2. Behavior change- a need for prevention
Behavior determines whether a person is at
risk or not.
Those with risky behavior need to change
their risky behavior to safe behaviors.
Those with safe behaviors need to maintain
existing behaviors.
Targeted interventions aim behavior change
of people with risky behaviors
www.drjayeshpatidar.blogspot.in
3. Change in behavior is the ultimate goal of
targeted interventions
Behavior change can take place at the
individual, community and societal
level
www.drjayeshpatidar.blogspot.in
4. Steps of behavior change
Knowledge
Approval
Intention
Practice
Advocacy
(motivating others to change)
www.drjayeshpatidar.blogspot.in
5. Steps of behavior change
Knowledge
Unaware
aware/informed
Approval
Concerned
Knowledgable
and skilled
Motivated to
change
Intention
Practice
Ready to
change
Trial change of
behaviour
Maintenenance
adoption of new
behaviour
www.drjayeshpatidar.blogspot.in
7. Behavior change communication
A key element of behavior change interventions
BCC involves negotiation with the individual or
community for behavior change
It uses dialogue, messages, persuasion,
interpersonal and group communication as a
means of exchanging information, ideas, skills
and values aimed at bringing about behavior
change or adoption of safe behavior
Negotiation happens at all levels and involves
several people. Ultimately it involves negotiation
with ‘Self’ to practice desired behavior
www.drjayeshpatidar.blogspot.in
8. Behavior change Communication
BCC is referred to by many names.
◦ IEC
◦ Health education
◦ Health promotion
◦ AIDS education
◦ Social Marketing
They share some common elements but have
differ in scope.
Most of them include attempts to change
behavior through communication in different
stages and methods
www.drjayeshpatidar.blogspot.in
9. BCC- Salient features
Behaviour change communication uses a science
based approach to communication that involves
behavioural sciences, social learning, persuasion
theory to achieve realistic targets.
Emphasises on audience involvement and
participation throughout the BCC process.
Recognises that behaviour change is much a
societal process as it is an individual decision
making process.
www.drjayeshpatidar.blogspot.in
10. BCC- Salient features
Appreciation of the crucial role of environment to capture
attention, interest and most importantly emotions to
make learning and change a pleasurable experience.
Focus on sustainability of communication messages and
strategies
Behaviour change is a goal, but people move through
several stages and steps before they change behaviour.
www.drjayeshpatidar.blogspot.in
11. Behavior change is a continuous process
Not all individuals go through the same steps of the
process in the same order, speed or time
People at different steps require different messages and
sometimes different approaches.
It is important to know what stage the person is before
beginning a communication process
As knowledge and approval reaches high levels, BCC
emphasis must shift to later steps
◦ identifying cues for action
◦ maximizing access and quality of services
◦ identifying and removing barriers to change
◦ creating opportunities for increased peer advocacy
www.drjayeshpatidar.blogspot.in
12. Percentage CSWs having knowledge, intent,
trial and maintainence for use of condom-
Bangladesh
37.8
27.8
14.6
6.3
0
5
10
15
20
25
30
35
40
Knowledge Intent Trial Maintenance
Knowledge= knows about use of condoms prevent STD; Intent=desire to use condom; Trial= tried condom at
aleast once in last 24 hrs; Maintanence= used condom>50% of all last sexual encounter in last 24 hrs
www.drjayeshpatidar.blogspot.in
13. BCC alone is not enough
Social norms and public policies influence
behavior change. A strategic shift must be also
be attempted simultaneously.
Behavior change communication is not a stand
alone strategy.
It has to be used in conjunction with other
strategies such as STD treatment, condoms and
creation of enabling environment
BCC often complements and supports other
prevention strategies and approaches
www.drjayeshpatidar.blogspot.in
14. Main methods of BCC
Interpersonal
◦ Interpersonal communication is the preferred
choice for Targeted interventions as it involves a
sustained contact and communication with the
sub-population
Mass Media
◦ Can be used to support Interpersonal
communication efforts and the creation of an
enabling environment
www.drjayeshpatidar.blogspot.in
15. Behavior change communication must adopt a
enabling approach in targeted interventions
•It involves strong community
participation
•Having gender sensitive strategies
www.drjayeshpatidar.blogspot.in
16. Common lessons learnt in development
of communication materials and
messages
◦ Professional quality and creativity
Approaches that work in developing messages
and materials for professional marketing and
advertising can work for health communication
Communication professionals know best how to
develop communication products, but finding the
right person takes time and effort
Communication professionals need close
supervision and support in developing
appropriate materials
www.drjayeshpatidar.blogspot.in
17. Common lessons learnt in development
of communication materials and
messages
◦ Health expertise
Health professionals need to provide input
and to review materials for technical quality
◦ Value
High quality materials hold up over time and
encourage reuse.
www.drjayeshpatidar.blogspot.in
18. Common lessons learnt in development
of communication materials and
messages
◦ Community participation
Message development is a collaborative and
participatory process
The participation of representatives of intended
audiences in pretesting helps ensure that the
materials will speak effectively to actual audiences.
