Promotion

National Breastfeeding Promotion Strategy

Alive & Thrive (A&T) is an initiative funded by the Bill and Melinda Gates Foundation as well as the governments of Canada and Ireland to improve breastfeeding and complementary feeding practices within 7 countries initially including Bangladesh, Burkina Faso, Ethiopia, India, Nigeria, SE Asia, and Viet Nam. The initiative incorporated 4 components to scale up nutrition through improvements in early infant nutrition: advocacy, interpersonal communication, mass communication, and strategic use of data.

A&T used mass communication within Ethiopia, Bangladesh, and Viet Nam to rapidly deliver breastfeeding and complementary feeding messages to families with children under 2 years of age.  These national mass media campaigns used broadcast, out-of-home, and digital channels to reach over 10 million families.  Their efforts have been published in a series of documents that: a) describe their campaigns and resulting success and b) help detail how to implement mass media campaigns to influence behavior change. 

A&T integrated national mass media campaigns within three target countries (Bangladesh, Viet Nam and Ethiopia) into its comprehensive program to improve infant and young child feeding.  They used a mass communication strategy which supported advocacy efforts and face-to-face communication by:

  • Reaching all audience groups with a common, tested message and in a consistent manner
  • Lending credibility to health workers’ messages about breastfeeding, thus making mothers more receptive to messages and support delivered by counselors
  • Reinforcing frontline worker commitment to breastfeeding and reminding them of key messages
  • Modeling the desired behaviors by showing “a mother like me” breastfeeding
  • Shifting social norms and people’s perceptions of the norms
  • Changing beliefs about outcomes of the behavior
  • Directly motivating mothers to practice exclusive breastfeeding for 6 months

Alive & Thrive followed six steps to design their mass media campaign:

  1. Conducted situation analysis and reviewed existing data to decide on which priority feeding practices to explore in the formative research, and which media/channels to use.
  2. Conducted formative research and a media audit (see Media Audit reference) to decide on the communication strategy, including priority behaviors, small doable actions, a behavior change model, concepts to test, a media buy strategy, and a monitoring plan.
  3. Tested concepts to decide on the messages, characters, storylines, visuals, formats, and developed materials (see Content Testing and TIPs references).
  4. Pretested materials to decide on final wording, exact call to action, and visuals.
  5. Produced materials, bought media (airtime and online), and launched campaign.
  6. Monitored campaign reach and changes in beliefs and behaviors, to decide on adjustments to keep campaign on target.

A&T ensured the media campaigns were grounded in the country’s context by utilizing the formative research findings they employed during their initial advocacy efforts and then adding in the concept testing and TIPs.

Viet Nam

Within Viet Nam, A&T first sought to identify and evaluate existing materials, messages, and media outlets with reference to feeding practices, infant formula, and other nutrition products through analyzing advertising expenditure and the messages in the market. This media audit covered radio, internet, TV, newspapers and magazines, cinema, advertising spend, top selling brands, and media penetration.  Ad expenditure data was obtained from TNS, a syndicated research company. This research monitored the number of child and infant foods advertisement placements on TV, radio and print media and tracked areas where most of the budget was spent on which media, which time belt and most popular channels. Messages analysis was done by MediaBanc, a communications tracking organization. They monitored all paid placements, radio, and print media, including editorial coverage and promotions offered.  These were then analyzed by the type of campaigns, key messages and reason to believe of each piece of communication. The main findings were:

  • TV remained the main channel for communication due to the 99% household penetration nationwide, followed by print whose impact and influence is strong in Ho Chi Minh City and Hanoi.
  • Internet usage saw tremendous growth particularly with the younger target audience (late teens and young adults).
  • Cost of radio was competitive but remained largely a medium for rural areas due to lack of drive time and programming.

The advertising strategies of infant formula manufacturers helped A&T to “market” breastmilk in an emotional and effective way. Marketing for infant formula in Viet Nam is pervasive so A&T had to purchase airtime rather than depend on free or “public service announcement” coverage.  However, even though they were outspent by infant formula companies on advertising by 13 to 1, they managed to win back some of the “market share,” significantly, increasing rates of exclusive breastfeeding for the first 6 months from a pre-campaign rate of 26% to 48% following a year of the mass media intervention.

