Theory of Change
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HCD MODULE 7
Identifying Community Centric Interventions
THEORY OF CHANGE
Theory of change is about continuous inquiry — measuring how the ideas respond to the barriers.
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TRIAL SOLUTION
Implement the solution on the smallest possible scale and continue to monitor its efficacy.
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CONTINUOUS INQUIRY
THEORY OF CHANGE
Devise a ‘theory of change’ for each must address challenge to determine what we need to measure and learn.
Continue to adapt the solution and update the ‘theory of change’ as it scales.
IN THIS LESSON:
An iterative process with simple tools
ABOUT HCD
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Share statistics
stories backed by data
DEFINITION
Discover learning goals
DIAGNOSIS
Empathize and understand
DESIGN
Ideate and prototype
IMPLEMENTATION RESEARCH
Test and evolve
People are
rational human
Closed Open inquiry about challenges and solutions
Report on �Evolve your interventions
Define messages for Design interventions with the community
Challenges are one �multi-dimensional
Linear validation Cyclical iteration
PERSONA MODELS
JOURNEY MAPPING
RAPID INQUIRY
SYNTHESIS
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IDEA GENERATION
PROTOTYPING
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THEORY OF CHANGE
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Report on Evolve the interventions
As contexts and communities evolve, so must our solutions. HCD maps the system of people and activities that we assume will bring about change to collaboratively monitor over time.
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THEORY OF CHANGE
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We collect building blocks of ToC throughout the process
ToC x HCD
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Important Roles/Inputs
Barriers + Enablers
Informs activities > outputs > outcomes
Activities + Strategies
Surface Implementation Research Questions and Key Indicators
PERSONA MODELS
JOURNEY MAPPING
RAPID INQUIRY
SYNTHESIS
IDEA GENERATION
PROTOTYPING
THEORY OF CHANGE
M+E
Theory of change serves two purposes:
(1) Collaboration — Lay out the ‘real world’ strategy, with all possible pathways leading to change, that can be socialized with communities / reference groups
(2) Accountability — A way to check if our assumptions are correct
THEORY OF CHANGE
TOC starts with the desired impact and works backwards.
RECAP
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ToC
If these people
Inputs
Do these activities
Activities
We will see this immediate change
Outputs
That builds toward changed drivers �of behaviors / influence
Intermediate Outcomes
Leading to changed �behavior / performance
Outcomes
And results in measurable change
Impact
TOC tracks for
intermediate outcomes on the road to long-term change
RECAP
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IMPACT
OUTCOMES
INTERMEDIATE OUTCOMES
OUTPUTS
ACTIVITIES
INPUTS
THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
changes in performance of individuals or institutions
actual change in behavior, civic engagement, policies
Leading to changed behavior/
performance
OUTCOMES
WHAT
THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
changes in performance of individuals or institutions
actual change in behavior, civic engagement, policies
Leading to changed behavior/
performance
OUTCOMES
precursors of individual or institutional change
attitudes, self-efficacy, participation opportunities
INTERMEDIATE OUTCOMES
That builds toward changed drivers of behavior/influence
WHAT
TOC is clear about what we can influence (outcomes) and what we can control (outputs)
RECAP
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THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
changes in performance of individuals or institutions
actual change in behavior, civic engagement, policies
Leading to changed behavior/
performance
OUTCOMES
precursors of individual or institutional change
attitudes, self-efficacy, participation opportunities
INTERMEDIATE OUTCOMES
That builds toward changed drivers of behavior/influence
RESULTS
(the difference we make)
OUTPUTS
WHAT
changes in capacity of individuals or institutions
something has been created, repaired, improved
We will see this immediate change
THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
changes in performance of individuals or institutions
actual change in behavior, civic engagement, policies
Leading to changed behavior/
performance
OUTCOMES
precursors of individual or institutional change
attitudes, self-efficacy, participation opportunities
INTERMEDIATE OUTCOMES
That builds toward changed drivers of behavior/influence
RESULTS
(the difference we make)
OUTPUTS
WHAT
what we do
actions taken to produce initial results
Do these activities
prioritized ideas after prototyping
HOW
ACTIVITIES
changes in capacity of individuals or institutions
something has been created, repaired, improved
We will see this immediate change
THEORY OF CHANGE
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change in conditions for children
impact resulting from change in behavior
And results in measurable change
results statement
can control
can influence
WHY
IMPACT
changes in performance of individuals or institutions
actual change in behavior, civic engagement, policies
Leading to changed behavior/
performance
OUTCOMES
precursors of individual or institutional change
attitudes, self-efficacy, participation opportunities
INTERMEDIATE OUTCOMES
That builds toward changed drivers of behavior/influence
changes in capacity of individuals or institutions
something has been created, repaired, improved
We will see this immediate change
RESULTS
(the difference we make)
OUTPUTS
WHAT
what we do
actions taken to produce initial results
Do these activities
prioritized ideas after prototyping
HOW
ACTIVITIES
resources
needed to carry out activities
If these people
anyone who uses, administers, or manages the idea
IMPLEMENTATION
(what we do)
INPUTS
In your groups, complete a theory of change for your prototype.