Pretesting and revision takes time and money but
helps to avoid greater costs of ineffective materials
and messages.
Pretesting can inform gatekeepers and policy makers
about communication strategies.
www.drjayeshpatidar.blogspot.in
19. Seven ‘C’s of communication
Command Attention
Only messages that are noticed and
remembered can be effective. Messages
need to attract attention and elicit
comments. Peer educators talking about
HIV/AIDS should be received by their
peers as an important issue.
www.drjayeshpatidar.blogspot.in
20. Seven ‘C’s of communication
Cater to the Heart and head
Most people are moved at least as much by
emotion as much as reason.
A message that arouses emotion are effective
because people learn better when their emotions
are aroused.
Emotions can be aroused by story telling,
reflecting however briefly on the individual or
group.
Appeal to reason at the same time adds staying
power to the message and consolidates the thought
process.
www.drjayeshpatidar.blogspot.in
21. Seven ‘C’s of communication
Clarify the message
Focus and freedom from clutter are important. A
message should convey a single important point.
Ancillary information and multiple themes
distract and some may simply miss the point.
www.drjayeshpatidar.blogspot.in
22. Seven ‘C’s of communication
Communicate a benefit
People need a strong motive to change their
behaviour. The best motivator is the expectation
of a personal benefit. People rarely use a clean
needle or a condom, unless they see practical
benefit in it. “The factories make the condoms…
the peers sell hope for life”.
www.drjayeshpatidar.blogspot.in
23. Seven ‘C’s of communication
Create trust
A message that people will act on their own
accord must come from sources they trust. If the
promise of trust does not come from a credible
source, they will not believe it. It is important
for the source to be available to support any
need arising as a result of the trial of the
messages given by them
www.drjayeshpatidar.blogspot.in
24. Seven ‘C’s of communication
Call for action
After seeing or receiving a message, people
should know exactly what they should do. Once
convinced that the promised benefit is worth
pursuing, people need to know how to how to
act on this belief ; where to go, what to do, what
to buy and how to use. Directives should be
clearly stated. Without a specific cue for action,
people may hear, understand and even approve
of a message but still take no action.
www.drjayeshpatidar.blogspot.in
25. Seven ‘C’s of communication
Consistency counts
Repetition is essential. The same message
repeated with variations, but with basic
consistency, becomes familiar and
acceptable.
www.drjayeshpatidar.blogspot.in
26. Seven ‘C’s and Behavior change
process
Clarify the message
command attention
know ledge
Cater to the heart and
head
Create trust
Approval
Convey a benefit
Intention
Practice
Advocacy
Call to action
Consistency counts
Create confidence to speak out
www.drjayeshpatidar.blogspot.in
27. Interpersonal communication
- main characteristics
Uses principle of outreach
Establishes personal relationships
Builds group consciousness
Encourages dialogue and feedback
Elicits community initiatives and
participation
Links to community events
Interpersonal communication could take
place with the help of peer or outreach
workers who are closely identified with the
communitywww.drjayeshpatidar.blogspot.in
28. Peer education
Peer education is the involvement of community
members of the sub-population as facilitators of
behavior change.
Peer educators are part of the sub-population
and hence more acceptable
Peer educators share similar life experiences as
those of the sub-population
Peer education can take place on a street corner,
a bar, a bus station, restraint, factory or any
place where people feel comfortable
www.drjayeshpatidar.blogspot.in
29. Benefits of peer education
Culturally appropriate: "Peer education provides a
means of delivering culturally sensitive messages from
within."
Community-based:"Peer education is a community-level
intervention which supports and supplements other
programs. It is a link to other community-based
strategies."
Accepted by their target audiences:"Many peers report
that they are more comfortable relating to a peer about
their personal concerns such as sexuality.”
