Kumar Vishwajeet, Kumar Aarti, Ghosh Amit Kumar, Samphel Rigzin, Yadav Ranjanaa, Yeung Diana, Darmstadt Gary L
Community Empowerment Lab, Shivgarh, Uttar Pradesh, India.
Community Empowerment Lab, Shivgarh, Uttar Pradesh, India.
Semin Perinatol. 2015 Aug;39(5):393-415. doi: 10.1053/j.semperi.2015.06.010. Epub 2015 Jul 26.
Despite significant advancements in the scientific evidence base of interventions to improve newborn survival, we have not yet been able to "bend the curve" to markedly accelerate global rates of reduction in newborn mortality. The ever-widening gap between discovery of scientific best practices and their mass adoption by families (the evidence-practice gap) is not just a matter of improving the coverage of health worker-community interactions. The design of the interactions themselves must be guided by sound behavioral science approaches such that they lead to mass adoption and impact at a large scale. The main barrier to the application of scientific approaches to behavior change is our inability to "unbox" the "black box" of family health behaviors in community settings. The authors argue that these are not black boxes, but in fact thoughtfully designed community systems that have been designed and upheld, and have evolved over many years keeping in mind a certain worldview and a common social purpose. An empathetic understanding of these community systems allows us to deconstruct the causal pathways of existing behaviors, and re-engineer them to achieve desired outcomes. One of the key reasons for the failure of interactions to translate into behavior change is our failure to recognize that the content, context, and process of interactions need to be designed keeping in mind an organized community system with a very different worldview and beliefs. In order to improve the adoption of scientific best practices by communities, we need to adapt them to their culture by leveraging existing beliefs, practices, people, context, and skills. The authors present a systems approach for community-centric design of interactions, highlighting key principles for achieving intrinsically motivated, sustained change in social norms and family health behaviors, elucidated with progressive theories from systems thinking, management sciences, cross-cultural psychology, learning and social cognition, and the behavioral sciences. These are illustrated through a case study of designing effective interactions in Shivgarh, India, that led to rapid and substantial changes in newborn health behaviors and reduction in NMR by half over a span of 16 months.
尽管在改善新生儿生存的干预措施的科学证据基础方面取得了重大进展，但我们尚未能够“扭转曲线”以显著加速全球新生儿死亡率的下降速度。科学最佳实践的发现与家庭对其的广泛采用之间不断扩大的差距（证据与实践的差距）不仅仅是提高卫生工作者与社区互动覆盖率的问题。互动本身的设计必须以合理的行为科学方法为指导，以便它们能够导致大规模采用并产生大规模影响。将科学方法应用于行为改变的主要障碍是我们无法打开社区环境中家庭健康行为的“黑匣子”。作者认为，这些并非黑匣子，而是经过深思熟虑设计、维护且多年来不断演变的社区系统，其设计秉持着特定的世界观和共同的社会目的。对这些社区系统的同理心理解使我们能够解构现有行为的因果路径，并对其进行重新设计以实现预期结果。互动未能转化为行为改变的关键原因之一是我们未能认识到互动的内容、背景和过程需要根据具有截然不同世界观和信仰的有组织的社区系统来设计。为了提高社区对科学最佳实践的采用率，我们需要通过利用现有的信仰、实践、人员、背景和技能使其适应社区文化。作者提出了一种以社区为中心的互动设计系统方法，强调实现社会规范和家庭健康行为内在动机驱动的持续改变的关键原则，并通过系统思维、管理科学、跨文化心理学、学习与社会认知以及行为科学的渐进理论进行阐释。通过印度希夫加尔设计有效互动的案例研究对这些原则进行了说明，该案例导致新生儿健康行为迅速且大幅改变，并在16个月内将新生儿死亡率降低了一半。