Bangladesh

In 2010, the International Food Policy Research Institute (IFPRI) conducted a baseline household survey in Bangladesh with a sample of 2000 households having children below 24 months of age. The survey looked at IYCF practices, including mothers’ knowledge, health worker interactions, and media habits. The media survey found that TV should be the main channel for high reach/coverage at national scale because viewership amounted to 68% of households watching TV at least once a week, irrespective of economics or education. However, the media survey also showed that media habits change rapidly, so A&T hired external media companies to track TV viewing habits, via devices embedded in homes, to keep abreast of these changing habits.  This information, along with routine A&T surveys and two more IFPRI surveys, enabled A&T to assess the level of coverage of their TV spots and the public’s level of recall of the key messages.

The Bangladesh IYCF Alliance had identified the priority behaviors that this media campaign was designed to help improve.  A&T utilized a process called Concept Testing in order to design a culturally appropriate TV media campaign (See Reference #5).  Concept Testing allows researchers to try out a variety of emotional appeals on the people they are trying to reach, while still being entertaining. It’s similar to a product testing process. Importantly, the concepts were tested before the TV scripts were finalized.  The documents referenced demonstrate how A&T developed the scripts and spots. Reference #6 is a copy of the TV scripts before and after concept testing.  It is interesting to note that the final script has about half the words.  Reference# 7 is the guide Alive & Thrive used when concept testing the TV spots.  It gives the objectives, scripts and questions to ask about each spot.  Reference # 8 is a link to the "stilomatic" Alive & Thrive used in concept testing.  It has the feel of a real TV spot without the expense of full production.

Ethiopia

In Ethiopia, A&T contracted Howard Delafield International (HDI) to develop material for their IYCF communication and marketing campaign.  HDI began with a desk review of all existing IYCF research and identified gaps in available information.  Next, they ran focus groups and in-depth interviews with mothers, fathers, mothers-in-law, health workers, CHWs, and religious, tribal and women’s associations leaders.  The topics covered included:

  • Motivating and enabling factors
    • Identified through the use of concept boards  
  • Family-level dynamics and decision making
    • Explore role of various family members in decision making and child care
  • Community-level dynamics and decision making
    • Roles of community leaders, school teachers and other educated persons, community institutions such as self-help associations, women’s associations, etc. 
  • Local anecdotes, folklore, folk tales and songs 
  • Mobile phone usage patterns, particularly among health workers and men
  • Identification of media opportunities

 
Information about lifestyles, media habits, knowledge, awareness and practices, motivators for behavior and psycho-social and physical hurdles to correct IYCF practices were gathered. Using this information, HDI and the local A&T team developed communication materials and tools which they then pretested with mothers, mothers-in-law and health workers for overall appeal, appropriate imagery, memorability, relevance, comprehension, and believability.

References:

  1. Alive and Thrive. (2015). Strategic design of mass media
  2. Howard Delafield International, LLP (HDI) Marketing and Communications. (2011).  Initial Insight Mining and Pretest Research for Alive & Thrive Ethiopia.
  3. Alive and Thrive. (2009). Media & Communication Audit To Identify Current Advertising /Marketing Trends and Spends, Messaging and Landscape.
  4. Sanghvi, T., Haque, R., Roy, S., Afsana, K., Seidel, R., Islam, S., . . . Baker, J. (2016). Achieving behaviour change at scale: Alive & Thrive's infant and young child feeding programme in Bangladesh.Maternal & Child Nutrition, 12(S1), 141-154.
  5. Alive and Thrive. (2015). Step-by-step Guide to Concept Testing.
  6. Alive and Thrive. (2015). Concept Testing: Before and After Scripts
  7. Alive and Thrive. (2015). Concept  Testing: A Pretest Instrument
  8. Alive and Thrive. (2015). Concept Testing: Stillomatic
Below are three critical components of strategic communication that must work together to be effective.  All of these processes should be evidence-based, results-orientated, involve consultation with participants, and grounded in the local context.
  • Program communication or behavior change communication - a research-based consultative process of addressing knowledge, attitudes and practices through identifying, analyzing and sub-dividing audiences/ participants in programmes by providing them with relevant information and motivation through well-defined strategies, using an audience-appropriate mix of interpersonal, group and mass-media channels, including participatory methods.
  • Advocacy -  a continuous and adaptive process of gathering, organizing and formulating information into argument, to be communicated to key decision-makers through many interpersonal and media channels, with a view to influencing their decision towards raising resources or political and social leadership acceptance and commitment for a development program, thereby preparing a society for its acceptance.
  • Social mobilization -  a process of bringing together all feasible and practical intersectoral social partners and allies to determine felt-need and raise awareness of, and demand for, a particular development objective. It involves enlisting the participation of: institutions, groups, networks and communities, in identifying, raising and managing human and material resources, thereby increasing and strengthening self-reliance and sustainability of achievements.

