One of the behaviour change campaigns designed and evaluated by the EHG is now being scaled up across several provinces in East Java, Indonesia. The campaign, called Gerakan Rumpi Sehat (The Healthy Gossip Movement) is aiming to reach 50 million mothers within the next 18 months, with the long term aim of reducing stunting and under-nutrition.
In 2014, members of the Hygiene Centre, within the EHG, collaborated with the Global Alliance for Imporved Nutrition (GAIN) to conduct research into infant and young child feeding practices and maternal nutrition. GAIN are working globally to improve under-nutrition and reduce stunting. This is a significant challenge considering almost half of all child deaths under the age of 5 are attributable to under-nutrition and world-wide one in four children are stunted. Our challenge was to look at this issue in Indonesia, which has among the highest rates of stunting in the world (35% of the population – more than double the regional average). Indonesia has also long been a test-case for nutritional interventions, but substantial, long-lasting change has yet to be realised.
We worked with GAIN, the Government of Indonesia, a creative agency and an implementing partner to design a behavior change campaign based on the formative research findings. This followed the five step process of Behaviour Centred Design (A: Assess, B: Build, C: Create, D: Deliver and E: Evaluate). The final intervention targeted 4 key behavioral areas: exclusive breastfeeding, complementary feeding, healthy snacking and maternal nutrition (specifically regular consumption of animal sourced protein). Rather than imparting knowledge, it employed emotional drivers of behaviour change, such as affiliation, nurture and disgust and used television commercials, community activations and house-to-house visits as delivery channels.
The concept for the campaign was Gerakan Rumpi Sehat (GRS) – The Healthy Gossip Movement. Emblematic of the campaign was the character of Ibu Rumpi (Mrs Gossip), who was always gossiping and judging the feeding practices of others before realising, to her great embarrassment, that she was the one who had actually been doing the wrong thing. The theory of change behind the intervention was that the target audience would implicitly sense that maternal and child feeding practices were being watched and judged by peers, so practicing the wrong behaviour would be embarrassing and damaging to one’s reputation. One of the signature elements of the community activations were the highly interactive, game-like “Emo-Demo” sessions which were carefully crafted to address specific barriers to the targeted behaviors by using emotions, story-telling, surprise and group dynamics to simplify messages and make them more memorable.
A three month pilot of the intervention was conducted and evaluated by LSHTM through a randomized control trial and a process evaluation. Initial findings found that even though the pilot had several limitations and did not reach as many mothers as was anticipated, the campaign was successful in improving dietary diversity of children under two and increasing the provision of fruit as a healthy snack. The pilot was too short to effectively measure improvements in breastfeeding yet there was some data to suggest an emerging positive trend. The process evaluation enabled GAIN to revise and improve elements of the campaign so that they could be effectively delivered at scale.
The scale-up of the campaign has already been received very postively by mothers in East Java. The facebook page associated with the campaign has already reached more than 500,000 women and attracted 7,000 likes in the first 48 hours.