Talking Books to Facilitate Behaviour Change in Rural Communities in Ghana
A CHPS nurse uses Talking Book connected to a kitty-shaped outdoor speaker to play local language health messages during a child welfare clinic.
This article by Anastasiya Nurzhynska, Head of Social and Behaviour Unit, UNICEF Ghana, was originally published in March on The Polio Network.
"A pilot program funded by UNICEF Ghana in five community-based health and planning services (CHPS) zones in the Jirapa municipality found that the Amplio Talking Book is perhaps the solution Ghana Health Service (GHS) needs to make the CHPS zones more effective in delivering health information to most underserved communities in order to protect children and save their lives — the core mandate of UNICEF."
In 2019, United Nations Children's Foundation (UNICEF) Ghana and Amplio, developed a pilot project utilizing the Talking Book to play pre-recorded behavior change messages to rural communities in their own local language. The aim was to help nurses in Ghana's community-based health and planning services (CHPS) zones. Many rural community health nurses struggle to effectively deliver their mandate due to inadequate staffing, logistics, and lack of communication skills resulting from language barriers.
Other CHPS challenges include poor community engagement strategies, and low male participation in child and maternal health engagement.
Under the pilot program, CHPS nurses used the Talking Book during their outreach visits to conduct child welfare checks and provide antenatal care across five CHPS zones in the Jirapa municipality. For example, they used the device to share messages and facilitate health education for pregnant women, lactating mothers, and men accompanying their spouses. Similarly, during outpatient department and group education sessions, the Talking Book served as the main tool for health education.
Designed to meet the needs of low-literate populations living in so-called "media dark" communities, behavior change messages are jointly produced by the beneficiary communities with program designers. Messages are recorded in different formats such as drama, endorsement messages by local community influencers, lessons conveyed via songs, and testimonies from successful behavior change adopters.
Community members, including CHPS nurses, use the Talking Book's easy-to-navigate menu to choose a topic and play the messages of their choice. Other menu functions include moving forward and backward in a playlist, volume control, content switch, and record feedback. The Talking Book uses visual symbols coupled with audio prompts to make it user-friendly to community members and program planners.
As part of the introduction for the Talking Book pilot, UNICEF and GHS jointly provide training for nurses on social and behavior change communication, interpersonal communication skills, and the operation and basic maintenance of the Talking Books, including tips on troubleshooting and simple repairs.
Health, Immunisation and Vaccines, Children
In Ghana's Upper West Region, women's access to information has been hampered by low literacy levels, poor connection to the internet, and a lack of modern communication devices such as radio sets and mobile phones. For instance, only 54.7% of women use mobile phones, compared to 84% of men in the same region, and only 51.2% of households own radio sets, with men having more access than women. Therefore, simple gadgets such as the Talking Books come in handy to bridge the gaps in women's information needs, especially in health facility settings.
According to the program organizers, the program contributed to an increase in women's attendance at child welfare clinics and antenatal care visits, men's participation in maternal and child health activities, and routine child immunization services, such as uptake of vitamin A supplementation in the beneficiary CHPS zones.
The program contributed to quality health care delivery in that nurses are now able to effectively combine their clinical care and health education duties.
Furthermore, language barriers for some CHPS nurses and their communities are no longer a challenge because the messages in the Talking Book are in the preferred local languages of the beneficiary communities.
Delivering health education to protect children is a UNICEF core mandate.
Partnering in the Upper West Region
Since 2013, with UNICEF Ghana's support, Amplio Ghana has been providing solutions to promote health behavior change in rural communities in the Upper West Region through the larger Talking Book CHPS initiative. As many as 61 communities with over 40,000 households in the Jirapa received cross-sectoral messaging on topics including health, nutrition, child protection, and water, sanitation, and hygiene (WASH).
UNICEF Ghana will scale up the program to cover all the 47 CHPS zones in the Jirapa municipality. It is expected that Amplio Ghana will transfer knowledge and skills to the Jirapa Health Directorate to sustain the program beyond the duration of this action.