Culturally Compelling Strategies for Behaviour Change: A Social Ecology Model and Case Study in Malaria Prevention

Author: Catherine Panter-Brick
Sian E. Clarke
Heather Lomas
Margaret Pinder
Steve W. Lindsay

Date: December 13, 2005

In this paper, the authors "propose a social ecology perspective to make explicit the links between intention to change, actual behaviour change, and subsequent health impact, as relating to both theory-based models and practical strategies for triggering change. A social ecology model focuses attention on the contexts of behaviour when designing, implementing or critically evaluating interventions. As a case study, we reflect on a community-directed intervention in rural Gambia designed to reduce malaria by promoting a relatively simple and low-cost behaviour: repairing holes in mosquito bednets. In phase 1, contextual information on bednet usage, transactions and repairs (the "social lives" of nets) was documented. In phase 2 (intervention), songs were composed and posters displayed by community members to encourage repairs, creating a sense of ownership and a compelling medium for the transmission of health messages. In phase 3 (evaluation), qualitative and quantitative data showed that household responses were particularly rapid and extensive, with significant increase in bednet repairs..., despite considerable constraints on human agency. We highlight a promising approach - using songs - as a vehicle for change, and present a framework to embed the design, implementation and critical evaluation of interventions within the larger context - or social ecology - of behaviour practices that are the bedrock of health interventions."

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