The Importance Of Segmentation And Tailoring Messages To Constructively Engage Men And Boys In Voluntary Family Planning

Publication date: 2020

1 INTRODUCTION Segmentation is a common approach used by marketers to identify population sub-groups based on common characteristics to identify target audiences. This approach is also used to tailor interventions and messaging around specific attitudes or behaviors. Transform/PHARE (hereafter referred to as PHARE) was a five-year USAID-funded project that used evidence- based social and behavior change communication (SBCC) strategies to develop and test innovative prototypes to address barriers to modern family planning (FP) use, transform attitudes about reproductive health, and promote FP in four francophone West African countries. PHARE adapted traditional segmentation to prioritize those population segments most likely to change their behaviors and designed interventions tailored to their specific needs, behaviors and attitudes. In Cote d’Ivoire and Niger, PHARE used segmentation to prioritize target audiences and develop effective FP interventions to increase voluntary FP uptake. Although the segments in Niger and Cote d’Ivoire were very different, both interventions led to significant improvements in attitudes and behaviors within the key audiences. THE IMPORTANCE OF SEGMENTATION AND TAILORING MESSAGES TO CONSTRUCTIVELY ENGAGE MEN AND BOYS IN VOLUNTARY FAMILY PLANNING AUDIENCE SEGMENTATION AND BEHAVIORAL OBJECTIVES Traditionally, audiences are primarily segmented using demographic indicators such as age, gender, and marital status, however, PHARE used non- traditional and innovative audience characteristics, such as attitudes and behaviors, for segmentation. This approach acknowledges that values, beliefs, as well as religious, economic, and social backgrounds are not homogenous across or even within populations. Individuals respond differently to products, services, and messages depending on their needs, values, and where they are in the behavior change process;1 they also have varying preferences for particular media or information channels.2 PHARE’s audience segmentation identified sub-groups of people who were likely to adopt a behavior, change an opinion or voluntarily adopt a product or service according to specific desires and personal characteristics. For each priority segment, PHARE developed behavioral objectives that would aid that segment in moving closer to behavioral change. These objectives aligned with moving segments from “Awareness” (i.e., having some level of FP knowledge), to “Interest” (i.e., having a desire 1Grable, Nicole and Samantha Lint. 2016. Strategies for Changing the Behavior of Private Providers. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates. 2Population Services International. (2020). Identify and Prioritize Target Consumer Segments. https://www.psi.org/wp-content/uploads/2020/04/psi_kdp_diagnose_target_consumer_segments-external.pdf 2 to learn more about FP methods), and “Trial” (i.e., voluntarily using an FP method). By defining behavioral objectives PHARE developed its positioning, tone and messages with intention. PHARE also considered gender and power dynamics in program and message design so as to not negatively affect women’s agency and choice. By identifying segments or groups of people with similar openness to change no matter their demographics, programmers can better design messages and interventions for their specific audiences. REACHING PRIORITY SEGMENTS OF MEN AND BOYS WITH TAILORED APPROACHES PHARE used segmentation in Niger and Cote d’Ivoire to design interventions that would increase boys’ and men’s support for FP. The detailed knowledge of the segments allowed PHARE to design targeted interventions that had the best chance of leading to behavioral change. NIGER: SARARI From a survey conducted with 1,144 men in three regions of Niger, PHARE learned that most men surveyed support positive couple dynamics: they believe women are and should be increasingly empowered3 and are open to sharing health and family decision making. Men who support women’s empowerment were more likely to accept and adopt birth spacing, birth limiting, and use of modern methods. However, PHARE found that support for women’s empowerment did not necessarily correlate with increased propensity for gender-transformative behaviors: compared to those who oppose female empowerment, male supporters are less likely to give partners an opportunity to voice disagreements around FP decisions; and equally unlikely to allow partners to determine the outcome of such disagreements. Using data from the statistical segmentation analysis, quantitative research, and key informant interviews, PHARE identified 11 distinct population segments (six for men and five for women) in Niger. A number of variables were assessed during the segmentation, including FP usage potential, matrimonial outlooks, gender perspectives, religiosity, and self-perception. The figure below shows the six male audience segments along with a quote that describes their belief system and how it relates to their FP decision-making. FIGURE 1. MALE AUDIENCE SEGMENT DESCRIPTIONS NOVICE YOUTH “I have different wants and values to my parents, but I’m not very sexually active so I haven’t felt the need to consider family planning.” IRREVERENT SCEPTICS “I trust my judgments, and my life and outlooks are very different to my peers’ - I don’t know much about family planning, but don’t trust health advice anyway.” CURIOUS TRADITIONALISTS “I prefer not to stray too far from the norms I know, but I do feel