Reference:

  1. Pelletier, D., Haider, R., Hajeebhoy, N., Mangasaryan, N., Mwadime, R., & Sarkar, S. (2013).  The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction.Maternal & Child Nutrition, 9, 83-100. doi:10.1111/mcn.12081

In 2008, The New Zealand Government funded the Ministry of Health to develop and implement a national breastfeeding promotion campaign to improve breastfeeding rates and duration, especially for high-need groups, which were identified as Māori and Pacific peoples as these two groups have lower rates of breastfeeding than the non-Māori and non-Pacific population. The timeline below shows the steps New Zealand took to develop and implement their campaign.  

2008: Breastfeeding is featured in the Ministry’s Healthy Eating - Healthy Action (HEHA) strategy and implementation plan.  A breastfeeding promotion campaign was planned to raise the number of babies exclusively breastfed for six months and the proportion of infants who continue to be breastfed beyond six months (in line with WHO breastfeeding recommendations).

The breastfeeding social marketing campaign included television and radio commercials, print advertising, and media coverage. It was specifically targeted at family/whānau, (for example the partners, grandmothers, aunties and close friends of Māori and Pacific mothers) as research showed that these were the people who most influence whether a mother breastfeeds and for how long.

The campaign had two phases. Phase one focused on encouraging partners, family/whānau and friends to support mothers to breastfeed. Phase two aimed to build 'environmental' support for breastfeeding, thus encouraging support for breastfeeding in settings outside the home. This phase included working with hospitality venues, councils, employers, early childhood education services, marae (a communal or sacred place that serves religious and social purposes in Polynesian societies), churches and shopping centers. The aim was to increase the perception of breastfeeding as a normal and usual part of everyday life, thus breastfeeding could be done anywhere, any-time, any place.

The Ministry also established a breastfeeding section on their website for mothers to get more information.

2009: The Ministry of Health(MoH) breastfeeding promotion campaign was launched by GSL (marketing company). In October 2009 Breastfeeding NZ communities was launched on Facebook, Twitter and with You Tube video clips. Breastfeeding NZ on YouTube quickly amassed more than 120,000 views of the channel in just three weeks – achieving the spot for most popular channel in New Zealand during the last week of October that year. The videos available cover attachment, early initiation, common challenges, returning to work and the role of fathers and family members.  The Twitter feed features questions from members of the public, publicity for upcoming events and health information from the MoH. The Facebook community reached 1,200 members within its first week.

2010: GSL launched a campaign blog, which served as a platform to increase the quality of engagement between the wider campaign and the social media community. The blog featured:

  • More in-depth campaign updates
  • Advice on various breastfeeding topics such as the importance of breastfeeding and overcoming common issues
  • Information and advice from stakeholder groups - Plunket, La Leche League and Women’s Health Action
  • Breastfeeding stories from some of the women who contributed to the Facebook community
  • Video logs from the campaign’s celebrity advocates describing their breastfeeding journeys

Reference:

  1. New Zealand Breastfeeding Alliance. (2014).  Baby Friendly Hospital Initiative: Documents for Aotearoa New Zealand.

Beginning in the 1970’s, Brazil’s policy environment was ready for the scaling up of breastfeeding advocacy and promotion at the national level. Brazil launched a national BF program in March 1981 that was based on extensive formative research. The “national breastfeeding program began with a mass media campaign that was designed to sensitize the public and government to the need for and types of major structural and behavioral changes needed to promote, protect, and support breastfeeding in Brazil (Pérez-Escamilla, 2012)". Using the results of the extensive formative research phase, three essential elements of a successful national breastfeeding program were identified: (1) national coordination; (2) social mobilization of all possible actors in the field; and (3) use well-designed media campaigns to promote the breastfeeding program. 

