Attempts to determine the relevance, eectiveness, and impact of activities in
relation to the intended objectives
• Can be conducted during or at the end of the project and measured against
baseline indicators
•Can estimate the reach, diusion eects, and process of behavior change
•Involves data collection of both quantitative and qualitative measures
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What is an Indicator?
Indicators are measurements used in monitoring and evaluating program performance. They
are program specic, dened by the objectives of the program, and should be measurable to
help assess the extent to which the SBCC intervention has changed the outcomes. Indicators
can be dened to provide both quantitative and qualitative measurements.
The process of selecting indicators can be fairly easy if objectives are presented clearly in terms
of dened quantity, quality, and timeframe of a particular program activity. Ideally, indicators
are dened and linked to program activities and objectives during the planning process.
It is important to understand and dierentiate program indicators and communication
indicators. Program indicators refer to the outcome of a program to achieve the goal, such as a
change in contraceptive use or reduction in unmet need. Communication indicators measure
the communications provided through dierent channels such as IPC, mid-media, or mass
media to reduce myths or misconceptions and increase correct knowledge. They also include
process indicators like reach of a given messages, comprehension of the messages, etc.
Types of Indicators
Monitoring Indicators
There are two types of monitoring indicators:
• Processindicators help to assess how the planned activities have been implemented
both with respect to time schedule and quality of the implementation. Examples could be
percentage of ASHAs passing competency-based training for improved counseling and
services, TV advertisement tested and adjusted to cultural context, messages given are
clear and understood by the target audience, or audience perceives characters present in
the entertainment education to be from their own community.
• Outputindicators measure the extent to which the planned activities have actually been
implemented. Monitoring indicators must be dened before implementation. In SBCC,
outputs are the direct products of the campaign and measured in terms of campaign
activities performed. Examples could be the number of street shows organized, number
of wall paintings done, number of TV spots with messages aired, number of group
meetings organized, or number of ASHA trained in counseling skills and provided with
counseling aids. It is important to note that outputs do not measure any outcomes like
behavior change or increase in knowledge of the audience.
Evaluation Indicators
There are also two types of evaluation indicators:
• Outcomeindicators measure the outcomes that the SBCC program hopes to achieve,
which are identied in the communication objectives. Outcome indicators are
intermediate results of the impact, which is the ultimate objective of the program.
Examples could be percentage of contraceptive uses, percentage of women who
initiated early breastfeeding, percentage of women who received postpartum care
for themselves and their newborn, percentage who adopted skin-to-skin care, or
percentage who delayed newborn’s rst bath.
• Impactsindicators measure the long-term eects, or end results, of an SBCC program.
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It takes a longer span of time to achieve. These indicators may not be achieved during
the life of the project, depending on the project’s length. Evaluation of a short-duration
campaign may not capture these indicators. Examples of impact indicators are change in
birth rate, change in HIV incidence rate, and change in neonatal and infant mortality.
A systematic framework provides a link between inputs, process, outputs, outcomes, and
impact indicators of a project goal. A visual presentation of these indicators in the case of a
family planning program can be seen in Figure 2.1.
FIGURE 2.1 MONITORING AND EVALUATION FRAMEWORK EXAMPLE
Baseline MONITORING EVALUATION Endline
Resources Delivery System Services Intermediate Changes Long-term Changes
Contraceptives Community- Counseling,
Clinic Space based Clinic
Services programs sessions
Providers organized
Inputs Process Outcomes
Output Impact
Increased service use
Increased providers
knowledge
Increase in handwashing
Increased use of ORS+zinc
Reduction in unmet needs
Increase in contraceptive
use
Reduction in
CBR/TFR
Decrease in
diarrheal death
Decrease in
MMR
Source: adopted from Williams, K. and Ramarao, S. 2009
Appropriate M&E questions on the objectives of SBCC intervention and work plan can be helpful
in developing appropriate indicators, as shown in the examples below.
Communication
Objective and Work
Plan Activity
Monitoring Questions Monitoring (Process/Output) Indicators
Objective: By end of
project, there will be an
X percent increase in the
number of women who
are aware of the benets
of family planning
Activity: Air a radio spot
in three communities
Was the radio spot aired?
How often was it aired?
At what time?
In how many communities?
Process indicator: Number of times radio spot
aired, dates/times radio spot aired, number of
communities in which radio spot aired
Output indicator: Number of community
members/ target audiences that heard the radio
spot
Evaluation Question Evaluation (Outcome) Indicators
Did women become more
aware of the benets of
family planning?
Increase in the percentage of women aware
of benets of family planning as compared to
baseline or the dierence in awareness between
those who heard and those who did not hear the
radio spots
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Characteristics of Good Indicators
A good indicator—
• Shouldbedenedinclearandunambiguousterms
• Mustbemeasurable
• Shouldproducethesameresultswhenusedrepeatedlytomeasurethesamecondition
or event (this is called reliable)
• Measuresonlytheeventthatisintendedtomeasure(thisiscalledvalidity)
• Shouldnotbecostlytocollect
Indicators should be describe what is to be measured—not the increase or decrease that is
expected. For example, an indicator should measure the number of clients receiving counseling
rather than increase or decrease in the number of clients receiving counseling. Similarly, indicator
should measure the contraceptive prevalence rate, rather than the increase or decrease in
contraceptive prevalence rate. Commonly the evaluation experts recommend indicators that
are SMART, indicating the trait of good indicators listed below:
A good indicator must follow the SMART criteria:
• Specic—Clearly written to avoid diering interpretations
• Measurable—Allows for monitoring and evaluating progress toward achieving
the result
• Appropriate—Matches the scope of your program or work activities, so that you
can inuence or make changes
• Realistic—Is achievable within the time allowed
• Time bound—Includes a specic time period
Example of a SMART objective: 15 percent increase in institutional deliveries in the 25
intervention districts of Uttar Pradesh through the SBCC program in next 3 years
References
Frankel, N. and Gage, A. 2007. M&E Fundamentals: A Self-Guided Minicourse,
Mswastik2014EASURE Evaluation
S. CChange. 2012. C Modules: A Learning Package for Social and Behaviour Change
Communication (SSBCC). Washington, DC: CChange/FHI 360
Williams, K. and Ramarao, S. 2009. A Manual for Monitoring and Evaluation of Service Delivery
Programs, Population Council
Reitbergen-McCracken J, Narayan D. Participation and Social Assessment: Tools and Techniques.
Washington, DC: World Bank; 1998. Available at: http://www.worldbank.org/poverty/impact/
resources/toolkit.pdf.
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Module 3
MONITORING AND EVALUATION OF SOCIAL AND BEHAVIOR
CHANGE COMMUNICATION PROGRAMS THROUGH A
LOGICAL FRAMEWORK MATRIX
Learning Objectives
By the end of this session, you will be able to:
Describe a Logical Framework Matrix and how it helps in monitoring and evaluating
SBCC programs
Develop a Logical Framework Matrix
What Is Logical Framework Matrix?
The Logical Framework Matrix (logframe) represents the relationship between planned work
and intended results. More specically, it gives a structured, logical approach for setting
priorities and determining the intended purpose and results of a project. It allows information
to be analyzed and organized in a structured way. The logframe encourages clear and specic
thinking about what the project aims to do and how, and highlights factors upon which success
of the program depends.
How Does a Logical Framework Matrix Help?
The logframe helps both program managers and M&E ocers by presenting a summary of the
project in a standard format:
• Toestablishandlayoutinalogicalmannerthemeansbywhichobjectiveswillbereached
• Toidentifythepotentialriskstoachievingtheobjectivesandsustainableoutcomes
• Toestablishhowoutputsandoutcomesmightbestbemonitoredandevaluated
• Tomonitorandreviewactivitiesduringimplementation
Thus, the logframe is a tool that links the planned activities for objectives with the expected
results in terms of outputs, outcomes, and impact and the associated risks. It indicates how they
would be monitored and evaluated. M&E ocers should develop the logframe in coordination
with the IEC Division so that the proposed indicators for the communication objectives and
activities are synchronized and the means of verication is clear to both. (Gawler, 2005).
The Logical Framework Matrix
The logframe is represented as a matrix (Table 3.1). It has a vertical logic and a horizontal logic.
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The vertical logic is the project intervention logic. It indicates sequential causal relationships of
activities to the goal. It lays out goals, objectives, activities, and inputs.
• Thegoalisahigh-levelobjectivethattheprojectisexpectedtocontribute.Itisabottom-
line condition of well-being of individuals, families, and communities.
• Objectivesanswerthequestion,“Howwillthisgoalbeachieved?”Theeectsofachieving
the objectives will result at achieving the goal.
• Activitiesaretheactionsthat,whenimplementedwithinthegiventimeperiod,willresult
in achieving the objectives. Activities are the main elements of the project implementation.
• Inputsarepreparationsmade toimplement an activity,like preparationof postersand
lms for a communication program. Inputs also include other investments like human
resources, equipment and supplies and nancial resources. Inputs are timebound tasks
that are critical to conduct the activities on time.
The horizontal logic links each of the intervention logic elements to their measurement
indicators. It has six columns: intervention logic (described above), objectively veriable
indicators of achievement, timeline, person(s) responsible, sources and means of verication
(source of the data to measure the indicator), and assumptions (external factors) on which the
results are based.
• Objectively veriable indicators of achievement are measurements used to assess the
progress of an intervention logic. They measure, directly or indirectly, the overall impact
of the project. Indicators for objectives measure the direct outcomes of the project;
they are often measured at a xed time during the project period, for example, at the
beginning, mid-course, and end of the project or on an annual basis. Measurement of
objectives constitutes evaluation of the project. Indicators for activities give the outputs
of implementation, which are measured at regular short intervals (e.g., weekly, monthly
or quarterly). Indicators for activities are used to monitor the progress and quality of the
project.
• Timelinesetsthetimeframewithin which the activitiesareexpectedtobecompleted
and objectives measured.
• Person(s)responsible:Thiscolumndenotestheperson(s)responsiblefordoingthegiven
activities. Often, the designation rather than names of the persons is given.
• SourcesandmeansofvericationareSourcesandmeanstoverifytheindicatorswouldbe
dierent for goal, objectives and activities. Mentioning sources and means of verication
in the logframe along with the indicators help in designing methodology and tools for
M&E.
• Assumptions are the external factors beyond the scope of the proposed project that
are necessary to eectively implement the activities and achieve the objectives. If
assumptions are materialized and risks reduced, that increases the chances for project
success. Assumptions are likely factors that may or may not happen. If they are denitely
going to happen, then there is no risk and they should not be included in the logframe.
On the other hand, if the factors are denitely not going happen, then the project is not
likely to reach its objectives and, therefore, the project would need to be redesigned.
