BEHAVIOUR CHANGE COMMUNICTION (BCC)Paper Presented by: Innocent Daka (ZANIS) UNFPA Journalists Training Workshop Fringilla Lodge Chisamba July 2 to 6, 2012 1
OBJECTIVESProvide definition for BCCKnow the six key stages of BCCUnderstand Different Approaches/Channels to BCCUnderstand Use of Mass Media & Alternative MediaDefine and Differentiate BCC ObjectivesUnderstand Audience SegmentationUnderstand Message Development in BCC
DEFINITIONBehaviour Change CommunicationBCC is an interactive process that works through individuals, familiesand communities and delivered through different communicationchannels to promote positive health behaviours and support anenvironment that enables the community to maintain positive healthbehaviours taken on.•BCC Moves People From Awareness to Action! •It is about identifying the causes and barriers to behaviour change and overcoming the barriers. •It is about understanding the communities, contexts and environments in which behaviours occur.
BCC Explained...BCC being interactive means examines the environment andidentifies different health issues that affect different segmentedgroups or stakeholders--people who are affected by differenthealth issues.These stakeholders include individuals’ families and communities.The communication messages that are developed and deliveredthrough different channels are designed, planned andimplemented to meet the needs of the different groupsThere is ownership of the BCC programmes by the community.
BCC ExplainedBCC has evolved from Information, Education andCommunication programmes that have formed part of healthcommunication for a long time.While IEC programmes have been focused at impartinginformation and improving health knowledge, they did not havethe depth of moving people to action.Therefore BCC does not just end at creating awareness.It also seeks to motivate people to believe that change in behaviourresults in gaining health benefits while increasing their sense ofcontrol over their own health behaviour choices.
BCC ExplainedThe success of BCC messages and programmes aims at providingboth information and appeals to individuals emotions.
Key Elements & StagesKey Elements & Stages (BCC MODEL)1. Awareness2. Knowledge3. Attitude change (Approval, Intention)4. Practice of new behaviour5. Reinforcement of behaviour6. Advocacy (telling and persuading others to also adoptnew behaviour)
Key Elements & StagesAwareness:One is aware of the existence of a threat in terms of HIV being realKnowledge:One first learns about how HIV is transmitted or (knowing correctuse of condoms)Recalls messages on use of condoms and understands meaning of themessagesCan name the strategies of safe sex and practices
Key Elements & StagesAttitude Change Approval: •One then approves of the new behaviour (safe sex and condom use Strategies) •Responds favourably to safe sex (condom use) messages •Discusses condom use with peers or others (professional, colleagues, family and friends) •Thinks professional colleagues, family, friends and community approves of condom use practices.
Key Elements & Stages Intention: •One then believes this behaviour is beneficial to them and intends to adopt it. •Recognizes that safe sex (condom) strategies can meet a personal need •Intends to adopt safe sex (condom use) practicesPractice: •One then attempts new behaviour and continues to practice. (Practices proposed under each strategy in safe sex (condom use)
Key Elements & StagesAdvocacy •One can then promote the new behaviour through their social or professional networks as a satisfied practitioner. •Experiences and acknowledges personal benefits of adopting behaviours that enhance safe sex (condom use).
Importance of the ElementsThe mentioned elements are crucial to the success of completingthese steps:The rational element, based on knowledge: People need to knowthe basic facts about a health issue.Example: how the virus is and is not transmitted, how likely theyare to become infected, and what they can do to avoid infection.People must be made to feel that the threat posed by the health problem isreal and serious. In other words, both perceived susceptibility andperceived severity of the threat must be high
Importance of the ElementsThe emotional element, based on the intensity of attitudes or feelings:Individuals need to feel the seriousness of being vulnerable to the virus.This makes them develop an emotional commitment to the behavioursneeded to avoid it.“In a heightened state of awareness because of the fear, people mustbelieve that they have the capability to take action that will avert thethreat. At this stage, people’s confidence in their ability to act—theirself-efficacy—and their belief about the effectiveness of the act—alsoknown as the response efficacy—must both be high”
Importance of the elementsThe practical element, based on personal skills in a newbehaviour: People need to be competent in practicing the newbehaviour and be confident in their ability to do so.They need a sense of self-efficacy to adoptnew, health-protective behaviours.―When high levels of existing threat are combined with high levels ofefficacy, then people invoke a “danger-control strategy,” which promptsthem to take meaningful steps that will minimize the threat, includingtaking precautions or preventive measures”
Importance of the elementsThe interpersonal element, or social networks: Peopleneed to associate with and be supported by their significantothers (such as family members and peer groups) whoseknowledge, emotions and skills can reinforce healthybehaviour changes.“There is the belief that people learn to act by observing the actionsof others, observing what happens as a result of thoseactions, evaluating the results in relation to their own lives, andthen rehearsing and attempting to reproduce those actionsthemselves. Social learning appreciates the use of role models”
Importance of the elementsThe structural element, or the social, economic and legalcontext in which behaviour takes place: People need to haveaccess to necessary supplies and services (such as voluntarycounselling and testing facilities), and to live in an environmentwhere safer behaviours are accepted and promoted while riskybehaviours are discouraged.