under- informed about family planning - and generally listen to those who know more than me.” DISSATISFIED PROGRESSIVES “Islam and my wife’s wellbeing are crucial - I’m keen to avoid too many children and know a bit about family planning, but abstinence and condoms are both poor options.” CONSERVATIVE PATRIARCHS “Men were intended to care for many wives and to lead large families - even if sometimes we do lose a child, I see no benefit in changing that.” PIOUS MODERNISTS “Islam is important to me, and family planning is no sin. My wife and I are ahead of the times, and by learning more we’ll build our big family together at the right pace.” 3 While the survey deliberately left the term ‘power’ undefined, men who support female empowerment stated they observed women having more power now than prior generations and considered this a good thing. 3 PHARE prioritized two segments, which the project named Curious Traditionalists and Novice Youth, based on their greater willingness to change FP behavior and potential for impact. The project set specific behavioral objectives and designed communication interventions to promote use and support of voluntary FP within these segments. Messaging evolved from simply raising FP awareness to more advanced messaging meant to encourage specific behaviors around voluntary FP. This new messaging nudged young men in the target segments along a behavior change continuum over time. PHARE then designed interventions and selected dissemination channels using a human-centered design (HCD) process4 which leveraged insights gathered from young men in the targeted segments on their barriers and needs related to FP and the sources they trust for health information. Top insights are included in Figure 2. Through a partnership analysis, PHARE collected qualitative data to explore the relationship dynamics between the male and female segments. Partnership analysis looks at the most likely primary and secondary female partner segments of each male segment and creates a snapshot of each partnership. PHARE used these snapshots to map out recommendations for activities for improving couples’ communication around FP and to ensure that messages addressing these relationship dynamics were built into the design of interventions targeting different male segments. CURIOUS TRADITIONALISTS Curious Traditionalists were characterized as being highly religious and having a tendency to follow social norms which view contraception as sinful; both factors discouraging FP use. However, they also showed interest in learning more about FP as a way to manage the pace of family growth. Curious Traditionalists were most likely to marry women from the group labeled Conservative Passive (who also tend to follow social norms that contraception is sinful) or Traditional Autonomist (who accept traditional FP use but perceive their husband’s permission as important). By understanding these characteristics, beliefs, and interplay with their female partners, PHARE was able to better tailor messages that would resonate with the particular male segments and encourage them to promote the benefits of modern FP methods with their female partners. PHARE’s interventions were based on the premise that religious leaders are a natural channel for delivering FP messaging (see messaging and dissemination channels in Figure 3 below) and sought to achieve the following behavioral objectives:5 • Convert high level of knowledge of FP and desire to learn more about FP into higher FP usage; • Soften the perception of FP as being at odds with Islam; and • Reduce the growth rate in family size by instilling birth spacing as the norm. FIGURE 2. KEY INSIGHTS FROM HCD • Insight 1: The primary determining factor of contraceptive uptake among married women is husbands’ support. • Insight 2: Men often make the decision to have children without considering financial implications. • Insight 3: More than four in five men would consider FP use if they perceived Islam as encouraging it. • Insight 4: Religious leaders can be allies (e.g., in promoting breastfeeding as a natural form of birth spacing, as the Koran states that mothers should breastfeed for 2.5 years). 4In human-centered design, audiences participate as equal partners in the development, implementation, and testing of interventions. 5USAID Transform/PHARE. (2018). Niger male segmentation: discussion of findings. https://www.psi.org/publication/niger-male-segmentation-analysis/ 4 FIGURE 3. MESSAGING AND DISSEMINATION CHANNELS TO REACH CURIOUS TRADITIONALISTS NOVICE YOUTH The strategy for engaging men in the category of Novice Youth was noticeably different from the strategy for engaging Curious Traditionalists. Novice Youth were characterized as single, young men with a strong sense of agency for whom FP is not a priority due to low (reported) sexual activity. They also preferred to discuss FP with their peers and other men and expressed support for birth limiting. Novice Youth typically partnered with those labelled Sheltered Skeptics, characterized as single, young women with similar mindsets and aspirations. PHARE identified a continuum of messages and dissemination channels (see Figure 4) in order to achieve the following behavioral objectives: • Create awareness for modern methods and how to access/use them, as a prerequisite to their first sexual experience; • Position modern methods as a positive tool for planning one’s life and achieving one’s aspirations; and • Encourage Novice Youth as future community leaders in supporting a favorable environment for voluntary FP use. Figure 3. Messaging and