Using Social Listening to Inform Integrated Social and Behavior Change Programs in Burkina Faso

"Social listening can be an important tool for understanding the beliefs, attitudes, expressed social norms, and behaviors of social media users."

Breakthrough RESEARCH, the United States Agency for International Development (USAID)'s flagship social and behaviour change (SBC) research and evaluation project, in collaboration with its resource partner M&C Saatchi is using social listening to understand the types of health information shared through social media in Francophone West Africa. This report summarises key themes emerging from social listening related to maternal and child health (MCH), nutrition, family planning (FP), and water, sanitation, and hygiene (WASH) and discusses how this information can be used to inform integrated SBC activities in Resilience in the Sahel Enhanced (RISE) II programme countries.

RISE II is implemented within communities and health facilities by four Resilience Food Security Assistance (RFSA) partners and health service delivery mechanisms in selected zones in Burkina Faso and Niger. RFSAs use a variety of SBC approaches, including community mobilisation, interpersonal communication (IPC), peer group activities, and mass media to address priority health behaviours. To support these implementation partners, Breakthrough ACTION, USAID's flagship SBC implementation project, facilitates RFSAs' adoption of technology-based approaches such as messaging through Viamo's 3-2-1 interactive voice response (IVR) service. Breakthrough ACTION also supports RISE II SBC activities through the development of an umbrella campaign to provide a framework with a common theme for different health messages and activities implemented by the Ministry of Public Health and USAID partners.

For the social media listening assessment, conducted from January 2019 through September 2020, Breakthrough RESEARCH selected Burkina Faso because literacy rates, access to electricity, and internet usage are higher compared to Niger, suggesting the environment is more conducive to social media engagement. For the FP health area, the team also leveraged relevant findings from a baseline understanding social listening report from the Breakthrough-ACTION-implemented Merci Mon Héros (MMH, Thank You My Hero) campaign multi-method evaluation, conducted in 2019 by M&C Saatchi using a similar methodology of social listening.

The findings are delineated in the report by health topic - MCH, nutrition, WASH, and FP. Also covered are emerging themes related to COVID-19. For each health topic, the report summarises relevant social media campaigns and messaging from more formal sources. It also examines organic online conversations about these topics taking place around the same time to understand the extent of potential misinformation, service quality issues, and related distrust in healthcare providers and services, as well as the roles of family, social support, the environment, and gender-related attitudes, as applicable. (In light of the fact that the vast majority of internet and thus social media users in the country reside in the capital city Ouagadougou, of the individual users who posted content, the majority were males.)

Sample findings:

1. MCH: Topics relating to MCH involved conversations related to childbirth, antenatal care (ANC), and childhood vaccinations. An example finding related to the latter topic: Most social conversation around President Roch Marc Christian Kaboré's efforts to increase child vaccination was largely driven by non-governmental organisations (NGOs), advocacy groups, and social newsfeeds. Conversations among individual users were more complex and, at times, indicated a level of distrust for vaccine safety and efficacy writ large. Given the complicated history with Western medical and vaccine trials among populations across Africa, it was not suprising that Burkinabe social media users expressed continued hesitation and distrust of potential vaccines, for treating the novel coronavirus in particular.
2. Nutrition: For example, conversations related to breastfeeding were driven by individuals and NGOs trying to raise awareness of the importance of breastfeeding infants until at least six months of age. An increase in conversation volume occurred in June 2020 with the launch of the regional "Stronger with Breast Milk Only" campaign. There was also a spike in volume on the related topics of breastfeeding and COVID-19, with people initially unsure of the virus's implications for breastfeeding.
3. WASH: Despite the government's water and sanitation programme, conversations on social media were seemingly driven by frustration with poor quality drinking water, delays in planned infrastructure projects, frequent water supply shortages, and poor sanitation.
4. FP: Much online conversation revealed potentially harmful gender attitudes not supportive of safe sexual health or FP. These conversations revealed sexist attitudes blaming women for unintended pregnancy, with no expectation of couples developing a shared understanding of the need for contraception to avoid pregnancy. Some social media users tried to normalise the idea that women should have the right to the same choices as men, without fear of being shamed. The 2020 coronavirus pandemic also brought child marriage to mainstream discussion, as the ability and right to a classroom education was compromised for many children during the pandemic, with girls at a disproportionate risk.

The report provides a series of recommendations for how the cross-cutting findings can be applied by RISE II implementing partners and Breakthrough ACTION to create cohesive messaging for their umbrella campaign strategy development in Burkina Faso. Examples include:

• Social media campaigns: Example: Consider concept testing the hashtag #Iwili (meaning "bird" in Mooré, used as a symbol for change) as a unifying theme for multiple health topics using a recognisable logo, as #lwili is currently used in social media posts relating to priority health outcomes.
• Misinformation: Example: Liaise with community and advocacy leaders to break the cycle of repetition or retweeting on social media platforms - limiting direct engagement with dubious sources of information, reporting it to social media companies, and providing accurate information in its stead.
• Service quality: Draw on social accountability approaches, such as community dialogues, community scorecards, and facility site visits, to help establish linkages between communities and health facilities, to provide opportunities for expressing client concerns, and to begin developing plans for improving service quality or dispelling misconceptions.
• Distrust: In addition to enabling community engagement for service quality improvement efforts, consider designing specific campaigns - e.g., one that invites beneficiaries to share their positive experiences with services.
• Role of family, social support, and environment: Example: Promote conversations that normalise the idea that women should have the right to make their own sexual and reproductive health (SRH) and FP choices, with campaign messages focusing on mitigating harmful gender norms and combatting gender-based violence, particularly in relation to child marriage.
• Emerging conversations related to COVID-19: Make efforts to understand inequities and factors contributing to increased health and socioeconomic vulnerabilities among certain populations, such as those without ready access to accurate health information and education, so resources can be directed to those most in need.