“If You Love Me…” Campaign
An SBC intervention to increase TB testing and treatment
Despite significant progress in recent years, Cambodia remains one of the 30 tuberculosis (TB) high-burden countries in the world with an estimated 49,000 Cambodians contracted TB in 2018, and 3,900 of those have died from their illness. Of the estimated 49,000 cases, roughly 20,000 went undiagnosed, with men over the age of 65 being six-times more likely to test positive for TB than general population. The TB problem is particularly pronounced in Battambang and Pailin, accounting for 13% of all TB cases nationwide despite representing just 7% of the total population.
The USAID-funded Promoting Healthy Behaviors Project (PHB) is implementing a social and behavior change (SBC) activity with its local implementing partner in Battambang, Pailin and Kampong Chhnang provinces to support TB testing and treatment, particularly among elderly populations over 55 of age. Under the umbrella concept of “If You Love Me…”, this SBC activity aims to encourage target audiences to 1) seek TB testing based on symptoms, and 2) complete a full course of treatment for those who tested positive.
TB TESTING
KEY MESSAGES
- A cough for 14 days is not normal, it may be TB
- TB is highly contagious, and you (or your loved ones) need to take steps to prevention transmission
- TB testing is readily available and free at health centers
- TB can be 100% cured if you are tested and treated
- It’s the whole family’s responsibility to ensure elderly get tested
TARGET AUDIENCES
- Primary: Elderly individuals aged 55+, who are at higher risk of contracting TB
- Secondary: Family members, friends, and neighbors of elderly individuals
BEHAVIORAL OBJECTIVES
- Primary: Elderly people who are experiencing a cough that last longer than 14 days go to a public health center for screening
- Secondary: Community members encourage and convince their symptomatic elderly relatives, friends, and neighbors to get tested
TB TESTING STRATEGIES AND TOOLS
The concept “If You Love Me…” connects getting tested for TB with expressing one’s love and care for family members, which is an important element of Cambodian culture. Family members love and respect each other and want to keep them safe – a powerful motivator for TB testing.
TB Community Engagement Events are conducted by interpersonal communication (IPC) agents with support from local authorities. During these events, IPCs provide information on TB symptoms, distribute referral cards, and collect names of individuals for follow-up active case finding. IPC agents also use a variety of engaging visual aids and games aligned with the “If You Love Me…” concept to facilitate events. Additionally, TB survivors are invited to share their testimonials with participants to encourage and motivate TB testing and treatment..
A multi-pronged approach using several communication and awareness tools were developed to increase knowledge of TB symptoms and to drive campaign visibility and demand. These include:
- Display boards at pharmacies and health centers
- Radio campaigns
- Referral card system for family & friends
TB TREATMENT
KEY MESSAGES
- You must complete your full treatment course to be cured, you can do it!
- Side effects are normal and there are ways to treat these side effects
- Ensure you continue practicing cough hygiene (covering with elbow) during your course of treatment. This will keep your family safe
- It’s the whole family’s responsibility to ensure elderly complete treatment
TARGET AUDIENCES
- Primary: Elderly individuals aged 55+ who have been diagnosed with TB
- Secondary: Family members, friends, and neighbors of elderly TB patients
BEHAVIORAL OBJECTIVES
- Primary: People who have been diagnosed with TB complete their full course of treatment
- Secondary: Family members, friends, and neighbors to encourage and support elderly TB patients to complete treatment
TB TREATMENT STRATEGY AND TOOLS
The concept “If you Love me…” continues to be the centerpiece of TB treatment strategy that focus on leveraging love and care for the family to motivate TB patients to complete their treatment. On the other hand, the concept motivates family members to provide encouragement, support, and care to TB patients to overcome challenges of TB treatment. Health centers are a key touchpoint for a successful treatment strategy. When patients tested positive, TB supporters at the health center meet with patients to initiate their treatment plan and provide them with TB care kit and other materials to support treatment adherence.
Each TB Care Kit contains a medicine tracker booklet, a water cup, a reminder sticker, and vitamin C – elements that have been designed to help individuals overcome barriers to complete their treatment.
The enhanced medicine tracker booklet breaks down the course of treatment in 30-day unit with motivating messages and images as patients progress through their treatment journey. It also includes visual information on what side effects to expect and how to manage them.
Health center staff are provided with a suite of videos to give to TB patients (via Bluetooth or Telegram) to take home and watch with family. These videos provide information on possible side effects (and management), creating the habit loop and how to support TB patient.
To continue encouraging and motivating TB patients through the 180-day treatment period, TB patients will receive daily and weekly automated phone calls (robocalls) with pre-recorded messages guiding them through treatment milestones, highlight ways to avoid relapse and provide emotion motivation.
MONITORING, EVALUATION AND LEARNING
PHB conducts ongoing monitoring of this and all its SBC activities, capturing data in terms of activities implemented, people reached, and materials distributed, as well as information on beneficiaries’ knowledge, attitudes, and behavior prior to and after exposure to PHB’s activities. Results and lessons learned are used to iterate and improve the SBC activities, and are regularly shared with the wider SBC community.
* The Promoting Healthy Behaviors (PHB) Activity is a USAID-funded Social and Behavior Change project that commenced in 2018. The goal of PHB is to improve health behaviors among Cambodians and ensure they seek and receive quality healthcare with decreased financial hardship. PHB initially targeted 6 key health areas: Maternal & Child Health; Nutrition; Water, Sanitation and Hygiene (WASH); Tuberculosis; Family Planning; and Malaria. In 2020-2021, PHB also implemented COVID-related activities in response to the global pandemic. Towards the end of 2021, noncommunicable diseases (NCDs) were added to PHB’s health portfolio, and the project was extended until June 2025.
