Behavior Change Communication In RMNCH+A new.pptx

Behavior Change Communication In RMNCH+A

1. Behavior Change Communication In RMNCH+A Presenter-Dr Akash Moderator- Dr Mamta Facilitator-Dr Aditi

2. Plan of Presentation Behavior. Communication. Evolution of Health Communication. Behavior Change Communication. Introduction. Principles of BCC. Theories And Models. Steps And Strategy. Steps References.

3. Behavior   Behavior is an action, activity, or process which can be observed and measured.  Behavior is  response  to stimuli which are either internal or external. Behavior is influenced by the up-bringing, education , experience, laws and rules. N. SMS. BEHAVIOR [Internet]. Psychology Dictionary. 2013 [cited 2025 April 10]. Available from: https://psychologydictionary.org/behavior.

4. Communication Communication is the two-way process of exchanging or shaping ideas, feeling and information. The communication can be at different level Cognitive level Affective level Psychomotor level Kumar. K. J.(1982) Business Communication. A Modern Approach, Jaico Publication House Mumbai.

5. The process of communication Sender should have his objectives clearly defined. Receivers can be controlled or uncontrolled. The message should be clear, specific and based on felt needs, fitting the audience. Communication channels can be interpersonal, mass media or traditional folk media. Feedback is flow of information from the audience to the sender . Sender (source) Message (content) Channel (media) Receiver (audience) Feedback (reaction) Awareness interest evaluation adoption Behavior change

6. Evolution of Health Communication

7. Behavior Change Communication BEHAVIOR CHANGE COMMUNICATION (BCC): An interactive process with communities (as integrated with an overall program) to develop tailored messages and approaches using a variety of communication channels to develop positive behaviors ; promote and sustain individual, community and societal behavior change ; and maintain appropriate behaviors. Family Health International Institute for HIV/AIDS. 2002 Sep.

8. Benefits of BCC Enhances knowledge Stimulates community dialogue. Promotes attitude change. Reduce Stress of patient and family. Promote preventive and curative health care services.

9. Principles Integration with program goals from the beginning. Conduct Formative assessment. Participation of target population. Stakeholders' involvement. Variety of linked Communication channels. Pre-testing. Monitoring and Evaluation. Positive and Action Oriented Strategies.

10. Theories and Models of BCC The Health belief model. Trans-theoretical model. Theory of planned behavior. Social cognitive theory. Diffusion of innovation theory.

11. The Health Belief Model Psychological and behavioral theory of two components: Desire to avoid illness and conversely recover if already ill. Belief that specific health actions will prevent or cure illness Four constructs of HBM 1.Perceived Susceptibility. 2.Perceived severity. 3.Perceived benefits. 4.Perceived Barriers

12. Behavior Perceived Severity Perceived Benefits Perceived Barriers Perceived Susceptibility Behavior Change

13. Trans-theoretical model. Given by J.O. Prochaska, Diclemente & Norcross 1992 Identifies the psychological process that people undergo and stages they reach as they adopt new behavior. These changes result when the psyche moves through several iterations- from pre-contemplation through contemplation, preparation and action, to maintenance of the new behavior.

14. Theory of planned Behavior According to this theory behavior depends on intention. Intention of person depends on Attitude towards behavior Subjective norms Perceived Behavior control

15. Social Cognitive theory Bandura’s social Cognitive theory proposes that people are driven not by inner forces, but by external factors. Human functioning can be explained by a triadic interaction of behavior, personal and environmental factors. Behavior Personal Factors Environmental

16. Diffusion of innovation theory. Theory was developed by E M Rogers in 1962. Adoption means that a person does something differently that what they had previously and it is possible when person perceives idea, behavior or product new or innovative. There are 5 established adopter categories and for promoting an innovation Innovators Early adopters Early majority Late majority Laggard

17. Steps in Developing BCC Strategy State program goals- Involve stakeholders- Identify target populations- Conduct formative BCC assessments- Segment target populations- Define behaviour change objectives- Monitoring and Evaluation (M&E) Plan Develop Communication products P retest Imple mentation and monitor Evaluate Analyze feedback and revision

18. 1.State Program Goal. Objective-Reduce Maternal And Infant Mortality. Align BCC strategy to JSY/ JSSK to Achieve Institutional Deliveries 2.Stakeholders People Who influence the Behavior directly or indirectly Stakeholders include policymakers, opinion leaders, community leaders, religious leaders and members of target populations.