Importance of elementsThe Change Agent element: the person or group that has adoptedhealth behaviour begin to encourage others to adopt the newbehaviour. They also start lobbying for structures that are supportiveto the health behaviour
BCC Different Approaches/Communication Channels
Different Approaches/ChannelsThe understanding of different approaches/communicationchannels is important to BCC because it determines how best toreach the intended audience with the messages.Individual ApproachesBCC on a one-to-one basis is important in the prevention bothsecondary and tertiary prevention of the disease. In secondaryprevention it can reverse the early symptoms of the disease whilein tertiary prevention it seeks to slow the progress of the diseasewhich already exists.
Different Approaches/ChannelsThe one-on-one or individually focused methods are useful in:•Home based care and support interventions•Counselling and testing for sexually transmitted diseases—HIV/AIDS•Peer education, reaching out to audiences that may be hard toreachBCC on a one-to-one basis is important in the prevention of bothsecondary and tertiary prevention of the disease.In secondary prevention it can reverse the early symptoms of thedisease while in tertiary prevention it seeks to slow the progress ofthe disease which already exists.
Different Approaches/ ChannelsGroup MethodsGroup methods of Behaviour Change Communication are usedwidely and offer an intermediary approach between one-to-oneapproaches and wider community approaches.Under this method groups can vary. The methods used areeducational or informative.These include: Lectures, seminars, workshops and Conferences,Active participation is part of these methods. Another method usedis Experiential, which include skills training, behaviourmodification, inquiry learning/problem solving, simulation, roleplay and self-help groups.
Different Approaches/ ChannelsGroup MethodsGroup Methods have shown to have a role in:Assisting individuals to gain knowledge and change attitudes andbehaviourProviding a supportive setting for people who may share a commongoal (such as a group of people attending ante natal clinic)Assisting members of a community or organization to improve theirability in approaching their own health problems or getting themempowered to facilitate change within their community or organization
Different Approaches/ ChannelsCommunity ApproachesCommunity based approaches to BCC can potentially have a greaterimpact on a larger amount of people. One of the principles of BCC iswork with individuals, families and communities to support anenvironment that enables the community to maintain positivehealth behaviours take on.BCC works through concrete and effective community action insetting priorities, making decisions, planning strategies andimplementing them to achieve better health.By developing this principle some major changes can potentially bemade at a community level as a result of community based BCCprograms.
Different Approaches/ ChannelsCommunity ApproachesCommunity –Based Formats include:Media—local newspapers, radio stations, bulletin boards, postersActivities—Health fairs, dramas, concerts rallies, parades, sportsevents, community meetingsMobilisation—a participatory approach of process ofcommunities identifying and taking action on shared concerns
Different Approaches/ ChannelsMass media approachesIn BCC, mass media will be effectively used by knowing the strengthsand weaknesses of the different methods.The mass-media methods includeTelevisionRadioNewspapersMagazinesOutdoor/transit publicityInternet
Approaches/ChannelsFrequency and Reach are important terms in planning use of thisapproach.Frequency—the average number of times that one person is exposedto a messageReach—the number or percentage of members of the targetaudience that will be exposed to the message.
