Acceptance of the Advocacy Core Group approach in promoting integrated social and behaviour change for MNCH+N in Nigeria: a qualitative study

Abstract

Objective: This paper examines the acceptance of the Advocacy Core Group (ACG) programme, a social and behaviour change intervention addressing maternal, newborn, child health and nutrition (MNCH+N) in Bauchi and Sokoto states, with an additional focus on the perceived endorsement of health behaviours by social networks as a potential factor influencing acceptance.

Design: This study used the qualitative social network analysis approach and used in-depth interviews to collect data from 36 participants across Bauchi and Sokoto states.

Setting: This study was conducted in selected communities across Bauchi and Sokoto states.

Participants: A purposive sample of 36 participants comprised of men and women aged 15-49 years who have been exposed to the ACG programme.

Results: Programme beneficiaries actively engaged in various ACG-related activities, including health messaging delivered through religious houses, social gatherings, home visits, community meetings and the media. As a result, they reported a perceived change in behaviour regarding exclusive breast feeding, antenatal care visits, family planning and malaria prevention. Our findings indicated consistent discussions on health behaviours between programme beneficiaries and their network partners (NPs), with a perceived endorsement of these behaviours by the NPs. However, a potential negative factor emerged, whereby NPs exhibited perceived disapproval of key behaviours, which poses a threat to behaviour adoption and, consequently, the success of the ACG model.

Conclusions: While findings suggest the successful implementation and acceptance of the model, it is important to address possible barriers and to further explore the socially determined acceptance of MNCH+N behaviours by NPs. Interventions such as the ACG model should mobilise the networks of programme participants, particularly those with decision-making power, to improve the uptake of health behaviours.

Keywords: community child health; health education; maternal medicine; public health.

Figure 1

Level of influence of network partners. This represents a distribution of influece levels ranging from ‘least influential’ to ‘most influential’ among network partners with organge bars representing decision makers and blue bars representing core influencers.

Figure 2

Selected sociograms from Bauchi state. An Ego/programme beneficiary is positioned at the center of each sociogram and labeled as such. They are also represented by a blue colour. Associated NPs are connected to the Ego/program beneficiary through a series of arrows that are either bidirectional or unidirectional. The shapes representing NPs are labelled with LoI score with green shapes representing CIs and orange shapes representing DMs. Arrows represent support provided or support received. Bidirectional arrows indicate that support is both provided and received (green arrow represents emotional support, blue arrow represents financial support, black arrow represents advice provided). Across all sociograms, males are represented by a rectangle and females are represented by a circle. DM, decision maker; CI, core influencer; CL, community leader; CV, community health volunteer; NP, network partner; RL, religious leader; TL, traditional leader; WDC, ward development committee member.

Figure 3

Selected sociograms for Sokoto state. An Ego/programme beneficiary is positioned at the center of each sociogram and labeled as such. They are also represented by a blue colour. Associated NPs are connected to the Ego/program beneficiary through a series of arrows that are either bidirectional or unidirectional. The shapes representing NPs are labelled with LoI score with green shapes representing CIs and orange shapes representing DMs. Arrows represent support provided or support received. Bidirectional arrows indicate that support is both provided and received (green arrow represents emotional support, blue arrow represents financial support, black arrow represents advice provided); NP labels in red indicates DM/CI that would not approve of MNCH+N behaviours. Across all sociograms, males are represented by a rectangle and females are represented by a circle. CI, core influencer; CL, community leader; CV, community health volunteer; DM, decision maker; MNCH+N, maternal, newborn, child health and nutrition; NP, network partner; RL, religious leader.