Guide Filter: Inquire

Introduction

Service providers play several roles within health systems. Their responsibilities may entail, but often are not limited to, client counseling and care, community mobilization and engagement, and managing supplies and logistics. A provider’s ability to perform these tasks effectively may be hindered by barriers within or beyond their immediate sphere of control or influence. A provider’s personal opinions and biases, attitudes and behaviors, capacity and skills, and working conditions may all impact their ability or motivation to deliver quality services.

Such facilitators and barriers are outcomes of a complex set of factors. Social and behavior change (SBC) interventions can help to identify and address some of the factors that lead to provider-side barriers to quality service delivery.

An SBC-based approach to addressing provider behaviors involves a strategic process of identifying individual provider perspectives on and needs for adopting desired behaviors and practices. This process starts with a provider behavior assessment, which is used to identify strengths, needs, gaps or best practices within a given service provider community. An SBC activity should be working toward a specific behavioral outcome for a population segment, thus the provider behavior assessment is conducted with a specific behavioral outcome in mind (e.g. youth contraceptive use, childhood immunization, exclusive breastfeeding, etc.).

Definition

A provider behavior assessment is conducted prior to initiating a provider behavior change intervention—and throughout a program intervention—to identify, understand, and prioritize the barriers service providers face in performing their job functions. Provider behavior is one entry point to addressing a behavioral outcome for a population segment, thus the assessment should be conducted in relation to a specific behavioral outcome or goal. The assessment results allow programs to strategically plan ways to most effectively motivate and support service providers to influence uptake of and deliver quality services to their clients. It primarily focuses on understanding facilitators and barriers that can be addressed through SBC approaches. There are various techniques that can support barrier analysis, including a doer/non-doer study or an examination of positive deviants. An assessment can be used with providers at any level of the health system, whether facility or community-based.

A barrier assessment typically seeks to answer questions such as:

1. What are the incentives and obstacles providers experience in providing quality services?
2. What are the values, norms and biases that influence provider actions?
3. What are the provider behaviors that positively and negatively influence service quality?
4. What are the techniques (words, actions, linkages) used by some providers to overcome difficulties in service provision and interact supportively with clients?

Why Conduct a Provider Behavior Assessment?

Providers have experiences, perspectives, and biases which may challenge or support their ability to adequately deliver quality services. It is important to have a better understanding of provider behaviors so they can be addressed or supported with evidence-based, targeted SBC solutions. SBC focuses on behaviors and not all provider barriers can be overcome through SBC interventions alone. SBC activities specifically seek to address providers’ knowledge and skills and their underlying motivations, norms, values, attitudes, and beliefs.

For example, In the context of routine immunization, service providers are among the most influential sources of information in community settings and serve as crucial facilitators in motivating demand for vaccination.* However, health systems challenges such as vaccine stockouts can cause frustration among caregivers and healthcare workers (HCW). SBC approaches such as strengthening the interpersonal communication skills of frontline immunizers can foster trust between HCWs and caregivers, increasing the likelihood that a caregiver will return for their child’s immunization appointment, even after experiencing a barrier such as a stockout.

A provider barrier assessment can help to:

• Identify the current and most important facilitators and barriers to delivering quality services in a facility or community settings.
• Identify provider needs, attitudes, motivations, and opportunities.
• Characterize provider perspectives that impact clients’ care-seeking behaviors.
• Characterize individual, interpersonal, community, organizational, and health system influences on provider performance.
• Identify areas needing capacity strengthening.
• Provide evidence to inform relevant SBC activities.

Who Should Conduct a Behavior Assessment?

A barrier assessment is best carried out by a team of individuals with an interest in improving the performance of service providers and the overall quality of health services. Ideally, the team will include a diverse group of stakeholders with sufficient access to providers, their supervisors, and community representatives. It is helpful to have the support of individuals with expertise in SBC, data collection and analysis, and service quality improvement.

Provider Behavior Assessment Process

1. Conduct background research
2. Define your audience
3. Develop a data collection plan and instruments
4. Analyze data and identify barriers
5. Summarize and report findings

*Waisbord, S. & Larson, H. (June 2005). Why Invest in Communication for Immunization: Evidence and Lessons Learned. A joint publication of the Health Communication Partnership based at Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (Baltimore) and the United Nations Children’s Fund (New York).

Banner image – © 2003 Center for Communication Programs, Courtesy of Photoshare

Learning Objectives

• Understand the relevance of conducting a provider barrier assessment
• Apply an approach to assess provider barriers and more effectively change provider behavior

Prerequisites

Carry Out a Situation Analysis and Root Cause Analysis

Before undertaking a provider behavior assessment, it is important to first have a clear sense of the context surrounding the specific behavioral outcome being impacted by provider behaviors. A situation analysis, which involves a systematic collection and study of health and demographic data, will help you identify the provider behaviors relevant to behavioral outcome you wish to address amongst your target audience. Reviewing evidence that provides insight into the social, economic, political, and health context in which the behavioral outcome exists will help establish whether service quality and provider-behaviors are issues constraining the behavioral outcome.

A root cause analysis will then help determine the extent to which provider behavior is a key constraint. The behavior assessment can then characterize the interactions between providers and clients and the factors that influence the nature of those interactions.

Steps

Step 1: Conduct Background Research

Use peer-reviewed and grey literature from public health and other relevant disciplines to identify gaps in knowledge about provider behaviors and perspectives. Start by investigating existing evidence on knowledge, attitudes, and practices through national or subnational data. If local data is not available or sufficient, review data from similar cultural, religious, or other contexts. The literature review should focus on defining the types of provider barriers and facilitators for service provision, and exploring the underlying cause of the barriers.

One such literature review was conducted by the by the Health Communication Capacity Collaborative in 2016. The review identified three key areas of factors impacting health care worker (HCW) behavior change: 1) knowledge and competency barriers in which HCWs lack the skills and knowledge to provide services; 2) structural and contextual barriers in which systemic and environmental factors affect HCW’s abilities to provide services; and 3) attitudinal barriers in which attitudes and societal beliefs influence HCW’s willingness to provide services. While literature reviews such as this one and the one you will conduct help to define types of provider barriers, they may not sufficiently identify the specific needs, attitudes, and behaviors of your provider community of interest. Further investigation is required to understand the characteristics and challenges of your provider audience.

To supplement the information gleaned from the literature review, consider interviewing key informants who can provide added perspectives on society, religion, and culture and how those factors might influence provider behavior. Key informant interviews are also a good opportunity to get a general sense of how service quality is defined; this will help you understand which provider behaviors and perspectives are impacting service quality.

After conducting the literature review and key informant interviews, use the findings to classify provider archetypes into hypothetical audience segments to be further explored through qualitative research.