19. 3.Identify the target population Determine the focus of communication Target Population Pregnant women, Her family members . 4.Conduct Formative BCC Assessment

20. 4.Conduct the formative assessment. Understand knowledge gaps, beliefs, barriers, and facilitators. 1. Knowledge Assessment What women/families know about institutional deliveries. 2. Attitudes Early marriages, delaying 1 st pregnancy and spacing between pregnancies. 3. Practice Assessment (Current Behaviors) Proportion of women delivering at home vs. health facilities Common birth preparedness practices. 4. Barrier Identification Economic : Cost of transport, delivery kits, or medicines-JSY Geographical : Distance to facility, poor roads-Ambulance Facility Social : Lack of support from husband or family-ASHA accompanies 5. Communication Channel Preferences Interpersonal communication by ASHA Mass media communication through radio channels

21. 5. Segment Target Populations Objective : Tailor messages for different sub-groups. Segmentation means dividing the broader target population into smaller, more specific sub-groups based on characteristics that influence behavior — particularly in the context of health communication . These segments can be based on: Demographics (age, gender, marital status, number of children) Psychosocial factors (beliefs, attitudes, motivations, fears) Behavioral traits (past health-seeking behavior, level of service use) Geography (rural vs. urban, accessibility to services) Life stage (pregnant women, new mothers, adolescents, etc.)

22. Segment Description Customized BCC Focus 1. Pregnant women( No. childrens ) Primigravida-Less Awareness changes during pregnancy ANC Birth preparedness Providing knowledge regarding changes Provide Knowledge about ANC Birth preparedness Multigravida-Aware about changes during pregnancy Compliance of knowledge Verify the knowledge regarding changes Motivation for the compliance of knowledge 2. Stages of Pregnancy 1 st 2 nd 3 rd trimester Different stages required tailored messages 3. Geographical area Urban and rural Rural Urban

23. 6.Define behaviour change objectives- Behaviour does the program intend to achieve? Observable changes in behaviour, as specified in the behaviour change objectives, are a final program outcome. Such changes include: Knowledge- Attitude change- Environmental change-

24. Knowledge change- P regnant women and families understand the benefits of institutional delivery and risks of home births Attitude change- Shift in perception where mothers-in-law and husbands believe that delivery at health facilities is safer and respectable. Environmental change- Communities begin to support women seeking institutional deliveries (e.g., access to transport, ASHA incentives, facility readiness).

25. 7.Design BCC strategy and Monitoring and Evaluation (M&E) Plan- A plan for monitoring and evaluation needs to be drawn up during the initial stage of BCC strategy design. Establish effective information-gathering systems. These include reports, site visits and reviews of materials. Reporting tools and protocols must be standardized to ensure consistency

26. 8.Develop communication products and train providers- Develop an overall theme that will appeal to and attract target populations. The theme should stem from the BCC formative assessment and further consultation. The theme should be positive. Call attention to the campaign and link its various elements together, functioning as a sort of umbrella. It should be catchy All target populations can relate and identify with it.

27. 9.Conduct pre-testing- At every stage with all audiences for whom the communication is intended, both primary and secondary. Themes, messages, prototype materials, training packages, support tools and BCC formative assessment instruments. Pre-testing of media, messages and themes should evaluate: Comprehension Attraction Persuasion Acceptability Audience members’ degree of identification

28. 10.Implement and monitor - In the implementation phase, all elements of the strategy go into operation. All partners, programmers and channels of the BCC strategy must be closely coordinated. There must be links among critical program elements, such as supply and demand. It is also necessary during the implementation phase to review the preceding steps in the BCC process. to ascertain whether the program has been addressing the target audiences’ previously identified problems and needs. Identify whether behaviour change and communication goals are being achieved, and whether channels are being used as wisely as possible.

