Short Course on Infectious Diseases in Humanitarian ... · they inform social mobilization and communication activities Fictitious scenario 4 groups interviewing selected members

Social Social mobilization:mobilization: communicating communicating

with affected communitieswith affected communities

Norma Johnston

Short Course on Infectious Diseases in Humanitarian Emergencies

LSHTM-WHO 3 April 2009

09.00 – 09.30 An overview of social mobilization and communities

09.30 – 10:15 Role play

10.15 – 10.45 Feedback and discussion

Session outlineSession outline

1. What is social mobilization?

2. What is the relevance of social

mobilization for outbreak control?

3. What are key principles and concepts

that underpin effective social

mobilization?

4. Introduction to case study/role play

OverviewOverview

1. What is social mobilization?1. What is social mobilization?1. What is social mobilization?

Social mobilizationSocial mobilization

Social mobilization is the task of mobilizing all societal and personal influences on an

individual and family to prompt individual and family action

with respect to specific healthy behaviours

COMBI differs from traditional social mobilization in two ways

– Concerned with reducing the burden of a disease

– Concerned with achieving behavioural impact through researching and communicating specific messages to specific target audiences

Social mobilization evolvedSocial mobilization evolved……WHO's approach: Communication-for-Behavioural-Impact (COMBI)

Different levels of communicationsDifferent levels of communications

Intrapersonal

Interpersonal

Group

Organizational

Societal

Global

2. What is the relevance of social mobilization in an outbreak response?

2. What is the relevance of social 2. What is the relevance of social

mobilization in an outbreak response?mobilization in an outbreak response?

The value of social mobilizationThe value of social mobilization

Organizes and promotes the behavioural responses of a broad range of individuals and institutions ranging from behaviours of individuals affected by or at risk of the outbreak to the behaviours of a host of others

– Supports ground personnel

– Provides information

– Raises a call to action

Outbreaks happen within existing social, cultural, political and economic settings

Success is dependent on the active participation of affected communities in control measures

More than just providing information and "sensitising" communities

The context is criticalThe context is critical

Where does social mobilization fit Where does social mobilization fit

into rapid response?into rapid response?

CONTAINMENT CONTAINMENT

COMMUNICATIONSCOMMUNICATIONS

CommunicationsCommunications

Logistics Logistics

SecuritySecurity

SurveillanceSurveillance

Laboratory investigationLaboratory investigation

Case managementCase management

Infection controlInfection control

CoCo--ordination ordination

and and

ManagementManagement

Exists as a distinct

communications

response strategy

Supports and

integrates all other

aspects of rapid

response

Organizes and

guides information

dissemination

Effective communications canEffective communications canEffective communications can

Help people overcome fear, anxiety and reduce feelings of vulnerability

Help people make informed decisions

Guide and inform outbreak control interventions

Save lives

Communications cannotCommunications cannot……

Resolve existing political,

technical, administrative and

institutional problems

3. What are key principles and concepts that underpin effective social mobilization?

3. What are key principles and concepts that underpin effective social mobilization?

Role PlayRole Play

Objective:– To highlight the importance of understanding the

socio-cultural context of disease outbreaks and how they inform social mobilization and communication activities

Fictitious scenario

4 groups interviewing selected members of a rural community

Explore – interpersonal communication

– key challenges for the adoption of control measures and how to overcome them

IntroducingIntroducing……

• Health worker:

• Parents:

• Religious leader:

• Village leader:

Within your group identify 1 rapporteur and 1 observer to feedback to the plenary

Within your group identify 1 rapporteur and 1 observer to feedback to the plenary

The diseaseThe diseaseShonky – viral haemorrhagic fever

Incubation period 2-21 days

Transmitted by direct contact with the blood, secretions, organs or other bodily fluids of infected personsSymptoms include sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is often followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding No specific treatment or vaccine is yet available for Shonky haemorrhagic fever

Suspected cases should be isolated from other patients and strict barrier nursing techniques implemented

Contact tracing and follow-up of people who may have been exposed to Shonky through close contact with other cases is essential

Messages…

Leaflets…

Posters…

T-shirts…

Radio spots…

TV adverts…

The usual responseThe usual response……

Content?