Step 2: Define Your Audience

When starting the assessment, it is important to think of providers as an audience in the same way you would define any other target audience for an SBC effort. The health system comprises various cadres of service providers with distinct and complementary roles. Tasks may be shared across facility-based providers such as physicians, midwives, and nurses; community-based providers such as health educators and community mobilizers; and community volunteers and outreach workers. As determined through the background research, the individuals working within those cadres have varying levels of education and experience as well as distinct needs, motivations, and challenges.

To define your hypothetical segments, consider the variables that may facilitate behavior change among your provider audience. The various and unique ways in which different types of providers are motivated and influenced will likely impact their interactions with different client segments. After you have defined a set of hypothetical segments, you may choose to focus on a specific segment of providers for further qualitative inquiry.

In treating providers as an audience segment, it is important to remember that, just like the clients they serve, providers are community members who operate within a social ecological system and are subject to multiple spheres of influence. Throughout the barrier assessment, return to the framework below to consider the ways in which individual, family, peer, community, organizational, and health system influences might affect what you are observing and learning about provider barriers.

Step 3: Develop Data Collection Plan and Instruments

The background research will give you an overview of the factors affecting provider performance, the nature of providers’ work in the area of interest, the expectations placed on service providers, and how provider performance is measured. The segmentation exercise will help you develop a segment model based on provider archetypes and the categories of barriers identified in the literature review.

To plan a social and behavior change intervention, you still need to identify the major drivers of specific barriers encountered by your hypothetical provider segments. Developing a data collection plan, including data sources, and methods of collection will help you identify these major drivers. Depending on resources and needs, you may decide to use qualitative or quantitative research to identify the specific behavioral, social, and technical barriers that impede the behavior change objective. Identify the individuals or data sources that can provide information to answer your questions and how will you engage with them. Your qualitative or quantitative study sample should be as inclusive as is feasible to ensure provider barriers, client experiences, and service quality are articulated from multiple perspectives. Consider the size of each group of individuals from which you would like to gather data. Tools such as the sampling overview document can help you think through the issues associated with reaching each group that is providing data.

Consider exploring questions such as:

• What is the provider’s current behavior regarding the targeted service/health area?
• How do gender norms and roles factor into provider’s attitudes and practices?
• Does the provider perform the desired behavior all the time, sometimes, or not at all?
• What are the reasons the provider does not consistently practice the desired behavior? Do they lack adequate resources, time, or pay, or are the barriers tied to lack of knowledge, skills, or other ideational factors?
• What is the provider’s current attitude about their job, the service, or the clients with whom they work?
• Are they happy with their job? Do they have any biases toward the services they are being asked to provide or toward the clients they see?
• What does the provider perceive to be the benefits of adopting the targeted behavior?
• What is the provider most motivated by—peer support, social status, financial incentives?

Note: It is crucial to pretest your research instruments before fielding them.

Step 4: Analyze Data and Identify Facilitators and Barriers

Conduct the appropriate type of analysis on each type of data you collect. For example, conduct qualitative thematic analysis on focus group data. The members of your team with experience in data analysis will be particularly useful here. Be sure to note any differences by segment and by gender. Summarize how the data responds to each of your questions. The result should be a set of biographical, situational, and societal drivers of provider job performance specific to your provider segments.

Step 5: Summarize and Report Findings

Now you can define the specific behaviors you want to change and decide which behaviors will be the focus of your intervention. Record these insights in a provider profile, which will help summarize the characteristics of the providers you intend to target and offer insights on how to position the desired behavior change.

Work with community or organization representatives to review the data collected and its analysis; identify needs; agree on prioritization of these needs; and plan interventions to address them. As with any other behavior change intervention, it is imperative the intervention, its messaging, and channel of delivery are appropriate to the audience segment to most effectively target your interventions. To conclude the assessment, stakeholders should agree on who will address each barrier and how behavior change will be monitored.

Tips & Recommendations

• When conducting qualitative research, consider analyzing documents such as performance reviews, quarterly reports, survey results or reports, community assessments, and employee satisfaction surveys that may also help answer your questions.
• Conducting focus group discussions, in-depth interviews, and/or participatory methods of inquiry with community members and key health system stakeholders can provide broader insight.
• Barriers and needs that cannot be addressed solely through SBC interventions are likely to surface. Engage decision makers in the assessment and analysis to motivate action to be taken on all identified needs.
• Involve community stakeholders throughout the assessment process to motivate the community to come together to help address provider barriers.
• Each factor impacting the performance of service providers should be examined through a gender lens to help develop a more comprehensive analysis, needs identification, and responsive intervention planning.
• Additional guidance and support on designing behavior change interventions for providers can be found in the Designing a Social and Behavior Change Communication (SBCC) Intervention for CHW Behavior Change and the Designing an SBCC Intervention for FBP Behavior Change I-Kits.

Resources and References

Resources

Barrières des prestataires et déviants positifs/ Provider barriers and positive deviants

Beyond Bias Literature Review and Expert Interviews on Provider Bias in the Provision of Youth Contraceptive Services:

Beyond Bias: Provider Survey and Segmentation Findings

Provider Behavior Change Implementation Kit

Provider Behavior Change Toolkit

Service Communication Implementation Kit

Barrier Analysis Facilitator’s Guide

Strategies for Changing the Behavior of Private Providers

Defining and Advancing Gender-Competent Family Planning Service Providers: A Competency Framework and Technical Brief

References

Beaulieu, M.D., Haggerty, J.L., Beaulieu, C., Bouharaoui, F., Lévesque, J.F., Pineault, R., … Santor, D.A. (2011). Interpersonal Communication from the Patient Perspective: Comparison of Primary Healthcare Evaluation Instruments. Healthcare Policy, 7(Spec Issue), 108–123.

Davis Jr., & Thomas P. (2004). Barrier Analysis Facilitator’s Guide: A Tool for Improving Behavior Change Communication in Child Survival and Community Development Programs, Washington, D.C.: Food for the Hungry.

Family Health International. (2013). Examining the Influence of Providers on Contraceptive Uptake in Rwanda.

The Health Communication Capacity Collaborative. (2016) Factors Impacting the Effectiveness of Health Care Worker Behavior Change: A Literature Review. Baltimore: Johns Hopkins Center for Communication Programs.

Hamid, S., & Stephenson, R. (2006). Provider and health facility influences on contraceptive adoption in urban Pakistan. International family planning perspectives, 71-78.

Kok, M.C., Broerse, J.E., Theobald, S., Ormel, H., Dieleman, M., & Taegtmeyer, M. (2017). Performance of community health workers: situating their intermediary position within complex adaptive health systems. Human resources for health, 15(1), 59.

