Habitat for Global Health, Shivgarh, Uttar Pradesh, India.
Semin Perinatol. 2010 Dec;34(6):446-61. doi: 10.1053/j.semperi.2010.09.006.
Despite an established evidence base of simple, affordable, and low-cost interventions to avert neonatal deaths, global progress in reducing neonatal mortality has stagnated in recent years. Under-recognition of the critical role played by behavior change in ensuring adoption and dissemination of innovations is a major reason for this gap between evidence and impact. A general lack of understanding of the mechanisms underlying behavior change at a population level coupled with an under-appreciation of the sociocultural context of newborn care behaviors has underscored ill-informed approaches towards behavior change that have met with limited success. This article draws upon available evidence from prevention-oriented, community-based newborn survival trials to derive insights into the role of behavior change in neonatal mortality reduction. We propose a simple model, the intervention-causation pathway, to explain the pathway through which behavior change interventions may lead to reductions in mortality. Further, we explore the unique nature of newborn care behaviors and their underlying sociocultural context, along with state-of-the-art advances in social, behavioral, and management sciences. These principles form the basis of the behavior change management framework that has successfully guided intervention design and implementation, leading to high impact on neonatal mortality reduction, in Uttar Pradesh, India. We describe how the behavior change management framework can be applied to inform the design of theoretically and empirically sound behavior change interventions with greater precision, predictability and pace towards reduction in neonatal mortality. We finally touch upon key overarching principles that should guide intervention execution for maximal impact.
尽管已经有了许多简单、经济且低成本的干预措施来避免新生儿死亡的成熟证据，但近年来全球在降低新生儿死亡率方面的进展已经停滞不前。未能充分认识到行为改变在确保创新的采用和传播方面的关键作用，是造成这一证据与影响之间差距的主要原因。一般来说，人们对人口层面行为改变背后的机制缺乏了解，对新生儿护理行为的社会文化背景认识不足，这使得行为改变的方法缺乏信息，导致收效甚微。本文从以预防为导向、以社区为基础的新生儿生存试验中获取的现有证据中汲取了关于行为改变在降低新生儿死亡率方面的作用的见解。我们提出了一个简单的模型，即干预因果途径，以解释行为改变干预措施如何导致死亡率降低的途径。此外，我们探讨了新生儿护理行为的独特性质及其背后的社会文化背景，以及社会、行为和管理科学的最新进展。这些原则构成了行为改变管理框架的基础，该框架成功地指导了干预措施的设计和实施，在印度北方邦成功降低了新生儿死亡率。我们描述了如何应用行为改变管理框架，以更精确、可预测和快速的方式为降低新生儿死亡率而设计理论上和经验上合理的行为改变干预措施。最后，我们还提到了指导干预措施执行以实现最大影响的关键总体原则。