Economical: "Peer educators provide a large service at a
small cost and they provide that service very effectively."
www.drjayeshpatidar.blogspot.in
30. Peer education
Peer education is unlikely to be an empowering
experience when educators are used as a free or
cheap source of labour.
Effective peer education is neither easy nor
necessarily cheap
Peer education requires considerable planning
and management
They use trained people to assist others in their
peer group to make decisions about
STDs/HIV/AIDS through activities undertaken
in one-to-one or small group settings.
www.drjayeshpatidar.blogspot.in
31. Role of peer educators
Identify new sex workers
Provide information to sex workers
Reinforcing BCC message to known contacted sex
workers
Distribute IEC material/BCC
Distribute condoms
Referral of STD/sick patients
Care of sick patients
Advocacy
Training of new peer educators from within project and
outside
www.drjayeshpatidar.blogspot.in
32. Criteria for selection of peer educators
They should have the ability to communicate
clearly and persuasively with their peers.
They should have good interpersonal skills,
including listening skills.
They should have a socio-cultural background
similar to that of the target audience (this may
include age, sex and social class).
They should be accepted and respected by the
target group (their peers).
www.drjayeshpatidar.blogspot.in
33. Criteria for selection of peer educators
They should have a nonjudgmental attitude.
They should be strongly motivated to work toward
HIV risk reduction.
They should demonstrate care, compassion and
respect for people affected by HIV/AIDS.
They should be self-confident and show potential
for leadership.
www.drjayeshpatidar.blogspot.in
34. Criteria for selection of peer educators
They should be able to pass a practical,
knowledge-based exam at the end of the training.
They should have the time and energy to devote to
this work.
They should have the potential to be a "safer-sex"
role model for their peers.
They should be able to get to the location of the
target audience.
They should be able to work irregular hours.
www.drjayeshpatidar.blogspot.in
35. Training of peer educators
it is less expensive to implement peer education
programs if the initial training is very thorough.
Where training is comprehensive, fewer peer
educators drop out and less supervision and
retraining are needed later.
Training can be given in a number of ways,
including half-day sessions spread out over an
extended period or full-day sessions for an entire
week or more.
Regardless of what schedule you choose, formal
training should be supplemented by on-the-job
training and supervision.
www.drjayeshpatidar.blogspot.in
36. Assumptions for deciding the number of
peer educators
For sub-populations such as sex workers,
MSM or IDUs, one peer educator will reach
25-35 peers
There will be at least one, one to one
meeting with each community member in a
week lasting 20-30 minutes
Each community member will atleast
participate in one fortnightly group meeting
of 4-5 members
www.drjayeshpatidar.blogspot.in
37. Peer education: need for constant
support and supervision
The amount of supervision and support peer
educators need will depend on:
◦ the types of activities they do. (Peer educators who
conduct large group educational sessions may need more
supervision and support than those who meet peers
casually; also, those who deal with emotionally difficult
situations may need more support.)
◦ the amount of training they have had. (Peer educators who
have had only a day or two of training may have more
support and information needs than those who have had
more thorough training.)
www.drjayeshpatidar.blogspot.in
38. Types of support to peer educators
Regular, in-service meetings for all peer educators
Additional educational materials for peer educators'
own use (e.g., a peer educator's handbook)
IEC materials and condoms for distribution to peers
Certificates, badges, t-shirts, bags or hats to
identify them as trained peer educators and
acknowledge their contribution to the project
Supervisor availability to help peer educators deal
with discouraging or difficult experiences
www.drjayeshpatidar.blogspot.in
39. Types of support to peer educators
AIDS information booklets that give
answers to commonly asked questions
Referral book that allows educators to send
peers to other available resources
Opportunities for established peer
educators to teach and mentor new peer
educators.
www.drjayeshpatidar.blogspot.in
40. What to supervise in peer education?
Supervision helps ensure that the peer educators are
doing a good job. There are various ways that peer
educators can be supervised. Check the supervision
techniques you will use.
◦ One-to-one visits or meetings with peer educators to answer
their questions and observe them at work
◦ Group meetings to resolve common problems
◦ Observation of peer educators during their activities
◦ Evaluation of peer educators' performance and feedback to
them about the evaluation
◦ Monthly written or oral reports and your responses to them
www.drjayeshpatidar.blogspot.in
41. Types of materials: some examples
Leaflets
Posters
Pamphlets
Fliers
Flip charts
Flip books
Cinema slides
Exhibitions
Audio tapes
Films
Video
Games
Comics
Puppets
Theatre
Local arts
www.drjayeshpatidar.blogspot.in