Tessema, G.A., Gomersall, J.S., Mahmood, M.A., & Laurence, C.O. (2016). Factors determining quality of care in family planning services in Africa: A systematic review of mixed evidence. PloS one, 11(11), e0165627.

Viswanathan, V., Seigerman, M., Manning, E., & Aysola, J. Examining Provider Bias In Health Care Through Implicit Bias Rounds, Health Affairs Blog, July 17, 2017.

Yadufashije, C., & Ndayizeye, A. The Factors of Under-Utilization of Family Planning Services by the Population of Gitega Health District in Burundi, in 2015 (September 21, 2017). Available at SSRN: https://ssrn.com/abstract=3040939 or http://dx.doi.org/10.2139/ssrn.3040939

Introduction

A root cause analysis is a process used to identify the primary source of a problem. In social and behavior change communication (SBCC), a root cause analysis is used to examine why there is a difference between the desired state of a health or social issue (vision) and what is happening now (current situation).

Why conduct root cause analysis?

A root cause analysis helps to identify the challenges a program should address to reach its vision. SBCC strategies that only address the obvious or most visible aspects of a problem are not likely to succeed. For example, a family planning campaign that only raises women’s knowledge of contraceptives will likely not result in increased family planning use if husbands or mothers-in-law are the primary decision makers regarding family planning use. Identifying the sources – the root causes – of a health problem helps programs develop a more effective strategy to overcome it.

Who should conduct a root cause analysis?

A small, focused team should conduct the root cause analysis. Members should include communication staff, health/social service staff and, if available, research staff. Typically, the same team conducting the situation analysis will also conduct the root cause analysis.

When should a root cause analysis be conducted?

A root cause analysis (or other forms of problem analysis listed in the resource section of this guide) should be conducted as part of the situation analysis. It can take place as part of a stakeholder workshop or, if needed, during additional discussions with stakeholders or audiences.

The steps below will help identify many possible causal factors including the root cause of the health issue identified during the situation analysis.

Estimated Time Needed

Completing a root cause analysis can take up to several hours. Consider how much data is available, how well the data identifies causes and whether additional stakeholder or audience input is needed.

Learning Objectives

After completing the activities in the root cause analysis guide, the team will:

• Know the difference between causal factors and the root cause of a problem.
• Identify causal factors of a public health problem.
• Identify root causes of a public health problem (these will be both program and communication challenges).
• Identify and rank communication challenges.

Prerequisites

• Situation Analysis

Steps

Step 1: Identify Possible Causal Factors

During the situation analysis, the project team set the vision, identified the problem and collected data needed to better understand the current situation. The team can use that information to identify causal factors – things that cause or contribute to the health problem.

To identify causal factors, ask:

• What sequence of events leads to the problem?
• What conditions allow the problem to occur? [E.g., traditional values and practices]
• What problems co-exist with the central problem and might contribute to it? [E.g., lack of health facilities]

Identify as many causal factors as possible. Start with the problem and brainstorm causal factors for that problem by asking “Why?” The desk review conducted during the situation analysis and a stakeholders’ workshop are good places to find causal factors. Project staff can also ask themselves (based on their own experience) and stakeholders “why” or “so what” questions to identify causal factors. Using the problem statement, “children under 5 are malnourished” some causal factors could include:

Step 2: Identify the Root Cause

To find root causes— the primary sources of the health problem —start with the causal factors identified above and ask why, such as “Why are couples not using modern contraceptive methods?” Root causes are seldom found in the most obvious causes. It is important to dig deeper and continue to ask “why?” until nearly all responses have been exhausted or roots that seem important to address are reached. There are several useful methods for identifying root causes.

One method for identifying root causes is to construct a root cause tree. Start with the problem and brainstorm causal factors for that problem by asking why. Connect them in a logical cause and effect order until arriving at the root of the problem. For example:

This process requires good judgment and might involve trial and error. For example, if the team decides to address an identified root cause and the problem continues to occur, that is a good indication it is not the root cause. Take another look at the identified root causes and keep digging deeper to go beyond the symptoms of the problem. Staff can also consult stakeholders and audience members to assess whether they have identified appropriate root causes.

Fishbone diagrams and 5 Whys are other methods for identifying problem sources and communication challenges (see the resources section below for examples).

Additional reading suggestion:

Understanding Operational Barriers to Family Planning Services in Conflict-affected Countries: Experiences from Sierra Leone. U.S. Agency for International Development, Health Policy Initiative Sonneveldt, Emily; Shaver, Theresa; Bhuyan, Anita. USAID. 2007.

Step 3: Identify Communication Challenges

Now ask which root causes are challenges that health communication can and should address – communication challenges – and which are not. The example below identifies the communication challenges. Share findings about other root causes with local authorities and leaders or organizations that might be able to address them.

In the example above, asking why questions points to root causes of child malnutrition. Health communication cannot address some of the reasons, such as poor soil and drought. Here, the root causes that represent communication challenges can be summarized as:

• The desire to give babies additional food too soon.
• The prioritization of bottle feeding over breastfeeding.
• Misinformation about weaning foods.

Step 4: Prioritize Communication Challenges

If root cause analysis identifies more than one communication challenge, decide which challenge to address first. Rank root causes in order, starting with the main cause (key communication problem). To determine rank, consider:

• The potential impact of addressing the communication challenge. The greater the potential impact, the more important it is to address.
• How difficult it will be to reach the audience associated with the communication challenge.
• The mandate attached to the funding.
• Other resources available to address the communication challenge. There may be other partners working on that communication challenge or additional funding streams available.
• Whether there is a logical order in which to address the communication challenges. It may make more sense to address negative provider attitudes before generating demand for provider services.
• If more than one causal factor is linked to the root cause. When a root cause is the source of multiple causal factors, it indicates that addressing the root cause can have far-reaching effects.

Include the prioritized list of communication challenges in the situation analysis to help the creative team focus its efforts. This will help determine what direction the project must take and the kinds of messages, materials and activities to develop.

Templates

Fishbone Diagram Template

5 Whys Template

Root Cause Tree Template

Tips & Recommendations

• Identify a root cause that is within the team’s sphere of influence. Stop asking why once the team has identified a root cause that is within their collective ability to control or influence.
• If any cause accounts for more than 70 percent of the causal factors, it can often be considered the root cause.

Lessons Learned

• Stakeholders (including those who practice the behavior to be changed) are not always aware of or able to say why the problem exists or why they do what they do as it relates to the problem. A skilled facilitator can get the answers by: Noticing and remarking on associations made during the discussion; Using brief case study scenarios to get reactions, responses and examples from discussion participants; and Asking questions other than “why.”

