Behaviors Change Communications presentation .pptx

Joseph Kungu
Behaviour Change Communication

Learning objectives
• By the end of this session learners should
– Explain the concepts: Behaviour Change Communication, Health
Education and IEC
– Explain factors that hinder people to change (unhealthy)
behaviours.
– Discuss factors that influence behaviour change
– Explain the behaviour change principles
– Critically analyse the common theories that influence health
behaviours
3/10/2024 joseph.kungu@mihs.ac.ug 2

Presentation Outline
• Health Education
• Role of BCC in Programs
• IEC
• Challenges of BCC

Health Education
• The process by which individuals and groups of people
learn to behave in a manner conducive to the
promotion ,maintenance or restoration of health (John
M Last)
• The declaration of Alma-Ata(1978) emphasized the
need for individual and community participation. The
dynamic definition is as follows…
• “A process aimed at encouraging people to want to be
healthy , to know how to stay healthy , to do what they
can individually and collectively to maintain health ,
and to seek help when needed”

Principles of Health Education
• 1. Community involvement in planning health
education is essential. Without community
involvement the chances of any programme
succeeding are slim.
• 2. The promotion of self esteem should be an
integral component of all health education
programmes

• 3. Voluntarism is ethical principle on which all
health education program should be built
without it health education programs become
propaganda. Health education should not seek to
coerce but should rather aim to facilitate
informed choice.
• 4. Health education should respect cultural
norms and take account of the economic and
environmental constraints face by people. It
should seek positively to enhance respect for all.

• 5. Good human relations are of utmost
importance in learning.
• 6. Evaluation needs to be an integral part of
health education.
• 7. There should be a responsibility for the
accuracy of information and the
appropriateness of methods used.
• 8. Every health campaign needs
reinforcement. Repetition of messages at
intervals is useful.

Information, Education & Communication (IEC)
• IEC can be defined as an approach which
attempts to change or reinforce a set of
behaviour in a target audience regarding a
specific problem in a predefined period of time.
• It is multidisciplinary and client centered in its
approach.
• Embodied in IEC is the process of learning that
empowers people to make decisions, modify
behaviours and change social conditions.

• Activities are developed based upon needs
assessments, sound educational principles,
and periodic evaluation using a clear set of
goals and objectives

Behaviour Change Communication (BCC)
• Studies revealed that traditional IEC methods
have stopped giving information and creating
awareness but BCC is characterized by its
direct approach towards changing behavior.
• BCC must be research based client centered
benefit oriented service linked professionally
developed , and linked to behavior change

Introduction…
• Behaviour Change Communication (BCC) is an
interactive process with communities to
develop tailored messages and approaches
using a variety of communication channels to
develop positive behaviors; promote and
sustain individual, community and societal
behaviour change; and maintain appropriate
behaviours.

Cont..
• Behavior change communication (BCC) is the
strategic use of communication to promote
positive health outcomes, based on proven
theories and models of behavior change.
• SBCC is the systematic application of interactive,
theory-based and research-driven
communication processes and strategies to
address change at:
– individual
– community, and
– societal levels

Cont…
• BCC employs a systematic process beginning with formative
research and behavior analysis, followed by communication
planning, implementation, and monitoring and evaluation
• Audiences are carefully segmented, messages and materials
are pre-tested, and both mass media and interpersonal
channels are used to achieve defined behavioral objective
• Behavior change objectives refer to intended changes in the
audience’s actual behavior

BCC Process
• BCC is a process of any intervention with
individuals, communities and/or societies to
develop communication strategies to promote
positive behaviors which are appropriate to
their settings

Objectives of BCC
• Major objectives for health are to enable
people:
- To define their own problems and needs
- To understand what they can do about these
problems with their own resources combined
with outside support
- To decide on most appropriate action to
promote healthy living and community well
being

Why BCC

Role of BCC in Nutrition
• Increase knowledge
• Stimulate community dialogue
• Promote essential attitude change
• Advocate for policy changes
• Create a demand for information and services
• Reduce stigma and discrimination
• Promote services for prevention and care

Insights
• BCC has its roots in behavior change theories
• BCC practitioners use a combination of
theories and practical steps that are based on
field realities, rather than relying on any single
theory or model.
• Rationale behind “staging” people is to tailor
therapy to a person’s needs at his/her
particular point in the change process.

Insights
• When changing behavior, the individual,
community, or institution goes through a
series of steps, sometimes moving forward,
sometimes moving backward, and sometimes
skipping steps. Even when new behaviors have
been adopted, the individual, community, or
institution, under certain circumstances, may
revert to old behaviors.

