KAP Endline Assessment at CBM International

1. Background of Project
Seeing is Believing (SiB) seeks to improve access to comprehensive eye health services for children.
The project addressed the avoidable, preventable and treatable causes of blindness and visual
impairment among children aged 0-14 in selected states of Nigeria. Equal access to both male and
female, as well as people with other disability was also be ensured on the project.

The components of the project include; Promotion, Prevention, Medical and
Rehabilitation/Education.

SiB was implemented in 11 States, across 4 geopolitical zones in the country, with each zone referred
to as a cluster– Cluster 1 (South-West- Oyo, Osun, Ogun); Cluster 2 (North-Central- FCT, Nasarawa,
Plateau); Cluster 3 (North-West- Kano, Katsina and Jigawa); and Cluster 4 (South-South- Cross
Rivers and Akwa-Ibom).

The key areas of activities for the project include:

• Reducing the risk of eye disease and injury;
• Increasing early detection;
• Improving access to eye health care services;
• Improving the systems and quality of care;
• Improving the underlying evidence base;
• Embedding child eye health into policies and programme of the ministries of health and education;
• and
• Improving the quality and availability of education for blind and visually impaired children.

2. Aims and Objectives

The primary aim of this endline KAP study is to examine the knowledge, attitude and practice of
community members and health care providers towards child eye health (CEH) after the SiB
implementation.

Specific objectives includes;

• To identify level of Knowledge, Attitudes and Practices related to eye health at community level;
• identify what is known and done about eye health-related subjects.
• To identify level of involvement of community and health care workers in child eye care
• management and determine associated challenges.
• To identify existing knowledge gaps with regard to appropriate health seeking behaviors and
• obstacles to initiating or completing treatment.
• To identify barriers that undermine child eye health promotion, prevention, treatment and
• management in the community as well as access and utilization of child eye health services within the
• various SiB intervention communities.
• To determine the attitude of care givers at the various levels of care towards people living with
• disability including children with blindness.
• To assess the perception of policy makers and opinion leaders about child eye health issues?
• To determine the health seeking behaviors on child eye health among community members in SiB
• intervention States?
• To compare points 1-7 with baseline findings, highlighting areas of change.

Timeline:

The survey will be conducted over a period of eight (8) weeks. The first week will be used for desk
review and development of the survey protocol, tools and instrument. Training of research/data
collection team and pre-testing of survey tools will be conducted in the second week. Field data
collection will be done in 5 sampled states. Data analysis and report writing will hold in week five and
six.

Location:

The study will be undertaken in 5 sampled states divided into 4 clusters based on the programme
implementation structure and will be repeated in the exact communities where the baseline KAP
study was conducted.

Target Population/Stakeholders
Study Participants:
Community Members: household members, care givers, community leaders, group leaders, religious
leaders, TBAs.

Clinical Group: CHEWs, Nurses, Health facility leads/Managers and policy makers
3. Evaluation Objective, Scope and Intended use

• One of the components of SiB is eye health promotion, which includes activities geared towards
• engaging and empowering individuals and communities to adopt positive child eye health behaviors,
• and create awareness to change harmful practices or attitudes; thereby improving uptake of child eye
• health service.
• A baseline KAP study was conducted before implementation. This KAP study identified knowledge
• gaps, cultural beliefs, or behavioral patterns that may facilitate understanding and action, as well as
• pose problems or create barriers for the programme. It revealed the understanding of the community
• on CEH, their feelings towards the subject, as well as any preconceived ideas that they may have
• towards it, and the ways in which they demonstrate their knowledge and attitude through their
• actions. This endline study seeks to measure the same by using the same tools and similar
• methodologies to discern how well the SiB programme worked in improving the knowledge of
• beneficiaries and changing unwanted attitudes and practices of beneficiaries.

In order to achieve the study objectives as above, the study team will follow the steps as outlined
below:
4. Development of the Research Protocol
A research protocol will be developed to provide the road map for the conduct of the KAP study. The
protocol will also be used to obtain an ethical approval from the National research and ethical
committee.
1. Desk Review: A literature search of relevant materials, documents, journal articles, and global
best practices will be undertaken by the research team under the leadership of the PI with support
and guidance from the PD. The results will be used as a broad guidance, which could be adapted
in the context of this study.
2. Develop Data Collection Tools: Data collection tools will be will be adapted from the baseline
tools to collect quantitative and qualitative data for key study questions.
3. Training for local enumerators and Finalization of Tools: A two-day training will be
organized for local enumerators and a one-day field testing of tools. After testing, the data
collection tools will be finalized and sampling will be reviewed and adjusted (if necessary) to
ensure appropriateness to local contexts.
Data Collection and Analysis:

Experienced local enumerators will be responsible for data collection on the field. Household survey will be conducted using structured questionnaires for household members. Health facility staff (CHEWs and Nurses) and non-facility care providers
(TBAs) will also receive a structured questionnaire, to explore their opinions and experiences.
Focus Group Discussions (FGD) will be held among different groups within the community, including women groups and religious groups; to allow dynamic group interaction and exchange of perspectives among peers. In-depths Interviews (IDI) will be held with key informants including key opinion leaders in the communities, community gate-keepers, group leaders,
religious leaders and health facility manager/lead. Qualitative data will be transcribed for analysis. Transcripts will be analyzed, while quantitative data generated from the study will be analyzed using descriptive and bivariate analyses.
5. Report Writing: Final report writing will be done by the Principal Investigator and submitted to
the Programme Director for review and for final approval by the Project Steering Committee.
5. Evaluation Questions

