Young people are the future and their nutritional needs are critical for the well-being of any country. As highlighted in the recent Global Accelerated Action for Health of Adolescents (AA-HA!) report investing in the nutrition and health of adolescents brings a triple dividend of benefits for the adolescent now, for their future adult lives, and for the next generation. However, interventions to improve the diets of adolescents have often only limited success, primarily because they tend to focus on imparting knowledge and information on healthy diets. However, as has been shown repeatedly, most adolescents already have a good idea of what healthy eating means. They are just not particularly excited about translating this knowledge into practice.
The Global Alliance for Improved Nutrition (GAIN) aims to address this shortfall by implementing different innovative interventions aimed at adolescents. GAIN, together with Shornokishoree Network Foundation (SKNF), is currently implementing the national-scale effort “Nourishing Dreams: improving the quality of adolescents’ diets in Bangladesh” that aims to improve consumption of nutritious and safe foods. Nourishing Dreams has several components, including a grassroots-led communication campaign motivating adolescents to recognize the importance of healthy diets to realise their dreams and join the social movement Bhalo Khabo Bhalo Thakbo, the “Eat Well, Live Well” Movement.
Following the campaign, a “pocket money pledge”, the Bhalo Khabo (Eat Well) Pledge, will be launched as a way for adolescents to individually and collectively demonstrate their commitment to eating more nutritious foods by spending their pocket money on healthier snacks before, during and after school. It is anticipated that Nourishing Dreams will directly increase the demand for healthier snacks, demonstrate to the food industry adolescents’ demand potential, and encourage adolescents to recognise their agency to make decisions in different aspects of life, including food habits.
There are currently 36 million adolescents in Bangladesh representing over one-fifth of the country’s total population. They are on the front line of the nutrition transition and increasingly face a triple burden of malnutrition that includes undernutrition, micronutrient deficiencies and weight gain (even within the same person).
Evaluating a dynamic campaign
The Nourishing Dream campaign aims to improve the diets of adolescents in Bangladesh by drawing on various consumer-marketing strategies and interactive, social media-based communication facilitated by videos, memes, popular social media influencers; a commitment pledge; supplementary in-real-life (IRL) events; activities organised by SKNF club members in secondary schools; and advocacy work with political actors and the national food industry. The various activities and elements of the campaign are still under development and there will also be a high level of dynamic adaptation throughout the entire lifecycle of the campaign.
IDS together with the Development Research Initiative (dRi) in Bangladesh has recently commenced an evaluation of the Nourishing Dreams campaign. Evaluating the innovative campaign presents several challenges:
- A dynamic and evolving campaign design with multiple and, in parts, overlapping activities
- An unpredictable and changing context within which the campaign is embedded (e.g. strict government surveillance of the social media landscape in Bangladesh)
- Adolescents self-select whether, how and how long they engage with the campaign
- Potential of low reach and low user engagement (as common in digital behaviour change intervention)
- National coverage of the social media campaign and thus absence of a ‘pure’ control group for traditional counterfactual design
- The desired outcomes of the campaign are complex and determined by many different steps and external factors
Given these challenges, traditional, locked-down experimental or quasi-experimental counterfactual designs (e.g. randomised controlled trial (RCT)) are likely to be too narrow and impossible to administer from a methodological point of view (as it is impossible to select a control group). Consequently, there is a need for a more agile and adaptive approach that will allow the evaluation team to stay in touch with the constantly changing campaign and facilitate learning throughout the lifecycle of the campaign, while also assessing its impact and the pathways of impact.
Using the Contribution Analysis method
To address these challenges the evaluation team opted for a theory-based approach with Contribution Analysis (CA) as the overarching methodological framework, a framework that IDS has developed sizable experience in. CA has become an increasingly popular approach for evaluations in which traditional designs are impossible. As recommended for CA, we will use a step-wise iterative process to develop, refine and test a theory of change of how the Nourishing Dreams campaign will bring about change. We will also test and verify the multiple underlying assumptions of the theory of change and assess potential risks. Empirical evidence for this process will come from a comprehensive mix of observational quantitative evaluation data, longitudinal qualitative case study research and social media metrics analysis. The ultimate aim is to develop a credible and evidence-based narrative of how the Nourishing Dream campaign changed (or not change) the diets of adolescents in Bangladesh.
The challenges that exist in this evaluation are not unique and are becoming increasingly common. Complex and unpredictable causal chains and interventions that constantly evolve in response to dynamic contexts are becoming the norm in international development. They probably always have been – but now the evaluation discourse is acknowledging this more. This means that evaluators must become more adaptive, as well as understand the wider threats to validity that may exist in their evaluations.
A key strength of CA is that it acknowledges this real-world complexity. CA recognises that interventions are embedded in existing systems and that there are multiple processes and other factors that interact with the intervention (and are outside of the direct influence of the intervention) that may ultimately lead to the observed outcomes. This means that there is a greater claim on the contribution a specific intervention and funder might have made towards change, rather than direct attribution. The benefit can be a deeper knowledge of causal mechanisms, and an adaptive approach that can innovate alongside the wider intervention. Furthermore, the multi-phased nature of the evaluation can provide insights that can be used to iteratively refine and improve the approach as it is being implemented.