Applying the COM-B behaviour change model in social and behaviour change message development towards increased uptake of Perennial Malaria Chemoprevention (PMC) delivered through routine immunization platform in Osun State, Nigeria

Abstract Background: To influence malaria-related behaviours, it is important to understand key behavioural drivers, encourage enablers and address barriers to individuals and communities adoption of interventions to prevent malaria. The capability(C), opportunity(O), and motivation(M) Behaviour(B) model (COM-B model) was used to inform development of perennial malaria chemoprevention (PMC) social, and behaviour change (SBC) message delivered through routine immunization (RI) platform. This paper presents how the COM-B model was used for designing the SBC messages for PMC using the findings from a qualitative study. Methodology The COM-B model provided the theoretical framework for designing the PMC SBC intervention by identifying, capability, opportunity motivation for PMC as well as the barriers, and possible enablers for PMC uptake. A qualitative study was conducted as key source of information. Twelve focus group discussions (FGDs) were conducted with the target audience comprising of mothers of children under two years, pregnant women, men, ward development committee members, community mobilizers and health workers. A total of 120 people participated in the study. An SBC workshop was conducted to develop key messages and content for a community dialogue flipbook and facilitators' guide. Results Knowledge of malaria signs that prompt mothers to seek health care for their children as well as awareness about malaria prevalence and severity, were identified as capabilities that could drive behaviour change, while forgetting the time to visit the health facility was noted as a hindrance. Opportunities and social influencers included spousal support, the positive influence of health workers, accessibility and affordability of the intervention, and the availability of transportation. Motivation was shaped by the perceived seriousness of malaria as a health problem that could lead to the death of children. Fathers were motivated when they observed reduced malaria burden and improved child health, although a lack of perceived urgency remained a demotivating factor for seeking care. Mothers' motivation was strengthened by encouragement from husbands, community mobilisers and health workers. Conclusion The COM-B model provided an effective framework for identifying and developing key messages that informed changes needed to improve capability, opportunities, motivation of individuals and communities towards increased uptake of PMC during PMC pilot study in Osun state Nigeria.