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TABLE 3.1: EXAMPLE OF A LOGFRAME FOR SBCC
Intervention Logic Objectively Veriable
Indicators of Achievement
Timeline Person(s)
Responsible
Sources
and
Means of
Verication
Assumptions
Goal: Increase
contraceptive use in
100 Gram Panchayats
(GPs) of one district
Impact: Reduce unmet
need, increase Contraceptive
Prevalence Rate (CPR)
By the end of
project
Large-scale
surveys
Objective: Increase use
of modern FP methods
through systematic
SBCC
Outcome:
• Percentofwomen
reporting discussion with
husband/family for FP
• Percentofwomenusing
modern FP
Start and
end of
project
Baseline
and end line
surveys
Contraceptives
are made
available
Activities:
1. Sensitization of
all government
department on the
SBCC strategy
2. SBCC activities
2.1 SBCC materials
showed/displayed
2.2 Training of ASHA in
FP counselling
3. Systematic M&E
plan
3.1 Prepare a M&E
framework
3.2 Design MIS and key
indicators
3.3 Baseline survey
3.4 Endline survey
Output:
• AtrainingontheSBCC
strategy for all concerned
government departments
• 10lmshowsorganizedin
each GP per month
• 50postersdistributed/
displayed in each GP
• AllASHAsaretrained
• M&Eframeworkdeveloped
• MISdevelopedand
operational
• Baselinereportpresented
• Endlinereportpresented
July 2014
from Oct
2014
Nov 2014
Nov 2014
July 2014
Sept 2014
Oct 2014
Oct 2015
Designation
Designation
Designation
Designation
Designation
Designation
Designation
Designation
Project
progress
report
MIS
MIS
MIS
Project
progress
report
Fund
release by
government is
timely
ASHAs are
committed to
counselling
No natural
calamities
Inputs:
1. Sta for the project
2. Development of an
SBCC strategy
3. Films and
SBCC materials
developed/adopted
4. Procurement of
projectors
• Stafortheprojectare
hired/identied
• SBCCstrategydeveloped
• 2lms,3typesofposters,
and counselling tool
developed/adopted
• 100copiesoflmsmade,
5,000 poster printed, and
500 counselling tools
prepared
• 10projectorspurchased
March 2014
June 2014
Sept 2014
Sept 2014
Sept 2014
Designation
Designation
Designation
Designation
Project
progress
report
Project
inventory
Project
progress
report
Resources
required are
budgeted
Fund
release by
government is
timely
The framework also includes outputs, outcomes, and impacts, which are used to measure the
short-term, intermediate and the long-term results of an intervention.
The framework also includes outputs, outcomes, and impacts, which are used to measure the
short-term, intermediate and the long-term results of an intervention.
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Outputs
Outputs are the most basic level of information, and they can be easily compared across time
and geographical area. They are the direct products of the campaign and measured in terms
of campaign activities performed. It is important to note that outputs do not measure any
attention, action, or response on the part of the audience. In evaluation output information
helps in assessing the extent of implementation of the planned activities. Examples:
• NumberofspotsairedorshownonTV
• Numberofadvertisementmadeinnewspapersormagazines
• Numberofdierenteventsorganized(e.g.,nukenatal,groupmeetings)
• NumberofpeoplewhowereengagedorreachedthroughIPC
Outcomes
Outcomes are the interim goals of a SBCC campaign. In a SBCC campaign, outcomes would be:
• Changesinknowledgeandattitudes
• Intentionstoadopttargetedbehavior
• Adoptionofthetargetedbehavior,dependingondurationofthecampaign
Recall of advertisement and its accuracy are common outcome variables to assess the reach and
understanding of the media campaign. Examples might be:
• 35 percent of recently delivered women recall the advertisement for exclusive
breastfeeding aired on TV, and 10 percent of them were able to accurately recall the
delivered messages.
• Fortypercentofrecentlydeliveredwomenrememberthattheywereadvisedaboutskin-
to-skin care by an ASHA during their last trimester of pregnancy and 15 percent could
accurately respond how to practice it; only 3 percent actually practiced it.
Actual behavior change may not be achieved with a short-term campaign. The interim outcomes
in such cases could be only knowledge of intervention components or intention to practice
desired behaviors.
• Examplesofattitudinalchangecouldbemorefavorabletousefamilyplanning,delaying
rst child, or rejecting gender-based violence.
• Examplesofbehavior change intentioncouldbeanindicationthataudiencemembers
would like to adopt a contraceptive method after the present delivery or after asking their
husbands, or respondents are going to take their children to the nearest facility soon to
get immunized.
• Examplesof behaviorchange couldbe an increasein familyplanning use,increase in
complete immunization of children, increase in institutional deliveries, or increase in early
breast feeding.
Impact
Impact measures the ultimate achievement of the goal of a program, and it takes a longer
span of time to achieve. This may not necessarily be captured in evaluation of a short-duration
campaign. Examples of impact variables include:
• Dropinneonataldeathrate
• ReductioninunmetneedofFP
• Reductioninmaternalmortality
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Strengths and Weaknesses of a Logframe
Strengths Weaknesses
• Ensures that decisionmakers ask
fundamental questions and analyze
assumptions and risks
• Engagesstakeholdersintheplanningand
monitoring process
• Is an eective management tool to
guide implementation, monitoring, and
evaluation
• Can limit creativity and innovation if
followed rigidly
• Mustbe updatedduringimplementation
to reect changing conditions
• Often requires training for project
personnel in developing and using a
logframe
In summary:
• Thelogframeisatoolforrepresentingtheprojectactivitiesandexpectedresultsina
logical manner.
• ThelogframeformsthebasisfordesigningmethodologyandtoolsforM&E.
• Thegoalisahigh-levelobjectivethattheprojectisexpectedtocontribute.
• Objectivesaretheeectsasaresultofwhichthegoalisachieved.
• Activitiesaretheactionswhenimplementedwithin thegiventimeperiod willreach
the objectives.
• Inputsarepreparationsmadetoimplementanactivity.
• Objectivelyveriableindicatorsofachievementaremeasurementsusedtoassessthe
progress of an intervention logic.
• Sourcesand means ofverifying the indicatorsare key elementsthat will determine
how M&E will be done.
• Assumptionaretheexternalfactorsthatmayormaynothappenbutareimportantfor
success the project.
References
1. ICTD project News Letter, July 2006. https://www.ipfm.in/Images/RBM%20Newsletter.pdf.
2. The logical framework approach Hand book for objective oriented planning. http://www.
norad.no/en/tools-and-publications/publications/publication?key=109408
3. A guide for developing a logical framework. Centre for International Development and
Training University of Wolverhampton.
4. Meg Gawler, 2005. Logical framework analysis. WWF Standards of Conservation Project and
Programme Management. www.artemis-services.com/downloads/logical-framework.pdf
5. Handbook for logical frame work A.nalysis. Economic Planning Unit. Prime ministers
department. http://www.epu.gov.my/c/document_library/get_le?uuid=2cc13468-
db3a-46a3-bf48-510fe348e282&groupId=283545
6. Katherine Williams and Saumya Rama Rao 2009. A Manual for Monitoring and Evaluation
of Service Delivery Programs, Population Council.
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Module 4
MONITORING SOCIAL AND BEHAVIOR CHANGE
COMMUNICATION PROGRAMS AT DISTRICT AND BLOCK
LEVELS
Learning Objectives
By the end of this session, you will be able to:
Develop a checklist for monitoring quantity and quality of SBCC activities, synthesizing
the ndings, and providing feedback to improve program implementation
Understand feedback system in SBCC programs
Eective monitoring at the lowest administrative levels helps to enhance program
implementation. Following are the salient points to remember for eectively monitoring a
program at block and district levels:
• Form a core monitoring team including members from the IEC team at the state and
district levels and review the overall program logframe to provide guidance for expected
activities at the lower level (e.g., block, PHC, and sub-center).
• Review the activity indicators. If necessary, consider including any additional indicators to
be monitored at the district level and lower level.
• Develop appropriate data collection tools and checklists, such as a mother and child
tracking system, that will help to measure the key activity indicators. This process should
also dene the involvement of program stakeholders and beneciaries.
• Decide on the personnel and frequency of data collection and the levels at which the
data will be collated.
• Verify quality of data collected and indicate its analysis, interpretation and program
action.
• Develop the feedback mechanism and its process
• Keep track of any change in the implementation plan and revise the logframe with the
indicators accordingly.
Monitoring SBCC Activities
For monitoring SBCC activities, collect location and contact details of key personnel related to
each activity. The following form (Table 4.1) may be used to get the required information.
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TABLE 4.1: LOCATION HUNT FORM
District Block
Village name:
Name of ASHA: Mobile number:
Name of ANM: Mobile number:
Name of Sarpanch: Mobile number:
VHSC representative: Mobile number:
Approximate population of village:
Suitable location for play/screening the lm: Time:
Checklist for Quality Assessment
A checklist for quality assessment is a list of essential characteristics needed to be
adopted in the process of implementing the activities. It provides a systematic structure
to observe, assess, and take corrective measures, as needed. Following are key elements
of developing and using checklists for communication activities:
• Thechecklistshouldbepreparedbasedontheexpectedtaskthattheproviders
have to perform.
• The checklist should be standardized for all who will use it. All the observers
(or supervisors) should be oriented with the checklists to have a common
understanding of the listed observations, their purpose, and measurement. This
will reduce observational bias/subjectivity in noting and reporting observations.
The observation checklist should be short, simple, and listed in a logical order as
activities/tasks are expected to occur.
• Therecordingofresponseinthechecklistshouldbesimplelike“yes/no”or“never/
rarely/sometime/most of the time/aIl the time.” However, if required, space could
be provided to record numerical as well as explanatory observations.
An example of checklist to observe a group meeting held by Community Health Workers
(CHWs) for family planning is provided in Table 4.2.
Checklist for Exit Interview
Regular eld visits provide insights into implementation processes and challenges faced
and people’s perceptions. An exit interview provides insight into people’s perception
and knowledge gained after SBCC activities such as lm shows, street plays, or group
meetings. The following exit interview form (Table 4.3) can be adapted for this purpose.
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TABLE4.2: CHECKLIST FOR QUALITY ASSESSMENT OF GROUP MEETING CONDUCTED BY
CHW
No Observations Yes No
1CHW reached the place of group meeting before the scheduled time and made
required arrangements (e.g., setting up posters, counselling aids).
2 CHW greeted all participants.
3 CHW welcomed those who joined late.
4CHW madesure all women were seated so that they could see the visuals or
demonstrations.
5 CHW showed the given ip chart while communicating.
6 CHW demonstrated the given family planning models.
7 The audiovisual shown could be heard well.
8 CHW discussed all types of FP methods available.
9 The information given by CHW was technically correct.
10 CHW engaged audiences by asking open-ended questions.
11 CHW allowed and encouraged participants to ask questions.
12 CHW claried questions raised by audiences in non-judgmental manner.
13 CHW was honest while clarifying questions.
14 CHW summarized/reinforced key messages before ending the session.
CHW thanked all participants.
TABLE 4.3: EXIT INTERVIEW FORM
1. Date:
2. Village Name: 3. GP Name:
4. Name of respondent: 5. Age: 6. Sex (M/F/other):
7. BPL HH (Yes/No):
Questions Answers
8. What is the theme of the play/
lm?
9. Have you ever heard of the
theme(s) before this show?
Yes……………… 1 Where:_______________
No……………… 2
10. Can you mention 5 things you
remember from the play/lm?
1. _________________________________________
2. _________________________________________
3. _________________________________________
4. _________________________________________
5. _________________________________________
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11. Would you like to use any
services shown in the play/
lm? If yes, which services?
1. Antenatal care................................................................A
2. Delivery ............................................................................ B
3. Postnatal care ................................................................C
4. Neonatal care ................................................................ D
5. Family planning ............................................................E
6. Others ............................................................................... X
7. None of the services ................................................... Z
12. Would you like to share today’s
learning with others (peer
group or family)?
1. Yes…………………………………………………1
2. No……………………………………………….....2
13. Mention 3 things you liked
about the play/lm.
1.___________________________________________
2.___________________________________________
3.___________________________________________
14. Mention 3 things to improve
the play/lm.
1.___________________________________________
2.___________________________________________
3.___________________________________________
Feedback System
Feedback is essential to learning, building capacity,and improving performance. Constructive
feedback is critical in SBCC programs, and feedback mechanisms should be built into the
program for eective management. All supervisors should be informed that lack of feedback
mechanism is a missed opportunity for learning. Lack of feedback mechanisms implies that
performance monitoring is not considered important. M&E and IEC ocers, as core team for
monitoring, should workout the feedback system.
One of the key roles of program managers is to provide constructive feedback. Review meetings
held within the block are an opportunity to provide feedback and reorientation to address any
gaps. Following are key elements of feedback:
• It should be based on sound and structured assessment—for example, based on an
analysis of data obtained from the checklists.