Dissemination Channels to Reach Curious Traditionalists Novice Youth The strategy for engaging men in the category of Novice Youth was noticeably different from the strategy for engaging Curious Traditionalists. Novice Youth were characterized as single, young men with a strong sense of agency for whom FP is not a priority due to low (reported) sexual activity. They also preferred to discuss FP with their peers and other men and expressed support for birth limiting. Novice Youth typically partnered with those labelled Sheltered Skeptics, characterized as single, young women with similar mindsets and aspirations. PHARE identified a continuum of messages and dissemination channels (see Figure 4 below) in order to achieve the following behavioral objectives: • Create awareness for modern methods and how to access/use them, as a prerequisite to their first sexual experience; • Position modern methods as a positive tool for planning one’s life and achieving one’s aspirations; and • Encourage Novice Youth as future community leaders in supporting a favorable environment for voluntary FP use. Figure 4. Messaging and Dissemination Channels to Reach Novice Youth 5 Figure 3. Messaging and Dissemination Channels to Reach Curious Traditionalists Novice Youth The strategy for engaging men in the category of Novice Youth was noticeably different from the strategy for engaging Curious Traditionalists. Novice Youth were characterized as single, young men with a strong sense of agency for whom FP is not a priority due to low (reported) sexual activity. They also preferred to discuss FP with their peers and other men and expressed support for birth limiting. Novice Youth typically partnered with those labelled Sheltered Skeptics, characterized as single, young women with similar mindsets and aspirations. PHARE identified a continuum of messages and dissemination channels (see Figure 4 below) in order to achieve the following behavioral objectives: • Create awareness for modern methods and how to access/use them, as a prerequisite to their first sexual experience; • Position modern methods as a positive tool for planning one’s life and achieving one’s aspirations; and • Encourage Novice Youth as future community leaders in supporting a favorable environment for voluntary FP use. Figure 4. Messaging and Dissemination Channels to Reach Novice Youth FIGURE 4. MESSAGING AND DISSEMINATION CHANNELS TO REACH NOVICE YOUTH RESULTS AND LESSONS LEARNED DURING PILOT PHASE AND SUBSEQUENT ROLL OUT Over the intervention period (February to August 2019), PHARE observed an increase in support for voluntary birth spacing and FP and greater willingness to discuss these topics among religious leaders and youth.6 The percentage of youth surveyed who said they agree that women have a right to choose their contraceptive method increased from 77% to 87%; while the percentage of religious leaders who reported being supportive of the use of modern contraceptive methods for birth spacing increased from 68% to 82%. Additional lessons learned include the following: • Using Koranic text to discuss various topics such as the benefits of birth spacing, proper child health, spousal relationships, and couples communication helped religious leaders to foster discussion around FP and encourage couples to jointly decide upon birth spacing and to discuss family planning.7 Highlighting Islam’s support for birth spacing was also an important factor in men’s support of FP, as identified during insight gathering. • Building on Novice Youth’s high value on agency, a financial planning tool was an effective resource to initiate conversations about voluntary family planning with young men and to frame voluntary FP as a tool for self-determination.8 This tool supported young men in matching their financial resources with the optimal family size and was created based on insights gathered early in the program design process. RESOURCES FOR IMPLEMENTERS • Video on the process of creating the SARARI intervention • Financial training tool • Religious Text booklet • Transform/PHARE: Examining Male and Female Family Planning Attitudes and Behaviors in Niger 6USAID Transform/PHARE. Transform/PHARE Niger: Engaging Religious Leaders. 7Ibid. 8Ibid. https://www.psi.org/publication/sarari-video/ https://www.psi.org/publication/sarari-video/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/transform-phare-examining-male-and-female-family-planning-attitudes-and-behaviors-in-niger/ https://www.psi.org/publication/transform-phare-examining-male-and-female-family-planning-attitudes-and-behaviors-in-niger/ https://www.psi.org/project/transformphare/transform-phare-in-niger/ 6 COTE D’IVOIRE: DIDIER In Cote d’Ivoire, PHARE identified men aged 15 to 24 years working in the informal sector as its primary audience in order to promote dialogue about beliefs, desires, and aspirations around sexuality and gender equity. Using qualitative, in-depth individual and group interviews, along with observation, PHARE interacted with young men and women, community leaders, parents, healthcare workers and the young men’s bosses to gather insights which led to the identification of four audience segments of young males working in the informal sector: the Hustler Boss, the Oblivious Playboy, the Honey-Mooner, and the Curious Virgin. Their profiles, available here, illustrate each of their typical experiences, desired relationships, outlook on women, and likelihood of taking responsibility for the consequences of their behavior. The Hustler Boss archetype, for example, is older, married, and relatively well-paid. He has multiple