An Adaptable Communication Strategy for Magnesium Sulfate

"A communication strategy provides a 'road map' for local action targeted at behavior change and creates a consistent voice for the messages, materials, and activities developed. It also ensures that activities and products work together to achieve the program goal and objectives. The final communication strategy should be used to guide content development of program materials, such as advocacy briefs, client leaflets, and job aides and tools for health providers, thereby ensuring consistent positioning and messaging across all activities."

This roadmap for communication on advocacy for use of magnesium sulfate for pregnancy-related pre-eclampsia and eclampsia (PE/E) forms part of a comprehensive Demand Generation Implementation Kit for Underutilized Commodities in RMNCH (Reproductive, Mother, Newborn, and Child Health from the Implementation Kit (I-Kit), offering resources for advocacy and demand generation communication. It is offered by the Health Communication Collaborative (HC3) in cooperation with the United Nations Children's Fund (UNICEF) and the United States Agency for International Development (USAID). The first part of the document outlines foundational guidance for communication on the "13 Lifesaving Commodities" (see description below of the foundational guidance section); then, the section on the specific commodity, magnesium sulfate, is presented.

The illustrative strategy for magnesium sulfate advocacy communication (beginning on page 28) details each step for this specific commodity used to treat PE/E (the dangerous elevation of blood pressure during pregnancy). The health and commodity contexts are detailed with information on standard treatment, use, cost, and availability. Barriers to uptake include "a lack of political will, lack of country specific clinical guidelines for administration, low availability of the medication and related supplies, lack of confidence among health care providers to use magnesium sulfate, poor knowledge and understanding of the symptoms of PE/E at the community level, inaccuracies about dosage calculation and administration and lack of provider and community knowledge about magnesium sulfate, including concern about side effects for the mother and fetus." Each barrier is elaborated in the document, and a chart on page 32 shows barriers to and effects of desired behaviours relating to use of the commodity. The illustrative vision is: "Ensure systematic detection of PE/E during ANC [antenatal care] and make sure that all women who have symptoms of severe PE/E are treated with the appropriate regimen of magnesium sulfate."

The primary audiences are: 1) pregnant women and families and 2) clinicians including specialists; clinical officers; nurse midwifes; skilled birth attendants; ANC nurses, etc. Influencing audiences are: 1) district and local health officials (Ministry of Health - MoH/local authorities/facility management) and 2) community health workers (CHWs - public and private). The document gives case study examples of potential audience members.

Message design strategy is elaborated through charts beginning on page 39, by designated audience. For example, an object for women and families: "identify and understand the signs of PE/E." Message positioning: "Knowing key danger signs during pregnancy means you are better prepared to protect your/your wife’s/your family member’s health, and that of the baby." Key promise: "Attending ANC regularly gives mothers and babies the best chance at a healthy pregnancy." A key message: "Talk to your partner and family about the importance of ANC."

Approaches, activities, and interventions are charted on page 47 and include the following categories with an example for each:

• Mass Media, for example: for long-form mass media, integrate PE/E into multi‐episode radio or TV drama serials to stimulate social dialogue and shift social norms around ANC and assisted childbirth.
• Clinic‐Based Services, for example: use digital distance learning and develop and train on electronic job aids such as smart- phone- and tablet-based-apps to increase knowledge and skills.
• Community‐Based Services, Outreach, and Community Approach, for example: for CHWs, develop low‐literacy flipcharts with PE/E danger signs.
• Structural, for example: to address policies and guidelines, develop advocacy brief for district level policy‐makers to promote importance of supplies and training related to PE/E.

The monitoring and evaluation step suggests illustrative indicators for measuring inputs, outputs, outcomes, and impact, with examples of potential data sources, for instance, proportion of women and their families who know that PE/E is dangerous but preventable or number of referrals for PE/E or ANC visits made by non‐clinical providers or proportion of local health commodity budgets that include magnesium sulfate.

The foundational guidance section: Materials associated with the I-Kit, like this commodity-specific strategy document for magnesium sulfate, were created to support the efforts of: communication professionals working directly on social and behaviour change communication (SBCC) programmes, as well as other professionals working in RMNCH. It was created as a "quick-start foundation based on available evidence to provide guidance" for communication designed to: create new users; convince members of the intended audience to adopt new behaviours, products, or services; increase demand among existing users; convince current users to increase or sustain the practice of the promoted behaviour and/or to increase or sustain the use of promoted products and services; take market share from competing behaviours (e.g., convincing caregivers to seek health care immediately) and products or services (e.g., convincing caregivers to use magnesium sulfate). Thus, the goal is to create informed and voluntary demand, help providers and clients interact effectively, shift social and cultural norms to support sustained commodity uptake, and encourage appropriate use of the commodity.

The strategy document offers key concept discussions on SBCC, social marketing, and channels and approaches, including advocacy, community mobilisation, entertainment education, information and communication technologies (ICTs), and mass and traditional media. The conceptual framework for the strategy is structured as a multi-directional continuum of social and environmental contexts: the individual level family and peer networks, community, and social and structural. The communication strategy includes 6 steps:

• ”Analyze the Situation
• Define a Vision
• Choose Intended Audiences
• Select Key Messages
• Determine Activities and Interventions
• Plan for Monitoring and Evaluation"