Malaria Behavior Change Communication (BCC) Indicator Reference Guide

"Behavior Change Communication (BCC) has been a critical component of malaria prevention and control strategies. Most programs, however, have not been rigorously evaluated, either due to a lack of funding for such evaluations and/or due to lack of clarity about best practices for measuring the contribution of BCC for malaria prevention and control."

From the Roll Back Malaria Partnership (RBM), the global framework for coordinated action against malaria, this guide is designed to support Ministries of Health, donor agencies, and implementing partners involved in malaria prevention and control to evaluate the effectiveness of their malaria BCC interventions in a more rigorous and standardised way.

The indicators included in the guide have been selected based on 4 commonly used theories of communication and behaviour change: (i) Reasoned Action/Planned Behaviour, which focuses primarily on cognitive or rational processes around decision-making; (ii) Social Learning, which focuses on how people learn to behave by observing others; (iii) Diffusion of Innovations, which focuses on the structure of the social environment and how this influences access to information and behavioural response; and (iv) Extended Parallel Processing or Fear Management, which focuses on how cognition and emotion work together to motivate behaviour. The indicators are informed by findings from literature that have examined determinants of behaviour - not only for malaria, but also HIV and family planning (adapted for the malaria context). The guide categorises the indicators into 3 groups:

1. Core indicators that have been shown to be associated with preventive behaviours for malaria. These include message exposure, knowledge, perceived risk, response efficacy, and self-efficacy, along with indicators measuring the targeted behaviours themselves.
2. Supplemental indicators, primarily reflecting social norms, that have demonstrated a significant role in HIV/AIDS and family planning behaviours but that have not yet shown an association with malaria behaviours (e.g., proportion of people who believe that the majority of their friends and community members currently practice the behaviour).
3. Experimental indicators, which include context-specific indicators, such as those related to bednet care and repair and non-adoption of certain malaria behaviours.

"These indicators - mostly related to practicing targeted behaviors - have clear definitions and data collection tools....For each indicator, the indicator formulation is presented and any additional indicators noted. Also outlined are the purpose, indicator definition, numerator and denominator, measurement of the indicator, interpretations, strengths and limitations. Gender implications are included where they are especially important for the indicator....Relevant references to complementary documents and resources are included for each group of indicators."

The indicators provide a template for the collection, analysis, and interpretation of data. Country programmes are encouraged to select from them and adapt them in a way that meets programme needs and is suitable for the local context. RBM welcomes feedback from the malaria BCC community on their use of the indicators as they develop future versions of the guidance. Please send your comments and questions to: malariabccindicators@gmail.com

The development of the guide was a collaborative and iterative process, with contributions from malaria BCC experts from Johns Hopkins Center for Communication Programs, ICF International, FHI 360, Tulane University, the United States Agency for International Development (USAID), and the Centers for Disease Control and Prevention (CDC), among others.