• Itcanbeverbalorwrittenwithkeyactionpoints.
• It should be given with a positive attitude to motivate and reduce future barriers. A
negative attitude can make the worker defensive and damage the working relationship.
• Itshouldincludeadialoguestartingwiththe SBCCworkersharingtheirownstrengths,
weaknesses and challenges
• Itshouldbearegularandtimelytoimproveperformance.
Feedback to the worker responsible for SBCC activity is easier if he or she maintains a standardized
SBCC activity report as given in Table 4.4.
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A consolidated report of the same could be assessed by the supervisors to provide feedback in
monthly review meetings in line with “5Ws and 1H,” which denotes where, when, what, who,
why, and how. For example feedback could be provides on the following issues:
• Numberofactivitiesachievedagainstplanned;andifnotthepossible,meanstoachieve
• Theintendedaudiencereachedornot
• Appropriatenessofthetimingofactivities
Possible means to reach the intended audience
TABLE4.4: SBCC ACTIVITY REPORT
Name of worker responsible for SBCC activity: Name of supervisor:
District: Block:
Gram Panchayat: Date (day/month/year):
Specify SBCC
activity
Village Time Theme BCC
activity
conducted
Yes/No
Reasons
for not
conducting
activity*
Number of Adults 19–49 Children
<14
Adole-
scents
14–18
Total
number
of people
present
Male Female Others
1. Film show
2. Street show
3. Group
meeting
4. IEC
materials
distribution
TOTAL NA NA NA
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Example: Feedback on Counselling by CHWs
Intervention: As part of the large campaign on promoting family planning, 25 ASHAs of the
Primary Health Centre area were trained on how to counsel women using a ip chart. They were
trained on various modern contraceptive methods available and how to use the ip chart while
counselling women. ASHAs were asked to make note of all eligible women in the reproductive
age group 15–49 years and their contraceptive status.ASHAs were asked to visit women not
using any modern contraception once every month and counsel them on contraceptive methods.
ASHAs were instructed to visit women using a spacing method once every 3 months to determine
whether they were still using any method. ASHAs were expected to counsel women who have
no desire to get pregnant but who are not using any method. ASHAs were asked to maintain
a register of eligible women, date of home visit made, and whether counselling was done. The
monitoring ocers during their eld visit observed counselling sessions done by 10 ASHAs and
recorded their observations using a checklist.
Feedback: The checklist was analysed and key observations noted. The M&E ocer and IEC
ocer held a monthly review meeting of all ASHAs; 20 ASHAs attended. Individual registers
were checked to assess completeness, and clarications were sought in a positive tone if they
were not complete or if women were not being counselled. Individual feedback on how to plan
and complete the activity was provided. All 20 ASHAs were brought together and, based on the
analysis of checklist, were given reorientation on counselling. For example, it was observed a
woman said she wanted to have tubectomy once her child became 1 year old. The ASHA talked
about where to get tubectomy and the care she would need after the surgery, but did not talk
about any other contraceptives. The ASHA was advised, in such an instance, to nd out if the
woman knows about other contraceptive methods and to explain those she is not familiar with,
even if she nally chooses only tubectomy.
In summary:
• Develop a checklist for monitoring quantity and quality of SBCC activities.
• Orient all supervisors on the checklist.
• Provide feedback that is supportive and constructive.
• Based feedback on sound and structured assessment—for example, based on an
analysis of data obtained from the checklists.
• Provide timely feedback.
• Wherever possible, give written feedback with suggested action points.
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Module 5
RESEARCH DESIGNS FOR EVALUATING SOCIAL AND BEHAVIOR
CHANGE COMMUNICATION PROGRAMS
Learning Objectives
By the end of this module, you will understand:
Why and what to evaluate in SBCC health interventions
Research design to evaluate SBCC health interventions
How to select a research design
Why Evaluate SBCC in Health?
• SBCCprogramsareimplementedtoenableindividuals,families,andcommunitiestolearn
about new innovations, approaches, and behaviors that have direct bearing on family
health, help change in attitudes, and stimulate adoption of healthy behavior leading to
better quality of life.
• SBCC provides information, gives reasons for adopting a particular behavior, and
reinforces the messages with other channel such as mass media, IPC, and mid-media.
• Itis, therefore,imperativethat SBCC programs are closely monitoredandsubjected to
evaluation which is robust and provides scientic evidence to assess how well the SBCC
program is achieving its goals and what interim correction is required, if any.
What should be Evaluated in SBCC Health Interventions?
SBCC strategy and its implementation plan should be based on theories of change and ndings
of the formative study, which should provide adequate understanding of the local context,
facilitating factors, and possible barriers to the desired behavior change.
A scientic and robust evaluation should also be based on the SBCC strategy and its
implementation plan and designed at the beginning of the SBCC campaign so that necessary
data or information required for the evaluation is decided, measured/collected, and analyzed.
Evaluation is conducted to:
• Determineifprojectgoals,objectives,andintendedoutcomesarehowimplementation
challenges are met
• Assessthe quality of the campaignintermofappropriatenessofthemessagegiven in
the local context, scheduling, reach, and recall
• Identifyconstraintsandareasforimprovementandsuggestacourseofaction
• Analyzethecostoftheinterventionimplementedandassessthecostofscalingup
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• Communicateandadvocateforthelearningandresultsoftheprogramand
• Explorepossibilityofscalingupinlargerareasandorotherareas
Methods to Evaluate SBCC Health Interventions
Evaluating an SBCC health intervention requires time, resources, and methodological rigor both
in design and analysis. Methods to collect required data can be qualitative, quantitative, or a
combination. A quantitative approach is used to measure the quantiable outcome and impact
variables, while a qualitative approach helps in understanding the process of behavior change
and answers some of the how and why questions both for the implementation process and
behavior change process (see Module 6 for qualitative approaches).
Common research designs used to evaluate the impact of an SBCC intervention range from true
experimental to quasi-experimental to non-experimental design. Understanding of the designs
by the program managers and program evaluators will be useful in planning and evaluating a
SBCC campaign with scientic rigor.
Typically, an experimental design protects the ndings from various conditions and factors
other than the program that could be responsible for observed net outcomes. These factors
are called threats to validity and include history, selection, maturation, mortality, testing, and
instrumentation. A brief denition of each of these terms follow. For more detail please refer to
the Population Council publication Handbook for Family Planning Operations Research Design.
• History: History refers to those unplanned events that occur during the project that
could inuence the intended outcomes of the project. For example, talk by a highly
respected religious leader in favor of family plan may motivate some of the couple who
were avoiding contraception because of religious reasons.
• Selection: A common threat to validity occurs when the people selected for the control
group dier greatly from the people selected for the experimental group. For example,
in a two-arm study, the villages selected in experimental group largely belong to higher
caste Hindus while the villages in the control arm are dominated by the Schedule Caste
(SC) population.
• Maturation: Over time, people change and become mature. The maturation process
can produce changes that are independent of the changes the intervention is designed
to produce. For example, in a longitudinal study, rst- and second-year students were
given sex education to encourage them to avoid risky sexual behavior. After 2 years, sex
behavior of these students was compared with the students of third- and fourth-year
students who were not part of the experimental group. No dierence was observed
between the two groups. Pre-post comparison of the experimental group showed an
increase in sexual activity. The study concluded that sex education increased sexual
behavior. It was misleading as increase in sexual activity was more because the students
of rst and second year matured and became adults leading to increased sexual desire.
This is natural. This change was not a result of the intervention.
• Mortality: In cohort studies (also called panel studies) where the same group of people
are followed over time, there is almost always some loss to follow-up. Mortality refers
to those losses. If the people who are loss to follow-up are substantially dierent
from those who are followed up, the results could change. This change is not due to
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experiment but due to losing some specic group of people, such as the mobile labor
class from the village or a young population that migrates to urban area for higher
education or job.
• Testing: Some respondents may be interested enough by the questions they are asked
to nd out more about the topic discussed. If those respondents are interviewed again,
they will likely do better in answering the questions based on their increased knowledge.
The dierence or better performance in the second interview might have nothing to do
with intervention, but instead be due to the eect of rst interview.
• Instrumentation: Change In a study instrument (such as a questionnaire) between
the pretest and the posttest is likely to result in an eect that is independent of
experimentation.
No design can protect the study from all threats to validity but some of them could control up
to three of the rst four threats to validity.
Refer to the example of a health intervention, which can be evaluated through dierent research
designs discussed below.
Non-Experimental Design
There are several non-experimental designs commonly used by researchers. These designs are
appropriate for collecting descriptive information or for doing small case studies of a particular
situation. They are not recommended for evaluating the eect of a program intervention unless
there are major constraints in selecting a better evaluation design. The three types of non-
experimental designs are described below:
Example of a Health Intervention:
A health intervention planned for husbands to provide voice messages, approximately
15–20secondslong,ontheirmobilephoneonceinaweekover12months.Thehealth
information will end with a message encouraging husbands to discuss the information
they heard with their wives and family members. Message about the following will be
given to husbands whose wives are in the third trimester of pregnancy:
• Threepostnatalcheckupsformotherandnewbornwithin7daysofdelivery
• Earlyinitiationandexclusivebreastfeeding
• Propernutritionafter6months
Evaluation of this program needs to measure knowledge and behavior change indicators
related to the intervention, such as awareness about the importance of receiving three
postnatal care (PNC) checkups for mother and newborn, family discussions initiated by
the husband about the importance of early and exclusive breastfeeding, receipt of three
PNC checkups (mother and child) within 7 days of delivery, initiation of breastfeeding
within an hour of delivery, exclusive breastfeeding, and improved nutritional status of
children.
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Posttest only design
In this design, impact of an intervention X is evaluated after it has been implemented for a
specied period of time. There is no baseline or control group in this design. The gure below
typically represents the design.
Time (T)
Experimental Group X O1
Where
X is intervention
T is the time period form implementing intervention X
O1 is the measure of the impact or outcome after time T
Example: In the health intervention example, this design could measure the reach of the phone
messages. In other examples, the impact of a TV campaign on condom use could be assessed
taking condom use as dependent variable and along with other independent variables; a
dummy variable (0 or 1) on the exposure of the condom advertisement or number of times
the subject was exposed to condom advertisement could be used.
Strength and/or limitation: This is a weak design and does not control the threats to validity
due to history, maturation, selection, and mortality. In the absence of baseline data and a
control group, multivariate analysis could be used.
Pretest posttest design
This is a commonly used design in measuring impact of SBCC campaigns as well as in other SBCC
intervention programs. In this design, pre-intervention measurement of the outcome variable
is compared with post-intervention measures. In this design, no control group is included. This
design is typically represented as in the gure below.
Time (T)
Experimental Group O1 X O2
Where
O1 is measure of the outcome before the intervention is implemented
O2 is measure of the outcomes after the intervention is completed
X represents intervention
T is the intervention period
Example: In the health intervention example, we can measure knowledge and behavior
change in maternal and child health, but we will not be sure that the change has happened
because of the intervention or any other factors as we do not have a control group.
Strength and/or limitation: Pretest-posttest design is subject to several threats to validity
like history, testing, maturation, and instrumentation.
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Post-experimental and control design
In this case, post-experimental measures of the outcome are compared with the measures of the
control group. No baseline data is collected from either group. Here, it is assumed that the level
of outcomes in both groups before the intervention is equal. Thus, any gain in the experimental
arm after implementation of the intervention is contributed to the intervention. No random
allocation is involved in assigning subjects in the experimental and control group. The following
gure depicts the post-experimental and control design.
