Behavior_Change_Communication_manual_-experimental_1_

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Developed by :
K.C. Sreenath, Senior Consultant (BCC)
Ministryof Health &FamilyWelfare
Governmentof India
New Delhi
Behaviour Change
Communication
Manual

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Contents
Chapter-1 Behaviour Change Communication
Chapter-2 Howto Developa BCC strategy
Chapter-3 Analysis- the key for any BCC strategy
Chapter-4 Budgeting for BCC
Chapter-5 Strategic Design
Chapter-6 Development and Pre-testing ofMessages
Chapter-7 Implementation
Chapter-8 Monitoring & Evaluation
Chapter -9 Key issues Approaches & Guidelines

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Chapter -1
Behaviour Change Communication
Communication plays a very important and strategic role in the development and progress
of every society. The whole process of communication is ever changing and is in a constant
state of evolution. The term behavioural change communication signifies this strategic and
decisive change in approach to communication. There are many theories and strategies that
explain the concept of Behavioural Change Communication. But in simple terms,
Behavioural Change Communication (BCC) is a process that motivates people to adopt
healthy behaviours and lifestyles. BCC programmes and interventions are aimed at
motivating individuals, groups and communities to change their unhealthy practices or to
sustain the healthy behaviours they are following or practicing.
Shift from IEC to BCC
The important thing about BCC is that it follows a systematic evidence based approach. BCC
activities help to bring about personal and interpersonal changes that empower people to
absorb new ideas and practices that bring about qualitative changes in their life. Many
health and development issues use BCC to improve people’s health and well being. Earlier,
organisations used information education and communication (IEC) strategies to improve
awareness to bring about positive behaviours. But today, the emphasis is on Behavioural
Change Communication (BCC) which builds on IEC. Traditional IEC methods concentrated on
giving information and creating awareness while BCC follows a more structured approach of
behavioural theories and systematic implementation processes.
A BCC strategy lays out a detailed plan for reaching desired behaviour change objectives. It
throws light on various issues like, should one focus on direct communication to
disseminate messages or interpersonal communications? Which communication media will
reach the target audience most effectively? How can one build on issues and portray it more
effectively that the audience is already familiar with?
A BCC strategy answers such crucial questions. In fact, a carefully planned and managed
BCC strategy ensures that the behaviour identified for change is feasible within the social
and cultural context in which people live.
BCC in Health Communications
Development programmes, especially health interventions use BCC to improve people’s
health and well being. BCC interventions have been effectively used the world over to

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tackle various issues like reproductive health, family planning, maternal and child health and
prevention of infectious diseases. To address health issues, BCC interventions must be
integrated within the overall health programme. This should include an effective service
delivery system with a supportive policy environment. For example, BCC campaign can
motivate people to go in for institutional delivery, but the health system has to respond with
the necessary services to facilitate institutional delivery. If this does not happen, the BCC
campaign will lose face and would not be successful.
RCH – 2 specifically emphasises that behaviours must be adoptable in the context of
people’s lives and behaviours must be amenable to change. Any BCC intervention will lose
credibility if it exhorts people to do things they are unable to do (such as use of
contraceptives that are not available) But at the same time, BCC activities may be used to
provide cues for a community to press for changes to improve service provision, thus
beginning the process of producing ‘active consumers’ of health care services.
Over the last decade BCC programmes are being used strategically the world over. Some of
them have helped family planning programmes to meet their goals. Take for example the
issue of reducing unmet needs for contraception, BCC interventions have helped people
make right family planning choices, addressed worries about contraceptive side effects,
opposition to family planning, encouraged couples to discuss reproductive health issues and
have made contraception more socially acceptable.
What BCC interventions can achieve
Strategic BCC programmes use a systematic process to understand people’s behaviour and
influences. They identify primary, secondary and tertiary audiences, develop messages that
respond to their concerns, define specific objectives that is to be achieved, integrate these
objectives into programme plans and use these objectives as a basis for measuring impact. A
carefully and scientifically executed BCC programme will increase awareness and knowledge
of a health problem by highlighting various issues and concern and will point out socially
acceptable solutions. It will demonstrate or depict healthy behaviours within the social
milieu and would highlight the benefits the individual or society might reap by adopting the
advocated behaviour.
A successful BCC plan would also help in refuting myths and misunderstandings prevalent in
the society by showcasing successful interventions and help shift social norms to encourage
more healthy behaviour. Moreover, it will also lead to a demand for the various health
services being provided, thus bringing about a behavioural change among individuals and
the community at large. In fact BCC is a dynamic process which involves an understanding
of capacity, sharing of ideas and information.

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Stages of behaviour change
A basic planned framework is necessary to implement a BCC strategy and create an enabling
environment to support new health seeking behaviours. A structured BCC strategy consists
of formative research, strategic design, development and pre testing of communication
materials, implementation of the communications plan and monitoring and evaluation of
the plan.
Any planned BCC strategy will have to operate in a framework of stages. People usually
move through several intermediate steps in the behaviour change process. They constitute
distinct audiences and need different approaches and messages. The transformation stages
involve the following: receiving information, understanding the received information,
changing health behaviour and finally health seeking behaviour. The audience can be
described as Pre-knowledgeable – unaware of the problem, / Knowledgeable- aware of the
problem/ Approving – in favour of the desired behaviours/ Intending – intends to take the
proposed action/ Practicing- practices the desired behaviour/ Advocating – Practices the
behaviour and advocates them to others.
Once a community attains the last two stages the demand factor sets in wherein quality of
care in health services and information are the natural outcome in the cycle of the BCC
process.
Characteristics of effective BCC programmes
BCC if used in a systematic and planned manner can impact the society to adopt healthy
practices. Any comprehensive BCC strategy should basically accomplish the following
objectives
 Address underlying causes of identified health problems and issues and create an
enabling environment at household, community and policy levels.
 Follow a structured communications plan with audience research, segmentation,
objectives, pre-tests, communication mix, detailed implementation plans,
monitoring, room for midcourse corrections and evaluation modules.
 Define and segment the audience, tailor messages and materials to the interests of
audience with readiness to change messages as per feedback
 Link shared understanding including ownership, implementation and monitoring of
initiatives and activities among various stakeholders to achieve the desired
objectives
 Build local capacities through education, training, work partnerships to create need
specific BCC interventions

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 Create demand for services and healthy behaviours and help ensure quality services
Need to be part of a larger framework
There has been a lot of debate whether BCC alone is sufficient to bring about total
behavioural change. It has been widely accepted the world over that BCC is very effective in
helping individuals and families at risk to reflect and analyse issues and change their beliefs.
But what is lacking and has been preventing holistic BCC from happening especially in
developing countries is the lack of support services like availability of health facilities,
infrastructure and policies to support the recommended behaviour.
Today, various BCC interventions and case studies emphasise that BCC must work as a part
of a larger programme and frame work that includes service delivery, advocacy activities
and social mobilisation programmes. It is imperative that a successful BCC intervention
requires stable and reliable service delivery infrastructure to supplement the BCC campaign.
To achieve this objective, there is a need to scale up social mobilisation initiatives and
secure active participation of various stakeholders including corporates, individual private
practitioners (in case of health), NGOs and the civil society in achieving health goals.
There is also a pressing need for Advocacy initiatives to bring about policy and legal changes
at the highest levels of the government and right up to the local governance level. The
citizens of the country also need to be educated about changes in laws and be made aware
of their rights to demand services that are to be provided mandatorily by the government to
create an enabling climate for behavioural change especially in developing countries.

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Chapter -2
How to Develop a BCC strategy
Successful BCC programmes follow a structured and systematic process. These approaches
consists of five to six major steps and takes a holistic view of the whole behavioural process
and how to address basic issues. Different organisations may give different name for these
steps but the approaches are basically the same. The steps followed include Analysis,
Budgeting for BCC, Strategic Design, Development and Pre-testing, implementation and
Monitoring and Evaluation. The various subheads and methods used under this plan process
might differ as per the available budgets; culturally specific approaches and the overall
objective but the generic process and the methods remain the same. In short every BCC
strategy to be effective should be research based, client cantered, benefit oriented, service
linked, professionally developed and related to behavioural change.
Following a proven process helps programmes to work in a structured and efficient manner.
A BCC strategy lays out a plan and a road map for reaching the desired behaviour change
objectives. A lot of work and collaboration precede implementation of an effective BCC
strategy
Analysis
Analysis or formative research provides the basic foundation of any BCC programme. This
involves defining the health problem, the intended audience and the communication needs
of the audience and the effective modes of communication channels that could be used to
reach out to the audience. Analysis also helps in collecting information about the audience,
their knowledge attitude and barriers with reference to the health problem. Analysis can be
carried out through primary and secondary research methods. The basic advantage of
analysis is that it will help identify the issues that be addressed through communication.
Moreover it is a key factor in supplementing the evaluation of any BCC programme.
Budgeting for BCC
It is imperative that the programme is clear about the budget it has before embarking on
the creation of a strategic design for the behavioural change process. The budgeting
strategy should focus on previous budget allocations and utilisations, ( if any) current
needs and resources available, budget to be used directly under the programme, budget to
be distributed to stakeholders and implementing agencies , duplication of activities by other
stakeholders and development of a budget matrix with activities, time schedules, and
allocation of funds under various subheads.