Glossary & Concepts

• A causal factor is something that contributes to a problem, but is not a root cause.
• A communication challenge is a root cause that communication can address.
• A root cause is something [a source] that, if removed, will eliminate the problem.

Resources and References

Resources

Leadership in Strategic Communication: Making a Difference in Infectious Disease and Reproductive Health

5 Whys: Getting to the Root of a Problem Quickly

Problem Tree Analysis

Fishbone Diagram

Root Cause Analysis Tracing a Problem to its Origins

References

• Leadership in Strategic Health Communication Handbook, Lozare, Storey, and Bailey
• Root Cause Analysis, Tracing a Problem to Its Core, http://www.mindtools.com/pages/article/newTMC_80.htm

Banner Photo: © 2012 Malcolm Spence/On Call Africa, Courtesy of Photoshare

Introduction

What is Qualitative Research?

Qualitative or formative research is an activity conducted at the start of the Social Behavior Change Communication (SBCC) project design process. Qualitative research is a key step in order to create program materials, tools and approaches that are culturally appropriate given the local context. Qualitative methods collect data and answers questions such as why and how and, although it provides rich detail, it is not meant to generalize to an entire population or intended audience.

Why conduct Qualitative Research?

Qualitative research is used to gain insight into the health issue or behavior the project intends to address; relevant characteristics of primary and secondary audiences; communication access, habits and preferences; and the main factors that hinder and drive behavior. Qualitative methods may be used when program planners need to get an understanding of the attitudes, habits and behaviors of their audience but do not need to estimate the proportion of the attitudes, beliefs or knowledge levels in the population.

It is critical to conduct qualitative research before implementing any SBCC program because without it you cannot know your intended audience, their current level of knowledge, their beliefs and attitudes, the channels through which they receive and act on information and the barriers to adopting new health behaviors. Any program development must begin with the audience and not be designed in isolation, removed from the intended audience.

Who should Conduct Qualitative Research?

Qualitative research should be developed by the research staff in close collaboration with program staff and any government or NGO counterparts who are designing the program and have clear knowledge of the program goals and objective. Once designed, using qualitative methods requires certain skills in interviewing or conducting group discussions and an understanding of what the program needs to know about its audience in order to design appropriate strategies and materials to achieve the intended results.

When should Qualitative Research be Conducted?

Qualitative research is conducted at the beginning of SBCC programs and can help researchers and program managers discover and explore themes or processes, provide personal narratives and uncover attitudes or ideas that are common among members of a population. However, this method cannot be used to determine the proportion or number of people in an intended audience who think or act in a particular way.

How is qualitative formative research conducted?

Two of the most common approaches used in formative research are focus group discussions (FGDs) and in-depth interviews (IDIs).

These methods are effective for gaining insight into what motivates individuals and communities to behave a certain way and how they view the world or the community around them. Both focus group discussions and in-depth interviews can reveal vital information that can help shape future quantitative research or they can be used to dig deeper or reveal additional insight into existing quantitative data, such as survey results.

FGD or IDI: Which one to use?

The reasons for using a focus group discussion or an in-depth interview are quite different.

Researchers will often opt for a combination of FGDs and IDIs in an effort to comprehensively study the population and their beliefs, attitudes and behaviors. Although the pros and cons of using FGDs or IDIs are different, the process of creating, executing and analyzing FGDs and IDIs are similar in some regards. The steps below can be applied to the development of both methods for conducting formative research.

Learning Objectives

After completing the activities in the Qualitative Research guide, the team will:

1. Explain the process for creating a guide for a focus group discussion (FGD) and in-depth interview (IDI)

2. Describe the rationale for an FGD and IDI

3. Describe the key elements in conducting an effective FGD and IDI

Steps

Step 1: Identify needs

When starting to plan for qualitative formative research it is necessary to answer these key questions:

• What are the main health issues to be addressed by the program?

• What is already known about the issue and the audience? For example, what is already known about the factors that drive or hinder behavior among members of the intended audience regarding the health issue being addressed?

• What other information is needed in order to create your SBCC strategy and program?

• How will the information gathered from this group discussion or interview be used to define a strategy, to create materials, to set priorities, etc.?

• What information is needed from participants that can inform decisions related to the design or implementation of an intervention?

Step 2: Define objectives

Formative research can have more than one objective, but each must be a clear statement about what you want to learn from the research. Use active words to state your objectives, that is, what you want the research to achieve, for example:

• Describe how women search for information about family planning methods.
• Determine the process men and women follow to decide whether or not to use family planning.
• Identify reasons why women do not talk to their husbands about family planning.
• Clarify how peer relationships affect family planning decisions among teenagers.

Determine whether each objective is:

• Specific, focused, clearly described?
• Relevant to the goals of the program and to the audience?
• Feasible to discuss in an interview or FGD?

Drop or rewrite any that are not Specific, Relevant and Feasible.

Put the objectives into order of importance.

• Which need to be answered first for program decision-making?
• Which are useful to know but may not be as essential?

Step 3: Recruit the respondents

Who to recruit for FGDs or IDIs depends on the topic and, especially for FGDs, the sameness of the participants. Some topics may be important only to a specific group of people. For example, a study on breastfeeding practices will not be relevant to women who have never breastfed. Family planning, on the other hand, is an issue of some relevance to both married men and women but not to unmarried men and women. In the breastfeeding example women who are currently breastfeeding might have different attitudes, knowledge, and practices than women who breastfed years ago. If both subgroups of women are part of the intended audience, then more discussion groups or interviews may be needed to understand the differences between them.

Identifying the right respondents is key to gaining insights and information that are relevant to your planned intervention.

Step 4: Determine the number of focus groups or in-depth discussions

The number of FGDs or IDIs that need to be conducted depends on a number of factors including the sameness (homogeneity) of the participants and saturation of the responses to more completely understand the issues. When determining how many FGDs or IDIs to conduct, consider the demographic composition of your intended audience. Develop a list of key attributes that represent the study’s intended population. If the target group is urban poor women, ages 15-24, then the FGDs or IDIs should consist of people who fit those criteria. Remember to think through different demographic factors that can affect the behaviors you are trying to influence and form the number of groups or interviews accordingly.

When putting together FGDs, it is important to consider the size of the groups. On average, 6-12 people participate in each FGD because fewer than six participants produce less than a critical mass of discussion and interaction; groups larger than 8-10 people can be hard to manage and it can be difficult to give everyone a chance to voice their opinions.

If the sample of participants is more heterogeneous (i.e., group members have different attitudes, levels of knowledge or experience with the issue or are geographically or demographically varied), more FGDs or IDIs will need to be conducted in order to capture all of the different perspectives. If the sample is more homogenous similar attitudes or demographics with regard to the health issue), fewer FGDs or IDIs will be necessary since a more homogenous population often produces a smaller range of views and opinions.