30 minutes
FINAL EXERCISE!
Theory of Change
How
What
Why
INPUTS
ACTIVITIES
OUTPUTS
INTERMEDIATE OUTCOMES
OUTCOMES
IMPACT
If these people
anyone who uses, administers, or
manages the idea
Do these activities
prioritized ideas after
prototyping
We will see this
immediate change
something created, repaired,
improved
That builds towards changed drivers of
behavior/influence
Leading to �changed behavior/
performance
And results in
measurable change
(results statement)
Iteration?
MINDSET
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If the idea isn’t working we ask ourselves why:
Do we really understand the underlying problems? Is the idea actually responsive to the barriers? How easy it is to implement? Can it work with something that already exists? Is the idea transforming behavior? Is it desirable to the community? How can it be more influential? Is it decreasing inequities? How long does the intervention need to be operational in order to solve the problem?
HCD + ToC
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Iteration forces us to
check our biases
BIASES
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Our level of intelligence does not shield us from cognitive biases.
Educated, high-income people are just as susceptible to forgetting important tasks or exaggerating probabilities as the less-educated and poor.
biases
Confirmation bias: Hearing what we want
BIASES
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We have a tendency to test ideas in a one-sided way, focusing on one possibility and ignoring alternatives.
From conducting field research to analysing research findings, we exhibit the tendency to fit what we see and hear into pre-existing notions of how we think things work. We may automatically ignore or forget information that goes against our prior beliefs.
Confirmation bias: Hearing what we want
Listen, but don’t only listen
BIASES
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HCD remedy:
Overconfidence bias: Having an answer
BIASES
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Definitive answers are more comfortable than ambiguity, but being unsure is far better than being falsely confident.
The preference for knowing the answer is so pervasive and ubiquitous, that overconfidence is one of the most powerful biases. It causes us to make important judgements and decisions without enough consideration.
Overconfidence bias: Having an answer
Community co-creation
BIASES
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HCD remedy:
Default bias:
Path of least resistance
BIASES
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We are inclined to accept the tried and tested (even if stagnant) solutions rather than challenge pre-selected options.
Resisting the familiar and ‘accepted’ opens our work to more possibilities for experimentation and effectiveness in the long run.
Default bias:
Path of least resistance
Expansive thinking
BIASES
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HCD remedy:
Implementation Research: paradigm shift
It takes between 10-20 years before evidence-based innovations and interventions are included in national health policies and programmes. These delays lead to substantial and preventable loss of lives.
The poorest and most marginalized segments of the population are the most likely to be affected, as their access to health and social services is already low and often compromised due to disadvantages in socio-economic circumstances, education, and geography.
Implementation research can help reduce such inequities, accelerate uptake of innovations and scale up of proven lifesaving interventions by providing the real-time evidence decision makers need to improve their policies, programmes and practice at relatively low cost (compared to discovery research).
UNICEF’s definition of implementation research (IR) is the integration of high-quality and real-time research within existing program implementation and policy-making to improve outcomes and overcome implementation bottlenecks.
Implementation Research
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67%
of UNICEF projects using IR led to changes in policies, programmes and/or practice
85%
of country team members engaged in UNICEF supported IR projects reported that they have acquired transferable skills they can use to improve programme management, to mount subsequent IR studies, and to help strengthen their careers
$50,000
is an average cost of implementing IR per project - as measured across 40 completed IR projects carried out by UNICEF in 28 countries
63%
is the reduction of child mortality upon embedding IR, while discovery research has a 22% mortality reduction potential
RESOURCES
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IR Resources
RESOURCES
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hcd4health.org
RESOURCES
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sbcguidance.org
Truths are buried - dig deep to unearth insights
�Incorrect assumptions alongside unrealistic expectations are the main reasons projects fail. We conduct thorough research to avoid basing interventions on assumptions of what might work. We unearth hidden truths and disentangle what people self-report about their behaviors from what they actually do. ’Thick data’ in the form of stories, emotions, and interactions gives us a more complete picture of barriers and solutions.
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HUMAN CENTRED DESIGN TRAINING
Attention is dispersed — narrow your focus
�With many priorities competing for attention in people’s daily lives, our programmes are unlikely to be given focused consideration or deep reflection. Understanding this, we focus on those behaviors that are most essential for achieving the project’s goals — and on community members whose behavior change will make the biggest difference. We go for the easy wins first to encourage people to try the more difficult behaviors.