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Strategic Design
Strategic design creates the actual road map for the communications programme. The data
and information collected from analysis/ formative research in the form of primary and
secondary data along with relevant behavioural approaches guides the strategic design or
the development of a BCC strategy. During strategic design, the programme establishes
objectives ( intended behavioural changes in the audiences behaviour), develops the
conceptual framework, selects indicators, chooses communication channels, develops the
creative brief for the agencies or organisations implementing the media plan and frames the
implementation process.
Development and pretesting of materials
The analysis / formative research and the strategic plan that has been created guide the
development of concepts, messages and materials. The development of concepts, messages
and materials should be different for different target audiences based on their position in
the stages of behaviour change. The tone of the messages could vary as per the profile of
the target audience. It could be entertaining or humorous or empowering or even
authoritative. Once the messages are developed they should be pretested in the community
and among the intended target audience for clarity and feedback. The messages then
should be revised as per feedbacks. Strategic development of messages and pre-testing is
crucial for the success of any communications campaign.
Implementation
The success of any BCC plan or for that matter any communication plan depends on how the
plan is implemented and monitored. Implementation includes mobilisation of key
stakeholders towards the programme and creation of a positive organisational climate. A
structured and well thought out Implementation plan calls for detailed timelines with
planned activities, responsibilities, budget for utilisation, staffing and manpower and
audience responses.
Monitoring and Evaluation
Monitoring and evaluation is another key aspect of any BCC intervention. Monitoring takes
place during the implementation of the programme. A proper monitoring strategy enables
programme managers to examine if the plan is moving in the right direction. It helps
authorities to track programme activities, outputs, reach of the programme and check costs
of implementation.
Evaluation of the programme is necessary for measuring the impact and success of BCC
interventions. It helps assess program achievements and how well the programme has met
its objectives. It also helps to understand shortfalls and discrepancies during BCC planning
and implementation. During recent times, a large number of organisations are going in for

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mid- term evaluations and incorporating corrective strategies. Evaluations can provide
valuable evidence to decision makers demonstrating that BCC programmes contribute to
health outcomes and justify future investments for BCC.
The Goli ki Hamjoli Campaign- Breaking myths and barriers through BCC
Who can forget the beautiful and smiling face of the girl who was the central character of
the ‘Goli ki Hamjoli’ campaign. The success of the campaign can be measured from the fact
that it launched the career of ‘ Vidya Balan’ in Hindi cinema. The campaign not only
changed the life of this bollywood star but brought laurels to many other including O&M
which was the creative agency behind the campaign. In fact, the Goli Ki Hamjoli campaign
could be touted as a standing example of an effective BCC intervention undertaken in
northern India.
The whole campaign was formulated keeping in mind two objectives (a) Improve knowledge
and use of low dose oral contraceptive pills among young married urban, semi -urban
women (b) encourage pharmaceutical firms to invest in low dose oral contraceptive market.
The campaign was to be launched in eight north Indian states of Rajasthan, Madhya
Pradesh, Uttar Pradesh, Bihar, Uttaranchal, Jharkhand, Chhattisgarh and Delhi. These states
ware identified taking into consideration the low level of OC consumption and the fact that
they were all Hindi speaking states which would facilitate the launching of a uniform BCC
campaign.
Formative research conducted
As per any BCC strategy, a formative research was conducted in the first place to know the
reason for the low acceptability of OC pills. The study pointed to the fact that very little OC’s
were available in the market as doctors and chemists did not approve of low dose oral
contraceptives believing that they had side effects similar to that of high dose estrogen and
progestin pills . Meanwhile analysis of various secondary research data including NFHS
survey showed that a large number of women (almost 27%) in urban and semi urban areas
intended to use oral contraceptive pills but was discouraged by its non availability and also
due to various myths prevalent regarding its side effects.
Objectives identified
So as per the formative research, the objective of the campaign and target audience were
identified. The initial task was to make sure that intended oral contraceptive users (young,
married, urban-semi urban women) had support in terms of information about oral
contraceptives and availability and regular supply of the pills. The first important task was to
address biases against oral contraceptives and bring about a change in the mindset of
general practitioners, gynaecologists, paediatricians and chemists.

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Direct and interpersonal communication launched
To address the misconceptions of the secondary audience, a direct mail addressing myths
and extolling the benefits of OCs were mailed to 30,000 doctors and 15,000 chemists in these
eight states. This was followed by an interpersonal campaign of organising sensitisation
/training workshops for over 28,600 traditional doctors and 34,000 chemists in these states
to dispel myths and barriers they had about the safety of oral contraceptive pills.
Mass Media campaign
A generic mass media campaign was then launched to address the primary target audience
of young, married urban and semi-urban women who were the users of oral contraceptive
pills. The advertising campaign mainly on T.V. had twenty different campaigns with a holistic
approach to address audience in their various stages of behaviour ranging from intending
audiences to advocates of oral contraceptive pills. The initial campaign mainly targeted
women in contemplation and preparation stages.
The first burst of the campaign which came out in November 1999 stressed the fact that
‘oral contraceptive pills’ put the future of a women’s family in her own hands. This was
followed by a second round of intensive campaign which stressed that the ‘side effects of
OC’s were temporary and reversible’. By February, 2000 the campaign was addressing the
pre- contemplative stage of young women by highlighting the benefits of oral contraceptives
as ‘tension free’.
By the third year of the five year campaign period, advertising addressing women in all five
stages of behaviour change ( pre –knowledgeable, knowledgeable, approving, intending,
practising) were being aired on television. The audio visual campaign was also supplemented
by print and radio campaigns were doctor’s endorsements and FAQ s where liberally used to
highlight the issue
Monitoring & Evaluation
A well defined monitoring and evaluation strategy was built into the campaign. Tracking
surveys of the campaign was conducted periodically. After every two years a major impact
assessment study was undertaken and mid course corrections were carried out to make the
campaign more effective. When it was found that the campaign had reached a plateau after
four years, some new advertisements were added to sustain the campaign and generate
interest.
It could be quite a difficult task to quantify the success of the Goli Ki Hamjoli campaign. But
this BCC intervention over a period of five years led to the increase in consumption of oral
contraceptive pills from 5% to almost 13%, a remarkable achievement considering the strong
social taboos that exist in these states against family planning and contraception

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Chapter -3
Analysis – the Key for any BCC strategy
Analysis is the most important component of any planned BCC intervention. It is imperative
for any structured communication plan to have a clear picture of what the communication is
going to address, whom it is going to address, what are the intended changes it proposes to
bring about and what process will it adopt to communicate the messages. Analysis or
formative research addresses the above issues and provides the foundation for any BCC
programme.
Formative research or analysis is carried out before any programme design is finalised. It is
done with the intention of gathering information about the magnitude of the health
problem, the intended audience, their knowledge, attitude, beliefs, socio- economic status
and various other factors that contribute to their health behaviour. Apart from these facts,
formative research is also used to gather information about the audience’s media habits
(what is their preferred channel of communication, is it Radio or Television? ) Formative
research also throws light on the target audience’s access to information, social conditioning
and various other factors which can influence their receptiveness to behavioural change of
the proposed health problem.
Audience segmentation
Most planned BCC programmes looks at clear segmentation of target audience before
finalising their communications strategy. The term audience segmentation means dividing
and organising an audience into different groups based on various characteristics such as
age, sex, religion, urban/ rural audience and stages of behaviour. In many cases, it is
necessary for BCC programmes to customise their messages to various target audience for
the desired effect or result. Specific messages are formulated to suit specific sub groups of
people who have similar characteristics, tastes, values and preferences.
Moreover, audience segmentation can help communications become more efficient and
effective. It can be efficient because the limited resources of the communications campaign
can be directed at those who are most in need or are most likely to adapt to the proposed
behaviour. It can be effective because message, content, form and style can be tailored to
suit the needs of various groups.
Primary and secondary audiences
One of the key aspects of any formative research is to identify the primary and secondary
audience who is concerned with the health problem. The whole communication strategy
would be developed keeping in mind the profile of the primary and the secondary audience.