Saturation refers to the point in the research process when all the viewpoints and information about the issue have been voiced already by participants. Saturation occurs when the last or final IDIs or FGDs do not reveal any new insights or ideas that were not mentioned in previous interviews or discussions. Unless the research must explore the views of many different subgroups, most formative research studies conduct no more than 10 FGDs or IDIs before saturation is achieved. At that point, if the discussions and interviews are still producing new insights, then more sessions may be necessary.

Step 5: Create the questions

Begin by drafting a list of questions that match the research objectives. Once the questions have been drafted, review the purpose and objectives of your study. Narrow the list of questions to the ones that are most relevant and important for the research, ideally 7 to 10 questions, keeping in mind that each question will be followed by additional probing questions. You may list some probing questions to keep at hand and use depending on the direction that the discussion or interview takes. The probing questions go deeper into understanding the underlying causes of the issue or behavior being discussed. Do not overload the discussion guide with too many questions. A FGD will generally last for 1 to 2 hours and an in-depth interview is usually shorter. Remember that the goal of qualitative research is to go deep into a few key ideas, not to cover a lot of topics superficially.

Questions should be open-ended (i.e., they cannot be answered simply “yes” or “no”) in order to invite ideas and stimulate conversation. Ensure that the questions are not biased and do not have language that might encourage participants to answer in a specific manner. Once the questions have been refined, arrange them in order so that they begin from the more general to the specific and in a way that will be comfortable for the participants. The first one or two questions should be simple introductory or warm-up questions that put the respondents at ease, help establish rapport between them and the interviewer, and lead into the more serious questions.

Step 6: Select a facilitator/interviewers

Facilitators or moderators lead FGDs and interviewers are used for IDIs. Effective FGD facilitation requires a special set of skills that not all facilitators have. In an FGD, the facilitator must ensure that all participants share their opinions and interact with each other. An additional person who can take notes on the discussion is also important so the facilitator is free to moderate the discussion.

Effective interviewing requires its own set of skills in creating personal rapport and trust that will enable the participant to honestly share his or her opinions and feelings. Both facilitators and interviewers should be able to diplomatically keep the discussion on track and ensure that every participant is heard. They must be open-minded, flexible, patient, observant and good listeners and ensure that they do not lead or influence the conversation. They need to be able to capture and build on trends in the conversation and use active and reflective listening. They should also be deeply familiar with the study topic and the larger project objectives so that he or she can help keep the conversation centered on the purpose and needs of the study. Facilitators or interviewers may be staff members, volunteers or third-party professionals, but in any case must have strong interpersonal communication skills, even though their interaction with the participants relies heavily on a script.

Step 7: Develop a script

A script is essential to FGDs or IDIs. The questions created in Step 5 will be part of, but not all of, the script. The script should be structured as follows:

1. An opening. Create an opening statement for the facilitator, where he or she will welcome the participants, introduce himself/herself, present the purpose of the study, explain how the focus group or individual interview will work and ask for brief introductions from the participants. If required by a research ethics board, this script may also include the language needed to obtain the informed consent of the respondents to participate in the research.
2. Questions. This part of the script consists of the questions created in Step 5. Remember to start with the introductory questions as a way of comfortably easing participants into a more serious and in-depth conversation.
3. Closing. When closing, the facilitator should summarize some general themes and insight that came out of the conversation and give participants an opportunity for any final words, thank them for their input, inform them how the data will be used and explain how the results will be disseminated.

Step 8: Choose a Place

Once you have the above the next consideration is finding the appropriate place to conduct the IDAs or FGDs. There are a number of factors to be taken into consideration when choosing the meeting place to ensure that you get the maximum input from the respondents who should be relaxed and open to share their thoughts and opinions. Local leaders and people will help in determining the right place for this. Ideal locations are places that are:

Step 9: Conduct the FGDs or IDIs

When conducting in-depth interviews or focus group discussions, keep the following in mind:

Step 10: Transcribe the Interviews

Once the FGD or IDI is over the facilitator or interviewer should immediately write down any impressions or observations made during the discussion or interview that might help the analysis. The audiotape of the discussions should be carefully transcribed and, if needed, translated. The facilitator is not required to do this, but if a third party provides that service, the facilitator should verify the accuracy of the transcriptions before they are subjected to analysis. The quicker an FGD or IDI is transcribed, the less likely there are to be mistakes due to lapses in the facilitator’s memory.

Step 11: Analyze the Information

Once the FGDs or IDIs are transcribed, they should be analyzed and coded for common themes related to the purpose and objectives of the study. Arranging or grouping the statements by theme allows for better organization of data when pulling out results and key findings. These findings should be put into a report that details the methods of the study, the key results and findings of the discussions and/or interviews, and the resulting implications as they relate to the design of the health campaign or program.

Conclusion

This qualitative formative research process and the resulting report will allow partners and key stakeholders to gain a better understanding of the target population, especially with regards to the health topic of interest. Once the formative research is complete, it is time to start considering the type of intervention the target population needs as well as what monitoring and evaluation system should be put in place in order to assess whether or not the population’s needs and interests are being met and to ensure that the program is on track.

Samples

Sample Focus Group Discussion and In-Depth Interview Guides

Tips & Recommendations

• Some health topics may be too sensitive or inappropriate for certain populations or groups to discuss in public. Adjust objectives or methodology accordingly. For example, it is sometimes inappropriate to discuss contraception in a mixed group of men and women together. Consider, instead, having separate FGDs for men and women.

Glossary & Concepts

• Statistically representative means that the numbers produced can be understood to reflect the whole intended audience of an SBCC program and not just the people who participated in the research.For example, For example, a audience survey might find that out of 1000 young married women aged 18-24 who were interviewed, 200 of them (20%) reported searching for health information on the internet in the past month.If those 1000 respondents were selected in an unbiased way (usually some kind of random sampling), then we can assume that they represent the entire audience and we can confidently expect the same rate of health information seeking (20%) among all young married women aged 18-24. We often need to calculate proportions of the audience with certain attributes in order to prioritize what the program should focus on.

Resources and References

Resources

Window of Opportunity Qualitative Research Field Staff Toolkit

Conducting In-Depth Interviews: A Guide for Designing and Conducting In-Depth Interviews for Evaluation Input

References

• CARE. Window of Opportunity Formative Research Field Staff Toolkit.
• Gittelsohn, J., Steckler, A., Johnson, C. C., Pratt, C., Grieser, M., Pickrel, J., and Staten, L. K. (2006). Formative research in school and community-based health programs and studies: “State of the art” and the TAAG approach. Health Education & Behavior, 33(1), 25-39.
• Lehigh University. Conducting a Focus Group.
• Oak Ridge Institute for Science and Education. Steps for Conducting Focus Groups or Individual In-depth Interviews.
• Overseas Development Institute. Research and Policy in Development: Focus Group Discussion.
• Pathfinder International. Conducting In-Depth Interviews: A Guide for Designing and Conducting In-Depth Interviews for Evaluation Input.