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HUMAN CENTRED DESIGN TRAINING
Some community members are uniquely equipped to incite change - seek allies
Each community has people whose opinions are respected and often followed, such as religious leaders, government authorities, grandmothers or successful farmers. If we manage to motivate them to support our work, we are likely to achieve better results.
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HUMAN CENTRED DESIGN TRAINING
Knowledge and awareness are not enough — go beyond logic
�Emotions, not facts, are the most effective agents of change. We need to give people a chance to experience the benefits the promoted behavior brings so that they can feel good about it. Knowledge matters, however, the feelings associated with practicing a different behavior and gaining tangible benefits are powerful motivators — more than logical information and education alone.
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HUMAN CENTRED DESIGN TRAINING
Intentions are not actions — make it easier for people to go from knowledge to action
�The main reason why people do not practice certain behaviors is often not their ignorance or lack of interest but the barriers they are facing. The most successful interventions are those that address the reasons (psychological, social, and environmental) preventing or discouraging people from achieving the desired change and at the same time increase motivation for change.
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HUMAN CENTRED DESIGN TRAINING
Context comes first — consider what people are already doing and align services with this
Asking people to change their behavior is not as effective as making a desired behavior easy. We assess and take advantage of the existing positive behaviors, beliefs and know-how. At the same time it is critical not to undermine important traditions that do not cause any harm.
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HUMAN CENTRED DESIGN TRAINING
In your group, teach back �each principle:
FINAL REVIEW
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6 PRINCIPLES
COMMUNITY LEADERS��Some community members are uniquely equipped to incite change - seek allies
Context comes first — consider what people are already doing and align services with this
�Intentions are not actions — make it easier for people to go from knowledge to action
�Knowledge and awareness are not enough — go beyond logic
HEAD OF HOUSEHOLDS��Attention is dispersed: narrow your focus!
ADOLESCENT��Truths are buried: dig deep to unearth insights!
Group 5
Group 3
Group 1
Group 2
Group 4
Group 6
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What’s one thing you’re going to share with someone else?
FINAL REFLECTION!
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Congratulations! You have completed the training!
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APPENDIX
Facilitator’s References
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Theory of Change
track the impact of your interventions
TOOLS
As contexts and communities evolve, so must our solutions. A theory of change maps the system of people and activities that we assume will bring about change to collaboratively monitor over time. It tracks for intermediate outcomes on the road to long-term change.
Theory of change serves two purposes:
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Theory of Change
Activity instructions:
TOOLS
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PDF POSTER VERSION ENG
FACILITATOR PREPARATION
Print one copy for each group.
Modify and/or translate to fit the challenge.
Editable version available on next slide.
Theory of Change
How
What
Why
INPUTS
ACTIVITIES
OUTPUTS
INTERMEDIATE OUTCOMES
OUTCOMES
IMPACT
If these people
anyone who uses, administers, or
manages the idea
Do these activities
prioritized ideas after
prototyping
We will see this
immediate change
something created, repaired,
improved
That builds towards changed drivers of
behavior/influence
Leading to �changed behavior/
performance
And results in
measurable change
(results statement)
46
Know your audience
(& don’t make assumptions)
PERSONA
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HUMAN CENTRED DESIGN TRAINING
Identify ‘barriers’ to seeking/ supporting immunization
Identify ‘enablers’ to positively support or make attending immunization services easy
Identify 1-3 starting ideas per persona
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A
B
C
Consider every point of an experience (service or behavior): before, during and after the action.
JOURNEY MAP – BARRIERS
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HUMAN CENTRED DESIGN TRAINING
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Insights arise from the different expectations, challenges, and roles within a community.
*based on The Behavioral Insights Team ‘EAST’ model
RAPID INQUIRY
TA Kalumbu
TEACHER
ADOLESCENT
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HUMAN CENTRED DESIGN TRAINING
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Uncover themes – root causes and motivations in common
Identify opportunities and informed solutions to take forward
*based on The Behavioral Insights Team ‘EAST’ model
SYNTHESIS
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HUMAN CENTRED DESIGN TRAINING
Switch from linear, logical and critical thinking to creative and dynamic thinking.
Nudge behavior by making it easy, attractive, social and timely.
IDEA GENERATION
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HUMAN CENTRED DESIGN TRAINING
Bring something rough to the community so that they can give feedback.
Continue to adapt the solution as it scales up.
PROTOTYPING
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HUMAN CENTRED DESIGN TRAINING
Start with the desired impact and work backwards.
Make the difference between what we can influence and what we can control.
THEORY OF CHANGE
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HUMAN CENTRED DESIGN TRAINING
hcd4health.org
thenucleusgroup.com
@TheNucleusGroup – IG
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