Using Data to Guide Action in Polio Health Communications: Experience from the Polio Eradication Initiative (PEI)

"[C]ommunications functions within the PEI programme have helped to provide more detailed, textured analysis of the local social, economic, institutional, and cultural conditions in which polio vaccine delivery - on the road to eradication - occurs."

Abstract

Health communication is increasingly considered a priority element of investments and interventions intended to improve personal and public health (Piotrow et al., 1997). But a prevailing focus in health communication on information, education, awareness and knowledge - and their assumed relation to changing behaviour among target individuals or households - can underestimate the complexity of wider ecological conditions that influence and limit individual, household, and even community choices and capacity to choose. Experience from the Polio Eradication Initiative (PEI) - drawing on evidence from the India and Nigeria country programmes - provides some insights into how the health communication interventions can be strengthened through the adoption of a more holistic ecological model of people and their health-related behaviours analysed in the context of larger social, economic, political, and cultural forces (see, for example, Kelly et al., 2008). In particular, polio eradication health communication offers useful lessons in the importance of generating and using data of sufficient quality to enable of more ecological analysis - combining and measuring specific communication inputs and epidemiological "outputs."

An excerpt from the article follows (footnote numbers removed):

"...Health communication advocates health behaviours, raises public awareness, and changes attitudes. Although these practices acknowledge a spectrum of levels from the individual to the social, the emphasis in practice remains heavily focused on the behavioural—implicitly the level of the individual or household...

...The evolution of health communication in the global Polio Eradication Programme may provide some valuable lessons for health communication, both in terms of the shift from mass awareness and behaviourist emphases to a more ecological understanding of PEI realities in local contexts, as well as improvement in the use of empirical evidence - better data - to improve understanding of local realities and to strengthen the overall programme's capacity to fashion appropriate responses...

...[T]he initial [PEI] strategy focused on large-scale, relatively straightforward information dissemination (Waisbord, 2004). A considerable part of communications investments and activities were directed to mass media, high-level political advocacy, and some largely events-based attempts at social mobilisation...

...The causes of remaining susceptibility in northern India and northern Nigeria required more detailed data than the epidemiological or coverage information alone could provide. Other kinds of "social" data were needed, which were more readily available through the health communication component of the PEI programme. This required the PEI to reexamine its concepts and practices - notably, to collect additional data and develop new strategic approaches considerably beyond the conventional health communication models applied previously. Central to these strategies was stronger use and linkage of epidemiological, social, and communication data...

...A central element of PEI's strategic renewal in the early 2000s was the near universal call for a better use of combined technical/epidemiological and social/communications data across the programme...

...A key shift in the quality and application of health communication in the polio eradication programme came when communication protocols were linked with the epidemiology and jointly mapped. In both India and Nigeria, communication actors contribute significantly to defining, targeting, and mapping high-risk communities in increasingly localised endemic areas using indicators that combine social and epidemiological data. These then are mapped at a number of levels to guide programming and allocation of resources...

...After a period of over-reliance on the concept of resistance, the willingness across the polio programme to explore underlying causes, break down categories of analysis, and set indicators more finely tuned to the actual conditions and perspectives of the targeted communities was key to understanding and addressing the global deadlock.

...A synopsis review of five PEI country programmes conducted in 2000 emphasised the need for communication programmes to institute better indicators for measuring impact (UNICEF, 2000)...

...In Nigeria after 2006-2007, communication programme evaluation similarly included trend analysis for reasons for missed children...and a combination of indicators for knowledge, behaviour, and vaccination outcomes...It is this merging of epidemiological, technical, and communication functions that constituted a significant advance in the conceptualization and operationalisation of the polio programme...

...The communication component in PEI expanded its organising concept from a focus on individuals' information, knowledge, and assumed consequent behaviour to one that embedded an understanding of individuals, their communities, their thought processes, and their actions, in a wider ecological framework of social, economic, political, and cultural determinants. Analysis of more distal ecological factors, however, such as political context and function of social institutions, is still, in many cases, in the early stages of development. The communication component in PEI has achieved some considerable success in this process, through a stronger, more rigorous use and analysis of data that includes, for example, identification, mapping, and measurement of programme communication activities for OPV vaccination of missed children. Further study to link communication interventions with epidemiological impact is needed, particularly in Nigeria..."