Behaviour Change Communication

Behaviour Change Communication

1. Dr Soni Rani PGT- 1 st Year Student Department Of Community Medicine Katihar Medical College BCC

2. Outline Of Presentation INTRODUCTION. HEALTH EDUCATION BCC ROLE OF BCC IN PROGRAMS REFERENCES

3. INTRODUCTION The 6 th report on world health situation states that health has to be attained &cannot be imposed. thus the 1 st requirement for attainment of health is a commitment by both people and the govt . Adequate education in general is essential for the development of this commitment.

4. 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”.

5. 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

6. 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. PRINCIPLES OF HEALTH EDUCATION

7. 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. PRINCIPLES OF HEALTH EDUCATION

8. IEC IEC can be defined as an approach which attempts to change or reinforce a set of behavior 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 behaviors and change social conditions.

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

10. 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.

11. Behavior Change Communication Definition-1 BCC is 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.

12. Behavior change communication (BCC) is the strategic use of communication to promote positive health outcomes, based on proven theories and models of behavior change. 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 objectives. Behavior Change Communication Definition-2

13. Behavior change objectives refer to intended changes in the audience’s actual behavior . Behavior Change Communication Definition-3

14. Research based Client centered Benefit oriented Service linked Professionally developed , and Linked to behavior change BCC must be……

15. 17 Why BCC? The increasing area of interaction

16. Objectives of BCC activities 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

17. 19 Defining tasks and educational objectives Planning an evaluation system Preparing and implementing an educational programme Implementing evaluation Principles of BCC The Educational Spiral

18. STEPS OF BCC UNAWARE INFORMED/AWARE CONCERNED KNOWLEDGEABLE AND SKILLED MOTIVATED TO CHANGE TRIAL CHANGE OF NEW BEHAVIOUR MAINTENANCE/ ADOPTION OF NEW BEHAVIOUR

19. Informed/ Aware Initially a person is unaware that a particular behavior may be harmful. The first step in a behavioural change programme is therefore to make people aware through various channels using mass media, group methods and through interpersonal communication.

20. Concerned Information must be given in such a way that the audience feel it applies to them. The audience becomes concerned and people are motivated to evaluate their own behavior. Targeted communication and interpersonal approaches are more useful.

21. Knowledge and Skill Once concerned individual may acquire more knowledge and develop skill by talking to peers, social worker and health care providers. More interpersonal communication needed at this stage, specially training programmes to build and develop skills.

22. Motivated and Ready to Change Individual might now seriously begin to think about need and importance of new health message and measures. Positive message from peers are particularly effective.

23. Trial change of Behaviour The individuals decide and try new health behaviour . The result of any trial will be evaluated and if satisfied than adoption takes place.

24. Behavior Change Communication (BCC) for family planning

25. Flow chart about family planning: Stages of Behavior change Stage1: Aware: If most of the people are unaware about family planning, then first of all we have to make awareness among people about the family planning. We have to explain cause-effect of family planning. Stage 2: Motivation: Second steps is, we have to motivate them for taking family planning. And then they will prepare for this. Stage 3: Action: 3 rd step is, we have to identify for them how to take an action about this planning. Then they will start acting on this family planning.

26. Flow chart about family planning: Stages of Behavior change contd. Stage 4: Maintenance: After staring action many people leave this. A suitable example for it is that about 62% is contraceptive use rate in Bangladesh. But 46% of them don’t continue it. So we have to show for them an effective way how to maintain family planning program for long time with benefits. Stage 5: Final stage Termination: Finally, we have to make sure that they won’t relapse their new practice about family planning.

27. Five steps of developing BCC about family planning Step 1: Analysis Step 2: Strategic Design Step 3: Development and Testing Step 4: Implementation and Monitoring Step 5: Evaluation and Re-planning

28. Step 1: Analysis Analysis helps program us to : Identify the issues about family planning to be addressed; 2. Understand the intended audience. There are two components of analysis: situation analysis and audience analysis.

29. Step 1: Analysis contd. Situation analysis is gathering information about : The issue (Increase CPR) of family planning and its severity; Factors that could promote(education) or hinder change(religion ). Audience analysis is gathering information about: 1. The knowledge, attitudes, skills, and behaviors of intended audience; and 2. Communication channels in the area where we plan to conduct our activity.

30. Step 2: Strategic Design Step 2: Strategic Design helps us to: 1. Define our project's objectives; 2. Decide the most effective way to achieve them; 3. Create an implementation plan; and monitoring and evaluation plan. To define our project's objectives, we should make them SMART: 1. Specific; 2. Measurable; 3. Appropriate; 4. Realistic; 5. and Time-bound For example, If we want to increase CPR, then we should remember this things .