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Primary audiences are individuals who are at the risk of being affected directly by the health
problem. They could also be individuals who are directly affected by the problem or are in a
position to directly influence the solution. For example take the case of breast feeding
immediately after birth. The primary audience here is the mother but in many cases, it is the
mother-in-law who takes the decision if the child should be breast fed immediately after
birth. The opinion of the mother of the baby is of not much consequence. So the primary
audience here is both the mother of the child and the mother-in-law.
Secondary audiences are people who influence the health behaviours of the primary
audience. They could be people who are in a position to influence the problem through the
influence they wield on the primary audience. For example religious leaders, political
leaders etc could be part of the secondary audience.
The importance of research
Research is one of the most important aspects of any BCC strategy. As we saw earlier, it is
imperative for any strategy to have in-depth understanding of the target audience. This is
done by collecting data on various aspects of the health problem. There are various ways in
which this data is collected. One of the most important methods that are adopted is primary
research.
Primary Research
Primary research is the means adopted to collect fresh need based data on various aspects
of the perceived health problem. One of the most important aspects of primary research is
that it is tailored to collect need based information through direct data collection about all
that one needs to know about the perceived health problem. Primary research is carried out
with the help of surveys, questionnaires, interviews and group discussions.
Questionnaire method
One of the most popular ways of collecting data through primary research is by framing a
questionnaire/ survey on various aspects of the perceived health problem. The objective of
the questionnaire is to understand the magnitude of the health problem, identify target
audiences, myths and barriers leading to the problem, tentative solutions and preference of
the audience in relation to the problem and the preferred media channels of the target
audience.
Steps involved in survey/ questionnaire process
 Describe / perceive your health problem by reading literature and relevant material
especially research ( if any ) done by various stakeholders
 Hold discussions with peers/ various stakeholders to gain insight into various aspects
of the problem

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 Review case studies and questionnaires of similar research studies to frame
questionnaire and understand research methodology.
 Frame the research questionnaire
 Design and investigative procedure as to how the study would be carried out (
Coordination of personnel’s, collection and storing of data)
 Select and retrieve data
 Proceed with analysis and interpretation of collected data
 Compare findings with other relevant studies
 Draw tentative conclusions to frame your BCC strategy.
Focus group discussions
Apart from the questionnaire method, another strategy adopted to gather primary data is
through focus group discussions. Focus group discussions are carried out in the community
with the objective of collecting data by observation method. This is mostly done in
communities by following a story based approach. For example, if the primary research is on
unwanted pregnancy, then the story of the dilemma of a young woman faced with
unwanted pregnancy is presented before the group. The facilitator of the discussion then
relates short segments of the story and asks a series of questions on the situation presented,
participants feelings on the situation and how the various characters presented in the story
should respond. In this way participants values, attitudes and practices are captured.
In some cases a more direct participatory method is adopted. This could be through a role
playing session with key community leaders. Here some key persons from the community
are assigned imaginary role of teacher, priest, panchayath president, doctor, health worker,
village mid-wife and policeman. A participant then presents a personal dilemma related to
unwanted pregnancy and seeks advice from the panel. The community is also encouraged to
join the discussions wherein the facilitator continuously challenges provokes and probes the
participants. This exercise is used to gather data about the community’s attitudes and
behaviour norms.
The only problem with collection of primary data is that it could be quite expensive. It also
requires ample planning and coordination and could be time consuming.
Secondary Research
Reprocess and reuse of already collected information and data is known as secondary
research. Secondary research is done by analysing information taken from studies of
stakeholder organisations, government agencies, NGO research etc. It is also carried out by
referring to books, information available in libraries and web sites.

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One of the basic advantages of secondary research is that it is cheap and accessible. It takes
much less time than doing organised primary research and if done properly can provide
useful and valuable information. Moreover, secondary research is the only way one can
analyse large scale issues and trends. But the disadvantage is that it can never be as
accurate or specific as customised information that can be collected by primary research.
Any research process involves a mix of secondary and primary research. The element of the
methodology depends on various factors like time frame, depth of the research, budget and
intensity.
Integral part of M&E
Analysis is one of the most important component for proper monitoring and evaluation of
any BCC campaign. In fact, the success of any BCC programme depends on the data
collected through analysis and formative research. The data collected gives a clear
indication of the problem, the percentage of people affected by the problem and the
percentage of people following the recommended health behaviour before the start of the
communication campaign.
The data collected through formative research is used as the bench mark for fixing the
target and perceived behavioural change that is to take place in the target audience through
the campaign. For any intensive BCC campaign, time frame for achieving behavioural change
is fixed as per stages of behaviour identified in the formative research. Mid course
evaluations are carried out during the course of the campaign to assess behavioural changes
in the community and to measure impact of the BCC campaign.
These evaluations are then analysed and assessed and problem areas identified and studied
to introduce mid course corrections for better impact of the campaign.
What analysis/ formative research should achieve
Thus a proper analysis/ audience segmentation should provide one with key insights on
 Severity and cause of the health issues
 Social, economic and political factors blocking the proposed behaviour
 In depth information about the audience, primary / secondary and where do they
stand in stages of behaviour
 Help in developing a profile/ description of various audience segments to help the
BCC strategists in developing customised messages and materials
 Identify various stakeholders, what roles resources and support they can offer?

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 What are the preferred communication channels of the target audience, what is the
reach and the percentage of people that can be covered by the BCC campaign

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Chapter- 4
Budgeting for BCC
Budgeting has not been provided much importance in generic BCC strategies. But in
developing countries or in government setups, developing a budget assumes much
importance. It ensures that the programme management has financial resources at its
disposal to carry out the communications strategy that is being planned. In fact budgeting is
one of the most essential components of effective implementation of the project. The
primary task behind undertaking the budgetary exercise is to plan the strategic design of the
communication intervention and see that the implementation stays within the sum
allocated for the project. While finalising the communications strategy, one needs to look at
the available resources for BCC. The formulation of the actual BCC intervention will depend
on the funding allocated for the project and the behavioural change objectives that need to
be achieved.
Linking budget allocation to priorities
Funding for any communications programme can never be sufficient in the sense that there
are various strategies, tools and interventions that can enhance your communication
intervention. Take for example the question of formative research, one can do an elaborate
secondary analysis and then go ahead with primary research involving a large percent of the
target population ( larger the sample size, better the results, but the sample size depends on
the available budget). But if your budget allocation is limited, one might be forced to settle
with secondary analysis and not do primary research to cut costs. So it is important to link
the budget with priorities as per the BCC objectives.
Another important factor that needs to be considered during budgeting is to avoid
duplication of costs. If the resources are scarce, one needs to study the activities of various
other stakeholders and look at communications material and matter developed by them to
see if they can be duplicated for the campaign. For example, under the National Rural
Health Mission, states can borrow materials on various RCH interventions from
neighbouring states and use them. Moreover, a large number of materials developed at the
national level can be translated into regional languages and used at the regional level
Linking budget to previous utilisation
In case the budget allocations are on an annual basis, it is very important to link your
utilisation to the previous budgeted amount. It is imperative to note whether the
programme has been able to spend all allocations as per plan. Any unutilised amount must
be included in the current requirements. The point to be noted is that programme managers

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need to see that they do not over budget and the fund projections they give are apt and can
be utilised as per the implementation plan ( Generally in development projects, its seen that
funds are spent in an unplanned and arbitrary manner to meet utilisation deadlines as
annual budgets are fixed on last year’s utilisation)
Budgeting for BCC
While budgeting for BCC, program managers need to see whether adequate resources have
been kept apart for
 Formative research/ analysis
 Designing a BCC strategy
 Development and Pretesting of Materials
 Capacity building and Training
 Implementation
 Monitoring & Evaluation
 Communication activities ( print/ broadcast/community media/ interpersonal
communication/ celebration of special days)
 Advocacy activities
It could be good if planners are able to develop a checklist as per the results of the
formative research. The checklist should be developed keeping in view the magnitude of the
health problem and the interventions that need to be carried to bring about the desired
behavioural change.
Activities Checklist for possible costs
Formative
Research
Cost of staff/ hiring consultants/ training for data collection/ travel
costs/TA for field work/ supplies/ research logistics/ data processing and
analysis/ report writing/ meetings/ travel and coordination logistics/
hiring of an agency.

