Localizing Interventions for Positive Behaviour Change

The role of integrated marketing communication is to increase awareness and reach a larger audience. This simply means utilizing different platforms and mediums to spread the intended message.

As the Covid-19 interventions are largely behavioral change skewed, Amref Health Africa has incorporated them in the Hygiene and Behaviour change program to reach out to communities in the 10 counties identified as Covid-19 hotspots in Kenya. Working closely with the Ministry of Health officials within the counties, Amref Heath has incorporated its murals and nudges (wall posters) in the hospitals/ dispensaries, markets and bus stations to reinforce healthy behaviors. The wall posters and murals in this instance act as constant reminders to individuals to take personal responsibility in protecting themselves against Covid-19 by adhering to the five key behaviors of wearing a mask, washing hands with soap, physical distancing, cough etiquette and ability to identify symptoms of the disease.

The nudges for HBCC program aim to in trigger positive action towards all Covid-19 preventative measures and demonstrate the action required but more importantly, the messages aim to place the responsibility to the individuals.

“COVID really scared us especially those of us who work in hospitals. We thank the organizations that put up this painting to remind everyone to observe the government guidelines so that life can go back to normal.” – Mohamed, a guard at the Coast Provincial Hospital.

The nudges and murals painted in Migori and other areas have been localized to personalize the message and eliminate translation gaps around COVID-19. The language localization is further amplified with training of Community health care workers and volunteers who understand and relate to the sensitivities of local cultures and norms being observed.

Results from localizing the interventions has allowed for messages to be owned and embraced by respective communities, new words and terminologies being added to local dialect helping raise the acceptance and success of interventions being delivered.

Why Murals and Nudges

Nudging is a concept in behavioral economics, political theory, and behavioral sciences which proposes positive reinforcement and indirect suggestions as ways to influence the behavior and decision making of groups or individuals.

To nudge literally means to gently push someone or something in a particular direction; figuratively it means to encourage through words or actions with the latter being referred to as the power of suggestion. Thus any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options is a nudge.

“Before this painting was done, we reminded our customers and other traders again and again to maintain distance from one another but since it was done we now remind only a few times by pointing at the painted wall.” – Mama Onyi, Trader in Bondo Market in Siaya market

While in Kisii and Migori, Amref Health Africa, County Health officials and National Business Compact on Coronavirus (NBCC) distributed and plastered nudges in more than 80 health centers, including markets and bus stations. Core to the effort was ensuring the nudges and murals are strategically placed within the health facilities, all aimed at promoting healthy habits in order to mitigate the spread of COVID-19.

Staff in recipient facilities expressed their appreciation, noting that it will now be easier to refer the patients to the posters instead of repeating the messages constantly.

Further a general observation across all health facilities was that the well-stocked and functioning handwashing stations was a good sign that the hand hygiene interventions are being adhered to as part of behavior change to reinforce the anti Covid-19 interventions.

“Art is my passion and I am happy that I can use it to express what the community feels like at this difficult time and how they want life to be in the coming days.” – Michael Onyango, a Migori-County based artist