Brazil launched several media campaigns to promote breastfeeding from 1981-1986. The first one included spots run on nearly 100 TV channels- reaching 15.5 million households – and 600 radio stations – reaching 20 million households. They placed the message to “Breastfeed your baby for at least six months” on lottery tickets, utility bill and bank statements for 45 days, totaling about ten million contacts.

The second mass media campaign improved on the first by using the lessons learned from the first one and the results of two surveys: a quantitative survey (measured the situation of breastfeeding in Brazil) and a qualitative (identified the optimal messages to communicate). This research showed that about 90% of women in Brazil initiated breastfeeding but many ceased because they didn’t think their breastmilk was enough to feed their babies.  So the message could not just be “Breastfeed!” because the majority of women would start to and then stop before 6 months, but rather the campaign needed to focus on continuing with breastfeeding.  Therefore, the slogan was: "Breastfeeding: continue; any woman can." Artists and other famous people pushed messages about breastmilk being enough.  TV commercials during popular shows reached 500 million viewers in São Paulo and 169 million in Recife and a special breastfeeding information pack given to reporters resulted in 78 articles in popular magazines/novels in 25 cities in a five-week period in 1983.

This demonstrates the importance of extensive formative research which is then used to design and implement a well-coordinated national breastfeeding program, anchored in a mass media campaign.

Reference:

  1. Rea, M. F. (2003). [A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration].Cad Saude Publica, 19(Suppl 1), S37-45. Epub 2003 Jul 2021.

In 2009, the IYCF Alliance were undertaking collaborative efforts to improve child nutrition across a range of interventions. Opinion leader research with government leaders, NGO representatives, and business, religious, and academic leaders revealed that key decision-makers did not have access to information on infant and young child feeding/nutrition and few grasped the impact of child undernutrition on the social and economic development of the country. Research found that the media was an effective communication channel to reach policymakers and a media assessment identified the need to improve journalists’ knowledge of IYCF issues and their importance, thereby increasing media attention to these issues. The initial media audit highlighted in BFCI benchmark PG1 found that TV should be the main channel for high reach/coverage at national scale. TV spots ensured a diverse audience, cutting across educational and cultural lines.  The spots were purposefully aimed at different groups of people- i.e. fathers, health sector, children etc.   Reaching medical doctors had been identified in the formative research stage as a key group to engage, so IYCF messages were inserted into newspapers. The audit also found that media habits changed regularly, so on-going assessments were undertaken to ensure the key messages were reaching the maximum audience. These key messages were also based on formative research and agreed through the IYCF Alliance, ensuring harmonized communications from all stakeholders.  In Bangladesh, the research found that challenges with optimal IYCF practices were similar across the country.

For the parts of the country without access to media, A&T engaged different sources of influence on mothers through "specifically tailored face-to-face contacts (through advocacy dialogue, community meetings/forums, home visits and clinic visits)”.

A catalogue of the print and AV material used in the A&T program in Bangladesh can be found below (see also reference #2):

The lessons learned by A&T to develop and implement a media engagement campaign in Bangladesh, where media engagement was the central focus of national-level advocacy work around IYCF, were described in case studies (including some from Viet Nam and Ethiopia) (Reference #3) and a detailed step-by-step roadmap of activities, recommendations, and best practices for conducting media outreach (Reference #4).   This roadmap is based on the experience of a media engagement and capacity building program in Bangladesh, specifically around child nutrition.  The list below show the steps taken to engage the media and are detailed more fully in the step-by-step guide:

Step 1: Assess the need and opportunity for media engagement
Step 2: Conduct a media landscape analysis
Step 3: Develop and execute a media engagement and capacity building program
Step 4: Monitor and evaluate program results

Details on activities are included throughout this guide, with specific insights on implementation throughout and a summary chart on pages 24-25.