Introduction

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Click here to access this Guide in Arabic – مراجعة هذا الدليل باللغة العربية، انقر هنا

Click here to access this Guide in Portuguese – Guias em Português

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A program analysis is the process of looking at an organization’s intended social and behavior change communication (SBCC) program and then identifying enabling and limiting factors to implementing it successfully.

A program analysis is used as a planning tool when the program is under development and helps the program team explore the following factors that may enhance or constrain the planned SBCC program and then utilizes the findings for program design:

• Human and Physical Resources
• Political Environment and Trends
• Programmatic and Management Structure
• Community and Client Dynamics
• Technological Resources
• Financial Resources and Funding

A program analysis is only as good as its information. Research and accurate data are vital to identifying key issues relevant to the success of a program.

Why Conduct a Program Analysis?

A program analysis helps the team understand key constraints that must be addressed for a program to be successful. SBCC programs risk failure if fundamental limiting factors, weaknesses and threats are not addressed. Findings from the program analysis inform the design of the program/campaign strategy and identify clear actions to be taken to enhance the potential for success.

Who Should Conduct a Program Analysis?

A small, focused team should conduct the program analysis. Members should include research, health/social service and program and communication staff. When feasible, it can be a good idea to include stakeholders from outside the program to participate and bring a neutral perspective to the process.

When Should a Program Analysis Be Conducted?

Conduct a program analysis after completing the situation analysis and audience analysis. Information collected during these analyses will inform the program analysis. Use the findings to develop the SBCC strategy.

Estimated Time Needed

Completing a program analysis can take up to two weeks. Consider the size of the project, scope of the literature review, how much data is available and easily accessible, and whether additional stakeholder or audience input is needed. Allow for additional time to fill in any gaps that may exist.

Learning Objectives

After completing the activities in the program analysis guide, the team will understand:

• The opportunities that exist to improve the design or implementation of the SBCC strategy.
• Which challenges to address before or as part of implementing the SBCC strategy.

Prerequisites

• Situation Analysis
• Audience Analysis

Steps

Step 1: Decide on a Framework

There are many ways to assess an organization’s ability to design and implement a program, including a full organization/communication capacity assessment, Force Field Analysis, Theory of Constraints and SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis (see Resources for more information). If an organization has a program that has already begun, it may rely on recent program assessments or evaluations if available.

Step 2: Implement Chosen Framework

This guide outlines the Force Field Analysis framework, which is a relatively quick and simple way to analyze a program and its potential for success. Force Field Analysis assists a program team in identifying what factors – both internal and external – can help them reach the shared vision/change desired (forces for change) and what factors might keep them from reaching the vision (forces against change). The graphic below illustrates the concepts behind implementing the Force Field Analysis framework.

Step 3: Describe Proposed Change

Using the Force Field Analysis template (see Force Field Analysis Template), in the center box, describe the change the program hopes to accomplish, which should be based on the shared vision established during the situation analysis. The shared vision may need to be condensed to create a concise version of the change the program desires.

Step 4: Brainstorm Forces for Change

Brainstorm all the forces, both internal and external, that might help the program achieve the desired change. See the table below for questions to help identify forces for change and examples of such forces:

Be sure to consider all the financial, human, technological and non-material resources the program can take advantage of. List each force for change in an arrow on the left side of the template (see Force Field Analysis Template).

Step 5: Brainstorm Forces against Change

Next, brainstorm all of the forces, both internal and external, that might prevent the program from achieving the desired change. See the table below for questions to help identify forces against change and examples of such forces:

List each force against change in an arrow on the right side of the (see Force Field Analysis Template).

Step 6: Score Each Force

For each force listed, assign a score that represents how much influence that force has on the desired change. The team can decide on the scale, but one way is to score each force from 1 to 5, with 1 being weak influence and 5 being strong influence. The team can add up the scores for each side (for and against) to determine whether forces for change are greater than forces against change. There does not need to be an equal number of forces for each side. For example:

Step 7: Consider Appropriate Actions

Examine the completed Force Field Analysis sheet and ask what actions the program team might take to increase the potential for successful change. Ask what the program could do to strengthen the forces that support change and weaken the forces that oppose change. What weaknesses should the program address? What strengths should it build on to enhance successful change? Typically, the program should focus on the forces with the strongest influence. These actions then make up the strategy the program develops. A successful SBCC strategy addresses the key constraints to reaching the vision and capitalizes on core opportunities and assets.

Step 8: Use the Analysis Findings

Whatever template the team uses, the program analysis should highlight actions for inclusion in the strategy that will help the program reach the shared vision defined during the situation analysis. Using the results from the analysis, determine how the program can:

• Eliminate or weaken the factors that stand in the way of reaching the vision.
• Enhance the factors that support reaching the vision.
• Build on key strengths and utilize available assets.
• Mobilize neutral forces to help the program achieve the vision.
• Minimize key weaknesses and avoid threats.
• Capitalize on key opportunities.

Use the results of the program analysis when designing the SBCC strategy, messages, interventions and monitoring and evaluation plans.

Repeat or revisit the analysis as needed to check assumptions, incorporate new information or as the program or environment changes.

Templates

Force Field Analysis Template

Samples

PMTCT Communication Interventions SWOT Analysis

Using SWOT for a Neighborhood Development Project

External Resources

https://www.urbanreproductivehealth.org/sites/mle/files/ar03jan-11.pdf

Tips & Recommendations

• Avoid writing a long list of influencing internal and external factors. Prioritize the list and include only those that are likely to have a major impact on the shared vision.
• Try to be honest and objective in identifying both positives and negatives. Overestimating abilities or underestimating challenges can negatively impact the program, strategy and health situation.
• If outsiders cannot participate in the analysis, try to look at the program’s challenges and opportunities as an outsider (in addition to looking at them as insiders).
• Really think through and analyze the enabling and limiting factors – listing them is not sufficient.

Lessons Learned

• Conducting a program analysis helps avoid unhappy surprises and capitalize on advantages and opportunities.
• A program analysis is most beneficial if it is used to support the vision and address the problem defined during the situation analysis and incorporate the information learned from the audience analysis.

