1 Contents What is the purpose of this guide? Part one: An introduction to the Community Dialogue Approach ...............................................4 Background ............................................................................................................................................ 5 This guide is intended for health programme implementers who want to help What is the Community Dialogue Approach? ........................................................................................ 6 communities make healthy choices. It introduces the Community Dialogue Approach, When is it appropriate to use the Community Dialogue Approach? .................................................... 7 an innovative and participatory approach used to help achieve and sustain social How does the Community Dialogue Approach work? ........................................................................... 8 action towards improving the health of communities. The approach could be What happens during a Community Dialogue Approach session? ........................................................ 9 considered both a community engagement and social and behaviour change Where has the Community Dialogue Approach been used before? .................................................... 10 intervention. How does the Community Dialogue Approach compare to other approaches? ................................. 11 What are the core principles of the Community Dialogue Approach? ................................................ 12 The focus of Part One of this guide is to help health programme implementers 1. Grounded in theory and context .............................................................................................. 12 decide whether the Community Dialogue Approach is appropriate and will be 2. Embedded within existing structures ........................................................................................ 12 effective in helping them to achieve their programme objectives. Part One explains 3. Social Accountability .................................................................................................................. 14 the approach’s theoretical underpinnings, and shares experiences from successful What are the key assumptions of the Community Dialogue Approach? ............................................. 16 implementation, as well as its limitations. By the end of Part One, prospective What resources are required to implement the Community Dialogue Approach? ............................. 18 implementers should understand what is involved in the approach and be able to How is the Community Dialogue Approach implemented? ................................................................. 19 determine whether or not it is right for them. What are the potential limitations of the Community Dialogue Approach? ....................................... 20 In Part Two, steps are provided in order to contextualise the approach for specific Part two: Things to think about ..................................................................................................... 22 health or behavioural outcomes. As it is well recognised that participation in design, Phase I: Programme inception and design .......................................................................................... 24 evaluation and research improves the likelihood of success,[1] Part Two provides 1. Conduct a situational analysis ................................................................................................... 26 guidance to implementers on how and when to effectively engage stakeholders from 2. Develop research protocol ........................................................................................................ 27 national, sub-national and community level, during design, implementation and 3. Conduct formative research ...................................................................................................... 29 evaluation. Guidance is also provided in order to develop the requisite material to 4. Prepare draft design and implementation strategy .................................................................. 29 support implementation. For training purposes the guide will refer to tested manuals 5. Hold consultative stakeholder meetings and design workshops ............................................... 29 used in prior implementation. Phase II: Pre-implementation.............................................................................................................. 36 6. Conduct courtesy visits .............................................................................................................. 36 The Community Dialogue Approach has been 7. Conduct baseline survey ............................................................................................................ 37 successfully implemented in a variety of low-resource 8. Recruit and register volunteer facilitators ................................................................................ 37 settings and hard to reach communities. It has been Disclaimer: the Community Dialogue Approach will be most impactful 9. Conduct training of trainers ...................................................................................................... 37 proven to increase knowledge, promote protective when full participation is achieved Phase III: Implementation .................................................................................................................... 38 health behaviours and improve the uptake of health and communities genuinely own the 10. Train volunteers ....................................................................................................................... 38 services. The approach provides a platform for platform. Interested readers should 11. Report and monitor ................................................................................................................. 38 learning about targeted health topics and developing be open to relinquishing creative 12. Support, supervise and act on feedback ................................................................................. 39 consensus for how best to manage these as a power and focus of the topics to be Phase IV: Post-implementation ............................................................................................................ 41 community. It uses structured and participatory explored, and potential solutions 13. Evaluate Impact ...................................................................................................................... 41 communication in order to support the production which may be put forward by 14. Share experience and findings ................................................................................................ 41 of plans of action while positively influencing social participants in order to remain true to norms and individual behaviour. the approach. References ................................................................................................................................................ 42 Acknowledgements ......................................................................................................................... 43 2 3 Background There are multiple factors responsible for risky or harmful behaviours or suboptimal health inequities. These are referred to as health seeking behaviours. Implementers the social determinants of health and are the from outside the community are often met conditions in which people are born, grow, with hesitation, where the information and live, work and age.[2] These forces include advice they provide is not accepted or readily economic policies and systems, development adopted by communities. This can be due agendas, social norms, social policies and to interventions being designed from the political systems.[2] While it is not possible to perspective of healthcare providers, and address all of these factors through social and not adequately taking into consideration behaviour change, it is possible to influence factors at the community level, including local social norms which play a role in influencing understanding, beliefs and practices, as well as individual behaviour. People, both rich and how local resources can be utilised better. The poor, sometimes make choices that do not Community Dialogue Approach was developed promote their own well-being.[3] This can with these challenges in mind. happen even after careful deliberation when thinking automatically.[3] “Automatic thinking Solutions to health issues often exist within means not bringing to bear full knowledge communities. The elimination of the root about the dimensions and consequences causes of disease requires positive action to of choices. People may also get stuck in be taken by community members to change habits, succumb to inertia, and repeatedly their social norms and patterns of behaviour procrastinate despite intentions to do from ones promoting sickness to those Part one: otherwise”.[3] promoting wellness.[4] In order to do this, an individual needs knowledge and awareness Implementers of health interventions of the diseases, as well as an understanding An introduction to the often face challenges when providing or of their role in protecting themselves, their extending services to the hard-to-reach families and their communities, and the and most affected populations. These motivation to take action and develop habits Community