The ORS Campaign That Stalled
A block health officer in a Rajasthan village wants 60 families with children under five to use oral rehydration solution (ORS) for diarrhoea. The current rate is 18%. The officer has prepared posters with the sentence 'ORS reduces diarrhoea deaths by 90%' and a graph; after two weeks, use has risen only to 21%. Mothers say, 'Our grandmothers used home fluids and children survived.' A local healer calls ORS 'hospital water' and says it makes children weak. One respected anganwadi worker, Kamla, has used ORS for her own child and is willing to speak. The officer has a ₹5,000 budget, one community meeting, and a district supervisor who wants 'a fear appeal with photographs of dying children'. The officer must choose a strategy.
1. Diagnose why the poster campaign failed. Use the components of attitude, attitude functions, and at least two social-cognitive biases.
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The poster failed because it addressed only one component of attitude and ignored the others.
Components:
- Cognitive: the belief 'ORS is hospital water and makes children weak' or 'home fluids are enough'. The poster's '90%' statistic did not engage with these beliefs; it may even have seemed exaggerated.
- Affective: distrust of outside/hospital products, fear, and attachment to grandmothers' practices. A graph does not address affect.
- Behavioural: the habit of using home fluids and the social script of consulting the healer. The poster gave no concrete, feasible action or demonstration.
Attitude functions:
- Utilitarian: what keeps the child well?
- Value-expressive: home fluids express tradition and good motherhood.
- Social identity: the healer's authority and community norms.
- Ego-defensive: admitting ORS might imply past practice was wrong.
Social-cognitive biases:
- Confirmation bias: mothers remember children who survived home fluids and ignore severe cases.
- Availability heuristic: a recent bad experience with a hospital makes 'hospital water' salient.
- Social proof: 'everyone here uses home fluids'.
- Authority: the healer's statement carries weight.
- Optimism bias: 'our children are strong; dehydration won't happen to us'.
Also source credibility: a government poster may be distrusted; the message is one-sided and not demonstrated. The 18% to 21% rise suggests some exposure, but not conversion. The diagnosis is a mismatch between message and audience, not simply 'ignorance'.
2. Design a one-meeting strategy using source, message and audience factors. Explain why Kamla matters and why the fear appeal may backfire.
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A one-meeting strategy should combine a credible source, a concrete message, and audience participation.
Source:
- Kamla, the anganwadi worker, is a 'similar other' - a local mother who has used ORS and is respected. Similarity and trustworthiness increase persuasion.
- Pair her with a health worker for expertise. Do not lead with a distant official.
- Involve the healer respectfully: ask him to attend, listen, and clarify; direct confrontation may entrench resistance.
Message:
- Acknowledge that home fluids are valuable and that mothers have kept children alive. Then add: 'In diarrhoea with signs of dehydration, ORS is the extra step that replaces salts and water quickly.'
- Use simple, concrete steps: how to mix, how much, when to seek care, continue feeding.
- Avoid the unsourced '90%' claim; use a modest, verifiable statement and a demonstration.
- Avoid the supervisor's fear appeal with photographs of dying children. High fear without a clear, feasible efficacy message can lead to avoidance, denial, or blaming mothers. If fear is used at all, pair it with immediate, low-cost action and support.
Audience:
- Mothers and grandmothers as decision-makers; include fathers if they control spending.
- Use group discussion, testimonials, teach-back, and a free ORS packet.
- Address cost and availability; say where to get ORS.
Evaluation: plan a follow-up visit and a simple measure of use. Reasoning: persuasion works through credibility, relevance, emotional engagement, and efficacy, not statistics alone.
3. How would you know whether the change is attitude change or only compliance? What would you measure, and what would you not conclude?
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To distinguish attitude change from compliance, measure more than one thing and measure over time.
Attitude change indicators:
- Beliefs: mothers can explain why ORS helps and when home fluids alone are insufficient.
- Evaluation: they rate ORS as useful and safe, not 'hospital water'.
- Intention: they say they will use ORS at the next episode.
- Consistency: the belief is held privately, not only in front of the health worker.
Compliance indicators:
- Behaviour changes only when the worker is watching.
- Mothers take the free packet but do not use it.
- They agree publicly but privately repeat the healer's view.
- Behaviour reverts after the meeting.
Measures:
- Anonymous or confidential short survey before and after, with the same questions.
- Home visits at 2 and 8 weeks to check ORS packets, preparation, and recall.
- Observation of a role-play or teach-back.
- Reports from Kamla and the healer, with consent.
- A comparison of villages or a follow-up group if feasible.
Do not conclude 'attitudes changed' from a raised hand, a poster recall, or one meeting. Behaviour can be compliance, and self-report can be social desirability. Triangulate: belief, intention, behaviour, persistence. Also check unintended effects - stigma, blame, or reduced use of home fluids. Reasoning: attitudes are multidimensional; change is inferred from convergent evidence, not a single indicator.