partners (who also all have multiple partners) and is aware of the risk of HIV transmission and how condoms provide protection, but sometimes he does not wear a condom with his girlfriends. He does not want his wife to use a modern method of birth control because he perceives that as promoting promiscuous behavior. The information for each archetype informed the type of message, channel selection, key influencers, message tone, and positioning for that segment. PHARE found that social norms for young men emboldened them to ignore gender equality. Alarmingly, the PHARE team identified that men often offer gifts and agree to condom use at the beginning of a relationship, but over time, men pressure women to offer unprotected sex to maintain the relationship. Young men noted few positive role models who could show them alternative behaviors. Many young men came to Abidjan from rural areas and looked to their Bachelor Bosses, men who are hustling in the informal economy, as role models when it comes to sex and relationships. Young men were excited about women and relationships but not interested in sexual health or contraception. PHARE used these learnings to design messaging to effectively reach young men and encourage their journey from inhibitors of FP use to being aware and supportive of positive FP behaviors; the resulting intervention was an ongoing interactive story delivered through Facebook called Didier. Didier provided dating advice as an entry point to sensitize young men about the benefits of supporting their partners’ needs and reproductive choices. At every touch point, the tone of Didier messaging was conversational, accessible, fun, simple, and gender-positive. In the storyline, Didier is presented with the power of choice, and when he veers towards gender-blind and irresponsible contraception FIGURE 5. KEY INSIGHTS FROM HCD • Insight 1: Young men emulate their bachelor bosses but dream of a traditional future. • Insight 2: Growing up with unspoken expectations, no one is equipped to talk about sex. • Insight 3: As relationships progress, young men’s supportive behavior often turns coercive. • Insight 4: Contraceptive methods are not relevant, and risks are an afterthought. relationships, outlook on women, and likelihood of taking responsibility for the consequences of their behavior. The Hustler Boss archetype, for example, is older, married, and relatively well-paid. He has multiple partners (who also all have multiple partners) and is aware of the risk of HIV transmission and how condoms provide protection, but sometimes he does not wear a condom with his girlfriends. He does not want his wife to use a modern method of birth control because he perceives that as promoting promiscuous behavior. The information for each archetype informed the type of message, channel selection, key influencers, message tone, and positioning for that segment. PHARE found that social norms for young men emboldened them to ignore gender equality. Alarmingly, the PHARE team identified that that men often offer gifts and agree to condom use at the beginning of a relationship, but over time, men pressure women to offer unprotected sex to maintain the relationship. Young men noted few positive role models who could show them alternative behaviors. Many young men came to Abidjan from rural areas and looked to their Bachelor Bosses, men who are hustling in the informal economy, as role models when it comes to sex and relationships. Young men were excited about women and relationships but not interested in sexual health or contraception. PHARE used these learnings to design messaging to effectively reach young men and encourage their journey from inhibitors of FP use to being aware and supportive of positive FP behaviors; the resulting intervention was an ongoing interactive story delivered through Facebook called Didier. Didier provided dating advice as an entry point to sensitize young men about the benefits of supporting their partners’ needs and reproductive choices. At every touch point, the tone of Didier messaging was conversational, accessible, fun, simple, and gender-positive. In the storyline, Didier is presented with the power of choice, and when he veers towards gender-blind and irresponsible contraception choices, he experiences the serious consequences of his actions. When Didier makes good choices, he experiences success. The storyline is presented in comic book style and follows the lives of a number of characters, some of whom represent the archetypes. Results and lessons learned during pilot phase and subsequent roll out: ● A challenge in reaching young men in the informal sector is their mobility and lack of formal structure through which to reach them. Using Facebook as the primary channel of communication allowed PHARE to overcome this challenge. Facebook allowed PHARE to gauge real time reactions relationships, outlook on women, and likelihood of taking responsibility for the consequences of their behavior. The Hustler Boss archetype, for example, is older, married, and relatively well-paid. He has multiple partners (who also all have multiple partners) and is aware of the risk of HIV transmission and how condoms provide protection, but sometimes he does not wear a condom with his girlfriends. He does not want his wife to use a modern method of birth control because he perceives that as promoting promiscuous behavior. The information for each archetype informed the type of message, channel selection, key influencers, message tone, and positioning for that segment. PHARE found that social norms for young men