On Safari in Tanzania: Spotting the big 5 (or big 40!) Behaviour Change Techniques
Change Exchange Behaviour Change Consultant, Eleanor Bull, writes about her recent experiences in Tanzania with the SAFE project
‘So if you give oxygen to the mother before starting her caesarian section, it really can save her life’, summarises the anaesthetist trainer. ‘Are we together?’ she adds. ‘Yes‘ chorus the nurse anaesthetist delegates in unison. Behind them, Nim and I begin tapping away at our ipads. The trainer just used the behavior change technique ‘information about health consequences’ to encourage the nurse delegates to give oxygen to mothers pre-surgery, a health practice the trainers are teaching in this maternity emergency medicine course.
In September we spent a week in Mwanza, northern Tanzania. Many people come to this beautiful part of the world for a safari, to spot lions, elephants or leopards sleeping in trees, but Nim and I were observing the three day emergency medicine training course Safer Anaesthesia From Education (SAFE) Obstetrics. We are behaviour change consultants volunteering on the latest Change Exchange project, helping the World Federation of Socieities of Anaesthesiologists (WFSA) explore the impact of its SAFE Obstetrics course. ‘Safari’ in Swahili actually means journey and it was clear from the welcome we received and warm atmosphere that the course would be a journey of discovery for all involved.
Part of the Change Exchange’s work was to understand which behaviour change techniques (BCTs) trainers use to help delegates to make changes in their practice when they go back to their health facilities across Tanzania. We live coded the course using an e-version of the Michie et al. (2013) BCT Taxonomy v1 on our tablets, which Manchester Implementation Science Collaboration has adapted for use in coding training courses.
Some of the BCTs we hoped to spot were ‘demonstration of behaviour’, ‘practice and behavioural rehearsal’, ‘action planning’ and ‘problem solving’, because of their evidence base in changing behaviour. In fact the faculty of 14 anaesthetist doctor trainers used nearly 40 techniques across the three days. Interestingly, this included a big focus on those used to build motivation for change which are rarely used in similar courses we’ve observed in the UK. For example, in a fantastic instance of the BCT ‘identification of self as a role model’ to encourage use of the World Health Organisation’s pre-surgery checklist, a trainer emphasised to delegates ‘you know the value the checklist can add to people’s lives… if you use it, you will be an example for others in your team and they will have no choice but to follow you…they will follow you’. One of the very entertaining local trainers even livened up a session by unexpectedly handing a delegate a 10,000 shilling note (£3.50) as she had given a great answer to a question. Unfortunately we couldn’t code this as the BCT ‘material reward’ because the reward was directed at the nurse’s knowledge not her actual behaviour…but still very amusing!
Aside from the BCT content, we loved noticing the different styles of the trainers (the ‘how’ of behaviour change) who hailed from six different countries. The international faculty from outside of East Africa tended to make more use of diagrams and check understanding by asking knowledge questions; the trainers from East Africa tended to engage learners by saying most of a sentence with a gap for delegates to reply in unison (‘in emergencies we must always be’…. ‘Prepared’) and asked the lovely question ‘are we together?’ to check understanding. Overall then, there were plenty of sights to be seen on our behaviour change technique safari and no one was sleeping!