References:

  1. Sanghvi, T., Haque, R., Roy, S., Afsana, K., Seidel, R., Islam, S., . . . Baker, J. (2016). Achieving behaviour change at scale: Alive & Thrive's infant and young child feeding programme in Bangladesh.Maternal & Child Nutrition, 12(S1), 141-154.
  2. Alive and Thrive. (2014). Print & Audio Visual Materials for Promoting Infant and Young Child Feeding, Bangladesh.
  3. Alive and Thrive. (2014). Media engagement and Capacity-Building to increase Commitment to child nutrition policies and programs: Lessons Learned From Alive & Thrive.
  4. Alive and Thrive. (2013). Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists.  
  5. Alive and Thrive. (2014). Power of Nutrition Advocacy Tools. Website includes:

The term social media “generally refers to Internet-based tools that allow individuals and communities to gather and communicate; to share information, ideas, personal messages, images, and other content; and, in some cases, to collaborate with other users in real time.” The meteoric rise in social media usage means health promotors have huge global networks at their disposal to rapidly spread information and mobilize people. All ages, professions and countries are actively using social media. In 2016:

Women of childbearing age, especially in industrialized nations, are using social media in record numbers and are seeking information about pregnancy, birth, and breastfeeding online. Those providing support to breastfeeding mothers are uniquely equipped to share information, guidance, and encouragement with new mothers. Lactation professionals, advocates, and volunteers should be aware that mothers are using web-based communication to gain information about breastfeeding. Those who support breastfeeding mothers can also learn to use these methods to engage with the breastfeeding community online. Regardless of the chosen platform(s), social media is most successful when it promotes “engagement” with a target audience. Engagement is the process of providing content, such as a blog post, commentary on new research, or a provocative image, on a platform with the goal of inspiring participation. That participation can happen through commenting, sharing with others, and expressing agreement or disagreement.

There is research to show that provision of credible information enables positive behavioral changes within these networks and a growing body of evidence suggests that interventions through social media channels has had observable effects on weight loss, tobacco cessation, risky sexual behaviors, and physical activity. Social reinforcement is a powerful motivator for behavioral change and the domino effect within social media networks can be a key tool in promoting positive behaviors.  For example, when Facebook allowed people to share their organ-donor status in their profile, online state organ-donor registries experienced a 23-fold surge in donor pledges.

For health promotion, social media is employed to educate, inform, and drive advocacy efforts. People join virtual communities, participate in research, receive financial or moral support, set goals, and track personal progress.

Non-health professionals use social media to connect with others in similar situations, such as new mothers. These sites are a source of information, suggestions, support and fund-raising. A breastfeeding promotion campaign can share their material on these sites. See below for examples of breastfeeding sites.

The advent of social networking sites and other online communities presents new opportunities and challenges for the promotion, protection, and support of breastfeeding. The study in Reference 3 examines the presence of infant formula marketing on popular US social media sites, using the World Health Organization International Code of Marketing of Breast-milk Substitutes (the Code) as a framework.  Researchers examined to what extent each of 11 infant formula brands that are widely available in the US had established a social media presence in popular social media venues likely to be visited by expectant parents and families with young children. The results showed that infant formula manufacturers have established a social media presence primarily through Facebook pages, interactive features on their own Web sites, mobile apps for new and expecting parents, YouTube videos, sponsored reviews on parenting blogs, and other financial relationships with parenting blogs. Many violations of the Code were identified.  However, useful by-products of this study are methods for countries to promote breastfeeding in a manner similar to the successful marketing of formula. 

There is evidence that consumers are more and more turning to social media to evaluate their options in health decision making.  Marketing research indicates that exposure to promotional content through one’s social network (i.e. Facebook newsfeed that a friend has “liked” a certain product’s page) are associated with significantly increased ad recall and purchase intent, compared to Internet ad exposure alone. 

When considering a promotion campaign, use of existing and emerging social media will be key. Research will be necessary to understand a country's interaction and use with social media to best direct efforts.  A critical aspect of success will be the maintenance of these media - creating online communities and a "buzz" around breastfeeding.

