title: The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence.
abstract: Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.
authors.affiliation: a DePelchin Children's Center , Houston , Texas , USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Vélez
authors.forename: Mary
authors.initials: M
authors.lastname: Sanitato
authors.forename: Donna
authors.initials: D
authors.lastname: Barry
authors.forename: Martin
authors.initials: M
authors.lastname: Alilio
authors.forename: Franklin
authors.initials: F
authors.lastname: Apfel
authors.forename: Gloria
authors.initials: G
authors.lastname: Coe
authors.forename: Amparo
authors.initials: A
authors.lastname: Garcia
authors.forename: Michelle
authors.initials: M
authors.lastname: Kaufman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Klein
authors.forename: Vesna
authors.initials: V
authors.lastname: Kutlesic
authors.forename: Lisa
authors.initials: L
authors.lastname: Meadowcroft
authors.forename: Wendy
authors.initials: W
authors.lastname: Nilsen
authors.forename: Gael
authors.initials: G
authors.lastname: O'Sullivan
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Daniel
authors.initials: D
authors.lastname: Raiten
authors.forename: Susan
authors.initials: S
authors.lastname: Vorkoper
mesh_terms: D002657:Child Development; D046688:Child Mortality; D002675:Child, Preschool; D003695:Delivery of Health Care; D003906:Developing Countries; D015438:Health Behavior; D006291:Health Policy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012922:Social Change