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Designing a BCC
strategy
Cost of consultants/ stakeholder workshops to plan strategy/ hiring of an
agency if needed
Development
and pre-testing
of materials
Fees, salaries for freelances, consultants, writers, artists, designers,
scriptwriters, producers, videographers technicians/ copywriting and
editing of print materials/ printing of samples/ pretesting of posters,
brochures flipcharts etc at the field level/ studio and equipment rental/
equipment hiring for pretesting broadcast material/ volunteers for
pretesting at the field level/ hiring of agency for pretesting/ evaluation
costs.
Capacity
building and
Training
Curriculum development/ fees for trainers/ cost for venues, materials for
training/ cost of hosting participants/ accommodation and travel logistics
Implementation Administrative cost/Identification of manpower as per tasks/ salaries/
expenses for field work/Telephone, internet, fax, postage/
transportation/ overhead costs
Monitoring and
evaluation
Development of monitoring and evaluation questionnaires and materials/
distribution and collection of M&E materials at the field level/ orientation
of trainers and training of trainers/ training of field workers/Travel
allowances for supervision, monitoring and data collection/ organising
events for impact evaluation/ compilation and analysis of data/ hiring of
agency
Communication
activities
Formulate budget for print media/ mass media/ community media/ Inter
personal communication.
Advocacy Press conferences, launch of particular programmes, prizes for
participants/ miscellaneous costs

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Chapter -5
Strategic Design
Designing a communication strategy is one of the most important aspect of any BCC
intervention. The information collected from formative research along with the various
behavioural theories guide the formation of an effective communication strategy. A
communication design gives a clear picture of the programme with clear cut objectives,
framework for implementation of BCC activities, the right choice of communication
channels and a proper implementation plan. Designing a communication strategy is a
painstaking process and one needs to study and look at various aspects including expected
outcomes. In fact, strategic design creates the road map for any communication program.
Objectives
The communications strategy must specify clear cut objectives. It must in clear terms state
what it wants to achieve through the communications/ BCC strategy. While framing
objectives, one has to specify the issues/ health needs that would be addressed by the
campaign in clear terms. This should be followed by stating the behaviour change that is
needed to address the issues . The objectives should also specify the behaviour change that
is expected to be achieved through the campaign and could specify a numerical percentage
of the change in the health behaviour that it believes it can achieve eg: raise the use of
contraception among the target audience from 2% to 10 %.
While framing the objectives, programme managers have to take care to link BCC objectives
to programme objectives ( for example if the programme objective is to decrease TFR among
married woman from 5.9 to 4.3, the BCC objective should be to increase contraceptive usage
among the target audience from 1% to 7%.) Moreover, the BCC objective should state a
timeframe in which the behaviour change is expected to happen.
In fact, the objectives should be Specific – who is the focus and what change is intended/
Measurable – Indicate the percentage of change expected/ Appropriate- sensitive to social
norms and the audiences preferences / Realistic- describe what can be achieved under
existing conditions with the available resources / Time bound-should specify the time limit in
which the behavioural change is expected to happen.
Conceptual framework
Once the objectives of the campaign is finalised, a conceptual framework should be
developed. A conceptual framework shows how programme activities are expected to
contribute to objectives. Communication interventions take place in three mutually
supportive domains:

20
 The socio-political environment
 The service delivery system
 Individuals and communities
The communication activities are intended to produce ‘initial outcomes’ at the above three
levels. This includes outcomes at the policy level which involves the decision makers, at the
social level which involves community and religious leaders, at the service delivery level
which involves government officials and the community level which involves communities
and individuals.
The tools of approach to target these various stakeholders are different ( for example
decision makers in all probability is aware of the recommended health behaviour but some
political or social pressure might be preventing them from implementing the desired health
policy. So the best way to target them is through advocacy which is through meetings/
discussions/ and the print media). As we discussed earlier, Behavioural Change is a slow
process, we have to target the above three domains and various stakeholders to achieve
initial behavioural outcomes. These initial outcomes lead to permanent behavioural
outcomes which finally lead to sustainable health outcomes.
Thus conceptual framework helps to streamline the action process of the campaign
Identify communication tools
Once the conceptual framework is in place, programme managers get a clear picture of the
objectives, the socio political environment, profile of the target audience, and the various
segments of the target audience and the expected initial outcomes of the campaign. The
formative research done earlier would also have given them a clear idea of the preferences
of the community and the reach of the media channels. The programme managers will need
to identify the various communication tools that they will need to engage to reach out to
various segments including policy makers, service providers, primary audiences and
secondary audiences. Only after deciding the tools will they be able to frame a media mix
and the various communications
 Advocacy activities- tools used to create a shift in public opinion and mobilise
stakeholders, social forces and resources to mould public opinion and policy ( Press
kits, press conferences, information brochures with case studies, meetings,
workshops, mailers)
 Advertising - a set of tools used to sensitise and persuade the target audience to
adopt behavioural change through paid medium of mass media ( Television, radio ,
print, newspapers, hoardings )

21
 Interpersonal communication enhancement - a set of tools that can enhance
personal interaction between clients and providers ( trainings, one to one
interaction, support materials)
 Community Participation – A set of tools meant to help a community to facilitate and
support the adoption of the desired behaviour ( rallies, street plays, health melas,
road shows)
 Events promotion and sponsorships - develop or sponsor events for attracting
attention on the desired behaviour ( celebrity appearances, concerts, award
functions )
Once these communication tools are identified on the basis of priority as per the objectives
of the programme and the target audience, programme managers can identify the
communication channels as per the identified activity, reach and resources available to
implement the BCC campaign.
Choose communication channels
A channel is a medium through which a message is disseminated. It is important to identify
which channels can most effectively reach the target audiences. Identifying the range of
various channels available is an important part of every formative BCC assessment.
Messages can be delivered through mass media, eg: television or radio spots, articles in
newspapers, periodicals or through brochures, posters, flip charts, comics, or in- person by
health workers, peer educators, counsellors and trained personnel. Messages can also be
communicated through musical,dramatic performances and community events. It is
important to judge which media reaches your target audience the most.
Broadly, the communication channels can be grouped under three basic categories:
Interpersonal channels, Community based channels and Mass media channels
 Interpersonal Channels
These are channels which emphasise one to one communication.
This form of communication include: peer counselling, provider to client counselling,
personal interaction with health workers like ASHAs, Individual training, flip charts etc.
 Community Based Channels
These are channels which reach a community or a group of people within a slum, village,
neighbourhood or kasba. These channels of communication are: community mobilisation
activities including community based activities like like street plays, village health fairs, folk
theatre, awareness rallies etc. Recently a large number of community based media channels
have emerged. These include community radio, street bulletin boards, posters etc.

22
 Mass media channels
These are generally paid channels that reach out to a large number of people across states
and even countries. This form of communication includes Television, Radio, Newspapers,
Magazines, outdoor advertising, direct mail and web based communication.
It is important to understand that how particular channels can help achieve particular goals.
Each medium has its own advantages and disadvantages and various mediums may suit
various circumstances. For example, advertorials in reputed newspapers carry a lot of
authority and credibility. As far as behaviour change communication is concerned it has been
noticed that the preference of medium changes as the target audience graduates to various
stages of behaviour. At the beginning of a campaign, mass media can induce recommended
behaviour and positive attitudes in the target community. However, as the target population
approach various stages of behaviour (from pre-knowledgeable to intended) they could
appear less interested in media and more interested in opinions and ideas to strengthen
their resolve to adopt the behaviour. This could happen through groups discussions or one to
one communications or through interpersonal communications.
Channel Audience
Reached
Advantages Disadvantages
Interpersonal Channels
Provider to client
Personal interaction
Individual
counselling
Individuals including
men , women and
other stakeholders
Most participatory
method of
communication
because it is two way
communication,
highly credible
because it is face to
face
communication/can
be very effective
Can reach only very
few audiences. Very
costly to scale up
activities.
Impractical in a large
scale campaign.
Requires
knowledgeable and
expert
communicators to
disseminate
messages.
Community Channels
Street plays, Village
Health fairs, folk
theatre, awareness
Various audience
segments of the
Participatory, has the
power to engage the
audience, encourages
Reach limited to
community. Difficult