Time (T)
Experimental Group X O1
Control Group O2
Where
O1 is post experimental measures of the outcomes in experimental arm
O2 is post experimental measures of the outcomes in control arms
X represents intervention
T is the intervention period
Example: With this design, we can compare the knowledge and behavior indicators in the
health intervention example between the two groups, but we cannot measure the change in
indicators as there is no baseline data.
This is another example of where this design could be applied well: Within the same block
of a district, X number of villages are exposed to community radio or mid-media activities,
while an equal number of villages are not exposed to any such intervention. Care must be
taken that the two villages are far enough apart to avoid contamination. Experimental and
control villages could be from two dierent blocks but within the same districts. The purpose
of keeping the same block or the same district is to avoid any big variation in the two groups
at the time of the study.
Strength and/or limitation: The primary source of error with this design is the threat to
validity due to selection and mortality.
Experimental Designs
Pre-post experimental-control design
This is also called a randomized control trial (RCT), a true experimental design. RCT is the gold
standard of evaluation and provides the highest quality of evidence of success. In this case, the
dierence in the measures obtained from pre- and post-intervention data of the experimental
group is compared with the corresponding dierence in the outcome measures of the control
group. The subjects (the sampling unit) are allocated randomly in the experimental and control
groups. Before random allocation of the subjects, they are matched and made pairs; from
each pair, one is randomly allocated to the control group and another to experimental group.
Random assignment helps to assure that the experimental and control groups are balanced
and the dierence at the end of the study will be largely due to the intervention. RCT thus helps
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in establishing a causal relationship between the intervention (independent variable) and the
outcome measures (the dependent variables). Presentation of a typical RCT is depicted in the
gure below.
Time (T)
Experimental Group O1 X O2
RA
Control Group O3 O4
Where
RA indicates random allocation of subjects
O1 and O2 are the pre and post measures of outcomes in the experimental group
O3 and O4 are the pre and post measures of outcomes in control group
X represents intervention
T is the intervention period
Example: With this design, we can compare the knowledge- and behavior-related indicators
in the example health intervention.
Strength and/or limitation: This is one of the strongest designs in terms of controlling threats
to validity, but random allocation remains a challenge, and this design is quite costly and
time-consuming.
Posttest-only control group design
This is also a true experimental design and similar to the one discussed above except there
is no baseline (pretest) measurement. The post-intervention data is collected from the both
groups and compared. As allocations of the subjects in the two arms are done randomly, it is
assumed that both the groups are balance in the beginning of the study and the dierence
which is observed is largely due to intervention. The design demonstrates causal relationship
between the intervention and outcome measures. However, this design does not allow measure
of changes that takes place within the groups during the period. It is depicted below:
Time (T)
Experimental Group1 X O1
RA
Control Group O2
Where
RA indicates random allocation of subjects
O1 is the post measures of outcomes in the experimental group
O2 is the post measures of outcome in control group
X represents intervention
T is the intervention period
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In this design there could be more than one experimental arm testing dierent SBCC
interventions or combinations of the interventions, as indicated in gure below.
Time (T)
Experimental Group 1 X O1
Experimental Group2 Y O2
RA
Experimental Group3 X+Y O3
Control Group O4
Where
RA indicates random allocation of subjects
O1, O2, and O3 are the post measures of outcomes in three experimental groups
O4 is the post measures of outcome in control group
X represents various form of mid-media intervention in Group1
Y represents IPC intervention in Group 2
X+Y represent both interventions simultaneously implemented in Group 3
T is the intervention period
Example: With this design, we can compare the knowledge and behavior indicators in the
example health intervention.
Strength and/or limitation: Random allocation will remain a challenge, and this design is
quite costly and time-consuming. It is economical as baseline data is not collected, yet the
causal relationship between intervention and outcomes can be demonstrated.
Quasi-Experimental Designs
In many eld research situations, it is not possible to conduct RCT, and it could be very costly
and or dicult to meet the random assignment criteria of a true experimental design. At the
same time, researchers want to avoid the problems of threats to validity associated with non-
experimental designs. A reasonable compromise often can be made by selecting a quasi-
experimental design. These designs do not have the restrictions of random assignment and
hence do not demonstrate causal relationship between intervention and the outcome measures.
However, they may help in measuring impact of the intervention and tend to control many
threats to validity.
Quasi-experimental control group design
It is quite similar to the RCT design except for the random allocation of subjects in experimental
and control groups. Such designs are good to evaluate program when a program intervention is
introduced into one area (say, one district) and we want to compare the program eects in that
district against a similar, but not necessarily equivalent, neighboring district. The gure below
typically represents such design:
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Time (T)
Experimental Group O1 X O2
Control Group O3 O4
Where
O1 and O2 are the pre and post measures of outcomes in the experimental group
O3 and O4 are the pre and post measures of outcomes in the control group
X represents intervention
T is the intervention period
Example: With this design, we can compare the knowledge and behavior indicators in the
example health intervention.
Strength and/or limitation: In such a design, must be careful when analyzing the data and
drawing conclusions. The dierence between the two groups (O2-O1 and O4-O3) will provide
the net impact of the intervention. Selection procedure and its eect on results are serious
threat to validity. Hence, in this design, care should be taken as much as possible, to match
the experimental and control groups. This design is less costly and time-consuming than RCT.
Time series design
Time series design measures the outcomes at several points both before and after intervention.
Such design does not only measure impact of the intervention immediately after the
intervention period but at several points of time after the campaign (intervention) is over.
This helps in understanding not only temporary gains but also the long-term impact on the
outcome. Time series design is particularly useful when the sampling unit is small and dividing
them into experimental and control groups is not practical.
Example: With this design, we can compare the knowledge and behavior indicators as well as
nutritional status of children in the example health intervention at several points of time, such
as every quarter, and see the progress. For cost-eectiveness, service statistics maintained
by the program could be used for measuring the impact of the intervention (nutritional
status) by analyzing the height and weight in the last four quarters before introducing the
intervention and the next four quarters after the intervention. This is not possible in any
other design. A comparison of data before and after intervention provides a better and more
precise understanding of how the program has contributed to change in nutritional status of
children. The following gure gives a typical presentation of such design:
Time (T)
Experimental Group O1 O2 O3 Program (X) O4 O5 O6
A time series graph could be revealing and help in understanding the process. The gures
given below show levels of impact of the dierent interventions to understand how much
dierence is the intervention making.
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CASE 1 (Sudden increase, Figure 5.1): If there is no dierence between O1, O2, and O3, but
then a sudden increase occurs between O3 and O4, which is subsequently maintained in O5
and O6, we can conclude with some degree of condence that the sudden increase was due
to the eect of the program (X).
CASE 2 (Steady increase, Figure 5.2): If there is a steady and constant increase over time
before the intervention and it continues at the same pace after the intervention, that is an
indicator there is no gain due to intervention.
CASE 3 (Regular increases and decreases, Figure 5.3): If there are regular and consistent
increases and decreases before and after the intervention, it is apparent the program did not
seem make a dierence. Had the evaluator used a pretest-posttest design and compared only
O3 against O4, he or she might have mistakenly concluded that the program had an impact
where, in reality, the trend shows no impact.
01
0
10
20
30
PRECENT
40
02 0 3040
50
6
Program Intervention (X)
01
0
5
10
15
PRECENT
20
25
02 0 3040
50
6
Program Intervention (X)
FIGURE 5.1: TREND IN FAMILY PLANNING KNOWLEDGE BEFORE AND AFTER AN INTERVENTION
SUDDEN INCREASE
FIGURE 5.2: TREND IN EXCLUSIVE BREASTFEEDING PRACTICE BEFORE AND AFTER AN
INTERVENTION
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FIGURE 5.3: TREND IN CONDOM USE BEFORE AND AFTER AN INTERVENTION
FIGURE 5.4: TREND IN NEW STERILIZATION ACCEPTORS BEFORE AND AFTER AN
INTERVENTION
CASE 4 (Temporary impact of a program intervention, Figure 5.4): If there is increase at one
point following the intervention and then a decrease at the next time point, this indicates
the program made an immediate dierence but not a long-term impact. Once again, had the
evaluator used a pretest-posttest design and compared only O3 against O4, he or she would
mistakenly have concluded that the campaign had a substantial impact; the evaluator would
have missed that the impact was only temporary.
Strength and/or limitation: Although the time series design does not include a control group
and does not control for history and possibly instrumentation threats to validity, it does allow
for a more detailed analysis of data and program impact than the pretest-posttest design. The
time series design provides information on trends before and after a program intervention. It
is a particularly appropriate design to use when it is possible for a researcher to make multiple
measurement observations before and after a program intervention.
01
0
5
10
15
PERCENT
20
25
02 0 3040
50
6
Program Intervention (X)
01
0
20
40
60
PERCENT
80
100
02 0 3040
50
6
Program Intervention (X)
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How to Select a Study Design
Selecting an appropriate research design depends on the research question, availability of
funds, human resources, time constraints, and ethical considerations. It is always advised to
start with the best and more rigorous design but the local context and the constraints may
force the design of a less rigorous design, compromising power and precision of the results. The
researcher and his or her team are in the best position to choose the design most appropriate
to the given context. However, the following rules of thumb suggested by Andrew et al. (1998)
provide some guidance:
a) Whenever possible, try to create experimental and control groups by assigning cases
randomly from a single population study group.
b) When random assignment is not possible, try to nd a comparison group that is as nearly
equivalent to the experimental group as possible.
c) When neither a randomly assigned control group nor a similar comparison group is
available, try to use a time series design that can provide information on trends before
and after a program intervention.
d) If a time series design cannot be used, at a minimum and before a program starts, try
to obtain baseline (pretest) information that can be compared against post-program
information (a pretest-posttest design).
e) If baseline (pretest) information is unavailable, be aware that you will be limited in the type
of analysis you can conduct. You should consider using multivariate analytic techniques.
Always keep in mind the issue of validity. Are the measurements true? Do they do what they are
supposed to do? Are there possible threats to validity (history, selection, testing, maturation,
mortality, or instrumentation) that might explain the results?
Apart from the above technical issues, also consider the following:
• Availabilityoftimeandresource
• Adviceofastatisticianoraresearcherwellacquaintedwithdesignandsamplingmethods
for the sample size calculation and nalization of design
• Eectsofsamplesizeoncost(largersamplesizemeanshighercost)
References
Andrew A. Fisher et. al., 1998 Handbook for Family Planning Operations Research Design
Population Council
C4Change. 2012. CModules: A Learning Package for Social and Behavior Change Communication
(SSBCC). Washington, DC: CChange/FHI 360.
Stephen S Lim, Lalit Dandona, Joseph A Hoisington, Spencer L James, Margaret C Hogan,
Emmanuela Gakidou 2010 Use of mass media campaigns to change health behaviour Lancet
2010;375:2009–23
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Module 6
USE OF QUALITATIVE METHODS IN MONITORING
AND EVALUATING SOCIAL AND BEHAVIOR CHANGE
COMMUNICATION
Learning Objectives
By the end of this session, you will be able to explain:
Qualitative research and how it does it dier from quantitative research
The various qualitative data collection methods and its application in monitoring and
evaluation of SBCC program
What Is Qualitative Research?
Qualitative research is a scientic research method that provides descriptions and explanations
of the research question. It aims to gather an in-depth understanding of human behavior
and the social dynamics that inuence people to behave one way or the other. It helps to
understand the “how” and “why” of the human behavior and provides complementary data
to the quantitative ndings to draw precise conclusions. Qualitative research is also done
independently as formative research prior to designing programs or quantitative data collection
tools. It can be done simultaneously along with the quantitative data collection or after analyzing
the quantitative data. During monitoring, qualitative methods help to learn the perception of
audiences and stakeholders about the activities implemented.
