Population Council, Abuja, Nigeria.
Department of Social, Behavioral, and Population Sciences, Center of Excellence in Maternal and Child Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
PLoS One. 2024 Aug 15;19(8):e0308527. doi: 10.1371/journal.pone.0308527. eCollection 2024.
Nigeria's Maternal, newborn, and child health and nutrition (MNCH+N) outcomes rank among the world's poorest. Engaging traditional and religious leaders shows promise in promoting related behaviors. The Breakthrough ACTION/Nigeria project worked with leaders in northern Nigeria to implement the Advocacy Core Group (ACG) model, a social and behavior change (SBC) approach aimed at influencing community norms and promoting uptake of MNCH+N behaviors. Qualitative assessment of the model contributes to evidence on SBC approaches for enhancing integrated health behaviors.
This qualitative study was conducted in Nigeria's Bauchi and Sokoto states in May 2021. It involved 51 in-depth interviews and 24 focus group discussions. The study was grounded in the social norms exploration (SNE) technique to examine normative factors influencing behavior change within the ACG model context. Data analysis used a reflexive thematic analysis approach. Ethical approvals were received from all involved institutions and informed consent was obtained from participants.
The ACG model was vital in the uptake of MNCH+N behaviors. The influence of ACG members varied geographically with greater impact observed in Sokoto State. Normative barriers to improving MNCH+N outcomes included perceived religious conflicts with family planning, preference for traditional care in pregnancy, misinformation on exclusive breastfeeding (EBF), and gender-based violence resulting from women's decision-making. The study demonstrated positive progress in norm shifting, but EBF and GBV norms showed slower changes. Broader challenges within the health system, such as inadequate services, negative attitudes of healthcare providers, and workforce shortages, hindered access to care.
The ACG model increased awareness of health issues and contributed to potential normative shifts. However, slower changes were observed for EBF and GBV norms and broad health system challenges were reported. The model appears to be a promising strategy to further drive SBC for better health outcomes, especially where it is combined with supply-side interventions.
尼日利亚的母婴和儿童健康与营养（MNCH+N）结果在全球范围内处于最差之列。与传统和宗教领袖合作，有望促进相关行为。突破行动/尼日利亚项目与尼日利亚北部的领导人合作，实施了倡导核心小组（ACG）模式，这是一种社会和行为改变（SBC）方法，旨在影响社区规范并促进 MNCH+N 行为的采用。对该模式的定性评估有助于为增强综合健康行为的 SBC 方法提供证据。
本定性研究于 2021 年 5 月在尼日利亚的包奇和索科托州进行。它涉及 51 次深入访谈和 24 次焦点小组讨论。该研究基于社会规范探索（SNE）技术，以检查影响 ACG 模型背景下行为变化的规范性因素。数据分析采用反思性主题分析方法。所有参与机构均获得伦理批准，并获得参与者的知情同意。
ACG 模式对于 MNCH+N 行为的采用至关重要。ACG 成员的影响力因地理位置而异，在索科托州观察到更大的影响。改善 MNCH+N 结果的规范性障碍包括与计划生育有关的宗教冲突、对怀孕期传统护理的偏好、对纯母乳喂养（EBF）的错误信息以及由于妇女的决策而导致的性别暴力。研究表明，规范转变取得了积极进展，但 EBF 和性别暴力规范的变化较慢。卫生系统内的更广泛挑战，如服务不足、医疗保健提供者的负面态度和劳动力短缺，阻碍了获得护理的机会。
ACG 模式提高了对健康问题的认识，并有助于潜在的规范转变。然而，对于 EBF 和性别暴力规范，变化较慢，并且报告了广泛的卫生系统挑战。该模式似乎是推动 SBC 以实现更好健康结果的有前途的策略，特别是在与供应方干预措施相结合的情况下。