Example: BCC goal for an HIV program
• Program goal: Reduce HIV prevalence among
young people in urban settings in country.
• Behaviour change goals:
– Increase condom use
– Increase appropriate STI care-seeking behaviour
– Delay sexual debut
– Reduce number of partners

Cont…
• BCC goals:
– Increase perception of risk or change attitudes toward
use of condoms
– Increase demand for services
– Create demand for information on HIV and AIDS
– Create demand for appropriate STI services
– Interest policymakers in investing in youth- friendly
VCT services (services must be in place)
– Promote acceptance among communities of youth
sexuality and the value of reproductive health services
for youth (services must be in place)

Steps in developing BCC
 State program goals
 Involve stakeholders
 Identify target populations
 Conduct formative BCC assessments
 Segment target populations
 Define behavior change objectives
 Define BCC strategy and M&E plan
 Develop communication products
 Pretest
 Implement and monitor
 Evaluate
 Analyze feedback and revise

Levels of BCC
• BCC has several levels it can be implemented
at.
• Each level includes several theories

Why many levels?
• Individual Level
– Health belief theory
– Theory of Reasoned Action and planned behavior
– Stages of change
– Social Learning
• Community Level
– Diffusion of innovations theory
– Community mobilization
• Change in organizations
– 4 stage change
• Public Policy Level
– Distinct stages of initiation, action, implementation, evaluation and re-
formulation

Theoretical framework
• BCC has its strong origins from behavior change theories
that explain why people behave the way they do
 According to these theories behaviour is determined by:
 Environmental characteristics
 Personal characteristics
 Behavioral characteristics
 Understanding behavioral change will improve the services offered
in these areas:
 Health
 Education
 Criminology

Cont…
• These theories have attracted growing
attention as the negative consequences of
unhealthy lifestyle behaviours have become
increasingly apparent
• They are pertinent to the development of
effective interventions in the field of health,
nutrition and physical activity

What is a theory
• “A theory is a set of interrelated concepts,
definitions, and propositions that explains or
predicts events or situations by specifying
relations among variables” – National
Institutes of Health Office of Behavioral and
Social Sciences Research

Why use Theory

Theories of behavior change
 These theories are important because:
The negative consequences of unhealthy lifestyle
behaviours have become increasingly apparent,
and
There is a growing need for the development of
effective interventions in the field of health and
physical activity.

Cont..
• A number of behavior change theories have been put
forth to explain and predict people’s behavior:
- The Health Belief model
- The Diffusions of Innovations theory
- The Theory of reasoned action
- The Expanded Parallel Process model, etc

Key elements of behaviour change
Key Element Strategies for Behavior Change
-------------------------------------------------------------------------------------------------------
Threat Raise awareness that the threat exists, focusing
on severity and susceptibility.
------------------------------------------------------------------------------------------------------
Fear Fear can powerfully influence behavior and, if it
is channeled in the appropriate way, can
motivate people to seek information, but it can
also cause people to deny they are at-risk.
------------------------------------------------------------------------------------------------------
Response Efficacy Provide evidence of examples that the
recommended response will avert the threat
------------------------------------------------------------------------------------------------------
Self-Efficacy Raise individuals’ confidence that they can
perform response and help ensure they can avert
the threat.

Cont…
-------------------------------------------------------------------------
Barriers Be aware of physical or cultural barriers
that might exist, attempt to remove
barriers.
--------------------------------------------------------------------------------
Benefits Communicate the benefits of performing
the recommended response.
---------------------------------------------------------------------------------
Subjective Norms Understand with whom individuals are
likely to comply.
-----------------------------------------------------------------------------------
Attitudes Measure existing attitudes before
attempting to change them..

Cont…
------------------------------------------------------------------------------
Intentions Determine if intentions are genuine or
proxies for actual behavior.
-------------------------------------------------------------------------------
Cues to Action Provide communication that might
trigger individuals to make decisions.
-------------------------------------------------------------------------------
Reactance Ensure individuals do not feel they
have been manipulated or are unable to
avert the threat.

Self efficacy
• Self-efficacy is the belief in one's own ability to complete
tasks and reach goals. such as facing an exam or undergoing
surgery.
• It is an important element of many of the theories, including:
– The Health Belief Model,
– The Theory of Planned Behaviour
– The Health Action Process Approach.

Self efficacy…
 The individual impression is based on factors like:
 individual’s prior success in tasks,
 physiological state,
 outside sources of persuasion.
 Self-efficacy expectations have been found repeatedly to be
important determinants of:
– the choice of activities in which people engage
– how much energy they will expend on such activities and
– the degree of persistence they demonstrate in the face of
failure and/or adversity.

