Digital messages for behaviour change in low-income contexts.

Digital and data solution to deliver rapid messaging that drives behaviour change among vulnerable populations, and provides evidence to decision-makers.

Yolandi J Rensburg, Every1Mobile Director of Digital Engagement: expert in behaviour change with 12 years’ digital experience to create engaged online communities and interactive learning for emerging markets. 

Behaviour Change Communications (BCC) is essential to prepare for and mitigate the impacts of pandemics, but challenges reaching scale with contextually appropriate messaging and evidence of impact, persist.  CARE’s rapid gender analysis (1) shows that women and youth are disproportionately affected by COVID-19. Complex socio-economic barriers, trust and relevance of health information, affects their agency to actively respond to public health-messaging and convert information into behaviour change (2). 

Traditional media channels used for BCC (TV, radio) cannot provide sufficient measurement of impact or reach. Increased mobile penetration creates new opportunities for digital BCC, and disseminate health messages rapidly and cost-effectively (67% of Kenyan youth received COVID-19 information via social media, 49% from friends/ internet) (3). Despite the digital opportunity, a steep increase of “infodemics” (ibid.), highlights the need for trusted sources of information.   

Civil society and government decision-makers lack data, insights and digital delivery mechanisms to reach scale, and evidence real-world behaviour change. This risks ineffective messaging and use of funds. 

Current data is limited to tracking only health-seeking behaviours (4) and there is limited disaggregated data on the impact of COVID-19 on vulnerable groups. (5). 

Low-income communities from the two-poorest quintiles in Kenya, targeting: 

• Women (typically caregivers, 30-45 years, urban and rural, active members of CARE’s Village Saving and Loans Associations (VSLAs)). 
• Youth (15-20 years, informal settlements in Nairobi, active members of CARE’s Youth Savings and Loans Associations (YSLAs) and youth coalition groups across each county.) 

Users will benefit from interactive, regular and accurate health information that engages them as active participants rather than passive recipients.  Messages will be contextualised to needs, actionable and relevant to users. Selected users (particularly youth) will become “digital behaviour change champions” and benefit from raised digital social status to build their confidence and role as multipliers of information – providing trusted peer information sources and mitigating misinformation.  

County Behaviour Change Communication (BCC) officers and other decision-makers indicate that there is lack of an all-inclusive health information infrastructure for disseminating BCC information to communities. District Health Information System (DHIS) is only available to a few health professionals. We will provide County/National officials with real-time analytics through the Dashboard filling this gap. Decision-makers will understand and have evidence of the impact of BCC messaging, and a more coordinated approach to BCC campaigns – leading to more effective planning and budget allocation.

CARE has established trusted relationships with county and national-level Ministry of Health and is an active participant in multiple health networks, committees, civil society networks- including COVID-19 response and vaccine groups where we advocate for policies that include the most vulnerable. As a result of this work, CARE will play an advocacy role to engage these stakeholders and develop and present a practitioner toolkit along with access to the Dashboard and lessons learned, to benefit a wider group of agencies and government decision-makers tasked with RCCE and BCC.

We will also work closely with authorities to determine the best strategy to improve access to data analytics for decisions-makers. This may involve a level of integration with District/National Health Information Systems, periodic data downloads and data visualisation reports from our BI platform, or direct access to the BI Dashboard. 

We will also explore how data captured through the BCC platform can be shared back to the citizens themselves, ensuring the data collection process is transparent and not merely extractive, but serves to truly put marginalised communities at the centre of the solution. 

Decision-makers will benefit from data, knowledge, learning and capacity building tools so they are more prepared for health emergencies and better able to make informed decisions about what messages are most effective to ensure public health messaging is inclusive and converts into behaviour change.  Decision makers will benefit from actionable insights, data, learning, evidence, and capacity building resources that demonstrate what messaging ensures public health messaging translates into behaviour change and the importance of using a data-driven, coordinated approach to public health messaging.  

Target communities will benefit from interactive learning and confidence building tools, via Every1Mobile’s BCC digital community, so they are better able to protect themselves from infectious diseases and benefit from improved overall health.  They will benefit from the platform’s social networking functionality that enables users to communicate with one another by posting and sharing information, comments, and form personal relationships. The interactivity of the platform will encourage them to share their own experiences, photos and stories to build one another’s confidence and challenge negative attitudes. Interactive, behaviour change tools will motivate community members to turn their knowledge and confidence into real-world actions through daily challenges, goal setting, action planning and self-monitoring.

In the first year we will consult communities, stakeholders, and customised the E1M existing community-facing mobile-web platform. We will develop and test varying messaging approaches, launching the first round of messaging with a cohort of 4,000 VSLA members in Western Kenya.  

