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Sarah Osman
In social and behaviour change intervention design, the use of evidence, theory and research is central. But this is easier said than done. The Core Processes offer a systematic approach for helping practitioners stay on track and offers clear guidance on how to use evidence, theory and research.
One paper that I repeatedly go back to is Core Processes: How to Use Evidence, Theories, and Research in Planning Behavior Change Interventions by Rob Ruiter and Rik Crutzen (2020). I love this paper because the six Core Processes proposed for intervention planning are so key to any practitioner’s toolbox.
While they may seem like obvious steps, my experience is that they are often overlooked by social and behavioural science practitioners. For example, while working on a recent project, we discovered that two large scale formative research activities took place at roughly the same time and employed the same theoretical foundations. This led to nearly identical findings which is an unfortunate waste of time, resources and efforts, not to mention missing the mark of improving services for people as a result.
According to the authors, “using Core Processes minimizes the likelihood of incomplete understanding and selecting ineffective solutions”. In my view, adopting the Core Processes is urgently needed to update the current principles followed in social and behaviour change intervention design. We can avoid frustrating scenarios and build on each other’s work to better understand the challenges we want to address by following the Core Processes.
The Core Processes are compatible with all frameworks, and can be added alongside current ways of working to minimise common pitfalls such as:
1. Not putting together a well thought-through planning team that will be involved throughout the design and implementation of the project.
2. Not asking the right questions about what is causing the problem to continue to exist.
3. Having insufficient overview of research that has been carried out.
4. Lack of skills in being able to relabel lay terms to theoretical social and behavioural science concepts.
5. Rushing into conducting primary research when it is not needed, or not being specific enough about the purpose of the primary research and how it will add value to the knowledge base. As the authors put it, “it should be clear what omissions and knowledge gaps to address in the research.”
6. Not having ‘experts by experience’ on the team that can help the team understand what has worked, what has not worked and what could potentially work. For an explanation of what I mean by ‘experts by experience’, please refer to this earlier blog I wrote.
7. Being mechanistic about using a general theories approach, which should be a last resort according to the authors.
8. Under-utilising existing monitoring and evaluation data and project reports as data sources.
While I highly recommend reading the insightful paper, I’ll go through the Core Processes below and offer some examples of how they can be applied for social and behaviour change (SBC) programmes. I adapted Figure 1 from the paper to be used by an SBC-implementing organisation. You can think of experts by experience as anyone who would have valuable insights on the topic you are tackling. In the case of routine immunization for example, this can be caregivers or community leaders. Technical advisors can be public health experts, nurses, community health workers, policymakers, etc. The point is to include the group of people who would provide the most material information at each step.
Even though the Core Processes paper focuses on designing health-related behaviour change interventions, I find it applicable to any global development topic using a social and behaviour change lens.
The first step when following the Core Processes is to pose the right questions. For me, this step is key because this is where we can unpack what we know and what we still don’t know enough about. This is the fundamental point to helping us not repeat what others have done. This clarity also prevents confusion in later steps.
It also brings up the issue of how, often, organisations do little with the evaluation reports they commission and hardly consult their routine monitoring data. Using existing data involves analysing internal data to identify patterns and potential causes of issues. Additionally, consulting with experts or community members with lived experience provides valuable insights to refine these questions further.
The second step involves brainstorming possible answers using a creative process that includes free association and consultation with technical and lived experience experts. Reviewing past programme reports and evaluations provides insights into what has been tried and its effectiveness. Facilitating brainstorming sessions with technical advisors and/or experts by experience helps gather practical suggestions from both experts and community members. Representing these explanations in a process model that shows causation can be particularly useful. Here, mapping the factors within your own organisation’s theory of change, the socio-ecological model or the COM-B model can be useful.
The third step is to review empirical findings from published research to support or refute the provisional answers the planning group has generated. This involves comparing organisational data with findings from similar programmes or regions to validate or challenge these provisional answers. Start by searching for existing systematic reviews, as these sources are invaluable before looking at individual studies. Engaging advisors and community members to interpret empirical findings within the context of the organisation’s data further enriches this process. It is crucial to follow the Core Processes in order, ensuring that explanations are backed by specific evidence on determinants before turning to general theories aimed at explaining behaviour. This methodical approach helps avoid making haphazard decisions based solely on brainstorming.
The fourth step involves finding theoretical support using the topic, concept, and general theories approaches. This step is essential for refining, adding to, and discarding provisional answers based on theoretical constructs from empirical literature. Given that the literature on a specific behaviour or target group may be limited in scope, this step aims to make the list of provisional answers as comprehensive as possible before conducting new research or making decisions.
Addressing real-life problems, which are inherently complex, requires a multi-theory approach. I particularly value the section in the paper where the authors distinguish between three approaches to using theory:
In global development, we need to use the Concept Approach a lot more than we currently do to stop replicating studies and repackaging concepts.
The fifth step involves identifying and addressing the need for new research by using a combination of qualitative and quantitative techniques to refine or add to the provisional answers. It is crucial that the planning group completes the previous steps before diving into new research, as conducting new research demands significant resources in terms of time, expertise, and money. More importantly, existing evidence and insights should be thoroughly utilised to identify what omissions and knowledge gaps need to be addressed.
At the final step, the planning group is ready to complete the provisional list of answers and summarise it into a working list of items for which the theoretical and empirical evidence is deemed sufficient. This involves assessing the answers in terms of their relevance and changeability. Feedback from technical advisors and community members is sought to evaluate the feasibility, relevance, and potential impact of the proposed interventions. This ensures that the final list of answers is practical, evidence-based, and ready for implementation.
We need to use theory and evidence to be able to retrace our steps and ensure quality. But at the same time, we should value what lived experience and practical implementation teach us and bring these learnings into the mix. This is what the Core Processes can help us achieve.
Do you think applying the Core Processes could be a useful tool before diving into a traditional intervention design process? Share your thoughts here!