Qualitative Research:
• Explores answers to what, why, and how of decisions and actions taken
• Explores and discovers the social phenomena in decision making process to action
taken
• Provides insight into the meaning of decisions and actions
• Leaves the respondent to describe their answers
• Is interactive rather than xed
• Involves respondents as active participants rather than subjects
Dierences between Quantitative and Qualitative Research
Quantitative research is measurement of phenomena in terms of quantity or amount.
Qualitative research is a means of understanding the process leading to the outcome. It focuses
on participants’ perceptions and experiences leading to the way they make decisions and act.
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Quantitative and qualitative research methods dier primarily in:
• Analyticalobjectives
• Questionanddataformat
• Flexibilityinstudydesign
Characteristics Quantitative Qualitative
Analytical
Objective
• Toquantifyvariation
• To describe characteristics of a
population
• Todescribevariation
• To describe individual
experiences and group
norms
Question Format • Closed-ended (select answers from
options given) or semi-structured
• Open ended (Answer is
descriptive)
Data Format • Givesresultsinnumbers • Givesresultsinwords
Tool Design •Design of data collection tool is
stable from beginning to end.
• Participants’ responses do not
inuence or determine how and
which questions researcher asks
next; interviewer asks all questions
and follows the same order given in
the questionnaire
• There is exibility in the
way questions are asked
• Participants’ responses
aect how and which
questions researcher asks
next; order of questions is
not important
Need for Qualitative Research Methods
To improve quality of the program: The qualitative monitoring methods collect data on how well
activities are being implemented. They are necessary for learning, re-planning, and addressing
the quality of a program.
• To understand participants’ perspective: The qualitative methods provide insight into
why participants do what they do. It provides information about the “human” side of
an issue—that is, the often contradictory behaviors, beliefs, opinions, emotions, and
relationships of individuals.
• To explain quantitative results: The qualitative complement quantitative methods by
exploring the reasons and patterns underlying the responses of quantitative methods
of enquiry. When used along with quantitative methods, qualitative methods can help
us to interpret and better understand the complex reality of a given situation and the
implications of quantitative data.
• Todevelopoptionsforanswersandcodesforquantitativestudy:Whentheresearcher
is exploring a new area and does not know which responses one could expect from the
respondents, a quick formative study before undertaking a large sample survey helps
in making the questionnaire better and more appropriate with respect to the context
and answers that could come from the eld.
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Example:
It is estimated that institutional delivery in rural areas of Bihar is less than 20 percent,
resulting in adverse eects on the health of women and infants. The Department
of Health and Family Welfare initiated an SBCC program in two villages through a
mass media campaign and interpersonal communication (IPC) to improve the rate of
institutional delivery. The mass media campaign was through spots in the TV channels
during the prime time and IPC was through ASHAs among the eligible women and their
family members.
While evaluating the program, the quantitative survey showed that the percentage of
institutional delivery increased from 18 percent to 40 percent in one village, while in the
second village, it improved from 18 percent to 23 percent.
In this situation qualitative research helped to understand why the change was not
achieved as expected in the second village. Qualitative research with eligible women in
the villages showed that in the village with a smaller increase:
• Therewasacommunityfestivalinthevillageduringtheinterventionperiod,and
the majority of the women were not able to see the spots in TV regularly.
• ASHAs were mostly interacting with the pregnant women and not with their
mothers-in-law or husbands, who were the major decision makers for place of
delivery.
• The ASHAs were living in the main village and not visiting regularly the large
hamlet that was situated about a kilometer away.
Overview of Dierent Qualitative Methods
The most common qualitative methods used are:
• Observation
• In-depthinterviews
• Keyinformantinterviews
• Focusgroupdiscussions.
Each method is particularly suited for obtaining a specic type of data or opinion about a
process.
Observation
This approach is useful for collecting data on naturally occurring behaviors in their usual contexts.
Observation can also be used to monitor and assess the quality of an activity implemented (as
discussed in Module 3). The observation method allows researchers to check expressions of
feelings, nd out who interacts with whom and how they communicate with each other, and
how much time is spent on various activities. Observation techniques can be used to understand
a practice in the community. For example, newborn care practices like cord care, bathing, and
feeding of infants born at home.
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Strengths Weaknesses
•Helps to understand contexts, relationships,
and behavior
•Can guide quality improvement of program
implementation
•Can provide new information that is crucial
for project design, data collection, and
interpretation of other data
•Collection of observations can also be analyzed
quantitatively to give an overall perspective of
program implementation
•It is time-consuming and costly
•Reporting of observations depends
on researcher’s attention, memory,
and personal discipline to note
each observation
•Dependent on the quality of
checklist used for observation
Example:
The use of modern spacing family planning method among postpartum women is less than
2 percent in Uttar Pradesh. It was also estimated that the average birth interval between two
births is less than 24 months. To increase awareness about the healthy timing and spacing
of pregnancy and to improve the use of modern reversible contraceptive methods, the
Department of Health and Family Welfare initiated an SBCC program through counseling of
young postpartum women attending the immunization sessions.
The department would like to know how eective the counseling is. The observation
technique can be used in this instance. An observation checklist would further facilitate
systematic documentation of the observations.
In this observation, it was found that:
• Thecounselorwasabletocommunicatetheimportanceofproperspacingbetween
pregnancies and the health problems of mother and children if pregnancies were not
spaced.
• Thecounselorwasprovidinginformationaboutallspacingcontraceptivemethods
and their use but not providing information about the possible side eects and how
to handle them.
• Thecounselorspokeinthelanguagethatthewomencouldunderstandandavoided
technical words.
• Womenwereattentiveandclariedtheirconcernsaboutthehealthoftheirchildif
they used pills during post-partum period.
Based on the observations, recommendations were given to improve the counseling
approach.
In-depth Interviews
This method is best for collecting data on individuals’ personal histories, perspectives, and
experiences, particularly when sensitive topics are being explored or when personal opinions
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are sought about the way activities were implemented. It can also help in monitoring and
evaluation of the understanding of the providers, their diculties in the given context
in counseling and covering distance area, etc. Similar data could be collected from the
user’s perspective. In-depth interviews are conducted face-to-face and involves a well-
trained interviewer. The researcher’s interviewing techniques are motivated by the
desire to learn everything the participant can share about the research topic or his or her
life, if that is the objective of the in-depth interview. For example, in-depth interviews
could be done on the reproductive behavior of the women. Interview questions could
address how she managed her reproductive goal, diculties faced, information-seeking
behavior about contraception, and decision making process in accepting or rejecting a
contraceptive method. Researchers pose questions in a neutral manner, listen attentively
to participants’ responses, and ask follow-up questions and probe based on those
responses. They do not lead participants according to any preconceived notions, nor
do they encourage participants to provide particular answers by expressing approval or
disapproval of what they say. Depending on the subject of inquiry, in-depth interview
could take more than one session.
The key characteristics of in-depth interviews are the following:
• Open-endedquestions/guidelines: Questions need to be worded such that
informants do not just answer “yes” or “no” but explains their answer. Many
open-ended questions begin with “why” or “how,” which gives informants
freedom to answer the questions using their own words.
• Semi-structuredformat: Although it is important to pre-plan the key questions
as guideline for interview, the interviewer should converse with participants by
asking questions or prompting based on the previous responses when possible.
• Seek understanding and interpretation: It is important to carefully listen
to what the participant is saying and ask for clarication of what is said. The
interviewer should understand what is said and should seek understanding and
interpretation throughout the interview.
• Recording responses: The responses are typically audio-recorded with the
permission of the informant, and complemented with written notes (i.e., eld
notes) by the interviewer.Written notes include observations of both verbal and
nonverbal behaviors as they occur, and immediate personal reections about
the interview, presence of other person, their relationship with the informant,
and their interference if any. This process is crucial to judge the authenticity of
information provided by the informant.
In sum, in-depth interviews involve not only asking questions, but systematically
recording and documenting the responses to probe for deeper meaning and
understanding.
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Strengths Weaknesses
• Provides more detailed information
than what is available through
quantitative surveys
• Respondents more likely to feel free to
talk when interviewed one-on-one in a
relaxed environment
• Interview takes more time and may
require more than one sitting with the
informant
• Specially trained investigators are
required
Example:
It was estimated that the number of female sex workers (FSWs) attending the STI clinic
and ICTC in Rajasthan is very low. The state AIDS control society in association with NGOs
working with FSWs initiated an SBCC program for improving the STI/HIV screening and
promoting safe sex through group discussion with a peer educator and showing short
documentary lms. .
To assess the impact of SBCC activities on access to STI/HIV services and safe sex practices
by FSWs, in-depth interview with FSWs were conducted. As given in the quotes below,
the in-depth interviews revealed that illiteracy, loss of wages, and fear were the reasons
for not accessing services and receiving more money the reason for not using condoms.
“I cannot read, but I could understand the documentary. It was very useful. Earlier I
never went for STI/HIV testing because I thought it will take time and I may lose my
income. But now I understand the benet of getting tested.”
”I was scared about checking for HIV because I thought if I am found to have HIV, clients
will not come to me, but now I understand how important it is to do health checkups.”
“Earlier if the customer oered me more money, I used to agree for not using condoms.
The documentary helped me to understand the risk of getting diseases if I do not
regularly use condoms. Now I do not agree if the client is not willing to use condoms.”
Key Informant Interviews
These interviews are freely structured conversations with people who have good knowledge
and can give detailed information about the topic the researcher wishes to understand.
Kkey informant interviews provide detailed, qualitative information about impressions,
experiences, and opinions. This is typically a one-to-one talk between the informant and
the researcher. It is mostly used in formative study when the researchers are not well aware
about the situation and could be used before planning the BCC interventions and messages.
In evaluation, this could be used to get explanation of some of the puzzles that emerge from
the quantitative evaluation.
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Strengths Weaknesses
•Opportunity to get an insider’s view
•Can provide in-depth information about the
topic in a short in-depth interview
•Quick and cheap method of gathering
information
•Your relationship with the informant
may inuence the information you get
•Informants may give their own
impressions and biases
•Takes time to select good informants
and build rapport and trust
Example:
To promote male participation in family planning, the Rajasthan state health department
puts up large posters and hoardings at strategic locations along the highway to Delhi
regarding at strategic locations, such as eating joints, regarding benets of using
family planning methods with specic reference to condoms as a means to prevent
pregnancy and sexually transmitted diseases. The health department wants to assess the
eectiveness of locations where the messages are displayed. To assess the eectiveness
of the displayed messages, key informant interviews were conducted with the dhaba
owners, betel shop owners, and chemists regarding the appropriateness of the locations
of the posters and hoardings and the messages and pictures used to illustrate and convey
the messages.
The key informant interview with dabha owner and betel shop owner showed:
“This is a halting point for trucks. I have heard many truckers discussing among
themselves while eating about the hoarding.”
“People come to buy cigarettes from me. I have seen them looking at the poster put up
in my shop as they are smoking. Sometimes they ask if I also sell condoms. Apart from
this they do not ask me anything. Maybe they understand the risk."
The chemist said:
“I think the truckers read and understand the message written in the hoarding because
now-a-days demand for condom has increased.”
Focus Group Discussions
Focus groups are eective in eliciting data on the cultural norms of a group and in generating
broad overviews and perception of issues of concern to the cultural groups or subgroups
represented. They can also be used in monitoring to understand about an activity implemented.
In a focus group discussion (FGD), two researchers (moderator and note taker) meet a group
of participants to discuss a given research topic. These sessions are usually audio-recorded,
and sometimes videotaped. One researcher (the moderator) leads the discussion by asking
participants open-ended questions that require in-depth responses rather than just simple
answers as “yes” or “no.” A second researcher (the note-taker) writes detailed notes on the
discussion and observes and notes their expression to questions.
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To keep the discussion focused, a guideline is prepared listing the key issues on the topic. The
rule of thumb is that one should continue FGDs until the information start getting repeated.