Resources and References

Resources

SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats

The Theory of Constraints (TOC)

SBCC Mapping Tool for Assessment

Writing a Communication Strategy for Development Programmes: A Guideline for Programme Managers and Communication Officers

SWOT Analysis

SBCC Capacity Assessment Tools

References

• O’Sullivan, G.A., Yonkler, J.A., Morgan, W., and Merritt, A.P. A Field Guide to Designing a Health Communication Strategy, Baltimore, MD: Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs, March 2003.
• UNICEF. Writing a Communication Strategy.
• Mind Tools. Force Field Analysis: Analyzing the Pressures For and Against Change.
• Business Dictionary

Banner Photo: © 2011 A.M. Ahad, Courtesy of Photoshare

Introduction

UPDATED September 2021

Introduction

Audience segmentation is fundamental to social and behavior change interventions. Segmentation serves to align messages, message delivery channels, products, and services with the needs and preferences of an intended audience to maximize program impact. Segmentation divides a population or market into subgroups that have, or are perceived to have, meaningfully similar characteristics, and significant differences from other subgroups. Audiences may be segmented based on demographic, attributional, psychographic, behavioral, or other key variables. Effective segmentation recognizes that the behavior change problem of interest may vary by segment and that different groups will respond differently to social and behavior change (SBC) approaches.

Definition

Advanced audience segmentation builds on traditional segmentation approaches by using mixed methods of research to hypothesize and test audience segments. Advanced audience segmentation relies on a phased process of background research, in-depth qualitative research, quantitative research, and advanced statistical analysis to create a representative base of audience segments. It produces a framework to understand how certain beliefs, behaviors, or needs vary across a given population. This rigorous process offers greater nuance and insight into how to best identify and reach priority groups to drive behavior change.

Why use advanced audience segmentation?

Program strategy can be effectively informed by traditional segmentation approaches focusing on demographic, psychographic, or attributional factors. However, SBC interventions can improve their tailoring and targeting of messages, or improve product design, pricing, and positioning by using advanced audience segmentation.

Segmentation can help to:

• Improve understanding of an audience’s experiences, desires, concerns, needs, and behaviors.
• Identify, estimate, and prioritize the potential for behavior change among a specific group .
• Predict the most promising opportunities for resource allocation.
• Tailor services, products, and interactions to specific groups.
• Shape communication efforts to effectively drive awareness, engagement, mobilization, and uptake.

For example, in contexts where the unmet need for family planning is low, advanced audience segmentation can help identify potential new users with the greatest unmet need and the highest willingness to adopt modern methods of contraception.

What are the steps?

Advanced Audience Segmentation Process

1. Review your objective
2. Synthesize background research
3. Conduct qualitative audience research to provide insights into current behavior
4. Develop hypothesis segments
5. Conduct quantitative audience research to establish segments
6. Derive and define audience segments

“Segments are not created but uncovered”

A Breakthrough ACTION How-to-Guide

Learning Objectives

• Define advanced audience segmentation
• Understand the importance of advanced audience segmentation to SBC
• Understand the advanced audience segmentation process

For comprehensive learning of the Advanced Audience Segmentation Process, with recent case studies (for high as also low data and resource availability), Breakthrough ACTION has created the new Applying Segmentation to SBC in Family Planning course that can be found on the Global Health eLearning Center (GHeL) platform.

Prerequisites

• How to Do Situation Analysis
• How to Do Audience Analysis

Steps

Step 1: Review Your Objectives

Before you begin the segmentation process, ensure that your program objectives are clearly defined and you have completed both a situational analysis and audience analysis. This will help you identify which opportunities you intend to address through improved segmentation of the intended audience. The results of your segmentation exercise will vary depending upon your program objective.

Step 2: Synthesize Background Research

The next step is to identify relevant characteristics of the broad target population. Conduct an initial brainstorm based on internal knowledge and a review of existing data to identify characteristics that may be used to segment the intended audience. Gather stakeholders whose work will be most impacted by the results of the segmentation process and engage in discussions on the ideas or assumptions about the broad target population. A synthesis of the knowledge and insights from this brainstorm should be used to identify topics for exploration through primary research.

Then use peer-reviewed and grey literature from public health and other relevant disciplines to identify gaps in knowledge about your target population. Start by investigating existing evidence on knowledge, attitudes, and practices through national or subnational data. If local data is not available or sufficient, review data from contexts with cultural, religious, or other significant similarities. Consider interviewing key informants who can provide added perspective on society, religion, and culture and how those factors might influence the behavior(s) of interest.

Once you have this background information, identify a set of variables that appear most relevant to the target population. It is important to consider the relative strength of each category of variables in predicting the factors that underlie behavior change. For complex or difficult behavior change challenges, it is useful to consider socio-demographic, geographic, and lifestyle variables, but it most helpful to focus on factors that are most likely to drive the intent to change behavior. For example, variables representing the main constructs of the Integrated Behavior Model, are likely better predictors of behavior change than demographic variables. Strongly consider focusing your research plan on investigating the variables in the highlighted boxes below. Next, develop a research plan to explore those variables and to uncover other important characteristics.

Table 1: Types of Variables to Consider

Step 3: Conduct Qualitative Audience Research to Provide Insights into Current Behavior

Now you have potential variables that may be significant factors in facilitating change among your intended audience and a set of information gaps to investigate. To create a strong segmentation, it is important to understand the range of factors that may influence your audience’s decision-making. To gain a comprehensive perspective on key decision making factors, conduct a qualitative investigation of the needs, attitudes, and behaviors of the population. This helps to identify what the barriers and motivators might be to adopting the desired behavior.

There are a number of qualitative research methodologies that may be appropriate to use. Data may be collected through methods such as focus groups discussions, interviews, consultations, and observations. Participatory methods such as human-centered design workshops and photovoice may also help to uncover differences between subpopulations that will guide your segmentation.

The qualitative audience research should include various populations relevant to the behavior of interest. For example, if your program is trying to increase family planning use among women of reproductive age nationally, your qualitative research should consider sampling a range of women that might include urban and rural women, younger and older women, married and unmarried women, or women at different critical life moments (e.g., recently married, new mothers, etc.). Results of qualitative research should help inform and refine the sampling strategy for the quantitative research.

The results of the qualitative research exercise will provide you with insight into behavioral determinants, including barriers, facilitators, and influences on the intended audience, as well as other socio-cultural factors associated with the desired behavioral outcome.

Step 4: Develop Hypothesis Segments

Now that you’ve conducted your qualitative research and analyzed the data, it is time to hypothesize target segments. Identify the characteristics that make subsets of the audience significantly different from the other subsets. A significant difference is one that requires different messages or approaches to reach and influence the audience.

