New guide to evaluating behaviourally and culturally informed health interventions in complex settings

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COVID-19 has demonstrated beyond doubt the important role that our behaviours and cultural contexts can play in the face of a health challenge. More and more governments are therefore beginning to look seriously at designing and implementing public health interventions that are informed by behavioural and cultural insights (BCI). However, evaluating these interventions, to make sure that they work as intended, can be difficult, particularly when time and money are limited.

WHO/Europe has now published its “Guide to evaluating behaviourally and culturally informed health interventions in complex settings”. It provides detailed information on how to evaluate the effectiveness and sustainability of BCI interventions, particularly when the conditions for attaining conclusive proof are difficult or impossible to meet. Instead, using contribution analysis as a starting point, this new WHO guide walks its readers through the process of creating an evidence-informed claim for the effect of the intervention.

“Exploring the value, effect and outcomes of interventions that seek to affect people’s health behaviours, in their daily lives or in their uptake of health services, is critical. Only this way can we learn and improve, avoid unintended negative effects, and replicate successful interventions,” says Katrine Bach Habersaat, Regional Advisor for Behavioural and Cultural Insights at WHO/Europe.

The interactive evaluation guide was developed, tested and improved in collaboration with several partners, while being applied in 3 different countries of the WHO European Region.

Miguel Telo de Arriaga, Head of the Division of Literacy, Health and Well-being at the Directorate-General for Health in Portugal, explains: “Throughout the COVID-19 response in Portugal, the Directorate-General for Health has used micro-influencers to communicate about public health and social measures. WHO/Europe’s BCI evaluation guide has provided us with a valuable, comprehensive tool to support our efforts in evaluating and refining the intervention, to a point where we can now see how to use it in settings beyond COVID-19”.

Capturing unintended effects

Evaluation is a critical element of any intervention. The evaluation process involves exploring and documenting the effects of the intervention, what works well and what could be improved. These insights are then used to continually improve, scale up or replicate successful interventions. Using a theory-based method helps to explore all relevant factors in a systematic manner and reach reliable findings. In the new guide, this model is based on the contribution analysis.

An evaluation must also be sensitive to potential unintended negative (or positive) effects. Uniquely, the BCI evaluation guide focuses on well-being, trust and social cohesion as key factors that should always be explored alongside the targets set for the intervention itself. This way, how behaviourally and culturally informed interventions impact societies more broadly is better documented and understood.