However, as resource constraints may not allow for conducting many FGDs, at least two FGDs
must be conducted for each type of sub-population. For example if reaction of young men
and women to an advertisement on sex education or an educational entertainment serial
aired on radio is to be assessed, at least two FGDs should be conducted for men and two for
women.
A principal advantage of FGDs is that a large amount of information can be collected over a
short period of time. The FGDs are eective in collecting dierent views on a specic topic
from various participants. Unlike in-depth interviews, FGDs are not the best method for
acquiring information on personal or socially sensitive topics.
Key characteristics of FGDs are:
• Heldwithagroupof6to10people
• Participantsarehomogenous with respecttoselected background characteristics and,
in most cases, gender, but not well known to each other. Often in villages it becomes
dicult as most people know each other.
• UsuallytworesearchersleadforeachFGD.OneFGDtakes1.5to2hours.
• FGDsgivequalitativedataonthetopic.Thegoalisnottocometoaconclusion,solvea
problem, or make a decision.
• FGDs seek to obtain insights into attitudes, perceptions, beliefs, and feelings of
participants.
• Thequestioningrouteusespredetermined,sequenced,open-endedquestions.
Steps for Conducting FGDs
Before the focus group discussion begins, the facilitator should obtain background information
on the participants.
The following steps are carried out:
1. After a brief introduction, explain the purpose and scope of the discussion.
2. Structure the discussion around the key themes using the probe questions prepared in
advance (guideline).
3. Use a variety of moderating tactics to facilitate the group.
4. Stimulate the participants to talk to each other, not necessarily to the moderator.
5. Encourage shy participants to speak.
6. Discourage dominant participants through verbal and nonverbal cues.
7. Pay close attention to what is said to encourage that behavior in other participants.
8. Use indepth probing without leading the participant.
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Strengths Weaknesses
• Participants canfreely giveinformation on
the topic that are important to them but
that the evaluator may not have anticipated.
• FGDs provide in-depth insights into how
the participants feel about specic topics
or an activity that was implemented.
Group dynamics during the FGD reduces
participants’ inhibition about sharing their
feelings and stimulates discussion.
• FGDs takeless timeand costcompared to
interviewing them individually.
• Findings are presented in narrative form,
often with actual participant quotations
that can help program leaders grasp
participant's concerns and beliefs.
• Thesmallnumberofrespondentsandthe
lack of random selection signicantly limit
the ability to generalize the ndings to a
larger population.
• The interaction of participants with the
researchers and with each other may
aect respondents’ willingness to give
diering opinions, particularly if the
group is not homogeneous with respect
to caste, class, and age prole.
• Respondentsmayhesitatetoexpresstheir
concerns in a group setting with peers or
colleagues, but be more likely to express
themselves in one-on-one interviews.
Example:
The use of spacing methods among young women was low in Bihar due to myths and
misconception regarding the side eects of IUCD. It was also noted that the involvement
of women in SHG meetings are high in the state. The Department of Health and Family
Welfare in association with various SHGs initiated an SBCC program on awareness about
the spacing method. In each SHG meeting, half an hour was devoted to discussing the
health issues and family planning use and the ASHAs/ANMs used video clips and leaets
to provide information about various spacing methods. They also tried to dispel various
myths associated with condom use.
The department wanted assess the eectiveness of using the SHG forum and the SBCC
program, whether the video clips were appropriate to convey the message and how
eective the sessions conducted by the ASHAs/ANMs were. FGDs were conducted with
eligible women and found that there was a common belief that the IUCD may go up to
the chest and can harm the woman using it, or it can cause cancer but the video clips and
sessions by the ASHAs/ANMs helped to overcome these beliefs and many women had
adopted IUCD use.
Sample Size Determination in Qualitative Methods
The study’s research objectives and the characteristics of the study population (such as size
and diversity) determine which and how many people to select. An appropriate sample size
for a qualitative study is one that adequately answers the research question and depends
on various factors. However, there are some informal rules. The following table gives some
thumb rules to decide about the number of such qualitative interviews:
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MinimumSampleSizeRequirementforEachQualitativeMethod
Data Collection Method Rule of Thumb
Observation method Observe at least 2 episodes for each category of the research
question. For example, for counseling of women and men, plan
to observe at least 4 sessions (2 for women and 2 for men).
Key Informant Interviews Select the persons highly recommended by the community and
who are knowledgeable about the topic under investigation.
Depending on the topic and purpose, interview approximately
3–5persons.
In-depth interviews
Interviewapproximately3–5personsforeachcategoryinthe
research question. For example, if interviewing mothers with
children younger than 6 months and children 6–12 months,
plan to interview 5 mothers in each group for a total of 10
mothers. To get variation in answers select informants from
diverse segments such as age group, caste, or income group.
Focus groups
Interview approximately 2 groups for each category in the
research question. For example, when studying males and
females of 3 dierent age groups, plan for 12 focus groups
discussions.
Source: Adapted from a presentation by Dr. Bonnie Nastasi, https://my.laureate.net/Faculty/docs/.../qualit_res__smpl_size_consid.doc
Development of Guidelines for In-depth Interviews/Focus Group
Discussions
While developing an interview guideline, ensure that the following steps are followed:
• Use open-ended rather than closed-ended questions. For example:
– Open-ended: “Please describe the services provided at the clinic” or “What are the
main sources from which you seek information about health care?”
– Closed-ended: “Do you know about the services provided at the clinic?”
• Ask general questions rst and then more specic questions.
• Ask positive questions before negative questions.
• Ask factual question before opinion questions. For example, ask, “What activities were
conducted?” before asking, “What did you think of the activities?”
• Ask follow-up questions about the views the informants give, such as:
– Would you please give me an example?
– Can you please describe that idea?
– Would you please explain that further?
– Is there anything more than this?
• Review the guide and eliminate any irrelevant questions.
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In summary, qualitative research:
Is scientic research that aims to gather an in-depth understanding of the“how” and
“why” of human behavior.
Complements and explains quantitative ndings.
Can be done independently as a formative study or to assess quality of an activity
Implemented.
References
1. Qualitative Research Methods: A Data Collector’s Field Guide. FHI 360, 2005.
2. Focus Group Facilitation Guidelines. Adapted from Centre for Higher Education Quality,
Quality Advisor at Monash University
3. Evaluation of HIV prevention programs using qualitative Methods. Booklet 9. CDC
4. C-Change Module 5 (Facilitator), USAID
5. www.nucats.northwestern.edu/...research/.../Family_Health_International.
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Module 7
DEVELOPING TERMS OF REFERENCE FOR SOCIAL AND
BEHAVIOR CHANGE COMMUNICATION EVALUATION
Learning Objectives
By the end of this session, you will be able to:
Develop a Terms of Reference for SBCC evaluation
Prepare timeline for an evaluation
Determine appropriate sample size
The Terms of Reference (ToR) is a document that describes the purpose and structure of
conducting an evaluation by consultants or organizations. Ensuring a meaningful and useful
evaluation is very much linked to a well-specied ToR. The ToR is the basis of a contractual
agreement with the evaluators. It states the objectives and species the scope of an evaluation
and the questions to be answered, leaving room for suggestions from the evaluators.
The ToR describes the distribution of tasks and responsibilities among the people participating
in the evaluation process. It species the qualications required of the evaluation team as well
as the criteria to be used to select an evaluation team. The ToR xes the deliverables, time frame,
andbudget.Itshouldbebrief(typically5–10pages),andifnecessarysupplementedbyrelated
appendices.
The purpose of this chapter is to acquaint program managers who are often involved in planning
evaluation and commissioning consultancy services or other research institutions. In such cases,
they must know the key components that go in the ToR, which ensures that the study follows
correct procedures and provides desired deliverables.
The following key elements should be included in developing the
ToR for the contracting process:
Background and rationale for the evaluation
This section should include:
• Programgoalandobjectivesandthecontextunderwhichthisprogramwasinitiated
• Relevant information about the program implementation, especially program
audience’s geographical area, roles and responsibilities of implementing partners, and
the program period
• Anyspecicareaoftheprogramthatneedsattentioninevaluation
• Rationaleforevaluation
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Objective of the evaluation
In this section, the ToR should explain the purpose/objective of the evaluation. This is an
important part of the ToR against which the evaluation activities will be planned and the
conclusion of ndings will be consolidated.
Scope of the evaluation
• Includekey evaluationquestions that needto be answeredwith respect torelevance,
eectiveness, and eciency of the program. Link key questions directly to the stated
objectives. The evaluation questions provide guidance to the evaluators. This will limit
gathering large quantities of data to generate sophisticated indicators that make little
contribution to practice or policy.
• Formulatekey questions thatthe stakeholderswillnduseful,forwhichthereis a real
need for answers. If a question is only of interest in terms of new knowledge, without any
immediate input into decision making in the program or into the public debate, it is more
a matter of scientic research and should not be included in an evaluation. Questions
should be directly linked to the main objective of the evaluation.
Check if the formulated questions can actually be answered in the evaluation:
1. Is the data required to answer the question available?
2. Are there already any results that can be evaluated?
3. Is the question clear? If the question can be interpreted in dierent ways, the program
might get a proposal that does not match its expectations.
4. Is it necessary to have an evaluation to answer the question, or could the monitoring
system or a discussion be sucient? This check may lead to a decision not to undertake
the question in the evaluation, or to revise the question.
Methodology for evaluation
• Thechoiceofmethodstobeusedisgenerallymadetoallowsucientexibilityforthe
agency responding to the ToR. It will allow the program manager to dierentiate in terms
of the relevance and clarity of their proposed methodology (refer to Module 5 for research
design) and sample size (refer to Appendix 1 for sample size determination).
• Thisisespeciallyimportantintheselectionphasebecauseassessingthemethodological
qualities of the proposals is a crucial step in selecting the right evaluator.
• The program manager who will be selecting the evaluation agency must be capable
of judging the methodological quality and proposed sample size in the proposals. So
including design, he or she should also have a fair idea about sample size for judging the
proposal. For sample size determination, consult a sampling expert.
Roles and responsibilities
• Fortimelyandeectiveevaluation,contributionisoftenmadebyvariousorganizations
or groups or consultants, for example:
– Sharing of detailed program background
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– Varioustoolsandcommunicationmaterialsusedintheprogram
– Listofprogramcommunitiesorlocations
– Baselinedata/reports,ifavailable
– Appointmentswithkeypersonnelforinterviews
It is useful to mention in the ToR the people/organization responsible for sharing of such
documents and records.
Time schedule & reporting
In this section, include the expected activity timeline for the evaluation:
• Indicatetheperiodoftheevaluation.
• Indicate the timeline for key activities proposed for the evaluation along with critical
dates and deliverables in the ToR.
• Ifanevaluationislinkedtocertaineventsfordecisionmaking,mentionthosetoensure
that the evaluation will be ready in time. This timeline could be proposed by the evaluator
and agreed upon before the task agreement is signed. A suggested format for activity
timeline in months is given below; it could be modied with activities and quarterly or
yearly timeline as per the requirements.
Format for Timeline of ToR for Evaluation
Activity M1 M2 M3 M4 M5 M6 M7 M8 M9
Communication of ToR to listed
agency or advertised
Deadline for proposals
Selection of an agency
Planning meeting to start
evaluation
Data collection and analysis
Meetings between program and
evaluating agency
Draft report
Feedback and meeting with
Evaluation Steering Group
Final report
Presentation and discussion of
nal report
It is also important to indicate the expected types of reports in the ToR:
• Broad framework for the nal report: background and objectives; sample size and
methodology; analysis and ndings; and discussion and conclusions. In addition, mention
in the ToR if there are any key elements to be included in the report like secondary data
ndings, evaluation tools used, and key personnel or groups.
• Indicateifanyinterimreportsorexecutivesummaryisrequired.