There are several factors that can be used to segment an audience and each has its advantages and limitations. Again, your approach to segmentation will depend on the program and behavioral objectives identified as a result of your situation analysis, audience analysis, and program analysis. Consider the various types of segmentation to determine which ones would make potentially viable audience segments. At this point, you should hypothesize as many segments as there are meaningful differences in subgroups related to the behavior change objective.

Traits such as age, education level, and income are typically not enough to form the basis of an effective SBC segmentation strategy. Values, tastes, and preferences are more likely to influence how an audience might react to messaging and activities and are, therefore, more useful in identifying segments. The hypothesized segments will help you predict which groups are most likely to adopt the behavior, and the major factors to address in order to enable those behaviors. Before you move into the quantitative research phase, outline what you know about your segments, what you believe to be true about them, and what remains to be uncovered.

Table 2: Segmentation Types

Step 5: Conduct Quantitative Audience Research to Establish Segments

Once the qualitative research is complete and hypothesis segments are developed, use quantitative research to test the hypotheses. Select a set of variables to test based on factors associated with willingness to practice the behavior of interest. Depending on the results of your earlier evidence-gathering exercise, the factors to test through statistical analysis may include demographic, behavioral, and attitudinal factors associated with willingness to adopt the desired behaviors and/or other key considerations.

Thoughtful survey design and recruitment criteria are integral to producing useful quantitative outputs. The survey instrument should be informed by the results of qualitative research, background research, and insights gathered starting from the initial brainstorm and stakeholder interviews. The screening criteria should be based on the hypothesis segments and the sample should be representative by factors such as geography, education, marital status, and income or socioeconomic group. The instrument should investigate needs, attitudes, behaviors, and other factors thought to influence the behavior(s) of interest.

Following an analysis plan that establishes which questions are to be answered, which sub-groups should be used, and which specific hypotheses are to be tested, the data should be analyzed using the appropriate analysis method. Analysis techniques typically used for segmentation included cluster analysis, latent class analysis, and perceptual mapping.

Two examplesthat used robust statistical segmentation are the National Demand Analyses by Camber Collective in Niger through funding from the William & Flora Hewlett Foundation and in Cote d’Ivoire under the USAID-funded Transform/PHARE project. National demand analysis is a method developed in the private sector to enable companies to understand the needs of their customers and how to best shape the consumer experience to attract and retain them. This quantitative approach to audience analysis was used in Niger and, later, in Cote d’Ivoire to identify the demographic, behavioral, and attitudinal factors associated with willingness to use modern contraceptives; the contraceptive characteristics most appropriate to each segment of women; and the communication channels and dimensions of the provider experience that are most important to each segment of women. Statistical analysis of survey data allowed Camber to estimate the size of each newly identified segment and the potential impact their uptake of family planning could have on the national modern contraceptive prevalence rate.

Step 6: Derive and Define Audience Segments

Reflect on the results of the quantitative analysis and the limitations of the data. Question whether the newly identified segments confirm or dispel your initial assumptions and hypotheses. In some cases, your final segments may look very similar to what you initially brainstormed and, in other cases, quite divergent. Transform/PHARE in Cote d’Ivoireidentified three segments based on life stage as a result of their qualitative investigation: pre-family women; family aspirationals; and family planners. Once the full advanced audience segmentation process was complete, six main subgroups of women were revealed: pre-family women; rural passives; independent matriarchs; struggling aspirationals; family builders; and family limiters. The rigorous segmentation exercise provided Cote d’Ivoirewith a far more nuanced national picture of the type of potential family planning users. This then allowed for more targeted programming and messaging strategies to adequately address the audience’s needs and concerns.

As you refine and finalize your segments, ensure the segments meet the criteria for segmentation. Segmentation is a blend of both art and science, requiring evidence and intuition. However, for the segmentation results to be useful, the segments must, at a minimum, meet the criteria outlined in the table below.

Table 3: Criteria for Segmentation

Finally, validate your segments. Share the results of your segmentation exercise with key stakeholders to assess whether they meet the criteria for segmentation within your context. One way to share the segments is to develop persona profiles or archetypes for each segment. The persona is a descriptive summary of a representative individual within the segment. To develop the persona, consider the needs, motivations, and beliefs that may drive a person within the segment to carry out the desired behavior. The profile should illustrate 3–5 characteristics that differentiate the segment from others. The profiles will help you conceptualize the statistically derived segment as a tangible audience.

Depending on resources, program objectives, and feasibility, you can also consider prioritizing select segments. Segments can be prioritized based on various factors. A segment may be prioritized based simply on its size or ease to access. Another means to prioritize is using statistical analysis to determine which audience has the greatest propensity to change behavior or which will have the greatest potential impact on the outcome of interest. Once again, review the insights you gathered through each step of the process and confirm that targeting the prioritized audiences will help you reach your program’s strategic objectives.

Tips & Recommendations

• To best understand audience behavior, a research approach that combines qualitative and quantitative methods is most effective.
• Observational research allows you to learn about an experience from the perspective of your audience and can be very useful in learning about their decision-making process and preferences.
• In your qualitative study, try to include a cross-section of individuals that will help test initial hypotheses and refine the sampling strategy for the quantitative research.
• The important differences that define your hypothesis segments should be based on their needs, attitudes, and behaviors of the audience segments, not only demographics, geography, and lifestyle characteristics.
• Create as many segments as are needed to reflect meaningful differences across the target population, while keeping in mind segment sizes and the overall complexity of the segmentation. While exceptions may exist, effective and practical segmentations tend to produce between four and seven segments.
• Considering resources and feasibility, your program will likely be most impactful if focused on a few priority segments.
• Using the statistical data to determine which segments have the greatest propensity to change behavior will allow you to prioritize based on, and forecast, potential to the impact program targets.
• Needs, attitudes, and behaviors often change with time so segmentation should be an ongoing process where insights continuously feed into program strategy.

Resources and References

References

Reports

Consultative Group to Assist the Poor (CGAP) Customer-Centric Guide

Qualitative Insights and Strategic Narratives in Niger: A Report of Findings, Insights and Ideas

Transform/PHARE Cote d’Ivoire Segmentation Final Report

Niger Family Planning Demand Analysis: Qualitative Research Brief

Increasing Contraceptive Use in Niger Final Report

Resources

Applying Segmentation to SBC in Family Planning

Accelerating Family Planning Demand Through Advanced Audience Segmentation

CGAP Customer-Centric Guide

Health Communication Capacity Collaborative (HC3) Audience Segmentation How-to Guide

HC3 Situation Analysis How-to Guide

HC3 Audience Analysis How-to Guide

Contacts

Jvani Cabiness: jcabine1@jhu.edu

Jim Malster: jmalster@psi.org

Jessica Vandermark: jessica@cambercollective.com