emboldened them to ignore gender equality. Alarmingly, the PHARE team identified that that men often offer gifts and agree to condom use at the beginning of a relationship, but over time, men pressure women to offer unprotected sex to maintain the relationship. Young men noted few positive role models who could show them alternative behaviors. Many young men came to Abidjan from rural areas and looked to their Bachelor Bosses, men who are hustling in the informal economy, as role models when it comes to sex and relationships. Young men were excited about women and relationships but not interested in sexual health or contraception. PHARE used these learnings to design messaging to effectively reach young men and encourage their journey from inhibitors of FP use to being aware and supportive of positive FP behaviors; the resulting intervention was an ongoing interactive story delivered through Facebook called Didier. Didier provided dating advice as an entry point to sensitize young men about the benefits of supporting their partners’ needs and reproductive choices. At every touch point, the tone of Didier messaging was conversational, accessible, fun, simple, and gender-positive. In the storyline, Didier is presented with the power of choice, and when he veers towards gender-blind and irresponsible contraception choices, he experiences the serious consequences of his actions. When Didier makes good choices, he experiences success. The storyline is presented in comic book style and follows the lives of a number of characters, some of whom represent the archetypes. Results and lessons learned during pilot phase and subsequent roll out: ● A challenge in reaching young men in the informal sector is their mobility and lack of formal structure through which to reach them. Using Facebook as the primary channel of communication allowed PHARE to overcome this challenge. Facebook allowed PHARE to gauge real time reactions 7 This brief is made possible by the generous support of the American people through the United States Agency for International Development (USAID). This brief was prepared by PSI for USAID, Contract Number AID-OAA-TO-15-00037. The contents are the sole responsibility of PSI and do not necessarily reflect the views of USAID or the United States Government. For more information, please visit: www.psi.org/project/transformphare/ choices, he experiences the serious consequences of his actions. When Didier makes good choices, he experiences success. The storyline is presented in comic book style and follows the lives of a number of characters, some of whom represent the archetypes. RESULTS AND LESSONS LEARNED DURING PILOT PHASE AND SUBSEQUENT ROLL OUT • A challenge in reaching young men in the informal sector is their mobility and lack of formal structure through which to reach them. Using Facebook as the primary channel of communication allowed PHARE to overcome this challenge. Facebook allowed PHARE to gauge real time reactions to messaging, storyline and character development, leading to adaptations throughout implementation. • Addressing myths and misconceptions about contraceptive use was an important part of the Didier intervention. The percentage of participants that believe contraception will affect future pregnancies declined from 50% at baseline to 27% at endline. • Many of the Facebook comments received were favorable towards gender equality and condom use. At the end of the intervention, 50% of young men surveyed reported discussing the use of a condom with their partner, up from 44% at the beginning of the intervention. Facebook was not only a popular channel to reach young men, it also provided them a safe space for dialogue and further behavior change communication. KEY TAKEAWAYS Providing information about FP alone does not necessarily lead to behavior change or greater gender equality. PHARE’s interventions aimed to increase support for FP uptake by addressing inequitable power dynamics and promoting women’s agency by framing them in the context of issues that affect the lives of adolescent boys and men. PHARE reached specific male audiences in ways that were meaningful and impactful to them thanks to the deep insights that were gathered as part of the segmentation and partnership analyses conducted prior to the design of interventions. Segmenting a target population can provide valuable information to better reach audiences with targeted messaging and interventions. Programmers need to look beyond demographic indicators such as age, gender, and marital status to identify segments using values, beliefs, and other background characteristics. Programmers can then further prioritize segments based on desired behaviors or attitudes and likeliness to change behaviors. Additionally, mapping the archetypal female partners of each male audience enabled PHARE to include messaging that strengthened relationship dynamics and couples’ communications. The development of behavioral objectives by segment and the resulting messaging, interventions, and strategies allows implementers to better focus their resources on the types of activities and populations that are most likely to lead to behavior change. RESOURCES FOR IMPLEMENTERS • Didier Playbook • Didier: Engaging young men in the informal sector • Didier Comic Book Season 1 • Didier Comic Book Season 2 • Emerging learning from Didier: Engaging young men in the informal sector www.psi.org/project/transformphare/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/ https://www.psi.org/publication/fwca-usaid-resources/

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