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• Specifytherequirednumberofhardcopiesandsoftcopiesofthevariousreports.
• Mentionisanyrequiredoralpresentationsofthendingsalongwiththetypeofaudience
expected to be present.
Budget
It is good practice to suggest an indicative maximum budget and then leave those competing
for an evaluation by open tender to suggest what they would be able to provide for the budget
available. This allows value-for-money assessments to be made. It also provides the contractor
of the evaluation with greater control over expenditures.
• Ask for a detailed budget. Use your organizational budget template and mentionkey
expected line items.
• Mentionifthereareanylimitstooverheadchargesandpurchasinghardware.
• Indicateifanyapprovalsarerequiredinshiftingbudgetlineitems.
• AskforadescriptionofeachbudgetlineitemintheToRtofurtherjustifythebudget.For
example, contribution of key personnel listed and details about travel budget.
Requiredqualicationsoftheevaluators
It is a good idea to reect in advance the expected criteria among the evaluators. Here are some
possible experiences lists that the evaluator could be asked to submit:
• Experiencewithevaluationandwithaspecictopic
• Academicresearchorpracticalsolutions
• Experiencewithcertainmethodsofevaluation
• SpecicevaluationofSBCCprograms,ifany
• Experiencewithcertaincountries/regions
• Knowledgeofcertainlanguages
The types of organizations or consultants eligible or not eligible to apply could also be included
in the ToR. For example:
• Those with ongoing evaluation of another program implemented by you may not be
eligible
• Onlyorganizationsthatareregisteredforatleast2yearsundertheSocietiesRegistration
Act are eligible
Proposal submission rules and assessment criteria
The ToR should specify the deadline and the modes of submission (post, email), the language
in which the proposal must be submitted, and how long the oer should remain valid. It should
also indicate the criteria according to which the proposals will be judged and selected. The ToR
should state, for example, the relative importance in percentage points that will be given to:
• Thequalityofthemethodologicalapproachproposed
• Thequalicationsandpreviousexperienceoftheconsultant/agency
• Thecapacitytoundertakethecurrentevaluation
• Thebudget
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Proposal Outline
• CoverPage–Projecttitle;contactperson’snameandcontactdetails;dateofsubmission.
• ExecutiveSummary
• Context/Background(UnderstandingandneedfortheRFP)
• Methodology
• HR/StangPlan
• Budget(Briefbudgetallocationunderlineitems)
• Personnel
• Travel
• DirectCostsandIndirectCosts/Overheads
• Appendices:CVs/biosofkeyteammembers
It is recommended to make a clear list of assessment criteria for the proposals and to include
these (in a summarized form) in the ToR. Many proposals use the assessment model shown
below.
• The content and budget are assessed separately and are therefore sent in separate
envelopes.
• The assessment of the proposal should be done anonymously with the names of the
evaluators concealed.
Criteria for Scoring Potential Evaluators
Topic Maximum
points(e.g.)
Initial
assessment
Revised
assessment
Organization and methodology
Rationale (understanding of and reection on the
ToR, risks and assumptions)
20 [score] [score]
Strategy (approach, activities, timetable,
milestones, logical framework)
40 [score] [score]
Evaluation team
Experience (description of company/consortium,
division of tasks). For example:
(a) Experience in evaluations
(b) Experience with the program area
(c) Experience with SBCC program evaluation
20 [score] [score]
Experts (CVs, division of tasks) 20 [score] [score]
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Appendix 1:
Sample Size Determination
The size of the sample is determined primarily by two things: 1) the availability of resources,
which sets the upper limit of the sample size; and 2) the requirements of the proposed plan of
analysis, which sets the lower limit. For instance, the availability of trained interviewers to do a
survey in specied period of time may be insucient to permit more than a certain number of
interviews, in which case the sample size cannot exceed this number. On the other hand, the
sample size must be large enough:
• Toallowforreliableanalysisofcross-tabulations
• Toprovidefordesiredlevelsofaccuracyinestimatesofproportions
• Totestforthesignicanceofdierencesbetweenproportions
If the resources available for a study are inadequate to obtain a sample of sucient size, then
the researcher must either nd additional resources or revise the plans for data analysis.
To calculate the minimum sample size required for accuracy in estimating proportions, answer
the following questions:
1. What are reasonable estimates of key proportions to be measured in the study? For
example, if you are studying contraceptive prevalence, you should try to guess what
prevalence rate you will obtain. If you cannot guess what it will be, the safest procedure is
to assume it is 50 percent, which maximizes the expected variance and therefore indicates
a sample size that is sure to be large enough.
2. What degree of accuracy do you want to have in your study? How far can you allow
the sample estimates of key proportions to deviate from the true proportions in the
population as a whole? For instance, if you nd that the sample estimate of the prevalence
rate is .50, do you want to be condent that this nding is accurate within 1 percent or
5 percent (usually referred to as the .01 and .05 level, respectively)? If you seek a high
degree of accuracy (such as .01), your sample will need to be much larger than if you seek
a relatively low degree of accuracy (such as .05).
3. What condence level do you want to use? How condent do you want to be that the
sample estimate is as accurate as you wish? Customarily, the 95 percent condence level
is specied.
4. What is the size of the population that the sample is supposed to represent? If it is greater
than 10,000, the precise magnitude is not likely to be very important. But if it is less than
10,000, the required sample size may be smaller.
5. If you are seeking to measure the dierence between the two subgroups with regard to
a proportion, what is the minimum dierence you expect to nd statistical signicance?
For instance, if you are comparing the contraceptive prevalence of an experimental group
and a control group, and you nd a dierence of only 5 percentage points, do you expect
a dierence this small to be statistically signicant? The smaller the dierence you expect
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to be signicant, the larger your sub-sample sizes will have to be.
On the basis of your answers to these ve questions, you can calculate the sample size needed
to measure a given proposition with a given degree of accuracy at a given level of statistical
signicance by using a simple formula, provided that the total population size is greater than
10,000:
n = z2pq
___________
d2
Where:
n = the desired sample size (when population is greater than 10,000)
z = the standard normal deviate, usually set at 1.96 (or more simply at 2.0), which
corresponds to the 95 percent condence level.
p = the proportion in the target population estimated to have a particular
characteristic. If there is no reasonable estimate, then use 50 percent (0.50).
q = 1.0–p.
d = degree of accuracy desired, usually set at 0.05 or occasionally at 0.02.
For example, if the proportion of a target population with a certain characteristic is 0.50,
the z statistic is 1.96, and we desire accuracy at the 0.05 level, then the sample size is:
1.96*1.96* (0.50)*(0.50)
___________________
(0.05*0.05)
= 384
If we use the more convenient 2.0 for the z statistic, then the sample size is 400.
Note that the numerator in this case is 1.0. This means that when you assume the proportion is
0.05 and set a 95 percent condence level by using z equal to 2.0, then formula for sample size
is simply:
n = 1
________
d2
In summary, these three steps are important for sampling:
1. Decide rst whether you want to draw a sample and, if so, whether it should be a
probability sample or a non-probability sample. In making this decision, take into account
the objectives of the study, the extent to which you want the ndings to be representative
of a larger population, and such resource factors as cost, time, and personnel.
2. Calculate the size of the sample required for your study. You may use the formulas given
above, but it is best to also seek the assistance of a statistician if possible. The statistician
will need to know your estimates of the proportions to be tested, the degree of accuracy
you seek or magnitudes of dierences you wish to test, the condence levels you wish to
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use, and the approximate size of the population from which the sample will be
drawn.
3. Bear in mind the following basic principles:
• Alargersamplewillyieldmoreaccurateresultsbutwillbemorecostlythana
smaller sample.
• Aprobability sample will providequantitativedatamore representativeofa
larger population than will a non-probability sample, but a non-probability
sample can be designed in such a way as to maximize insightful qualitative
data from relatively small samples.
• Ifyourproposedanalysiscallsforstudyingparticularsubgroupsofyoursample,
your sample size will need to be expanded accordingly. For example, to study
characteristics of a group of acceptors, you may need a sample of only 400,
but if you want to extend the analysis to the acceptors of particular methods,
the sub-sample sizes will be too small to yield signicant ndings unless the
total sample size is increased. Even if statistical signicance is not considered
very important, there should be at least 50 cases in the smallest subgroup to
be studied if you want to obtain even moderately reliable percentages.
References
Andrew A. Fisher et. al., 1998 Handbook for Family Planning Operations Research Design.
Population Council.
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Glossary
Accredited Social Health Activist (ASHA): are local women trained to function as community
health workersinstituted by theMinistry of Health and Family Welfare, Government of India,
as part of the National Rural Health Mission.
Attitude: is a cross cutting factor. Personal dispositions towards a particular subject or
situation; how we generally feel about a situation. This is a concept from the individual level
theories in the Graphic: Concepts of Selected SBCC Theories
Barrier: is a diculty or obstacle that can stop people from performing desired behaviors to
the identied problem.
Behavior Change Communication (BCC): is a researched based, consultative process
of addressing knowledge, attitudes, and practices through identifying, analyzing, and
segmenting audiences and participants in programs and by providing them with relevant
information and motivation through well-dened strategies, using an appropriate mix of
interpersonal, group, and mass media channels including participatory methods.
Biomedical Interventions: are interventions in which the administration and use medicines
are key features.
Campaign: is goal oriented recognizable attempt to inform, persuade or motivate change
within the intended audiences; linked series of activities using dierent media with mutually
supportive messages.
Channel: is the medium used for communication. The three categories of communication
channels are interpersonal, mid-media, and mass media. Interpersonal channels include direct
communication with an individual or group of individuals. Mid-media channels reach a group
of people within a distinct geographic area or reach a group that shares common interests or
characteristics. Mass media channels are those which can reach large audiences quickly.
Cohort: is a group of people sharing a common characteristic, e.g. females born in 1985,
males who have never had sex, etc.
Control: Scientists investigate the eect of various factors one at a time in an experiment and
keep control for study. Control group do not receive treatment and represents population
before treatment or if no treatment. They are kept for comparison purpose.
Communication Objective: Communication objectives are ways to address barriers to
achieve desired change in policies, social norms, or behaviors. They are audience specic and
contribute to program objectives.
Communication Strategy: is a comprehensive document that guides and links decisions on
intended audiences, communication objectives, channels and materials based on analysis
and integrated by a strategic approach.
Community: is a group united around a shared characteristic or concern or a group of people
located in the same area.
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Conceptual Framework: is a diagram of a set of relationships between factors that are believed
to impact or lead to a target condition. It is the foundation of project design, management,
and monitoring.
Crosscutting Factors: These are represented in the triangle of inuence in the socio ecological
model. These factors are put into four large categories: information, motivation, ability to act,
and norms which SBCC interventions may be able to modify to generate change.
Data Sources: The resources used to obtain the data needed for M&E activities. These sources
may include, among many others, ocial government documents, clinic administrative
records, sta or provider information, client-visit registers, interview data, sentinel-surveillance
systems, and satellite imagery.
Dependent Variable: The measure of behavior that is used to assess the eect of the
independent variable. In most research, several dependent variables are measured to assess the
eects of the independent variable.
Determinant: Are factor that cause changes in behavior such as media exposure, education
etc.
Diusion of Innovation: is a process by which an innovation is spread in a given population
over time. Under the right conditions, innovations (new services, products, best practices) can
be successfully introduced/communicated and adapted at the individual, community, and
organizational level.
Ecological: In this context, ecological means the relationships between individuals and their
environments.
Environment: is the physical, emotional, or social contexts that shape community and
individual attitudes and behaviors.
Epidemic: denotes signicantly high incidence of disease occurrence in a population.
Evaluation: is a process that attempts to determine as systematically and objectively as
possible the relevance, eectiveness, and impact of activities in light of their objectives.
Experiment: is an empirical method that arbitrates between competing hypotheses.
