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From Praxis to Practitioners

by Will Story 
MPH Child Survival and Health Technical Advisor, CRWRC
wstory@crwrc.org

I wanted to take this opportunity to follow up on the article I wrote for the Fall 2008 issue of Voices in Dialogue entitled, “Designing for Behavior Change: Using Barrier Analysis as a Tool to Catalyze Transformative Learning.” In the article I discussed my experience with the Designing for Behavior Change workshop which is built upon Dialogue Education™ principles and provides a practical behavioral framework that helps community health managers and planners to strategically plan for behavior change. One of the tools used in this workshop is called Barrier Analysis, a rapid assessment tool used to identify behavioral determinants associated with a particular behavior. In the previous article I described how Barrier Analysis was used to help learners identify behavioral determinants and use these determinants to design behavior change strategies. As many of you know, this process of learning a new concept by practicing it, followed by reflection on the new concept, is what Jane Vella terms praxis. After facilitating the Designing for Behavior Change workshop in six different countries over the past four years, it occurred to me that this little word – praxis – is the key to the sustainable impact of the learning experience.

The long-term impact of incorporating praxis into a learning design was illustrated during my recent visit to Bangladesh for the final evaluation of a five-year, USAID-funded child survival project. In March 2006, CRWRC hosted a Designing for Behavior Change workshop in which we followed a very similar process as was described in my previous article about our experience in India. Learners were given space and time to understand a new concept about behavioral determinants by applying it and reflecting on its relevance using Barrier Analysis. After the workshop, many of the learners became practitioners by immediately applying the new learning to some of the most difficult to change behaviors. One of these behaviors was related to seeking health care when a child shows signs of acute respiratory infection (ARI) and needs immediate medical attention. All three project areas noticed poor care-seeking behaviors related to ARI during the midterm evaluation. Therefore, they each conducted a Barrier Analysis survey in their working area to discover which behavioral determinants were causing a delay in care-seeking. They used this information to design a behavior change approach that was tailored to the needs of their communities. During the final evaluation, we found a remarkable increase in care-seeking for children with symptoms of ARI in all three working areas (Figure 1). Although we cannot directly attribute the increase in care-seeking to the behavior change approach or the workshop that we facilitated, a clear correlation exists. In addition, after interviewing the project staff, it was clear that their competence in applying this new approach to behavior change was connected with their opportunity for praxis during our workshop years earlier. By integrating Dialogue Education™ principles, such as praxis, into the Designing for Behavior Change workshop, we have observed an impact far longer than the duration of a scheduled workshop and reach far beyond the walls of a classroom.

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