The 4 dominant Social Media Platforms when creating and implementing a social media promotion strategy:

Facebook:

  • Largest audience of any social media platform;
  • Newsfeeds automatically inform users’ contacts when they have become a fan of a Facebook page or post comments to it;
  • Gaining fans will increase exposure;
  • A majority (57%) of users are women; and
  • 71% of users describe themselves as parents

Most successful types of content:

  • Visual content, such as infographics (research or inspirational messages crafted into eye-catching visuals), tends to increase engagement;
  • Videos or pictures; and
  • Short posts that invite comments, “likes,” or sharing.

Strategies:

  • Engage your audience by generating content (called “status updates” on Facebook) and liking, sharing, and commenting on the content others post;
  • Establish a Facebook page, which differs from a personal profile. Pages can be established for businesses, organizations, support groups or causes;
  • Sponsored photo contests, in which users are incentivized to submit photos; and
  • Facebook groups allow for interactive discussions with varying levels of privacy, depending of the type of group established.

Twitter

  • Twitter is favored by younger users and is used by one-quarter of Internet users 18-29 years old;
  • In the United States, 25% of African Americans and 19% of Latinos use Twitter, compared to 9% of whites; and
  • Twitter’s one-on-one networking and organizing capacities favor relationship building.

Most successful types of content:

  • Headline-type messages with links to relevant blog posts or research; and
  • Content that promotes the work of others and demonstrates your organization’s   generosity and willingness to share information.

Strategies:

  • Participate in conversations and share information by creating short (140-character) messages called “tweets’;
  • Manage the high volume of tweets by choosing whose content to follow, and by following specific topic areas;
  • Learn about relevant Twitter users by searching topic areas, called hashtags, because they are marked with a “#” symbol (#breastfeeding or #IBCLC); and
  • All tweets are public, but they are most likely to be seen by those who follow you. A tweet also is seen by more people when it is “retweeted,” or forwarded, to other followers.

Blogging:

  • 81% of mothers who use social media report that blogs, more than any other platform, help “build confidence about parenting skills.”; and
  • 67% of mothers report using blogs as a primary source of parenting advice.

Most successful types of content:

  • Blog posts provide an opportunity for longer-form writing that can be linked to shorter posts in other platforms like Facebook, Twitter, and Pinterest;
  • A combination of personal experiences and commentary on current research/information offers a relatable connection for blog audiences;
  • Content that includes a strong visual element is more likely to be shared on other platforms;
  • Writing should include the use of keywords so that your content will be searchable by major search engines;
  • Increase engagement by including an invitation to readers to comment and share the post; and
  • Check to see which posts are the most read. Understanding your audience will help guide your future posts.

Strategies:

  • Consistency is key. Research finds that blogging 2 or 3 times per week is a minimum for building your audience;
  • If this level of maintenance is too high, other strategies include guest blogging (writing for other blogs) and becoming a content curator (sharing the best of others’ writing);
  • A blog reader, such as Google Reader, can help you identify and follow other breastfeeding blogs; and
  • Check out Lactation Matters, ILCA’s blog, for a breastfeeding-related example.

Pinterest:

  • Very high level of engagement with mothers: 80% of users are women and those who are mothers are 61% more likely than those who are not to use the platform;
  • Pinterest is particularly suited to lifestyle connections, including breastfeeding choices; and
  • Pinterest is driving more traffic to some websites than Facebook.

Most successful types of content:

  • Visual content: photos, inspirational quotes, or infographics highlighting research data; and
  • Visuals from blog posts: if you are creating blog content, be sure to include a strong visual for Pinterest.

Strategies:

  • Develop “pinboards” (a page of “pinned” images like photos or videos) on message or strategy areas; and
  • Add links to the descriptions of your pins to direct users to content such as blog posts or research.

Other Platforms
New social media platforms continue to emerge: Instagram, interactive features on MOH and/or Advocacy groups web sites, mobile apps for new and expectant parents, YouTube videos, MySpace, Google+, LinkedIn, Reddit, on-line message boards, sponsored articles on parenting blogs, and links on pages to educational content and resources for help. Each platform reaches a different population of breastfeeding mothers and professionals. As with all new tools, it is wise for users to explore and determine whether each tool is effective in reaching the intended audience.