Experimentation is used to test existing theories or new hypotheses in order to support them
or disprove them. Any study in which a treatment is introduced is an experiment. It looks for
cause and eect relationships.
Experiments vs Non-experiments: An experiment is any study in which a treatment is
introduced. However, a non-experimental study does not introduce a treatment but is
exploratory in nature.
Focus Group Discussion: is discussion in which a small group of people, usually 8 to 10, talk
about a topic of common interest to all the participants. These group discussions take place
under the guidance of a facilitator and are used to collect research data or test materials.
Formative Research: is the research conducted during the planning process that allows
program planners to obtain insight into the knowledge, attitudes, and practices of the
situation. This research helps to form, plan and develop communication programs and
determine audiences and strategies.
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Framework: is an open set of tools for project planning, design, management, and performance
assessment. Frameworks help to identify project elements (goals, objectives, outputs, and
outcomes), their causal relationships, and the external factors that may inuence success or
failure of the project.
Goal: is a broad statement of a desired, long-term outcome of a program. Goals express
general program intentions and help guide a program’s development. Each goal has a set of
related, more specic objectives that, if met, will collectively permit program sta to reach the
stated goal.
Incidence: is the number of new cases of infection within a specied period of time.
Independent variable: are factors that researchers control or manipulate in order to determine
the eect on behavior.
Indicators: are quantitative or qualitative measures of program performance that are used to
demonstrate change and that detail the extent to which program results are being or have
been achieved. Indicators can be measured at each level: input, process, output, outcome,
and impact.
Information: is a crosscutting factor. People need information that is timely, accessible, and
relevant. When looking at information consider the level of knowledge held by that person or
group, e.g., about modern contraceptives and their side eects.
Informal Communication: is a communication networks that fall outside of established
systems for conveying information, e.g. information communicated over drinks at the bar or
by the communal pipe stand.
Information Education and Communication (IEC): a process of providing information and
education to individuals and communities to promote healthy behaviors that are appropriate
to their context.
Impact: is the anticipated end results or long-term eects of a program. For example, changes
in health status such as reduced disease incidence or improved nutritional status.
Impact Evaluation: is a set of procedures and methodological approaches that show how
much of the observed change in intermediate or nal outcomes, or “impact,” can be attributed
to the program. It requires the application of evaluation designs to estimate the dierence in
the outcome of interest between having or not having the program.
Input: are the resources going into conducting and carrying out the project or program.
These could include sta, nance, materials, and time.
Interpersonal Communication: is a face to face exchange of e.g.; information, education,
motivation, or counseling.
Intervention: is a set of complementary program activities designed to achieve program
goals.
Learning: is a process of mastering or internalizing values, knowledge, skills through
socialization, formal instruction, or experience.
Logic model: is a visual representation that charts (or maps) a path for the problem to be
addressed, to the inputs (available resources), then outputs (activities and participation) to
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nally arrive at outcomes (short, medium and long term results), which will ideally lead to
impact (long lasting change).
Logical Framework: is a dynamic planning and management tool that logically relates the
main elements in program and project design and helps ensure that an intervention is likely to
achieve measurable results. It helps to identify strategic elements (inputs, outputs, purposes,
and goal) of a program, their causal relationships, and the external factors that may inuence
success or failure.
Message: is a brief, value based statement aimed at an audience that captures a concept.
Messages must be personally appealing and discuss only one/two key points. The information
in the message should be new, clear, accurate, and complete, culturally appropriate, and
include specic suggestions of what people can do.
Metric: is the precise calculation or formula that provides the value of an indicator.
Model: it draws upon multiple theories to try to explain a given phenomenon.
Modeling: is a process where people learn not only from their own experiences but also by
observing others actions and the benets that they gain through those actions.
Monitoring: is the routine process of data collection and measurement of progress toward
program objectives. It involves tracking what is being done and routinely looking at the types
and levels of resources used; the activities conducted; the products and services generated
by these activities, including the quality of services; and the outcomes of these services and
products.
Monitoring and Evaluation (M&E) Plan: is a comprehensive planning document for all
monitoring and evaluation activities within a program. This plan documents the key M&E
questions to be addressed: what indicators will be collected, how, how often, from where,
and why; baseline values, targets, and assumptions; how data are going to be analyzed and
interpreted; and how/how often reports will be developed and distributed.
Multivariate Analysis (MVA): refers to any statistical technique used to analyze data that arises
from more than one variable. This essentially models reality where each situation, product, or
decision involves more than a single variable. In design and analysis, the technique is used to
perform trade studies across multiple dimensions while taking into account the eects of all
variables on the responses of interest.
National Institute of Health and Family Welfare: is an autonomous organization, under
the Ministry of Health and Family Welfare, Government of India, acts as an ‘apex technical
institute’ as well as a ‘think tank’ for the promotion of health and family welfare programs in
the country.
National Rural Health Mission: is the Indianhealth program, run by theMinistry of Health
since 2005, for improvinghealth care deliveryacross rural India.
Objectives: are signicant development results that contribute to the achievement of goals
and provide a general framework for more detailed planning for specic programs. Several
objectives can contribute to each goal. Examples: “to reduce the total fertility rate to 4.0 births
by Year X” or “to increase contraceptive prevalence over the life of the program.”
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Outcomes: are the changes measured at the population level in the program’s target
population, some or all of which may be the result of a given program or intervention.
Outcomes refer to specic knowledge, behaviors, or practices on the part of the intended
audience that are clearly related to the program, can reasonably be expected to change over
the short-to-intermediate term, and that contribute to a program’s desired long-term goals.
Output: are the immediate result obtained by the program through the execution of activities
(e.g., number of commodities distributed, number of sta trained, number of people reached,
or number of people served). Good process monitoring of outputs from activities (if mutually
supportive) can lead to program outcomes and hopefully have impact!
Population: is set of all cases of interest. For example: All currently married women aged 15-49
in a district.
Pretesting: is a type of formative evaluation that involves systematically gathering intended
audience reactions to messages and materials before the messages and materials are
produced in nal form.
Prevalence: is the proportion of persons in a population who have a particular disease or
condition.
Process: is set of activities in which program resources are used to achieve the results expected
from the program (e.g., number of workshops or number of training sessions).
Process Evaluation: is a type of evaluation that focuses on program implementation. Process
evaluations usually focus on a single program and use largely qualitative methods to describe
program activities and perceptions, especially during the developmental stages and early
implementation of the program.
Qualitative Method: it helps build an in-depth picture among a relatively small sample
of people on a specic issue. Questions are asked in an openended way and the ndings
are usually analyzed as data is collected. Information gathered should not be described in
numerical terms, and generalization about the intended audience cannot be made.
Quantitative Method: are things that are either measured or counted, or questions are
asked according to a dened questionnaire so that the answers can be coded and analyzed
numerically by asking a large number of people identical (and predominantly close ended)
questions.
Randomization: is true experiment that involves assignment to treatment groups based on
random selection. All participants have equal chance of being chosen for experimental group
or control group
Reliable: Results those are accurate and consistent through repeated measurement.
Risk: is an increased probability of being aected.
Risk Factors: are conditions associated with increased likelihood of a particular disease
or condition, e.g. individual behaviors, lifestyle, environmental exposure or hereditary
characteristics.
Routine Data Sources: are resources that provide data collected on a continuous basis, such
as information that clinics collect on the patients utilizing their services.
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Sample: subset of the population used to represent the population.
Sampling: refers to the procedures used to obtain a sample.
Sampling Frame: is the list of members of a population. For example: All currently married
women aged 15-49 delivered a baby in last one year in 50 gram panchayat
Situation Analysis: is a systematic review of social, cultural, political, and behavioral data
aimed to identify internal and external determinants of a situation, such as immediate and
underlying cause and eects.
SMART (Objectives): specic, measureable, attainable, realistic, time bound
Social and Behavior Change Communication (SBCC): is an evidence -based, consultative
process of addressing knowledge, attitudes, and practices through identifying, analyzing, and
segmenting audiences and participants in programs and by providing them with relevant
information and motivation through well-dened strategies, using an appropriate mix of
interpersonal, group and mass media channels, including participatory methods.
Social Change Intervention: are activities directed at changing conditions within the social
environment.
State Institute of Health and Family Welfare: is a state level institution for improving the
total eectiveness of health care delivery system by imparting knowledge and technical skills
at dierent levels within the state.
State Project Implementation Plans: are the annual health plans developed by the state that
includes strategies to be deployed and budgetary requirements against the expected health
outcomes.
Strategy: is a coordinated and comprehensive set of activities aimed at achieving an objective.
Theory: is a systematic and organized explanation of events or situations. Theories are
developed from a set of concepts (or “constructs”) that explain and predict events/situations,
and provide explanations about the relationship between dierent variables.
Theory of Change (TOC): is a “concrete statements of plausible, testable pathways of change
that can both guide actions and explain their impact”
Tipping Point: is the dynamics of social change where trends eventually become permanent
change. They can be driven by a naturally occurring event or a strong determinant for change,
suchaspoliticalwillthatcanprovidethenalenergyto“tipover”asituationtochange–they
are events that prompt change.
Tools: are instruments (e.g. worksheet, checklist, or graphic) that assist or guide practitioners
in the understanding and application of concepts in their programmatic work.
Trend: is a pattern in frequencies of disease incidents or prevalence over time, within or across
various subgroups.
Triangulation: is the use of multiple data sources or methods to validate ndings, discover
errors or inconsistencies, and reduce bias.
Valid: a term used to describe an objective, methodology or instrument that measures what
it is supposed to measure.
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Variables: a trait or characteristic with two or more categories. Categories should be mutually
exclusive (Each participant belongs to one and only one category) and exhaustive (Variable has
a category for each participant).
Theory of Change (TOC): is a “concrete statements of plausible, testable pathways of change
that can both guide actions and explain their impact”
Tipping Point: is the dynamics of social change where trends eventually become permanent
change. They can be driven by a naturally occurring event or a strong determinant for change,
suchaspoliticalwillthatcanprovidethenalenergyto“tipover”asituationtochange–they
are events that prompt change.
Tools: are instruments (e.g. worksheet, checklist, or graphic) that assist or guide practitioners
in the understanding and application of concepts in their programmatic work.
Trend: is a pattern in frequencies of disease incidents or prevalence over time, within or across
various subgroups.
Triangulation: is the use of multiple data sources or methods to validate ndings, discover
errors or inconsistencies, and reduce bias.
Valid: a term used to describe an objective, methodology or instrument that measures what
it is supposed to measure.
Variables: a trait or characteristic with two or more categories. Categories should be mutually
exclusive (Each participant belongs to one and only one category) and exhaustive (Variable has
a category for each participant).
The Family Health International (FHI 360)-managed Behavior Change Communication –
Improving Healthy Behaviors Program (IHBP) in India project is a United States Agency for
International Development (USAID)/India-funded program. IHBP aims to improve adoption
of positive healthy behaviors through institutional and human resource capacity building of
national and state institutions and through development of strong, evidence-based social and
behavior change communication programs for government counterparts.
IMPROVING HEALTHY BEHAVIORS PROGRAM IHBP
FHI 360
1825 Connecticut Avenue, NW
Washington, DC 20009
www.fhi360.org, www.ihbp.org
The Population Council confronts critical health and development issues—from stopping the
spread of HIV to improving reproductive health and ensuring that young people lead full and
productive lives. Through biomedical, social science, and public health research in 50 countries,
we work with our partners to deliver solutions that lead to more eective policies, programs,
and technologies that improve lives around the world. Established in 1952 and headquartered
in New York, the Council is a nongovernmental, nonprot organization governed by an
international board of trustees.
POPULATION COUNCIL
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Tel: 91-11-24642901/2, Fax: 91-11-24642903
Email: Info.india@popcouncil.org
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