The health belief model
The HBM includes 3 major levels of interaction between
variables:
(i) Background factors (age, sex, etc)
(ii) Perceptions (expectations and threats)
(iii) Action (cues to action, outcome behavior)

Health belief model

Cont…
• Human beings are rational and consciously
deliberate about the likely consequences of
behavioral alternatives available before they engage
in action
(Gross,2005;Kippax,Connell,Dowsett&Crawford,1993)
• They Can judge the benefits and costs associated with an
action /behaviour before they take it up.

Elements of the HBM
• Perceived susceptibility
• Perceived severity
• Perceived threats
• Perceived benefits
• Perceived barriers

HBM Summary
Two major factors influence the likelihood that a
person will adopt a recommended preventive
health action.
• First they must feel personally threatened by the
habit or behaviour i.e. they must feel personally
susceptible to a disease with serious or severe
consequences.
• Second they must believe that the benefits of
taking the preventive action outweigh the
perceived barriers to (and/or costs of) preventive
action.

How might we apply this theory to John?
• John is a 30 year old, single
man, whose brother recently
died of AIDS. He has come to
the clinic for a HIV test, which
is negative. You are
demonstrating how to use a
condom, but John is telling
you that he never uses
condoms because he doesn’t
think they really work, and still
even those who use condoms
get HIV. He says his girlfriend
will think he has been cheating
on her if he uses condoms
with her.

Application of HBM
Example:
• “I know I can catch HIV”
• “but HIV has now become more of a ‘flu-like’
infection”
• “I think condoms can protect me from
acquiring HIV”
• “I can try but I hear condoms reduce sexual
sensation”
• “and I think I don’t know how to use condoms
perfectly well, anyway”

Using the HBM to design intervention
• Intervention: Condom promotion for HIV
prevention for Mr/MsX
• From HBM, we can see that this person has:
- High susceptibility
- Low severity
- High knowledge of benefit of condom use
- High barriers to taking action
- Low self-efficacy

Intervention components
• Maintain high susceptibility
• Increase severity levels (show that HIV is still a
fatal infection, etc)
• Emphasize the benefits of condom use
• Reduce barriers to taking action
• Increase self-efficacy
• Use cue cards

Theory of reasoned action
• Assumes that individuals consider a behavior's
consequences before performing the particular
behaviour.
• As a result, intention is an important factor in
determining behaviour and behavioral change.
• Intention is shaped by personal attitude and social
pressure .

Theory of planned behaviour
• Represents an expansion upon the theory of
reasoned action.
• It states that behaviour performance is proportional
to the amount of control an individual possesses
over the behaviour and the strength of the
individual's intention in performing the behaviour.
• Self-efficacy is important in determining the strength
of the individual's intention to perform a behaviour.

Stages of Change Model Stages of
Change S
Transtheoretical Model
• The five stages, between which individuals may oscillate
before achieving complete change, are:
Precontemplation,
Contemplation,
Preparation,
Action, and
Maintenance.

Cont…
Precontemplation:
• In this stage, there is no intent on the part of the individual to change his
or her behaviour in the foreseeable future.
Contemplation:
• People are aware that a problem exists and are seriously considering
taking some action to address the problem.
Preparation:,
• Involves both intention to change and some behaviour, usually minor,
and often meeting with limited success
Action:
• Individuals actually modify their behaviour, experiences, or environment
in order to overcome their problems or to meet their goals.
Maintenance:
• People work to prevent relapse and consolidate the gains attained in the
action stage.

Challenges of BCC
• BCC vs. IEC. In practice, IEC has often resulted
in the production of discrete communication
materials. The use of the term BCC is part of
an effort to establish communication as
strategic and integrated into entire programs.
• Integrating BCC into all programs. BCC is a
component of all successful interventions and
must be included in their original design.
However, in reality this doesn’t always happen

Cont….
• Limited training resources
• Political and physical environments. In some
countries, geography and population diversity
can complicate the development of BCC
programs. This is especially the case where
vast distances must be covered, or multiple
languages and cultural traditions included, in a
single country program

Cont….
• Sustainability- To be effective, BCC strategies and
components must evolve constantly to meet the
changing needs of target populations. This
requires the continuous input of human and
financial resources.
• Budgets.
• Linkages and coordination. For BCC to be
effective, their messages and information should
be coordinated. Building and maintaining linkages
and coordination is an ongoing challenge.

Conclusion
• BCC based is on application of behavior change
theories such as those mentioned above
• Most theories so far applied to BCC have tended
to target individuals
• Need for interventions that emphasize the social
context within which behavior occur
• Hence the new dimension to health
communication: “communication for social
change”

Behaviors Change Communications presentation .pptx

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