Measure and Budget for Social Media
Built-in tools to help analyze efforts are offered by most platforms, or free third-party tools are available in order to measure impact. Incorporating social media into your current workload may be as simple as establishing a social media time budget and routine, or as involved as hiring a social media manager.

Glossary:

App: A software program that performs a specific function that is used on a computer or mobile device.
Avatar: A graphic or illustration that represents a particular person in a computer game or on an Internet site.
Blog: An interactive website, or part of a website, maintained by an individual, a group of individuals, or an organization that posts regular entries of commentaries and events.
Crowdsource: Harnessing the knowledge base and skills of an external community for the purpose of collaboratively solving problems, sharing knowledge, or gathering opinions.
Direct message: Private messages between Twitter users.
Handle: The unique user name selected by a Twitter user. It is designated by an “@username” identifier.
Hashtag: The # symbol used in front of key words to index and make the topic of a tweet searchable.
List: Publicly or individually curated groups of Twitter users.
Microblog: A Web service that allows subscribers to send short messages to other subscribers.
Podcast: Audio or audiovisual content that can be downloaded to a computer or mobile device for later playback.
Re-tweet: The redistribution of a tweet from another user on Twitter to a user’s personal network.
Tags: Names or key words added to blog posts or photos.
Timeline: A real-time list of posts on Facebook.
Tweet: A Twitter message, which by definition must be no more than 140 characters.

Breastfeeding Website examples
http://normalizebreastfeeding.org/
http://banthebags.org/
http://kellymom.com/
http://www.babycentre.co.uk
http://www.netmums.com/baby/breastfeeding

References:

  1. McCann, A. D., & McCulloch, J. E. (2012). 2)  Establishing an online and social media presence for your IBCLC practice.J Hum Lact, 28(4), 450-454. doi:10.1177/0890334412461304
  2. Abrahams, S. W. (2012). Milk and Social Media: Online Communities and the International Code of Marketing of Breast-milk Substitutes.  Journal of Human Lactation, 28(3), 400-406. doi:10.1177/0890334412447080
  3. Ventola, C. L. (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices.P t, 39(7), 491-520.

Government or Civic Breastfeeding Promotion Theme

In 2008, the Central Lancashire Primary Care Trust, the Little Angels breastfeeding peer support organization and The Hub social marketing agency partnered to launch a breastfeeding promotion campaign targeted to young women, ages 16-25, in England.  The Be a Star campaign highlighted local breastfeeding young mothers as “Stars” for breastfeeding.  These mothers were featured in ad campaigns that transformed them to look like models, actresses, singers, etc. to emphasize that mothers who breastfeed are stars.  The goal of the campaign was to “support these women through the breastfeeding process, via peer support and improve understanding and acceptance of breastfeeding within the community”.  Within the first few months of the campaign, breastfeeding initiation rates among the target group increased 11%.

References:

  1. Central Lancashire Primary Care Trust. (2008).  Be a Star.  
  2. www.beastar.org.uk

Other Resources

Trials of improved practices, or TIPs, is a method for testing which behaviors a person really can do and can be used for Advocacy and BCC program strategies.  All potential practices should be tested, ideally in people’s homes, before they are recommended. For Alive & Thrive, their objectives were to: 1. To test mothers’ responses to recommendations for improving infant and child feeding and determine which are most feasible and acceptable and 2. To investigate the constraints on mothers’ willingness to change feeding patterns and their motivations for trying and sustaining new practices.

Through using TIPs, researchers can discover:

  • The relative ease or difficulty of communicating various recommended practices;
  • Modifications that make the recommendations more acceptable;
  • Unanticipated resistance points that limit behavior change;
  • Ways in which recommendations are undermined by practices such as dilution, replacement, or children’s resistance to new foods; and
  • The approximate proportion of families who are and are not able to modify feeding practices and improve nutrition without additional resources.

Reference:

  1. Alive and Thrive. (2015). Introduction to TIPs, Trials of Improved Practices.    

The purpose of this manual is to provide the tools to design, carry out, and analyze the results of formative, consultative research and to use them to design effective programs to improve infant and young child feeding. This approach is based on evidence that community nutrition programs are more effective in changing child feeding practices and improving nutrition when program planners pay close attention to the voices of the families who will participate in the program.