Do we need them?

For what purpose?

How are they going to be

used?

What will they contribute

to control efforts?

Communications must contribute to achieving the public health goalCommunications must contribute to achieving the public health goal

Anthropological researchAnthropological research

Perceptions

Beliefs

Sources of information

Behaviour

Education

Socio-economic status

Culture

Politics

Family and society

Observation

Ethnography

Behaviour and communication models

Day-In-the-Life-Of Analysis

Top-of-the-mind Analysis

Segmentation

Number-of-Steps-Away

from Analysis

Information Tools

Anthropological researchAnthropological research

Communications theoryCommunications theory

Message

Source

Channel

Receiver

Effect

Feedback

Setting

3 Important communication factors3 Important communication factors

Trust

Credibility

Empathy

The 3 pains of communicationThe 3 pains of communication

1. Selective attention

2. Selective perception

3. Selective retention

The three painsThe three pains

1. Selective attention

attention wanders attention wanders

The three painsThe three pains

2. Selective perception

The three painsThe three pains

2. Selective perception

The three painsThe three pains

2. Selective perception

The three painsThe three pains

2. Selective perception

The three painsThe three pains

3. Selective retention

The 3 COMBI principlesThe 3 COMBI principles

1. Identify key, specific behaviouralobjectives linked to prevention and control objectives

2. Conduct a market situational analysis to define the behavioural and communication objectives

3. Apply a strategic mix of communication interventions

There is no single magic bulletThere is no single magic bulletThere is no single magic bullet

The five integrated action areas

1. Administrative Mobilization/Public Relations/Advocacy

2. Community Mobilization

4. Advertising 3. Personal selling/ Interpersonal communication

5. Point-of-Service Promotion

Multiple channels and multiple levels

Community perceptions

• Not convinced it was Ebola

• No cure – no point in treatment

• Fear of isolation

• Inappropriate prevention measures

• Evil eye

• Blood samples sold

Promotional materials

Leaflets

Banners

T-shirts

Social Mobilization Team

Strategy: COMBI

� Blend of communication interventions� 1.Administrative mobilization/public advocacy• Commissioner, chiefs and church leaders made emotional appeal to reduce

personal and collective risk and addressed rumours

• 2.Community mobilization• Official meetings with chiefs, traditional healers and local communities in

areas with high number of cases

• House-to-house where possible

• Target market places and churches

• 3. Interpersonal communication/counselling• Intensify counselling/training in basic communication techniques

• Provide distinct uniforms for credibility

• Produce and distribute leaflets for compliance and credibility

• 4.Advertising

• Banners, placed in market places, schools and churches (triggers to remind people)

• Evening announcements (when people are home)

• Easily recognisable branding

Successes

• Behavioural Impact? • Were people reporting sick cases more frequently?

• Were sick people staying at home and avoiding gatherings?

• Were those looking after sick people taking precautions?

• Were those attending burials avoiding touching dead bodies?

• Programme experiences

• Having ex-Ebola patients on the team was extremely helpful in allaying

fears of the isolation ward personalising risk

• Specific and more appropriate information was being circulated

amongst communities

Weaknesses

• Anticipation of traditional responses to crisis (egwitchcraft)

• Planning of teacher’s training – missed opportunity to distribute simple leaflet encouraging active participation of school children within their families

• The influence of local hierarchies and relationships on decision-making and implementation

Future recommendations

• Credibility with communities should be

established very early. Simple signs of status

(such as badges/T-shirts/armbands) should be a

standard part of an outbreak response enabling

a visible distinction of Ebola Control Teams

• Resource list of local and available

communication expertise should be compiled eg

artists, printing companies, translators, radio

producers…