23
rallies, group
meetings
community discussion in the
community,
sustainability of
effort, low cost.
to scale up
Community media
like radio, bulletin
boards etc
Women, Men and
children, various
segments
Credible because it is
localised, can be very
effective, low cost.
Limited reach,
difficult to scale up
Mass MediaChannels
Television Households, Rural
and urban
audiences, all
segments
Highly watched,
reaches a large wide
audience, delivers
impact due to
colourful audio visual
presentation
Expensive
production costs.
Spots very costly
especially on prime
time.
Radio All segments of the
society, both urban
and rural audiences
Used as a personal
medium, good reach,
effective in reaching
specific targets, not
expensive, can
respond in local
languages. Cheap
means of large scale
communication
Fragmented
medium, reach for
programmes vary
from programme to
programme.
Newspapers Literate audience Timely medium,
repeated eyeballs on
adverts, scope of
messaging and
disseminating large
information. Highly
effective for
advocacy.
Can be very
expensive, low shelf
life
Magazines Literate audience Very effective in
reaching niche
audiences (there are
magazines catering
Can be expensive.
Can only cater to
particular segments

24
to various sections,
eg: women, youth
etc) Good shelf life.
Print Media:
Pamphlets, posters,
flyers, direct mail
Literate audience Cater to particular
segments, cheap and
cost effective
Limited reach
Outdoor/ transit
Eg : bill boards,
hoardings, bus
panels
Various audience
segment
Effective in urban
areas, repeated
viewing,
reinforcement of
other media
messaging
Limited messaging,
cannot change
messages
Web based media/
internet
Educated, savvy
audience
Effective among
youths, educated
audience, not very
expensive, scope for
being interactive.
Can reach large
numbers rapidly. Can
combine audio visual
benefits with reading
Can only cater to
particular segment,
low frequency
Selecting the channel mix as per the target audience, budget and objectives of the
communication strategy is a crucial exercise. Programme Managers have to decide whether
they want the messages to reach the maximum number of people or want a particular
audience to be reached frequently over a particular period of time.
Multichannel Approach
To reach the target audience, one can use various channels of communication but research
has proved that a multichannel approach has a better chance for changing behaviour than a
single channel approach. Using a mix of several channels helps programme managers to
reach both primary and secondary audiences in various environments. Moreover, it gives
depth, visibility and synergy to the campaign.
For the multichannel approach to be very effective there has to be clear synergy and
coordination between various communication channels. The messages being disseminated

25
on all mediums should be consistent and should reinforce one another. Take the case of a
BCC campaign on breastfeeding. An initial burst of TV spots on breastfeeding could be
followed by radio messaging to reinforce the concept followed by advertisements through
display boards and hoardings for audience recall. This can be followed by advertisements on
breastfeeding in the print media for more information dissemination. (The audience is
already aware of the benefits of breastfeeding through TV and radio campaigns. The print
media can give more information to consolidate the audience) This can be followed by an
interpersonal communications campaign to reinforce the desired behaviour and clear any
doubts and convince the target audience.
Strategic approach for multichannel mix
To derive the maximum impact for any communications strategy, one needs to focus on the
best channel mix to reach the intended audience as per the communication objectives.
Should the approach be based on Reach or on Frequency is an important question the
programme will need to address.
Reach – This is defined as the number or percentage of people who are exposed to your
communications campaign through a particular medium ( TV/ newspaper). Reach is used to
build momentum of a campaign
Frequency- This may be defined as the number of times a person is exposed to a television,
radio spot or newspaper advertisement. Frequency is the key for the penetration of the
message.
As per the objectives, timeframe and budget, programme managers will have to decide if
they want to reach as many different people in the audience segment as quickly as possible
or steadily convey messages to build awareness over a period of time. If the priority is quick
dissemination, they will focus or reach where the lead channels selected are the ones that
reach a large audience ( television/ radio) . But if the priority is to build awareness over a
period of time, programme managers would be opting for a media mix with equal
preference to mass media, community channels and interpersonal communications.
Behavioural change as explained earlier is a slow process and one needs to focus on
frequency if proper behavioural change targets have to be achieved.
Apart from reach and frequency, one will have to look at scheduling of the advertisements
particularly in cases of Mass Media like television and radio. Scheduling is very important as
the viewership of these channels depends on prime time and the viewership as per when
the popular programmes with maximum TRP’s are aired. One will have to work on proper
scheduling patterns for the communication campaign as per your primary , secondary and
target audiences ,for example if your primary target is housewife’s, may be, one can ignore
the prime time and select TV, Radio slots in the afternoon when the housewife’s are alone at
home and have free access to entertainment channels

26
Identify Lead channel with supporting channels
As the programme managers finalise the multi channel mix. It is important to identify the
lead channel with the supportive channels for the communication intervention at the
ground level. The lead channel would be the ‘fulcrum’ on which the communication strategy
revolves. The lead channel could be selected on the following basis
 The channel which reaches the largest proportion of the target audience
 The channel which can convey effective messages for the intended behavioural
change.
 The channel which can achieve the greatest impact as per the BCC objectives.
Once the lead channel has been identified the other channels can be identified on the basis
of how they will add value to the lead channel and reach out to audience segments that
cannot be reached by the lead channel.
A good channel mix has to balance a variety of factors like reach, cost and credibility of the
channel. It has to take into consideration the size of the audience reached and the cost that
is incurred for reaching the audience through the various channels with due consideration
to the credibility rating of the channel being used.
Evaluate channel efficiency
To judge the efficiency of a television spot, the airing cost of the spot is divided with the
audience reached in thousands. The result will give you cost per thousand of audience
reached for comparison purpose among various communication channels. Suppose if a TV
spot reaches 700,000 women and the cost for airing the spot is 10,000, the cost per
thousand is seventy rupees. The same calculation can be applied for other channels also. For
example you can do the same for a newspaper advertisement. Divide the cost of your
insertion by readership (in thousands) to obtain a cost per thousand. Cost per thousand
comparisons can be used to compare the reach of one channel with another. But cost again
is not the only way to check the efficiency of the channel.
Another equally important factor is the credibility of the channel. The credibility of channel
varies from its stature to viewership to accessibility of the channel as per the target
audience. For example, we are talking of reaching a primary audience of 200,000 in the hilly
district of Chamba in Himachal Pradesh. It may be assumed that the reach of television in
Chamba is 30%. It is only practical to assume that an advertisement advocating behavioural
change on breast feeding practices needs to be repeated 20 times to have an impact on the
target audience . To reach this prime audience, the advertisement has to be released on the
Shimla Doordarshan network where the cost per thousand is 500 rupees. For twenty
repetitions, the cost will work out to 10,000 per thousand. The impact twenty
advertisements will have on your target audience can be achieved by just one interpersonal
communication interaction where the cost is working out to only 9,000 per thousand. So

27
which is an efficient channel? In this case Inter personal communications has a clear edge
over mass media.
Thus the efficiency of the channel will depend upon various factors like reach, frequency,
cost and credibility. In most cases mass media will reach more people at a less cost per
thousand but the credibility of mass media may be low on a particular target audience
compared to Interpersonal communication or community media. One has to take careful
consideration of various factors while finalising the media mix. Again the media mix will
depend on various factors like time frame, resources, manpower etc. It would be better to
work on a channel efficiency matrix where the channel, the issue for behavioural change,
the audience reached through the particular channel, the cost incurred, the frequency or
repetitions needed for impact, the credibility of the channel ( as per its reach on the target
audience and the preference are listed
Channel efficiency matrix
Channel Issue of
intervention
Audience
reached
Cost Cost per
thousand
Frequency Credibility
factor
Scale of1-10
Pre
fere
nce
Television
Radio
Print
Group
discussion
Folk theatre
Interpersonal
Communication
Develop a creative brief
Once the media matrix is ready, programme managers will have to develop a creative brief
for the benefit of the implementation team. The creative brief is a document that the
communication team develops and shares with the people/organisations/ agencies that is
involved in the creation and development of messages for the communications campaign.