• 1. What is the current level of Knowledge, Attitudes and Practices related to eye health at
• community level; including what is known and done about eye health-related subjects within the
• various SiB intervention communities?
• 2. What are the existing knowledge gaps with regard to appropriate health seeking behaviours and
• obstacles to initiating or completing treatment?
• 3. What is the level of involvement of communities and health care workers in child eye care
• management and what are the associated challenges.
• 4. How does the attitude of health care workers affect persons with disability including children with
• blindness of visual impairments?
• 5. What are barriers that undermine child eye health promotion, prevention, treatment and
• management in the community as well as access and utilization of child eye health services within
• the various SiB intervention communities?
• 6. What are the perception of policy makers and opinion leaders about child eye health issues and
• programmes?
• 7. How do evaluation questions 1-6 compare with the baseline research questions?
• If any, what progress or barriers have been made since the baseline study?

Methodology
This a mix method approach that will involve the use of both quantitative and qualitative methods. As
differing groups in the community will likely to have differing levels of KAP, hence, communities will
be divided into two groups- (i) the general community members, i.e. community leaders (religious and
traditional leaders, as well as influential individuals, (ii) the clinical community, i.e. the health care
workers and policy makers. However, the same method of data collection will be used for the two
groups, to ensure that differences in the result are independent of the sampling method and depend
solely on the characteristics of the population.
Sample Selection: This will involve multi-stage sampling design. At the first stage,
communities (Primary Sampling Units (PSU)) within the states will be purposely selected. At the
second stage, respondents among health workers within supported health facilities; and
community members and households will be randomly selected (consultant can suggest method
of selection that will be representative).
Sample Size: To select the minimum sample and spread the sample widely, it is proposed to
select 1 state in each of the clusters and FCT. Then 3 communities will be selected in each state to
represent the three senatorial zones; which will bring the total to 5 states and 15 communities for
the entire study. For the qualitative and quantitative data, it is proposed that;
Household surveys: n=225 (45 per state)
IDI: n=30 (6 per state)
FGD: n=30 (6 per state)
Limitations
Limited sample size
Time

Key Deliverables

• A detailed report of the study findings, and recommendations for future interventions and the
• government.
• A hard copy of all collected information
• An e-copy of raw data (SPSS or any other software used for analysis) and final version of report
• (MS Word and PDF).

Research Team and Management Responsibilities
Commissioning responsibility

Research Team

For the purpose of this survey, a consultant with expertise in qualitative and quantitative research will
be contracted on a short-term engagement to act as the Principal Investigator who will lead the study.
The SiB Programme Director (PD) and the M&E Manager will provide oversight and technical
guidance to the study. Other members of the research team will include;

• Data Analyst
• Data Entry Clerks
• Local Enumerators
• FGD &KII moderators
• Translators

Notetakers
Consultant’s Competencies

• CBM will engage the services of a consultant from within or outside the country. The following
• qualifications and skills will guide selection of the consultant for this assignment:
• Proven senior-level evaluation experience (at least 8 years) and ability to provide strategic
• recommendations to key stakeholders;
• Demonstrated experience in conducting KAP study using mixed method approach and providing
• proper recommendation to programmers and the capacity to work collaboratively with multiple
• stakeholders and on a team;
• Good knowledge of strategic and operational management of programmes, preferably in Nigeria; the
• ability to bring on board national consultants(s) from different geopolitical zones would be an asset;
• Good knowledge of the health system and local government and programme implementation
• structures and systems;
• Strong experience in disability and in disability inclusive eye health programme;
• Strong analytical skills and ability to clearly synthesize and present findings, draw practical
• conclusions and to prepare well‐written reports in a timely manner;
• Strong workshop facilitation skills;
• Excellent writing and presentation skills in English
• Availability for the period indicated.
• 9. Management of the Studies and Logistics**
• Programme Coordination office has responsibility for: logistics (accommodation, transport,
• providing communication means to study teams, organizing meetings etc.)
• Project Partner has responsibility for: being available to be interviewed by the consultants,
• facilitating access to data and project team, facilitating meeting beneficiaries if requested by the
• consultants.
• SiB Team has responsibility for: Overall management of the study, providing all information related
• to Seeing is Believing project in Nigeria and being available for interviews if requested by the
• consultants.

Expected Results

• Inception report (including tools and methodology)
• Zero draft of the evaluation report for review by the SiB team.
• Final draft of the evaluation report and raw data/tools used for the endline evaluation.
• A PowerPoint presentation of evaluation methodology, findings and recommendations, conclusions
• and learnings.
• Present findings in a validation/dissemination meeting
• The Consultant is solely responsible for the final products. While maintaining independence, the
• consultant and team members will adhere to professional standards and language, particularly that
• which may relate to the protection of staff and operations. Direct consultations with affected
• populations will be a formal requirement of the study unless security conditions are overriding.
• Additionally, agencies at the country level and the SiB will be consulted prior to the dissemination of
• any products emanating from the evaluation.
• Compliance with CBM study principles standards is expected and the KAP report will be judged in this
• regard. All external study reports will also be submitted to CBM International Office.
• Agreed Terms of Reference.
• Detailed work plan and study tools.