Different Approaches/ Channels Advantages & DisadvantagesInterpersonalSome Advantages:Most credible sourceMost participatoryHighly effectiveSome DisadvantagesDifficult to control messagesRequires trainingCostly to scale upTakes time to build reach
Different Approaches/ Channels Advantages & DisadvantagesCommunitySome AdvantagesParticipatoryMay be more credible than mass mediaLow costEncourages sustainability of effortSome DisadvantagesCostly to scale upLow reach beyond immediate communityLow Frequency
Different Approaches/ Channels Advantages & DisadvantagesRadioSome AdvantagesHas wide reach in both urban and rural areasLess expensiveDoes not require a literate audienceCost efficientMessages can be repeated a number of times in a daySome DisadvantagesCostly to build reach when many different stations cover areaNo visualsCan be interactive with audienceFragmented
Different Approaches/ Channels Advantages & DisadvantagesNewspapersSome AdvantagesWide circulation—people can share a copyTimelyMessage lengthPeople can clip and save news articlesCan reach influential people—policy makersSome DisadvantagesRequires literate audienceBias against visual impairedPoor photo reproductionMay be expensive to some people
Approaches/Channel Advantages and DisadvantagesOutdoor/TransitSome AdvantagesGood for awareness buildingHigh Traffic areasBrief messageReinforces other media messagesCan reach influential people—policy makersSome DisadvantagesLimited time of exposureLimited message contentIt is not durable
Selecting Communication Channels and Media MixIf you want a message to reach as many different people as possiblein the targeted audience, the channel mix will be based on reachtype—TV, Radio, well attended Community EventIf you intend to communicate a gradual message that will createawareness over a period of time, the media that is affordable enoughto increase the frequency of the message is ideal. Radio,Interpersonal Communication and print fall in this category.Sometimes it is ideal to mix both reach and frequency media to getthe optimum outcome of the BCC activity
Audience SegmentationSegmenting target populationsAssess the target population, understand its psychosocial anddemographic characteristics.This enables targeting groups specifically to their interests andinfluencing factors when designing interventionsPsychosocial characteristics include knowledge, attitudes and practices.Demographic characteristics are represented by age, place of residence oreconomic activity, place of birth, ethnicity and beliefs.Others considered are structural factors and settings like workplace, risksettings and border settings.Example, if truck drivers are target population, border points, lay-byvillages and brothels constitute risk settings.
Audience SegmentationThe target population is segmented into three parts as follows:Primary Target Audience:Secondary Target Audience:Tertiary Target Audience:Primary Target AudienceThis is the group of people that you are hoping will change in some way as aresult of the BCC program.Example BCC for safe motherhood primary target will be pregnant women.For reduction of HIV transmission in the transport sector, the primary targetpopulation could be truck drivers, because they are away from home forlong periods of time and more likely to engage in risky behaviour.
Audience SegmentationSecondary Target AudienceThis is the people who have significant influence on the primarytarget audience.Example: for expecting mothers early attendance of antenatal, thetarget may be Mother in Laws, husbands and TBA’s.For the truck drivers, the wives and girlfriends of men whofrequent sex workers might fall into this category. There are oftenseveral secondary target populations around one primary targetgroup, requiring different communication approaches and messages.
Audience SegmentationTertiary Target AudienceThese are the people that wield significant power to assist you inyour program.Example, these are people who may be able to influence policy andfunding for resources that will support your intervention.Examples of tertiary target audiences may be Community leadersor traditional leaders, ministry of health officials, and NGO’s.“After identifying the targets an assessment of the groups segmented isdone so that stakeholders are fully aware of the realities of the targets. Thisensures that when the BCC programme is developed the messages, themesand channels resonate with the target group”.
Defining BCC ObjectivesBCC objectives are looked at from two levels.First, there is Behaviour change objectivesThese answer questions about the health behaviour that target groupmust adopt. They are derived from programme objectives.For Fish mongers at higher risk of STIs and HIV the behaviour youwant adopted include1. Reduction in number of sexual partners2. Use of STI and HIV services3. Consistent use of condoms
Defining BCC ObjectivesBCC Objectives should be SMART:SpecificMeasurableAchievableRelevant andTime-based
Defining BCC objectivesSecond, there is Behaviour change communication objectives:These objectives are developed from behaviour change objectives. Theyanswer questions about what the communication messages will do tosupport the adoption of the behaviour by the target groupExamples:1. Increase self risk assessment2. Increase confidence in condom use3. Increase demand for VCT and STI testing services4. Increase knowledge and enhance positive attitude about services
BCC objectivesBCC Objectives must result in the followingRelating to the behaviour change model, media personnel working onBCC programme or undertaking BCC activities should ensure theirBCC objectives have the corresponding outcomes:Awareness: results in increased awareness about the threat of a healthproblem or threat e.g. HIV/AIDS, resulting in increased demand forinformation about HIV and AIDS. (Target must be asking ask forinformation about HIV and AIDS.)Knowledge: Increased knowledge about HIV and AIDS. (Target groupwill have correct knowledge of modes of transmission of HIV andAIDS.)