28
This could include public relation firms, advertising agencies, designers, film makers and
writers among others.
The creative brief is very important as it provides direction and guidance for developing
uniform and creative messages and materials through various channels for various target
audiences. The creative brief will be based on the formative analysis done earlier to give key
information on the profile of the target audience, their preferred media channels and the
key stages of behaviour. These aspects are very crucial for developing effective and correct
messages.
The creative experts use the message as a springboard for developing creative concepts. It is
the job of these experts to develop creative materials for the communications campaign.
The programme managers outline what the message has to say, but it is the creative team
that decides how the messages will be designed. A clear and well crafted creative brief will
help the creative experts to explore various options and come up with the best messages for
the campaign
The creative brief should clearly state the programme objectives as well as the BCC
objectives. It should also clearly specify who the communications strategy should target
which includes the primary and secondary audience and the various stages of behaviour
they are in. To develop correct messages it is important to convey the various myths and
practices that are prevalent and the socio- cultural attitudes that are preventing the desired
health outcomes. This will help the message that is being developed to be culturally
sensitive and have the desired impact.
Apart from this, the creative brief should also state the preferred channels of reaching out
to the audience (radio, television, group discussions, counselling). Finally, it should also
define the key messages that are to be disseminated under the communications strategy.
Thus, a creative brief should spell out the
 Target audience ( primary /secondary)
 BCC objectives to be achieved
 Various obstacles preventing the intended behaviour at the ground level
 Key benefits that the target audience will acquire by adopting the intended
behaviour
 The preferred channels of the target audience
 Key message points to be conveyed to the audience.
Develop an implementation plan
Once the creative brief is finalised the next step in a strategic design is to work on an
implementation plan. The implementation plan should reflect how the BCC strategy would

29
be implemented. The most important thing is to identify the manpower for implementation
of the strategy and channels from where manpower can be obtained. One has to take into
consideration the role of partners and various stakeholders who will work on the project
and designate roles and responsibilities. The implementation plan should be based on the
activities, timelines for implementation of the BCC intervention, available budget at hand
and roles and responsibilities of various stakeholders.
The implementation plan should also include monitoring and evaluation strategies as they
are the key to assess the success of any campaign. A monitoring plan should describe what
aspects of the programme would be monitored, how will it be monitored, how often will it
be monitored and what indicators will be used for monitoring while and evaluation plan can
be developed as per the nature of the BCC intervention , the budget available and the
objectives that need to be achieved.
What a strategic design plan should achieve
 Define and spell out programme objectives, link it to behavioural change issues and
frame clear cut behavioural communication objectives.
 Identify various communication tools which will help in addressing behavioural
change issues from a holistic and sustainable viewpoint
 Identify a media mix that will have the maximum impact on the target audience
 Prioritise/ identify communication channels as per reach, frequency, cost, credibility
and available resources
 A clear creative brief that identifies the target, the obstacles, benefits to the
community by adopting the desired behaviour and key message points that need to
be conveyed.
 A well planned and strategic implementation, monitoring and evaluation plan that
will help in smooth implementation, identify and correct barriers during
implementation and help in achieving BCC objectives within the timeframe.

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Chapter- 6
Development and Pre-testing of
Messages
The situational analysis and strategic design component that has been formulated in the
earlier stages plays an important role in the development of messages for communication.
In fact, development of clear, sensitive and correct messages is the key for the success of
any strategic communication campaign. Developing and pre-testing of messages and
materials are important because they allow programme managers to learn early in the
programme which messages are the most effective and appealing to the audience. This is
crucial as it saves the campaign a lot of time and resources ensuring that the programme
does not go ahead with a campaign of ineffective messages.
Message to be modelled on audience’s behaviour
One of the most important facts that have to be kept in mind while developing messages is
that they have to cater to the stage of audience’s behaviour pattern. The programme should
tailor messages based on the audience’s position in the stages of behaviour. ( Pre-
knowledgeable, knowledgeable, approving, intending, practicing and advocating) If the
situational analysis had pointed out that people were already aware of the desired
behaviour, but were not practicing it, the thrust of the behaviour change campaign should
be on the benefits of following the desired practice rather than on awareness creation.
For example, primary research conducted in Chennai on contraceptive practices had
revealed that people where aware of the benefits of contraceptive methods but did not
know where to procure them. Then the trust of the Behavioural Change Communications
campaign should be to educate them on where they can obtain condoms, oral
contraceptives and intra uterine devices and how they can use them to derive maximum
benefit.
Review existing messages/ materials
Before going ahead with developing new messages and materials, it would be good to
review existing materials on the desired health behaviour. One can contact various
stakeholders and obtain various communications materials they have developed. One can
get hold of posters, booklets, brochures, flipcharts, films, print advertisements to get an
overview of the issue as well as the interventions that have been successfully carried out ( in
case of state governments, it would be great to study communications interventions and
materials developed by neighbouring states) . While reviewing existing materials, one
should look if the messages are accurate, appropriate and relevant in the current context. It

31
is also necessary to check if they are culturally sensitive and whether they can be modified
to suit the requirements of the intended campaign.
Develop message concepts
Before one starts developing messages one has to gain a holistic view of the intended
behaviour that needs to be addressed. For this the best way is to start working on various
message concepts based on the findings of the formative research. Message concepts are
detailed ideas about what you want to say in each message and how you would like to say
it. Message concepts are various ideas put together in rough form and represent ways of
presenting the information to the various intended audience. This may include approaches,
like the type of appeal such as positive emotional appeals, humorous, entertaining, or fear
invoking appeals.
Actual messages are not developed as this point of time but the emphasis would be to
finalise the approach and tone of the message. If one has two or three concepts for each
issue , then the matter can be discussed with various stakeholders and experts taking into
consideration the findings of the situational analysis and the stage of audiences behaviour(
knowledgeable, intending, practicing) before finalising the main concept and identifying the
lead message.
Emphasis on lead/theme message
Once the message concepts are clear, the focus should be to develop the exact messages
that are to be used through various channels. It would always be useful to develop one or
two lead ( theme) messages about the health problem and the other messages could be
woven around it. The idea behind the development of an overall theme is that it will appeal
to the target audience and attract their attention. The theme should be the central part of
the campaign linking various other messages , functioning as sort of an umbrella. The theme
should be conceptualised in such a way that all the target population can relate and identify
with it.
It is crucial that various segments of the target population should be able to link the various
messages/visuals that is appearing as a part of the campaign to the central theme. The
theme will provide overall guidance for the development of all messages. Usually the theme
of the communications campaign is developed on the basis of the findings of the formative
research that has been undertaken at the beginning of the programme. The creative talent
to develop the messages could come from the organisation or the BCC section itself. If this is
not possible, consultant agencies or individuals could be awarded the contract to develop
the materials. It is imperative to note that the tone, length and presentation of the
messages differ from channel to channel
Once the creative team has been identified, the creative brief that had been developed
during strategic planning should be handed over to them so that they have clarity regarding

32
the bcc objectives, the target audience, obstacles to the intended behaviour change, key
benefits of the intended practice and the preferred channels of communication of the target
audience.
Pretesting of materials
Pretesting is done to test the impact, relevance, acceptance and effectiveness of the
messages developed among the intended target audience. Pretesting of messages is crucial
to the success of the campaign as it gives an indication whether the communications
campaign is headed in the right direction. During pre testing, members of the intended
audience see or hear preliminary version of the campaign materials and give their
comments on the materials. It is always better to pre test draft materials as testing at this
stage helps the programme to identify flaws before spending money on final production of
the materials. For example to test the effectiveness of a poster, its sketch could be used
while for TV advert, the video version of the spot could be shown among the target
audience. The tests should be done to assess the following
 Assess comprehensibility – Are the messages simple and clear? Are they easy to
understand and comprehend? Are messages appealing to the audience?
 Identify strong and weak points – What parts of the material are most attractive or
preferred? Which message or visual motivates one to act?
 Identify relation of the audience with the messages – are the messages well
received? Does the audience relate to the characters in the advert or T.V. spot
 Spot sensitive, confusing or controversial elements/ issues – are the messages or
situations culturally appropriate? Is there anything that hurts the sentiments of the
audience in the messages? Is there anything offensive?
Pretesting at the field level
Pretesting is usually done by employing volunteers who go to the target audience and
ascertain their reaction to the messages through self administered surveys/ questionnaires,
interviewer administered surveys/ questionnaires, theatre testing ( group testing) and
through observational method. Pretesting is also done through stakeholder discussions and
expert reviews. In some cases, advisory groups comprising of key stakeholders who are
working at the field level or closely with the target audience are formed to take advice.
But there is no substituting to pre testing at the ground level with the intended audience/
community groups for corrective feedback. Once pretesting is done it is important to review
the materials and take corrective actions as per the findings of the survey.

