Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh.
Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh.
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DOI：
10.1111/mcn.13408
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发表时间：
2022-10
影响因子：
3.4
通讯作者：
Hoddinott, John
中科院分区：
文献类型：
--
作者：
Grandner, Gargi Wable;Rasmussen, Kathleen M.;Dickin, Katherine L.;Menon, Purnima;Yeh, Tiffany;Hoddinott, John
关键词：
社区卫生工作者 (CHW) 越来越多地向育龄妇女及其家人提供人际咨询，以提高对建议的孕产妇和儿童营养行为的采用。人们对社区卫生工作者在资源匮乏地区改善孕产妇营养和母乳喂养实践获得家庭支持的第一手经验知之甚少。在孟加拉国农村进行的一项行为改变沟通试验中，我们利用重点民族志，从社区卫生工作者说服有影响力的家庭成员支持有关孕产妇饮食、休息和母乳喂养的建议的策略中汲取了见解。我们采访了 7 个“Alive & Thrive”干预点的 35 名社区卫生工作者，他们为孕妇及其家人提供家庭人际咨询。深入探讨的重点是社区卫生工作者如何解决缺乏家庭支持的问题。基于费舍尔叙事范式的主题编码揭示了社区卫生工作者对三种修辞原则的战略运用：精神（可信度）、悲情（情感）和标志（逻辑）。社区卫生工作者报告称，根据孕妇、丈夫和婆婆对行为收养的影响，有选择性地针对孕妇、丈夫和婆婆。支持推荐行为的关键动机是改善胎儿生长和儿童智力。改善孕产妇健康是最没有激励性的结果，即使对于母亲来说也是如此。逻辑连贯的信息能够引起丈夫的共鸣，而母亲们也需要同理心的咨询。婆婆们最不妥协，但还是通过情感诉求被说服了。对产妇休息的说服是最费力的，导致内容吸引人但科学上不准确的信息。我们的研究表明，社区卫生工作者可以就与背景相关的可行策略提供重要见解，以改善家庭支持和营养建议的采纳。它还确定了对社区卫生工作者进行集中培训和监测的必要性，以解决存在科学缺陷的咨询叙述。对孟加拉国农村社区卫生工作者（CHW）提倡营养的叙述的分析表明，说服丈夫的行为改变沟通（BCC）策略需要逻辑和可信的信息（标识和精神）来建立他们的支持，而育龄妇女可能还需要情感诉求（悲情）来采取提倡的行为。传统上影响多种营养行为的婆婆可以通过战略性地运用精神和情感来说服。 CHW 沟通策略有助于制定有说服力的叙述，捕捉有影响力的家庭成员的价值信念和结果预期，并促进行为改变。然而，需要采取额外的计划努力来阻止社区卫生工作者使用不科学的叙述。
Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives. Analysis of narratives of nutrition‐promoting, rural Bangladeshi community health workers (CHWs) suggest that behavior change communication (BCC) strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers‐in‐law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos. CHW communication strategies are useful in developing persuasive narratives that capture influential family members’ value beliefs and outcome expectancies and promote behavior change. However, additional programmatic efforts are needed to discourage use of unscientific narratives by CHWs.
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