BCC objectivesBCC Objectives must result in the followingAttitude Change: Increased self-risk assessment. (Sexually active targetaudience with multiple partners realise if they do not adopt safer sexthey feel at increased risk of contracting HIV)Practice: Increased demand for information on STIs. (Miners or truckdrivers will ask for more information on STIs).Reinforcement of Behaviour: Increased demand for services. (Sexworkers will demand VCT services.)Advocacy: Encouraging others to take on positive health behaviourTake each target population’s needs and situation into consideration, alongwith the initiatives that answer those needs
Developing MessagesBCC messages must support your objectivesExamples:1. Reduce number of sexual partners2. Use STI/HIV services3. Use condoms consistentlyBCC messages have two components they intend to meet1. Desired behaviour2. Key benefitOne must be able to perceive a benefit for adopting a health behaviour.Example: If I stick to one sexual partner, I will protect myself and myfamily from HIV/AIDS, I will save money and I will be seen to beresponsible.
Sample MessagesMESSAGES FOR YOUNG PEOPLE1. YOUNG PEOPLE NEED YOUR SUPPORT TO PROTECT THEMSELVESFROM HIV/AIDS2. YOUR RIGHTS TO REPRODUCTIVE HEALTH SERVICES AREYOUNG PEOPLE’S RIGHTS TOO3. PREVENT ABORTIONS, SUPPORT YOUNG PEOPLE TO ACCESSREPRODUCTIVE HEALTH SERVICES4. CONDOMS CAN PREVENT UNWANTED PREGNANCIES5. PROTECT YOURSELF FROM HIV USE CONDOMS EVERY TIME YOUHAVE SEX
Sample MessagesMESSAGES FOR ANTENATAL/POSTNATAL ATTENDANCE1. MEN ACCOMPANY YOUR PARTNERS TO ANTENATAL2. MEN SUPPORT YOUR PARTNERS ATTEND ANTENATAL3. ALL ANTENATAL VISITS ARE IMPORTANT WHEN PREGNANTPROTECT YOUR LIFE AND THAT OF THE BABY4. THE FIRST DAY I KNEW I WAS PREGNANT I MADE MY FIRST VISITTO ANTENATAL5. VISIT ANTENATAL CLINIC AT LEAST FOUR TIMES DURINGPREGNANCY6. DELIVER AT A HEALTH FACILITY PROTECT YOUR LIFE ANDTHAT OF YOUR BABY
Sample Messages3. I CARE FOR MY FAMILY I TESTED FOR HIV4. PROTECT YOUR UNBORN BABY FROM HIV GO WITH YOURPARTNER FOR HIV COUNSELLING AND TESTING3. FATHERHOOD IS A RESPONSIBILITY FEW CHILDREN ARE EASYTO SUPPORT USE FAMILY PLANNING
Sample MessagesMESSAGES FOR HIV/AIDS PREVENTION1. GO FOR VCT KNOW YOUR HIV/AIDS STATUS PROTECT THEUNBORN CHILD2. KNOW YOUR HIV STATUS USE A CONDOM AND PROTECT YOURWANTED BABY
Seven Characteristics of Effective MessagesCater to the Heart and the Head (messages must appeal to theemotions to make people think seriously about the problem)Create trust; (People trust what makes sense to them. Messagesmust be believable and consistent with reality)Call for action (Purpose of messages is to change people’sbehaviour. A message must call to action.
Seven Characteristics of Effective MessagesCommand Attention (Effective messages must stand out and getnoticed)Are Clearly Stated (Keep It Short and Simple. Clear messageshave an impact)Communicate a Benefit (Messages that communicate a benefithave a greater chance to appeal to people)Are Consistently Repeated (Credibility is built when messagesare repeated over time)
Seven Characteristics of Effective MessagesCater to the Heart and the Head (messages must appeal to theemotions to make people think seriously about the problem)Create trust; (People trust what makes sense to them. Messagesmust be believable and consistent with reality)Call for action (Purpose of messages is to change people’sbehaviour. A message must call to action
Developing communication productsDevelopment of specific communication support materials should bebased on decisions made about channels and activities. They caninclude:Print news and feature articlesPrint materials to support health workers on specific care issuesTelevision spots for general broadcastPromotional materials about the project, for advocacyScripts for theatre and street theatreRadio or television drama (soap opera)
What to remember! Knowledge change: an increase in knowledge e.g. among targetedyouth on modes of transmission of STIs such as HIVAttitude change: an increase in perception of personal risk or achange in authorities’ attitudes toward promoting condoms toyouthEnvironmental change: a decrease in conditions that compelwomen not to use Family Planning Products or an increase inacceptance of messages about condom e.g. In institutions preachingfidelity.