33
Steps in development and pretesting of messages
 Develop messages and materials keeping in mind the findings from the formative
research
 Identify message concepts ( themes) and choose the type of appeal ( positive,
informative, humorous, persuasive) as per the target audience
 Tailor messages to the audience’s stage of behaviour
 Pre test messages and materials with the target audience through advisory groups,
questionnaires, observation method and random feedbacks
 Revise messages as per feedback from the ground level

34
Chapter-7
Implementation
Implementation is the process of putting a project or programme into action to fulfil the
planning process and accomplish the setting up and management of the execution of the
project. It is necessary to have a proper implementation plan in place for timely and
successful implementation of any programme. A well thought out implementation plan will
identify various implementation partners and their mandate. It will list out the various
activities planned and assign responsibilities as per manpower availability by working out
timeline worksheets and operational activities for various phases. It will also spell out
training and capacity building needs at various stages of the programme. Overall a well
thought out implementation plan will help in the smooth execution of the project.
Manpower/collaboration partners
One of the most important aspects of any implementation plan is to identify the available
manpower and the skills for implementing the strategic design of the communications/BCC
strategy. It is imperative to look at the available staff within the organisation, identify gaps
and look towards the help of agencies or external consultants for timely execution of the
communication plan. In some cases, even though expertise may exist within the
organisation, staff members are committed to multiple responsibilities and may not be in a
position to devote ample time to the area of their expertise. So it would be good to look at
various heads and identify the technical and manpower needs.
Research,monitoring and evaluation- These are very specialised fields and requires technical
expertise and manpower. One might need to identify research firms/ consultants. The
parameters of their scope of work can be fixed as per the formative research and the
strategic design
Advertising– The in-house group might have the technical knowledge but not the expertise
and manpower to run a comprehensive media campaign that involves development of
creative materials, production, media planning and buying. An advertising agency might
need to be contracted for the work
Advocacy and publicrelations- If the communications strategy calls for impacting policy
changes through special events and by impacting the media, there might be a need to
identify a PR agency for this work.
Mediaplacement- Media buying and ensuring that television spots are aired as per plan
might need the services of a professional agency.
Communitybased activities- These activities require a lot of coordinated work especially for
field based media activities and interpersonal communication. There might be a need to

35
involve community based cultural troupes or volunteers for various activities. The services of
a mother NGO might be needed for community based activities.
Capacity buildingand training- identifying areas of gaps in knowledge/ skill is an important
part of any management exercise. There is a need to prepare worksheets and list the needed
skills for project implementation. It might not be rational to provide training for all areas
where gaps exist. But critical areas where training needs are most apparent can be identified
and prioritised as per budget constraints.
In the implementation phase, all elements of the strategy go into operation. Timing and
coordination is the key for managing any programme effectively. There is need for close
coordination and sharing of all activities. BCC specialists must work as members of a broad
team and coordinators of each component must keep the other coordinators posted of their
progress and activities. For developing an effective implementation plan it would be good to
follow certain guidelines.
 List tasks and activities as per the strategic design and the BCC plan
 List steps in order in which they must occur
 State and assign tasks and activities, who does what?
 Identify staff who is responsible for each task and activity
 Frame work plans for each phase
 Check dates/ timeframes – if there is enough time for each activity
 Consult with other collaborating partners if they will be part of the implementation
process
 Set up reporting systems/ mention who will report to whom
 Ensure proper coordination among various components of the strategy
Timeframes and checklists
Successful implementation of a project can be more assured if checklists and worksheet
listing what to do are used by planners. Any implementation plan should point out clear
paths that need to be followed. This clarity can be achieved by encouraging program
managers to develop checklists. A worksheet can be developed prepared and managed for
each activity or phase of the implementation of the project. Suppose if a project has five

36
phases, five different worksheets could be prepared for overall implementation. Moreover,
each person responsible for each activity can develop his own checklist.
Timelineworksheet
TASK WHO IS RESPONSIBLE DATE
Establish BCC task force
Conduct quarterly meetings of the task
force
Coordination of BCC programme
Conduct formative research
Frame budget for the BCC campaign
Set BCC objectives with indicators
Work on a strategic design/ approach
for the BCC campaign
Finalise communication
channels/media mix
Develop creative brief
Develop concept/ messages
Pre-test messages, concept at the field
level
Finalise monitoring and evaluation
framework
Finalise communication materials
Production of print communication
materials
Production of TV/ radio materials
Coordination of community /
interpersonal communications

37
Capacity Building and Training
Planning for ongoing communication capacity building is essential in implementing a BCC
strategy. Training and capacity building assumes a lot of importance for the success of BCC
interventions. With the changing approach in development communications from IEC to
planned BCC, there is a need to build capacities at two distinct levels. One is at the project
level where the project director needs to be sensitised about the importance of BCC and the
need for following a systematic approach in the execution of the BCC programme. Many of
the project directors do not attach much important to BCC activities leading to inadequate
funding for BCC activities and lack of manpower for implementation. For many of them, BCC
implies development of communication materials like posters, flip charts, TV spots and
newspaper advertisements.
No BCC programme can be successful without the approval, support and recognition of
various programmes. The programme staff should feel and believe that BCC is central to the
success of their projects. There is a need to sensitise the staff of various programmes
regarding the benefits of adopting a systematic BCC intervention and the linking of
programme objectives with that of BCC objectives. The best way to go about this is to invite
the programme directors for external meetings, internal discussions as well as training
workshops. It would also be fruitful to conduct a sensitisation workshop for programme
personnel and constitute a BCC task force comprising of heads/ deputy heads of various
department which could meet on a quarterly basis to review BCC interventions.
At the department level, there is a need to develop skills of BCC personals on various
aspects of BCC design such as communication planning, project management, audience
research, steps involved in production of materials, pretesting of messages and monitoring
and evaluation. BCC staff receives training on behavioural change communication in many
ways. Training can happen through routine meetings, workshops, on the job, through self
instructional material (like this document) or through distance learning courses.
Capacity building of ground level personnel like peer educators, outreach workers,
councillors and community workers whose primary responsibility is communicating with
target audience is also equally important and crucial to the success of the program. For
Coordinate capacity building/training
activities
Monitoring of programme
implementation
Evaluation of programme activities

38
example, under NRHM, state programme managers have to make sure that the peer
educators like ANM’s and ASHAs have adequate knowledge about the objectives and
content of the communication messages to reinforce messages at the ground level and
stimulate discussion.
To derive maximum benefit from the existing staff, it would be wise to identify them for
various tasks as per their orientation (competency based training approach) and build their
capacities as per the requirement of the organisation. Moreover the BCC department can
have institutional tie-ups with other specialised organisations/ agencies where the
departmental staff can be sent for need based capacity building.
Strategies for increasing capacities in BCC should include
 Qualitative strategic planning and design
 Development of standardised tools including training modules, guidelines and
protocols
 Identifying of training programmes for various staff at state, district and community
level
 Identifying institutes/ consultants who can impart training for various staff at
different levels

39
Chapter-8
Monitoring & Evaluation
Monitoring is an important part of the ongoing management of communication activities
and focuses on the process of the implementation of the communications plan. It helps
planners and program managers to track implementation of communication activities such
as reach of the programme, outputs and costs incurred. It will help you ascertain whether
community group meetings have taken place as per the strategic design or if T.V. spots have
been aired as per the programme schedule. I n fact, monitoring apart from tracking also
helps managers to identify weak links in the implementation process.
For example a large number of posters have been printed at the state BCC unit and has been
dispatched to the districts for further distribution at the primary health centres. In many
cases these posters do not reach their destination as they are stored at the district centre
and are not dispatched any further due to the lack of coordination or communication. As per
budget utilisation, the activity has been carried out but in reality, it has not benefitted the
target audience. But if a monitoring system is in place, this discrepancy would be pointed out
during the monitoring process and necessary action would be taken.
Basically three types of monitoring activities are carried out to assess the impact of a
communication programme.
Process monitoring- Under this process, programme managers measure whether activities
were carried out as per the plan. Here the planned frequency, the timing and the reach of
the message is studied. Usually process monitoring begins at the start of the
communications campaign and continues till the end of the campaign
Performance monitoring- under performance monitoring, the quality of the communication
material, the distribution of communication messages among various target audiences and
the frequency of the communication dissemination is tracked. For example, where the
expected number of posters printed and distributed at the designated primary health
centres? Where the quality of the T.V spots made for information dissemination up to the
desired level? Did all members of the communication team perform the tasks assigned to
them? Where all the health workers trained as per the communications module? Under
performance monitoring, the facts being gathered should be specific and quantitative as
possible to determine the success of the communication plan.
Outcome monitoring- under outcome monitoring , the emphasis is on communication
objectives planned at the beginning of the campaign and how much shift has taken place
due to the impact of the campaign. Suppose one of the objectives was to increase the use of
oral contraceptive pills from 3% to 20 % by the end of the campaign the outcome

