RT Journal Article SR Electronic T1 Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 383 OP 395 DO 10.9745/GHSP-D-19-00410 VO 8 IS 3 A1 Zelee Hill A1 Pauline Scheelbeek A1 Yashua Hamza A1 Yared Amare A1 Joanna Schellenberg YR 2020 UL http://www.ghspjournal.org/content/8/3/383.abstract AB Key FindingsIn Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers (CHWs) drove behav-ior change.In Nigeria, exposure to messages was limited, CHW were less trusted, and behavior change was reported less frequently.Key ImplicationsThe role of saturation and trust in behavior change in Ethiopia suggests that CHW counseling interventions should not be assumed to work through didactic provision of messages that focus on the behavior benefits.In settings with low coverage of CHW visits, low levels of message reinforcement from other sources, and low trust in CHWs, achieving behavior change may be difficult, even among people who receive visits.Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.