Behavior Change for Newborn Survival in Resource-Poor Community Settings: Bridging the Gap Between Evidence and Impact

Despite an established evidence base of simple, affordable, and low cost interventions to avert neonatal deaths, global progress in reducing neonatal mortality has stagnated in recent years Under recognition of the critical role played by behavior change in ensuring adoption and dissemination of innovations is a major reason for this gap between evidence and impact A general lack of understanding of the mechanisms underlying behavior change at a population level coupled with an under appreciation of the sociocultural context of newborn care behaviors has underscored ill informed approaches towards behavior change that have met with limited success This article draws upon available evidence from prevention oriented, community based newborn survival trials to derive insights into the role of behavior change in neonatal mortality reduction We propose a simple model the intervention causation pathway to explain the pathway through which behavior change interventions may lead to reductions in mortality Further, we explore the unique nature of newborn care behaviors and their underlying sociocultural context, along with state of the art advances in social, behavioral, and management sciences These principles form the basis of the behavior change management framework that has successfully guided intervention design and implementation leading to high impact on neonatal mortality reduction, in Uttar Pradesh, India We describe how the behavior change management framework can be applied to inform the design of theoretically and empirically sound behavior change interventions with greater precision, predictability and pace to wards reduction in neonatal mortality We finally touch upon key overarching principles that should guide intervention execution for maximal impact Semin Perinatol 34 446 461 (C) 2010 Elsevier Inc All rights reserved