Behaviour Change Communication in Public Health
as presentated at the VIII International Communication for Development Roundtable, Managua, Nicaragua
Click here to download this as a Power Point presentation.
A Generation Ago...

The 70s: "Field Era"

- Need to reach people beyond the clinics
- Derived from extension agent approach in agriculture
- Field work supported by IEC materials, films and audio visuals
- Mass media impact on behavior considered modest due to limited reach
- Large volume IEC
- SMCR(E) as dominant communication model
The 80s: "Social Marketing Era"
Moving from non-paying clients to customers who ask and pay
The 90s to Present: "Strategic Era"

Moving from dialogue to mutual adjustment and convergence
On the process side
- Participants in the communication process create and share together
- Distinction between "senders" and "receivers" begin to disappear
- Communication not as a spare wheel
- Greater multi-channel integration
- Multiplicity of stakeholders
- Increased attention to evaluation and evidence-based programming
- Increased sophistication in audience segmentation
- Large scale impact at national and sub-national level
- Role of electronic media more pervasive
Developing World Radio and TV Receivers

Strategic Communication Today
Strategic communication is a process carried out with the active participation of stakeholders and beneficiaries that addresses a long-term vision and affects the causes of as well as the barriers to behavior change.
Strategic communication includes many approaches such as: community mobilization, client-centered counseling, social network interventions, social marketing, entertainment-education, TV/radio spots, dramas and music, provider promotion, behavior change communication, public policy advocacy, media advocacy, personal and community empowerment, public relations, mass media dissemination...
12 Key Elements of Strategic Communication: Making Evaluation More Complex
| Results-oriented | Multi-channeled |
| Science-based | Technically high quality |
| Client-centered | Advocacy-related |
| Participatory | Expanding to scale |
| Benefit-oriented | Programmatically sustainable |
| Service-linked | Cost-effective |
Strategic Directions in HIV/AIDS Behavior Change Communication
More applications of theory-driven communication and behavior change at multiple levels
Theory Driven Behavior Change Communication
Ideation is defined as new ways of thinking and the spread of those whays of thinking by means of communication and social interaction in local, culturally homogeneous communities.
Cleland & Wilson, 1987
Influence of ideational element on behavior

Ideational Factors Related to Condom Use (Zambia)
- Perceives self to be at a moderate-to-high risk of contracting HIV/AIDS
- Knows at least three ways to protect self from HIV/AIDS
- Has talked with at least three people about safe sex
- Has a positive attitude towards people who use condoms
- Knows where to purchase condoms
- Has an above-average sense of efficacy regarding ability to use condoms even when facing opposition from partner



Controlling for TV use, sex, age, educational attainment, residence
Theory Driven Behavior Change Communication
Ideation
Need to Identify/influence ideational factors related to desired behaviors
- Abstinance
- Being faithful to one partner
- Consistent condom use
- Delaying sexual debut
- Seeking treatment for STIs
- Seeking VCT
- Preventing MTCT
Social legitimization: improving social environment
- Breaking the silence
- Improving policy environment/strengthening political will
- Overcoming stigma
- Agenda priority setting
- Increasing public understanding of HIV impact
Social network
- Stimulating couple & community discussions
- Influencing community norms
- Developing community capacities
Social learning/modeling
- Modeling individual and collective self-efficacy
- Modeling health provider behaviors
- Scaling up entertainment education programming
The Individual - Social Continuum

Indicators for Community Empowerment and Change
- Leadership
- Degree & Equity of Participation
- Information Equity
- Collective Self-Efficacy
- Sense of Ownership
- Social Cohesion
- Social Norms




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