How to Measure Provider Behavior Change Impact

"The PBC evidence base is growing, but to have the best evidence available to guide implementation, we must improve measurement of provider behavior and behavioral drivers."

It is increasingly clear that adequate health worker training and structural support are insufficient on their own to support provision of high-quality health services. Thus, social and behaviour change (SBC) programmes have introduced strategies to improve health worker performance. However, it can be difficult to measure provider behaviour change (PBC). Developed by Breakthrough RESEARCH, this guide - with an accompanying free online course - is intended to help programme planners and designers better understand PBC initiatives and their impact on service delivery and quality. The guide is also meant to advance measurement of PBC by providing frameworks and illustrative examples of how PBC measurement can inform programme planning and design. Finally, the guide offers ways to continue building the evidence base for PBC approaches and impact.

The guide centres on the PRECEDE-PROCEED model, which highlights individual-level influences and their interactions with system-level ones. The model illustrates factors beyond health worker ability (i.e., competency and skills) that influence provider behaviour (e.g., service provision or specifically, client-provider interactions). The model groups factors into three categories that can be used to facilitate measurement approaches:

1. Predisposing factors: an individual's attitudes, beliefs, and perceptions.
2. Reinforcing factors: factors that follow a behaviour and determine whether, for example, health workers receive positive (or negative) feedback from their supervisors.
3. Enabling factors: resources and skills required to make desired behavioural and environmental changes (e.g., availability of medical supplies).

According to Breakthrough RESEARCH, identifying these three categories of factors, when combined with measures of ability (the competency and skills of the provider) can help explain what influences provider behaviour (e.g., person-centred care) and where best to target interventions. Multiple study methods, including provider interviews, client-provider observations, and health facility assessments, may be required to provide a comprehensive understanding of provider behaviour and factors that influence it.

This how-to guide accompanies an interactive online learning course ["Measuring Provider Behavior Change"] that focuses on understanding and measuring PBC. While the steps presented include examples specific to family planning, SBC practitioners can apply them to any programme. Offered as part of the SBC Learning Central Platform, available at Related Summaries, below, the course is available in English and in French, is self-guided, and includes instructional video content, PowerPoints, a post-test, and opportunities to further the discussion with other SBC professionals.