Behavior is Key

1
Behavior is Key!

• Lonna Shafritz and Rebecca Fields
• CHANGE/AED
• UNISTAF Workplan Meeting
• Entebbe, Uganda
• September 9, 2003

2
Objectives of presentation

• Behavior Change (BC) is crucial to success in
  improving injection safety
• Systematic BC approaches can be applied
• Issues
• Reduce unnecessary injections
• Improve safety of necessary injections
• Assure safe management of injection waste

3
Reduce Unnecessary Injections Determinants??

• Patients
• Used to getting injections for both curative
  and preventive purposes
• Think more effective/quicker than pills
• Expect to get them
• Magical, but modern technology
• Prescribers and providers
• Satisfy client expectations
• What is available
• Result in higher income
• Guarantee compliance
• Treatment protocols

4
Improve Safety of Necessary Injections

• Use of sterile needle and syringe
• Families - home based usage
• Fear of contamination from unknown people
• Dont know how to/not able to sterilize
• Health workers
• Availability of appropriate supplies
• Time constraints
• Unaware
• High demand
• Logistics/supplies mgmt staff
• Those who train/motivate HWs and logistics staff

5
Assure safe management of injection waste

• Families/Health staff
• Not aware of how to destroy
• Not aware of danger to community or self
• Health Staff (all types)
• Lack of safe boxes/supplies to burn
• Time constraints high waste volume of ADs
• No protocol for regular destruction

6
Who are prescribers/ providers of injections

• Health staff
• Different cadres
• Public, private sector, NGO, mission
• Drug sellers
• Pharmacists
• Family members
• Traditional Healers

7
What is a behavior?

• Action
• Observable
• Specific (time, place, quantity, duration,
  frequency)
• Measurable
• Doable
• Has a direct link to an improved health outcome

8
Exercise Exercise
9
Exercise Exercise

• Disconnect knowledge and beliefs vs.
  actions/behavior
• Public awareness campaigns limitations and/or
  dangerous
• Standard training limited success
• Competition
• New ways to group people
• Targets of opportunity
• Research essential

10
How to change actions

• Describe desired action specifically
• Who to take action
• What are they currently doing?
• What are their reasons for current action?
• What are barriers to desired action?
• What are motivators to desired action?
• What can program do make this action easier to do?

11
Behavior change requires a range of efforts

• Policies and procedures
• Service improvements
• Training/motivation
• Supplies/logistics (products/technologies)
• Communication/community mobilization

12
Behavioral Analysis Target Audience
Desired Behavior
Barriers
Motivations/ Facilitating Factors
13
Program Strategy Target AudienceDesired
Behavior
Policies and proce- dures
Service Improvements
Train ing/Motivation
Supplies/Logistics
Communicat ion
14
Behavioral Analysis Target Audience Families

• Desired Behavior

Barriers
Motivations/ Facilitating Factors
When necessary for injection, use health sector
sterile injections, rather than your own shared
home-based (HB) equipment
- Home based easier/cheaper - Fear of HF
non-sterile equipment - Poor access to health
sector - HB traditional - Dont under-stand HB
risks
- HF experts - Demonstrate HF equipment/ procedure
s - HF cheaper - Dont need to sterilize
yourself - Families that dont share needles are
healthier
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Program Strategy Target Audience
FamiliesDesired Behavior Use HF sterile
injections
Policies proce dures
Service Improvements
Training/ Motivation
Supplies/Logis-tics
Communicat ion
.Develop dissemina te protocol .Health workers
refuse use of family syringe .Raise price to
ind ividuals
.Behavior trials .Demo sterile process .Make
service personal
. Attitude, values,efficacy training (public/priva
te, etc) .Feedback .Self/peer evaluation
.Assure adequate sterile supplies .Train HF to
order equipment supplies.
. IPC bet HW and comm .Theatre . Radio . Comm
leaders . Private and informal sector
16
Behavioral Analysis Target Audience Public
Health Workers

• Desired Behavior

Barriers
Motivations/ Facilitating Factors
Proper waste management of sharps on ongoing
basis (exact actions must be defined).
17
Program Strategy Target Audience Public Health
Workers Desired Behavior Proper regular disposal
of sharps
Policies and proce- dures
Service Improvements
Training/Motivation
Supplies/Logistics
Communicat-ion
18
Summary

• Dont forget
• Behavior is Key!