At Calcutta Kids, community meetings are held to divulge health messages through meetings focused on various health topics. The community meetings also serve to promote interaction among the mothers of the community. Through the monthly meetings, Calcutta Kids promotes positive health-seeking behavior through the method of Behavior Change Communication (BCC). Women from the community have expressed the need for such a platform where they can share ideas, discuss challenges they face or simply sit along with other women from their community as they drink chai and listen to the health workers about life-saving practices they may adopt.
The health workers do a great job of getting the health messages across to the mothers, usually through an interactive lecture. They encourage mothers to ask questions, share personal experiences and initiate discussions. However, there seems to be a gap between the information that is conveyed during these meetings and the change in practices of the women. After a meeting, the women are able to repeat verbatim, some of the messages of “You must wash your hands before cooking” or “You must eat 6 times a day when pregnant.” Are they really adopting these practices in their homes though? In some of my visits to the community I found that this is not the case in all households.
For example, during my community visit with a health worker on the day of a religious festival, I observed 6 pregnant women who were fasting all day for the good health of their husbands in the future. In some of these cases pregnant women were fasting despite discouragement to do so from their husbands and mothers-in-law (both powerful family members who influence the actions of the mothers). These were mothers who had been to the community meetings and knew well the information about the importance of good nutrition for themselves and their children but continued this detrimental practice. Cultural and religious factors, domestic burden of having to work at home all day, and the simplicity of not having to take that extra step to eat one more meal or wash your hands one extra time often becomes the cause of poor health.
In order to initiate transformative change in the mothers of the community, it is necessary to create reflective processes in a safe space for women to explore their feelings. Providing them with health messages is necessary to build awareness, but in addition to this the health workers need to use approaches that encourage women to think about their behaviors. “Experts who study behavior change agree that long-lasting change is most likely when it is self-motivated and rooted in positive thinking.”(1) Additionally, the setting of a community meeting helps to “recognize the social nature, because it is the co-presence of others thinking alongside us that matters as much as the thinking itself, helping us change our attitudes and reflect on our values, while also acting as commitment devices.”(2)
In order to address this challenge and use different strategies to inculcate positive health behaviors, we are having an offsite training this week where we will introduce various counseling techniques to the health workers. A review of Child Health topics such as “Care of a Sick Child”, “Care of a Low birth Weight Baby, Child Growth and Development”, “Post natal care and Breastfeeding”, and “Feeding practices and Immunizations” will be carried out through the use of various activities to communicate the health messages. Two new topics will also be introduced 1) Family Planning and 2) Hygiene and Sanitation. These health topics will be reviewed using puppet shows, discussion groups, role-play, interactive games and ‘Forum Theater to demonstrate the use of multiple techniques that can aid in communicating behavior change.
Forum theater created by the Brazilian director Augusto Boal, serves as an interactive form of theater where dramatic sketches are created through discussion to show scenes where we see a problem that needs to be changed. When the play is acted out, members of the audience are allowed to step in and portray their solution in the given situation thus evolving from mere spectators into “spect-actors”. “The aim is not to find the best solution but to produce a variety of options that could be used in this type of situation.”(3) Forum theater functions by allowing the audience as well as the actors to experience real-life situations in a stage setting with the opportunity to offer multiple solutions to a problem they face. We aspire to introduce the concept of Forum theater to the staff of Calcutta Kids to build community and dialogue on the various problem situations that create obstacles for behavior change in the community. Through this training we hope to ignite the creative minds, especially our community health workers who can use such activities at the community meetings to aid in their counseling techniques.
The training begins at our MoSSK on Thursday 7th February and will continue at an outside training center where we will spend the weekend together. There will be briefing about the various protocols, lecture sessions, leadership training activities and group work. Word on the street is that there is also an eco-friendly newspaper fashion show to encourage staff bonding and a little bit of fun! -Sriya Srikrishnan
(1) Harvard Women’s Health Watch January 2007 issue
(2) John, Peter and Smith, Graham and Stoker, Gerry (2009) Nudge nudge, think think: two strategies for changing civic behaviour. Political Quarterly, 80 (3). pp. 361-370. ISSN 0032-3179
(3) Séguin, Angèle Rancourt, Clémence The Theatre: An Effective Tool for Health Promotion http://whqlibdoc.who.int/whf/1996/vol17-no1/WHF_1996_17(1)_p64-74.pdf