40
monitoring tries to track the percentage shift that has happened over one year of the
campaign.
In a nutshell, the monitoring process should track:
 Reach - Is adequate numbers of the target population bring reached / frequency
maintained as per the communication plan
 Coordination – Is the communication effectively integrated with the target audience,
issues and services? Are messages/ information being disseminated at the ground
level in tune with the service delivery system? Are communication activities
happening as per plan? is there proper coordination between various sections ( Print/
TV/ interpersonal communications)
 Quality – What is the quality of the campaign? ( messages, radio, TV spots, print
campaigns, interpersonal communications) Is the media mix effective? Does it have
the necessary impact needed for the behavioural change to happen?
 Objectives - is the campaign moving in the right direction? Can the projected
objectives of the communication campaign be achieved
 Feedback- Are the obstacles, constraints in the campaign being addressed? Is
corrective action happening? Are the changing needs of the target population being
addressed
All monitoring frameworks should establish effective information gathering systems. This
can be achieved by generating periodic progress reports, site visits undertaken by
coordinators, review of communication materials with the target population or by framing
feedback questionnaires. It is necessary to undertake periodic focus group discussion and
hold in-depth interviews with the community and the health workers to assess the
perceptions of the target population. Peer educators must be trained to collect responses
from the target population to help identify necessary changes that may need to made to
make the communication material clear, sharp and precise. One of the key factors to be
noted here is that that all reporting tools and protocols must be standardised to ensure
consistency for uniform feedbacks.
Difference between monitoring and evaluation
It has been argued that there is a very thin dividing line between monitoring and evaluation
which overlaps each other. But, monitoring and evaluation are two different words
depicting shift in approaches to assessment of a programme. Monitoring involves the
continuous assessment of project implementation in relation to agreed schedules, use of
inputs, infrastructure and services by the project beneficiaries. Evaluation on the other hand
has a larger mandate, it looks at programme objectives. The key difference is that
evaluation is concerned with tracing causes to outcomes whereas monitoring is concerned
with tracking the progress of implementation

41
Evaluation
Evaluation designs and modules play a key role in measuring the success of any
communications/ BCC strategy. Without a proper evaluation strategy in place, it would be
very difficult to judge whether the strategy had been implemented as per the strategic
design/ communications plan and if the strategy has been effective or not. Evaluation helps
in assessing the impact and achievements of the communication program and how well the
communication objectives have been met.
The essence of the evaluation plan is formulated with the baseline indicators of the
formative research (the baseline gives a clear picture of the current position, practices
prevalent and percentages adopting the behaviour) and the conceptual framework. (the
overall long term goals) The programme objectives and the evaluation indicators are framed
keeping in mind the findings of the formative research and the long term goals. Apart from
being the only major tool to assess the success of the communication intervention,
programme evaluation offers various advantages
Programme evaluation can help the programme find out ‘what works’ and ‘what does not
work ‘ – this is crucial as it helps programme managers make mid course corrections and
work towards plugging loopholes in the communication interventions. Finding out what
works helps in further strengthening the programme while finding what does not work helps
in saving time and wastage of resources
It can help conduct critical self assessment and improve staff efficiency and practices -
evaluation can help the programme in achieving positive results and systematically assess
staff performances and training needs it can also be a learning process for the programme
to understand and study the reality at the ground level
It can help guide and design future interventions- one of the most important aspects of
conducting an evaluation is that it would serve as a major component of the future learning
curve. The evaluation findings can go a long way in strengthening future interventions and
can be a major tool for secondary research. It can also provide valuable evidence and justify
future interventions in BCC programmes.
In all strategic evaluation methods of communication programmes, questions may be asked
to the degree to which a communication campaign has contributed to changing the
behaviour. To address this programme managers and evaluators consider eight criteria’s
 Observation of changes in outcome
 Correlation between exposure to the programme and the observed outcome
 Evidence that the exposure occurred before the observed changes in outcome
 Lack of evidence suggesting that the observed changes is due to other factors
 Observation of a large abrupt change over time in the outcome in the absence of
other major influences
 Evidence of consistency with theory
 Evidence that the impact increases as the levels of duration of exposure increases

42
 Consistency with findings of previous research
Basically there are two types of evaluation designs that are generally followed to asses
programme achievements and how it has achieved its objectives and goals.
Impact evaluation & outcome evaluation
Impact evaluation assesses the immediate effects of the communication intervention and
corresponds with measuring the communication objectives. Impact evaluation is micro in
nature and is concerned with the immediate programme objectives. It could be termed as a
systematic identification of the effects, positive or negative, intended or not on individuals,
households and institutions caused by a given developmental activity. Meanwhile outcome
evaluation is macro in nature and looks at the how well the programme is progressing to
achieve its long term goals. Outcome evaluation measures long term effects of the
intervention and the impact it will have in realising the goals.
Examples of evaluation designs
Good evaluation exercises should be based on the conceptual framework and
communication objectives based on the formative research and BCC theory. They use
practical and strategic methods appropriate to the ground realities. The various evaluation
designs compare groups exposed to the programme with those that are not exposed and
use multiple data sources to compare and cross check consistency.
Pre-test/Post-test sample design- Under this exercise, evaluators collects information
before the start of a BCC programme from randomly selected sample members of the target
audience. After the end of the BCC intervention, another random sample is collected from
the target audience.
Pre-test/ Post-test non-equivalent control group design - Here, evaluators select a group
that is exposed to the BCC campaign and a group that is not exposed to the campaign.
Information is collected from the group both before and after the BCC campaign.
Panel design- Under this method, evaluators collect information from the same members of
the target audience at multiple times. This evaluation helps one to assess which factor
influenced their behaviour change or in which stage of behaviour change they are in. Here
stages of behaviour change are linked to programme exposure.
Time series design- This design relies on a large number of data collection points over time
to identify trends observed before the start and end of the BCC programme.

43
All the above evaluation processes involve various types of data collection. Since
communication affects individuals, groups and communities, it is important to collect
various types of data which includes both quantitative information as well as qualitative
information
Data collection and evaluation
Evaluation is heavily dependent on data. It is crucial to collect different types of data from
various sources. The different types of data collected for evaluation can be classified under
quantitative and qualitative data.
Quantitative data
This data is compiled from surveys, research studies and in case of social marketing from
sales data
 Surveys- The most common way in which quantitative data is collected is through
surveys. Surveys are mainly conducted through questionnaires among randomly
selected individual respondents
 Research studies- Data through research studies is collected by visiting various
institutions and likeminded organisations
Qualitative data
This data is collected from qualitative evaluation methods like Focus Group Discussions,
Interviews, Observation Methods and Diaries. Qualitative analysis is done at the start of
every project to get an in depth understanding of the problem. If done in an effective
manner, it can provide the programme with rare insights and provide a wealth of
information.
 Focus group discussions- These are held among homogenous individuals by trained
moderators
 Interviews- if conducted in an intelligent manner, it can weed out a lot of critical
information
 Observation method- This survey is carried out by studying the reaction or listening
to the comments of the target audience during events, visits to clinics etc.
 Diaries- Community health workers or communication volunteers who work in the
community can maintain daily diaries to record day to day observations and
comments which can provide valuable feedback.
Qualitative evaluation helps to gather insight into the practiced behaviour the BCC
programme wants to change while qualitative analysis tries to explain why and to which
level the behaviour has changed among the target audience
The crucial elements to be considered in Monitoring and evaluation is to
 Manage and monitor the progress of the communication programme- various
activities, manpower, budget, time of implementation, reactions at the field and
responses of the target audience

44
 Make midcourse corrections to the programme based on feedbacks from the field.
 Measure outcomes with objectives and assess the impact of the communication
campaign among the target audience
 Conduct analysis of evaluation results and frame recommendations
 Revise or redesign the communication programme if necessary based on evaluation
findings
 Document evaluation research findings for use in further programmes.

Behavior_Change_Communication_manual_-experimental_1_

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