31. Step 2: Strategic Design contd. To prepare ourselves for making an implementation plan, we need to decide the most effective way to achieve our project's objectives. We should: Select our approach to behavior change about family planning; State why and how we expect to affect change in our intended audience; and Select the partners and communication channels that provide us the most effective access to our intended audience, resulting, if possible, in both mobilizing the community as a whole and reaching individuals through interpersonal communication. Once we have made these decisions, we can develop an implementation plan with the following characteristics outlining our strategy: a. Regular benchmarks to track our progress over time; b. Clear responsibilities for all stakeholders;

32. Step 3: Development and Testing Before we are ready to launch our BCC materials, we need to develop and test them. This helps us confirm that our product motivates our audience to change. To do so, we can conduct design workshops on family planning, which: 1. Include key stakeholders, such as field workers, and members of our intended audience; 2. Use participants input to determine whether our products meet our audience's needs; and

33. Step 3: Development and Testing contd. 3. Test our approach to the project and the ideas we include in our products. After the material is designed, we should pre-test it, noting whether all information is: a . Clear; b. Easy to remember c. Socially appropriate d. and culturally appropriate Based on input from the workshop and pre-test, we can revise and retest the products.

34. Step 4: Implementation and Monitoring Implementation involves: 1. Participation by all key participants to distribute the materials; 2. Flexibility and communication so that problems that arise can be quickly solved; 3. Training so that all key players have the necessary skills for the project;

35. Step 4: Implementation and Monitoring contd. Monitoring is about : Tracking existing statistics related to the targeted behavior; 2. Tracking outputs to ensure that materials are: a. Utilized as planned; and b. Have the desired effect; 3. Tracking the reaction of our intended audience to ensure that they are: a. Motivated by the product; and b. Change their behavior.

36. Step 5: Evaluation and Re-planning Evaluation can: 1. Study whether the materials have assisted in achieving the desired change in….. a. knowledge, b. attitude, c. and behavior in the targeted audience; 2. Identify the lessons learned: a. Where our program is weak and needs revision; b. Where our program is strong and should be replicated;

37. Step 5: Evaluation and Re-planning contd. We should widely distribute our evaluation results throughout the community, so that everyone involved is aware of the program's impact. our evaluation results may indicate that we need to re-plan the design of our materials. Re-planning involves: 1. Returning to the analysis stage to properly address the issues; and 2. Continuing through the five steps with our new plan and materials (strategic design, development and testing, implementation and monitoring, and evaluation and re- planning). These are a cyclic way until a good things occur about family planning or any other issues related to behavior change.

38. Role of BCC in HIV/AIDS

39. Role of BCC in HIV/AIDS Increase knowledge : BCC can ensure that people are given the basic facts about HIV and AIDS in a language or medium that they can understand and relate to . Stimulate community dialogue : BCC can encourage community and national discussions on the basic facts of HIV/AIDS & the underlying factors that contribute to the epidemic, such as risk behaviors and risk settings, environments and cultural practices related to sex and sexuality .

40. Role of BCC in HIV/AIDS Promote essential attitude change : BCC can lead to appropriate attitudinal changes about, for eg , perceived personal risk of HIV infection, belief in the right to and responsibility for safe practices and health supporting services etc . Advocate for policy changes : BCC can lead policymakers and opinion leaders toward effective approaches to the epidemic. Improve skills and sense of self-efficacy: It can focus on teaching or reinforcing new skills and behaviors, such as condom use, negotiating safer sex and safe injecting practices .

41. Role of BCC in HIV/AIDS Create a demand for information and services: BCC can spur individuals and communities to demand information on HIV/AIDS and appropriate services. Reduce stigma and discrimination: Communication about HIV prevention and AIDS mitigation should address stigma and discrimination and attempt to influence social responses to them .

42. Role of BCC in HIV/AIDS Promote services for prevention and care : BCC can promote services for STIs, intravenous drug users (IDUs), orphans and vulnerable children (OVCs); voluntary counseling and testing (VCT) for mother-to-child transmission (MTCT); support groups for PLHA; clinical care for opportunistic infections; and social and economic support.

43. 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.

44. Presentation 2 Process Of Behavior Change

45. BCC GOALS FOR HIV/AIDS Program goal : Reduce HIV prevalence among young people in urban settings in country . Behavior change goals: Increase condom use Increase appropriate STI care-seeking behavior Delay sexual debut Reduce number of partners

46. Increase perception of risk or change attitudes toward use of condoms Increase demand for services Create demand for information on HIV and AIDS Behavior change goals

47. 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) Behavior change goals

48. Presentation 2

49. Role of BCC in RCH

50. Role of BCC in RCH

51. Multiple influences & influencers are needed to make BCC strategies effective. for eg : mothers-in-law are known to influence the birth spacing behavior of newly married couples. She will also play a significant role in pregnancy, delivery and infant nutrition, perhaps discouraging immediate and exclusive breast feeding. So, they will be an important target group for BCC for young mothers. Role of BCC in RCH

52. BCC in NHM

53. IEC-BCC STRATEGY IN HEALTH

54. CHALLENGES 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.

55. Limited training resources Political and physical environments. In some countries, geography and populational 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. CHALLENGES

56. 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. CHALLENGES

57. Sunderlal , Adarsh , Pankaj ,Text book of community medicine, 4 th edition , chapter 2, P 3-48 J . Kishore , national health programs of India, 12 th edition WHO TRS 690(1983).New Approaches to health Education in Primary Health care. REFERENCES http://www.hivpolicy.org/Library/HPP000533.pdf http://en.wikipedia.org/wiki/Behavior_change_communication WHO, AFMC Text book of Public Health and Community Medicine

58. THANK YOU