Strategic Behavior Change Communication in Public Health

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OHNS HOPKINS OHNS HOPKINS J J

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Strategic Behavior Change Communicationin Public Health

Beyond Dialogue: Moving Toward Change of Behavior

DR G U AHSANChairman

NORTH SOUTH UNIVERSITY

854 PPT CCP 6/7/00 3Center for Communication Programs

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OHNS HOPKINS OHNS HOPKINS J J Center for Communication Programs

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A predictive model of communication & change:Influence of ideational elements on behavior

Knowledge

Attitudes

Self-Image

Perceived Risk

Self-Efficacy Norms

Emotion

Social Influence

Personal Advocacy

BEHAVIOR

Implies simultaneous effect of all influences.

854 PPT CCP 6/7/00 3


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OHNS HOPKINS OHNS HOPKINS J J Expert (sender) sending messages to

non-expert (receiver)

A Generation Ago . . . .

Monologue: The “Medical Era”

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Doctor speaking to patients

BCC Dr GU Ahsan


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Moving from monologue to dialogue (both-way)

The 70s: “Field Era”


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• Need to reach people beyond the clinics

• Derived from extension agent approach in agriculture

• Field work supported by IEC materials, films and audio visuals

• Mass media impact on behavior considered modest due to limited reach

• Large volume IEC

• SMCR(E) as dominant communication model

The 70s: “Field Era”


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Moving from non-paying clients to customers who ask and pay

The 80s: “Social Marketing Era”


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Moving from dialogue to mutual adjustment and convergence

The 90s to Present: “Strategic Era”


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On the process side

• Participants in the communication process create and share together

• Distinction between “senders” and “receivers” begin to disappear

• Communication not as a spare wheel



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• Greater multi-channel integration

• Multiplicity of stakeholders

• Increased attention to evaluation and evidence-based programming

• Increased sophistication in audience segmentation

• Large scale impact at national and local level

• Role of electronic media more pervasive



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Developing World Radio and TV Receivers

0

300

600

900

1200

1500

1800

1955 1965 1975 1985 1995 2000

Radio

Television

2100

Th

ou

san

ds

of

Rec

eive

rs

YearSource: International Broadcasting Audience Research Library/ British Broadcasting Company, 1996.


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Strategic Communication Today

Strategic communication is a process carried out with the active participation of stakeholders and beneficiaries that addresses a long-term vision and affects the causes of as well as the barriers to behavior change.


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Strategic Communication Today

Strategic communication includes many approaches such as: community mobilization, client-centered counseling, social network interventions, social marketing, entertainment-education, TV/radio spots, dramas and music, provider promotion, behavior change communication, public policy advocacy, media advocacy, personal and community empowerment, public relations, mass media dissemination...


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Results-oriented

Science-based

Client-centered

Participatory

Benefit-oriented

Service-linked

Multi-channeled

Technically high quality

Advocacy-related

Expanding to scale

Programmatically sustainable

Cost-effective

12 Key Elements of Strategic Communication: Making Evaluation More Complex


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More applications of theory-driven communication and behavior change

at multiple levels

Strategic Directions in HIV/AIDS Behavior Change Communication


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Theory Driven Behavior Change Communication

Ideation is defined as new ways of thinking and the spread of those ways of thinking by means of communication and social interaction in local, culturally homogeneous communities.

Cleland & Wilson, 1987


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• Perceives self to be at a moderate-to-high risk of contracting HIV/AIDS

• Knows at least three ways to protect self from HIV/AIDS

• Has talked with at least three people about safe sex• Has a positive attitude towards people who use

condoms• Knows where to purchase condoms• Has an above-average sense of efficacy regarding

ability to use condoms even when facing opposition from partner

Ideational Factors Related to Condom Use (Zambia)


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27

4147

23

4

0

10

20

30

40

50

1 Factor 2 Factors 3 Factors 4 Factors 5-6 Factors

Cumulative Effect of Ideational Factors on Condom Use among Male Adolescents, Zambia 2000


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36

5461

25

11

0

10

20

30

40

50

60

70

1 Factor 2 Factors 3 Factors 4 Factors 5-6 Factors

Cumulative Effect of Ideational Factors on Condom Use among Female Adolescents, Zambia 2000


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Odds of Condom Use by Ideation and Exposure, Zambia Youth Survey, 2000

1 1

3

2.3

0

0.5

1

1.5

2

2.5

3

3.5

Ideation ExposureLow High

Controlling for TV use, sex, age, educational attainment, residence


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IdeationNeed to Identify causal (proven) factors related to desired behaviors

• Abstinence

• Being faithful to one partner

• Consistent condom use

• Delaying sexual debut

• Seeking treatment for STIs

• Seeking VCT (Voluntary Counseling and Testing)

• Preventing MTCT (Mother-to Child transmission)



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Social acceptance: improving social environment

• Breaking the silence

• Improving policy environment/strengthening political will

• Overcoming stigma

• Agenda priority setting

• Increasing public understanding of HIV impact



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Social network

• Stimulating couple & community discussions

• Influencing community norms

• Developing community capacities



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Social learning/modeling

• Modeling individual and collective self- efficacy

• Modeling health provider behaviors

• Scaling up Enter-educate (education through entertainment) programming


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The Individual - Social Continuum

Individual Behavior Change

Collective BehaviorChange

Couple Community

(e.g.) Consistent condom use

(e.g.) Reducingstigma

854 PPT CCP 6/7/00 26

HIV/AIDS - related behaviors


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Indicators for Community Empowerment and Change

• Leadership• Degree & Equity of Participation• Information Equity• Collective Self-Efficacy• Sense of Ownership• Social Cohesion• Social Norms

Adapted from draft Rockefeller/JHU document

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OHNS HOPKINS OHNS HOPKINS J J 854 PPT CCP 6/7/00 28

UgandaNicaraguaZambia

Ghana


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THANK YOU VERY MUCH

Documents

Strategic Behavior Change Communication in Public Health