Shining a Light on Untapped Resources for Behavior Change Communication in Guatemala

"These studies provided new and important insights on three avenues for engagement that have, to date, been underutilized for social and behavior change communication."

The Health Communication Capacity Collaborative (HC3) Guatemala team worked with United States Agency for International Development (USAID) and partners and stakeholders from 18 USAID-funded projects to develop an overall brand identity and a social and behaviour change communication (SBCC) strategy for the Western Highlands Integrated Program (WHIP). As part of this pre-strategy situation analysis, HC3 Guatemala sought to better understand how the forces of religion, mobile phone ownership and use, social media and internet use, and radio programming can be better utilised to promote healthy behaviours in the Western Highlands of Guatemala. With the support of the USAID Mission in Guatemala, the project designed 3 landscaping studies as part of a broader formative research agenda. Using qualitative methods such as focus group discussions, key informant interviews, and direct observation, the team gathered insights that they then fed into the creation of the SBCC strategy.

HC3 explains that the country's cultural profile is diverse, with a large percentage of the population identifying as indigenous, mostly from 1 of the 4 primary Mayan indigenous groups: K'iche', Q'eqchi, Kaqchikel, and Mam. Twenty-two non-Spanish indigenous languages are spoken in the country.

Whereas the vast majority of the population of Latin America is of the Catholic faith, Guatemala has a complex and multifaceted spiritual landscape: While 50% of Guatemalans do identify as Catholic, 41% identify as Protestant, with many of those identifying as Protestants belonging to unique and individual evangelical belief systems and churches, especially Pentacosalism. It is estimated that within Guatemala, there are at least 300 individual religious communities. Regarding the role that religious leaders play in the lives of residents of the Western Highlands of Guatemala, the collected data suggests that churches have a large presence in the communities, and religious leaders live among their constituents. Religious leaders also work in their communities, helping the sick, the widowed, and young married couples. They frequently incorporate themes of development and health into their sermons, and the majority of those interviewed expressed interest in collaborating with HC3.

Guatemala also has high levels of access to communication channels and platforms, even within the Western Highlands, where poverty and malnutrition are high and can create great challenges. Radio is transmitted via national radio stations, district-/department-level radio stations, and "pirate" radio stations at the community level that operate without any registration. Even in the most remote areas of Guatemala, it is still possible to listen to the radio. During the landscaping study conducted with radio stations and radio listeners, HC3 Guatemala learned that radio has a high level of penetration throughout the Western Highlands, with the majority of radio stations focusing on religious topics. Radio listeners say that they keep the radio on to hear the news, hear sermons, listen to music, and to feel entertained or accompanied during their daily work. Women listen to the radio at higher rates than other groups, and young people stated they listen to the radio on their mobile phones. The most popular programmes are religious, followed by music and news. Three-quarters of the radio stations interviewed incorporate advice and tips on health and development topics into their programmes, with health being the most popular with listeners. Nearly 90% of radio station representatives interviewed said they would be interested in collaborating with non-governmental organisations (NGOs) on development and health programmes. Though many development projects in the Western Highlands have collaborated with radio stations in the past, these initiatives have not included long-running campaigns for social and behaviour change.

Mobile phones are very accessible to those of all socioeconomic backgrounds and are commonly owned in households of all income levels throughout the country. Rates of mobile phone ownership throughout the country are very high, with most individuals owning basic phones capable of calling and texting; smartphone ownership is on the rise. (While access to internet is somewhat low, it is also increasing with the diffusion of smartphones and improved infrastructure throughout the country.) Study participants reported that ownership and use of mobile phones has increased dramatically during the last 5 to 10 years due to improvements in mobile signal and decrease in the price of phones. They note that people seek to better communicate with loved ones living in the United States. Young people tended to have more advanced smartphones, while older adults were more likely to have simple phones that they tended to keep and use for many years. Men, young people, and married women were most likely to own cell phones. Those with more advanced cell phones said they depended greatly on apps such as Facebook, Tango, Imo, Line, and WhatsApp to communicate with friends and loved ones. Mobile phone users expressed interest in receiving information about health, nutrition, agriculture, hygiene, and the environment on their phones.

The WHIP SBCC strategy was designed to facilitate complete and comprehensive integration of key elements of development including health, family planning, income generation, nutrition, education, local governance, water, and agriculture. The strategy design and its implementation serve as a unifying force for key stakeholders to collaborate on the reduction of chronic malnutrition in Guatemala. The USAID Guatemala sectors involved in this SBCC venture include Health, Education, Economic Growth, Agriculture, Environment, Democracy and Governance, and Food for Peace.

The reports, in Spanish, are as follows:

• Estudio Sobre el Uso y Disponibilidad de Telefonía Celular y Redes Sociales en Cuatro Comunidades Rurales del Altiplano Occidental de Guatemala - March 2016 [Study on the Use and Availability of Cell Phones and Social Networks in Four Rural Communities in the Western Highlands of Guatemala]
• Estudio Sobre la Presencia de Emisoras de Radio, Programación y Potenciales Alianzas con Estas en las Zonas Prioritarias del Programa Integrado del Altiplano Occidental de Guatemala - September 2015 [Study on the Presence of Radio Programming and Potential Alliances in Priority Areas of the Western Highlands of Guatemala Integrated Programme]
• Estudio Sobre la Presencia y Actuación de las Diversas Iglesias, Organizaciones y Ministerios Religiosos en las Zonas Prioritarias del Programa Integrado del Altiplano Occidental de Guatemala - September 2015 [Study on the Presence and Activities of the Various Churches, Religious Organizations and Ministries in Priority Areas of the Western Highlands of Guatemala Integrated Programme]

In addition, the HC3 Guatemala team carried out a nutrition message analysis in an effort to help harmonise supporting messages. With so many projects actively promoting behaviours related to food security in the same communities, there was concern that Western Highlands' community members might be hearing conflicting health and nutrition messages from different projects. Guatemala's USAID mission wanted to integrate this diverse development portfolio in the Western Highlands region. The analysis compared key messages on 31 topics that appeared in 131 SBCC materials collected from 8 development projects. HC3's analysis revealed that cases of messages outright contradicting each other were rare, meaning a low possibility someone would hear conflicting messages. However, the analysis also revealed that projects are using a wide variety of different and varying supporting messages to promote the same behaviours. Additionally, though key messages are similar, in many cases the project materials are using different terms and language to talk about them in their supporting messages, and this can cause confusion. Click here to learn more about the analysis and to access the full report (in Spanish), Materiales De Comunicación De La Región Whip De Guatemala (March 2015).

The findings from these research undertakings are informing HC3's work in 2016-2017 with USAID and its implementing partners to design and develop communication platforms and disseminate messages to create behaviour change. HC3 plans to create a radio programme platform, a digital health platform to support community and household communication by community health workers, and other platforms that will allow community members to access vital health and development information on demand.