29. 11.Evaluate- Evaluation refers to the assessment of a project’s implementation and its success in achieving predetermined objectives of behaviour change. Various research designs are suitable for evaluating the impact of health communication programs- Randomized control group design Non-equivalent control group design One-group, before after design Interrupted time series design

30. 12.Elicit feedback and modify the program- As programs evolve, target populations acquire new knowledge and behaviours, and communication needs may change. The needs of target populations must be periodically reassessed to understand where they stand along the behaviour change continuum. Monitoring and evaluation studies should lead directly to modifications of the overall program, as well as of the BCC strategies, messages and approaches.

31. 1.State Program goals. Increase Institutional deliveries Increase ANC 2.Involvement of stake holders Policy makers , religious leaders 3.Target population Primary population-Pregnant women Secondary population –Husband Family members 4.Formative assessment At least 4 ANC visits-39% EBF-20% 5.Segment target population Primi and multi gravida Stages pf pregnancy 1 St 2 nd 3 rd trimester 6.Define BCC objectives Promote >4 ANC visits -80 % EBF-70% 7.Monitoring and evaluation A pre- and post-test non-randomized interventional study was conducted, measuring practices on antenatal care 8.Develop Communication product IPC mass media approach 9.Pretest Pretest the BCC product in small sample 10.Implement and monitor 11.Evaluation 12.Feedback

32. Intervention:-1)Visiting with pregnant women two or more times to provide education, assist in birth plans, screen for danger signs, advise on care of newborn. 2) Community Health Centers organized community dialogue sessions to raise awareness of MCH issues. 3) Community health extension workers (CHEWs) supervised the CHWs and facilitated community trainings, providing a link between the CHW and health facilities. Indicators Pre-intervention Post-intervention At least 4 ANC visits made 39% 62% Deliveries by skilled health professionals 31% 57% Postnatal check-up within 2 days 52% 58% Exclusive breastfeeding 20% 52%

33. Steps of Behavior Change Knowledge: Approval: Intention: Practice: Advocacy:

34. Effective communication- Seven C’s Command attention… Cater to the heart and mind… Clarify the message… Communicate a benefit… Create trust… Call for action… Consistency counts…

35. Clarify the message Command action Cater to heart & mind Create trust Convey benefits Call for action Consistency counts 5. Advocacy 4. Practice 3. Intention 2. Approval 1. Knowledge Influential people -mobilize the community -strengthens program -build capacity -generate resources Service providers -promote usage & trust -train providers for effective communication -coordinate communication & activities COMMUNICATION Clients

36. References N. SMS. BEHAVIOR [Internet]. Psychology Dictionary. 2013 [cited 2025 April 10]. Available from: https://psychologydictionary.org/behavior . Kumar. K. J.(1982) Business Communication. A Modern Approach, Jaico Publication House Mumbai. Family Health International Institute for HIV/AIDS. 2002 Sep. Ajzen, i . (1991). the theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50, 179–211. Armitage, C., & Conner, M. (2001). Efficacy of the theory of planned behaviour : A meta-analytic review. British Journal of Social Psychology, 40, 471–499. Grizzell, J. (2007, 1/27/2007). Behavior Change theories and Models. retrieved January 28, 2007, from http://www.csupomona. edu /~ jvgrizzell / best_practices /bctheory.html. Prochaska, J., Johnson, S., & Lee, P. (1998). The transtheoretical model of behavior change. In S. Schumaker, E. Schron, J. Ockene & W. McBee (eds.), The Handbook of Health Behavior Change, 2nd ed. new York, nY : springer.

37. References Bandura, A. (1986). Social Foundations of Thought and Action. englewood Cliffs, new Jersey: Prentice-Hall. Perry, C. L., Barnowski, t., & Parcel, G. s. (1990). How individuals, environments, and health behavior interact: social learning theory. in K. Glanz, F. M. Lewis & B. K. rimer (eds.), Health Behavior and Health Educaiton : Theory Research and Practice. san Fran cisco, CA: Jossey-Bass.