Year 2 will continue conducting research and robust evidence-gathering with 5 more user groups of 4,000 VSLA members across a variety of geographic contexts in Kenya (including urban informal settlements), equating to 24,000 VSLA members. Users will be exposed to different combinations of digital tools and messaging approaches over a 4-month cycle to measure shifts in knowledge, attitude and practice related to COVID-19 transmission prevention.

While the beginning of year 3 will continue with evidence-gathering, we will also be: 

1. Preparing to scale to 900,000 members in Kenya using the automated WhatsApp Chatbots and existing community-facing mobile web platform. 
2. Developing the practitioner toolkit, a research and insights report and holding learning events with RCCE practitioners to scale the use of the technology through other agencies.
3. Conducting internal advocacy and knowledge sharing within CARE to identify opportunities to scale up the BCC technical platform and approach with a broader body of funded programmes across the CARE federation to reach millions. 

A comprehensive monitoring framework will be designed and linked to theories of change developed during programme design, to define and track performance of key success indicators comprising quantitative metrics and qualitative metrics. This will include but not be limited to metrics already used by Every1Mobile including self-reported data, anecdotal data, pledges, habit tracking, voucher redemption and e-learning progress and completion. Other existing standard engagement metrics used to measure success will include page visits, comments and dwell-time. 

Pre- and post-KAP surveys will be used to measure shifts in knowledge, attitude and practice towards key health-influencing and COVID-19 preventative behaviours.  These metrics will be complemented through our ongoing insight gathering activities from community engagement activities and WhatsApp groups. 

Live remote user observation aids such as HotJar will be used to capture Heatmaps, and user activity, scroll maps and screen recordings will be used to capture user engagement and navigation. Our sentiment analysis will be applied to all the user feedback data captured from the baseline and endline interviews, WhatsApp messages, and user interactions on surveys, comments and shared stories and photos. 

Digital Literacy & Access

While Kenya presents a mobile-fertile territory, women’s lack of access to the internet is an additional gender inequality that could exacerbate adverse differential impacts of COVID-19 (9). Youth targeted in this programme will be digitally literate however remote women are likely to face greater barriers.   

CARE’s existing VSLA infrastructure offers a trusted space for members to access peer support and build confidence in technology without fear of judgment. Session facilitators and CARE’s network of Community Based Trainers will also act as digital champions. 

E1M platform is designed for low-connectivity low-literacy and low-cost to users, requiring a minimum of 2G-EDGE coverage. With this in mind, target communities are situated in both urban and rural geographic areas in Kenya with good connectivity (10).  

Government buy-in for scale
Leveraging existing relationships, CARE will engage local/ national-level government throughout, advocating for inclusive, disaggregated data and evidence to improve BCC public-health messaging.  We will ensure Dashboards are publicly available and integrate where possible with existing data infrastructures. 

Third Party Support
To include mobile vouchering in this solution requires collaboration with Unilever to approve discounts on hygiene products. We will extend work Every1Mobile already does with Unilever in Kenya.  

CARE works with international and local NGOs/CBOs and service providers, academic institutions, aid agencies and corporates, trusts and foundations. CARE Kenya works with local health authorities and COVID-19 coordination committees and sits on the national taskforce in Kenya. 

In Kenya, Every1Mobile is already working with Unilever and AMREF. 

COVID-19 has demonstrated the opportunity for digital technology to deliver BCC at scale and measure impact of messaging with far more immediacy and accuracy than other channels.

However, despite being the fastest regions of technology-adoption on the planet, the global south experiences a dearth of data on BCC. Robust evidence is central to successful adoption of such technologies by local authorities - who are essentially the catalyst to scale - but funding to develop this evidence-base is hard to access, particularly in Africa. 

TTC’s support will enable CARE and E1M to conduct robust research, build evidence and enhance technology that has the potential to scale and transform BCC/RCCE across the development/humanitarian sector.

TTC brings together innovation thought-leaders who understand this landscape well and with whom we would love to collaborate on this journey. Our solution team would benefit from TTCs network of technology and academic institution members and partners. We also believe that CARE’s global expertise as a strategic partner for TTC going forward is an area to explore.

Our solution would benefit from potential partnership during the 3 year period.

1. Retail Partner

If products and geographies align, we would be interested to engage a TTC FMCG retail partner such as Reckitt, to make the mobile vouchering of WASH products more affordable and at scale to vulnerable communities and provide discounts on selected products, onboarding of low-income customers

2. Behavioural science academic institution research partner

We would be interested to engage with TTC academic partners with a specific expertise in behavioural science, to provide oversight and technical assistance in the design and delivery of the MEAL strategy for this project ad in synthesising and writing the final insights for peer review submission