This is a step-by-step guide on how to:

  • Define the key problems in child feeding practices.
  • Identify simple and effective actions within the household that will improve child feeding.
  • Test these recommended practices in homes to determine which are the most practical and culturally acceptable ones.
  • Develop an effective strategy to promote these improved child feeding practices among the population. 

The methods used are open-ended questioning, discussions, trials, and observation to gather in-depth, descriptive information on what people say, believe, do, and want to do. The results are usually descriptions, not numbers. People are asked to tell their stories and describe their feelings rather than give short answers to structured questions. Mixed with the qualitative information are a few quantitative methods such as dietary assessment, structured observation, and some aspects of trials of practices and recipes. These quantitative methods help the researcher and participants assess the significance of the qualitative information.

A valuable method described in the manual is the Trials of Improved Practices (TIPs). TIPs is used to test every new feeding practice with mothers and children, to make sure they are willing and able to try it, and like it enough to continue. People are given the chance to explore how they can take action themselves to improve their children's health and nutrition. 

This manual covers the research process from design to analysis and interpretation. For each phase of the research this manual provides:

  • Task boxes listing all the important steps
  • Step-by-step guidelines
  • Worksheets for planning
  • Program examples
  • Samples of research tools:
    • Question guides
    • Research plans
    • Assessment and counseling guides
    • Focus Group Reports
    • Final recommendations
    • Household In-depth Interview Guides
    • Observation Form
    • Recruitment Form
    • Summary Sheets for Scoring Behaviors
    • Sample Diet History
    • Recipe Trials Recording and Assessment Forms
    • Trial of Improved Practices (TIPs) Guide for a Three-Visit Interview
    • TIPs Tabulation Guide
    • Focus Group Discussion Guides.

Alive & Thrive adapted this manual for their handout, "Introduction to TIPs, Trials of Improved Practices" (See reference).

Reference:

  1. Kate Dickin, Marcia Griffiths, Ellen Piwoz. (1997).  Designing By Dialogue: A Program Planners Guide to Consultative Research for Improving Young Child Feeding.

Formative research in Ethiopia found that the key influencers for the feeding practices chosen by mothers are their husbands and they are likely to have the most direct influence on the women. A&T developed a case study kit based on their experiences with challenging traditional gender roles and engaging fathers in child feeding. The brief:

  • Offers a way to determine if a focus on fathers is right for your program.
  • Introduces 6 strategies to ensure fathers’ program is more likely to change behaviors:
    • Grab them with emotion: Testing concepts to find compelling and emotion-based approaches;
    • Ease the way by busting stereotypes: Making it “a man’s job” to lead the family to support 6 months of exclusive breastfeeding;
    • Find fathers where they already are: Investing in channels that already reach fathers;
    • Provide crystal-clear direction for actions fathers can take: Naming clear and simple actions;
    • Give fathers practice: Designing materials that make fathers interact and that “model” the new actions; and
    • Show fathers a benefit that they care about: Finding the “sweet spot,” the benefit that makes the change seem irresistible.
  • Provides examples from Alive & Thrive interventions that engage fathers in child feeding. 
  • Links to tested program activities and materials that may be tailored for in-country settings.

Reference:

  1. Alive and Thrive. (2012). Spotlight on Innovation: Dads can do that! Strategies to involve fathers in child feeding.

The IYCF Alliance in Bangladesh grew from the development of their national communication plan.  Workshops coordinated by the International Food Policy Research Institute, who sit within the MOH, were convened with the specific intention of coordinating activities around IYCF programs.  The Alliance includes the Government of Bangladesh and key NGOs working in the region -  National Nutrition Services, NICEF, CARE, Alive & Thrive, BRAC, Save the Children and many other government departments, NGOs and professional organizations.

This document is the framework outlining the role of communication to improve rates for early initiation of breastfeeding, exclusive breastfeeding, and quality complementary feeding for IYCF. The plan sets out actions for reaching mothers and families through interpersonal and mass media channels and creating an enabling environment for them to adopt healthy behaviors through social actions and supportive policies.

Reference:

  1. Institute of Public Health Nutrition, Bangladesh. (2010). National Communication Framework and Plan for Infant and Young Child Feeding in Bangladesh.