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Think | BIG
INSIGHT
Define pathways to change using behavior analysis.
1. Quick Links:
  1. Behavior Profiles Behavior Profile Example Behavior Profile Samples
ACTION
Influence pathways to change by implementing a behavior-led social and behavior change strategy.
1. Quick Links:
  1. Behavior Summary Behaviors First
CHANGE
Track success along pathways to change by measuring behavioral outcomes.
1. Quick Links:
  1. Behavior and Factor Data Dashboards Measuring Along the Pathways Behavioral Outcomes = Results
BIG | Tools
Online and offline tools to implement a behavior-driven program.
Resources
Your full library of BIG guidance documents.

A Behavior Profile puts an easy-to-read snapshot of a priority behavior’s pathway to change at your fingertips. Follow along on our interaction example. Be sure to click on a factor to see the pathways to change.

Our quick primer shows you how to read this essential tool. Click on the How to Read button to start the tutorial.

How to Read a Behavior Profile

Example Behavior Profile

Behavior Profile: Antenatal Care

	Health Goal	Health Goal: Improve maternal and child survival
	Behavior	Pregnant women complete a full course of quality antenatal care (ANC) Indicator: Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits

Behavior Analysis			Strategy
BEHAVIOR AND STEPS What steps are needed to practice this behavior? Behavior Pregnant women complete a full course of quality antenatal care (ANC) Steps Recognize signs and symptoms of pregnancy Decide to seek ANC early, before the end of the first trimester Plan transport, resources, and logistics Attend all recommended ANC visits Obtain all required services (history, examination, screening and tests, treatments, preventive measures, health education and counseling) from qualified provider at each visit Adhere to provider instructions during and following each visit, including when to return for the next visit	FACTORS What factors may prevent or support practice of this behavior? Structural Accessibility: Pregnant women cannot access health facilities because they are too far. Accessibility: Pregnant women do not attend multiple ANC visits because they struggle to afford the costs that come in addition to on-going essential expenditures. Service Provider Competencies: Pregnant women cannot obtain quality ANC because providers neither respect them nor effectively communicate relevant technical information or explain the benefits of the different services, tests, and medications given during ANC. Service Experience: Pregnant women do not go for ANC because the health facilities often lack the tests, medications, or supplements that women need, or payment is required when services and products should be free. Social Family and Community Support: Many pregnant adolescents and unmarried women are reluctant to seek early care because of stigma or the risk that they will be asked to leave school or quit their job. Family and Community Support: Pregnant women do not plan to attend, or attend ANC because family and community members do not encourage or support their attendance. Norms: Pregnant women do not seek ANC because many societies have strict cultural or traditional practices around disclosure of pregnancy. Internal Attitudes and Beliefs: Pregnant women do not always perceive a value to multiple ANC visits if they have already had one or more healthy pregnancies. Attitudes and Beliefs: Pregnant women do not always comply with provider's instructions particularly related to medications, supplements, or foods because of beliefs about the adverse effects of the medication or foods on their fetus. Knowledge: Most pregnant women attend at least one ANC visit because they understand its benefits.	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior, and what actions must they take? Institutional Policymakers: Ensure pregnant adolescents can still attend school. Policymakers: Ensure maternity care is accessible via insurance schemes, conditional cash transfers (CCTs) or other financing. Managers: Provide effective supervision and on-site support to ensure quality ANC services. Logistics Personnel: Monitor and properly forecast stock of essential tests, medicines, and supplements. Providers: Offer counseling and support to pregnant women during ANC visits, including thorough explanations of services provided as well as the importance of multiple visits and adherence to supplements or medications given. Community Community and Religious Leaders: Publicly support or promote ANC including programs that attempt to reduce stigma and encourage women to talk to their partners about early pregnancy care. Community Health Workers/Peer Educators : Encourage or actively support women to seek a full course of ANC and to continue following provider's instructions once at home. Household Family Members: Actively participate in ANC and support women, especially first-time mothers and adolescents, in all aspects of pregnancy and delivery planning. Male Partners: Actively support finances, planning, and transportation for ANC for pregnant women.	POSSIBLE PROGRAM STRATEGIES What strategies will best focus our efforts based on this analysis? Strategy requires Communication Support Enabling Environment Financing: Finance task-shifting and explore community-based service delivery such as iron and folic acid supplements. Financing: Expand free or low-cost access to products and services through vouchers or fee exceptions to ensure access to ANC. Policies and Governance: Establish a policy for areas with poor health facility access to have the most basic ANC services, such as iron and folic acid supplement resupply managed at the community level. Policies and Governance: Adopt and enforce policies to permit pregnant adolescents to attend school. Systems, Products and Services Supply Chain: Strengthen supply chains for essential drugs, supplements, and preventative medicines for ANC. Quality Improvement: Ensure that services are client- and family-friendly and that counseling on follow-up care is provided to both the pregnant women and any family members accompanying her. Quality Improvement: Expand services and improve structures, including hours offered, types of services available, transparent costing of services when appropriate and use of ANC outreach services to encourage pregnant women to use ANC. Quality Improvement: Train and support providers to emphasize value of completing all ANC visits as well as active birth planning. Demand and Use Communication: Create pregnancy and new-mother groups to help mothers understand the benefit of care throughout pregnancy and the post-partum period. Communication: Use targeted media, including SMS where possible, to send tailored reminders and tips for pregnant women and their families on both ANC attendance and adherence to supplements like iron and folic acid. Collective Engagement: Train and use traditional leaders and traditional birth attendants to encourage women to seek early and multiple ANC visits.

Think | BIG was developed under the ACCELERATE project, which was made possible by the generous support of the American people through the United States Agency for International Development (USAID) and implemented by The Manoff Group, Inc. in association with Howard Delafield International, OneWorld UK, Social Impact, Inc., and Sonjara, Inc. The information on this website does not necessarily represent the views of USAID or the United States Government.

The Manoff Group was acquired by JSI in 2022. JSI is a global nonprofit dedicated to improving lives around the world through greater health, education, and socioeconomic equity for individuals and communities.

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